Radiation Injury and Emergency Medicine

The discovery of radiation has led to many advances. Guidelines have been created to minimize radiation exposure and treatment management following both unintentional and intentional exposure. The effects of radiation exposure on specific tissues varies. Tragic consequences can result, ranging from severe, acute injury to long- lasting effects that present years after the initial exposure. In this chapter we provide observations that demonstrate the importance of understanding guidelines to minimize radioactive exposure and the expectations and treatment management following exposure. For the safety and well-being of patients, health care professionals need to remain well-informed to minimize the risks of this tool.

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A study on legal and medical dimensions of radiation exposure in neurosurgery clinics in Turkish practice

Surgical Neurology International ◽

10.25259/sni_703_2020 ◽

2020 ◽

Vol 11 ◽

pp. 397

Author(s):

Abdulkadir Karaarslan ◽

Fatma Bahar Hacioğlu Kasim ◽

Numan Karaarslan ◽

Ozkan Ates

Keyword(s):

Health Care ◽

Radiation Exposure ◽

International Atomic Energy Agency ◽

Health Care Professionals ◽

Legal Rights ◽

Energy Agency ◽

Radioactive Substances ◽

Multicenter Survey ◽

Effects Of Radiation ◽

Harmful Effects

Background: In the present study, the first aim was to address the detrimental effects of the fluoroscopy procedure performed by physicians and other health-care professionals in neurosurgery clinics, then to examine precautions that should be taken to avoid harmful effects of radiation and radioactive substances during this process. The second aim was to handle the rights provided for health-care professionals exposed to the radiation in workplaces. Methods: A standardized questionnaire was used for a multicenter survey. Volunteer, intellectual, and cooperative participants (n = 41) were randomly chosen. The survey was prepared considering reports drawn up by the International Atomic Energy Agency. The questions concerning safe and effective fluoroscopy procedure were asked to the participants. The answers received were statistically evaluated. The alpha significance value was accepted as 0.05. Results: Two neurosurgeons only knew the legal rights that they might possess due to the exposure to the radiation or radioactive substances. Conclusion: The survey conducted among the health-care professionals revealed the insufficiency of knowledge about the protection from the radiation exposure or radioactive substances in workplaces. Furthermore, both health-care professionals working in radiology clinics, and those in neurosurgery and other clinics who are likely to be exposed to the radiation or radioactive substances have the rights afforded by the law.

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Easier and Faster Is Not Always Better: Grounded Theory of the Impact of Large-Scale System Transformation on the Clinical Work of Emergency Medicine Nurses and Physicians (Preprint)

10.2196/preprints.11013 ◽

2018 ◽

Author(s):

Elaine Zibrowski ◽

Lisa Shepherd ◽

Kamran Sedig ◽

Richard Booth ◽

Candace Gibson

Keyword(s):

Health Care ◽

Emergency Medicine ◽

Grounded Theory ◽

Health Care Professionals ◽

Large Scale ◽

Clinical Work ◽

Well Being ◽

Clinical Workflow ◽

Nurses And Physicians ◽

The Impact

BACKGROUND The effectiveness of Lean Thinking as a quality improvement method for health care has been contested due, in part, to our limited contextual understanding of how it affects the working conditions and clinical workflow of nurses and physicians. Although there are some initial indications, arising from prevalence surveys and interviews, that Lean may intensify work performed within medical environments, the evidence base still requires detailed descriptions of the changes that were actually introduced to individuals’ clinical workflow and how these changes impacted health care professionals. OBJECTIVE The aim of this study was to explore ways in which a Lean intervention may impact the clinical work of emergency medicine nurses and physicians. METHODS We used a realist grounded theory approach to explore the clinical work of nurses and physicians practicing in 2 emergency medicine departments from a single teaching hospital in Canada. The hospital has 1000 beds with 128,000 emergency department (ED) visits annually. In 2013, both sites began a large-scale, Lean-driven system transformation of their practice environments. In-person interviews were iteratively conducted with health care professionals from July to December 2017. Information from transcripts was coded into categories and compared with existing codes. With repeated review of transcripts and evolving coding, we organized categories into themes. Data collection continued to theoretical sufficiency. RESULTS A total of 15 emergency medicine nurses and 5 physicians were interviewed. Of these, 18 individuals had practiced for at least 10 years. Our grounded theory involved 3 themes: (1) organization of our clinical work, (2) pushed pace in the front cell, and (3) the toll this all takes on us. Although the intervention was supposed to make the EDs work easier, faster, and better, the participants in our study indicated that the changes made had the opposite impact. Nurses and physicians described ways in which the reconfigured EDs disrupted their established practice routines and resulted in the intensification of their work. Participants also identified indications of deskilling of nurses’ work and how the new push-forward model of patient care had detrimental impacts on their physical, cognitive, and emotional well-being. CONCLUSIONS To our knowledge, this is the first study to describe the impact of Lean health care on the working conditions and actual work of emergency medicine nurses and physicians. We theorize that rather than support health care professionals in their management of the complexities that characterize emergency medicine, the physical and process-based changes introduced by the Lean intervention acted to further complicate their working environment. We have illuminated some unintended consequences associated with accelerating patient flow on the clinical workflow and perceived well-being of health care professionals. We identify some areas for reconsideration by the departments and put forward ideas for future research.

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Teaching Interspiritual Dialogue to Health Care Professionals

10.1093/oso/9780190677565.003.0022 ◽

2017 ◽

Author(s):

Kelly R. Arora

Keyword(s):

Health Care ◽

Doctoral Students ◽

Health Care Professionals ◽

Well Being ◽

Course Structure ◽

Beliefs And Practices ◽

Pedagogical Choices ◽

Dimensions Of Teaching ◽

Contemporary Context ◽

Made In

Interspiritual conversations are becoming more common in health care settings as providers recognize that patients’ diverse spiritual/religious values, beliefs, and practices may influence their health care decision-making and general well-being. This essay explores the practical dimensions of teaching health care professionals how to use an interspiritual dialogue approach grounded in values and particularism through a course entitled “Faith, Spirituality and Culture in Health Care,” which was designed for and taught to doctoral students at a Denver, Colorado, School of Pharmacy. After considering the contemporary context for teaching interspiritual dialogue to healthcare professionals, the essay reflects upon and relates the pedagogical choices made in designing and teaching the course, as well as the course structure, outline, objectives, and schedule.

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Caring for Gravely Ill Children

PEDIATRICS ◽

10.1542/peds.94.4.433 ◽

1994 ◽

Vol 94 (4) ◽

pp. 433-439 ◽

Cited By ~ 5

Author(s):

Alan R. Fleischman ◽

Kathleen Nolan ◽

Nancy N. Dubler ◽

Michael F. Epstein ◽

Mary Ann Gerben ◽

...

Keyword(s):

Health Care ◽

Decision Making ◽

Health Care Professionals ◽

Treatment Plan ◽

Ethics Committees ◽

Well Being ◽

Pediatric Health Care ◽

Spiritual Well Being ◽

Primary Focus

Background. Much has been written about the care of the hopelessly ill adult, but there is little guidance for pediatric health care professionals in the management of children who are critically or terminally ill. Methods. Through a 3-day meeting in Tarrytown, NY, attended by a group of pediatricians and others directly involved in these issues, a principled approach was developed for the treatment of, and health care decision-making for, children who are gravely ill. Results. The group agreed that the needs and interests of the child must be the central focus of any treatment plan and that the child should be involved to as great extent possible, consistent with developmental maturity, in the decision-making process. Quality of future life should be viewed as being relevant in all decisions. Parents are believed to be the natural guardians of children and ought to have great latitude in making decisions for them. However, parental discretion is not absolute and professionals must maintain an independent obligation to protect the child's interests. Conclusions. Decision-making should be collaborative among patient, parents, and professionals. When conflict arises, consultation and ethics committees may assist in resolution. When cure or restoration of function is no longer possible, or reasonable, promotion of comfort becomes the primary goal of management. Optimal use of pain medication and compassionate concern for the physical, psychological, and spiritual well-being of the child and family should be the primary focus of the professionals caring for the dying child.

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Health-care Workforce Training to Effectively Support Family Caregivers of Seniors in Care

Canadian Geriatrics Journal ◽

10.5770/cgj.23.384 ◽

2020 ◽

Vol 23 (2) ◽

pp. 160-171

Author(s):

Rachel Fisher ◽

Jasneet Parmar ◽

Wendy Duggleby ◽

Peter George J. Tian ◽

Wonita Janzen ◽

...

Keyword(s):

Health Care ◽

Family Caregivers ◽

Health Care Professionals ◽

Health Care Services ◽

Well Being ◽

Workforce Training ◽

Community Dwelling ◽

Canadian Health Care System ◽

Care Services ◽

Qualitative Thematic Analysis

Introduction Family caregivers (FCGs) play an integral, yet often invisible, role in the Canadian health-care system. As the population ages, their presence will become even more essential as they help balance demands on the system and enable community dwelling seniors to remain so for as long as possible. To preserve their own well-being and capacity to provide ongoing care, FCGs require support to the meet the challenges of their daily caregiving responsibilities. Supporting FCGs results in better care provision to community-dwelling seniors receiving health-care services, as well as enhancing the quality of life for FCGs. Although FCGs rely upon health-care professionals (HCPs) to provide them with support and services, there is a paucity of research pertaining to the type of health workforce training (HWFT) that HCPs should receive to address FCG needs. Programs that train HCPs to engage with, empower, and support FCGs are required. Objective To describe and discuss key findings of a caregiver symposium focused on determining components of HWFT that might better enable HCPs to support FCGs. Methods A one-day symposium was held on February 22, 2018 in Edmonton, Alberta, to gather the perspectives of FCGs, HCPs, and stakeholders. Attendees participated in a series of working groups to discuss barriers, facilitators, and recommendations related to HWFT. Proceedings and working group discussions were transcribed, and a qualitative thematic analysis was conducted to identify key themes. Results Participants identified the following topic areas as being essential to training HCPs in the provision of support for FCGs: understanding the FCG role, communicating with FCGs, partnering with FCGs, fostering FCG resilience, navigating healthcare systems and accessing resources, and enhancing the culture and context of care. Conclusions FCGs require more support than is currently being provided by HCPs. Training programs need to specifically address topics identified by participants. These findings will be used to develop HWFT for HCPs.

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Efficacy of a brief online mindfulness-based intervention on the psychological well-being of health care professionals and trainees during the COVID-19 pandemic: A mixed method design

Health SA Gesondheid ◽

10.4102/hsag.v26i0.1682 ◽

2021 ◽

Vol 26 ◽

Author(s):

Iram Osman ◽

Shaista Hamid ◽

Veena S. Singaram

Keyword(s):

South Africa ◽

Health Care ◽

Mixed Method ◽

Health Professionals ◽

Health Care Professionals ◽

Well Being ◽

Personal Accomplishment ◽

Intervention Analysis ◽

Health Crisis ◽

The Impact

Background: During the coronavirus disease 2019 (COVID-19) pandemic, health professionals were pushed to the front line of a global health crisis unprepared and resource constrained, which affected their mental well-being.Aim: This study aimed to investigate the effectiveness of a brief online mindfulness-based intervention (MBI) on stress and burnout for health professionals training and working in South Africa during the COVID-19 crisis.Setting: The context of the study is the overburdened, under-resourced health care system in South Africa during a global pandemic.Methods: A mixed method framework was adopted for this study. The quantitative data was analysed using descriptive analysis and the participants’ qualitative experiences were interpreted using interpretative phenomenological analysis.Results: Forty-seven participants took part in this study. The study found a statistically significant (p 0.05) reduction in stress levels and emotional exhaustion as well as an increase in mindful awareness and feelings of personal accomplishment after the intervention. The participants’ shared experiences were analysed in two parts. The pre-intervention analysis presented with central themes of loss of control and a sense of powerlessness because of COVID-19. The post-intervention analysis comprised themes of a sense of acquired control and empowerment through increased mindfulness.Conclusions: The study found that a brief online MBI can be associated with reduced levels of stress and burnout as well as an increased sense of control and empowerment, felt both personally and professionally, during a global crisis.Contribution: The impact of an online MBI for health care professionals amidst a pandemic has not been previously documented.

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“I’m Just Forgetting and I Don’t Know Why”: Exploring How People Living With HIV-Associated Neurocognitive Disorder View, Manage, and Obtain Support for Their Cognitive Difficulties

Qualitative Health Research ◽

10.1177/1049732318761364 ◽

2018 ◽

Vol 28 (6) ◽

pp. 859-872 ◽

Cited By ~ 4

Author(s):

Alexander R. Terpstra ◽

Catherine Worthington ◽

Francisco Ibáñez-Carrasco ◽

Kelly K. O’Brien ◽

Aiko Yamamoto ◽

...

Keyword(s):

Health Care ◽

Lived Experience ◽

Health Care Professionals ◽

Management Strategies ◽

Well Being ◽

People Living With Hiv ◽

Neurocognitive Disorder ◽

Cognitive Difficulties ◽

Hiv Associated Neurocognitive Disorder ◽

Living With Hiv

HIV-associated neurocognitive disorder (HAND) is common, but the lived experience of HAND is not well-understood. In this descriptive qualitative study, we explored how adults with HAND view, manage, and obtain support for cognitive difficulties. We interviewed 25 participants (20% female; median age = 51 years) who were diagnosed with HAND using neuropsychological assessment and a clinical interview. Semistructured interviews, co-developed with community members living with HIV, focused on how cognitive difficulties manifested and progressed, impacted well-being, and were discussed with others. We analyzed interview transcripts using a team-based, thematic approach. Participants described concentration, memory, and multitasking difficulties that fluctuated over time, as well as potential risk factors, management strategies, and psychosocial consequences. They reported they seldom discussed cognitive impairment with health care professionals, and that receiving a HAND diagnosis was validating, informative, yet somewhat disconcerting. Conversations between health care professionals and people living with HIV about HAND may provide opportunities for education, assessment, and support.

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Getting Senior Leadership on Board

Mayo Clinic Strategies To Reduce Burnout ◽

10.1093/med/9780190848965.003.0008 ◽

2020 ◽

pp. 61-72

Author(s):

Stephen J. Swensen ◽

Tait D. Shanafelt

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Business Strategy ◽

Well Being ◽

Business Case ◽

Organizational Environment ◽

Senior Leadership ◽

Senior Leaders

Optimizing the organizational environment to promote esprit de corps can’t happen without senior leadership prioritizing the issues and dedicating time, attention, and other resources to address them. For meaningful and sustainable results, the commitment by leadership must be authentic. In other words, leaders must embrace this quest because they genuinely care, not just because they believe it is a good business strategy. There are four triggers for senior leaders to become committed to the well-being of the health care professionals in their organization: the moral/ethical case, the business case, the regulatory case, or the tragic case.

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Using the Job Demands–Resources Model to Evaluate Work-Related Outcomes Among Norwegian Health Care Workers

SAGE Open ◽

10.1177/2158244020947436 ◽

2020 ◽

Vol 10 (3) ◽

pp. 215824402094743

Author(s):

Sabine Kaiser ◽

Joshua Patras ◽

Frode Adolfsen ◽

Astrid M. Richardsen ◽

Monica Martinussen

Keyword(s):

Job Satisfaction ◽

Health Care ◽

Service Quality ◽

Health Care Professionals ◽

Turnover Intention ◽

Structural Equation ◽

Job Demands ◽

Well Being ◽

Job Resources ◽

Work Related

The job demands-resources (JD-R) model was used to evaluate work-related outcomes among 489 health care professionals working in public health services for children and their families in Norway. In accordance with the JD-R model, the relationship of job demands and job resources with different outcomes (turnover intention, job satisfaction, and service quality) should be mediated through burnout and engagement. The results of the multilevel structural equation model analysis indicated good model fit: The χ2/degrees of freedom ratio was 1.54, the root mean square error of approximation was .033, and the Tucker Lewis index and comparative fit index were both .92. Job demands were positively associated with burnout; job resources were positively related to engagement and negatively related to burnout. Burnout was positively related to turnover intention and negatively related to job satisfaction and service quality. Engagement was inversely related to the outcome variables. Both job demands and job resources are important predictors of employee well-being and organizational outcomes.

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Risk Perception and Worries among Health Care Workers in the COVID-19 Pandemic: Findings from an Italian Survey

Healthcare ◽

10.3390/healthcare8040535 ◽

2020 ◽

Vol 8 (4) ◽

pp. 535

Author(s):

Mariangela Valentina Puci ◽

Guido Nosari ◽

Federica Loi ◽

Giulia Virginia Puci ◽

Cristina Montomoli ◽

...

Keyword(s):

Health Care ◽

Risk Perception ◽

Health Care Providers ◽

Health Care Workers ◽

Health Care Professionals ◽

Sleep Disturbances ◽

Well Being ◽

Care Providers ◽

Cross Sectional ◽

Care Workers

The ongoing pandemic scenario, due to the coronavirus disease 2019 (COVID-19), has had a considerable impact on public health all over the world. Italy was one of the most affected countries, as the first European full-blown outbreak occurred there. The exposure of the Italian health care workers to COVID-19 may be an important risk factor for psychological distress. The aim of this cross-sectional study was to describe worries and risk perception of being infected among Italian Health Care Workers (HCWs) during the first wave of the pandemic. In total, 2078 HCWs participated in a web survey (78.8% were females). The highest percentage of respondents were physicians (40.75%) and nurses (32.15%), followed by medical (18.00%), health care support (4.50%) and administrative (4.60%) staff. In a score range between 0 (not worried) and 4 (very worried), our results showed that participants declared that they were worried about the Coronavirus infection with a median score of 3 (IQR 2-3) and for 59.19% the risk perception of being infected was very high. In addition, HCWs reported they suffered from sleep disturbances (63.43%). From the analysis of the psychological aspect, a possible divergence emerged between the perceived need for psychological support (83.85%) and the relative lack of this service among health care providers emerged (9.38%). Our findings highlight the importance of psychological and psychiatric support services not only during the COVID-19 pandemic, but also in other emerging infectious diseases (EIDs) scenarios. These services may be useful for health authorities and policymakers to ensure the psychological well-being of health care professionals and to promote precautionary behaviors among them.

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