RESUMEN
Background Cardiovascular disease is a major health issue for Maori that requires timely and effective first-response care. Maori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Maori and their whanau who received acute pre-hospital cardiovascular care from paramedics. Methods Utilising a qualitative descriptive methodology and Kaupapa Maori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Maori patients and/or whanau, and a general inductive approach was used for analysis. Results Three key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Maori. Participants described paramedics' clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health. Conclusion Maori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Maori.
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Competencia Cultural , Servicios Médicos de Urgencia , Pueblo Maorí , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Técnicos Medios en Salud , Enfermedades Cardiovasculares/etnología , Enfermedades Cardiovasculares/terapia , Enfermedades Cardiovasculares/prevención & control , Accesibilidad a los Servicios de Salud , Entrevistas como Asunto , Nueva Zelanda , Paramédico , Investigación CualitativaRESUMEN
BACKGROUND: As care homes play an important role in the lives of an increasing number of older people, it is pivotal to understand how residents' and their families engage in decision-making about their care and support. Internationally, there is an increasing emphasis in long-term care settings on the right of residents to be actively involved in all aspects of decision-making about their care and support. However, the steps necessary to achieving a culture of shared decision-making in long-term care settings remain unclear. The aim of this literature review is to summarise what is known in the literature about the factors that influence care home residents' and families' engagement with decision-making about their care and support. METHODS: An integrative literature reviews was carried out, guided by the methodological framework proposed by Whittemore and Knafl (2005). CINAHL, Medline Ovid and ProQuest Health and Medical databases were searched for relevant articles from 2011 to 2021. A three-step method was used, including the use of reference and citation management software to manage search results and identify duplicate citations. Abstracts and full texts were reviewed by two reviewers. Details of the selected articles were then extracted using the Data Extraction Form. RESULTS: In total, 913 articles were located and 22 studies were included in the final analysis. The thematic analysis identified three main themes that illustrate the complexities of shared decision-making in care homes: (a) a positive culture of collaborative and reciprocal relationships; (b) a willingness to engage and a willingness to become engaged; and (c) communicating with intent to share and support rather than inform and direct. CONCLUSION: The implementation of shared decision-making in care homes is highly dependent on the support and nurturing of collaborative and reciprocal relationships between residents, families, and staff. Part of this process includes ascertaining the willingness of residents and families to become engaged in shared decision-making. Communication skills training for staff and guided approaches that view decision-making as a supportive process rather than a once off event are essential prerequisites for implementation.
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Toma de Decisiones , Cuidados a Largo Plazo , Humanos , Anciano , Toma de Decisiones ConjuntaRESUMEN
Evidence suggests that phenobarbital can be used to treat alcohol withdrawal syndrome as monotherapy; however, the therapeutic cornerstone remains benzodiazepines. To date, studies comparing the two treatment modalities in the emergency department (ED) are few. We sought to determine whether phenobarbital versus benzodiazepine monotherapy impacts ED length of stay and need for admission among adult presentations at a single regional hospital. In June 2019, a treatment algorithm offering both phenobarbital and diazepam pathways was introduced at the Battlefords Union Hospital ED, an 11-bed unit treating 27 000 patients annually in North Battleford, Saskatchewan, Canada. A subsequent retrospective observational study evaluated all adult alcohol withdrawal syndrome presentations between June 2019 and January 2021. Medical records were reviewed for visit date, age, sex, comorbidities, psychosocial factors, Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scores, secondary diagnoses, time of day, protocol adherence, attending physician, length of stay, disposition, and ED return. Descriptive statistics, log-rank testing, simple regression, and multiple regression were used in analysis. Of the 184 presentations, 30.4% were treated with phenobarbital. Median length of stay for phenobarbital versus benzodiazepine therapy was 4.4 h and 4.4 h, respectively (p = 0.21). Of the phenobarbital presentations, 9.4% were hospitalized versus 17.1% of the benzodiazepine presentations (p = 0.20). When adjusted for confounders, phenobarbital-treated presentations were 71.3% less likely to be admitted (p = 0.03). This research suggests that phenobarbital performs similarly to benzodiazepines regarding alcohol withdrawal ED length of stay and may result in reduced hospitalizations.
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Alcoholismo , Síndrome de Abstinencia a Sustancias , Adulto , Alcoholismo/tratamiento farmacológico , Alcoholismo/epidemiología , Benzodiazepinas/uso terapéutico , Canadá/epidemiología , Servicio de Urgencia en Hospital , Humanos , Tiempo de Internación , Fenobarbital/uso terapéutico , Estudios Retrospectivos , Síndrome de Abstinencia a Sustancias/diagnóstico , Síndrome de Abstinencia a Sustancias/tratamiento farmacológico , Síndrome de Abstinencia a Sustancias/epidemiologíaRESUMEN
AIM: To explore the effect of the My Home Life 12-month leadership support programme on care home managers' leadership skills and professional development, and their relationships with staff, residents and relatives. METHOD: A qualitative study of 15 care home managers was undertaken, using focus groups to explore the study's aims and objectives. Data were analysed using Colaizzi's phenomenological method. FINDINGS: The leadership support programme enabled managers to develop their leadership skills, which had a positive effect for them and for their relationships with staff, residents and relatives. Conclusion Participation in the programme enabled managers to make real practice development improvements with meaningful effect for residents.
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Capacitación en Servicio , Liderazgo , Cuidados a Largo Plazo , Enfermeras Administradoras , Grupos Focales , Enfermería Geriátrica , Humanos , Modelos de Enfermería , Irlanda del Norte , Casas de Salud , Medicina EstatalRESUMEN
The roles of phonological short-term memory (pSTM) and speech perception in spoken sentence comprehension were examined in an experimental design. Deficits in pSTM and speech perception were simulated through task demands while typically-developing children (N [Formula: see text] 71) completed a sentence-picture matching task. Children performed the control, simulated pSTM deficit, simulated speech perception deficit, or simulated double deficit condition. On long sentences, the double deficit group had lower scores than the control and speech perception deficit groups, and the pSTM deficit group had lower scores than the control group and marginally lower scores than the speech perception deficit group. The pSTM and speech perception groups performed similarly to groups with real deficits in these areas, who completed the control condition. Overall, scores were lowest on noncanonical long sentences. Results show pSTM has a greater effect than speech perception on sentence comprehension, at least in the tasks employed here.