Objectives: The management of depression and anxiety in primary care in the UK is not consistent with clinical guidelines. This has led to training initiatives that aim to change practice by improving the implementation of research evidence, but little is known about what constitutes effective healthcare professional training in this area. This thesis addressed this issue by identifying what determines effective training to improve the management of psychological distress in primary care. Methods: The research was undertaken in three stages. A systematic review and narrative synthesis was conducted to investigate the effects of controlled trials of training interventions delivered to primary care practitioners (PCPs) to improve the management of psychological distress on process outcomes (practitioner behaviour, knowledge, attitudes). Then two qualitative studies using semi structured interviews with PCPs (n=18) and experts in training/behaviour change (n=16) were conducted to explore their perceptions of effective healthcare professional training in this area and in general. The qualitative data were synthesised to produce recommendations for designing effective healthcare professional training to improve the primary care management of psychological distress. The research findings were used to develop a taxonomy of training intervention components for use in the design and reporting of healthcare professional training interventions in this area and more widely. Results: Forty Papers (36 studies) were included in the systematic review. The papers reviewed provide a mixed picture of the effective characteristics of training interventions. Two components: the inclusion of skills practice (role-play) and the use of theory to inform intervention content were associated with positive outcomes. Limitations with outcome measures, absence of theory and poor descriptions of the interventions made it difficult to determine effective intervention components. The analysis of the qualitative studies resulted in the development of the Perceived Effectiveness of Training (PET) framework. It incorporates five themes or core areas that underpin effective training: social interaction, credibility, relevance, information processing, and practicalities. The PET framework was used to identify effective training intervention components. Finally, the qualitative synthesis led to the development of a taxonomy of training intervention components, which was evaluated for comprehensiveness by mapping the training components to the interventions identified in the systematic review. This culminated in a 171 item taxonomy with hierarchical groupings divided into three phases: pre-training, training delivery and post training. Conclusions: Healthcare professional training to improve the management of psychological distress in primary care can be optimised for effectiveness using the PET framework to address core quality training standards. It is recommended that the taxonomy of training intervention components should be used to improve the science of healthcare professional training interventions. Further research to develop the taxonomy and to establish valid training evaluation measures would provide further scope to identify which training components can predict healthcare professional behaviour change and improve the management of psychological distress in primary care.

Healthcare professionals who practice while impaired by alcohol or drugs endanger the well-being of patients. In the workplace, the substance-impaired healthcare professional poses challenges for healthcare leaders who are responsible for the provision of safe patient care and safe work environments. The purpose of this multiple case study was to explore management strategies used by some healthcare organizational leaders to address the substance-impaired healthcare professional in the workplace. The conceptual framework for this study drew upon the legal and ethical concepts of due diligence. Data collection consisted of surveys of 40 managers and supervisors, and 3 senior leaders, semi structured interviews of executive leaders from one large hospital, and a review of company documents. A software program was used to organize the data for analysis. Five themes emerged that yielded 6 possible strategies that leaders could use to address the substance-impaired healthcare professional in the workplace: an affective healthcare business model, healthcare leader training, monitoring and surveillance systems, synergistic integration of work and life balance, and legal and ethical incident reporting. These research findings may contribute to positive organizational and social change by reducing the risk patients have from substance-impaired healthcare professionals.

Healthcare professionals are expected to know their role in patient safety. In a rural hospital, they may have different roles along with their professional role. Staff and services are fewer and the community is often part of the hospital. This can influence patient safety culture. Researchers and governing bodies have focused on developing processes to assist healthcare leaders developing their patient safety culture. Researchers and governing bodies have tended to focus on urban hospitals and then implement the same processes in rural hospitals. This strategy has not always been successful. The purpose of this study is to explore the roles and responsibilities in patient safety culture of health care professionals in rural hospitals. A systematic review, using the Joanna Briggs Institute (JBI) review process, was completed to discover how patient safety culture and rural hospitals are described and measured. Some common elements in the literature were unique characteristics of rural hospitals, leadership, error reporting and the use of patient safety culture surveys. Ethnographic methods were used to explore healthcare professional’s roles in patient safety culture in a rural hospital. Healthcare professionals describe their roles differently than described in the literature. A patient safety culture model was developed from the literature and refined with the study findings. The affinity model was developed based on the study findings from the small rural hospital and the literature. Everything they do is how rural hospital practitioners described their role in patient safety. / Thesis (Ph.D, Nursing) -- Queen's University, 2014-02-20 09:15:25.007

No description available.

Systematic Review: Healthcare professionals work in highly emotive environments and are considered to be at high risk of developing burnout due to the nature of their roles. There has been increased interest in applying mindfulness-based interventions for stress reduction in healthcare professionals. Previous reviews have tended to include a heterogeneous mix of patients, healthcare students and healthcare professionals. The inherent differences in these roles limits the conclusions that can be drawn regarding the effectiveness of mindfulness-based interventions for healthcare professionals. The current review aimed to address this gap in knowledge by reviewing mindfulness-based interventions specifically for healthcare professionals. Eight studies were included in the review. It was concluded that despite some methodological weaknesses there was promising evidence of the effectiveness of mindfulness-based interventions in reducing stress and improving well-being particularly when baseline levels of stress were high. The evidence in support of reducing burnout was less conclusive. Future studies employing larger samples using active controls and longitudinal designs will provide valuable information on the long-term efficacy of these interventions. Empirical Research Study: Several studies have identified psychological adjustment as one of the most important factors correlating with psychological distress and quality of life in people with cancer. Identifying ways to promote positive adjustment to cancer is an important goal in helping to alleviate distress and improve quality of life for this client group. This can be facilitated by identifying robust predictors of distress. Previous studies have identified a number of useful predictors, such as coping styles and psychological adjustment styles. The current study aimed to explore the predictive power of two newer constructs aligned to mindfulness-based processes: self-compassion and cognitive fusion - in determining adjustment to cancer. 114 adults with various cancer diagnoses completed the Mini Mental Adjustment to Cancer Scale, Brief COPE, the Self-Compassion Scale, Cognitive Fusion Questionnaire; and two outcome measures: the Hospital Anxiety and Depression Scale and the Functional Analysis of Cancer Therapy – General. Hierarchical multiple regression was used to explore relationships between predictor variables: mental adjustment, coping style, self-compassion and cognitive fusion, and outcome variables: distress and quality of life. Results showed that a known predictor, emotional avoidance coping and the newer construct, cognitive fusion were significant predictors of distress over and above other known predictors. Emotional avoidance coping was the only significant predictor of quality of life over and above known predictors and the newer constructs under examination. Self-compassion did not account for any significant incremental variance in distress or quality of life after controlling for other known predictors. The results of this study indicate that interventions focused on reducing cognitive fusion and emotional avoidance are warranted and potentially beneficial in reducing distress in this population.

AbstraktBakgrundKvinnlig könsstympning är, en djupt rotad tradition som drabbar över 200 miljoner kvinnor världen över idag. Detta är en olaglig handling i många länder i världen och ett brott mot de mänskliga rättigheterna. Studier har visat att dessa kvinnor upplever allvarliga hälsorisker och komplikationer både fysiskt och psykiskt. Kvinnor som är könsstympade känner sig sårbara och utlämnade i mötet med sjukvården, på grund av brist på förståelse hos sjukvårdspersonalen. Kvinnlig könsstympning är svårt att prata om. Könsstympade kvinnor riskerar att få fel diagnos vilket i sin tur leder till fortsatt ohälsa och diskriminering.SyfteSyftet med denna studie var att beskriva sjukvårdspersonals erfarenheter av att vårda kvinnor som är könsstympade.MetodDetta var en systematisk litteraturstudie med en innehållsanalys enligt Forsberg och Wengström (2013) av 3 kvalitativa och 5 kvantitativa studier.SlutsatsStudien visar att det är svårt att ge vård på lika villkor till kvinnor som är könsstympade om inte sjukvårdspersonalen ges rätt förutsättningar för att göra det. Sjukvårdspersonal känner sig utlämnade, inkompetenta, rädda och oroliga när de vårdar den könsstympade kvinnan. Studien visar att sjukvårdpersonalens avsikt och önskan att ge en jämlik och personcentrerad vård till dessa kvinnor, inte möjliggörs på de olika vårdinrättningar där de arbetar. Studien visar att det behövs tillgängliga och tydligare riktlinjer och behov av mer träning och utbildning.Nyckelord - Healthcare professional, experience, female genital mutilation.Stort tack till Emil Danehorn för hans stöd och uppmuntran genom hela detta arbete.

A prevalência baixa de aleitamento materno exclusivo em nosso país aponta a necessidade de novas abordagens, a valorização de ações efetivas na promoção, proteção e apoio ao aleitamento materno (AM), mas também o contexto de processo de trabalho em que acontecem. Nesse sentido a Rede Amamenta Brasil (RAB) se constitui de uma proposta inovadora no contexto da Atenção Básica em consonância com os atributos da Atenção Primária a Saúde (APS). A APS reúne atributos com características fundamentais nas ações quanto à garantia de adesão e continuidade do cuidado, possibilitando autonomia dos sujeitos, condição fundamental para manter a amamentação. Buscou-se avaliar as ações do processo de amamentação segundo a RAB em unidades de saúde certificadas e não certificadas, sob a perspectiva da APS, em Ribeirão Preto-SP. Estudo quantitativo, transversal, descritivo, com profissionais médicos e enfermeiros que atendem diretamente as mães/bebês em AM. Participaram 53 profissionais (25 médicos e 28 enfermeiros) pertencentes a 10 unidades de saúde. Para a coleta de dados utilizamos um roteiro de caracterização dos profissionais e o instrumento de avaliação da Atenção Primária PCA-Tool Brasil-versão profissionais, validado no Brasil. Na análise dos dados foram calculadas as medidas de tendência central (mínima, máxima e média) e dispersão (desvio padrão) e proporções foram usadas para variáveis categóricas. A maioria dos profissionais que participaram do estudo era do sexo feminino, enfermeiros, idade média de 36 anos e graduação em instituições públicas. No que se refere à prática da amamentação, os participantes consideraram como boa/satisfatória, devido aos aspectos relacionados ao profissional. As atividades mais citadas pelos profissionais foram orientação, aconselhamento, acolhimento e consulta. Aspectos relacionados ao binômio mãe/bebe foram os mais citados como dificuldades em desenvolver tais atividades, enquanto aspectos relacionados ao profissional foram os mais citados para facilidades. Nas 10 unidades de saúde, verificou-se baixo grau de orientação para a APS dos atributos Acesso e Coordenação integração de cuidados, e forte grau de orientação para a APS para Longitudinalidade, Coordenação sistemas de informação e Integralidade. As unidades certificadas pela RAB responderam mais positivamente aos atributos da APS do que as unidades não certificadas. Os enfermeiros responderam mais positivamente para os atributos Integralidade e Acesso. O grupo de participantes com treinamento para a RAB respondeu mais positivamente para os atributos Acesso, Coordenação sistemas de informação, Coordenação integração de cuidados e Integralidade do que o grupo que não recebeu este treinamento. Este estudo contribui com resultados relevantes para a melhoria na assistência às mães e a seus filhos, fornecendo subsídios que podem gerar ações de promoção, proteção e apoio ao AM visando a melhoria nos indicadores; na qualidade da APS e maior sustentabilidade dessa política / The low prevalence of exclusive breastfeeding in our country indicates the need for new approaches, the valuation of effective action in promoting, protecting and supporting breastfeeding, but also the work process context happen. In this sense the Brazilian Breastfeeding Network (BBN) constitutes an innovative proposal in the context of primary care in line with the attributes of the Primary Health Care (PHC). The PHC combines attributes with key features in the actions with regard to bond guarantee and continuity of care, enabling autonomy of individuals, fundamental condition for maintaining breastfeeding. We sought to evaluate the actions of the breastfeeding process according to BBN certified health facilities and uncertified, from the perspective of APS in Ribeirão Preto-SP. Quantitative, cross-sectional, descriptive, medical professionals and nurses that directly meet the mother/baby in breastfeeding. On that participated 53 professionals (25 doctors and 28 nurses) belonging to 10 health units. For data collection we used a script characterization of professionals and instrument evaluation of Primary PCA-Tool Professional Brazil-version validated in Brazil. In the data analysis we calculated the measures of central tendency (minimum, maximum and average) and dispersion (standard deviation) and proportions were used for categorical variables. Most of the professionals who participated from the study were female, nurses, average age of 36 years old and degree in public institutions. As regards the practice of breastfeeding, the participants considered as good/satisfactory due to the aspects related to the professional. The most cited professional activities were guidance, counseling, care and consultation. Aspects related for both the mother/baby were the most cited as difficulties in developing such activities as aspects related from professional were the most mentioned facilities. In the 10 health units, there was a low degree of orientation for PHC attributes Access and coordination integration of care, and high degree of orientation for PHC to longitudinality, coordination of information and Completeness systems. The units certified by BBN responded more positively from the PHC attributes of the not certified units. Nurses responded more positively to the Completeness attributes and first contact access. The group of participants with training for BBN responded more positively to access attributes, coordination of information systems, coordination and integration of care Completeness more than the group that did not receive this training. This study provides relevant results to improve care for mothers and their children by providing subsidies that can generate promotion, protection and breastfeeding support aimed at improving the indicators; the quality of PHC and greater sustainability of this policy

Background: An Implantable Cardioverter Defibrillator (ICD) is a technical device used in the treatment of ventricular arrhythmias. After the implantation of an ICD the entire life situation can be affected with psychological and social consequences for the patient and his/her next of kin. The healthcare professionals play a vital role in providing educational information, support, and technical follow-up of the device. During recent years more and more hospitals have introduced a more team based organisation where the physicians collaborate with specialised ICD nurses. Aim: The overall aim of the thesis was to explore how patients with an ICD experienced their life situation and howhealthcare professionals described their experiences of delivering care to ICD patients. Methods: The design was descriptive, combining both quantitative and qualitative approaches, and the data was collected from Sweden and the USA. The Uncertainty of Illness Scale (MUIS-C) and Quality of life Index (QLI) instruments were used to determine the level of uncertainty and satisfaction with life (I), in-depth interviews with a phenomenographic approach was used to describe how Swedish and US patients living with an ICD conceived their life situation (II, III) and how healthcare professionals’ experienced delivering care to patients with an ICD, (IV). Finally, to explore clinical aspects of ICD care in Sweden, the Delivery of ICD Questionnaire (DOIQ) was used to describe the healthcare professionals’ experiences and a content analysis was used to describe the written educational information material provided to patients (V). Results: There were no differences in uncertainty between pre and post ICD implantation either in Swedish or the US patients. Satisfaction with life was significantly higher among US patients compared to Swedish patients both before and after ICD implantation within the health-functioning, socio-economic and psychological-spiritual domains. The Swedish ICD patients experienced a significantly higher satisfaction with life within the socioeconomic domain after 3 months. (I). The patients felt safe in having an ICD implanted, but the conceptions varied from seeing the device as a life saver to being worried about what could happen. Gratitude at having an ICD varied from happiness at being alive to something that was alien and disturbed the patient. Being more or less dependent included how patient experienced feelings from well-being to grief. Having a network varied from having sufficient support to loneliness. Having a belief in the future ranged from having confidence to look forward to resignation. Gaining awareness described patients’ adaptation to living with an ICD and limitations due to the ICD (II). The patients also underwent a transition from becoming aware of the restriction in the life situation through a process of adaption and having trust in the ICD. This phase was followed by a reorientation phase where they adapted to their life situation and the patient and his/her family regained of their lives (III). The healthcare professionals strove to provide competent and individualised care and infuse confirmation to the patients in form of information, education and support. They gave the patients tools to handle their life situation, through existential support and mediating security (IV). Half of the hospitals had nurse-based clinic and others planned to introduce them. Three hospitals performed follow-up in the form of remote home monitoring. The nurse had specific ICD education from ICD companies and/or various university courses. In the educational information material the biophysical dimensions dominated while the emotional dimension was scarcely described, and the spiritual-existential was not referred to at all (V). Conclusions: This thesis offers a further contribution to the scholarly discussion about the relationship between technology and human existence and how to cope with this transition. Our studies revealed that the embodiment of the ICD reflects a merger of experiences about its presence and potential from both patients’ and healthcare professionals’ perspective. This research hopefully encourages healthcare professionals to carefully reflect on what it is like to live with an ICD and to consider practice improvement for the patients’ and the next of kin.

A prevalência baixa de aleitamento materno exclusivo em nosso país aponta a necessidade de novas abordagens, a valorização de ações efetivas na promoção, proteção e apoio ao aleitamento materno (AM), mas também o contexto de processo de trabalho em que acontecem. Nesse sentido a Rede Amamenta Brasil (RAB) se constitui de uma proposta inovadora no contexto da Atenção Básica em consonância com os atributos da Atenção Primária a Saúde (APS). A APS reúne atributos com características fundamentais nas ações quanto à garantia de adesão e continuidade do cuidado, possibilitando autonomia dos sujeitos, condição fundamental para manter a amamentação. Buscou-se avaliar as ações do processo de amamentação segundo a RAB em unidades de saúde certificadas e não certificadas, sob a perspectiva da APS, em Ribeirão Preto-SP. Estudo quantitativo, transversal, descritivo, com profissionais médicos e enfermeiros que atendem diretamente as mães/bebês em AM. Participaram 53 profissionais (25 médicos e 28 enfermeiros) pertencentes a 10 unidades de saúde. Para a coleta de dados utilizamos um roteiro de caracterização dos profissionais e o instrumento de avaliação da Atenção Primária PCA-Tool Brasil-versão profissionais, validado no Brasil. Na análise dos dados foram calculadas as medidas de tendência central (mínima, máxima e média) e dispersão (desvio padrão) e proporções foram usadas para variáveis categóricas. A maioria dos profissionais que participaram do estudo era do sexo feminino, enfermeiros, idade média de 36 anos e graduação em instituições públicas. No que se refere à prática da amamentação, os participantes consideraram como boa/satisfatória, devido aos aspectos relacionados ao profissional. As atividades mais citadas pelos profissionais foram orientação, aconselhamento, acolhimento e consulta. Aspectos relacionados ao binômio mãe/bebe foram os mais citados como dificuldades em desenvolver tais atividades, enquanto aspectos relacionados ao profissional foram os mais citados para facilidades. Nas 10 unidades de saúde, verificou-se baixo grau de orientação para a APS dos atributos Acesso e Coordenação integração de cuidados, e forte grau de orientação para a APS para Longitudinalidade, Coordenação sistemas de informação e Integralidade. As unidades certificadas pela RAB responderam mais positivamente aos atributos da APS do que as unidades não certificadas. Os enfermeiros responderam mais positivamente para os atributos Integralidade e Acesso. O grupo de participantes com treinamento para a RAB respondeu mais positivamente para os atributos Acesso, Coordenação sistemas de informação, Coordenação integração de cuidados e Integralidade do que o grupo que não recebeu este treinamento. Este estudo contribui com resultados relevantes para a melhoria na assistência às mães e a seus filhos, fornecendo subsídios que podem gerar ações de promoção, proteção e apoio ao AM visando a melhoria nos indicadores; na qualidade da APS e maior sustentabilidade dessa política / The low prevalence of exclusive breastfeeding in our country indicates the need for new approaches, the valuation of effective action in promoting, protecting and supporting breastfeeding, but also the work process context happen. In this sense the Brazilian Breastfeeding Network (BBN) constitutes an innovative proposal in the context of primary care in line with the attributes of the Primary Health Care (PHC). The PHC combines attributes with key features in the actions with regard to bond guarantee and continuity of care, enabling autonomy of individuals, fundamental condition for maintaining breastfeeding. We sought to evaluate the actions of the breastfeeding process according to BBN certified health facilities and uncertified, from the perspective of APS in Ribeirão Preto-SP. Quantitative, cross-sectional, descriptive, medical professionals and nurses that directly meet the mother/baby in breastfeeding. On that participated 53 professionals (25 doctors and 28 nurses) belonging to 10 health units. For data collection we used a script characterization of professionals and instrument evaluation of Primary PCA-Tool Professional Brazil-version validated in Brazil. In the data analysis we calculated the measures of central tendency (minimum, maximum and average) and dispersion (standard deviation) and proportions were used for categorical variables. Most of the professionals who participated from the study were female, nurses, average age of 36 years old and degree in public institutions. As regards the practice of breastfeeding, the participants considered as good/satisfactory due to the aspects related to the professional. The most cited professional activities were guidance, counseling, care and consultation. Aspects related for both the mother/baby were the most cited as difficulties in developing such activities as aspects related from professional were the most mentioned facilities. In the 10 health units, there was a low degree of orientation for PHC attributes Access and coordination integration of care, and high degree of orientation for PHC to longitudinality, coordination of information and Completeness systems. The units certified by BBN responded more positively from the PHC attributes of the not certified units. Nurses responded more positively to the Completeness attributes and first contact access. The group of participants with training for BBN responded more positively to access attributes, coordination of information systems, coordination and integration of care Completeness more than the group that did not receive this training. This study provides relevant results to improve care for mothers and their children by providing subsidies that can generate promotion, protection and breastfeeding support aimed at improving the indicators; the quality of PHC and greater sustainability of this policy

Bakgrund: Självskadebeteende är ett vida utbrett problem världen över och år 2016 vårdades omkring 6900 personer i Sverige för självskadebeteende. Orsakerna till självskadebeteende kan skilja sig åt mellan olika personer och kan bland annat bero på trauma, depression, ångest eller misshandel. Vårdpersonalen kommer ofta i kontakt med patienter som skadar sig själva, där vårdpersonalens föreställningar och attityder skulle kunna inverka på bemötandet och vården av dessa patienter.  Syfte: Belysa vårdpersonalens erfarenheter av att vårda patienter med självskadebeteende inom den psykiatriska vården. Metod: Litteraturstudie med integrativ ansats. Tolv studier inkluderades med antingen en kvantitativ eller kvalitativ ansats, som ligger till grund för resultatet. Analysen genomfördes med stöd av Whittemore och Knafl (2005) i fem steg. Resultat: Analysen genererade fyra kategorier: känslomässigt utmanande, svårigheter att vara professionell och tillämpning av olika interventioner, samt, förutsättningar för ett professionellt förhållningssätt. Slutsats: Föreliggande studie belyste att vården var känslomässigt umanande och visade på brister i bemötande, kunskaper, vård och behandling gällande patienter med självskadebeteende. Bristerna skapade missförstånd och konfliker som påverkade vården negativt, samt ökade patientens självskadebeteende. Genom föreliggande studie kan det antas att en utveckling av vården kring patienter med självskadebeteende kan resultera i ett gott bemötande, samt en gynsam vård och behandling genom utbildning av vårdpersonalen, införande av en alliansbaserad eller lösningsfokuserad vård, samt upprättande av vårdplaner med återinläggning vid försämrat mående. / Background: Self-harm is a worldwide problem and the year 2016 6900 people were admitted to hospital care in Sweden because of their self-harm. The reasons to self-harm vary between people and the cause can be trauma, depression, anxiety or abuse. Healthcare professionals are regularly exposed to patients who self-harm, where the professionals beliefs and attitudes can impact on the care and treatment the patient get. Aim: Highlight the healthcare professionals experience in caring for patients with self-harm in psychiatric care. Method: Literature review with integrative design. Including twelve studies with qualitative or quantitative design, for the foundation of the results. Analysis where conducted in support of Whittemore and Knafl (2005) in five steps. Results: The analysis generated four categories, Emotionally unmanageable, Difficulties in being professional, Application of various interventions, and Presumption for a professional approach Conclusion: The present study highlighted that the care was emotionally unmanageable and showed deficiencies in attending, knowledge, care and treatment regarding patients with self-harm. The deficiencies created misunderstandings and conflicts that negatively affected the care, and increased the patient's self-harm. By the present study, it can be assumed that a development of care around patients with self-harm can result in a good response, as well as favorable care and treatment through training of the healthcare staff, the introduction of an alliance-based or solution-focused care, and the establishment of care plans with re-admission in the event of deterioration.