Physician Associate and Physician Associate comparable (PA/PA-comparable) professions are classified by the 2012 International Labour Classification of Occupations within ISCO group 2240 paramedical practitioners. However, to date, there is no single global framework which categorizes and/or describes their scopes of practice, or a single unifying occupational group name. In 2022, the World Health Organization (WHO) published its Global Competency and Outcomes Framework for Universal Health Coverage which focuses on the practice activities for health workers with a pre-service training pathway of 12-48 months, thus including many PA/PA-comparable roles. In this study we describe the similarities and differences between the SOP documents for PA/PA-comparable professions with a pre-service pathway of 12-48 months, thus excluding any extra-training and specializations, from 25 countries using the WHO Framework as a frame of reference. SOP documents were collected from 25 countries and mapped to the WHO Framework by 3 independent reviewers. We used descriptive statistics to examine the percent agreement between the WHO Framework and SOP documents by country, as well as the ubiquity of each WHO practice activity across the examined documents. To test the hypothesis that country-specific economic indicators and healthcare workforce metrics may be linked to the presence or absence of specific SOP elements, we utilized Wilkoxon and Fisher Exact tests to examine associations between World Bank economic indicators and country specific healthcare workforce metrics and presence/absence of specific WHO Framework practice activities within each SOP. We identified significant heterogeneity between the WHO practice activities reported in the 25 SOP documents, particularly related to the provision of individual health services. We also identified statistically significant associations between World Bank economic indicators and country specific healthcare workforce metrics and presence/absence of the following seven practice activities relating to Individual Health, Population Health, and Management and Organization practice domains: (1) "Formulating a judgement following a clinical encounter," (2) "Assessing community health needs" (3) "Planning and delivering community health programmes," (4) "Managing public health communication," (5) "Developing preparedness for health emergencies and disasters, including disease outbreaks," (6) "Providing workplace-based learning and supervision," and (7) "Participating in evaluation and research." In each case, presence of the above practice activities was associated with lower health economic and workforce indicators, suggesting that these SOP practice activities are more common in lower income countries and countries with a smaller per-capita health workforce. The WHO practice activities provide an effective framework to catalogue and compare the responsibilities of PA/PA-comparable professions recorded by country specific SOP documents. This approach could also be used to compare different occupational SOPs within a country, as well as SOPs between countries. The authors propose that additional information relating to the types of procedures and the level of supervision or autonomy would enable a more comprehensive comparison of SOPs, going beyond the granularity offered by the WHO framework. At that level, the evaluation could then be used to inform gap analyses for training needs in the context of migration, or to better understand the health team skill mixes across different countries. The study also offers reflections on the importance of clarity of intended meaning within the SOP documents.
Health care professionals' perceptions of telemedicine, its usability, and the presence of organizational barriers are important determinants of the successful implementation of digital solutions in health care. In Kazakhstan, the use of international assessment instruments requires contextual adaptation. The Telehealth Usability Questionnaire-Model for Assessment of Telemedicine-Kazakhstan version (TUQ-MAST-KZ) questionnaire was previously developed and psychometrically validated by integrating elements of the TUQ and MAST frameworks to assess perceptions of telemedicine within the national context. The aim of this study was to conduct the first pilot application of the TUQ-MAST-KZ questionnaire with physicians in Kazakhstan and perform an initial assessment of the organizational, technical, and educational aspects of telemedicine implementation. This cross-sectional study involved an anonymous online survey using the TUQ-MAST-KZ questionnaire, which covers perceptions of telemedicine, formats of use, platform usability, communication-related aspects, telemonitoring, organizational conditions, and implementation barriers. Responses from 156 physicians were analyzed. Stratified nonparametric comparisons were performed by sex, age group, work experience (years), and workplace, adjusted for multiple comparisons. The most used telemedicine formats were telephone consultations (78/156, 50%), video consultations (69/156, 44.2%), chats and messaging applications (57/156, 36.5%), and mobile apps (48/156, 30.8%). The Kazakhstan National Telemedicine Network was used by 14.7% (23/156). Wearable devices were used by 5.8% (9/156). Telemedicine technologies incorporating artificial intelligence elements were used regularly by 13.5% (21/156) and occasionally by 32.1% (50/156) and not used by 50.6% (79/156). Positive ratings were as follows: 48.7% (76/156) regarding the simplicity and intuitiveness of telemedicine platforms; 56.4% (88/156) regarding the timeliness of patient condition monitoring; 51.9% (81/156) regarding the effectiveness of telemedicine for the management of patients with chronic diseases. The potential usefulness of telemonitoring for earlier detection of deterioration of a patient's condition was rated as fairly or very high by 48.7% (76/156); 41% (64/156) rated it as moderate. Only 35.9% (56/156) positively rated the connection's reliability and stability. Regarding the accuracy of wearable device data transmission, 57.1% (89/156) responded neutrally, potentially indicating ambiguity in perception, limited personal experience, or difficulty evaluating this aspect. Readiness to recommend telemonitoring at the national level was more often rated as moderate, high, or very high (78/156, 50%; 42/156, 26.9%; 14/156, 9%, respectively). This pilot application of the TUQ-MAST-KZ questionnaire showed a generally moderately positive perception of telemedicine by physicians, who recognized its potential clinical and organizational value. However, we identified substantial technical and institutional barriers, including connection instability, concerns about the accuracy of data transmission, insufficient process formalization, and a need for additional training. These preliminary findings should be interpreted in light of the pilot study design; however, they may serve to inform future larger-scale research and the development of organizational measures related to physician training, protocol standardization, and infrastructure support for telemedicine implementation.
Systematic reviews have quantified the effectiveness, feasibility, acceptability, and cost-effectiveness of digital health technologies (DHTs) used by health-care workers. We aimed to collate available evidence on technologies' effect on health-care workers' competencies and performance. We searched the Cochrane Database of Systematic Reviews, Embase, MEDLINE, Epistemonikos, and Scopus for reviews published from database inception to March 1, 2023. Studies assessing the effects of DHTs on the organisational, socioeconomic, clinical, and epidemiological levels within the workplace, and on health-care workers' performance parameters, were included. Data were extracted and clustered into 25 domains using vote counting based on the direction of effect. The relative frequency of occurrence (RFO) of each domain was estimated using R software. AMSTAR-2 tool was used to appraise the quality of reporting, and the Confidence in the Evidence from Reviews of Qualitative research approach developed by Grading of Recommendations Assessment, Development and Evaluation was used to analyse the certainty of evidence among included studies. The 12 794 screened reviews generated 132 eligible records for assessment. Top-ranked RFO identifiers showed associations of DHT with the enhancement of health-care workers' performance (10·9% [95% CI 5·3-22·5]), improvement of clinical practice and management (9·8% [3·9-24·2]), and improvement of care delivery and access to care (9·2% [4·1-20·9]). Our overview found that DHTs positively influence the daily practice of health-care workers in various medical specialties. However, poor reporting in crucial domains is widely prevalent in reviews of DHT, hindering our findings' generalisability and interpretation. Likewise, most of the included reviews reported substantially more data from high-income countries. Improving the reporting of future studies and focusing on low-income and middle-income countries might elucidate and answer current knowledge gaps.
The objective of this review was to investigate the available qualitative evidence to enhance understanding of the experiences of children and young adults living with juvenile idiopathic arthritis, and their carers, in any setting. Juvenile idiopathic arthritis is the most common chronic rheumatic disease in childhood. Despite the availability of effective treatments, persistent pain, growth retardation, physical disability, and psychological problems can occur. This may reduce the quality of life for patients with juvenile idiopathic arthritis by negatively affecting their family, educational, and social well-being. Patient-centered management and care for patients with juvenile idiopathic arthritis requires increasing attention to their self-reported quality of life and experiences, in addition to clinically measured disease activity. Furthermore, caring for children with juvenile idiopathic arthritis may have negative impacts on the lives of their carers and families. The experiences of carers have been poorly understood and studied. This review describes experiences and perspectives from patients and carers in order to inform the needs of families throughout their juvenile idiopathic arthritis journey. Studies describing the experiences of patients aged <21 years who have been diagnosed with juvenile idiopathic arthritis according to the International League of Associations for Rheumatology criteria, as well as the experiences of their carers, have been considered. A comprehensive search using PubMed, CINAHL, Embase, PsycINFO, Web of Science, and Google Scholar, as well as relevant conference proceedings of the American College of Rheumatology (2018-2019), the European Pediatric Rheumatology Congress 2018, the European League Against Rheumatism (2018-2019), and the Asia Pacific League of Associations for Rheumatology (2018-2019), was undertaken in December 2020 to identify pertinent published and unpublished studies. Studies published in English from 2001 to 2020 were included. The JBI approach to study selection, critical appraisal, data extraction, and data synthesis was used. Ten studies were included in this review. A total of 61 findings were extracted and aggregated to form 12 categories. From the 12 categories, five synthesized findings were developed: i) Self-management of juvenile idiopathic arthritis requires pain management, medication management, and the acquisition of knowledge and professional support; ii) A promising relationship with health care professionals but unbalanced access to services; iii) Parental financial burden and their adjustment to maintain family happiness; iv) Patients and parents support the web-based approach to communicate and develop self-management skills and acknowledge the importance of clinical trials; v) Desire to live a normal life without prejudice from school, social settings, and the workplace. This review has provided a comprehensive overview of experiences and perceptions of patients juvenile idiopathic arthritis and their parents. It is important to understand what they need to know about the disease. This review also highlights the importance of appropriate web-based programs, career counseling, infrastructures, and school facilities. Findings in this review can guide future policy and practice in order to improve care for families and children with juvenile idiopathic arthritis. Further research is required to develop management strategies for medication intolerance and to evaluate the longitudinal benefits of relevant juvenile idiopathic arthritis programs. PROSPERO CRD42019133165.
The mental health status of nurses affects not only their well-being but also the organisational outcomes and the quality of patient care. Hence, stress management strategies are critical as a universal prevention measure that address an entire population and are not directed at a specific risk group to maintain nurses' mental health in the workplace. No systematic review or meta-analysis has been conducted to evaluate the effect of cognitive-behavioural therapy (CBT) that specifically focuses on universal prevention. Therefore, the aim of this study is to examine the effectiveness that is reported in published randomised controlled trial (RCT) studies. This systematic review and meta-analysis will analyse published studies selected from electronic databases (ie, Cochrane Central Register of Controlled Trials, PubMed, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, PsycARTICLES, Web of Science and the Japan Medical Abstracts Society). The inclusion criteria for studies are that they (1) were conducted to assess the effect of CBT on the mental health of nurses as a universal prevention, (2) used an RCT design and (3) provided sufficient results (sample sizes, means and SD) to estimate the pooled effect sizes with 95% CIs. Studies will be excluded if they only targeted nurses who had been screened as being at high risk in terms of their mental health and indicated that they required the prevention. The methodological quality of the included studies will be assessed using the Cochrane Collaboration's risk of bias tool. Ethical approval is not required because this study is based on information obtained from previous studies. The results and findings of this study will be submitted for publication in a peer-reviewed international scientific journal. Results from this study will be helpful when implementing CBT strategies for nurses as a universal preventative measure in the workplace and for managing stress-related outcomes. CRD42020152837.
In high-risk areas of medicine, such as anesthesiology, intensive care, emergency medicine and pain management, existing organizational and team cultures can significantly impede the delivery of effective and safe care. A predominantly numbers-driven management approach, structural overload and sometimes insufficient leadership competency contribute to overburdening, demotivation and the departure of key personnel. This in turn exacerbates the already critical shortage of healthcare professionals. This study explores the extent to which a targeted transformation toward a Just Culture, a culture of fairness and trust, can enhance patient safety, improve staff well-being and sustainably support the performance and economic resilience of medical organizations. The study is based on a narrative review of the current literature on the topic of Just Culture, leadership, error and learning culture and team development. In addition, selected practical examples from the German and international healthcare sectors were analyzed. The review also incorporated studies on the effectiveness of (simulation) training and incident reporting and learning systems. The introduction of a Just Culture promotes a climate of trust, fairness and continuous learning in the workplace. It facilitates open communication about adverse events, supports systematic root cause analysis and reduces individual blame. Staff report increased psychological safety, reduced work-related stress and higher job satisfaction. Modern leadership approaches, such as transformational, shared and humble leadership, can further enhance teamwork and care quality. Evidence also suggests positive effects on employee retention and organizational performance, although causal relationships remain underexplored. An organizational culture shaped by Just Culture principles constitutes a key success factor for healthcare institutions. It fosters psychological safety, strengthens a sense of responsibility and enables collective learning; however, successful implementation requires a targeted evolution of leadership structures, continuous training and the development of supportive frameworks, such as reporting systems and interprofessional reflection formats. When effectively implemented, Just Culture can help secure care quality, retain skilled professionals and create a strategic advantage in an increasingly complex and economically pressured healthcare environment. HINTERGRUND: In Hochrisikobereichen der Medizin, wie der Anästhesiologie, Intensiv- und Notfallmedizin sowie der Schmerztherapie, können bestehende Organisations- und Teamkulturen eine effektive und sichere Versorgung erschweren. Eine vorwiegend zahlenbasierte Steuerung, strukturelle Belastungen sowie teilweise unzureichend ausgeprägte Führungskompetenzen begünstigen Überlastung, Demotivation und die Abwanderung von Schlüsselpersonal. Dies verschärft den bereits bestehenden Fachkräftemangel zusätzlich. Die vorliegende Arbeit untersucht, inwiefern der gezielte Wandel hin zu einer Just Culture, einer Kultur der Gerechtigkeit und des Vertrauens, zur Erhöhung der Patientensicherheit, zur Stärkung des Wohlbefindens der Mitarbeitenden und zur langfristigen Sicherung der Leistungsfähigkeit und Wirtschaftlichkeit medizinischer Organisationen beitragen kann. Die Grundlage bildet eine narrative Literaturauswertung aktueller Fachveröffentlichungen zu den Themen Just Culture, Führung, Fehler- und Lernkultur sowie Teamentwicklung. Ergänzend wurden konkrete Praxisbeispiele aus dem deutschen und internationalen Gesundheitswesen betrachtet. Darüber hinaus wurden Studien zur Wirksamkeit von (Simulations‑)Trainings sowie von Lern- und Berichtsystemen einbezogen. Die Einführung einer Just Culture begünstigt eine Arbeitsatmosphäre des Vertrauens, der Gerechtigkeit und des kontinuierlichen Lernens. Sie erleichtert eine offene Kommunikation über unerwünschte Ereignisse, unterstützt eine systematische Ursachenanalyse und reduziert die individuelle Schuldzuweisung. Mitarbeitende erleben eine höhere psychologische Sicherheit, berichten über niedrigeren Arbeitsstress und gesteigerte Arbeitszufriedenheit. Auch moderne Führungsansätze – wie transformationale, geteilte oder demütige Führungsformen – können die Zusammenarbeit in Teams sowie die Versorgungsqualität verbessern. Studien deuten zudem auf positive Effekte hinsichtlich Personalbindung und wirtschaftlicher Kennzahlen hin. Gleichwohl bleibt die Evidenzlage hinsichtlich kausaler Effekte begrenzt. Eine von Just Culture geprägte Organisationskultur stellt einen relevanten Erfolgsfaktor für medizinische Einrichtungen dar. Sie stärkt die psychologische Sicherheit, erhöht das Verantwortungsbewusstsein und fördert Lernprozesse im Team. Die Einführung einer solchen Kultur erfordert jedoch eine gezielte Weiterentwicklung bestehender Führungsstrukturen, kontinuierliche Schulungsmaßnahmen und den Ausbau lernförderlicher Strukturen wie Lern- und Berichtsysteme oder interprofessionelle Reflexionsformate. Wenn der Kulturwandel gelingt, kann Just Culture dazu beitragen, die Versorgungsqualität nachhaltig zu sichern, Mitarbeitende langfristig zu binden und einen strategischen Vorteil im komplexen und ökonomisch herausfordernden Gesundheitswesen zu schaffen.
To assess workplace factorsinfluencing the tolerance of ambiguity among trainee doctors. The sequential mixed-method study was conducted from June 2021 to February 2022 at the Fauji Foundation Hospital, Islamabad, Pakistan, and comprised postgraduate trainee doctors of either gender associated with various specialties.Thebaseline toleranceof ambiguity scorewas establishedusingtheToleranceofAmbiguity in Medical Students and Doctors scale. A group of selected trainees was interviewed face-to-face to examine the workplace factors that they regarded as beneficial or detrimental to their tolerance of ambiguity. Quantitative data was analysed using SPSS 24 and thematic analysis was done for qualitative data. Of the 132 subjects, 59 (21.9%) were males and 73 (55.3%) were females. The overall mean age was 20.95±2.186 years. Of the total, 55(41.7%)subjects were in the first year of training, 28(21.2%) in the second year, 26 (19.6%) in the third year, and 23(17.4%) in the fourth year. There were 78(59.1%)trainees who were married compared to 54 (40.9%) who were unmarried. Against the baseline tolerance of ambiguity score of 132, the overall aggregate mean tolerance of ambiguity level was 71.28 ± 5.81 showing a moderate level. There was no significant correlation between the tolerance of ambiguity and the trainees'age, years oftraining and maritalstatus(p>0.05).The qualitative phase comprised interviews with 9(6.8%) subjects.Thematic analysis suggested that the traineesperceivedautonomy,peersupport,supervisorsupport,manageable workload, and professional development opportunities asfacilitat or softolerance of ambiguity,whilebarrierswere identified as poor physical environment, attitude ofseniors and supervisors, management issues and excessive workload.During the coronavirus diseae-2019 pandemic, excessive workload and fear of infection were identified asfactors affecting tolerance of ambiguity. The medical trainees were found to have a moderate level of tolerance to ambiguity. Autonomy, peer support, supervisor support, manageable workload, and professional development opportunities contributed positively to this aspect.
To translate, adapt, and validate the Watson Caritas Co-Worker Score in Italian. A cross-sectional study was conducted with 182 nurses and healthcare professionals. Content Validity and construct validity, with Cronbach's alpha (α) and test-retest Intraclass Correlation Coefficients (ICCs), were calculated to assess validity and reliability. The Watson Caritas Co-Worker Score - Italian retained the one-factor structure comprising five items, consistent with the original instrument. It demonstrated strong internal consistency (α = 0.91) and high test-retest reliability (ICCs ≥ 0.84). The scale CVI suggests good content validity. The WCCW-I exhibited good psychometric properties, supporting its use in nursing practice and research to evaluate and promote caring behaviors and humanization among nurses and healthcare professionals. The WCCW-I may help healthcare professionals and organizations assess and promote caring behaviors in the workplace. In clinical practice, it can be used to foster compassionate environments by identifying relational strengths and vulnerabilities among co-workers, particularly in high-pressure settings. For nursing leadership, the tool offers a practical means of evaluating team dynamics and designing targeted interventions to reinforce mutual respect, empathy, and collaboration. By enhancing the quality of professional relationships, the WCCW-I contributes to the humanization of care and the well-being of both caregivers and patients. What problem did the study address? This study addressed the lack of validated instruments in Italian to assess caring behaviors among healthcare professionals, particularly in co-worker interactions, an area critical for promoting compassionate and humanized care environments. What were the main findings? The WCCW-I demonstrated strong psychometric properties, including a clear unidimensional structure, excellent internal consistency (α = 0.91), and high test-retest reliability (ICCs ≥ 0.84). The tool retained the original conceptual framework and was found to be culturally appropriate for the Italian context. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: This research will impact clinical practice, nursing education, and healthcare management in Italy by providing a theoretically grounded and empirically validated tool to assess and improve caring relationships among healthcare teams. It may also influence international efforts to measure caring behaviors cross-culturally. This study was conducted and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for observational research. No patient or public contribution.
While equality and inclusion practices in healthcare have been advanced from a service user perspective, little is known about the application of workplace equality and inclusion practices in healthcare on upper-middle-income and high-income countries. In the developed world, the composition of the healthcare workforce is changing, with nationals and non-nationals working 'side-by-side' suggesting that healthcare organisations must have robust and meaningful workplace equality and inclusion practices. Healthcare organisations who welcome and value all their employees are more creative and productive, which can lead to better quality of care. Additionally, staff retention is maximised, and workforce integration will succeed. In view of this, this study aims to identify and synthesise current best evidence relating to workplace equality and inclusion practices in the healthcare sector in middle-income and high-income economies. Using the Population, Intervention, Comparison and Outcome (PICO) framework, a search of the following databases will be made-MEDLINE, CINAHL, EMBASE, SCOPUS, PsycInfo, Business Source Complete and Google Scholar-using Boolean terms to identify peer-reviewed literatures concerning workplace equality and inclusion in healthcare from January 2010 to 2022. A thematic approach will be employed to appraise and analyse the extracted data with the view to assessing what is workplace equality and inclusion; why it is important to promote workplace equality and inclusion in healthcare; how can workplace equality and inclusion practices be measured in healthcare; and how can workplace equality and inclusion be advanced in health systems. Ethical approval is not required. Both a protocol and a systematic review paper are to be published concerning workplace equality and inclusion practices in the healthcare sector.
The healthcare setting is a stressful and demanding work environment, and healthcare workers face a continuous expansion of their job roles and responsibilities. Past studies have shown that factors affecting burnout, resilience, and quality of life among healthcare workers merit further research, as there were inconsistent findings, especially with regards to the influence of demographic and work-related factors. Therefore, this study aims to determine whether demographic and work-related factors are associated with burnout, resilience, and quality of life among healthcare workers. This cross-sectional study was conducted between February 15, 2022 and March 15, 2022, among 394 healthcare workers from Putrajaya and Selangor hospitals, Malaysia. Maslach Burnout Inventory, World Health Organization Quality of Life-BREF 26 inventory, and Brief Resilience Scale were utilized to capture information on burnout, quality of life, and resilience, respectively. The mean score of physical health of participants who work more than 10 h (11.38) is lower than participants who work from 8 to 10 h (13.00) and participants who work 7 h daily (13.03), p-value < 0.001. Similarly, the mean score of psychological health of participants who work more than 10 h (12.35) is lower than participants who work from 8 to 10 h (13.72) and participants who work 7 h daily (13.68), p-value = 0.001. Higher income levels were associated with high resilience and quality of life. It is imperative that healthcare practitioners and policy makers adopt and implement interventions to promote a healthy workplace environment, address ethical concerns, and prevent burnout among healthcare workers during the COVID-19 pandemic. Managing the issue of long working hours could possibly result in improved resilience, burnout, and quality of life among healthcare workers. Despite this study able to tickle out some policy specific areas where interventions are needed, identifying effective solutions and evaluating their efficiency will require larger and interventional studies.
To validate the cross-national psychometric properties of the Mental Health Quality of Life questionnaire (MHQoL) and to develop an open-source toolbox for its scoring, transformation and presentation. Secondary analysis of data from a multicentre international randomised controlled trial (EMPOWER). Workplace settings in small-sized and medium-sized enterprises (SMEs) and public sector organisations in Finland, Spain and the UK. The sample included 564 employees: 122 from Finland, 114 from Spain and 328 from the UK. Most were white-collar workers in SMEs or public organisations, mainly in public administration, manufacturing, health/life sciences or higher education. Women were the majority (56%-91% across countries), and mean age ranged from 43 to 48 years. No intervention was delivered for this analysis; data were drawn from baseline assessments. Primary outcomes were internal consistency and construct validity of the MHQoL, evaluated using Cronbach's alpha, measurement invariance testing and multilevel analyses of associations between MHQoL dimensions and its visual analogue scale (VAS). Secondary outcomes were convergent validity, assessed through correlations between MHQoL scores and other mental health and quality of life measures (EuroQol 5-Dimension 5- level questionnaire (EQ-5D-5L), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), Insomnia Severity Index, Perceived Stress Scale-4 (PSS-4), Psychosocial Risk Scale, and World Health Organization Five Well-Being Index (WHO-5)). The MHQoL showed good internal consistency across countries, with Cronbach's alpha ranging from 0.741 in Finland to 0.806 in Spain (overall α=0.787). Measurement invariance across Finland, Spain and the UK supported construct validity. Multilevel regression analyses showed associations between MHQoL dimensions and the MHQoL-VAS, with strongest contributions from Self-Image, Daily Activities, Mood and Future. Convergent validity was supported by moderate to strong correlations between MHQoL, EQ-5D-5L and related mental health measures. An open-source R package and Shiny web application ('MHQoL Toolbox') were developed for scoring, transformation and visualisation CONCLUSIONS: The MHQoL is a reliable and valid measure of mental health-related quality of life across countries. The MHQoL toolbox supports consistent, transparent implementation, facilitating use in research, clinical practice and economic evaluations. NCT04907604.
Proximal femoral fractures are a major public health issue due to an increasing ageing population, with an important impact on patients' quality of life. This study was designed by the Authors through a national survey with the purpuse to investigate the italian experience and practice about management and perioperative/operative trends of intracapsular proximal femoral fractures (PFF). In February-March 2022 a national survey was submitted online to the members of SIOT (Società Italiana Ortopedici e Traumatologi) and SIDA (Società Italiana dell'Anca) societies. Demographic data of the participants such as age, type of workplace and years of working experiences were registered. The questionnarie included 21 multiple choice questions about: demographic data, preoperative management, surgical indications (treatment of non-displaced and displaced fractures), management of the geriatric patient and surgical technique. Resulting data were collected and stored in a database, the results were then processed and compared with the international literature and registries. The Survey was completed by 372 surgeons; answers reported were often in accordance with the literature and national and international guidelines, with, on the other hand, important controversies regarding preoperative management (radiological studies and preoperative planning), some surgical indications and choice of stem fixation. Management of proximal femoral fractures is not always clear and univocal; it is mandatory to produce a diagnostic-therapeutic process supported by scientific evidence. In this context the SIOT Guidelines 2021 offer a real help for the surgeon managing a PPF.
Motivation of health workers is crucial for providing high-quality healthcare services and improving the performance of health facilities. However, less attention has been given to this aspect of workplace climate in hospital settings, and there is scant evidence on the level of health workers' motivation on healthcare delivery. Therefore, this study aimed to assess the motivation of health workers and its determinants at public and private hospitals in Bahir Dar City, Northwest Ethiopia. A facility-based comparative cross-sectional study was conducted from November 3rd to December 4th, 2021. A simple random sampling technique was used to select 472 study participants. Motivational status was measured using the mean of 14 items on a Likert scale. Descriptive statistics were computed to present results using tables and figures. Bi-variable and multivariable logistic regressions were performed to identify factors associated with motivational status. Strength of association was measured using adjusted odds ratios with the corresponding 95% confidence intervals and statistical significance was declared at p-values less than 0.05. A total of 458 health workers participated in our study the health workers' motivational status was found to be 56.3% (95% CI: 52-60.7%). A significant difference in motivational status was observed between private (62.3%) and public hospitals (50.4%) (χ2 = 6.532, p = 0.011). Working in private hospitals (AOR = 1.52; 95% CI: 1.03-2.23), good collegial relationships (AOR = 1.61; 95% CI: 1.1-2.32), job satisfaction (AOR = 1.49; 95% CI: 1.02-2.20), a favorable work environment (AOR = 1.56; 95% CI: 1.06-2.30), and educational status (AOR = 0.4; 95% CI: 0.17-0.94) were significantly associated with higher health workers' motivational status. The motivational status of health workers was significantly higher in private hospitals than in public hospitals. The proportion of motivated health workers was low, which poses challenges in maintaining a regulated health workforce within the health system. Working in private hospitals, job satisfaction, working environment, higher educational status, and collegial relationships were predictors of motivational status. Therefore, public hospitals should promptly implement both intrinsic and extrinsic motivational strategies.
Social determinants of health (SDH), such as socioeconomic status, education, healthcare access, and social support, play a significant role in shaping individuals lived experiences. Dual sensory loss (DSL), a distinct disability involving both vision and hearing loss, poses greater challenges for daily living compared to the general population. This scoping review synthesized evidence on how various SDH indicators influence the life experiences of older adults with DSL. Five scientific databases were searched from January 2014 to May 2024. Articles focusing on individuals aged 60 and older with DSL, in the context of at least one SDH indicator, were included. A total of 69 studies met the eligibility criteria. Most studies addressed the following SDH indicators: disability (n = 46), social inclusion and non-discrimination (n = 21), gender (n = 10), and access to healthcare services (n = 9). Disability-related indicators revealed higher risks of mobility limitations, cognitive decline, depression, anxiety, social isolation, and workplace discrimination, all adversely affecting mental health and quality of life. Older adults with DSL encounter significant barriers to accessing healthcare, such as absence of adequate assistive devices, communication challenges, and high healthcare costs. Many report dissatisfaction with the quality of care received. Our review identifies disparities that increase the vulnerability of older adults with DSL and restrict their access to healthcare, rehabilitation, and social participation. These findings warrant further research on underexplored SDH factors, using robust data sources that collects information on the lived experiences of older adults with DSL. Addressing these social determinants requires a comprehensive approach, including raising awareness, improving service access, enhancing social support networks, and ensuring inclusive policies and practices.
Job satisfaction significantly influences the quality of patient care. Healthcare staff working with vulnerable patients in tertiary obstetrics and gynaecology hospitals faces specific work challenges and higher expectations from patients. The secondary data analysis from the National Survey of Employee Satisfaction aimed to evaluate job satisfaction and its association with intrinsic and extrinsic factors. A cross-sectional study was conducted involving 385 employees (physicians, nurses, administrative and technical staff) at two tertiary obstetrics and gynaecology hospitals. Data were collected using a self-administered, anonymous questionnaire (National Survey of Employee Satisfaction). This single instrument assessed demographic characteristics and 14 factors of the work environment and working conditions. Participants rated their level of satisfaction on a 5-point Likert scale, with scores ranging from 1 ('very dissatisfied') to 5 ('very satisfied'). Participants were aged 35-54 years, with nurses comprising the largest proportion of the sample (60.3%). The greatest proportion reported dissatisfaction with their salary (61.8%), while the highest level of satisfaction was reported for work equipment (41.5%). Overall job satisfaction varied across professional categories of employees. Exploratory factor analysis among healthcare professionals identified two underlying dimensions of job satisfaction: extrinsic (hospital-related) and intrinsic (profession-related) factors, which together explained 59% of the total variance. Both factors were significantly associated with overall job satisfaction, with extrinsic factors showing a slightly stronger correlation. Improving non-financial incentives (recognition of work, organizational support and workload management) may enhance healthcare staff engagement, communication, staff morale, retention and service quality. Given the identified intrinsic and extrinsic dimensions of job satisfaction and their significant association with overall job satisfaction, this empirically derived framework may be used for comparative analyses across different healthcare contexts and may inform the development of more targeted measurement tools and intervention models.
The 2005 revision of the code of ethics for nurses has been in effect in Taiwan for more than 17 years. Although this code has been smoothly implemented during this time, changing social expectations and ethical perspectives, advancements in science and technology, and the evolution of the nurse-patient relationship suggest this code should be once again be updated. This study was conducted to suggest revisions to the Taiwan code of ethics for nurses necessary to meet current needs and address social and medical care environment trends. A multivariate research approach was adopted. The classification of the code of ethics for nurses norms in six international nursing organizations and evidence-based ethical and philosophical thinking literature were referenced, with the main notification demands incorporated into the Ministry of Health and Welfare's Nursing Workplace Controversy Reporting Platform. After drafting the aspects and provisions of Taiwan code of ethics for nurses norms, expert review procedures such as focus groups, Delphi expert consensus, and public forums were conducted. After three expert focus group discussion rounds, a structured questionnaire was completed, and 50 Delphi experts in six fields completed the online questionnaire. After the second consensus round, the importance and clarity of the 47 ethical code provisions in the four aspects were determined with 100% and 99.8% agreement reached, indicating no significant difference in scores between the multidisciplinary expert group and the ethical code. The resulting revision proposed for the Taiwan code of ethics for nurses includes: nursing staff and care recipients (14 provisions), nursing staff and practice (13 provisions), nursing staff and the profession (10 provisions), and nursing staff and society (10 provisions). In terms of education, the revised Taiwan code of ethics for nurses should be integrated into the nursing education curriculum of nursing colleges and used as teaching material for the continuing education of nurses. In terms of policy, these norms should be included as evaluation benchmarks and inspection items for hospitals. In addition, the attention and support of senior managers in institutions must be secured and a handling protocol for moral dilemma cases and related consultation mechanisms must be established. Nursing supervisors should be guided to develop the ability to address these dilemmas to help foster a positive workplace and a respectful team atmosphere. All professional groups should participate actively in promoting issues related to nursing ethics, organize seminars and continuing education activities, and make the revised Taiwan code of ethics for nurses and learning cases available online for reference by nursing staff nationwide. 台灣護理倫理規範修訂. 台灣目前採用的護理倫理規範2005年修訂版本，實施17年多以來，雖未出現窒礙難行處，但隨著時代推演和科技的進步，對倫理問題的判斷方式，所重視的倫理觀點和護病關係，已有明顯改變。. 旨在更新台灣護理倫理規範，以符合現今社會及醫療照護環境之行為指引要求。. 採用多元研究法，參照六個國際護理組織護理倫理規範分類，和以實證為基礎的倫理與哲學思維文獻，並納入衛生福利部護理職場爭議通報平台主要通報訴求，初擬台灣護理倫理規範修訂版之面向及條文，再進行專家焦點團體座談、Delphi專家學者共識及公共論壇等程序。. 經三回合專家焦點團體座談完成的結構式問卷，由50位六大領域Delphi專家學者進行線上問卷填答，經二回合共識，四面向47項倫理規範條文的重要性及清晰度之收斂度分別達100%及99.8%；不同領域專家與面向條文間評分無顯著差異，顯示結果具一致性。台灣護理倫理規範修訂版包含：護理人員與照護對象（14項條文）、護理人員與執業（13項條文）、護理人員與專業（10項條文）、護理人員與社會（10項條文）。. 在教育面，應將新版護理倫理規範納入護理院校的常規課程，並作為繼續教育的教材。在政策面，則應列為醫院評鑑基準及查核項目。此外，應促使機構高層主管重視與支持，建立道德困境案例處理流程和諮詢機制，輔導護理主管培養處理能力，以營造正向職場及團隊尊重氛圍。各專業團體應共同參與推動護理倫理相關議題，舉辦研討會及繼續教育活動，將新版護理倫理規範及案例置於網頁，以供全國護理人員參考。.
Physiotherapy services are often integrated within the broader healthcare system in India. Unlike in developed countries, physiotherapy is still limited to indirect access and needs a referral from other healthcare providers, which potentially limits physiotherapists. The purpose of this study was to explore the knowledge or skill, attitude, and behavior towards the implementation of evidence-based practice (EBP) in physiotherapy care. In addition, the physiotherapist's perception of barriers in the implementation of EBP was inquired. A cross-sectional study was conducted through an online survey involving two thousand nine hundred and ninety-six physiotherapists from 22 states/union territories in India. A 24-item EBP questionnaire (EBPQ) investigating knowledge, attitude, and behavior domains with a 1 to 7 Likert scale response for each item, with a higher score indicating a favorable response. A linear regression model was used to analyze the relationship between factors and evidence-based practice behavior among physiotherapists. The mean age of the participants was 35.8 ± 6.2 years, with a work experience of 13.25 ± 6.38 years. The overall EBPQ mean score of Indian physiotherapists was 3.6 ± 0.38, and the mean scores of the domains-knowledge, attitude, and implementation of EBP-were 3.59 ± 0.53, 4.29 ± 0.79, and 3.20 ± 0.62, respectively. The EBP domains were mainly determined by the educational attainment and workplace, which explained 46.1% of the variance. Lack of time and skills was identified as the top barrier influencing EBP among physiotherapists in India. The behavior dimension score of EBPQ is determined by 8 knowledge items and 2 attitude items, which explain 61.2% of the variance. The Indian physiotherapists reported a positive attitude toward evidence-based practice; however, their knowledge and behavior were observed to be insufficient. Lack of time, limited skills, a shortage of resources, and limitations in applying EBP were reported as the main barriers.
The need for stress management strategies has been empirically investigated and supported considering demands in workplaces. However, some people in public offices do not seem to have been exposed to occupational health strategies that could reduce the adverse impacts of stress on job productivity and quality of life. Consequently, they become susceptible to mental health disturbances requiring the attention of occupational therapists. Given this, we studied the impact of occupational health coaching for job stress management among technical college teachers. Using a randomized control design study, 90 technical college teachers were screened and ready to participate. The eligible teachers were included and assigned to intervention and control groups. An occupational stress index was given to the participants before, immediately after, and 2 months after the delivery of occupational coaching program by career counselors while the comparison group received no intervention. Data collected were analyzed using multivariate analysis of variance analysis. The results showed a significant improvement in the management of job stress after receiving rational emotive occupational health coaching. According to the multivariate analysis of variance analysis, there were between-group differences immediately after the intervention and 3 months later. As a result, the study suggested that career counselors and school management systems should incorporate rational-emotive behavioral therapy into workforce and workplace programs.
We explored the importance of digital technologies to health responses during the COVID-19 pandemic. The benefits, challenges and barriers to developing digital capabilities are identified, and strategies to establish enduring digital proficiency among nurses and healthcare colleagues gained during the pandemic are canvassed. Since the mid-20th century, technology uptake by health practitioners has prioritised digital information and communication technology. The COVID-19 pandemic accelerated the need to adapt digital communication to dangerous clinical workplaces. Organisational policies enabled digital capabilities to replace in-person processes while preserving regulatory compliance, safety and security of patient information and staff deployment. All evidence was accessed from publicly available sources. The COVID-19 pandemic was a catalyst for implementing Technology Enhanced Care Services. Health practitioners need appropriate digital capabilities for their roles and scope of practice. Nursing proficiency includes technological skills. Combining the Jisc Digital Capability Framework and the Health and Care Digital Capabilities Framework helps nurses achieve the technical expertise needed for clinical proficiency in contemporary healthcare environments. Healthcare workforce digital capability requires policies that resource digital technologies and individual user skills in dangerous COVID-19 workplaces. All involved must be abreast of technological changes and monitor technology effectiveness in innovation in patient care, professional education and evidence-based infectious disease management of healthcare systems. Nurses and other practitioners in COVID-19-compromised settings must be able to use the embedded digital technologies in patient care, clinical management and education. Policies securing resources for nurses to learn to use digital technologies will ensure that digital systems are regularly upgraded and that nurses develop proficiency in using technology in their clinical practice. Work and workplace redesign needs compatible computer systems and software to support nursing innovation and digital proficiency.
Lead, which is widely used in various industrial settings, is a major health hazard for manufacturing workers. Therefore, control of lead exposure has been implemented in an effort to prevent lead-related health problems. In this study, our aim was to evaluate temporal trends in occupational lead exposure in Korean lead workers using data from monitoring of workplace exposure. A nationwide work environment monitoring database, data from a work environment monitoring institution, and data extracted from a review paper were utilized. Different versions of standard industrial classification codes were aligned with the 10th Korean Standard Industrial Classification, which is generally consistent with the 4th revision of the International Standard Industrial Classification. The multiple data sources were combined and temporal trends over the period from 1994-2021 were estimated. In addition, separate estimation of temporal trends in the storage battery manufacturing industry over the period from 1987-2021 was also performed. A total of 444,296 personal airborne lead measurements were used for the estimation process. The temporal trends in occupational exposure to lead declined by -6% annually over the study period. In particular, levels of lead exposure in the storage battery manufacturing industry showed a steeper decline of -12% annually. Findings of our study showed that occupational exposure to lead declined over the period from 1994 to 2021 in Korea. However, adverse effects of exposure to lead on health should be regarded with caution. The results will be useful in conduct of epidemiological studies examining lead-related effects on health.