Clinics in Integrated Care最新文献

There are times within health and social care settings where professionals ask recipients of services to make complex and life altering choices. How these choices are presented by professionals has a profound impact on the experience of those accessing services. These experiences pattern their subsequent understanding of and response to both services and the professionals working within them. For professionals, the ways in which choices are offered and the culture of practice within which they are working affects both the relationship and engagement they have with those accessing services; as well as personally impacting upon their workplace wellbeing and motivation. There is a need to better understand how the context of choice-making affects both those accessing services and professionals and how it can be improved.

The structure of the healthcare system has a profound impact on patient care and their health outcomes, especially among racial and ethnic minority groups. Structural and systemic barriers are crucial in shaping health disparities and inequities, with various components exacerbating or mitigating the problem. Research on this subject has grown exponentially into a multifaceted field. In the past 20 years, The Agency for Healthcare Research and Quality (AHRQ) has published annual reports with measurable trends related to accessibility, affordability, coordination, effective treatment, healthy living, patient safety, and person-centered care. Focusing on the challenges plaguing underserved populations is essential to achieve meaningful progress in addressing health care disparities.

Nursing has long faced barriers to effective advocacy, based on the gendered identity of the profession and its status as a second class or “softer” profession. The Covid pandemic showed the importance of the profession to the health of the world and the profession has been adversely impacted as a result of the pandemic. The nursing profession has long had skill in advocating for the recipients of their care but many nurses do not make the connection with advocacy for change in the health care systems in which they work or for themselves. Yet, advocacy for change in the health care system and for the profession will impact larger areas of global health than advocacy at the individual care recipient level. Advocacy for system change includes: recognizing the context, problem solving, building relationships, excellent communication skills and leveraging influence. Nursing has a long history of advocating for those who are historically marginalized and now it is time to advocate for nurses who are historically marginalized, like those who are internationally educated and working outside their home countries. Effective advocacy techniques that go beyond individual interactions to advocating for policy and systems change must be included in future leadership development for nurses.

This article traces the developing role of nurses in response to emergencies, from the Crimean war to the Covid-19 pandemic and beyond. The scope and definition of the nursing role has developed in response to crises, from the work of nurses like Florence Nightingale and Mary Seacole to advancements in aspects of professional development such as regulation to the development of advanced nurse practitioners today. Crises place pressure on healthcare professionals, and roles are advanced because of this. Resilient health infrastructure is fundamental to effective crisis management and this article traces how existing inequalities can be worsened during emergency response. The four phases of disaster management are discussed; Mitigation, Preparedness, Response and Recovery, as well as the political impact of managing global disasters and providing international resources.

The increasing diversity of a nation's population brings opportunities and challenges for healthcare professionals, healthcare systems, and policymakers to create and deliver culturally competent services. This requires empowering healthcare professionals to navigate intercultural interactions and relationships sensitively and respectfully. Conducting cultural assessments serves two primary purposes. First, it allows the individual to reflect and assess their levels of competence. Second, it provides the organization with information to develop the appropriate action plan. The ultimate goal is that healthcare professionals adapt their communication and behavior to effectively engage with people from various cultural backgrounds, avoiding misunderstandings and promoting inclusivity. When healthcare professionals develop cultural proficiency, they are better equipped to tailor medical care to the patient's needs, beliefs, and preferences. This personalized approach results in better treatment adherence and improved health outcomes.

Eating disorders are an insidious dangerous mental illness which have the highest mortality rate out of any other mental illness, but yet they are still massively misunderstood. A illness with so much stigma. In this article we explore some of the myths behind eating disorders, hear a harrowing but inspiring story and take home some practical tips on how to support those affected by eating disorders because remember they are often hidden in plains sight.

Cardiopulmonary resuscitation (CPR) was first described in 1960, when Kouwenhoven and colleagues described a novel technique of ‘closed chest cardiac massage’. CPR is an emergency medical intervention undertaken in an attempt to restore breathing and circulation following a respiratory or cardio-respiratory arrest. The intervention includes the administration of external chest compressions, artificial ventilation, and consecutive electric shocks applied to the bare chest (known as defibrillation) and the rapid administration of medicines intravenously or intra-osseously. But there are clear differences in who will and will not respond to these ferocious interventions in cardiac arrest situations. In some instances, clinicians may be as certain as they can be that future attempts at CPR will not work. In those situations, a Do Not Attempt CPR form may be filled out, after a consultation with the patient. Here, the authors review current policies, guidelines and resources, discuss how the prospect of a natural, anticipated and accepted death in the near future can be a trigger to advance care planning, and outline resources that can help improve communication in an area rife with misconceptions and misunderstanding.

The gabapentinoid drugs gabapentin and pregabalin are medications used clinically across a range of neurological and psychiatric conditions. They have analgesic, anticonvulsant and anxiolytic effects. Their specific licensed indications differ, and vary across countries, but include certain neurological problems such as focal seizures, peripheral neuropathic pain, spasticity in multiple sclerosis, and muscular symptoms in motor neurone disease, and the psychological condition of generalized anxiety disorder. However, in many countries, gabapentin and pregabalin are frequently prescribed outside the terms of their market authorisations, and non-prescribed use has become widespread and troublesome in many populations. Increasing concerns regarding non-prescribed use have led some regulatory authorities to designate gabapentin and pregabalin as controlled substances, with accompanying regulations regarding prescriptions. This review describes the pharmacological properties of gabapentin and pregabalin, highlights evidence regarding efficacy and tolerability, summarises the findings of investigations of potential hazards with these drugs, and concludes with guidance on the clinical management of non-prescribed use.

Integrated care is critical to the successful delivery of modern day health and social care services, however the implementation into practice poses many barriers and challenges. This article seeks to identify these barriers and present methods through which to aim to address and overcome these.

While LGBTQ+ people have received increased media coverage over the past two decades, awareness has not necessarily been productive towards including all identities. Rather, some identities have been ‘othered’ or neglected within research and practice, for example, bisexual, pansexual, trans and non-binary people. Health and social care organisations have a key role in addressing discrimination to ensure minoritized gender and sexual identities are included within integrated care systems. There is an opportunity to rebuild systems, procedures and policies using contemporary knowledge of LGBTQ+ peoples' lives to contribute to a more inclusive form of integrated care. It is hoped that in doing so, the public sector can embody an integrated care approach that includes and empowers LGBTQ+ voices and perspectives to inform ethical, respectful and equitable practice. This chapter explores the ways in which health and social care sector staff and systems can work together to build a shared knowledge and understanding of LGBTQ+ people, as well as a coordinated approach to assessing and responding to their specific needs.