Decisions on eating and drinking in older adults admitted with pneumonia and referred for swallowing difficulties.

PURPOSE: Older patients with pneumonia are commonly restricted from oral intake due to concerns towards aspiration. Eating and drinking with acknowledged risks (EDAR) is a shared decision-making process emphasising patient comfort. As part of our project to find the barriers and facilitators of EDAR, we aimed for this initial study to see how frequently EDAR was selected in practice. METHODS: We performed a retrospective cohort study at an acute hospital where EDAR was initially developed, of patients aged ≥ 75 years-old admitted with pneumonia and referred to speech and language therapy. RESULTS: Out of 216 patients, EDAR decisions were made in 14.4%. The EDAR group had a higher 1-year mortality than the modified/normal diet groups (p < 0.001). Pneumonia recurrence rate did not differ significantly between the groups (p = 0.070). CONCLUSION: EDAR decisions were comparatively less common and most were associated with end-of-life care. Underlying reasons for the low EDAR application rate must be investigated to maximise patient autonomy and comfort as intended by EDAR while minimising staff burden.

Adolescent idiopathic scoliosis: treatment outcomes, quality of life and implications for practice.

Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder among children and adolescents, with most cases being diagnosed around puberty. While the majority of people with AIS do not undergo treatment, a small but significant number are treated, depending on the extent of their spinal curvature. Treatment typically involves bracing, which requires substantial adherence, and/or surgery, which is invasive and permanent. Furthermore, decisions about treatment often need to be made at a critical stage of the person's development. This article examines the evidence on AIS and its treatment, synthesising the current literature and drawing from the authors' empirical work to explore the clinical outcomes of bracing and surgery, as well as the longer-term effects on people's quality of life. Drawing from this evidence, the authors provide guidance for nurses and healthcare professionals who care for people with AIS.

A scoping review of the qualitative literature reporting experiences of living with a stoma for inflammatory bowel disease.

AIMS: Surgical treatment for inflammatory bowel disease (IBD) potentially includes stoma formation. Although positive clinical outcomes are widely reported, patients' responses to stoma surgery, including coming to terms with and adjusting to the stoma, vary widely. This scoping review charts the qualitative literature addressing the question: What is known about any personal psychosocial and quality of life factors that inform adjustment to living well with an intestinal stoma for IBD? DESIGN: A scoping review methodology was employed. DATA SOURCES: Searches of Scopus, Web of Science, CINAHL, Medline and PsycInfo in August 2023. REVIEW METHODS: Levac et al.'s (2010) methodology was followed. PRISMA-ScR guidelines were adhered to. RESULTS: Thirteen cross-sectional studies were included, involving a total of 142 participants. Four themes were identified: (1) facilitative factors; (2) barriers to adjustment; (3) personal attributes; and (4) time and temporality. Data indicate that personal and psychological factors influence adjustment, but not how this occurs. Adjustment takes longer to achieve than is conventionally (clinically) expected. CONCLUSION: All available evidence is cross-sectional. The identified gap in the evidence is the notable lack of longitudinal research to assess, monitor and understand the complex process of adjustment in people with IBD having stoma-forming surgery. Detailed understanding of the process of adjustment would enable more targeted support for patients preparing for, and learning to live with, a stoma for IBD. IMPACT: This paper highlights the need to understand the multiple personal and psychosocial factors that affect adjustment to life with a stoma and identifies that adjustment takes significantly longer than the few weeks required to become competent in managing the stoma. PATIENT OR PUBLIC CONTRIBUTION: Not applicable.

Social media opposition to the 2022/2023 UK nurse strikes.

Previous research has established that the success of strikes, and social movements more broadly, depends on their ability to garner support from the public. However, there is scant published research investigating the response of the public to strike action by healthcare workers. In this study, we address this gap through a study of public responses to UK nursing strikes in 2022-2023, using a data set drawn from Twitter of more than 2300 publicly available tweets. We focus on negative tweets, investigating which societal discourses social media users draw on to oppose strike action by nurses. Using a combination of corpus-based approaches and discourse analysis, we identified five categories of opposition: (i) discourse discrediting nurses; (ii) discourse discrediting strikes by nurses; (iii) discourse on the National Health System; (iv) discourse about the fairness of strikers' demands and (v) discourse about potential harmful impact. Our findings show how social media users operationalise wider societal discourses about the nursing profession (e.g., associations with care, gender, vocation and sacrifice) as well as recent crises such as the Covid-19 pandemic to justify their opposition. The results also provide valuable insights into misconceptions about nursing, strike action and patient harm, which can inform strategies for public communication.

Using Ethics Committees to Justify Force-Feeding Political Prisoners in Israel.

Thousands of Palestinian prisoners are held in Israeli prisons without trial. For some of them, engaging in hunger strikes is the last resort in opposing unlawful detention and inhumane prison conditions. While mainstream bioethics deliberation, reasonable arguments, and international legal and medical professional declarations prohibit force-feeding, local ethical deliberations, professional medical guidelines, and legislation allow the use of medical judgment and clinical ethics committees to force-feed these prisoners. Until now, Israeli physicians have refused to do so, but this may change in the future. The international medical and bioethics communities need to stand behind these medical professionals, as well as prisoners. Clinical ethics committees in Israel must choose whether they serve the interests of these prisoner-patients and perhaps their political or human rights agenda, or whether they are subservient to an unjust, oppressive regime.

Resistance and the delivery of healthcare in Australian immigration detention centres.

There are few issues that have been as vexing for the Australian healthcare community as the Australian governments policy of mandatory, indefinite, immigration detention. While many concepts have been used to begin to describe the many dilemmas faced by healthcare professionals and their resolution, they are limited, perhaps most fundamentally by the fact that immigration detention is antithetical to health and wellbeing. Furthermore, and while most advice recognises that the abolition of detention is the only option in overcoming these issues, it provides little guidance on how action within detention could contribute to this. Drawing on the work of political theorists and the broader sociological literature, we will introduce and apply a form of action that has not yet been considered for healthcare workers within detention, resistance. We will draw on several examples from the literature to show how everyday resistance could be enacted in healthcare and immigration detention settings. We argue that the concept of resistance has several conceptual and practical advantages over much existing guidance for healthcare workers in these environments, namely that it politicises care and has synergies with other efforts aimed at the abolition of detention. We also offer some reflections on the justifiability of such action, arguing that it is largely consistent with the existing guidance produced by all major healthcare bodies in Australia.

Everyday Resistance in the U.K.'s National Health Service.

Resistance is a concept understudied in the context of health and healthcare. This is in part because visible forms of social protest are sometimes understood as incongruent with professional identity, leading healthcare workers to separate their visible actions from their working life. Resistance takes many forms, however, and focusing exclusively on the visible means more subtle forms of everyday resistance are likely to be missed. The overarching aim of this study was to explore how resistance was enacted within the workplace amongst a sample of twelve healthcare workers, based in the United Kingdom; exploring the forms that such action took and how this intersected with health and healthcare. In depth-interviews were conducted and results were analysed utilizing Lilja's framework (2022). Our findings suggest that resistance took a number of forms, from more direct confrontational acts, to those which sought to avoid power or which sought to create alternative or prefigurative practices or norms. These findings speak to the complexities, ambiguities, and contradictions of resistance, as carried out by healthcare workers in the workplace. While many acts had clear political motives, with issues like climate change in mind for example, participants also described how the act of providing care itself could be an act of resistance. While saying something about our participants, this also said something about the healthcare systems in which they worked. These findings also raise a range of normative issues. Perhaps needless to say, there appears to be substantial scope to expand and interrogate our findings and apply the idea of resistance to health and healthcare.

A deliberative framework to assess the justifiability of strike action in healthcare.

Healthcare strikes have been a remarkably common and varied phenomenon. Strikes have taken a number of forms, lasting from days to months, involving a range of different staff and impacting a range of healthcare systems, structured and resourced vastly differently. While there has been much debate about strike action, this appears to have done little to resolve the often polarising debate that surrounds such action. Building on the existing normative literature and a recent synthesis of the empirical literature, this paper will present a deliberative framework to assess the justifiability of strike action. I will first review the empirical literature that explores the impact of strike action, on patient outcomes and healthcare delivery. I will then discuss the debates that have occurred in this area, including an existing deliberative framework proposed by Selemogo (2014). I will argue that this framework is overly restrictive in that it could lead us to find otherwise justified strike action, unjust. I will then propose a framework that remedies these shortcomings. The framework outlines two broad conditions that should be met if strike action is to be justified. It then goes on to outline two deliberative, interrelated questions that should be used to assess whether strike action meets these conditions. For the purposes of this framework, healthcare strike action is justified when 1) it makes demands or raises grievances about some form of injustice, unfairness or threat to health and when 2) the risks in striking are proportionate to its demands or grievances. These two conditions should be considered in light of two further questions, namely, the 3) social and political context of the strike and 4) the characteristics of the strike. I will offer some further reflections on the application of this framework and its shortcomings.

The delivery of health services as resistance.

In this article, I will argue that the delivery of healthcare could be an act of resistance, that is, day-to-day, routine and perhaps mundane acts, undertaken in the course of the delivery of health services, which for many could also be considered otherwise routine care. I first consider how resistance has been conceptualised. How we understand resistance will determine if we believe healthcare could be conceptualised this way. I will show how resistance has been applied to day-to-day struggles elsewhere and argue that it can clearly encompass open, collective dissent and more subtle, day-to-day action that does not necessarily make clear political demands. I go on to introduce some examples, where the delivery of health services could be conceptualised as resistance. While I advocate for a broad understanding of resistance, clearly not every act could be considered resistance; I will consider some points of tension and contention in utilising resistance to describe the delivery of health services, in particular discussing the issue of intent and opposition as they relate to resistance. Finally, while I hope that I make a convincing case, one final issue remains, namely, why turn to resistance at all, when many of the examples that I provide could be labelled using concepts that are more widely utilised. I will offer some general reflections on this point, speaking to the benefits and potential of resistance.

Ethical climate in healthcare: A systematic review and meta-analysis.

BACKGROUND: Ethical climate refers to the shared perception of ethical norms and sets the scope for what is ethical and acceptable behaviour within teams. AIM: This paper sought to explore perceptions of ethical climate amongst healthcare workers as measured by the Ethical Climate Questionnaire (ECQ), the Hospital Ethical Climate Survey (HECS) and the Ethics Environment Questionnaire (EEQ). METHODS: A systematic review and meta-analysis was utilised. PSYCINFO, CINAHL, WEB OF SCIENCE, MEDLINE and EMBASE were searched, and papers were included if they sampled healthcare workers and used the ECQ, HECS or EEQ. ETHICAL CONSIDERATION: Ethical approval was not required. RESULTS: The search returned 1020 results. After screening, 61 papers were included (n = 43 HECS, n = 15 ECQ, n = 3 EEQ). The overall sample size was over 17,000. The pooled mean score for the HECS was 3.60. Mean scores of individual studies ranged from 2.97 to 4.5. For the HECS studies, meta-regression was carried out. No relationship was found between the country of the studies, the study setting (ICU v non-ICU settings) or the mean years of experience that the sample had. For the ECQ, sub-scales had mean scores ranging from 3.41 (instrumental) to 4.34 (law) and were all observed to have significant and substantial heterogeneity. Three studies utilised the EEQ so further analysis was not carried out. CONCLUSIONS: The above results provide insight into the variability of scores as measured by the HECS, ECQ and EEQ. To some extent, this variability is not surprising with studies carried out across 21 countries and in a range of healthcare systems. Results also suggest that it may be that more local and context specific factors are more important when it comes to predicting ethical climate.

A scoping review exploring the impact and negotiation of hierarchy in healthcare organisations.

Healthcare organisations are hierarchical; almost all are organised around the ranking of individuals by authority or status, whether this be based on profession, expertise, gender or ethnicity. Hierarchy is important for several reasons; it shapes the delivery of care, what is prioritised and who receives care. It also has an impact on healthcare workers and how they work and communicate together in organisations. The purpose of this scoping review is to explore the qualitative evidence related to hierarchy in healthcare organisations defined broadly, to address gaps in macro-level healthcare organisational research, specifically focusing on the (1) impact of hierarchy for healthcare workers and (2) how hierarchy is negotiated, sustained and challenged in healthcare organisations. After a search and screening, 32 papers were included in this review. The findings of this review detail the wide-reaching impacts that hierarchy has on healthcare delivery and health workers. The majority of studies spoke to hierarchy's impact on speaking up, that is, how it shaped communication between staff with differential status: not only what was said, but how it had an impact on what was acceptable to say, by whom and at what time. Hierarchy was also noted to have substantial personal costs, impacting on the well-being of those in less powerful positions. These findings also provide insight into the complex ways in which hierarchy was negotiated, challenged and reproduced. Studies not only detailed the way in which hierarchy was navigated day to day but also spoke to the reasons as to why hierarchy is often entrenched and difficult to shift. A number of studies spoke to the impact that hierarchy had in sustaining gender and ethnic inequalities, maintaining historically discriminatory practices. Importantly, hierarchy should not be reduced to differences between or within the professions in localised contexts but should be considered at a broad organisational level.

A systematic scoping review on the evidence behind debriefing practices for the wellbeing/emotional outcomes of healthcare workers.

Introduction: Debriefings give healthcare workers voice through the opportunity to discuss unanticipated or difficult events and recommend changes. The typical goal of routine debriefings has been to improve clinical outcomes by learning through discussion and reflection of events and then transferring that learning into clinical practice. However, little research has investigated the effects of debriefings on the emotional experiences and well-being of healthcare workers. There is some evidence that debriefings are a multi-faceted and cost-effective intervention for minimising negative health outcomes, but their use is inconsistent and they are infrequently adopted with the specific intention of giving healthcare workers a voice. The purpose of this systematic scoping review is therefore to assess the scope of existing evidence on debriefing practices for the well-being and emotional outcomes of healthcare workers. Methods: Following screening, 184 papers were synthesised through keyword mapping and exploratory trend identification. Results: The body of evidence reviewed were clustered geographically, but diverse on many other criteria of interest including the types of evidence produced, debriefing models and practices, and outcomes captured. Discussion: The current review provides a clear map of our existing understanding and highlights the need for more systematic, collaborative and rigorous bodies of evidence to determine the potential of debriefing to support the emotional outcomes of those working within healthcare. Systematic Review Registration: https://osf.io/za6rj.

A systematic scoping review of undergraduate nursing hub-and-spoke placement models.

BACKGROUND: While nursing education has been forecast to continue to grow, placement capacity is now the key factor precluding growth in supply. AIMS: To provide a comprehensive understanding of hub-and-spoke placements and their ability to increase placement capacity. METHOD: A systematic scoping review and narrative synthesis were used (Arksey and O'Malley, 2005). PRISMA checklist and ENTREQ reporting guidelines were followed. FINDINGS: The search returned 418 results. After a first and second screen 11 papers were included. Results suggest that hub-and-spoke models were generally evaluated favourably by nursing students, with a range of benefits reported. However, many of the studies included in the review were small and of low quality. CONCLUSION: Given the exponential increase in applications to study nursing, hub-and-spoke placements appear to have the potential to better meet these increased demands, while also providing a number of benefits.

The impact of Covid-19 on self-employed female psychologists in the UK.

This scoping study reports on the experiences of 41 female self-employed psychologists (or psychologists in private practice) during the first Covid-19 lockdown in the UK. Psychologists are more likely to be female, and unlike employed people, self-employed female psychologists were more likely to be working in lone contexts, and they were unlikely to have had broader organisational and government support available to them. Yet, self-employed female psychologists still made a significant contribution to the UK's response to the Covid-19 pandemic. In addition to supporting children and adults, they have played an important role in shaping government policy, and in the delivery of mass media campaigns and public health messaging. In view of this, the current scoping study focused on how self-employed female psychologists were fairing during the unprecedented circumstances. How were their needs being met? Responses to open-ended survey questions were qualitatively examined using a thematic analysis approach. Overall, the findings suggest that lockdown has afforded some positive opportunities for self-employed female psychologists in the UK. However, for many, it has also had a detrimental impact on their family relationships, and on their own mental health and wellbeing. The findings indicate that self-employed female psychologists may need a more nuanced approach to mitigate against any long-term negative effects of Covid-19.

Anarchy and Its Overlooked Role in Health and Healthcare.

In this paper, I will argue that a number of well-known health interventions or initiatives could be considered anarchist, or at the very least are consistent with anarchist thinking and principles. In doing this I have two aims: First, anarchism is a misunderstood term-by way of example, I hope to first sketch out what anarchist solutions in health and healthcare could look like; second, I hope to show how anarchist thought could stand as a means to improve the health of many, remedying health inequalities acting as a buffer for the many harms that threaten health and well-being. On this second point, I will argue that there are a number of theoretical and instrumental reasons why greater engagement with anarchism and anarchist thinking is needed, along with how this could contribute to health and in addressing broader injustices that create and perpetuate poor health.

A last resort? A scoping review of patient and healthcare worker attitudes toward strike action.

While strike action has been common since the industrial revolution, it often invokes a passionate and polarising response, from the strikers themselves, from employers, governments and the general public. Support or lack thereof from health workers and the general public is an important consideration in the justification of strike action. This systematic review sought to examine the impact of strike action on patient and clinician attitudes, specifically to explore (1) patient and health worker support for strike action and (2) the predictors for supporting strike action and the reasons given for engaging in strike action. A systematic scoping review was employed to identify all relevant literature, followed by a textual narrative synthesis. A total of 34 studies met inclusion criteria. Support for strike action was largely context-dependent. A range of factors impact support for strike action; broader cultural and structural factors, such as unionisation and general acceptance of strike action; systemic factors, such as the nature of the healthcare system, including infrastructure and work conditions; the strike itself and a range of individual factors, the most notable of which was being a student or in an early career stage. There were also some surprising results, for example, during doctors strike, nurses were provided with the opportunity to expand their role, which led to greater professional autonomy and job satisfaction.

Inequalities in Covid-19 Messaging: A Systematic Scoping Review.

The impact of the Covid-19 pandemic has been widely documented. While deaths are now in the millions and many more have been impacted in other ways, the impact of Covid-19 has not been felt equally, with it exacerbating existing inequalities and disproportionately impacting a number of populations. With this Covid-19 has created unprecedented challenges in relation to health communication, with the need to reach disadvantaged populations. This systematic scoping review sought to 1) synthesize the existing research regarding communication inequalities in the response to the Covid-19 pandemic, and 2) analyze the recommendations that emerge from this body of evidence on how to best address these inequalities. This review includes 40 studies that fell into three broad groups (1) those revealing a disadvantage or inequality in studies of general population; (2) those focussing on communication with sub-groups disproportionately affected by the pandemic; and (3) those reporting and evaluating practical attempts to address inequalities. The results largely corroborate those found in past pandemics, highlighting the role of sociodemographic, cultural/religious, and economic factors in facilitating/jeopardizing the public's capacity to access and act upon public health messaging. In a number of studies it was encouraging to see recommendations from the literature - particularly, lessons learnt on the importance of community partnerships, trusted messengers and the co-creation of health and risk messages - being applied, however many challenges remain unmet. Covid-19 has also highlighted the need to actively tackle misinformation, something which was recognized, but largely unaddressed.

The impact of strike action on healthcare delivery: A scoping review.

BACKGROUND: Strike action carried out by healthcare workers raises a range of ethical issues. Most fundamentally, as a strike is designed to disrupt, it has the potential to impact patient outcomes and healthcare delivery. This paper synthesises and analyses the empirical literature that details the impact of strike action on healthcare delivery. METHODS: A systematic scoping review was utilised to examine the extent, range and nature of research activity. Embase, Medline, CINAHL, Bioethicsline, EconLit and Web of Science were searched, yielding 5644 results. Papers were included if they examined the impact that strike action had on healthcare delivery (i.e., admissions, presentations, waiting time). After screening, 43 papers met inclusion criteria. RESULTS: Nineteen studies explored presentations to emergency or admissions to hospital. Both dropped dramatically when comparing non-strike to strike periods. Ten studies examined length of stay in hospital and waiting times. No clear relationship was found with strike action, with some studies showing that wait times decreased. Nine studies examined the impact of strike action in facilities that were not on strike, but were impacted by nearby strike action along with the impact that strike action had on treatment seeking. Hospitals dealing with these upstream impacts often saw increase in presentations at hospitals, but results relates to treatment seeking during strike action were mixed. CONCLUSION: Strike action can have a substantial impact on the delivery of healthcare, but this impact is not felt uniformly across services. While many services are disrupted, a number are not, with several studies reporting increased efficiency.