Exploring patient safety in rural general practice - a mixed-methods approach

Unsafe medical practices and incidents where safety hazards cause harm to patients occur daily in general practice. The costs to society, health care personnel and individual patients are substantial and deserve attention. “Hazards” can be regarded as local error-producing factors, latent failures, which create conditions for unsafe medical practice to take place. “Harm” occurs when these conditions breach safety barriers and reach the patients. Individual doctors who make mistakes created by these factors are most likely to continue to make mistakes until the underlying conditions are remedied. The responsibility for establishing safety barriers in healthcare systems is assigned to health professionals, health organisations and the government. In Norway, there is a general practitioner (GP) scheme involving more than 4700 doctors at present. It includes a patient list system that enables the care of individuals over time, i.e. continuity of care. Continuity varies between municipalities in Norway. In small municipalities, the GP scheme is affected by the frequent use of locums (substitute GPs). Rural GP clinics also face challenges in care provision in terms of vast transportation distances and possible support of secondary care specialists. Little is known about patient safety threats in these clinics, which is the basis for my research for this doctoral dissertation. In the first study we interviewed rural general practice patients and in the third study GPs and other health care personnel. In these studies we asked about their experiences with hazards, harm, patient safety incidents and low quality of care. The second study was a quantitative analysis of disciplinary actions against doctors in Norway in 2011-2018. The doctoral dissertation is based on a mixed-method approach to analyse these results in combination. In paper I and III the participants described many different safety hazards and harm. In paper I patients coped with these conditions by accepting, confronting or planful problem-solving. In paper III the rural general practice staff described how vulnerability for patient safety incidents were linked to frequent use of locums, work overload and contextual factors like bad weather and distance to hospitals. The personnel used knowledge of local context and an awareness to risk of error to hinder patient safety incidents. Results from paper II showed that primary care doctors got 8 times more disciplinary actions than hospital doctors. Rural GPs got relatively most disciplinary actions, 1.7 times more compared to urban GPs. To perform a scientific analysis of qualitative and quantitative results, I have used pragmatism as a theory of science and a mixed-methods design. In brief, this means transforming the quantitative results in Paper II into narrative descriptions. These descriptions are then jointly analysed with the results from Papers I and III. The analysis shows that safety hazards and harm in rural general practice are diverse and seem to occur nation-wide. The causes of harm are both individual and system safety hazards such as frequent use of locum GPs, lack of continuity of care, long distances and high workload. Patients, health care personnel, and the Norwegian Board of Health Supervision (NBHS) are aware of this. Harming patients in rural areas is likely to continue. However, health care workers and patients both help to reduce risks through an awareness of potential safety hazards, the use of local contextual knowledge and confronting errors, especially those made by locum GPs. The method of risk reduction used by the NBHS is system-based by taking disciplinary action against individual doctors based on individual behaviour. Incentives and initiatives from local and national health care leaders to address the safety issues mentioned here and develop safer health care are needed. Greater insight into patient safety in general practice can be revealed through future qualitative, quantitative and mixed-methods studies.Utrygg medisinsk praksis som skader pasienter, forekommer daglig i allmennpraksis. Helsetjenesten i distrikt er påvirket av store reiseavstander for pasientene til legekontoret, og til spesialisthelsetjenesten på sykehus. Lite er imidlertid kjent om pasientsikkerheten ved slike legekontor i distrikt. Vi intervjuet pasienter, og deretter fastleger og helsepersonell som alle bor og jobber i distrikt. Vi har undersøkt deres erfaringer med uheldige hendelser, utrygg medisinsk praksis, pasientskader og lav kvalitet på helseomsorgen. Vi har også gjort en kvantitativ analyse av administrative reaksjoner gitt norske leger mellom 2011-2018. Doktorgraden baserer seg på en mixed-methods tilnærming til disse resultatene. Uheldige hendelser og utrygg medisinsk praksis ved distriktslegekontor er varierte og forekommer antakelig over hele landet. Hyppig bruk av vikarleger, manglende kontinuitet, lang reiseavstand og høy arbeidsbelastning er alle mulige risikofaktorer. Basert på indikasjoner fra trendanalysene, vil skade av pasienter på legekontor i distrikt sannsynligvis fortsette å skje i fremtiden. Flere insentiver og initiativ fra lokale og nasjonale myndigheter trengs for å bedre pasientsikkerheten. Gjennom kvalitativ, kvantitativ og mixed-methods forskning kan man øke forståelsen og bedre kunnskapen om pasientsikkerhet på legekontor i distrikt

Insiders\u27 Guide to the Student Academic Conference: 11th Annual SAC

Minnesota State University Moorhead Student Academic Conference abstract book

The aesthetics and architecture of care environments : a Q methodological study of ten care environments in Japan and the European countries of Finland, Sweden, the UK, France and Austria

This study explores the aesthetic dimensions of the care environment as experienced by the users and stakeholders of ten case studies in Japan and the European countries of Finland, Sweden, the UK, France and Austria. The evaluation of the built environment in a comprehensive manner is both challenging and topical. The surrounding environment influences us in a multitude of ways and healthcare buildings, in particular, are complicated and their effects on the users difficult to estimate. To overcome these problems the study applies experimental Q methodology for this context in search of a new way of evaluating care environments. The aims are to increase our understanding of care environment aesthetics and architecture, and thus contribute to the design of future care buildings that fulfil the values and expectations of the users. In previous research, first-hand user experiences have been overlooked in favour of comparing medical reports, survey questionnaires or environmental features, thereby leaving many of the underlying reasons unaccounted for. The aesthetic is often reduced to the appearance of things, assessed by random respondents reacting to photographs. This study instead approaches the aesthetics of care environments in a holistic manner, founded in the multisensory experience of architecture, and affected by contextual, social and functional considerations. The study compares different types of healthcare buildings; hospitals, clinics, rehabilitation centres and facilities for the elderly, by asking users and stakeholders to react to their actual environment. Differences are explored in the aesthetic definitions and solutions of the different building types, the cultural contexts and the user groups. In a broader sense, the study touches on the role of care environment aesthetics in users’ perceptions of wellbeing and quality of life. To operationalize this framework, a Q methodological study was conducted on ten case studies in Japan and five European countries. Q methodology is a qualitative method used for systematically analysing human subjectivity. In accordance with Q methodology, I invited 45 respondents – including patients and residents, family members and visitors, care staff, administration and architects – to arrange a set of 48 statements describing the aesthetic features of the care environment on a scale of preference. These preferences were statistically analysed, identifying five aesthetic discourses: the ‘putting patients first’ (ADI), the Nightingale discourse (ADII), the nature – wellbeing – personalization (ADIII), the ‘my home is my castle’ (ADIV) and the rational wayfinding system (ADV). The findings show that although some aesthetic values and solutions stem from building type specific and cultural considerations and that they reflect users’ and stakeholders’ backgrounds, there also exist shared aesthetic values that transcend the specific. A set of consensus statements was uncovered revealing aesthetic preferences shared by all discourses. As a synthesis, best-practice features are put forward as lessons learnt from the case studies. In the future, reconciliation between the various aesthetic discourses is called for in order to respect the values of all stakeholders and users

The Impact of the COVID-19 Emergency on the Quality of Life of the General Population

COVID-19 is a pandemic that has forced many states to declare restrictive measures in order to prevent its wider spread. These measures are necessary to protect the health of adults, children, and people with disabilities. Long quarantine periods could cause an increase in anxiety crises, fear of contagion, and post-traumatic stress disorder (frustration, boredom, isolation, fear, insomnia, difficulty concentrating). Post-traumatic stress disorder (PTSD) is a condition that can develop in subjects who have been or have witnessed a traumatic, catastrophic, or violent event, or who have become aware of a traumatic experience that happened to a loved one. In fact, from current cases, it emerges that the prevalence of PTSD varies from 1% to 9% in the general population and can reach 50%–60% in subgroups of subjects exposed to traumas considered particularly serious. PTSD develops as a consequence of one or more physical or psychological traumatic events, such as exposure to natural disasters such as earthquakes, fires, floods, hurricanes, tsunamis; wars, torture, death threats; road accidents, robbery, air accidents; diseases with unfavorable prognoses; complicated or traumatic mourning; physical and sexual abuse and abuse during childhood; victimization and discrimination based on gender, sexual orientation, gender identity. It can also develop following changes in lifestyle habits caused by the COVID-19 epidemic

The Impact of the COVID-19 Emergency on the Quality of Life of the General Population

COVID-19 is a pandemic that has forced many states to declare restrictive measures in order to prevent its wider spread. These measures are necessary to protect the health of adults, children, and people with disabilities.Long quarantine periods could cause an increase in anxiety crises, fear of contagion, and post-traumatic stress disorder (frustration, boredom, isolation, fear, insomnia, and difficulty concentrating).Post-traumatic stress disorder (PTSD) is a condition that can develop in subjects who have witnessed a traumatic, catastrophic, or violent event, or who have become aware of a traumatic experience that happened to a loved one.In fact, from current cases, it emerges that the prevalence of PTSD varies from 1% to 9% in the general population and can reach 50%–60% in subgroups of subjects exposed to traumas considered particularly serious. PTSD develops as a consequence of one or more physical or psychological traumatic events, such as exposure to natural disasters such as earthquakes, fires, floods, hurricanes, tsunamis; wars, torture, death threats; road accidents, robbery, air accidents; diseases with unfavorable prognoses; complicated or traumatic mourning; physical and sexual abuse and abuse during childhood; or victimization and discrimination based on gender, sexual orientation, or gender identity. It can also develop following changes in lifestyle habits caused by the COVID-19 epidemic.Thank you for reading the manuscripts in this Special Issue, "The Impact of the COVID-19 Emergency on the Quality of Life of the General Population"

Redistributing Care Work for Gender Equality and Justice – a Training Curriculum

People contribute to the economy through their work in many different ways; such as small-scale trading in the local market or as casual labourers in commercial farms. Others are factory workers, miners, teachers, and domestic workers etc. Through their work women and men contribute to the productive economy by producing goods and services that people use every day. It is this work that is counted and measured by governments. Yet, the work of social reproduction – which refers to the activities needed to ensure the reproduction of the labour force – is not counted. Social reproduction includes activities such as child bearing, rearing, and caring for household members (such as children, the elderly and workers). These tasks are completed mostly by women and girls and support all the activities in the productive economy. Unpaid care work is a component of social reproduction relating specifically to all the activities that go towards caring for people within a household or community. This work is not paid, requires time and energy, and is done out of social obligation and/or love and affection. However, this is an essential component of the economy – care work sustains all other human activity. We know that care is critical in our lives – it has a widespread, long term, positive impact on well-being and development. However, prevalent gender norms – the ways in which women and men are expected to behave – and class inequalities lead to an imbalance in care work with women and girls living in poverty taking on a far greater share of unpaid and paid care work under difficult working conditions.UK Department for International Developmen

Emotion and Stress Recognition Related Sensors and Machine Learning Technologies

This book includes impactful chapters which present scientific concepts, frameworks, architectures and ideas on sensing technologies and machine learning techniques. These are relevant in tackling the following challenges: (i) the field readiness and use of intrusive sensor systems and devices for capturing biosignals, including EEG sensor systems, ECG sensor systems and electrodermal activity sensor systems; (ii) the quality assessment and management of sensor data; (iii) data preprocessing, noise filtering and calibration concepts for biosignals; (iv) the field readiness and use of nonintrusive sensor technologies, including visual sensors, acoustic sensors, vibration sensors and piezoelectric sensors; (v) emotion recognition using mobile phones and smartwatches; (vi) body area sensor networks for emotion and stress studies; (vii) the use of experimental datasets in emotion recognition, including dataset generation principles and concepts, quality insurance and emotion elicitation material and concepts; (viii) machine learning techniques for robust emotion recognition, including graphical models, neural network methods, deep learning methods, statistical learning and multivariate empirical mode decomposition; (ix) subject-independent emotion and stress recognition concepts and systems, including facial expression-based systems, speech-based systems, EEG-based systems, ECG-based systems, electrodermal activity-based systems, multimodal recognition systems and sensor fusion concepts and (x) emotion and stress estimation and forecasting from a nonlinear dynamical system perspective