TRANSALUD : A qualitative study of the healthcare experiences of transgender people in Barcelona (Spain)

Transgender identities are still considered a psychiatric pathology in many countries according to the prevailing biomedical model. However, in recent years, this pathologizing vision has begun to shift towards a perspective that focuses on the diversity of transgender peoples' experiences. However, some transgender people still face denial of services, discrimination, harassment, and even violence by healthcare professionals, causing them to avoid seeking ongoing or preventive healthcare. This article describes the health experiences of transgender people in Barcelona regarding their access and use of non-specialized health services. Semi-structured interviews were conducted using a descriptive phenomenological approach with sixteen transgender people between December 2018 and July 2019. The data were analyzed descriptively and thematically following the method proposed by Colaizzi with the help of the Atlas.ti8 software. Transgender people care experiences were divided into three categories: overcoming obstacles, training queries, and coping strategies. Participants identified negative experiences and difficulties with the health system due to healthcare providers' lack of competence. Discriminatory, authoritarian, and paternalist behaviors are still present and hinder the therapeutic relationship, care, and access to healthcare services. There is a fundamental need for the depathologization of transgender reality and training for healthcare professionals in the field of sexual diversity. Training in sexual and gender diversity must be included in the curricula of university courses in the health sciences

Sexuality in people living with a serious mental illness: a meta‐synthesis of qualitative evidence

Introduction: Sexuality-related nursing care is scarce and mainly focuses on biological issues. There is also a lack of knowledge about how serious mental illnesses affect sexuality.Aim: To explain how people with a serious mental illness perceive and experience their sexuality. Method: A meta-synthesis was conducted to integrate qualitative studies. Four databases were used to perform the search, focused in the last ten years. Nine articles were included, and their results analysed thematically. Results: Four categories were identified: 'Pathologized sexuality', which explains how the disorder and treatment affect sexuality; 'Not my sexuality anymore", which describes feelings emerging from the perceived limitations and the role of selfacceptance; "Learning to manage intimate relationships", which explains the desire to establish intimate personal relationships and define their meaning; and 'Reconstructing my sexuality', which elucidates the influence of the environment on sexuality. Discussion: Sexuality is influenced by several factors, the main ones being: the clinical complications, the side effects of drug treatment, the social support, the relationship with the health sector, and stigma. Implications for Practice: Having a serious mental illness affects sexuality and can provoke suffering and social isolation. Mental health services should address this issue and carry out community interventions to reduce stigma. RELEVANCE STATEMENT: This study shows that having a serious mental illness affects sexuality and can provoke suffering and social isolation. Also, people living with a serious mental illness have not lost interest in maintaining an active sex life and, therefore, mental health services must respond to this need. Nurses can develop their role as health educators and should receive training on affective and sexual education to allow them to advise on options to develop the sexual dimension of these people. Additionally, mental health services should address this issue and carry out community interventions to reduce stigma

Sexuality in people living with a serious mental illness: A meta-synthesis of qualitative evidence

"Introduction: Sexuality-related nursing care is scarce and mainly focuses on biological issues. There is also a lack of knowledge about how serious mental illnesses affect sexuality. Aim: To explain how people with a serious mental illness perceive and experience their sexuality Method: A meta-synthesis was conducted to integrate qualitative studies. Four databases were used to perform the search, focused in the last ten years. Nine articles were included, and their results analysed thematically. Results: Four categories were identified: ""Pathologized sexuality,"" which explains how the disorder and treatment affect sexuality; ""Not my sexuality anymore,” which describes feelings emerging from the perceived limitations and the role of self-acceptance; “Learning to manage intimate relationships,” which explains the desire to establish intimate personal relationships and define their meaning; and ""Reconstructing my sexuality,"" which elucidates the influence of the environment on sexuality. Discussion: Sexuality is influenced by several factors, the main ones being: the clinical complications, the side effects of drug treatment, the social support, the relationship with the health sector and stigma. Implications for practice: Having a serious mental illness affects sexuality and can provoke suffering and social isolation. Mental health services should address this issue and carry out community interventions to reduce stigma.

Cultura de seguretat del pacient en la pràctica infermera a Europa

Els efectes adversos com a conseqüència de l'atenció sanitària estan presents en els països desenvolupats. L'estudi de la cultura de seguretat del pacient a les institucions sanitàries és un punt de partida per implementar estratègies de millora. Malgrat que la recerca quantitativa en aquest àmbit ha estat creixent en els últims anys, l’evidència qualitativa és limitada. Els experts en cultura de seguretat suggereixen l’aplicació d’enfocaments de mètodes mixtes que permetin l’estudi en profunditat en aquesta matèria. Objectiu: Comparar la cultura de seguretat del pacient en l’àmbit hospitalari i determinar el nivell de maduresa cultural des de la perspectiva infermera entre quatre països de la Unió Europea amb una inversió en sanitat per càpita diferenciada: Suècia, Espanya, Hongria i Croàcia. Metodologia: Mixta, disseny de triangulació concurrent. La població d’estudi va estar constituïda per professionals d’infermeria de les unitats de Medicina Interna, Cirurgia General i Urgències de dos hospitals regionals i públics de cada país participant. Les dades quantitatives (n = 538) es van obtenir a través del qüestionari validat en tots els països “Hospital Survey on Patient Safety Culture” (HSOPSC), compost per 12 dimensions. Es van realitzar un total de 24 entrevistes en profunditat i 147 hores d’observació no participant en les unitats d’estudi entre tots els països participants. Resultats: La percepció global del grau de seguretat es va considerar bona a Suècia i acceptable en la resta de països. Les dades qualitatives indicaven diferències notables entre Espanya, respecte a Hongria i Croàcia. El treball en equip va ser la dimensió més ben valorada en tots els països excepte a Croàcia. Les dades qualitatives no sempre evidenciaven suport, respecte i treball en equip a les unitats d’Hongria i Croàcia. En tots els països, es va considerar la dotació de personal com a oportunitat de millora tot i que les ràtios infermera pacient eren superiors a Suècia, seguit d’Espanya, Hongria i Croàcia. Conclusions: La metodologia mixta ha permès identificar diferències en la cultura de seguretat del pacient des de la perspectiva infermera entre països de la Unió Europea amb diferent despesa sanitària per càpita. Hi ha una correlació positiva entre la despesa sanitària i el nivell de maduresa de cultura de seguretat de les infermeres a Suècia i Espanya. Hongria i Croàcia presenten característiques similars, indicant de forma global un nivell més baix de maduresa cultural de seguretat.Adverse effects as a consequence of healthcare provision are present in developed countries. The study of patient safety culture in healthcare institutions is a starting point for implementing strategies of improvement. Quantitative research in this field has increased in recent years but qualitative evidence is limited. Experts in safety culture propose the application of mixed methods approaches in order to achieve a deeper understanding in the subject. Objective: To compare the culture of patient safety in hospital settings and to determine the cultural maturity level from the nurse perspective between four countries of the European Union: Sweden, Spain, Hungary and Croatia. Methodology: Mixed methods, concurrent triangulation design. The study population was formed by nursing professionals from the Internal Medicine, Surgical and Emergency departments of two public regional hospitals in each participating country. Quantitative data (n = 538) was obtained through the questionnaire "Hospital Survey on Patient Safety Culture" (HSOPSC), composed of 12 dimensions and validated in all the participating countries. A total of 24 in-depth interviews and 147 hours of non-participating observation were conducted among all the participating countries. Results: The overall perception of safety was considered good in Sweden and acceptable in the other countries. The qualitative data indicated notable differences between Spain, compared to Hungary and Croatia. Teamwork was the most valued dimension in all countries except Croatia. The qualitative data did not always evidence support, respect and teamwork in the units of Hungary and Croatia. In all countries, staffing was considered an opportunity for improvement, although patient nurse ratios were higher in Sweden, followed by Spain, Hungary and Croatia. Conclusions: The mixed methods methodology allowed to identify differences in the culture of patient safety from the nurse perspective between countries of the European Union with different health expenditure per capita. There is a positive correlation between health spending and the level of safety culture maturity of the nurses in Sweden and Spain. Hungary and Croatia have similar characteristics, indicating globally a lower level of cultural maturity

Cultura de seguretat del pacient en la pràctica infermera a Europa

Els efectes adversos com a conseqüència de l'atenció sanitària estan presents en els països desenvolupats. L'estudi de la cultura de seguretat del pacient a les institucions sanitàries és un punt de partida per implementar estratègies de millora. Malgrat que la recerca quantitativa en aquest àmbit ha estat creixent en els últims anys, l’evidència qualitativa és limitada. Els experts en cultura de seguretat suggereixen l’aplicació d’enfocaments de mètodes mixtes que permetin l’estudi en profunditat en aquesta matèria. Objectiu: Comparar la cultura de seguretat del pacient en l’àmbit hospitalari i determinar el nivell de maduresa cultural des de la perspectiva infermera entre quatre països de la Unió Europea amb una inversió en sanitat per càpita diferenciada: Suècia, Espanya, Hongria i Croàcia. Metodologia: Mixta, disseny de triangulació concurrent. La població d’estudi va estar constituïda per professionals d’infermeria de les unitats de Medicina Interna, Cirurgia General i Urgències de dos hospitals regionals i públics de cada país participant. Les dades quantitatives (n = 538) es van obtenir a través del qüestionari validat en tots els països “Hospital Survey on Patient Safety Culture” (HSOPSC), compost per 12 dimensions. Es van realitzar un total de 24 entrevistes en profunditat i 147 hores d’observació no participant en les unitats d’estudi entre tots els països participants. Resultats: La percepció global del grau de seguretat es va considerar bona a Suècia i acceptable en la resta de països. Les dades qualitatives indicaven diferències notables entre Espanya, respecte a Hongria i Croàcia. El treball en equip va ser la dimensió més ben valorada en tots els països excepte a Croàcia. Les dades qualitatives no sempre evidenciaven suport, respecte i treball en equip a les unitats d’Hongria i Croàcia. En tots els països, es va considerar la dotació de personal com a oportunitat de millora tot i que les ràtios infermera pacient eren superiors a Suècia, seguit d’Espanya, Hongria i Croàcia. Conclusions: La metodologia mixta ha permès identificar diferències en la cultura de seguretat del pacient des de la perspectiva infermera entre països de la Unió Europea amb diferent despesa sanitària per càpita. Hi ha una correlació positiva entre la despesa sanitària i el nivell de maduresa de cultura de seguretat de les infermeres a Suècia i Espanya. Hongria i Croàcia presenten característiques similars, indicant de forma global un nivell més baix de maduresa cultural de seguretat.Adverse effects as a consequence of healthcare provision are present in developed countries. The study of patient safety culture in healthcare institutions is a starting point for implementing strategies of improvement. Quantitative research in this field has increased in recent years but qualitative evidence is limited. Experts in safety culture propose the application of mixed methods approaches in order to achieve a deeper understanding in the subject. Objective: To compare the culture of patient safety in hospital settings and to determine the cultural maturity level from the nurse perspective between four countries of the European Union: Sweden, Spain, Hungary and Croatia. Methodology: Mixed methods, concurrent triangulation design. The study population was formed by nursing professionals from the Internal Medicine, Surgical and Emergency departments of two public regional hospitals in each participating country. Quantitative data (n = 538) was obtained through the questionnaire "Hospital Survey on Patient Safety Culture" (HSOPSC), composed of 12 dimensions and validated in all the participating countries. A total of 24 in-depth interviews and 147 hours of non-participating observation were conducted among all the participating countries. Results: The overall perception of safety was considered good in Sweden and acceptable in the other countries. The qualitative data indicated notable differences between Spain, compared to Hungary and Croatia. Teamwork was the most valued dimension in all countries except Croatia. The qualitative data did not always evidence support, respect and teamwork in the units of Hungary and Croatia. In all countries, staffing was considered an opportunity for improvement, although patient nurse ratios were higher in Sweden, followed by Spain, Hungary and Croatia. Conclusions: The mixed methods methodology allowed to identify differences in the culture of patient safety from the nurse perspective between countries of the European Union with different health expenditure per capita. There is a positive correlation between health spending and the level of safety culture maturity of the nurses in Sweden and Spain. Hungary and Croatia have similar characteristics, indicating globally a lower level of cultural maturity

Cultura de seguretat del pacient en la pràctica infermera a Europa = : Patient safety culture en nursing practice in europe

Els efectes adversos com a conseqüència de l'atenció sanitària estan presents en els països desenvolupats. L'estudi de la cultura de seguretat del pacient a les institucions sanitàries és un punt de partida per implementar estratègies de millora. Malgrat que la recerca quantitativa en aquest àmbit ha estat creixent en els últims anys, l'evidència qualitativa és limitada. Els experts en cultura de seguretat suggereixen l'aplicació d'enfocaments de mètodes mixtes que permetin l'estudi en profunditat en aquesta matèria. Objectiu: Comparar la cultura de seguretat del pacient en l'àmbit hospitalari i determinar el nivell de maduresa cultural des de la perspectiva infermera entre quatre països de la Unió Europea amb una inversió en sanitat per càpita diferenciada: Suècia, Espanya, Hongria i Croàcia. Metodologia: Mixta, disseny de triangulació concurrent. La població d'estudi va estar constituïda per professionals d'infermeria de les unitats de Medicina Interna, Cirurgia General i Urgències de dos hospitals regionals i públics de cada país participant. Les dades quantitatives (n = 538) es van obtenir a través del qüestionari validat en tots els països "Hospital Survey on Patient Safety Culture" (HSOPSC), compost per 12 dimensions. Es van realitzar un total de 24 entrevistes en profunditat i 147 hores d'observació no participant en les unitats d'estudi entre tots els països participants. Resultats: La percepció global del grau de seguretat es va considerar bona a Suècia i acceptable en la resta de països. Les dades qualitatives indicaven diferències notables entre Espanya, respecte a Hongria i Croàcia. El treball en equip va ser la dimensió més ben valorada en tots els països excepte a Croàcia. Les dades qualitatives no sempre evidenciaven suport, respecte i treball en equip a les unitats d'Hongria i Croàcia. En tots els països, es va considerar la dotació de personal com a oportunitat de millora tot i que les ràtios infermera pacient eren superiors a Suècia, seguit d'Espanya, Hongria i Croàcia. Conclusions: La metodologia mixta ha permès identificar diferències en la cultura de seguretat del pacient des de la perspectiva infermera entre països de la Unió Europea amb diferent despesa sanitària per càpita. Hi ha una correlació positiva entre la despesa sanitària i el nivell de maduresa de cultura de seguretat de les infermeres a Suècia i Espanya. Hongria i Croàcia presenten característiques similars, indicant de forma global un nivell més baix de maduresa cultural de seguretat.Adverse effects as a consequence of healthcare provision are present in developed countries. The study of patient safety culture in healthcare institutions is a starting point for implementing strategies of improvement. Quantitative research in this field has increased in recent years but qualitative evidence is limited. Experts in safety culture propose the application of mixed methods approaches in order to achieve a deeper understanding in the subject. Objective: To compare the culture of patient safety in hospital settings and to determine the cultural maturity level from the nurse perspective between four countries of the European Union: Sweden, Spain, Hungary and Croatia. Methodology: Mixed methods, concurrent triangulation design. The study population was formed by nursing professionals from the Internal Medicine, Surgical and Emergency departments of two public regional hospitals in each participating country. Quantitative data (n = 538) was obtained through the questionnaire "Hospital Survey on Patient Safety Culture" (HSOPSC), composed of 12 dimensions and validated in all the participating countries. A total of 24 in-depth interviews and 147 hours of non-participating observation were conducted among all the participating countries. Results: The overall perception of safety was considered good in Sweden and acceptable in the other countries. The qualitative data indicated notable differences between Spain, compared to Hungary and Croatia. Teamwork was the most valued dimension in all countries except Croatia. The qualitative data did not always evidence support, respect and teamwork in the units of Hungary and Croatia. In all countries, staffing was considered an opportunity for improvement, although patient nurse ratios were higher in Sweden, followed by Spain, Hungary and Croatia. Conclusions: The mixed methods methodology allowed to identify differences in the culture of patient safety from the nurse perspective between countries of the European Union with different health expenditure per capita. There is a positive correlation between health spending and the level of safety culture maturity of the nurses in Sweden and Spain. Hungary and Croatia have similar characteristics, indicating globally a lower level of cultural maturity

Patient Safety Culture in European Hospitals: A Comparative Mixed Methods Study

Background: Poorly organized health systems with inadequate leadership limit the development of the robust safety cultures capable of preventing consequential adverse events. Although safety culture has been studied in hospitals worldwide, the relationship between clinician perceptions about patient safety and their actual clinical practices has received little attention. Despite the need for mixed methods studies to achieve a deeper understanding of safety culture, there are few studies providing comparisons of hospitals in different countries. Purpose: This study compared the safety culture of hospitals from the perspective of nurses in four European countries, including Croatia, Hungary, Spain, and Sweden. Design: A comparative mixed methods study with a convergent parallel design. Methods: Data collection included a survey, participant interviews, and workplace observations. The sample was nurses working in the internal medicine, surgical, and emergency departments of two public hospitals from each country. Survey data (n = 538) was collected with the Hospital Survey on Patient Safety Culture (HSOPSC) and qualitative date was collected through 24 in-depth interviews and 147 h of non-participant observation. Survey data was analyzed descriptively and inferentially, and content analysis was used to analyze the qualitative data. Results: The overall perception of safety culture for most dimensions was ‘adequate’ in Sweden and ‘adequate’ to ‘poor’ in the other countries with inconsistencies identified between survey and qualitative data. Although teamwork within units was the most positive dimension across countries, the qualitative data did not consistently demonstrate support, respect, and teamwork as normative attributes in Croatia and Hungary. Staffing and workload were identified as major areas for improvement across countries, although the nurse-to-patient ratios were the highest in Sweden, followed by Spain, Hungary, and Croatia. Conclusions: Despite all countries being part of the European Union, most safety culture dimensions require improvement, with few measured as good, and most deemed to be adequate to poor. Dimension level perceptions were at times incongruent across countries, as observed patient safety practices or interview perspectives were inconsistent with a positive safety culture. Differences between countries may be related to national culture or variability in health system structures permitted by the prevailing European Union health policy