Hand-washing compliance was examined by thematic analysis of focus group discussions in nurses, mothers and children. Perceptions in these groups were identical, with the purpose of hand-cleansing seen as self-protection from infection. This assessment is not grounded in microbiology, but is strongly driven by emotion. Two types of hand-cleansing (???hand-hygiene???) behaviour were identified: (a) ???inherent??? hand-washing. This behaviour is taught by mothers to their children early in life. The behaviour occurs when hands have been visibly or ???emotionally??? soiled or feel sticky, and drives most hand-hygiene undertaken in the community; and (b) ???elective??? hand-hygiene, which occurs in the absence of perceived threat. As patient contact by healthcare workers is frequently assessed by healthcare workers as not posing risk, healthcare workers omit much elective hand-hygiene, leading to potential cross-infection. Modelling responses of 754 nurses on the Theory of Planned Behaviour for these two hand-hygiene behaviours in the healthcare setting explained 64% of elective hand-hygiene and 76% of inherent hand-washing intention. Translation of hand-washing behaviour patterns of the community into the healthcare setting is the predominant driver of all hand-hygiene in healthcare workers. In-hospital elective hand-hygiene behaviour is further significantly predicted by belief in the benefit from the activity, peer pressure and role modelling of senior physicians and administrators. For inherent hand-washing intent, only attitudes and peer behaviour are predictive. Time constraints, commonly implicated to explain poor compliance, are important mostly to elective hand-hygiene. Reduction in necessary effort by introducing an alcohol-based hand rub without a concomitant behavioural modification program will therefore have only minimal impact. Further components essential to hand-hygiene programs have been identified. These accord with the outcomes of the modelling and include the need for institutional recognition of hand-hygiene as a priority, overt clinician leadership support, and reinforcement of purpose by both education and performance feedback. In the long-term, society would be best served by altering the entire paradigm of hand-hygiene behaviour with nationwide campaigns based on principles of social marketing. Ideally, hand-hygiene should be taught by mothers and reinforced in early education programs as behaviour that is self-protective but with the defining theme: ???clean your hands, and protect others, not just yourself.???

The aim of this thesis was to assess the effects of providing community education and training to healthcare workers to improve community response, healthcare and support for rape survivors in the Kilombero district of Tanzania. The overall design of the project was to begin with an exploratory study (Paper I) to establish the community’s perceptions towards sexual violence and their perceived recommendations to address this issue. Using a structured questionnaire, the community’s knowledge and attitudes towards sexual violence were determined along with their associations with demographic factors (Paper II). Papers III and IV assessed the effect of healthcare workers’ training and a community information package, respectively, using a controlled quasi-experimental design. The findings highlighted the social norms and variety of barriers that impacted negatively on the survivors’ care-seeking from support services and health outcomes. Increasing age and higher education were associated with better knowledge and less accepting attitudes towards sexual violence. Training on the management of sexual violence was effective in improving healthcare workers’ knowledge and practice but not attitude. Knowledge on sexual violence among the communities in the intervention and comparison areas increased significantly over the study period; from 57.3% to 80.6% in the intervention area and from 55.5% to 71.9% in the comparison area. In the intervention area, women had significantly less knowledge than men at baseline (53% Vs 64%, p<.001).There was a reduction, though not significantly, in acceptance attitudes from 28.1% to 21.8% in favor of women. In conclusion, the current intervention provides evidence that healthcare workers’ training and community education is effective in improving knowledge but not attitudes towards sexual violence. The findings have potential implications for interventions aimed at preventing and responding to violence. The broader societal norms that hinder rape disclosure need to be re-addressed.

abstract: Vaccinations are important for preventing influenza infection. Maximizing vaccination uptake rates (80-90%) is crucial in generating herd immunity and preventing infection incidence. Vaccination of healthcare professionals (HCP) against influenza is vital to infection control in healthcare settings, given their consistent exposure to high-risk patients like: those with compromised immune systems, children, and the elderly (Johnson & Talbot, 2011). Though vaccination is vital in disease prevention, influenza vaccination uptake among HCP is low overall (50% on average) (Pearson et al., 2006). Mandatory vaccination policies result in HCP influenza vaccination uptake rates substantially higher than opt-in influenza vaccination campaigns (90% vs. 60%). Therefore, influenza vaccination should be mandatory for HCP in order to best prevent influenza infection in healthcare settings. Many HCP cite individual objections to influenza vaccination rooted in personal doubts and ethical concerns, not best available scientific evidence. Nevertheless, HCP ethical responsibility to their patients and work environments to prevent and lower influenza infection incidence overrules such individual objections. Additionally, mandatory HCP influenza vaccination policies respect HCP autonomy via including medical and religious exemption clauses. While vaccination as a prevention method for influenza is logically sound, individuals’ actions are not always rooted in logic. Therefore, I analyze HCP perceptions and actions toward influenza vaccination in an effort to better explain low HCP uptake rates of the influenza vaccine and individual objections to influenza vaccination. Such analysis can aid in gaining HCP trust when implementing mandatory HCP influenza vaccination policies. In summary, mandatory HCP influenza vaccination policies are ethically justified, effective, scientifically-supported method of maximizing HCP influenza vaccine uptake and minimizing the spread of the influenza virus within healthcare settlings. / Dissertation/Thesis / Masters Thesis Biology 2016

The Criminal Offence of Failure to Provide Assistance in the Context of Healthcare Abstract The diploma thesis deals with the specifics of the criminal offence of failure to provide assistance which arise when the perpetrator is a healthcare worker. The thesis analyses the conditions under which the obligation to provide assistance arises from affiliation to a healthcare profession applies, and the content of this obligation. Given that the exercise of a healthcare profession is an activity significantly regulated by non-criminal regulations, the obligation in question is interpreted in the context of the entire legal order. The initial proposition is that the obligation in question is narrower than literal interpretation of criminal law provisions may imply, if interpreted in isolation. Contrary to the general assumption, both the range of persons to whom the provision applies, as well as the conditions under which the obligation arises, and quality of the required level of the assistance, are limited. In its first part, the paper first deals with the definition of key terms (with focus on the concept of a healthcare worker) and defines the basic obligations that the legal system imposes on healthcare workers. The subsequent part is devoted to explications of the criminal offence of failure to provide...

1 Criminal liability in healthcare with focus on an analysis of Czech and Slovak court rulings Abstract This master's thesis deals with the issue of criminal liability of healthcare workers. The aim of this thesis is to create a comprehensive overview of the Czech legislation of the relevant part of criminal law and individual institutes of medical law and to present related case law. Slovak legislation is used for comparison. The thesis consists of six parts, the first chapter is focused on the legal regulation of medical law and its international and national sources. It also deals with types of legal liability of healthcare professionals such as civil, labour, administrative and disciplinary liability. The second and one of the most extensive chapters approaches criminal liability and its necessary conditions. It describes the current concept of crime in more detail as well as the analysis of the necessity of the principle of subsidiarity of criminal repression. It also includes legal regulation of criminal liability of legal entities. The third chapter is dedicated to a cardinal concept - lex artis as an appropriate level of expertise, which contains a number of obligations that every healthcare worker must comply with. The process of proving criminal liability of medical workers in criminal proceedings...

The thesis focuses on the attitudes of health care professionals in intensive care to patients after a suicide attempt. First chapter deals with suicide issues in detail, outlines sources of emotional problems and stress which can health care professionals encounter. The next chapter talks about burnout syndrome. The research part surveys the attitudes of healthcare professionals to suicidal patients, investigates the level and effectiveness of the awareness of health care professionals in the psychiatric and psychological issues and its impact on their attitudes, assesses awareness of burnout syndrome and eventual respondent's own experiences with this condition and evaluates the degree of mental and emotional demands of care of suicidal patients. On the qualitative research in the form of semi-structured interviews participated 20 respondents. We found that the attitudes of health care professionals to patients after a suicide attempt are rather positive. A surprising finding was that 70 % of respondents didn't receive any seminar or course focused on topics mentioned above, and that none of them are actively interested in the specific issue of psychiatric intensive care of patients with somatic disease and neither the issue of suicides. A disturbing finding was that 85 % of respondents observed...

Introduktion: Övervikt är stigmatiserat både i samhället och inom vården. Förutfattade meningar om ohälsosamma levnadsvanor relaterat till högt Body Mass Index (BMI) leder till att överviktiga personer kan bli diskriminerade av vården. Detta kan göra att dessa individer undviker att söka vård. Kunskap om överviktiga personers upplevelse av vården kan leda till prevention av sjukdom och lidande.  Syfte: Syftet var att beskriva hur personer med övervikt upplever bemötandet av vårdpersonal. Metod: Litteraturöversikt med deskriptiv design. Elva artiklar identifierades i databaserna CINAHL och PubMed. Samtliga artiklar hade en kvalitativ metodik. Granskningsmall användes vid kvalitetsgranskning och innehållsanalys genomfördes.  Resultat: Fem kategorier samt tre underkategorier identifierades. Kategorier där de positiva mötena placerades handlade om personcentrerad vård samt en god relation mellan patient och sjuksköterska. De kategorierna som berörde negativa vårdmöten beskrev bristerna i hur vårdpersonalen diskuterar vikt samt hur det finns förutfattade meningar och fördomar inom vården. Resultatet visade också att överviktiga personer ständigt utsätts för orättvis behandling.  Slutsats: Överviktiga personer beskrev att de upplever majoriteten av vårdmöten som negativa och diskriminerande.  Nyckelord: Bemötande, patientupplevelse, vårdpersonal, överviktiga / Introduction: Being overweight is stigmatized both in society and in healthcare. Preconceived notions about an unhealthy lifestyle related to high Body Mass Index (BMI) lead to overweight people being discriminated by healthcare workers. This could cause these individuals to avoid seeking care. Knowledge of overweight people's experience of health care can lead to prevention of disease and suffering. Aim: The aim was to describe how individuals with obesity experience the treatment of healthcare workers.  Method: Literature review with descriptive design. Eleven articles were identified in databases CINAHL and PubMed. All articles had a qualitative methodology. A review template was used for quality review and content analysis was accomplished. Result: Five categories and three subcategories were identified. Categories in which the positive encounters were placed referred to person-centered care and a good relationship between patient and nurse. The categories that illustrated negative care encounters shed light on the lack of how the care staff discuss weight and how there are preconceived notions and prejudices within healthcare. The result also showed that overweight people are constantly subjected to unfair treatment. Conclusion: Overweight people described that they experienced the majority of healthcare encounters as negative and discriminatory. Keywords: Experience, healthcare worker, nurse-patient relation, obesity

Many healthcare providers are at risk of compassion fatigue and burnout from prolonged occupational stress, which can adversely affect workers, patients, and the healthcare system. This qualitative research project inquired into eight female healthcare providers’ experiences of sustaining their own wellbeing. Participants (27 to 60 years old) engaged in semi-structured interviews and participant observation of a self-care activity. Themes were found relating to the variety of self-care strategies used, challenges and supports in the work context, and the important role of authenticity in health promotion practice. Self-care strategies included: social support, pacing, taking breaks, exercise, nutrition, emotional self-care, adapting self-care routines over time, goal setting and prioritization. Supports to wellbeing included: flexible scheduling, taking personal responsibility for wellness, workplace wellness programs, and positive relationships with supervisors, colleagues, friends and family. This arts-informed research project is presented in graphic novel form to enhance its accessibility.

Many healthcare providers are at risk of compassion fatigue and burnout from prolonged occupational stress, which can adversely affect workers, patients, and the healthcare system. This qualitative research project inquired into eight female healthcare providers’ experiences of sustaining their own wellbeing. Participants (27 to 60 years old) engaged in semi-structured interviews and participant observation of a self-care activity. Themes were found relating to the variety of self-care strategies used, challenges and supports in the work context, and the important role of authenticity in health promotion practice. Self-care strategies included: social support, pacing, taking breaks, exercise, nutrition, emotional self-care, adapting self-care routines over time, goal setting and prioritization. Supports to wellbeing included: flexible scheduling, taking personal responsibility for wellness, workplace wellness programs, and positive relationships with supervisors, colleagues, friends and family. This arts-informed research project is presented in graphic novel form to enhance its accessibility.

Mémoire de fin d'études de maitrise réalisé par l'étudiante Clerveau Vanessa, sous la direction du professeur Denis Jean-Louis et Johri Mira pour l'obtention de la maitrise en administration des services de santé, option santé mondiale / La pénurie de main-d’œuvre en santé représente une problématique de santé mondiale et sa gestion par les pays de destination pourrait entraîner de graves conséquences sur les systèmes de santé des pays d’origine. Afin d’en atténuer certaines, l’Organisation mondiale de la santé (OMS) a créé le Code de pratique mondiale. Nous avons exploré le potentiel des accords bilatéraux proposés par ce Code dans le processus de migration des infirmiers haïtiens au Québec. Une analyse qualitative exploratoire a été menée avec des données de la littérature grise, scientifique et du grand public, ainsi que des entrevues semi-dirigées d’experts d’Haïti et de Québec selon un échantillon raisonné, au moyen d’un guide d’entrevue. Elles ont été transcrites manuellement, enregistrées sur Teams et analysées sur Nvivo. La formation des infirmiers haïtiens nécessaire au renouvellement de la main-d’œuvre, le renforcement des capacités du système de santé haïtien, le transfert de connaissances et de compétences, et l’intégration du personnel infirmier haïtien font partie des éléments clés évoqués par les experts en vue d’explorer le potentiel des accords bilatéraux. Haïti et le Québec devraient désigner des éléments nécessaires définissant clairement les besoins respectifs de leur système de santé. Cependant, la mise en œuvre pourrait être compromise par les enjeux d’équité, de dynamique, de pouvoir et d’instabilité en Haïti. Les accords bilatéraux dans le processus de migration des infirmiers haïtiens pourraient servir de levier d’amélioration des politiques de santé publique et de la coopération internationale entre Haïti et le Québec. / The shortage of healthcare workers is a global health issue, and its management by destination countries could impact healthcare systems in countries of origin. The World Health Organization (WHO) has taken steps to mitigate some of these issues by implementing the Global Code of Practice. We explored the potential of the bilateral agreements proposed by this Code in the migration process of Haitian nurses to Quebec. An exploratory qualitative analysis was conducted using data from the grey, scientific, and public literature, as well as semi-structured interviews with experts from Haiti and Quebec based on a purposive sample, using an interview guide. They were manually transcribed, recorded on Teams, and analyzed on Nvivo. The training of Haitian nurses needed to renew the workforce, capacity building of the Haitian healthcare system, transfer of knowledge and skills, and integration of Haitian nurses were among the key elements raised by experts to explore the potential of bilateral agreements. Haiti and Quebec should identify the necessary elements that clearly define the respective needs of their healthcare systems. However, implementation could be compromised by issues of equity, dynamics, power, and instability in Haiti. Bilateral agreements in the Haitian nurse migration process could serve as a lever for improving public health policies and international cooperation between Haiti and Quebec.