Published in: SAMJ November 2016, Vol. 106, 1096-1102, DOI:10.7196/SAMJ.2016.v106i11.10689 / Background. Healthcare professionals (HCPs) produce various types of waste in the course of rendering healthcare services. Each classification of waste must be disposed of according to the prescribed guidelines. Incorrect disposal of waste may pose a danger to employees, patients and the environment. HCPs must have adequate knowledge of the disposal of medical waste. Objectives. To determine the knowledge and practices of HCPs with regard to medical waste disposal at a hospital in Mpumalanga Province, South Africa. Methods. A quantitative cross-sectional research approach was used. The study respondents included nurses, medical doctors, dental health staff and allied health staff. Data were collected through self-administered questionnaires and analysed using IBM SPSS version 22.0. Results. A high proportion of HCPs did not have adequate knowledge regarding the disposal of medical waste, but nevertheless disposed of medical waste appropriately. While the knowledge and practices of HCPs with regard to medical waste disposal were not associated with age, gender or years of experience, there was an association between professional category and knowledge and practices. Conclusions. Disposal of medical waste is the responsibility of all HCPs. All categories of HCPs should receive regular training to improve their knowledge regarding disposal of medical waste and to minimise the risks associated with improper waste management. This will further increase compliance with the guidelines on disposal of medical waste.

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No / Aims and specific learning outcomes To examine cultural influences on the adoption of simulation as an educational innovation among health care professionals. Background/ rationale Whilst there has been an increase in research supporting simulation based education and training, there is a notable lack of evidence examining the relationship between culture and simulation, and factors influencing adoption and diffusion of this innovation, Fors (2009), Chung (2013). If cultural factors influence simulation adoption, either as an enabler or a barrier, they are worthy of examination. This literature review aims to examine these important dimensions., Methodology The literature review is being undertaken systematically based on techniques described by Booth et al, (2012).Study selection will be undertaken using the following inclusion criteria: Population: Students and health practitioners engaged in medicine, nursing, midwifery and allied health professional practice, participating in simulations. Intervention: Simulation training and education; relating to: learning, teaching and assessment in clinical practice and in learning environment, technological and non- technological. Outcome: Cultural factors-enable/hinder, voluntary and involuntary uptake or rejection of simulations. Practitioners value/do not value simulations. Study: International research papers, published in English, from 2010 to 2014. Data synthesis Data synthesis will be undertaken using Thematic Synthesis (Thomas, Harden, 2008). Results - To be developed following data synthesis. Conclusions/ recommendations/ take home messages -To be developed following data synthesis

Health care changes, including increased hospital admissions, an aging population and the chronicity of diseases and conditions have led to increased collaboration with unregulated professionals. Within the professions of occupational therapy and physiotherapy, there is a paucity of literature that addresses the perceptions of Occupational Therapist Assistants and Physiotherapist Assistants (OTAs and PTAs) with respect to their competence in clinical practice. This research study investigates the perceptions of clinical competence of OTA and PTA graduates from one Ontario community college. A phenomenological theoretical framework was used to explore the participants’ lived experiences. Eight individual in-depth interviews were used to gather data representing the graduate OTAs and PTAs’ perspectives. In addition, the viewpoints from a stakeholder focus group of eight participants comprised of occupational therapists, physiotherapists, and administration personnel from one Ontario hospital were used to triangulate the data.. Four themes emerged: 1) employing effective communication, 2) emerging knowledge, skills and competencies in clinical practice, 3) transitioning into clinical practice, and 4) developing confidence as an OTA and PTA. The Person Environment Occupation (PEO) model (Law et al., 1996) was used to organize the themes and to assist in determining the optimal fit between the themes. Confidence was articulated as a continuous concept that facilitated the graduates’ competence in their clinical skills. Proficiency in their roles, a supportive transition, and demonstrated competence were the presenting factors that empowered the graduate OTAs and PTAs to affirm their competence in clinical practice. This research study is foundational for future research related to OTAs and PTAs in the areas related to use of title, educational credentialing, and collaborative competency documentation. / Thesis / Master of Science (MSc) / Currently, there are changes in health care services that require modifications to the delivery of the treatment. Occupational Therapist Assistants and Physiotherapist Assistants (OTAs and PTAs) work within patient rehabilitation; however, their perceptions of competence have not been assessed. This study reviews the perceptions of the OTAs and PTAs when completing their role with patients by interviewing them and interviewing the staff that work with them. The data from this thesis will provide us with an enhanced understanding of the perceptions of OTAs and PTAs and the supports they believe enable them to be competent and confident health care professionals. This information will facilitate the identification of the next steps in research specific to OTAs and PTAs in the areas of competency and educational programs.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

Despite increased awareness about patient safety and quality of care, errors and adverse outcomes occur frequently in clinical practice. An estimated 10% of the 35.1 million U.S. hospital patients suffered injuries caused by medical errors; the most common were medication errors, which accounted for more than 50% of all medical errors. Work-related stress is associated with medication errors for health care professionals (HCP) in Saudi Arabia (SA) hospitals; however, the specific types of stressors and their effect on the level of medication errors have not been studied in SA. The purpose of this quantitative correlational study was to examine the relationship between the overall level and sources of work-related stress using the job stress scale on the level of medication errors for a group of 269 HCPs working at King Abdul-Aziz Hospital (KAH) in SA. The theoretical framework for this research was the Donabedian patient safety model, which relates healthcare quality to personal, environmental, and organizational factors. Binary logistic regression analyses indicated there was no relationship between overall levels of stress and medication errors. However, specific sources of work related stress such as disruption to home life, excessive workload, and night/weekend call duties were associated with a significant increase in the medication error rate, while pressure to meet deadlines and difficulties with colleagues was associated with a significant decrease in the medication error rate. Positive social change implications include how understanding the impact of work-related stress on medication errors by SA HCPs may lead to specific interventions to reduce medication errors and improve patient care.

Background: Health care professionals are at risk of developing burnout due to the inherently stressful nature of their work. Burnout has been found to compromise the wellbeing of health care professionals and their ability to provide optimal patient care. Job engagement is proposed to be the antipode of burnout and is concerned with occupational well-being. It is hoped that through a better understanding of factors related to job engagement and burnout, occupational well-being of health care professionals and their ability to care for patients can be improved. Systematic review: A systematic review of the literature on burnout and job engagement in physicians and nurses since 2002 identified seven studies. Findings suggest that burnout and job engagement are independent constructs, albeit negatively related. These findings contribute to the current knowledge about the relationships between burnout and engagement dimensions and provide a framework for interventions aimed at increasing occupational well-being among front line medical professionals. Aims: A study was conducted to assess levels of job engagement and burnout and their relationship with turnover intentions and job satisfaction and stress in the entire workforce of a Cancer Centre in the United Kingdom. Participants and procedure: 150 cancer care workers completed a cross-sectional questionnaire entailing the Maslach Burnout Inventory, the Engagement Indicator, measures of job satisfaction, stress, turnover intentions and demographics. Results: Mean scores of emotional exhaustion did not differ from normative data, while lower levels of depersonalisation and lack of accomplishment were found. Furthermore, engagement scores were significantly higher than in the normative sample and the majority reported high levels of job satisfaction and indicated no turnover intentions. Path analysis provided preliminary support for an exploratory model indicating that engagement mediates the relationship between job stress, burnout and job satisfaction and turnover intentions. Implications: It is important that, despite increasing pressure to reduce costs, service planning is mindful of the continuous and long-term process required to maintain and facilitate engagement and job satisfaction, which appear important to the long term retention of staff. Conclusions: Work overload and a perception of being poorly managed and resourced appear to be risk factors for burnout. However, engaged employees with high levels of personal accomplishment may experience job satisfaction and desire to stay in their jobs despite high levels of occupational stress. Further research is required to identify factors predictive of personal accomplishment and job engagement in oncology services.

Bakgrund: Psykisk ohälsa är vanligt förekommande hos Sveriges befolkning och räknas till en av folksjukdomarna. Personer med psykisk ohälsa kan drabbas av psykiska eller fysiska besvär och söker sig då till primärvården och kommer där att möta sjuksköterskor och annan vårdpersonal. Syfte: Syftet var att belysa vårdpersonals upplevelse av att bemöta patienter med psykisk ohälsa inom primärvården. Metod: En litteraturöversikt baserad på nio vetenskapliga kvalitativa artiklar genomfördes. Resultat: Två huvudkategorier med fyra subkategorier framkom. Den första huvudkategorin ”Kommunikationens betydelse för bemötandet” bestod av subkategorierna Verbal kommunikation och Icke-verbal kommunikation. Kommunikationen, både den verbala och icke-verbala, mellan vårdpersonal och patient hade stor betydelse för hur det upplevdes att bemöta patienten. Den andra huvudkategorin ”Begränsningar som påverkar bemötandet”, bestod av följande subkategorier: Begränsningar i den egna professionen och Begränsningar i organisationen. Brist på kunskap hos personalen eller brist på resurser i organisationen påverkade personalens möjlighet att bemöta patienten så som var önskvärt. Slutsats: Vårdpersonal behöver ta mer eget ansvar för att tillgodogöra sig ny forskning och information om bemötande och patienters sjukdomar, samtidigt bör staten fortsätta med uppmaningar och uppmuntran till utveckling av sjukvården och fortbildning av personal. / Background: Mental illness is common among the Swedish population and is one of the endemic diseases. People with mental illness can be sticken with psychological or physical inconveniences and then turn to primary health care and will there meet nurses and other health care professionals. Aim: Was to illustrate health care professionals experience of encounter patients with mental illness in primary health care. Method: A literature review was carried out based on nine scientific qualitative articles. Result: Two main categories and four subcategories emerged. The first category ”To experience the meaning of communication to the encounter” consisted of the subcategories Verbal communication and Non-verbal communication. The communication, both verbal and non-verbal, meant a lot for the experience to encount the patients. The other main category: ”To experience limitations that affect the encounter” consisted of following subcategories: Limitations within the own profession and Limitations within the organization. Lack of knowledge within the staff or lack of resources within the organization affected the staffs’ ability to encount patients as desirable. Conclusion: Health care professionals have their own responsibility to utilize new research and information about the encounters with and the diseases of patients. The government should continue to request and encourage to develop the health care.

Bakgrund: Sjuksköterskor i allmänt upplever det svårt att smärtlindra patienter eftersom smärta är en subjektiv företeelse. Sjuksköterskor belyser att det råder en brist på kunskap och riktlinjer vid hantering av smärtlindring. Sjuksköterskor som möter patienter med drogberoende som befinner sig i smärta anser att det är stressfullt och komplicerat. Detta på grund av att sjuksköterskorna upplevde det vara förenat med inre konflikter och moraliska dilemman. Syfte: Syftet var att beskriva patienters upplevelser av vårdpersonalens bemötande när patienterna upplever smärta som samtidigt är beroende av droger Metod: En litteraturöversikt baserad på tio vårdvetenskapliga artiklar gjordes. Artiklarna har analyserats enligt Fribergs (2012) analysmetod där författarna sökte efter likheter och skillnader av ett fenomen som sedan skapade resultatets teman. Resultat: Resultatet presenteras i två huvudteman. I det första temat: Hinder i vårdpersonalens bemötande uppkom det fem subteman. I dessa subteman beskrivs det om hur patienter upplever ett negativt bemötande ifrån vårdpersonalen. I det andra huvudtemat: Förutsättningar för bemötandet uppkom ett subtema. Det subtemat beskriver hur patienter med ett drogberoende upplever en god vårdrelation och hur den skapas. Diskussion: Författarna har diskuterat resultatets huvudfynd i förhållande till litteraturöversiktens bakgrund, författarnas synpunkter samt med Katie Erikssons caritativa teori som referensram. / Background: Nurses in general find it difficult to provide patients with pain relief because pain is a subjective phenomenon. Nurses emphasize that there is a lack of knowledge and guidelines for the handling of pain. Nurses who encounter drug dependent patients in pain find it to be stressful and complicated. The reason for this is that the nurses felt that it was fraught with their own inner conflicts and moral dilemmas. Aim: The aim of this study was to describe patient experiences of health care professionals treatment when the patient experiences pain and when they are at the same time addicted to drugs. Method: A literature review based on ten scientific articles was made. The articles was analysed with Fribergs (2012) method where the authors searched for similarities and differences out of a phenomenon that created the results themes. Results: The results of this litterature review are presented in two main themes. In the first main theme – Obstruct in the health care professionals treatment the authors could find five sub themes. These sub themes highlights how patients experience negative treatment from the health care professionals. In the second main theme: Preconditions in the treatment the authors could find one sub theme. This sub theme highlights how patients with drug addiction experience a caring relationship and how it can evolve. Discussion: The authors have discussed the results main findings in relation to the literature review background, the authors aspects and with Katie Erikssons “caritative” theory used as a theoretical framework