scholarly journals Making complex decisions in uncertain times: experiences of Dutch GPs as gatekeepers regarding hospital referrals during COVID-19—a qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Dieke Westerduin ◽  
Janneke Dujardin ◽  
Jaap Schuurmans ◽  
Yvonne Engels ◽  
Anne B. Wichmann
Keyword(s):  
General Practitioners ◽  
Thematic Analysis ◽  
Ethical Dilemmas ◽  
Self Determination ◽  
Duty Of Care ◽  
Care Provision ◽  
Structured Interviews ◽  
Inpatient Hospitalization ◽  
Adequate Care ◽  
Hospital Beds

Abstract Background General practitioners often act as gatekeeper, authorizing patients’ access to hospital care. This gatekeeping role became even more important during the current COVID-19 crisis as uncertainties regarding COVID-19 made estimating the desirability of hospital referrals (for outpatient or inpatient hospitalization) complex, both for COVID and non-COVID suspected patients. This study explored Dutch general practitioners’ experiences and ethical dilemmas faced in decision making about hospital referrals in times of the COVID-19 pandemic. Methods Semi-structured interviews with Dutch general practitioners working in the Netherlands were conducted. Participants were recruited via purposive sampling. Thematic analysis was conducted using content coding. Results Fifteen interviews were conducted, identifying four themes: one overarching regarding (1) COVID-19 uncertainties, and three themes about experienced ethical dilemmas: (2) the patients’ self-determination vs. the general practitioners’ paternalism, (3) the general practitioners’ duty of care vs. the general practitioners’ autonomy rights, (4) the general practitioners’ duty of care vs. adequate care provision. Conclusions Lack of knowledge about COVID-19, risks to infect loved ones, scarcity of hospital beds and loneliness of patients during hospital admission were central in dilemmas experienced. When developing guidelines for future crises, this should be taken into account.

scholarly journals Knowing me, knowing you: a qualitative study of the effects on patients of doctors’ self-illness disclosures

2019 ◽  
Vol 11 (4) ◽  
pp. 327
Author(s):  
Laura Bolger ◽  
Katherine Helen Hall ◽  
Martyn Williamson
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
General Practitioners ◽  
Current Literature ◽  
Thematic Analysis ◽  
Patient Relationship ◽  
Structured Interviews ◽  
Depth Analysis ◽  
Potential Benefits ◽  
Emotional Dimensions

ABSTRACT INTRODUCTIONVery little is known how patients react to learning about their own doctors’ illnesses. Doctors can be uncertain if and when such disclosures can be helpful, and in what way, to patients. This paper attempts to bridge this gap by providing an in-depth analysis of one group of patients’ experiences with this type of disclosure. AIMTo understand from patients’ perspectives, the effects on them of doctors disclosing their own illnesses, to provide guidance concerning the uses of this disclosure for general practitioners. METHODSThis qualitative study was an exploration of 13 patients’ reactions to receiving such information, using semi-structured interviews and thematic analysis. RESULTSThe major themes were the emotional dimensions of illness and patienthood, the doctor–patient relationship and patients’ concerns about disclosures. Disclosures can have profound effects on patients with both negative and positive consequences. CONCLUSIONWe present suggestions about how to use such disclosures in primary care to minimise potential harms and emphasise potential benefits, based on these patients’ perspectives and the current literature.

scholarly journals Conceptualizing difference: an analysis of physicians’ views on delivering care to asylum seekers

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Jahn ◽  
L Biddle
Keyword(s):  
Medical Care ◽  
Patient Group ◽  
Health Care Professionals ◽  
Patient Population ◽  
Asylum Seekers ◽  
Care Provision ◽  
Structured Interviews ◽  
Appropriate Care ◽  
Adequate Care ◽  
Delivery Of Medical Care

Abstract Background International migration leads to an increasingly fluctuating and superdiverse migrant population in reception countries. In Germany, structural, legal, social and political barriers to adequate care complicate the ability of health care professionals to respond to the challenges associated with caring for such a dynamic patient population. In this analysis, we explore the views of physicians working with asylum seekers and refugees in Germany, and aim to identify the barriers and enablers they face in providing appropriate care. Methods We performed a secondary qualitative analysis of 16 semi-structured interviews conducted for two studies on the delivery of medical care to asylum seekers in Germany. To examine physicians' views towards their work with asylum seekers, we analysed evaluative judgements on interpersonal and workplace factors, the external environment, the physician's own self, and individual medical conduct. Analysis was conducted by identifying cross-cutting themes through thematic analysis and mapping these onto a framework matrix. Results We found that evaluative judgements made by physicians providing care to asylum seekers emphasized one of three conceptualisations of “difference”: regarding personal or cultural attributes of the patient group; the spaces of care provision; or the context of asylum seeking patients. Emphasis on differences of the patient population and the spaces of care provision to asylum seekers was found to impede appropriate care, while physicians emphasizing contextual factors reported more responsive medical practices. Discussion Our findings suggest that processes of “othering” asylum seekers as a patient group as well as the heterotopic spaces of care provision endanger the doctor-patient relationship and responsiveness of care. Appropriate training, physical and human resources and encouraging support between physicians working with asylum seeking patients could alleviate these processes. Key messages Physicians’ conceptualisations of “difference” in providing care to asylum seekers focus on the patient group, workplace, or structural context; and affect the way in which medical care is provided. Structural competency training, resource investments, and clear structures could reduce physicians’ experiences of “difference” of the patient group and workplace, and facilitate responsive care.

Control in Flexible Working Arrangements

2015 ◽  
Vol 14 (2) ◽  
pp. 61-69 ◽  
Author(s):  
Cornelia Gerdenitsch ◽  
Bettina Kubicek ◽  
Christian Korunka
Keyword(s):  
Self Determination Theory ◽  
Digital Natives ◽  
Self Determination ◽  
Structured Interviews ◽  
Similar Extent ◽  
Decision Latitude ◽  
Media Technologies ◽  
Exploratory Approach ◽  
Flexible Working ◽  
Temporal And Spatial

Supported by media technologies, today’s employees can increasingly decide when and where to work. The present study examines positive and negative aspects of this temporal and spatial flexibility, and the perceptions of control in these situations based on propositions of self-determination theory. Using an exploratory approach we conducted semi-structured interviews with 45 working digital natives. Participants described positive and negative situations separately for temporal and spatial flexibility, and rated the extent to which they felt autonomous and externally controlled. Situations appraised positively were best described by decision latitude, while negatively evaluated ones were best described by work–nonwork conflict. Positive situations were perceived as autonomous rather than externally controlled; negative situations were rated as autonomously and externally controlled to a similar extent.

Thinking about Publishing? On Seeking Patient Consent to Publish Case Material

2015 ◽  
Vol 5 (2) ◽  
Author(s):  
Christopher Clulow ◽  
Ernest Wallwork ◽  
Caroline Sehon
Keyword(s):  
Ethical Dilemmas ◽  
Professional Community ◽  
Case Material ◽  
Clinical Material ◽  
Duty Of Care ◽  
Therapeutic Action ◽  
Scientific Advancement ◽  
Patient Consent ◽  
Ethical Responsibilities

The onus on therapists to seek the consent of their patients before publishing clinical material may be one reason why so few decide to write about their experience. There are inevitable and unavoidable tensions in balancing the duty of care to patients with other ethical responsibilities, including the needs of the professional community for education and scientific advancement. In this paper, we explore the context and dynamics of seeking consent from couples and families to publish material relating to their therapy and propose a way to manage some of the ethical dilemmas involved in writing about patients that is in keeping with the contemporary analytic literature on the interpersonal unconscious between patient and therapist, and the interpsychic/interpersonal dimensions of therapeutic action. Throughout this paper, the term “patient” is used to designate couples and families as well as individuals.

‘Are we on the same wavelength?’ International nurses and the process of confronting and adjusting to clinical communication in Australia

2017 ◽  
Vol 13 (3) ◽  
pp. 263-274 ◽  
Author(s):  
Tonia Crawford ◽  
Peter Roger ◽  
Sally Candlin
Keyword(s):  
Communication Skills ◽  
Thematic Analysis ◽  
Care Setting ◽  
Linguistically Diverse ◽  
The Other ◽  
Culturally And Linguistically Diverse ◽  
Central Theme ◽  
Structured Interviews ◽  
Clinical Communication ◽  
Professional Experiences

Effective communication skills are important in the health care setting in order to develop rapport and trust with patients, provide reassurance, assess patients effectively and provide education in a way that patients easily understand (Candlin and Candlin, 2003). However with many nurses from culturally and linguistically diverse (CALD) backgrounds being recruited to fill the workforce shortfall in Australia, communication across cultures with the potential for miscommunication and ensuing risks to patient safety has gained increasing focus in recent years (Shakya and Horsefall, 2000; Chiang and Crickmore, 2009). This paper reports on the first phase of a study that examines intercultural nurse patient communication from the perspective of four Registered Nurses from CALD backgrounds working in Australia. Five interrelating themes that were derived from thematic analysis of semi-structured interviews are discussed. The central theme of ‘adjustment’ was identified as fundamental to the experiences of the RNs and this theme interrelated with each of the other themes that emerged: professional experiences with communication, ways of showing respect, displaying empathy, and vulnerability.

Care for delirium superimposed on dementia at an early stage

2020 ◽  
Keyword(s):  
Behavioral Problems ◽  
Healthcare Professionals ◽  
Early Stage ◽  
Good Care ◽  
Structured Interviews ◽  
Ethical Considerations ◽  
Appropriate Care ◽  
Adequate Care ◽  
Insight Into ◽  
Delirium Superimposed On Dementia

Delirium is a common serious complication in dementia that is associated with poor prognosis and a high burden on caregivers and healthcare professionals. Appropriate care is therefore important at an early stage for patients with delirium superimposed on dementia To gain insight into the care of six patients with delirium superimposed on dementia, 19 semi-structured interviews were conducted focused on the experiences of caregivers and professionals. The interviews revealed four themes that appeared to play a role: 1. experiences with and views on behavioral problems of these patients, 2. recognition and diagnosis of delirium in dementia, 3. views on good care and 4. organizational aspects. Knowledge gaps about delirium in dementia, as well as ethical considerations, play an important role in organizing timely and adequate care for patients with delirium superimposed on dementia.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

Acceptance of the HPV Vaccine in a Multiethnic Sample of Latinx Mothers

2021 ◽  
Vol 31 (3) ◽  
pp. 472-483
Author(s):  
Ana Cristina Lindsay ◽  
Madelyne J. Valdez ◽  
Denisse Delgado ◽  
Emily Restrepo ◽  
Yessica M. Guzmán ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Thematic Analysis ◽  
Hpv Vaccine ◽  
Female Adolescents ◽  
Future Research ◽  
Care Providers ◽  
Foreign Born ◽  
Structured Interviews ◽  
Direct Benefits ◽  
Multiethnic Sample

This descriptive qualitative study explored Latinx mothers’ acceptance of the human papillomavirus (HPV) vaccine for their adolescent children. Data were collected through individual, semi-structured interviews and analyzed using a hybrid method of thematic analysis that incorporated deductive and inductive approaches. Twenty-two ( n = 22), mostly foreign-born, Latinx mothers of male and female adolescents participated in the study. Three main themes and nine subthemes emerged from the analyses. Findings identified the need for increased efforts to raise awareness and knowledge among Latinx mothers of the direct benefits of the HPV vaccine for sons, including stressing prevention of HPV-associated cancers in males. Findings also underscore the need for improved health care providers’ communication and recommendation of the HPV vaccine for Latinx adolescent males. Future research should intervene upon the study’s findings to address barriers that remain and affect Latinx mothers’ acceptance and uptake of the HPV vaccine for their children, in particular their sons.

Ethical Issues in Private Practice: A Phenomenological Investigation of Music Therapy Business Owners

2021 ◽  
Author(s):  
Kyle Wilhelm ◽  
Lindsey Wilhelm
Keyword(s):  
Music Therapy ◽  
Private Practice ◽  
Phenomenological Study ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
The United States ◽  
Business Owners ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Music Therapists

Abstract As a music therapy private practice is both a business and a healthcare service, it should adhere to ethical standards from both disciplines. However, this topic has rarely been examined in the music therapy literature. The purpose of this phenomenological study was to explore ethical dilemmas experienced by music therapy business owners (MTBOs) in their private practice and how MTBOs avoid or address ethical dilemmas. Utilizing convenience and snowball sampling techniques, 21 MTBOs in the United States were interviewed using semi-structured interviews. To answer the two areas of inquiry, we identified three themes and 12 subthemes: (1) Ethical issues related to client welfare, (2) Ethical issues related to business relationships and operation, and (3) Strategies to address or avoid ethical dilemmas. MTBOs also shared how they ensure ethical behavior in themselves, with their employees or independent contractors, and when interacting with professionals outside the private practice. These findings provide a better understanding of MTBOs’ lived experiences of ethics in their private practice and may benefit other music therapists who are in private practice or are wanting to go into private practice. Limitations and recommendations for further research are provided.

scholarly journals Staying Home, Staying Alive: Campus Food Pantry Student Clients’ Experiences During the COVID-19 Pandemic

2021 ◽  
pp. 193672442110356
Author(s):  
Elmira Jangjou
Keyword(s):  
Coping Strategies ◽  
Thematic Analysis ◽  
Future Research ◽  
Postsecondary Students ◽  
Structured Interviews ◽  
Short Term ◽  
Income Loss ◽  
Food Pantry ◽  
Global Pandemic ◽  
Seeking Help

In response to students’ food insecurity, a number of colleges and universities have taken action and established campus food pantries as part of their intervention plans. However, many of these pantries ceased operation due to COVID-19 campus shutdowns. The purpose of this study is to illustrate the short-term impacts of the COVID-19 pandemic on postsecondary students, who use a university-provided food pantry. Drawing from semi-structured interviews with 12 participants, the thematic analysis explored the initial coping strategies these students used to endure the pandemic. Findings revealed that many students experienced the immediate effects of the pandemic in the form of income loss, self-isolation, anxiety, and appetite change. Although the pandemic interrupted these students’ journeys to continue their studies and become independent in various ways, the affected students implemented various coping strategies, including seeking help from family or friends, using available resources, cooking at home, and even trying to save money. However, considering that the targeted population in this study was already at risk because of their basic needs insecurity, these postsecondary students require extra attention from their higher education institutions in the case of emergencies, such as a global pandemic. In addition to its timely and relevant findings, this study provides important avenues for future research and intervention efforts.

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