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BMC Medical Education Jan 2019Cultural awareness training for health professionals is now commonplace across a variety of sectors. Its popularity has spawned several alternatives (i.e., cultural... (Review)
Review
Cultural awareness training for health professionals is now commonplace across a variety of sectors. Its popularity has spawned several alternatives (i.e., cultural competence, cultural safety, cultural humility, cultural intelligence) and overlapping derivatives (diversity training, anti-racism training, micro-aggression training). The ever-increasing reach of cultural awareness initiatives in health settings has generally been well intentioned - to improve cross-cultural clinical encounters and patient outcomes with the broader expectation of reducing health disparities. Yet the capacity of cultural awareness training to accomplish or even impact such outcomes is seldom comprehensively scrutinized. In response, this paper applies a much needed critical lens to cultural awareness training and its derivatives by examining their underpinning philosophies, assumptions and most importantly, verification of their effectiveness. The paper finds cultural awareness approaches to be over-generalizing, simplistic and impractical. They may even induce unintended negative consequences. Decades of research point to their failure to realize meaningful outcomes in health care settings and beyond. Broader expectations of their capacity to reduce health disparities are almost certainly unachievable. Alternative suggestions for improving cross-cultural health care interactions and research are discussed within.
Topics: Awareness; Cultural Competency; Cultural Diversity; Culturally Competent Care; Health Personnel; Humans
PubMed: 30621665
DOI: 10.1186/s12909-018-1450-5 -
Healthcare Management Forum Mar 2017Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, creates serious barriers to access and quality care....
Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, creates serious barriers to access and quality care. It is also a major concern for healthcare practitioners themselves, both as a workplace culture issue and as a barrier for help seeking. This article provides an overview of the main barriers to access and quality care created by stigmatization in healthcare, a consideration of contributing factors, and a summary of Canadian-based research into promising practices and approaches to combatting stigma in healthcare environments.
Topics: Attitude of Health Personnel; Evidence-Based Practice; Health Personnel; Health Services Accessibility; Humans; Mental Disorders; Organizational Culture; Quality of Health Care; Stereotyping
PubMed: 28929889
DOI: 10.1177/0840470416679413 -
BMC Health Services Research Feb 2019Cross-cultural educational initiatives for professionals are now commonplace across a variety of sectors including health care. A growing number of studies have...
BACKGROUND
Cross-cultural educational initiatives for professionals are now commonplace across a variety of sectors including health care. A growing number of studies have attempted to explore the utility of such initiatives on workplace behaviors and client outcomes. Yet few studies have explored how professionals perceive cross-cultural educational models (e.g., cultural awareness, cultural competence) and the extent to which they (and their organizations) execute the principles in practice. In response, this study aimed to explore the general perspectives of health care professionals on culturally competent care, their experiences working with multi-cultural patients, their own levels of cultural competence and the extent to which they believe their workplaces address cross-cultural challenges.
METHODS
The perspectives and experiences of a sample of 56 health care professionals across several health care systems from a Mid-Western state in the United States were sourced via a 19-item questionnaire. The questionnaire comprised both open-ended questions and multiple choice items. Percentages across participant responses were calculated for multiple choice items. A thematic analysis of open-ended responses was undertaken to identify dominant themes.
RESULTS
Participants largely expressed confidence in their ability to meet the needs of multi-cultural clientele despite almost half the sample not having undergone formal cross-cultural training. The majority of the sample appeared to view cross-cultural education from a 'cultural awareness' perspective - effective cross-cultural care was often defined in terms of possessing useful cultural knowledge (e.g., norms and customs) and facilitating communication (the use of interpreters); in other words, from an immediate practical standpoint. The principles of systemic cross-cultural approaches (e.g., cultural competence, cultural safety) such as a recognition of racism, power imbalances, entrenched majority culture biases and the need for self-reflexivity (awareness of one's own prejudices) were scarcely acknowledged by study participants.
CONCLUSIONS
Findings indicate a need for interventions that acknowledge the value of cultural awareness-based approaches, while also exploring the utility of more comprehensive cultural competence and safety approaches.
Topics: Adult; Attitude of Health Personnel; Cultural Competency; Cultural Diversity; Culturally Competent Care; Female; Health Personnel; Humans; Male; United States
PubMed: 30808355
DOI: 10.1186/s12913-019-3959-7 -
The Lancet. Global Health May 2023
Topics: Humans; Health Personnel; Community Health Workers
PubMed: 37061296
DOI: 10.1016/S2214-109X(23)00172-9 -
PloS One 2021Effective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected...
BACKGROUND
Effective teamwork is critical for safe, high-quality care in the operating room (OR); however, teamwork interventions have not consistently resulted in the expected gains for patient safety or surgical culture. In order to optimize OR teamwork in a targeted and evidence-based manner, it is first necessary to conduct a comprehensive, theory-informed assessment of barriers and enablers from an interprofessional perspective.
METHODS
This qualitative study was informed by the Theoretical Domains Framework (TDF). Volunteer, purposive and snowball sampling were conducted primarily across four sites in Ontario, Canada and continued until saturation was reached. Interviews were recorded, transcribed, and de-identified. Directed content analysis was conducted in duplicate using the TDF as the initial coding framework. Codes were then refined whereby similar codes were grouped into larger categories of meaning within each TDF domain, resulting in a list of domain-specific barriers and enablers.
RESULTS
A total of 66 OR healthcare professionals participated in the study (19 Registered Nurses, two Registered Practical Nurses, 17 anaesthesiologists, 26 surgeons, two perfusionists). The most frequently identified teamwork enablers included people management, shared definition of teamwork, communication strategies, positive emotions, familiarity with team members, and alignment of teamwork with professional role. The most frequently identified teamwork barriers included others' personalities, gender, hierarchies, resource issues, lack of knowledge of best practices for teamwork, negative emotions, conflicting norms and perceptions across professions, being unfamiliar with team members, and on-call/night shifts.
CONCLUSIONS
We identified key factors influencing OR teamwork from an interprofessional perspective using a theoretically informed and systematic approach. Our findings reveal important targets for future interventions and may ultimately increase their effectiveness. Specifically, achieving optimal teamwork in the OR may require a multi-level intervention that addresses individual, team and systems-level factors with particular attention to complex social and professional hierarchies.
Topics: Adult; Attitude of Health Personnel; Communication; Cooperative Behavior; Female; Health Knowledge, Attitudes, Practice; Health Personnel; Humans; Interprofessional Relations; Male; Models, Theoretical; Operating Rooms; Patient Care Team; Patient Safety; Professional Role; Qualitative Research
PubMed: 33886580
DOI: 10.1371/journal.pone.0249576 -
Infectious Disease Clinics of North... Sep 2021An effective occupational health program is a key aspect of preventing exposure to infectious agents and subsequent infection, as well as evaluation and management of... (Review)
Review
An effective occupational health program is a key aspect of preventing exposure to infectious agents and subsequent infection, as well as evaluation and management of postexposure prophylaxis and infections in health care personnel (HCP) by educating HCP regarding proper handling of sharps, early identification and isolation of potentially infectious patients, implementation of standard and transmission-based precautions, and offering counseling of HCP regarding nonroutine prophylaxis. Occupational health services (OHS) must also apply standardized processes for determining when exposures have occurred and providing appropriate management, and provide immediate availability of a medical evaluation following a nonprotected exposure to an infectious disease.
Topics: Delivery of Health Care; Health Personnel; Humans; Immunization; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Occupational Health; Pre-Exposure Prophylaxis; Vaccines
PubMed: 34362540
DOI: 10.1016/j.idc.2021.04.008 -
Revista de Saude Publica 2020Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel's perspective.
OBJECTIVE
Identify barriers and facilitators to implementing the Group Prenatal Care model in Mexico (GPC) from the health care personnel's perspective.
METHODS
We carried out a qualitative descriptive study in four clinics of the Ministry of Health in two states of Mexico (Morelos and Hidalgo) from June 2016 to August 2018. We conducted 11 semi-structured interviews with health care service providers, and we examined their perceptions and experiences during the implementation of the GPC model. We identified the barriers and facilitators for its adoption in two dimensions: a) structural (space, resources, health personnel, patient volume, community) and b) attitudinal (motivation, leadership, acceptability, address problems, work atmosphere and communication).
RESULTS
The most relevant barriers reported at the structural level were the availability of physical space in health units and the work overload of health personnel. We identified the difficulty in adopting a less hierarchical relationship during the pregnant women's care at the attitudinal level. The main facilitator at the attitudinal level was the acceptability that providers had of the model. One specific finding for Mexico's implementation context was the resistance to change the doctor-patient relationship; it is difficult to abandon the prevailing hierarchical model and change to a more horizontal relationship with pregnant women.
CONCLUSION
Analyzing the GPC model's implementation in Mexico, from the health care personnel's perspective, has revealed barriers and facilitators similar to the experiences in other contexts. Future efforts to adopt the model should focus on timely attention to identified barriers, especially those identified in the attitudinal dimension that can be modified by regular health care personnel training.
Topics: Attitude of Health Personnel; Female; Health Personnel; Humans; Interviews as Topic; Maternal-Child Health Services; Mexico; Physician-Patient Relations; Pregnancy; Prenatal Care; Primary Health Care; Qualitative Research
PubMed: 33331532
DOI: 10.11606/s1518-8787.2020054002175 -
Chest Jul 2022
Topics: Delivery of Health Care; Equipment Design; Health Personnel; Humans; Materials Testing; Occupational Exposure; Respiratory Protective Devices; Ventilators, Mechanical
PubMed: 35809934
DOI: 10.1016/j.chest.2022.02.043 -
Journal of the International... 2019With regard to the disease pandemics of HIV/AIDS, it is clear that there is need for prevention, treatment, care, and support of HIV positive patients in the health care...
BACKGROUND AND AIMS
With regard to the disease pandemics of HIV/AIDS, it is clear that there is need for prevention, treatment, care, and support of HIV positive patients in the health care system. In order to achieve these goals, job satisfaction should be a priority for health care staff. This study examined the problems of health care personnel and the behavior of patients undergoing HIV/AIDS counseling at Imam Khomeini Hospital in Tehran, Iran.
METHODS
Interviews were conducted individually with 5 health care personnel who participated in this study. Participants had 30 to 45 minutes each per session at the clinic, during which they were able to discuss the problems they faced in their careers. All conversations were officially recorded.
RESULTS
The most common problems mentioned by these health care workers included the lack of safety and standardization of work conditions, the lack of appropriate equipment, limited space, high numbers of patients, low staffing levels and financial and morale problems compounded by the lack of support by hospital authorities.
CONCLUSION
The authorities need to allocate more funds to provide facilities and appropriate working conditions for health care staff in order to increase job satisfaction and enable staff to provide the best services and care to HIV positive patients.
Topics: Attitude of Health Personnel; HIV Infections; Health Personnel; Humans; Iran; Job Satisfaction; Patients; Qualitative Research; Social Stigma
PubMed: 30782052
DOI: 10.1177/2325958219829606 -
Annals of Emergency Medicine Jul 2021We determine the percentage of diagnosed and undiagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among a sample of US emergency department...
STUDY OBJECTIVE
We determine the percentage of diagnosed and undiagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among a sample of US emergency department (ED) health care personnel before July 2020.
METHODS
This was a cross-sectional analysis of ED health care personnel in 20 geographically diverse university-affiliated EDs from May 13, to July 8, 2020, including case counts of prior laboratory-confirmed coronavirus disease 2019 (COVID-19) diagnoses among all ED health care personnel, and then point-in-time serology (with confirmatory testing) and reverse transcriptase-polymerase chain reaction testing in a sample of volunteers without a previous COVID-19 diagnosis. Health care staff were categorized as clinical (physicians, advanced practice providers, and nurses) and nonclinical (clerks, social workers, and case managers). Previously undiagnosed infection was based on positive SARS-CoV-2 serology or reverse transcriptase-polymerase chain reaction result among health care personnel without prior diagnosis.
RESULTS
Diagnosed COVID-19 occurred in 2.8% of health care personnel (193/6,788), and the prevalence was similar for nonclinical and clinical staff (3.8% versus 2.7%; odds ratio 1.5; 95% confidence interval 0.7 to 3.2). Among 1,606 health care personnel without previously diagnosed COVID-19, 29 (1.8%) had evidence of current or past SARS-CoV-2 infection. Most (62%; 18/29) who were seropositive did not think they had been infected, 76% (19/25) recalled COVID-19-compatible symptoms, and 89% (17/19) continued to work while symptomatic. Accounting for both diagnosed and undiagnosed infections, 4.6% (95% confidence interval 2.8% to 7.5%) of ED health care personnel were estimated to have been infected with SARS-CoV-2, with 38% of those infections undiagnosed.
CONCLUSION
In late spring and early summer 2020, the estimated prevalence of severe acute respiratory syndrome coronavirus 2 infection was 4.6%, and greater than one third of infections were undiagnosed. Undiagnosed SARS-CoV-2 infection may pose substantial risk for transmission to other staff and patients.
Topics: Adult; COVID-19; Cross-Sectional Studies; Emergency Service, Hospital; Female; Health Personnel; Hospitals, University; Humans; Male; Middle Aged; Prevalence; SARS-CoV-2; United States
PubMed: 33771413
DOI: 10.1016/j.annemergmed.2020.12.007