Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days.</p> <p>Methods</p> <p>The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation.</p> <p>Results</p> <p>The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators.</p> <p>Conclusions</p> <p>The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.</p

A fundamental, national, medical disaster management plan : an education-based model

During disasters, especially earthquakes, health systems are expected to play an essential role in reducing mortality and morbidity. The most significant naturally occurring disaster in Iran is earthquakes; they have killed >180,000 people in the last 90 years. According to the current plan in 2007, the disaster management system of Iran is composed of three main work groups: (1) Prevention and risk management, (2) Education, and (3) Operation. This organizational separation has resulted in lack of necessary training programs for experts of specialized organizations, e.g., the Ministry of Health and Medical Education (MOHME). The National Board of MOHME arranged a training program in the field of medical disaster management. A qualified training team was chosen to conduct this program in each collaborating center, based on a predefined schedule. All collaborating centers were asked to recall 5–7 experts from each member university. Working in medical disaster management field for ≥2 years was an inclusion criterion. The training programs lasted three days, consisted of all relevant aspects of medical disaster management, and were conducted over a six-month period (November 2007–April 2008). Pretest and post-tests were used to examine the participants’ knowledge regarding disaster management; the mean score on the pre-test was 67.1 ±11.6 and 88.1 ±6.2, respectively. All participants were asked to hold the same training course for their organizations in order to enhance knowledge of related managers, stakeholders, and workers, and build capacity at the local and provincial levels. The next step was supposed to be developing a comprehensive medical disaster management plan in the entire country. Establishing nine disaster management regional collaborating centers in the health system of Iran has provided an appropriate base for related programs to be rapidly and easily accomplished throughout the country. This tree-shaped model is recommended as a cost-benefit and rapid approach for conducting training programs and developing a disaster management plan in the health system of a developing countryNonePublishe

Tactile massage and hypnosis as a health promotion for nurses in emergency care-a qualitative study

<p>Abstract</p> <p>Background</p> <p>This study explores nursing personnel's experiences and perceptions of receiving tactile massage and hypnosis during a personnel health promotion project. Nursing in a short term emergency ward environment can be emotionally and physically exhausting due to the stressful work environment and the high dependency patient care. A health promotion project integrating tactile massage and hypnosis with conventional physical activities was therefore introduced for nursing personnel working in this setting at a large university hospital in Sweden.</p> <p>Methods</p> <p>Four semi-structured focus group discussions were conducted with volunteer nursing personnel participants after the health promotion project had been completed. There were 16 participants in the focus groups and there were 57 in the health promotion intervention. The discussions were transcribed verbatim and analysed with qualitative content analysis.</p> <p>Results</p> <p>The findings indicated that tactile massage and hypnosis may contribute to reduced levels of stress and pain and increase work ability for some nursing personnel. The sense of well-being obtained in relation to health promotion intervention with tactile massage and hypnosis seemed to have positive implications for both work and leisure. Self-awareness, contentment and self-control may be contributing factors related to engaging in tactile massage and hypnosis that might help nursing personnel understand their patients and colleagues and helped them deal with difficult situations that occurred during their working hours.</p> <p>Conclusion</p> <p>The findings indicate that the integration of tactile massage and hypnosis in personnel health promotion may be valuable stress management options in addition to conventional physical activities.</p

Programme Re-Configuration : Hospital Buildings, Internal and External Workflow Conditions, and Communicatory Benefits

Healthcare buildings are of great specific and general interest for architectural research as they are decidedly spatial at the same time as they are highly programmed, a type of architecture that has consistently challenged research to find clear relations between design solutions and performance or use. This paper argues that one of the main problems of finding consistent relations between workflow, organization, and spatial configurations valuable for the design of healthcare environments lies in that programmes and activities studied have been described from an organizational point of view rather than a spatial, and have been studied as efficiency machines. This paper attempts to begin a shift towards a more complex, if still ordered, approach. The line of argument is meant to be supportive in the programmatic and early planning stages, focused on how space and working conditions facilitate workflow for and communication between different personnel groups. It is proposed that of vital importance for such an understanding is the dual relations of primary (‘functional’) and secondary (‘informational’, ‘communicative’) benefits of programme configuration and distribution, as well as internal and external conditions of workflow – where the latter can be seen as a difference between conditions inherent in activities themselves and conditions produced by technical, organizational, practical, or other means that affect them. These benefits and conditions are rather studied as tensions where on one hand priorities need to be made between benefits, and on the other hand material conditions of architectural design force choices to be made on distribution and configuration of programme. This discussion is supported by empirical data gathered through interviews and observations from a research project of Karolinska University Hospital in Huddinge, south of Stockholm, where several hospital units have been studied to allow a continuously refined understanding of workflow and its spatial conditions in consecutive iterations.The fulltext provided is the same as the conference proceedings/website. Please see the included link for further details. Reference the paper as:Koch, Daniel, Steen, Jesper, AND Öhlén, Gunnar. "Programme Re-Configuration: Hospital Buildings, Internal and External Workflow Conditions, and Communicatory Benefits" ARCH 2012. Available at: http://conferences.chalmers.se/index.php/ARCH/arch12/paper/view/440.The conference website offers further information / formats for referencing. Please see the link to full proceedings.QC 20130114</p

The key actor: a qualitative study of patient participation in the handover process in Europe

Contains fulltext : 109871.pdf (publisher's version ) (Open Access

Effectiveness of integrated person-centered interventions for older people's care : Review of Swedish experiences and experts' perspective

Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field