'This is uncharted water for all of us': challenges anticipated by hospital clinicians when voluntary assisted dying becomes legal in Victoria

2020 ◽  
Vol 44 (3) ◽  
pp. 399 ◽  
Author(s):  
Rosalind McDougall ◽  
Barbara Hayes ◽  
Marcus Sellars ◽  
Bridget Pratt ◽  
Anastasia Hutchinson ◽  
...  
Keyword(s):  
Health Service ◽  
Online Survey ◽  
Hospital Setting ◽  
Organisational Culture ◽  
Qualitative Description ◽  
Health Staff ◽  
Assisted Dying ◽  
Text Data ◽  
Start Date ◽  
The Individual

ObjectiveThe aim of this study was to identify the challenges anticipated by clinical staff in two Melbourne health services in relation to the legalisation of voluntary assisted dying in Victoria, Australia. MethodsA qualitative approach was used to investigate perceived challenges for clinicians. Data were collected after the law had passed but before the start date for voluntary assisted dying in Victoria. This work is part of a larger mixed-methods anonymous online survey about Victorian clinicians’ views on voluntary assisted dying. Five open-ended questions were included in order to gather text data from a large number of clinicians in diverse roles. Participants included medical, nursing and allied health staff from two services, one a metropolitan tertiary referral health service (Service 1) and the other a major metropolitan health service (Service 2). The data were analysed thematically using qualitative description. ResultsIn all, 1086 staff provided responses to one or more qualitative questions: 774 from Service 1 and 312 from Service 2. Clinicians anticipated a range of challenges, which included burdens for staff, such as emotional toll, workload and increased conflict with colleagues, patients and families. Challenges regarding organisational culture, the logistics of delivering voluntary assisted dying under the specific Victorian law and how voluntary assisted dying would fit within the hospital’s overall work were also raised. ConclusionsThe legalisation of voluntary assisted dying is anticipated to create a range of challenges for all types of clinicians in the hospital setting. Clinicians identified challenges both at the individual and system levels. What is known about the topic?Voluntary assisted dying became legal in Victoria on 19 June 2019 under the Voluntary Assisted Dying Act 2017. However there has been little Victorian data to inform implementation. What does this paper add?Victorian hospital clinicians anticipate challenges at the individual and system levels, and across all clinical disciplines. These challenges include increased conflict, emotional burden and workload. Clinicians report concerns about organisational culture, the logistics of delivering voluntary assisted dying under the specific Victorian law and effects on hospitals’ overall work. What are the implications for practitioners?Careful attention to the breadth of staff affected, alongside appropriate resourcing, will be needed to support clinicians in the context of this legislative change.

An Exploration of the Unmet Demand forHome Birth in Ireland

2015 ◽  
Vol 5 (1) ◽  
pp. 20-32 ◽  
Author(s):  
Eileen Kenny ◽  
Colm OBoyle
Keyword(s):  
Health Service ◽  
Online Survey ◽  
Hospital Setting ◽  
Home Birth ◽  
Online Questionnaire ◽  
Health Service Executive ◽  
Unmet Demand ◽  
Community Midwives ◽  
High Level ◽  
Planned Home Birth

PURPOSE: The home birth rate in Ireland is less than 0.5%. There is no formal record of the demand for home birth; however, it is suggested that it exceeds availability by as much as tenfold. This study sought the experiences of women who had tried but were unsuccessful in securing a midwife-attended, planned home birth in Ireland in the years 2009–2013.STUDY DESIGN: An online questionnaire was made available over an 8-week period in the summer of 2013.RESULTS: Sixty-two women responded. Three main reasons were identified for refusal of home birth: “unsuitability for home birth,” “unavailability of a midwife,” and “distance from the midwife.” The Dublin regions’ high level of unmet demand is consistent with its high population density. December and other holiday periods were reported as particularly difficult times to access a midwife. Eighty percent of women eventually gave birth in a hospital setting, whereas 15% gave birth outside a hospital setting without a midwife in attendance. Five percent of women accessed a planned home birth elsewhere.DISCUSSION: Online survey is a methodology that is unable to quantify unmet demand for home birth. This exploratory study has however confirmed the inequity of the home birth service, even for those fully eligible. The choice made by some multiparous women to birth at home unattended, even in the knowledge of risk criteria, is a concern and remains unaddressed by the Irish Health Service Executive.CONCLUSION: Health Service Executive dependence on self-employed community midwives (SECMs) to deliver their “national” home birth service means that demand for home birth is greater than can be supplied. This research highlights the need for the inclusion of requests for home birth in their audit of services. Capacity building of community midwifery in Ireland is recommended, with recruitment and support of SECMs identified as a priority.

scholarly journals Measuring and Assessing Healthcare Organisational Culture in the England’s National Health Service: A Snapshot of Current Tools and Tool Use

Healthcare ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 127
Author(s):  
Dominic Simpson ◽  
Sharon Hamilton ◽  
Robert McSherry ◽  
Rebecca McIntosh
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Online Survey ◽  
Response Rate ◽  
Healthcare Delivery ◽  
Organisational Culture ◽  
Determining Factors ◽  
The Impact ◽  
English National Health

Healthcare Organisational Culture (OC) is a major contributing factor in serious failings in healthcare delivery. Despite an increased awareness of the impact that OC is having on patient care, there is no universally accepted way to measure culture in practice. This study was undertaken to provide a snapshot as to how the English National Health Service (NHS) is currently measuring culture. Although the study is based in England, the findings have potential to influence the measurement of healthcare OC internationally. An online survey was sent to 234 NHS hospital trusts, with a response rate of 35%. Respondents who completed the online survey, on behalf of their representative organisations, were senior clinical governance leaders. The findings demonstrate that the majority of organisations, that responded, were actively measuring culture. Significantly, a wide variety of tools were in use, with variable levels of satisfaction and success. The majority of tools had a focus on patient safety, not on understanding the determining factors which impact upon healthcare OC. This paper reports the tools currently used by the respondents. It highlights that there are deficits in these tools that need to be addressed, so that organisations can interpret their own culture in a standardised, evidence-based way.

scholarly journals An Analysis of Sport-Specific Pain Symptoms through Inter-Individual Training Differences in CrossFit

Sports ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 68
Author(s):  
Maria Bernstorff ◽  
Norman Schumann ◽  
Nader Maai ◽  
Thomas Schildhauer ◽  
Matthias Königshausen
Keyword(s):  
Online Survey ◽  
Personal Information ◽  
Gluteus Medius ◽  
Single Type ◽  
Training Methods ◽  
Personal Training ◽  
Muscle Groups ◽  
Small Muscle ◽  
The Individual ◽  
Pain Symptoms

Background: CrossFit is one of the fastest growing “high-intensity functional training” methods in recent years. Due to the very demanding motion sequences and high loads, it was initially assumed that there was an extremely high risk of injury. However, studies have shown that injury rates are given between 0.74–3.3 per 1000 h of training, which is not higher than in other individual sports such as weightlifting. The purpose of the study was to estimate the type of pain symptoms that are directly related to CrossFit, to estimate the frequency of injuries that occur within a population of recreational CrossFit athletes, and, finally, to identify the factors influencing the frequency of pain during CrossFit training. Methods: A total of 414 active CrossFit athletes completed an online survey inclusive of 29 items focusing on individual physical characteristics and training behavior, as well as simultaneous or previously practiced sports. Results: There was a significantly higher proportion of knee pain in athletes who had previously or simultaneously played another sport (p = 0.014). The duration, intensity, or type of personal training plan developed, along with personal information such as age, gender, or BMI, had no significant influence on the pain data. We could not find any significant variance between the groups that we formed based on the differently stated one-repetition max (RMs). There were differences in athletes who stated that they did specific accessory exercises for small muscle groups. Above all, athletes performing exercises for the hamstrings and the gluteus medius indicated fewer pain symptoms for the sacro-iliac joint (SIJ)/iliac and lower back locations. Conclusions: It is important not to see CrossFit as a single type of sport. When treating a CrossFit athlete, care should be taken to address inter-individual differences. This underlines the significant differences of this study between the individual athletes with regard to the ability to master certain skills or their previous sporting experience. The mere fact of mastering certain exercises seems to lead to significantly more pain in certain regions. In addition, there seems to be a connection between the previous or simultaneous participation in other sports and the indication of pain in the knee region.

Living With Both a Total Ankle Replacement and an Ankle Fusion: A Qualitative Study From the Patients’ Perspective

2021 ◽  
pp. 107110072110044
Author(s):  
Catherine Conlin ◽  
Ryan M. Khan ◽  
Ian Wilson ◽  
Timothy R. Daniels ◽  
Mansur Halai ◽  
...  
Keyword(s):  
Hospital Setting ◽  
Case Series ◽  
Total Ankle Replacement ◽  
Qualitative Description ◽  
Level Of Evidence ◽  
Foot Placement ◽  
Advantages And Disadvantages ◽  
Ankle Fusion ◽  
Ankle Replacement ◽  
Patient Reported

Background: Total ankle replacement (TAR) and ankle fusion are effective treatments for end-stage ankle arthritis. Comparative studies elucidate differences in treatment outcomes; however, the literature lacks evidence demonstrating what outcomes are important to patients. The purpose of this study was to investigate patients’ experiences of living with both a TAR and ankle fusion. Methods: This research study used qualitative description. Individuals were selected from a cohort of patients with TAR and/or ankle fusion (n = 1254). Eligible patients were English speaking with a TAR and contralateral ankle fusion, and a minimum of 1 year since their most recent ankle reconstruction. Surgeries were performed by a single experienced surgeon, and semistructured interviews were conducted by a single researcher in a private hospital setting or by telephone. Ankle Osteoarthritis Scale (AOS) scores, radiographs, and ancillary surgical procedures were collected to characterize patients. Themes were derived through qualitative data analysis. Results: Ten adults (8 men, 2 women), ages 59 to 90 years, were included. Average AOS pain and disability scores were similar for both surgeries for most patients. Participants discussed perceptions of each reconstructed ankle. Ankle fusions were considered stable and strong, but also stiff and compromising balance. TARs were considered flexible and more like a “normal ankle,” though patients expressed concerns about their TAR “turning” on uneven ground. Individuals applied this knowledge to facilitate movement, particularly during a first step and transitioning between positions. They described the need for careful foot placement and attention to the environment to avoid potential challenges. Conclusion: This study provides insight into the experiences of individuals living with a TAR and ankle fusion. In this unusual but limited group of patients, we found that each ankle reconstruction was generally perceived to have different characteristics, advantages, and disadvantages. Most participants articulated a preference for their TAR. These findings can help clinicians better counsel patients on expectations after TAR and ankle fusion, and improve patient-reported outcome measures by better capturing meaningful outcomes for patients. Level of Evidence: Level IV, case series.

scholarly journals Role of attitude in nurses’ responses to requests for assisted dying

2020 ◽  
pp. 096973302096677
Author(s):  
Michael Wilson ◽  
Marie Wilson ◽  
Suzanne Edwards ◽  
Lynette Cusack ◽  
Richard Wiechula
Keyword(s):  
Online Survey ◽  
Rare Event ◽  
Control Beliefs ◽  
Assisted Dying ◽  
Cross Sectional ◽  
Assisted Death ◽  
Institutional Ethics ◽  
The Face ◽  
Generalised Linear Modelling ◽  
And Control

Background: Legal assisted dying is a rare event, but as legalisation expands, requests for it will likely increase, and the nurse most often receives the informal, initial request. Objectives: To assess the effects of attitude in interaction with normative and control beliefs on an intention to respond to a request for legal assisted dying. Ethical considerations: The study had the lead author’s institutional ethics approval, and participants were informed that participation was both anonymous and voluntary. Methodology: This was a cross-sectional correlational study of 377 Australian registered nurses who completed an online survey. Generalised linear modelling assessed the effects of independent variables against intended responses to requests for legal assisted dying. Results: Compared to nurses who did not support legal assisted dying, nurses who did had stronger beliefs in patient rights, perceived social expectations to refer the request and stronger control in that intention. Nurses who did not support legal assisted dying had stronger beliefs in ethics of duty to the patient and often held dual intentions to discuss the request with the patient but also held an intention to deflect the request to consideration of alternatives. Discussion: This study advances the international literature by developing quantified models explaining the complexity of nurses’ experiences with requests for an assisted death. Attitude was operationalised in interaction with other beliefs and was identified as the strongest influence on intentions, but significantly moderated by ethical norms. Conclusion: The complex of determinants of those intentions to respond to requests for an assisted death suggests they are not isolated from each other. Nurses might have distinct intentions, but they can also hold multiple intentions even when they prioritise one. These findings present opportunities to prepare nurses in a way that enhances moral resilience in the face of complex moral encounters.

scholarly journals Comparative physical activity as a global question to assess physical activity among university students

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Katharina Diehl ◽  
Alessia Brassat ◽  
Jennifer Hilger-Kolb
Keyword(s):  
Physical Activity ◽  
University Students ◽  
Online Survey ◽  
Group Level ◽  
Comparative Measurement ◽  
Cross Sectional ◽  
Physically Active ◽  
Comparative Optimism ◽  
Individual Assessment ◽  
The Individual

Abstract Background To assess physical activity (PA), a comparative measurement – evaluating one’s own PA compared to others – may be an appropriate method. In previous studies, the use of comparative measurements led to an effect known as unrealistic comparative optimism (UCO) – people being unrealistically optimistic about their behavior. Our aim was to use this comparative measurement in university students to quantify the prevalence of UCO at the group level and to draw conclusions on its validity. Methods We used data from the Nutrition and Physical Activity in Adolescence Study (NuPhA), a cross-sectional online survey that included only self-reports (n = 689). To assess PA among students, they were asked to rate their PA level compared to that of their same-aged fellow students. In addition, we used the Godin-Shephard leisure-time PA questionnaire and other questions on PA for comparisons. We used bivariate and cluster-based analyses to identify potential UCO. Results We found that UCO at the group level led to an uneven distribution, with a higher proportion of students who rated themselves as being more physically active than average. However, the individual assessment of PA with a single and simple comparative question seemed to be valid. Discussion A global single comparative question seems useful for studies where PA is measured as a covariate in university students.

Exploring the Dimensions of Recovery and User Experience

2014 ◽  
Vol 3 (4) ◽  
pp. 305-311
Author(s):  
Peter Jones
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Health Service Provision ◽  
Domain Specific ◽  
The Past ◽  
Economic Climate ◽  
Health And Social Care ◽  
The Individual ◽  
Mental Health Service Provision

The concept of recovery is widely applied within service delivery in the field of mental health. The dimensions of recovery were explored using a singular conceptual framework known as Hodges’ model, which is shown to be suited to this particular task. This arises from the model’s structure, in that it encompasses the individual-group and a care domain specific to the political aspects of both health and social care. The evidence was found by relating recovery to the model’s care domains, which is also relevant to the experience of mental health service users and developments over the past decade in mental health service provision. Particular attention is given to the ‘Recovery Star’. This can be used as a key-working and outcomes tool. The discussion is also placed in a context of the current socio-economic climate, notably the ‘politics of recovery’ at a time of austerity.

The influence of culture on consumer perceptions of deceptiveness

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Haithem Zourrig ◽  
Mengxia Zhang ◽  
Kamel El Hedhli ◽  
Imene Becheur
Keyword(s):  
Culturally Diverse ◽  
Online Survey ◽  
Consumer Perceptions ◽  
Chinese Consumers ◽  
Content Type ◽  
Individual Level ◽  
Information Manipulation ◽  
Societal Level ◽  
The Individual ◽  
Situational Constraint

Purpose This study aims to apply McCornack’s (1992) information manipulation theory to the context of fraud and investigates the effects of culture on perceived deceptiveness. Design/methodology/approach In total, 400 Chinese consumers and an equal-size sample of Canadian consumers were recruited to fill an online survey. The survey integrates four scenarios of insurance fraud and measures of perceived deceptiveness, cultural tightness and horizontal-vertical idiocentrism allocentrism, in addition to some control variables. Findings Results show that at the societal level of culture, perceived deceptiveness is higher in individualistic than in collectivistic cultures. When accounting for the level of situational constraint, cultural tightness was found to magnify the perceived deceptiveness. At the individual level of culture, vertical-allocentrism and vertical-idiocentrism were found to weigh against the perception of deceptiveness. Originality/value Understanding cultural differences in perceived deceptiveness is helpful to spot sources of consumers’ vulnerability to fraud tolerance among a culturally diverse public.

Dynamic roles of social presence and individual differences in social TV platforms

2021 ◽  
pp. 135485652110575
Author(s):  
Jihyun Kim ◽  
Kelly Merrill
Keyword(s):  
Individual Differences ◽  
Social Presence ◽  
Online Survey ◽  
Unique Form ◽  
Tv Viewing ◽  
Television Content ◽  
Social Tv ◽  
The Social ◽  
Private And Public ◽  
The Individual

These days, many individuals engage in a unique form of TV viewing that includes a simultaneous act of watching television content and talking about it with others in a mediated environment. This phenomenon is commonly referred to as social TV viewing. Responding to the popularity of this form of TV viewing behavior, the present study examines the individual differences of the social TV viewing experience, particularly with regard to different communication platforms (e.g. private vs. public). Based on the data collected from an online survey, primary findings indicate that extroverted and lonely individuals have different social TV viewing experiences such as preferences for a particular type of platforms for social TV viewing. Further, social presence plays an important role in the understanding of social TV enjoyment in private and public platforms.

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