PP9 Managing alcohol intoxication in the night-time economy: staff and patient perspectives

2019 ◽  
Vol 36 (10) ◽  
pp. e5.2-e5
Author(s):  
Andy Irving ◽  
Davina Allen ◽  
Joanne Blake ◽  
Simon Moore ◽  
Steve Goodacre
Keyword(s):  
Emergency Services ◽  
Positive Impact ◽  
Care Pathway ◽  
Alcohol Intoxication ◽  
Alternative Pathway ◽  
Structured Interviews ◽  
Night Time ◽  
Ambulance Personnel ◽  
Frontline Staff ◽  
Street Level

BackgroundAlcohol-related harms arising in the Night-Time Economy (NTE) impose a substantial burden on emergency services (ES) especially ambulance services engaged in both street level care and transportation of acutely intoxicated patients to a hospital Emergency Department (ED). Alcohol Intoxication Management Services (AIMS) are intended as an alternative care pathway for intoxicated patients who would normally use emergency services and are often run by ambulance services in partnership with other agencies. Despite growing policy interest in AIMS as an alternative pathway it is not known what their users think of them nor the experiences of frontline staff engaged in and around AIMS.MethodsAs part of a mixed-method study semi-structured interviews were followed by a survey of users recruited from six different AIMS. A parallel ethnographic component used observations and interviews with ambulance staff in two cities with AIMS and one without.ResultsSurveys and interviews found AIMs users retrospectively viewed the decision to take them to AIMS favourably and highly rated the care they received, especially the friendly, non-judgemental atmosphere created between ambulance staff and other agents involved in AIMS. A majority of AIMS survey respondents said they would not have called emergency services (85%) or gone to the ED (75.6%). Ethnographic work showed ambulance personnel considered AIMS to have a positive impact on ES, freeing capacity to attend to other emergencies. Ambulance staff without AIMS worked to avoid conveyance to ED but this could result in extended periods risk assessing individuals at street level, which meant they felt unavailable to address other emergency calls.ConclusionsAIMS are viewed very positively by their users and the ambulance staff involved. Findings from surveys, interviews and ethnography suggest that AIMS and EDs are managing different patient groups in different ways, and thus may represent complementary rather than competing alternatives care pathways.

scholarly journals Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirsten Austad ◽  
Michel Juarez ◽  
Hannah Shryer ◽  
Patricia L. Hibberd ◽  
Mari-Lynn Drainoni ◽  
...  
Keyword(s):  
Health Workers ◽  
Positive Impact ◽  
Qualitative Evaluation ◽  
Obstetric Care ◽  
Hospital Staff ◽  
Public Hospitals ◽  
Future Research ◽  
Care Seeking ◽  
Structured Interviews ◽  
The Impact

Abstract Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

scholarly journals Examining the magnitude and perception of summertime overheating in London care homes

2021 ◽  
pp. 014362442110136
Author(s):  
Rajat Gupta ◽  
Alastair Howard ◽  
Mike Davies ◽  
Anna Mavrogianni ◽  
Ioanna Tsoulou ◽  
...  
Keyword(s):  
Thermal Comfort ◽  
Care Home ◽  
Thermal Conditions ◽  
Care Homes ◽  
Structured Interviews ◽  
Night Time ◽  
Institutional Practices ◽  
Subjective Data ◽  
Hybrid Buildings ◽  
Hot Weather

This paper brings together objective and subjective data on indoor temperature and thermal comfort to examine the magnitude and perception of summertime overheating in two London-based care homes occupying modern and older buildings. Continuous monitoring of indoor and outdoor temperature, relative humidity and CO2 levels was conducted in summer 2019 along with thermal comfort surveys and semi-structured interviews with older residents and staff of the care settings. Indoor temperatures were found to be high (>30°C) with bedroom temperatures often higher at night than daytime across both care settings. Limited opening due to window restrictors constrained night-time ventilation. Overheating was prevalent with four out of the five monitored bedrooms failing all four overheating metrics investigated. While 35–42% of staff responses perceived indoor temperatures to be uncomfortably hot, only 13–19% of resident responses were found to do so, indicating that elderly residents tend to be relatively insensitive to heat, leaving them open to overheating without realising it. Residents and staff in the modern care setting were less satisfied with their thermal conditions. As hybrid buildings, care settings need to keep both residents and staff comfortable and healthy during hot weather through night-time ventilation, management of heating and supportive institutional practices. Practical application: Care home designs have focused on keeping residents warm through the winter, neglecting the risks of summertime overheating. Care homes are hybrid buildings serving as living spaces for vulnerable older residents and offices/workspaces for staff. Providing comfort to both groups during periods of hot weather is challenging. Opportunities for ventilation are limited by Health & Safety regulations that mandate up to 10 cm maximum window openings and institutional practices that result in windows routinely kept closed, particularly at night. Utilising natural and where possible cross-ventilation should be considered along with external shading. Heating should be managed to avoid unwanted heat gains in the summer.

scholarly journals Video-Based Intervention for Improving Maternal Retention and Adherence to HIV Treatment: Patient Perspectives and Experiences

2021 ◽  
Vol 18 (4) ◽  
pp. 1737
Author(s):  
Steven Masiano ◽  
Edwin Machine ◽  
Mtisunge Mphande ◽  
Christine Markham ◽  
Tapiwa Tembo ◽  
...  
Keyword(s):  
Positive Impact ◽  
Low Cost ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Long Term Conditions ◽  
Art Initiation ◽  
Retention In Hiv Care

VITAL Start is a video-based intervention aimed to improve maternal retention in HIV care and adherence to antiretroviral therapy (ART) in Malawi. We explored the experiences of pregnant women living with HIV (PWLHIV) not yet on ART who received VITAL Start before ART initiation to assess the intervention’s acceptability, feasibility, fidelity of delivery, and perceived impact. Between February and September 2019, we conducted semi-structured interviews with a convenience sample of 34 PWLHIV within one month of receiving VITAL Start. The participants reported that VITAL Start was acceptable and feasible and had good fidelity of delivery. They also reported that the video had a positive impact on their lives, encouraging them to disclose their HIV status to their sexual partners who, in turn, supported them to adhere to ART. The participants suggested using a similar intervention to provide health-related education/counseling to people with long term conditions. Our findings suggest that video-based interventions may be an acceptable, feasible approach to optimizing ART retention and adherence amongst PWLHIV, and they can be delivered with high fidelity. Further exploration of the utility of low cost, scalable, video-based interventions to address health counseling gaps in sub-Saharan Africa is warranted.

scholarly journals Music Is Life—Follow-Up Qualitative Study on Parental Experiences of Creative Music Therapy in the Neonatal Period

2021 ◽  
Vol 18 (12) ◽  
pp. 6678
Author(s):  
Friederike Barbara Haslbeck ◽  
Lars Schmidli ◽  
Hans Ulrich Bucher ◽  
Dirk Bassler
Keyword(s):  
Music Therapy ◽  
Positive Reinforcement ◽  
Positive Impact ◽  
Complementary Therapy ◽  
Structured Interviews ◽  
Developmental Problems ◽  
Creative Music ◽  
Modifiable Factors ◽  
Hospitalization Period ◽  
Extremely Preterm

Developmental problems in extremely preterm (EP) infants and the associated longitudinal burden for their families are major health issues worldwide. Approaches to social-emotional support such as family-integrating Creative Music Therapy (CMT) are warranted. We aimed: (1) to explore parental perspectives on the use of CMT with EP infants in the neonatal hospitalization period and (2) to examine the possible longitudinal influence of CMT. A qualitative design was used to examine the perspective of six families from various backgrounds. Semi-structured interviews were carried out when the infants reached school age. We used an inductive–deductive thematic analysis to identify three main themes, each with three sub-themes: (1) the positive impact of CMT on the infants, the parents, and bonding; (2) the attitude toward CMT, from being open-minded to recommending it as complementary therapy; and (3) the experience of overall healthy infant development despite unique developmental delay issues. The findings elucidate the positive and formative impact of CMT on both infants and parents in the stressful NICU setting and beyond. CMT may empower positive transformation in the parents through individualized early nurturing musical interactions, capacity building, and positive reinforcement. Further research may help to identify and implement potentially modifiable factors for improving health care in this vulnerable group through early family-integrating, resource-based approaches such as CMT.

scholarly journals Improving Equine Welfare through Human Habit Formation

Animals ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 2156
Author(s):  
Jo White ◽  
Ruth Sims
Keyword(s):  
Management Practices ◽  
Habit Formation ◽  
Positive Impact ◽  
Proof Of Concept ◽  
Mutual Benefit ◽  
Structured Interviews ◽  
Behavioural Research ◽  
Equine Welfare ◽  
Lasting Change

This paper explores the potential for interventions to develop pro-animal welfare habitual behaviours (PAWHBs) in people to improve the lives of animals. Human behavioural research indicates that opportunities exist to deliver lasting change through developing positive habitual behaviours. The routine nature of many equine care and management practices lends itself to habit formation and maintenance. This proof-of-concept paper aims to evaluate a theory-based intervention of developing and maintaining a PAWHB in people caring for equines. Qualitative research methods were used. A 30 day PAWHB intervention (PAWHBInt) of providing enrichment to an equine by scratching them in a consistent context linked to an existing routine behaviour was undertaken. Participants (n = 9) then engaged in semi-structured interviews that were analysed using thematic analysis, where the participants self-reported the outcomes they observed during the intervention. The study findings suggest that the PAWHBInt had a positive impact on human behaviour and habit formation. The research helps to address the dearth of evidence regarding the application of habit theory to equine welfare interventions and emphasised linking a desired new behaviour to an existing routine behaviour when developing PAWHBs. The research also highlights the role of mutual benefit for human and equine, and emotion in providing feedback and potential reward, supporting the link to the cue-routine-reward principle of habit theory.

Labour Input Logic of Street-Level Bureaucrats: Evidence from Chinese Market Supervision Commission

2021 ◽  
pp. 147892992110215
Author(s):  
Chunna Li ◽  
Jun Yang
Keyword(s):  
Organizational Climate ◽  
Time Allocation ◽  
Public Management ◽  
New Public Management ◽  
Strong Impact ◽  
Chinese Market ◽  
Frontline Staff ◽  
Street Level ◽  
Labour Input ◽  
Street Level Bureaucrats

The theory of street-level bureaucracy and its relevant data have proven the expected duties of the frontline staff of local government may be excessive but their time spent working remains quite low. Using data from participatory observations of street-level officials in a Chinese city, this study reveals the logic of this labour input paradox. Organizational climate incentive and promotional incentive jointly influence the time allocation of street-level bureaucrats. The organizational climate incentive reflects the weak incentive characteristic of the maintenance function of labour; promotional incentives have a strong impact on motivation, which is characteristic of the promotional function of labour. These findings reveal the costs of the New Public Management movement in an organization lacking an effective promotion mechanism and a positive organizational climate incentive. This is a snapshot of the dilemma faced by China’s public organization reforms, but it is also a problem other country must solve.

scholarly journals What matters to patients? A mixed method study of the importance and consideration of oncology patient demands

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mathias WAELLI ◽  
Etienne Minvielle ◽  
Maria Ximena Acero ◽  
Khouloud Ba ◽  
Benoit Lalloué
Keyword(s):  
Cancer Patients ◽  
Mixed Method ◽  
New Technologies ◽  
Care Pathway ◽  
Scale Up ◽  
Healthcare Delivery ◽  
Delivery Systems ◽  
Breast Cancer Patients ◽  
Structured Interviews ◽  
Oncology Patient

Abstract Background A patient-centred approach is increasingly the mandate for healthcare delivery, especially with the growing emergence of chronic conditions. A relevant but often overlooked obstacle to delivering person-centred care is the identification and consideration of all demands based on individual experience, not only disease-based requirements. Mindful of this approach, there is a need to explore how patient demands are expressed and considered in healthcare delivery systems. This study aims to: (i) understand how different types of demands expressed by patients are taken into account in the current delivery systems operated by Health Care Organisations (HCOs); (ii) explore the often overlooked content of specific non-clinical demands (i.e. demands related to interactions between disease treatments and everyday life). Method We adopted a mixed method in two cancer centres, representing exemplary cases of organisational transformation: (i) circulation of a questionnaire to assess the importance that breast cancer patients attach to every clinical (C) and non-clinical (NC) demand identified in an exploratory inquiry, and the extent to which each demand has been taken into account based on individual experiences; (ii) a qualitative analysis based on semi-structured interviews exploring the content of specific NC demands. Results Further to the way in which the questionnaires were answered (573 answers/680 questionnaires printed) and the semi-structured interviews (36) with cancer patients, results show that NC demands are deemed by patients to be almost as important as C demands (C = 6.53/7 VS. NC = 6.13), but are perceived to be considered to a lesser extent in terms of pathway management (NC = 4.02 VS C = 5.65), with a significant variation depending on the type of non-clinical demands expressed. Five types of NC demands can be identified: demands relating to daily life, alternative medicine, structure of the treatment pathway, administrative and logistic assistance and demands relating to new technologies. Conclusions This study shows that HCOs should be able to consider non-clinical demands in addition to those referring to clinical needs. These demands require revision of the healthcare professionals’ mandate and transition from a supply-orientated system towards a demand-driven approach throughout the care pathway. Other sectors have developed hospitality management, mass customisation and personalisation to scale up approaches that could serve as inspiring examples.

Healthcare professionals' roles within UK welfare-to-work provision: a multiple case study exploration

2021 ◽  
Vol 28 (7) ◽  
pp. 1-24
Author(s):  
Jenny Ceolta-Smith ◽  
Christine Kenney
Keyword(s):  
Clinical Supervision ◽  
Qualitative Methodology ◽  
Healthcare Professionals ◽  
Welfare To Work ◽  
Job Descriptions ◽  
Structured Interviews ◽  
Frontline Staff ◽  
Complex Needs ◽  
Work Settings ◽  
Multiple Case

Background/aims Healthcare professionals play an important role in vocational rehabilitation for people receiving welfare support. The research questions for this study were: how do qualified healthcare professionals operate in UK welfare-to-work settings? What factors influence healthcare professionals' practice within a UK welfare-to-work setting? Methods A qualitative methodology was adopted. Four semi-structured interviews were conducted and additional documents (the awarded Work and Health Programme bids and job descriptions) about the healthcare professionals' roles were reviewed. Inductive thematic analysis was undertaken. Results Five themes were generated from the interview data: supporting frontline staff to understand clients' health needs; moving clients with complex needs closer to work; getting it right for the client by individualising support; gaining consent and maintaining confidentiality; and seeking and organising clinical supervision. These themes were corroborated with the document data. Conclusions Healthcare professionals have a key role within welfare-to-work provision. Further research is needed to determine if the proposed healthcare professional roles have come to fruition, to identify their prevalence, and to explore their effectiveness.

Recovery colleges: long-term impact and mechanisms of change

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Holly Thompson ◽  
Laura Simonds ◽  
Sylvie Barr ◽  
Sara Meddings
Keyword(s):  
Mental Health ◽  
Lived Experience ◽  
Positive Impact ◽  
Evidence Base ◽  
College Attendance ◽  
Personal Recovery ◽  
Structured Interviews ◽  
Content Type ◽  
Educational Paradigm ◽  
Long Term Impact

Purpose Recovery Colleges are an innovative approach which adopt an educational paradigm and use clinician and lived experience to support students with their personal recovery. They demonstrate recovery-orientated practice and their transformative role has been evidenced within mental health services. The purpose of this study is to explore how past students understand the influence of the Recovery College on their on-going recovery journey. Design/methodology/approach An exploratory, qualitative design was used and semi-structured interviews took place with 15 participants. Data was analysed using the “framework method” and inductive processes. Findings All participants discussed gains made following Recovery College attendance that were sustained at one year follow-up. Three themes emerged from the data: Ethos of recovery and equality; Springboard to opportunities; and Intrapersonal changes. Originality/value This research explores students’ experiences a year after attendance. This contrasts to most research which is completed immediately post course. This study contributes to the emergent evidence base highlighting the longitudinal positive impact of Recovery Colleges. This study is of value to those interested in recovery-oriented models within mental health. Recovery Colleges are gaining traction nationally and internationally and this research highlights processes underlying this intervention which is of importance to those developing new Recovery Colleges.

Cost Analysis of the Country of Georgia’s Street Level Drug Testing Policy

2017 ◽  
Vol 10 (2) ◽  
Author(s):  
Dessa Bergen-Cico ◽  
David Otiashvili ◽  
Irma Kirtadze ◽  
Tomas Zabransky ◽  
Vano Tsertsvadze
Keyword(s):  
Drug Use ◽  
Cost Analysis ◽  
Drug Screening ◽  
Drug Testing ◽  
Impact Analysis ◽  
Positive Impact ◽  
National Sample ◽  
Labor Costs ◽  
Street Level ◽  
Use Behavior

AbstractBackgroundIn 2006 the country of Georgia implemented Article 45 of the Administrative code and Article 273 of the Criminal Code of Georgia, a public policy that enable police to detain any individual, anywhere, at any time on grounds of suspicion of drug use; and require them to submit to urine screening to test for the presence of illegal drugs and their metabolites. This policy is referred to as the street drug testing policy. Positive drug screening results in fines and potential jail time. The purpose of this paper is to conduct a cost analysis of this policy and assess the execution of the policy and the extent to which the policy meets its stated aims.MethodsThis study employed cost analysis methodology to calculate annual direct material and labor costs associated with carrying out Georgia’s street level drug testing policy. These costs encompassed law enforcement, drug testing, associated judicial processes, imprisonment and income offset through fines collected during the two years covered in this study (2008 and 2014). In addition, we measured: fidelity of the execution of the policy measured by the accuracy of the percentage of people detained who were found to actually have used drugs; and the policy’s effectiveness in deterring drug use among those who tested positive. Impact on drug use behavior was measured through impact analysis interviews conducted with a national sample of 500 detainees who tested positive for drugs under Article 45 and Article 273.ResultsUsing conservative financial estimates the cost of carrying out the policy offset by fine revenues broke even in 2008 (−111,889 GEL); however, by 2014 the costs increased 20 % in conjunction with an 18 % increase in the number of people detained for testing. However, the percentage of people who tested positive for drugs declined 39 % indicating decreased fidelity in the execution of the policy; accompanied by a financial imbalance of −10,277,909 GEL. Moreover, effectiveness analysis revealed that within one month of being detained and having tested positive for drug use, over 90 % of individuals had returned to pre-detention drug use levels, and within 12 months 100 % of detainees had resumed prior drug use behaviors.ConclusionThe financial costs associated with Georgia’s street level drug screening policy has rapidly increased while becoming decreasingly accurate and efficient in its execution. Moreover, data indicates that the policy is not effective in reducing or stopping drug use among those who tested positive. In conclusion, it is fiscally unsustainable to continue the policy as it is being executed and the policy is ineffective in changing drug use behavior among people who use illegal substances.

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