Ethical and culturally competent care of transgender patients: A scoping review

Background: Transgender individuals experience discrimination, stigmatization, and unethical and insensitive attitudes in healthcare settings. Therefore, healthcare professionals must be knowledgeable about the ways to deliver ethical and culturally competent care. Ethical considerations: No formal ethical approval was required. Aim: To synthesize the literature and identify gaps about approaches to the provision of ethical and culturally competent care to transgender populations. Design: A Scoping Review Literature Search: Literature was searched within CINAHL, Science Direct, PubMed, Google Scholar, EMBASE, and Scopus databases using indexed keywords such as “transgender,” “gender non-conforming,” “ethically sensitive care,” and “culturally sensitive care.” In total, 30 articles, which included transgender patients and their families and nurses, doctors, and health professionals who provided care to transgender patients, were selected for review. Data were extracted and synthesized using tabular and narrative summaries and thematic synthesis. Findings: Of 30 articles, 23 were discussion papers, 5 research articles, and 1 each case study and an integrative review. This indicates an apparent dearth of literature about ethical and culturally sensitive care of transgender individuals. The review identified that healthcare professionals should educate themselves about sensitive issues, become more self-aware, put transgender individual in charge during care interactions, and adhere to the principles of advocacy, confidentiality, autonomy, respect, and disclosure. Conclusions: The review identified broad approaches for the provision of ethical and culturally competent care. The identified approaches could be used as the baseline, and further research is warranted to develop and assess organizational and individual-level approaches.

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Living life in limbo: experiences of healthcare professionals during the HCPC fitness to practice investigation process in the UK

BMC Health Services Research ◽

10.1186/s12913-021-06785-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jill Maben ◽

Linda Hoinville ◽

Dawn Querstret ◽

Cath Taylor ◽

Magdalena Zasada ◽

...

Keyword(s):

Healthcare Professionals ◽

Psychological Impact ◽

Structured Interviews ◽

Framework Analysis ◽

Individual Level ◽

Healthcare Settings ◽

Lack Of Information ◽

The Uk ◽

The Impact ◽

Investigation Process

Abstract Background It is the responsibility of healthcare regulators to ensure healthcare professionals remain fit for practice in healthcare settings. If there are concerns about an individual healthcare professional they may undergo a fitness to practice investigation. This process is known to be hugely stressful for doctors and social workers, but little is known about the impact of this experience on other professions. This study explores the experiences of registrants going through the process of being reported to the UK’s Health and Care Professions Council (HCPC) and attending fitness to practice (FTP) hearings. We discuss the implications of this process on registrants’ wellbeing and, from our findings, present recommendations based on registrants experiences. In doing so we articulate the structural processes of the HCPC FTP process and the impact this has on individuals. Methods This study uses semi-structured interviews and framework analysis to explore the experiences of 15 registrants who had completed the FTP process. Participants were sampled for maximum variation and were selected to reflect the range of possible processes and outcomes through the FTP process. Results The psychological impact of undergoing a FTP process was significant for the majority of participants. Their stories described influences on their wellbeing at both a macro (institutional/organisational) and micro (individual) level. A lack of information, long length of time for the process and poor support avenues were macro factors impacting on the ability of registrants to cope with their experiences (theme 1). These macro factors led to feelings of powerlessness, vulnerability and threat of ruin for many registrants (theme 2). Suggested improvements (theme 3) included better psychological support (e.g. signposting or provision); proportional processes to the incident (e.g. mediation instead of hearings); and taking context into account. Conclusions Findings suggest that improvements to both the structure and conduct of the FTP process are warranted. Implementation of better signposting for support both during and after a FTP process may improve psychological wellbeing. There may also be value in considering alternative ways of organising the FTP process to enable greater consideration of and flexibility for registrants’ context and how they are investigated.

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Nudging healthcare professionals in clinical settings: a scoping review of the literature

BMC Health Services Research ◽

10.1186/s12913-021-06496-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Anita Sant’Anna ◽

Andreas Vilhelmsson ◽

Axel Wolf

Keyword(s):

Scoping Review ◽

Healthcare Professionals ◽

Clinical Decision Making ◽

Clinical Decision ◽

Clinical Settings ◽

Feedback Information ◽

Information Transparency ◽

Clinical Procedures ◽

Healthcare Settings ◽

Active Choice

Abstract Background Healthcare organisations are in constant need of improvement and change. Nudging has been proposed as a strategy to affect people’s choices and has been used to affect patients’ behaviour in healthcare settings. However, little is known about how nudging is being interpreted and applied to change the behaviour of healthcare professionals (HCPs). The objective of this review is to identify interventions using nudge theory to affect the behaviour of HCPs in clinical settings. Methods A scoping review. We searched PubMed and PsycINFO for articles published from 2010 to September 2019, including terms related to “nudging” in the title or abstract. Two reviewers screened articles for inclusion based on whether the articles described an intervention to change the behaviour of HCPs. Two reviewers extracted key information and categorized included articles. Descriptive analyses were performed on the data. Results Search results yielded 997 unique articles, of which 25 articles satisfied the inclusion criteria. Five additional articles were selected from the reference lists of the included articles. We identified 11 nudging strategies: accountable justification, goal setting, suggested alternatives, feedback, information transparency, peer comparison, active choice, alerts and reminders, environmental cueing/priming, defaults/pre-orders, and education. These strategies were employed to affect the following 4 target behaviours: vaccination of staff, hand hygiene, clinical procedures, prescriptions and orders. To compare approaches across so many areas, we introduced two independent dimensions to describe nudging strategies: synchronous/asynchronous, and active/passive. Conclusion There are relatively few studies published referring to nudge theory aimed at changing HCP behaviour in clinical settings. These studies reflect a diverse set of objectives and implement nudging strategies in a variety of ways. We suggest distinguishing active from passive nudging strategies. Passive nudging strategies may achieve the desired outcome but go unnoticed by the clinician thereby not really changing a behaviour and raising ethical concerns. Our review indicates that there are successful active strategies that engage with clinicians in a more deliberate way. However, more research is needed on how different nudging strategies impact HCP behaviour in the short and long term to improve clinical decision making.

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Toward Understanding Culturally Sensitive Care for Transgender Blood Donors: A Scoping Review of Health Care Provider Knowledge

Transgender Health ◽

10.1089/trgh.2019.0062 ◽

2020 ◽

Vol 5 (2) ◽

pp. 104-115

Author(s):

Terrie Butler-Foster ◽

Ian Chin-Yee ◽

Mary Huang ◽

Kimberley T. Jackson

Keyword(s):

Health Care ◽

Health Care Provider ◽

Scoping Review ◽

Care Provider ◽

Blood Donors ◽

Culturally Sensitive ◽

Culturally Sensitive Care ◽

Provider Knowledge

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Family Psychology and Providing Culturally Competent Care: Missing Force or Essential Force?

PsycEXTRA Dataset ◽

10.1037/e318102004-012 ◽

2004 ◽

Author(s):

James Dobbins

Keyword(s):

Culturally Competent ◽

Culturally Competent Care ◽

Family Psychology

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Culturally competent care

PsycEXTRA Dataset ◽

10.1037/e411952005-026 ◽

2005 ◽

Author(s):

Sadie F. Dingfelder

Keyword(s):

Culturally Competent ◽

Culturally Competent Care

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A Prescribing Psychologist's Quest to Provide Culturally-Sensitive Care

PsycEXTRA Dataset ◽

10.1037/e625812012-011 ◽

2010 ◽

Author(s):

Mimi Sa

Keyword(s):

Culturally Sensitive ◽

Culturally Sensitive Care

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Prospective associations between ECG abnormalities and death or myocardial infarction in a cohort of 980 employed, middle-aged Swedish men

The Egyptian Heart Journal ◽

10.1186/s43044-020-00114-9 ◽

2020 ◽

Vol 72 (1) ◽

Author(s):

Lennart Dimberg ◽

Bo Eriksson ◽

Per Enqvist

Keyword(s):

Myocardial Infarction ◽

Health Examination ◽

Individual Level ◽

Increased Risk ◽

Significant Difference ◽

Ethical Approval ◽

Independent Association ◽

Repeat Examination ◽

Normal Ecgs ◽

Ecg Abnormalities

Abstract Background In 1993, 1000 randomly selected employed Swedish men aged 45–50 years were invited to a nurse-led health examination with a survey on life style, fasting lab tests, and a 12-lead ECG. A repeat examination was offered in 1998. The ECGs were classified according to the Minnesota Code. Upon ethical approval, endpoints in terms of MI and death over 25 years were collected from Swedish national registers with the purpose of analyzing the independent association of ECG abnormalities as risk factors for myocardial infarction and death. Results Seventy-nine of 977 participants had at least one ECG abnormality 1993 or 1998. One hundred participants had a first MI over the 25 years. Odds ratio for having an MI in the group that had one or more ECG abnormality compared with the group with two normal ECGs was estimated to 3.16. 95%CI (1.74; 5.73), p value 0.0001. One hundred fifty-seven participants had died before 2019. For death, similarly no statistically significant difference was shown, OR 1.52, 95%CI (0.83; 2.76). Conclusions Our study suggests that presence of ST- and R-wave changes is associated with an independent 3–4-fold increased risk of MI after 25 years follow-up, but not of death. A 12-lead resting ECG should be included in any MI risk calculation on an individual level.

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The Surprise Question and Serious Illness Conversations: A pilot study

Nursing Ethics ◽

10.1177/0969733020983392 ◽

2021 ◽

pp. 096973302098339

Author(s):

Kathy Le ◽

Jenny Lee ◽

Sameer Desai ◽

Anita Ho ◽

Holly van Heukelom

Keyword(s):

Pilot Study ◽

Healthcare Professionals ◽

Post Intervention ◽

Acute Medicine ◽

Serious Illness ◽

Patient Goals ◽

Ethical Approval ◽

Seriously Ill Patients ◽

Surprise Question ◽

Seriously Ill

Background: Serious Illness Conversations aim to discuss patient goals. However, on acute medicine units, seriously ill patients may undergo distressing interventions until death. Objectives: To investigate the feasibility of using the Surprise Question, “Would you be surprised if this patient died within the next year?” to identify patients who would benefit from early Serious Illness Conversations and study any changes in the interdisciplinary team’s beliefs, confidence, and engagement as a result of asking the Surprise Question. Design: A prospective cohort pilot study with two Plan-Do-Study-Act cycles. Participants/context: Fifty-eight healthcare professionals working on Acute Medicine Units participated in pre- and post-intervention questionnaires. The intervention involved asking participants the Surprise Question for each patient. Patient charts were reviewed for Serious Illness Conversation documentation. Ethical considerations: Ethical approval was granted by the institutions involved. Findings: Equivocal overall changes in the beliefs, confidence, and engagement of healthcare professionals were observed. Six out of 23 patients were indicated as needing a Serious Illness Conversation; chart review provided some evidence that these patients had more Serious Illness Conversation documentation compared with the 17 patients not flagged for a Serious Illness Conversation. Issues were identified in equating the Surprise Question to a Serious Illness Conversation. Discussion: Appropriate support for seriously ill patients is both a nursing professional and ethical duty. Flagging patients for conversations may act as a filtering process, allowing healthcare professionals to focus on conversations with patients who need them most. There are ethical and practical issues as to what constitutes a “serious illness” and if answering “no” to the Surprise Question always equates to a conversation. Conclusion: The barriers of time constraints and lack of training call for institutional change in order to prioritise the moral obligation of Serious Illness Conversations.

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Evaluating pictorial support in person-centred care for children (PicPecc): a protocol for a crossover design study

BMJ Open ◽

10.1136/bmjopen-2020-042726 ◽

2021 ◽

Vol 11 (5) ◽

pp. e042726

Author(s):

Stefan Nilsson ◽

Angelica Wiljén ◽

Jonas Bergquist ◽

John Chaplin ◽

Ensa Johnson ◽

...

Keyword(s):

Healthcare Professionals ◽

Qualitative Interviews ◽

Research Process ◽

Crossover Design ◽

Self Report ◽

Ethical Review ◽

High Dose ◽

Digital Tool ◽

Legal Guardians ◽

Ethical Approval

IntroductionThis study protocol outlines the evaluation of the pictorial support in person-centred care for children (PicPecc). PicPecc is a digital tool used by children aged 5–17 years to self-report symptoms of acute lymphoblastic leukaemia, who undergo high-dose methotrexate treatments. The design of the digital platform follows the principles of universal design using pictorial support to provide accessibility for all children regardless of communication or language challenges and thus facilitating international comparison.Methods and analysisBoth effect and process evaluations will be conducted. A crossover design will be used to measure the effect/outcome, and a mixed-methods design will be used to measure the process/implementation. The primary outcome in the effect evaluation will be self-reported distress. Secondary outcomes will be stress levels monitored via neuropeptides, neurosteroids and peripheral steroids indicated in plasma blood samples; frequency of in-app estimation of high levels of distress by the children; children's use of analgesic medicine and person centeredness evaluated via the questionnaire Visual CARE Measure. For the process evaluation, qualitative interviews will be carried out with children with cancer, their legal guardians and case-related healthcare professionals. These interviews will address experiences with PicPecc in terms of feasibility and frequency of use from the child’s perspective and value to the caseworker. Interview transcripts will be analysed using an interpretive description methodology.Ethics and disseminationEthical approval was obtained from the Swedish Ethical Review Authority (reference 2019-02392; 2020-02601; 2020-06226). Children, legal guardians, healthcare professionals, policymaking and research stakeholders will be involved in all stages of the research process according to Medical Research Council’s guidelines. Research findings will be presented at international cancer and paediatric conferences and published in scientific journals.Trial registrationClinicalTrials.gov; NCT04433650.

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