The Role of the Indigenous Patient Navigator: A Scoping Review

Background Healthcare systems are complex and as a result patients may experience fragmentation of services. Indigenous populations experience increasingly disproportionate health disparities compared to non-Indigenous populations. Patient navigation is known as a patient-centered approach to empower individuals to connect with appropriate services. Literature surrounding the Indigenous Patient Navigator (IPN) remains sparse necessitating this scoping review. Purpose: To map the current state of the role of the IPN internationally within Canada, United States, Australia and New Zealand. Methods Estalished methodological framework by Arksey and O’Malley and the PRISMA extension for scoping reviews was used. Results A total of 820 articles were reviewed from four databases, yielding sixteen articles. Conclusions The absence of published literature surrounding the IPN role in Australia and New Zealand was surprising considering similar histories of colonization. The term navigator was used most often and was typically used when describing lay/peer roles. Professional roles were described using specific role descriptions. Six IPN roles were identified including: (1) social service navigation, (2) wholistic support of Indigenous people, (3) advocacy/building capacity, (4) health assessment, (5) administrative navigation, and (6) outreach. Additionally, barriers and enablers IPNs address are identified. This scoping review will assist to promote and reinforce the IPN role.

Knowledge of recent medical graduates and views of stakeholders and teachers regarding medical ethics and professionalism in Bangladesh

Medical education aims to produce competent medical professionals and gives emphasis on competency-based learning in Bangladesh. Medical ethics and professionalism are considered as a core competency. A competent physician can ensure patient-centered health care system. This was an effort to obtain data regarding the knowledge of recent medical graduates and the opinion of medical educational stakeholders and teachers about medical ethics and professionalism at undergraduate medical education in Bangladesh. This mixed-method study was conducted in two rounds. The Round I was conducted from January 2018 to June 2019 for assessing the knowledge of 308 recent medical graduates towards medical ethics and professionalism. In Round II, key informant interviews were conducted among 30 medical educational stakeholders and teachers from July 2020 to December 2020. Data were collected by pre-tested self administered semi-structured questionnaire and interview guidelines. The percentages of recent medical graduates who could give correct answers regarding autonomy, justice, presenting a subject to visual social media, breaching of confidentiality, organ donation and medical certificate were 19.8%, 54.9%, 73.1%, 37.3%, 91.6% and 74.4% respectively. Most of the medical educational stakeholders and teachers (80%) expressed their opinion related to curriculum. They also suggested for practicing ethics (20.0%) and training (20.0%). A gap was observed in the knowledge regarding medical ethics and professionalism of recent medical graduates. To improve practice of ethics and professionalism, enhancement of the knowledge by incorporating “medical ethics and professionalism” in curriculum might be considered. A separate compulsory module for training on medical ethics and professionalism can be added at pre-internship period for the recent medical graduates. Bangladesh Journal of Medical Education Vol.13(1) January 2022: 40-48

Human Factors and Ergonomics in Healthcare: Industry Demands and a Path Forward

This article reviews three industry demands that will impact the future of Human Factors and Ergonomics in Healthcare settings. These demands include the growing population of older adults, the increasing use of telemedicine, and a focus on patient-centered care. Following, we discuss a path forward through improved medical teams, error management, and safety testing of medical devices and tools. Future challenges are discussed.

The Diabetes Simulation Challenge: Enhancing Patient Perspective-Taking for Medical Students

The Diabetes Simulation Challenge is a unique training tool to foster empathy, a key facet of patient-centered care, for medical students. Thirty-two medical students participated in a 24-hour perspective-taking activity as part of their curriculum, during which they simulated some common experiences of living with a chronic health condition, specifically type 1 diabetes. Students’ written reflections were analyzed using a phenomenological qualitative approach to provide a composite description of the experience. An exhaustive, iterative method of thematic analysis that included manual coding was used to determine whether this activity led to expressions of empathy or thoughts and beliefs consistent with patient-centered health care. Nine unique themes emerged, six of which indicated that students adopted the perspective of an individual with a chronic illness. Most of the students’ reflections illustrated an understanding of the behavioral, social, and emotional challenges related to living with type 1 diabetes, as well as increased empathy toward individuals with the disease. Medical students who aim to provide patient-centered care benefited from this perspective-taking exercise, and training programs should consider using such methods to extend learning beyond traditional didactic education.

Psychological Impact of the Hospital Indoor Public Spaces on Patients’ Health, Assessment, and Analysis

Due to the rapid development of social economy, general hospital buildings of China are undergoing changes in their models, technology, and medical systems. Changes in the model of hospitals may affect the functional structure, streamline layout, and spatial form of the hospital building. The biological-psychological-social (biopsychosocial) model covers the overall significant factors in healthcare. The model focuses on the hospital public environment. For the advocacy of patient-centered medical concepts, researchers have put forward newer and higher requirements as well. However, there is scarcity of research that targets the psychological impact of general hospital public space environment construction on the patients’ health. Moreover, there is no unanimously recognized standard questionnaire for the public space environment. The purpose of this article is to investigate the needs of inpatients for the space environment, to understand the influencing factors of various space environments, and to explore the law of patient needs. The research intends to provide a theoretical background for the construction of a patient-centered space environment. A dedicated questionnaire was designed to systematically collect the significant features and factors. Using cluster sampling, a total of four medical and surgical wards were investigated. The data obtained from 430 questionnaires were statistically analyzed by SPSS-10.0. Various statistical operations such as descriptive analysis, independent sample t test, one-way analysis of variance, and linear and logistic regressions were performed over the data. The psychological impact was studied from four aspects. The highest score (3-4 points) obtained for the larger number of patients (84.4%) testifies that the public space environment has a significant impact on patients’ mental health. Besides healthcare, outcomes of the paper may be used in various related domains such as psychological well beings, spatial analysis, social interaction, and public space designing.

From a View of the Hospital as a System to a View of the Suffering Patient

Purpose: Hospitals aspire to provide patient-centered care but are far from achieving it. This qualitative mixed methods study explored the capacity of hospital directors to shift from a hospital systemic-view to a suffering patient-view applying the Salutogenic theory.Methods: Following IRB, we conducted in-depth narrative interviews with six directors of the six Israeli academic tertiary public hospitals, focusing on their managerial role. In a second meeting we conducted vignette interviews in which we presented each director with a narrative of a suffering young patient who died at 33 due to medical misconduct, allowing self-introspection. Provisional coding was performed for data analysis to identify categories and themes by the three dimensions of the sense-of-coherence, an anchor of Salutogenics: comprehensibility, manageability, and meaningfulness.Results: While at the system level, directors reported high comprehensibility and manageability in coping with complexity, at the patient level, when confronted with the vignette, directors acknowledged their poor comprehensibility of patients' needs and patient's experience during hospitalizations. They acknowledged their poor capacity to provide patient-centered care. Meaningfulness in the narrative interview focused on the system while meaningfulness in the vignette interview focused on providing patient care.Conclusions: The evident gaps between the system level and the patient level create lack of coherence, hindering the ability to cope with complexity, and are barriers to providing patient-centered care. To improve the delivery of patient-centered care, we suggest ways to consolidate the views, enabling the shift from a systemic-view to a patient-view.

A Qualitative Analysis to Understand Perception about Medication-Related Problems among Older Minority Adults in a Historically Black Community

Older adults taking multiple chronic medications experience an increased risk of adverse drug events and other medication-related problems (MRP). Most current literature on medication management involves researcher-driven intervention, yet few studies investigate patients’ understanding of MRP in a diverse community setting. This report investigates patients’ perception of MRP and patient-centered strategies among a cohort of the older adult group in a historically Black urban community. The study design is qualitative using structured open-ended questions in a multidisciplinary patient-centered focus group. Patients (age 65 years or older) taking seven or more medications were recruited. The group comprises patients, caregivers, pharmacists, health educators, a physician, and a nurse. Recordings of the group discussion are transcribed verbatim and analyzed using thematic content analysis and categorized by codes developed from the social-ecological model. The group reports patient-provider relationships, previous experience, fear of side effects played important roles in medication adherence. There is an unmet need for medication management education and tools to organize complex medication lists from multiple providers. This study provides important insights into MRP experienced by minority older adults and provided researchers with potential strategies for future interventions.