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1.
BMC Health Serv Res ; 24(1): 866, 2024 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-39080750

RESUMEN

BACKGROUND: Demographic changes, such as an increase in older adults, present a challenge to the healthcare service's current capacity. Moreover, the need for healthcare personnel is rising, while the availability of labour is dwindling, leading to a potential workforce shortage. To address some of these challenges, enhanced collaboration between home-based healthcare frontline workers, service users, and next of kin is a necessity. The trust model is an organisational model where home-based healthcare services are organised into smaller interdisciplinary teams aiming to tailor the services in collaboration with service-users and their next of kin'. This study explores how the next of kin and frontline workers perceive and perform involvement in making decisions regarding tailoring the services for the users of home-based healthcare services organised after the trust model. METHODS: Four in-depth interviews and 32 observations were conducted, and thematic analysis was employed to identify meaningful patterns across the datasets. RESULTS: The results are presented as two themes: (i) unspoken expectations and (ii) situational participation. The results highlight the complex nature of next-of-kin involvement and shared decision making, raising questions about meeting expectations, evaluating available resources, and developing sustainable involvement processes. CONCLUSION: This study indicates that despite of an interdisciplinary organisational model aiming for shared decision making as the trust model, the involvement of next of kin continues to be a challenge for frontline workers in home-based healthcare services. It also points to the importance of transparent communication and how it is deemed essential for clarifying implicit expectations.


Asunto(s)
Servicios de Atención de Salud a Domicilio , Investigación Cualitativa , Humanos , Servicios de Atención de Salud a Domicilio/organización & administración , Femenino , Confianza , Masculino , Familia/psicología , Entrevistas como Asunto , Modelos Organizacionales , Toma de Decisiones , Adulto , Conducta Cooperativa , Persona de Mediana Edad , Toma de Decisiones Conjunta
2.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2024 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-38796768

RESUMEN

PURPOSE: With the soaring rise in popularity of social media platforms in recent decades, the use of website posts for the expression of work-related views has also increased. Despite websites being extensively used, there has been no examination of the views and concerns expressed by frontline workers through website posts. The present research aims to contribute to the "voice literature" first by evaluating how frontline workers utilize anonymous media platforms to express their views and work-related concerns and, second, by demonstrating how anonymous voice systems can encourage frontline health workers in providing feedback and dissatisfaction. DESIGN/METHODOLOGY/APPROACH: The study utilizes the thematic analysis method to analyze the content of posts by psychologists on a collaborative consultation website administrated by Israel's Ministry of Health, discussing their perceptions of work-related concerns. FINDINGS: The analysis identified three work-related themes through the employees' voices. These include insufficient support from management, conflicts and excessive occupational demands. The workers expressed their apprehension with regard to organizational pressures, deficient budget allocations, excessive workloads, lack of recognition and work-life imbalances. ORIGINALITY/VALUE: The application of thematic analysis method to anonymous open-public data should be viewed as an effective, affordable, genuine and unique research method for data analysis. Anonymous platforms can generate unique insights that may not be possible through traditional means. This can provide practitioners with a comprehensive understanding of various issues and challenges and be a useful tool for identifying shortcomings within health settings.


Asunto(s)
Personal de Salud , Humanos , Personal de Salud/psicología , Israel , Medios de Comunicación Sociales , Internet , Satisfacción en el Trabajo , Actitud del Personal de Salud
3.
Cureus ; 16(4): e58860, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38800187

RESUMEN

BACKGROUND: Vaccination is among the most important public health tools for preventing the harm caused by communicable diseases. This was particularly true in the case of COVID-19 vaccination during the COVID-19 pandemic. However, no vaccine is 100% effective, and all carry the risk of breakthrough infection in vaccinated individuals. METHODOLOGY: This longitudinal observational study was done on COVID-19-vaccinated individuals at a vaccination site in a tertiary care hospital. The study participants were categorized into the general community, frontline workers, and healthcare workers and were followed up during the study period from June 2021 to May 2022 post-vaccination. They were interviewed by telephone regarding adverse effects and breakthrough infections post-vaccination during the second and third wave of the COVID-19 pandemic in India. Incidence of breakthrough infection was calculated in all three categories after they received their first, second, and booster doses of vaccination. RESULTS: Fever was the most common adverse effect among all the categories of participants after the first and second doses. Incidence of breakthrough infection after the second dose of vaccination among frontline workers (RR: 5.7, 95% CI: 0.7-44.2) and healthcare workers (RR: 18.9, 95% CI: 2.6-138.6) was observed to be higher compared to the general community, but no such difference was observed among the three categories after the first dose of vaccination. CONCLUSIONS: The incidence of breakthrough infection was found to be the highest in healthcare workers, followed by frontline workers compared to the general community, justifying their work profile and the risk associated with it.

4.
Cureus ; 16(2): e55181, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-38558590

RESUMEN

Background  The COVID-19 pandemic has been difficult for all healthcare providers. Nurses in Indian hospitals are at risk for mental health consequences of COVID-19-related stress. The study aimed to evaluate the mental health responses of Indian nurses working during the COVID-19 pandemic.  Method The study was carried out during the COVID-19 pandemic from November 2020 to February 2021. Frontline nurses (n=387) working in both government and private sectors were recruited from four hospital centers across Mangalore, India. Nurses were selected based on specific inclusion criteria, including active duty within wards and intensive care units designated for COVID-19 care or suspected cases of SARS-CoV-2 infection. Recruitment and data collection were facilitated by medical residents using a mix of physical and electronic survey methods. Results Nurses within the private sector with low personal protective equipment (PPE) security experienced heightened anxiety. Somatic symptoms were incrementally related to mental health depending on the workplace setting; private sector staff reported greater depression symptoms compared to those in government-run hospitals. Self-efficacy buffered against depression outcomes only in nurses within the private sector working within non-COVID units. Conclusions This study's findings showed differential responses to the stress of COVID-19 based on the setting. Future studies should further explore the factors associated with such differences. Somatic symptoms can be indicators of mental health adversity. Early detection and supportive interventions need to be taken into account.

5.
Hum Vaccin Immunother ; 20(1): 2324527, 2024 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-38584120

RESUMEN

Although COVID-19 vaccination has been widely considered as an important remedy to confront COVID-19, people remain hesitant to take it. The objective of this study was to assess the moderation effects of demographic characteristics on the relationship between forms of misinformation and COVID-19 vaccine uptake hesitancy among frontline workers in Dar es Salaam and Dodoma, Tanzania. Using a sample of 200 respondents, it assessed the differences in ratings on misinformation regarding COVID-19 vaccine based on respondents' demographics. The study used a Five-point Likert scale questionnaire distributed through snowball sampling to frontline workers from Dar es Salaam and Dodoma regions. Data was analyzed using binary logistic regression. It was found that the forms of misinformation revealed were manipulated imposters, satire, fabricated contents and false contents with their connection, which they influenced COVID-19 hesitancy significantly. With exception of age, that significantly moderated hesitancy, this study uncovers that, sex and education level moderated insignificantly in predicting those who are misinformed; misinformed individuals are not any less educated or not based on one's sex, different than individuals who are informed. The study informs policy makers on devising appropriate strategies to promote COVID-19 vaccination uptake among the different contextual demographic variables. Promotion of information, media and health literacy to the general public should be considered to deter spreading of vaccine-related misinformation.


Asunto(s)
COVID-19 , Humanos , Tanzanía , COVID-19/prevención & control , Vacunas contra la COVID-19 , Escolaridad , Vacunación , Demografía
6.
Int J Equity Health ; 23(1): 28, 2024 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-38347516

RESUMEN

BACKGROUND: Despite considerable investment in maternal-child programs in Canada, there has been little positive impact on the health of Indigenous mothers and their children. The reasons for this are unclear and there is a need to identify how such programs can be successfully implemented. Community input is essential for successful programs; however, it is unclear what the contributions of frontline workers have been in the health program process, i.e., program development, delivery, and evaluation. Based on these identified gaps, this scoping review aimed to: (1) identify factors of success and barriers to successful Indigenous maternal-child community health programs for mothers and their children aged 0-6 years; and (2) explore how frontline workers are included in the program process. METHODS: This scoping review was completed using the Arksey and O'Malley framework, informed by Levac et al. Four data bases (Medline, CINAHL, Embase, and Scopus), grey literature, and reference lists were searched for relevant materials from 1990-2019. Data was extracted from included articles and analysed using descriptive statistics, thematic analysis with the Braun and Clarke framework, and a Principal Component Analysis. RESULTS: Forty-five peer-reviewed and grey articles were included in the review. Factors of program success included: relationship building; cultural inclusion; knowledge transmission styles; community collaboration; client-centred approaches; Indigenous staff; and operational considerations. Barriers included: impacts of colonization; power structure and governance; client and community barriers to program access; physical and geographical challenges; lack of staff; and operational deficits. Frontline workers were found to have a role in program delivery (n = 45) and development (n = 25). Few (n = 6) had a role in program evaluation. CONCLUSION: Although a better understanding of the frontline worker role in maternal-child health programs was obtained from the review, in a large proportion of literature the authors could not determine if the role went beyond program delivery. In addition, no direct input from frontline workers and their perspectives on program success or barriers were identified, suggesting areas to explore in future research. This review's findings have been applied to inform a community-based participatory research project and may also help improve the development, delivery, and evaluation of Indigenous maternal-child health programs.


Asunto(s)
Salud Infantil , Humanos , Niño , Canadá
7.
Vaccines (Basel) ; 12(2)2024 Feb 15.
Artículo en Inglés | MEDLINE | ID: mdl-38400182

RESUMEN

This study evaluated the immune response to vaccination against COVID-19 in 534 healthcare frontline workers in Vilnius, Lithuania. The incidence of COVID-19 was reduced significantly after vaccination started in the healthcare sector. SARS-CoV-2 antibodies were detected in groups V-VII and this level of antibodies was found to be effective in preventing COVID-19. Sustained immune response was achieved after two vaccination doses, which remained stable for up to 6 months. After the booster dose, antibody levels remained high for an additional 12 months. Although SARS-CoV-2 antibody levels decreased after 6 months, even lower levels of antibodies provided protection against the Delta strain. The booster dose distributed the antibody titer in the high-level antibody groups, offering maximum protection at 12 months. However, even individuals with high antibody titers were observed to contract COVID-19 after vaccination with a booster dose and 6 months in the presence of the Omicron strain. Unfortunately, high levels of antibodies did not provide protection against the new strain of COVID-19 (the Omicron variant), posing a risk of infection. When comparing the antibody titer of vaccinated participants without COVID-19 and those with COVID-19, the change in antibodies after vaccination was significantly lower in infected participants. Individuals with comorbidities and specific conditions had lower antibody levels.

8.
Indian J Pediatr ; 2024 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-38282106

RESUMEN

OBJECTIVES: To compare the difference between the growth and developmental status of the children who were residing in the area where Inclusive Early Childhood Development (IECD) project was being implemented and who had received interventions through trained Anganwadi workers (Frontline workers) under Integrated Child Development Services (ICDS) scheme with the children who had not received the Inclusive ECD project interventions. METHODS: It was a mixed method cohort study, nested in an ongoing project in a medical college in which Inclusive ECD was used as an intervention through International Guide for Monitoring Child Development (GMCD) which is a tool for both monitoring and assessment with the help of existing government structures and personnel such as Anganwadi workers, Anganwadi supervisors and their contact points with communities. A sample of 200 children was selected; 100 each from intervention group (IECD cohort) and comparison group (Usual care cohort) and were followed till the child became 2 y of age. RESULTS: IECD intervention showed statistically significant effect on weight (p = 0.04) and height (p = 0.03) of the IECD cohort. Overall developmental assessment showed that the identified developmental issues (Concerns + Delays) were approximately half in IECD cohort (9.67% + 5.37% = 15.04%) as compared to usual care cohort (17.20% + 11.82% = 29.02%). The results from binomial logistic regression performed for developmental outcomes were statistically significant (p = 0.04) suggesting that children with IECD intervention have lower odds of developing developmental issues. CONCLUSIONS: The study indicates that it is possible to implement IECD interventions through frontline workers, which significantly improves the growth and development of the children.

9.
Int J Occup Saf Ergon ; 30(1): 119-128, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37766489

RESUMEN

Objectives. The emergence of COVID-19 has drastically changed the safety outlook of how the work world is viewed by leaders and followers. In this backdrop, the current study aimed at extending the safety leadership literature in the context of organizations operating in crisis situations by investigating the impact of safety-specific transformational leadership on the followers' extra-role behaviors through the mediation of psychological contract fulfillment. Methods. Using a time-lagged and multisource design, data were collected from 384 frontline rescue and healthcare workers dealing with COVID-19-related situations. Results. Results revealed that safety-specific transformational leadership behavior positively affects extra-role behaviors of frontline employees by enhancing their innovative work behavior, knowledge sharing behavior and organizational citizenship behavior. Also, psychological contract fulfillment plays a bridging role in translating the impact of safety-specific transformational leadership behavior on extra-role behaviors. Conclusion. The followers working in an unsafe context view the safety concern of their leader as a fulfillment of their unwritten expectations from their employers. Implications of these findings along with limitations and future research directions are also delineated.


Asunto(s)
COVID-19 , Liderazgo , Humanos , Actitud , Contratos , Conductas Relacionadas con la Salud
10.
Health Promot Pract ; 25(2): 170-172, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37073499

RESUMEN

VALUE (Vaccine Acceptance & Access Lives in Unity, Engagement & Education) Baltimore began in February 2021 with the vision of helping underserved communities in Baltimore City value COVID-19 vaccination and have access to the vaccine. VALUE dispatched ambassadors to provide COVID-19 education and risk-mitigation strategies in their communities. Once the project was implemented, we noticed that our ambassadors were often overwhelmed by misinformation in the community and our priority populations faced deeper issues relating to the social determinants of health (SDOH) and social needs such as food, transportation, job loss, and housing.To help our ambassadors cope with and address these issues, we created Healing Baltimore in April 2021. Healing Baltimore aims to support our VALUE ambassadors as they contribute toward improving the wellbeing of Baltimore now and after COVID. Healing Baltimore has four elements: (1) Weekly Self-Care Tips, (2) Weekly Positive Facts about Baltimore, (3) SDOH Referral to Baltimore City Health Department Services, and (4) Webinars to teach us about the VALUE communities while offering the opportunity to discuss historical trauma. We share our lessons learned from Healing Baltimore, which include (1) increasing ambassador input, (2) engagement, (3) co-creation, (4) collaboration, and (5) community appreciation.


Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Humanos , Baltimore , Pandemias/prevención & control , COVID-19/prevención & control , Alimentos
11.
Am J Ind Med ; 67(1): 3-9, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-37837415

RESUMEN

Workers who become ill or injured on the job while undertaking extraordinary risks on behalf of the public are, at times, granted facilitated access to workers' compensation (WC) benefits through the application of presumptions in the compensation process. Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, a broad range of occupational groups faced an elevated risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure at work to perform vital services to maintain our food supply, sustain needed transportation, provide health care, assure energy supply and others. Some states or jurisdictions in the United States recognized both the risk and the service of these workers by enacting COVID-19 presumption laws to streamline selected essential workers' eligibility for WC benefits. Other states did not. Results of these contrasting public approaches permit an examination of the impact of presumptions in compensation by examining the frequency and outcomes of COVID-19 claims in "COVID-19 presumption" and "nonpresumption" states. Despite state-level variations in economic response to the pandemic, industry mix, and presumption eligibility criteria, the use of COVID-19 presumptions appears to have substantially increased claim filing rates and improved access to benefits. Lastly, the additional costs of COVID-19 claims to employers and insurers were lower than initially predicted. In response to future airborne infectious disease outbreaks, workers' compensation presumption laws should be universally implemented to permit a broad range of high-risk workers to work on the public's behalf without fear of losing wages and incurring medical expenses associated with a work-related viral exposure.


Asunto(s)
COVID-19 , Enfermedades Profesionales , Salud Laboral , Humanos , Estados Unidos/epidemiología , COVID-19/epidemiología , SARS-CoV-2 , Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/etiología , Industrias , Indemnización para Trabajadores
12.
Front Public Health ; 11: 1177634, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37900017

RESUMEN

Objectives: India's Covid-19 vaccination campaign engaged frontline workers (FLWs) to encourage vaccination among vulnerable segments of society. The FLWs report encountering a variety of barriers to vaccination and are often unsuccessful despite multiple visits to the same person. This cross-sectional study aims to pinpoint which of these barriers drive vaccine hesitancy among these segments, to help streamline vaccine communication, including FLW training, to better safeguard the population. Methods: Trained field enumerators contacted 893 individuals from five states across India and collected self-reported assessments of fifteen vaccination barriers (identified through discussions with FLWs), current vaccination status and future vaccination intentions, and covariates (demographics/comorbidities). Factor analysis of the fifteen barriers yielded two factors, one relating to fear of vaccine adverse effects and a second focused on peripheral concerns regarding the vaccine. The covariates significantly associated with current vaccination status were combined under a latent class regime to yield three cluster types (health access, financial strength, and demographics). The primary analysis examined the effect of the two barrier factors, the covariate clusters, and comorbidity, on current vaccination status and future vaccine intentions. Results: Fear of vaccine adverse effects was the primary driver of vaccine hesitancy; peripheral concerns frequently mentioned by the FLWs had no impact. Although cluster membership and the presence of comorbidities predicted vaccine uptake, neither of them materially altered the effect of fear of vaccine adverse effects with the following exception: fear of adverse effects was not associated with vaccination status among young Muslim men. Conclusion: Subject to limitations, these results indicate that interventions to decrease vaccine hesitancy should focus primarily on fear associated with vaccines rather than spend resources trying to address peripheral concerns.


Asunto(s)
Vacilación a la Vacunación , Poblaciones Vulnerables , Masculino , Humanos , Vacunas contra la COVID-19 , Estudios Transversales , India
13.
Data Brief ; 50: 109497, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37663775

RESUMEN

The data belongs to a sample of 201 frontline workers in Malaysia. This demographic data was collected using a cross-sectional questionnaire via an online survey and analyzed using SPSS version 25. This data was used to investigate the relationship between workplace incivility, emotional exhaustion and adaptive performance (handling emergencies, handling work stress, creative problem solving, learning new tasks, technology and procedure and demonstrating interpersonal adaptability) among frontline workers. The analyzed data will be useful in contributing to further research into the effects of workplace incivility on employees' well-being and job performance. It will also give insights to stakeholders and those at managerial level who formulate appropriate intervention plans to overcome or reduce the issue of workplace bullying among frontline workers.

14.
Healthcare (Basel) ; 11(16)2023 Aug 18.
Artículo en Inglés | MEDLINE | ID: mdl-37628536

RESUMEN

During the COVID-19 pandemic, persons under surveillance (PUS) were isolated in quarantine centres instead of at home. However, there is limited knowledge regarding the mental health issues experienced by these persons. This study aimed to assess mental health outcomes and associated factors among PUS and frontline workers at quarantine centres. This study conducted an analysis of secondary data from a cross-sectional survey carried out by the Mental Health and Psychosocial Support Services (MHPSS). The MHPSS employed the Depression, Anxiety, and Stress Scale (DASS-21) to evaluate mental health outcomes across 49 quarantine centres in Malaysia. The study included a total of 4577 respondents. The prevalence of stress, anxiety, and depression was found to be 0.9%, 11.4%, and 10.2%, respectively. Frontline workers and being part of the younger age group were found to be associated with depression, anxiety, and stress. Other factors associated with mental health issues were being female, staying at an institution-type centre, and a longer duration of the stay or work at the centre. In conclusion, assessing the mental health status and its associated factors among quarantine centre occupants is crucial for developing future strategies to safeguard their mental well-being.

15.
J Gen Intern Med ; 38(13): 2888-2897, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37460922

RESUMEN

BACKGROUND: Engaging frontline clinicians and staff in quality improvement is a promising bottom-up approach to transforming primary care practices. This may be especially true in federally qualified health centers (FQHCs) and similar safety-net settings where large-scale, top-down transformation efforts are often associated with declining worker morale and increasing burnout. Innovation contests, which decentralize problem-solving, can be used to involve frontline workers in idea generation and selection. OBJECTIVE: We aimed to describe the ideas that frontline clinicians and staff suggested via organizational innovation contests in a national sample of 54 FQHCs. INTERVENTIONS: Innovation contests solicited ideas for improving care from all frontline workers-regardless of professional expertise, job title, and organizational tenure and excluding those in senior management-and offered opportunities to vote on ideas. PARTICIPANTS: A total of 1,417 frontline workers across all participating FQHCs generated 2,271 improvement opportunities. APPROACHES: We performed a content analysis and organized the ideas into codes (e.g., standardization, workplace perks, new service, staff relationships, community development) and categories (e.g., operations, employees, patients). KEY RESULTS: Ideas from frontline workers in participating FQHCs called attention to standardization (n = 386, 17%), staffing (n = 244, 11%), patient experience (n = 223, 10%), staff training (n = 145, 6%), workplace perks (n = 142, 6%), compensation (n = 101, 5%), new service (n = 92, 4%), management-staff relationships (n = 82, 4%), and others. Voting results suggested that staffing resources, standardization, and patient communication were key issues among workers. CONCLUSIONS: Innovation contests generated numerous ideas for improvement from the frontline. It is likely that the issues described in this study have become even more salient today, as the COVID-19 pandemic has had devastating impacts on work environments and health/social needs of patients living in low-resourced communities. Continued work is needed to promote learning and information exchange about opportunities to improve and transform practices between policymakers, managers, and providers and staff at the frontlines.


Asunto(s)
COVID-19 , Pandemias , Humanos , COVID-19/epidemiología , COVID-19/terapia , Lugar de Trabajo
16.
Nurs Open ; 10(9): 5887-5899, 2023 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-37282352

RESUMEN

AIM: The aim of this study was to identify the influencing factors of sleep disorders and sleep quality in healthcare workers during the COVID-19 pandemic. DESIGN: Systematic review and meta-analysis of observational research. METHODS: The databases of the Cochrane Library, Web of Science, PubMed, Embase, SinoMed database, CNKI, Wanfang Data, and VIP were systematically searched. The quality of studies was assessed using the Agency for Healthcare Research and Quality evaluation criteria and the Newcastle-Ottawa scale. RESULTS: A total of 29 studies were included, of which 20 were cross-sectional studies, eight were cohort studies, and 1 was a case-control study; 17 influencing factors were finally identified. Greater risk of sleep disturbance was associated with female gender, single relationship status, chronic disease, insomnia history, less exercise, lack of social support, frontline work, days served in frontline work, department of service, night shift, years of work experience, anxiety, depression, stress, received psychological assistance, worried about being infected, and degree of fear with COVID-19. CONCLUSIONS: During the COVID-19 pandemic, healthcare workers did have worse sleep quality than the general population. The influencing factors of sleep disorders and sleep quality in healthcare workers are multifaceted. Identification and timely intervention of resolvable influencing factors are particularly important for preventing sleep disorders and improving sleep. PATIENT OR PUBLIC CONTRIBUTION: This is a meta-analysis of previously published studies so there was no patient or public contribution.


Asunto(s)
COVID-19 , Calidad del Sueño , Estados Unidos , Humanos , Femenino , Estudios de Casos y Controles , Pandemias , Personal de Salud
17.
BMC Health Serv Res ; 23(1): 715, 2023 Jun 30.
Artículo en Inglés | MEDLINE | ID: mdl-37391763

RESUMEN

BACKGROUND: Achieving access to quality healthcare services to ensure healthy lives and promote well-being for all at all ages is one of the United Nation's Sustainable Developments Goals. In view of this goal, sustainable community healthcare services in Norway need to be urgently restructured in light of demographic changes, including an increase in the percentage of older adults in the country. National healthcare policies recommend finding new ways to organise and perform services using new technology, new methods and new solutions. The goal is to ensure greater continuity in the provision of services and softer transitions that enable service users to deal with a smaller number of people. The trust model is one such suggested organisational approach. The goal of the trust model is to involve service users and their next of kin in decisions that concern them while also trusting frontline workers' professional judgement in assessing the need for services and adjusting them to address changes in the health of the users, thus making the services individually tailored and more flexible. This study aims to explore how organisational work structures influence the delivery of interdisciplinary home-based healthcare services. METHODS: Observations, individual-, and focus groups interviews were conducted within community home-based healthcare services in a large Norwegian city with managers at different levels, nurses, occupational therapists, physiotherapists, purchaser-unit employees and other healthcare workers. Data was analysed thematically. RESULTS: The results are presented in terms of themes- "Balancing on the margins: Negotiations between the time available, users' needs, unforeseen events and administrative tasks" and "One gathered unit, but with different work structures". The results identify organisational work structures that influence the performance of the trust model with regard to its intention of making flexible and individually tailored services available. However, these structures are different for the members of the interdisciplinary team, thus creating several paradoxes that need to be negotiated while fulfilling their daily responsibilities. CONCLUSION: This study suggests that it is crucial to pay attention to paradoxes and structures experienced by interdisciplinary frontline workers in home-based healthcare services, since they are unavoidable factors that need to be acknowledged when designing approaches for addressing the changes expected in community healthcare services.


Asunto(s)
Servicios de Salud , Confianza , Humanos , Anciano , Servicios de Salud Comunitaria , Investigación Cualitativa , Atención a la Salud
18.
Psychol Res Behav Manag ; 16: 1439-1444, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37124074

RESUMEN

The spread of the novel coronavirus has led to a rise in morally conflicting situations for healthcare professionals. Doctors and nurses who were serving as frontline workers, require special attention to alleviate the long-lasting impact of the potentially morally injurious events. The current study aims to validate the Moral Injury Symptom Scale-Healthcare Professionals (MISS- HP) among Indian healthcare workers. The 10-item MISS was administered to 150 doctors and 150 nurses using the purposive sampling method. Firstly, reliability was assessed using internal consistency measure. Secondly, item discrimination index was assessed by calculating the point biserial correlation for each item. Cronbach alpha indicated high internal consistency (0.77). The point biserial correlation value for each item indicated good discrimination. Finally, confirmatory factor analysis (CFA) was performed to replicate the factor structure. CFA results suggested a good fit to the data. In conclusion, MISS-HP is a reliable and valid tool to assess moral injury among Indian healthcare professionals in India.

19.
Health Policy Plan ; 38(6): 655-664, 2023 Jun 16.
Artículo en Inglés | MEDLINE | ID: mdl-37148361

RESUMEN

Multisectoral collaboration has been identified as a critical component in a wide variety of health and development initiatives. For India's Integrated Child Development Services (ICDS) scheme, which serves >100 million people annually across more than one million villages, a key point of multisectoral collaboration-or 'convergence', as it is often called in India-is between the three frontline worker cadres jointly responsible for delivering essential maternal and child health and nutritional services throughout the country: the Accredited Social Health Activist (ASHA), Anganwadi worker (AWW) and auxiliary nurse midwife (ANM) or 'AAA' workers. Despite the long-recognized importance of collaboration within this triad, there has been relatively little documentation of what this looks like in practice and what is needed in order to improve it. Informed by a conceptual framework of collaborative governance, this study applies inductive thematic analysis of in-depth interviews with 18 AAA workers and 6 medical officers from 6 villages across three administrative blocks in Hardoi district of Uttar Pradesh state to identify the key elements of collaboration. These are grouped into three broad categories: 'organizational' (including interdependence, role clarity, guidance/support and resource availability); 'relational' (interpersonal and conflict resolution) and 'personal' (flexibility, diligence and locus of control). These findings underscore the importance of 'personal' and 'relational' collaboration features, which are underemphasized in India's ICDS, the largest of its kind globally, and in the multisectoral collaboration literature more broadly-both of which place greater emphasis on 'organizational' aspects of collaboration. These findings are largely consistent with prior studies but are notably different in that they highlight the importance of flexibility, locus of control and conflict resolution in collaborative relationships, all of which relate to one's ability to adapt to unexpected obstacles and find mutually workable solutions with colleagues. From a policy perspective, supporting these key elements of collaboration may involve giving frontline workers more autonomy in how they get the work done, which may in some cases be impeded by additional training to reinforce worker role delineation, closer monitoring or other top-down efforts to push greater convergence. Given the essential role that frontline workers play in multisectoral initiatives in India and around the world, there is a clear need for policymakers and managers to understand the elements affecting collaboration between these workers when designing and implementing programmes.


Asunto(s)
Partería , Niño , Embarazo , Humanos , Femenino , India , Población Rural , Salud Infantil , Agentes Comunitarios de Salud
20.
Front Psychol ; 14: 1129912, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37063579

RESUMEN

Objective: Frontline mental health, emergency, law enforcement, and social workers have faced unprecedented psychological distress in responding to the COVID-19 pandemic. The purpose of the RCT (Randomized Controls Trial) study was to investigate the effectiveness of a Group EMDR (Eye Movement Desensitization and Reprocessing) therapy (Group Traumatic Episode Protocol-GTEP) in the treatment of Post-Traumatic Stress Disorder (PTSD) and Moral Injury. The treatment focus is an early intervention, group trauma treatment, delivered remotely as video-conference psychotherapy (VCP). This early intervention used an intensive treatment delivery of 4x2h sessions over 1-week. Additionally, the group EMDR intervention utilized therapist rotation in treatment delivery. Methods: The study's design comprised a delayed (1-month) treatment intervention (control) versus an active group. Measurements included the International Trauma Questionnaire (ITQ), Generalized Anxiety Disorder Assessment (GAD-7), Patient Health Questionnaire (PHQ-9), Moral Injury Events Scale (MIES), and a Quality-of-Life psychometric (EQ-5D), tested at T0, T1: pre-treatment, T2: post-treatment, T3: 1-month follow-up (FU), T4: 3-month FU, and T5: 6-month FU. The Adverse Childhood Experiences - International version (ACEs), Benevolent Childhood Experience (BCEs) was ascertained at pre-treatment only. N = 85 completed the study. Results: Results highlight a significant treatment effect within both active and control groups. Post Hoc comparisons of the ITQ demonstrated a significant difference between T1 pre (mean 36.8, SD 14.8) and T2 post (21.2, 15.1) (t11.58) = 15.68, p < 0.001). Further changes were also seen related to co-morbid factors. Post Hoc comparisons of the GAD-7 demonstrated significant difference between T1 pre (11.2, 4.91) and T2 post (6.49, 4.73) (t = 6.22) = 4.41, p < 0.001; with significant difference also with the PHQ-9 between T1 pre (11.7, 5.68) and T2 post (6.64, 5.79) (t = 6.30) = 3.95, p < 0.001, d = 0.71. The treatment effect occurred irrespective of either ACEs/BCEs during childhood. However, regarding Moral Injury, the MIES demonstrated no treatment effect between T1 pre and T5 6-month FU. The study's findings discuss the impact of Group EMDR therapy delivered remotely as video-conference psychotherapy (VCP) and the benefits of including a therapist/rotation model as a means of treatment delivery. However, despite promising results suggesting a large treatment effect in the treatment of trauma and adverse memories, including co-morbid symptoms, research results yielded no treatment effect in frontline/emergency workers in addressing moral injury related to the COVID-19 pandemic. Conclusion: The NICE (2018) guidance on PTSD highlighted the paucity of EMDR therapy research used as an early intervention. The primary rationale for this study was to address this critical issue. In summary, treatment results for group EMDR, delivered virtually, intensively, using therapist rotation are tentatively promising, however, the moral dimensions of trauma need consideration for future research, intervention development, and potential for further scalability. The data contributes to the emerging literature on early trauma interventions.Clinical Trial Registration:Clinicaltrials.gov, ISRCTN16933691.

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