Behaviors That Eliminate Health Disparities for Racial and Ethnic Minorities: A Narrative Systematic Review

Within the health care provider-health care recipient relationship the communication must be culturally competent to eliminate barriers to equitable health care for all Americans. This assertion has conceptual grounding in Public Law 106-129 (the Health Care Research and Quality Act of 1999) and Public Law 106-525 (the Minority Health and Health Disparities Research and Education Act of 2000). This narrative systematic review examines this assertion by using selection and exclusion criteria to gather interventions, assessments, and testimonies conducted from 2000-2007. Reports that were not eliminated via these criteria were analyzed to determine the effect of specific practices that were undertaken in interventions, assessments, and testimonies. Which practices does research propose as indispensable to efforts to eliminate health disparities for racial and ethnic minority health care recipients? Findings indicate that culturally competent behaviors by providers and recipients promote effective intercultural communication that eliminates health care disparities, and removes obstacles to care

Labour Management for Profit and Welfare in Extensive Sheep Farming

Sheep welfare is an emerging topic in research and food marketing, and recent studies suggest that farm labour is a key factor for both animal welfare and productivity in extensive sheep farming systems, although little research has been done into labour utilisation in these systems. This paper reports field data collection on two commercial farms and the use of a linear programming (LP) model to link labour economics and animal welfare analysis. The model maximises the number of ewes to clooked after over the lambing period, when constrained by labour availability for various key tasks and by a pre-determined level of sheep welfare. The results show a trade-off between welfare level and labour input per sheep. Dropping tasks with less significant welfare and productivity consequences is an effective way of increasing carrying capacity (from 977 ewes/shepherd to 1428), as is working longer hours (1174 ewes/shepherd) or only doing the legal minimum of welfare checking (labour reduced from 0.68 min/ewe to 0.44 min/ewe) . The field data suggest that farmers currently provide high welfare, and that, despite much time spent away from the flock (e.g. driving), they spend a large amount of time (39% of total) with their sheep.Labour, Sheep, Linear Programming, Animal Welfare, Livestock Production/Industries, Q10, Q19, Y1,

Why are Spiritual Aspects of Care so hard to Address in Nursing Education?’ A Literature Review (1993-2015)

Difficulties persist in conceptualising spiritual needs and understanding their relationship to religious needs and relevance to wellbeing. This review was undertaken to clarify some of these issues. It set out to establish what is already known about how issues of spiritual assessment and care are addressed in undergraduate nursing education. Using a systematic approach, a literature review covering the period 1993-2015 was undertaken. Reviewed materials were collected from mainly online sources including with searches conducted using CINHAL, SUMMON and PubMed databases, after defining keywords and inclusion and exclusion criteria. The study found that Spirituality appears to be a broad but useful category which is concerned with how people experience meaning and purpose in their lives. However, it also established that here are relatively few studies focused on how spiritual care competencies could be developed in nursing students. There is also little work exploring nursing educators’ perspectives and experiences about how to develop spiritual competencies in their students. The study concludes that further research is necessary in order to bridge the gap between aspirations and practice

A multilevel neo-institutional analysis of infection prevention and control in English hospitals: coerced safety culture change?

Despite committed policy, regulative and professional efforts on healthcare safety, little is known about how such macro-interventions permeate organisations and shape culture over time. Informed by neo-institutional theory, we examined how inter-organisational influences shaped safety practices and inter-subjective meanings following efforts for coerced culture change. We traced macro-influences from 2000 to 2015 in infection prevention and control (IPC). Safety perceptions and meanings were inductively analysed from 130 in-depth qualitative interviews with senior- and middle-level managers from 30 English hospitals. A total of 869 institutional interventions were identified; 69% had a regulative component. In this context of forced implementation of safety practices, staff experienced inherent tensions concerning the scope of safety, their ability to be open and prioritisation of external mandates over local need. These tensions stemmed from conflicts among three co-existing institutional logics prevalent in the NHS. In response to requests for change, staff flexibly drew from a repertoire of cognitive, material and symbolic resources within and outside their organisations. They crafted 'strategies of action', guided by a situated assessment of first-hand practice experiences complementing collective evaluations of interventions such as 'pragmatic', 'sensible' and also 'legitimate'. Macro-institutional forces exerted influence either directly on individuals or indirectly by enriching the organisational cultural repertoire

Transitions at the end of life for older adults - patient, carer and professional perspectives

BackgroundThe end of life may be a time of high service utilisation for older adults. Transitions between care settings occur frequently, but may produce little improvement in symptom control or quality of life for patients. Ensuring that patients experience co-ordinated care, and moves occur because of individual needs rather than system imperatives, is crucial to patients’ well-being and to containing health-care costs.ObjectiveThe aim of this study was to understand the experiences, influences and consequences of transitions between settings for older adults at the end of life. Three conditions were the focus of study, chosen to represent differing disease trajectories.SettingEngland.ParticipantsThirty patients aged over 75 years, in their last year of life, diagnosed with heart failure, lung cancer and stroke; 118 caregivers of decedents aged 66–98 years, who had died with heart failure, lung cancer, stroke, chronic obstructive pulmonary disease or selected other cancers; and 43 providers and commissioners of services in primary care, hospital, hospice, social care and ambulance services.Design and methodsThis was a mixed-methods study, composed of four parts: (1) in-depth interviews with older adults; (2) qualitative interviews and structured questionnaire with bereaved carers of older adult decedents; (3) telephone interviews with care commissioners and providers using case scenarios derived from the interviews with carers; and (4) analysis of linked Hospital Episode Statistics (HES) and mortality data relating to hospital admissions for heart failure and lung cancer in England 2001–10.ResultsTransitions between care settings in the last year of life were a common component of end-of-life care across all the data sets that made up this study, and many moves were made shortly before death. Patients’ and carers’ experiences of transitions were of a disjointed system in which organisational processes were prioritised over individual needs. In many cases, the family carer was the co-ordinator and provider of care at home, excluded from participation in institutional care but lacking the information and support to extend their role with confidence. The general practitioner (GP) was a valued, central figure in end-of-life care across settings, though other disciplines were critical of GPs’ expertise and adherence to guidelines. Out-of-hours services and care homes were identified by many as contributors to unnecessary transitions. Good relationships and communication between professionals in different settings and sectors was recognised by families as one of the most important influences on transitions but this was rarely acknowledged by staff.ConclusionsDevelopment of a shared understanding of professional and carer roles in end-of-life transitions may be one of the most effective ways of improving patients’ experiences. Patients and carers manage many aspects of end-of-life care for themselves. Identifying ways to extend their skills and strengthen their voices, particularly in hospital settings, would be welcomed and may reduce unnecessary end-of-life transitions. Why the experiences of carers appear to have changed little, despite the implementation of a range of relevant policies, is an important question that has not been answered. Recommendations for future research include the relationship between policy interventions and the experiences of end-of-life carers; identification of ways to harmonise understanding of the carers’ role and strengthen their voice, particularly in hospital settings; identification of ways to reduce the influence of interprofessional tensions in end-of-life care; and development of interventions to enhance patients’ experiences across transitions.FundingThe National Institute for Health Research Health Services and Delivery Research programme

THE SURVEY OF THE BARRIERS TO NOT REPORTING MEDICATION ERRORS FROM THE PERSPECTIVE OF NURSING STUDENTS

ABSTRACTObjective: Reporting the medication errors, on the one hand, causes the preservation and observation of the patient security, and on the other hand,it is regarded as a valuable information treasure in line with the prevention of the medication errors expression in the future. Therefore, the presentstudy has been conducted with the objective of the survey of barriers to medication errors reporting from the perspective of the nursing students.Methods: This study is a descriptive research which has been conducted on 87 nursing students who have been selected based on a random method. Togather the required information, there has been made use of a two-part questionnaire, the first part of which deals with the study of the demographiccharacteristics and the second part pertains to the factors influencing not reporting the medication errors. In the end, after the necessary informationcollected the data were analyzed by taking advantage of SPSS 19 and descriptive statistics.Results: The individuals average age in the present study was 21.09±2.48, 51 individuals were female. 24 individuals were studied in semester4, 31 people were passing term 6, and 32 individuals were in term 8. The highest mean score as obtained in managerial aspect. In addition, the highestmean score was related to the items concentration of the managers solely on the person who has made the mistake and disregarding of the otherfactors involved in mediation error†and lack of receiving a positive feedback from the nursing supervisors following reporting the medication errorâ€and the lowest mean score was related to the item not being considerate to some of the medication errors reporting.â€Conclusion: The results of this study indicated that the highest mean score for not reporting the medication errors went to the managerial dimensions.Therefore, the supervisors and the nursing staff should be cautioned regarding their behavior, regarding the medication errors reporting, and considerthe problems and issues systematically.Keywords: Medication error, University students, Zahedan, Nursing

Using Existing Response Repertoires to Make Sense of Information System Implementation

The implementation of information systems (IS) in organizations often triggers new situations in which users experience a disruption of existing work patterns and routines. Sensemaking becomes central in making users’ meanings explicit, serving as a foundation for further actions and interactions with the new technology. The purpose of this paper is to study how users make sense of new technologies by building on existing response repertoires. Empirically, we present findings from a study of an Electronic Patient Record (EPR) system implementation in two Danish hospital wards. Our findings illustrate: (1) how doctors’ and nurses’ existing routines are disrupted by the new technology, (2) how identity construction plays an important part in the users’ meaning construction process, and (3) how self-fulfilling prophecies are formed as a natural part of their sensemaking. The study contributes to existing literature by providing a detailed account of how users’ early sensemaking of a technology influences their subsequent actions and reactions towards it. Our findings support managers in understanding users’ perceptions of a new technology, helping them in planning and executing the implementation process

Health care service delivery and infant feeding practices in KwaZulu-Natal, South Africa: results from a cross-sectional survey at 14 weeks of age

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