BACKGROUND: Parental involvement in the decision-making processes about medical treatment for children with life-limiting conditions is recognised as good practice. Previous research highlighted factors affecting the decision-making process, but little is known about how parents experience their participation. AIM: To explore how parents experience their participation in the process of decision-making about treatment and future care for their children with life-limiting conditions. DESIGN: A systematically constructed review using narrative synthesis. The PRISMA guidelines were followed to report the findings. Databases Medline, EMBASE, SCOPUS, CINAHL and PsycINFO were searched up to December 2023. The study protocol was registered at PROSPERO (RN CRD42021215863). RESULTS: From the initial 2512 citations identified, 28 papers met the inclusion criteria and were included in the review. A wide range of medical decisions was identified; stopping general or life-sustaining treatment was most frequent. Narrative synthesis revealed six themes: (1) Temporal aspects affecting the experience with decision-making; (2) Losing control of the situation; (3) Transferring the power to decide to doctors; (4) To be a 'good' parent and protect the child; (5) The emotional state of parents and (6) Sources of support to alleviate the parental experience. CONCLUSIONS: Parental experiences with decision-making are complex and multifactorial. Parents' ability to effectively participate in the process is limited, as they are not empowered to do so and the circumstances in which the decisions are taking place are challenging. Healthcare professionals need to support parental involvement in an effective way instead of just formally asking them to participate.
- MeSH
- dítě MeSH
- klinické rozhodování MeSH
- lidé MeSH
- rodiče * psychologie MeSH
- rozhodování * MeSH
- vyprávění MeSH
- zdravotnický personál psychologie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
Purpose: The aim of this study is to understand how healthcare practitioners experience organisational boundaries and silos in day-to-day operations. Based on a multi-dimensional scale of organisational boundaries, the study examines how organisational demarcation lines enable and constrain daily work tasks in the healthcare sector.Research design: The study is based on a quantitative and qualitative analysis of survey responses from 895 healthcare practitioners in Denmark.Results: The results indicate that tendencies toward organisational silos relate to systems and hierarchies (management-staff) rather than professions and departments. Moreover, the study identifies resource scarcity as an important undercurrent in the understanding of the respondents' perceptions of boundaries and silos.Conclusion: The study contributes to existing research by documenting the coordination and collaboration challenges linked to the multitude of demarcation lines in complex health organisations.
- MeSH
- dospělí MeSH
- kooperační chování MeSH
- kvalitativní výzkum MeSH
- lidé středního věku MeSH
- lidé MeSH
- postoj zdravotnického personálu MeSH
- průzkumy a dotazníky MeSH
- sektor zdravotní péče * organizace a řízení MeSH
- zdravotnický personál psychologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Dánsko MeSH
INTRODUCTION: A growing body of research is examining how healthcare systems are responding to the increasing numbers of migrants and the resulting superdiversity of patients. The aim of this article is to identify and explain communication barriers in the provision of healthcare to Ukrainian war refugees in the Czech Republic from the perspectives of healthcare professionals and intercultural mediators. METHODS: The exploratory case study is based on a qualitative analysis of semi-structured interviews with frontline health professionals: 20 with doctors and 10 with nurses. The second source of data is two focus groups aimed at capturing communication problems from the perspective of intercultural mediators who accompany refugees to health facilities. The interview transcripts and FGs were analysed using six-stage thematic coding. RESULTS: The survey identified five main themes related to barriers to communication: (1) language barriers and interpreting, (2) cultural barriers, (3) differing expectations of health and the healthcare systems in the Czech Republic and Ukraine, (4) prejudices and negative attitudes and unethical behaviour towards refugees and migrants and (5) lack of awareness of patient rights. CONCLUSIONS: The arrival of large numbers of migrants has highlighted deficiencies in the system that may affect other vulnerable groups and the general population. These include the lack of general communication skills and legal awareness among many health professionals, which are barriers to the development of patient-centred care. The involvement of intercultural mediators fundamentally improves communication between health professionals and (not only) migrant patients. Nevertheless, it is necessary to legally anchor and define the position of intercultural mediators within the healthcare system. PATIENT OR PUBLIC CONTRIBUTION: Collaboration with intercultural mediators who interpreted the extensive experiences of Ukrainian refugee patients and also have personal experience as migrant or migrant-origin patients contributed to shaping research questions, facilitating study participation and enriching evidence interpretation. Researchers with multicultural backgrounds and experience with working with people from refugee backgrounds were involved in the study design and analysis.
- MeSH
- dospělí MeSH
- komunikace MeSH
- komunikační bariéry * MeSH
- kvalitativní výzkum MeSH
- lidé středního věku MeSH
- lidé MeSH
- poskytování zdravotní péče MeSH
- postoj zdravotnického personálu MeSH
- rozhovory jako téma MeSH
- uprchlíci * psychologie MeSH
- zdravotnický personál psychologie MeSH
- zjišťování skupinových postojů MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Ukrajina MeSH
BACKGROUND: Long-term deterioration in the mental health of healthcare workers (HCWs) has been reported during and after the COVID-19 pandemic. Determining the impact of COVID-19 incidence and mortality rates on the mental health of HCWs is essential to prepare for potential new pandemics. This study aimed to investigate the association of COVID-19 incidence and mortality rates with depressive symptoms over 2 years among HCWs in 20 countries during and after the COVID-19 pandemic. METHODS: This was a multi-country serial cross-sectional study using data from the first and second survey waves of the COVID-19 HEalth caRe wOrkErS (HEROES) global study. The HEROES study prospectively collected data from HCWs at various health facilities. The target population included HCWs with both clinical and non-clinical roles. In most countries, healthcare centers were recruited based on convenience sampling. As an independent variable, daily COVID-19 incidence and mortality rates were calculated using confirmed cases and deaths reported by Johns Hopkins University. These rates represent the average for the 7 days preceding the participants' response date. The primary outcome was depressive symptoms, assessed by the Patient Health Questionnaire-9. A multilevel linear mixed model (LMM) was conducted to investigate the association of depressive symptoms with the average incidence and mortality rates. RESULTS: A total of 32,223 responses from the participants who responded to all measures used in this study on either the first or second survey, and on both the first and second surveys in 20 countries were included in the analysis. The mean age was 40.1 (SD = 11.1), and 23,619 responses (73.3%) were from females. The 9323 responses (28.9%) were nurses and 9119 (28.3%) were physicians. LMM showed that the incidence rate was significantly and positively associated with depressive symptoms (coefficient = 0.008, standard error 0.003, p = 0.003). The mortality rate was significantly and positively associated with depressive symptoms (coefficient = 0.049, se = 0.020, p = 0.017). CONCLUSIONS: This is the first study to show an association between COVID-19 incidence and mortality rates with depressive symptoms among HCWs during the first 2 years of the outbreak in multiple countries. This study's findings indicate that additional mental health support for HCWs was needed when the COVID-19 incidence and mortality rates increase during and after the early phase of the pandemic, and these findings may apply to future pandemics. TRIAL REGISTRATION: Clinicaltrials.gov, NCT04352634.
- MeSH
- COVID-19 * mortalita epidemiologie psychologie MeSH
- deprese * epidemiologie MeSH
- dospělí MeSH
- incidence MeSH
- lidé středního věku MeSH
- lidé MeSH
- průřezové studie MeSH
- SARS-CoV-2 MeSH
- zdravotnický personál * psychologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Understanding the communication dynamics between vaccine-hesitant parents and healthcare professionals (HCPs) is vital for addressing parent concerns and promoting informed decision-making. This paper focuses on strategies used by HCPs to communicate with vaccine-hesitant parents. It draws on empirical evidence generated as part of the international project VAX-TRUST. More specifically, 60 hours of observations were carried out in three different pediatric practices during vaccination-related visits, and 19 physicians and nurses were interviewed. We focused on the specific context of the Czech Republic, which represents a country with a mandatory vaccination system and in which children's immunization is the responsibility of pediatric general practitioners. We demonstrate that the dynamics between parents and HCPs and their willingness to invest time in the vaccination discussion are influenced by how HCPs categorize and label parents. Furthermore, we outline some of the different strategies HCPs employ while addressing concerns regarding vaccination. We identified two different strategies HCPs use to manage the fears of vaccine-hesitant parents. The first strategy focused on the communication of risks associated with vaccination (and lack thereof). HCPs used a variety of discursive practices to familiarize the unfamiliar risks of vaccine-preventable diseases (by mobilizing representations that are part of collective memory, incorporating personal experiences to materialize the presence of risk and the confidence in the safety of vaccines and by situating risk as embedded in everyday processes and integral to the uncertainty of the global world). The second strategy involved the conscious employment of medical procedures that may contribute to reducing vaccination fears.
- MeSH
- dítě MeSH
- dospělí MeSH
- komunikace * MeSH
- lidé MeSH
- odkládání očkování * psychologie statistika a číselné údaje MeSH
- pacientův souhlas se zdravotní péčí psychologie MeSH
- rodiče * psychologie MeSH
- rozhodování MeSH
- vakcinace * psychologie MeSH
- vakcíny aplikace a dávkování MeSH
- vztahy mezi odborníkem a rodinou MeSH
- zdraví - znalosti, postoje, praxe MeSH
- zdravotnický personál * psychologie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Introduction: The coronavirus epidemic caught the world by surprise. The already overburdened and understaffed health sector faced new challenges that made the daily lives of health workers even more difficult. Aim: The purpose of this study was to evaluate the extent of burnout and symptoms of depression in health workers, and their association with work in COVID care and other sociodemographic and workplace factors. Methods: The cross-sectional study was conducted from 27 January 2022 to 14 February 2022 with a self-constructed questionnaire. Data were analysed with descriptive statistics, Chi-square tests, and Spearman correlations (p < 0.05). Results: Of the 10,285 Hungarian respondents who completed the questionnaire, 42.3% suffered from varying degrees of depression and 64.4% from burnout. These two psychological factors are significantly associated with marital status, sex, number of years in health care, levels of health care, and the length of time working in COVID care. A high degree of burnout and severe depression will result in a negative assessment of the COVID vaccine. The older the respondent, the lower the levels of depression and burnout. Conclusion: Working in COVID care has had a significant negative impact on the mental health of health workers. It is important to note that the Beck Depression Scale alone is not sufficient to diagnose depression.
- MeSH
- COVID-19 psychologie MeSH
- deprese diagnóza psychologie MeSH
- duševní vyhoření * MeSH
- lidé MeSH
- průzkumy a dotazníky MeSH
- sociodemografické faktory MeSH
- zdravotnický personál psychologie MeSH
- Check Tag
- lidé MeSH
- Geografické názvy
- Maďarsko MeSH
BACKGROUND AND OBJECTIVES: The mental health of healthcare workers (HCWs) may have improved after the COVID-19 pandemic. We aimed to model the trajectories of psychological distress, depressive symptoms, and resilience during the COVID-19 pandemic and toward its end in HCWs in Czechia and investigate, which COVID-19 work stressors were associated with these trajectories. METHODS: The study included 322 HCWs from the Czech arm of the international HEROES Study who participated in an online questionnaire in two waves during the pandemic and one wave toward its end. Growth mixture modeling identified trajectory patterns of depressive symptoms (measured with Patient Health Questionnaire), distress (General Health Questionnaire), and resilience (Brief Resilience Scale). Logistic regression was applied to estimate the association of COVID-19 stressors with mental health trajectories, adjusting for baseline characteristics. RESULTS: Trajectory classes revealed both high and low depressive symptoms (high in 61% of participants), distress (high in 82% of participants), and resilience (low in 32% of participants). Depressive symptoms and distress trajectories demonstrated the same shape, first increasing during the pandemic and decreasing toward its end, while resilience remained constant. Exposure to COVID-19 stressors, in particular, the experience of stigmatization, discrimination, and violence, was associated with high depressive symptoms and distress trajectories, but not with resilience. CONCLUSIONS: Interventions provided to HCWs during crises such as pandemic should target distress and depressive symptoms and need to address stigmatization, discrimination, and violence.
- MeSH
- COVID-19 * psychologie epidemiologie MeSH
- deprese * psychologie epidemiologie MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- pracovní stres psychologie epidemiologie MeSH
- průzkumy a dotazníky MeSH
- psychická odolnost * MeSH
- psychický distres MeSH
- psychický stres psychologie epidemiologie MeSH
- SARS-CoV-2 MeSH
- zdravotnický personál * psychologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
Health care workers have been exposed to COVID-19 more than people in other professions, which may have led to stigmatization, discrimination, and violence toward them, possibly impacting their mental health. We investigated (1) factors associated with stigma, discrimination, and violence, (2) the association of stigma, discrimination, and violence with mental health, (3) everyday experiences of stigmatization, discrimination, and violence. We chose a combination of a quantitative approach and qualitative content analysis to analyze data collected at three time points: in 2020, 2021 and 2022. A higher age was associated with lower odds of experiencing stigma, discrimination, and violence, whereas female gender was related to more negative experiences. The intensity of exposure to COVID-19 was associated with greater experience with stigmatization, discrimination, and violence across all three years (for example in 2022: odds ratio, 95% confidence interval: 1.74, 1.18-2.55 for mild exposure; 2.82, 1.95-4.09 for moderate exposure; and 5.74, 3.55-9.26 for severe exposure, when compared to no exposure). Stigma, discrimination, and violence were most strongly associated with psychological distress in 2020 (odds ratio = 2.97, 95% confidence interval 2.27-3.88) and with depressive symptoms in 2021 (odds ratio = 2.78, 95% confidence interval 2.12-3.64). Attention should be given to the destigmatization of contagious diseases and the prevention of discrimination, violence, and mental health problems, both within workplaces and among the public.
- MeSH
- COVID-19 * psychologie epidemiologie MeSH
- dospělí MeSH
- duševní zdraví * MeSH
- lidé středního věku MeSH
- lidé MeSH
- násilí psychologie MeSH
- pandemie * MeSH
- SARS-CoV-2 MeSH
- sociální diskriminace psychologie MeSH
- společenské stigma * MeSH
- zdravotnický personál * psychologie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: Many anti-stigma programs for healthcare workers already exist however there is less research on the effectiveness of training in skills for health professionals to counter stigma and its impacts on patients. AIMS: The objective of this study was to examine the theory base, content, delivery, and outcomes of interventions for healthcare professionals which aim to equip them with knowledge and skills to aid patients to mitigate stigma and discrimination and their health impacts. METHODS: Five electronic databases and grey literature were searched. Data were screened by two independent reviewers, conflicts were discussed. Quality appraisal was realized using the ICROMS tool. A narrative synthesis was carried out. RESULTS: The final number of studies was 41. In terms of theory base, there are three strands - responsibility as part of the professional role, correction of wrongful practices, and collaboration with local communities. Content focusses either on specific groups experiencing health-related stigma or health advocacy in general. CONCLUSIONS: Findings suggest programs should link definitions of stigma to the role of the professional. They should be developed following a situational analysis and include people with lived experience. Training should use interactive delivery methods. Evaluation should include follow-up times that allow examination of behavioural change. PROSPERO, ID: CRD42020212527.
- MeSH
- lidé MeSH
- ochrana zájmů pacientů MeSH
- společenské stigma * MeSH
- zdravotnický personál * psychologie výchova MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- systematický přehled MeSH
