Human Resources for Health最新文献

Background: Planning for surge capacity, that is, the ability of a health service to expand beyond normal capacity and meet an increased demand for clinical care, is an essential component of public health emergency preparedness. During the COVID-19 pandemic, family physicians (FPs) were called upon to provide surge capacity in settings such as hospital units and emergency departments while also maintaining their primary care responsibilities. Most research reports on projection models, hospital settings, or the use of virtual care, with limited focus on the firsthand experiences of FPs in this role. To address this gap, this study examines the experiences of FPs and their roles in supporting surge capacity during the COVID-19 pandemic.

Methods: As part of a mixed methods, multiple case study, we conducted semi-structured interviews with FPs between October 2020 and June 2021 across four Canadian provinces (British Columbia, Ontario, Nova Scotia, Newfoundland and Labrador). During the interviews, FPs were asked about the roles they assumed during the different stages of the pandemic and the factors that impacted their ability to fulfil these roles. Interviews were transcribed verbatim and a thematic analysis approach was employed to identify recurring themes.

Results: We interviewed a total of 68 FPs across the four provinces and identified two overarching themes: (1) mechanisms used to create surge capacity by FPs, and (2) key considerations for an organized surge capacity program. During the pandemic, surge capacity was achieved by extending FP working hours, expanding the FP workforce, and redeploying FPs to new roles and settings. The effective implementation of FP surge capacity requires organized communication and coordination mechanisms, policies to clarify scope of practice during redeployment, training and mentorship related to new redeployment roles, FPs holding hospital privileges, and policies that help to preserve primary care capacity.

Conclusions: FPs make critical contributions to surge capacity but require structured support to balance their redeployment roles with their ongoing primary care responsibilities. Ensuring adequate coverage for their practices and employing strong communication and coordination mechanisms are essential for maintaining high-quality care and managing the strain on FPs and the health system during public health emergencies.

Background: The recruitment and retention of public health professionals are critical to the effective functioning of public health systems and the promotion of population health, especially in the face of pandemic threats. This study aims to examine how job embeddedness, job satisfaction, work-related factors, and COVID-19-related factors affect the intention to stay of public health professionals, and explore the potential mediating roles of job embeddedness in explaining these effects.

Methods: A cross-sectional survey was conducted among 912 public health professionals from January to March, 2022. Hierarchical multiple regressions were performed to explore the relationships between factors and intention to stay. We used path analysis to examine how job embeddedness affected these relationships.

Results: Public health professionals with high job embeddedness had high levels of intention to stay in their jobs. Job satisfaction, perceptions of Centers for Disease Control and Prevention (CDC) work, and COVID-19 influence were directly related to intention to stay. In addition, job satisfaction, perceptions of CDC work, family factors, and COVID-19 influence indirectly affected intention to stay via organization-embeddedness; job satisfaction and family factors indirectly affected intention to stay via community-embeddedness.

Conclusions: Highly embedded public health professionals who are satisfied with their current jobs and have gained family support have high levels of intention to stay. Highly job embeddedness and a sound work-life balance can inspire staff to stay in their current jobs and actively engage in public health tasks in the face of high turnover rates and pressure.

Background: The COVID-19 pandemic has forced nucleic acid detection to be essential for prevention and control. The psychological and physical health of healthcare staff who conducted nucleic acid sampling (NAS) should be paid attention to. This study aims to investigate the status and explore the predictors of stress among nucleic acid sampling support nurses (NASSNs) by an online survey.

Material and methods: Totally 388 NASSNs were recruited through cluster random sampling for the research. An online cross-sectional survey with structured questionnaires was used, including socio-demographic information, the stressor scale of nucleic acid sampling nurses (SSNASN), and the challenge-hindrance stress scale (CHSS). T-tests, ANOVA, and multivariable linear regression model were used to analyze data.

Results: A total of 324 NASSNs filled out questionnaires online with a response rate of 83.51%. NASSNs had an overall mean score of (2.199 ± 0.917) for challenge stress and (2.014 ± 0.805) for hindrance stress. The item "the amount of responsibility I have" scored highest in the challenge stress dimension, while "the lack of job security I have" scored highest in the hindrance stress dimension. The predictors of challenge and hindrance stress include concern about the preparedness of NASSNs and their families, working environment, and competence of emergency disposal. An additional socio-demographic predictor of challenge stress was motivation, while that of hindrance stress was longer nursing experiences.

Conclusions: During the COVID-19 pandemic, stress among NASSNs was moderately low. The factors detected to be predictors of stress include motivation, nursing experiences, concern about the preparedness of NASSNs and their families, working environment, and competence in emergency disposal. Therefore, in advance of responding to a public health event, we recommend that subsequent short-term psychological counseling be given to healthcare workers and accompanying psychological counseling be provided to prevent the emergence of mental health problems thereafter.

Background: Developing a skilled and motivated pharmacy workforce is imperative for strengthening healthcare systems. This narrative review examines challenges faced by Indonesian pharmacists in practice and identifies strategies and initiatives that have been implemented to support workforce development in Indonesia.

Method: A systematic search of three databases (PubMed, EBSCO, and OVID) was conducted to identify research articles published from database inception to 30 June 2022. Data were synthesised narratively and mapped to a multidimensional healthcare workforce framework.

Result: Forty studies were included, revealing four interrelated themes of workforce challenges: (1) personal challenges, (2) workplace conditions, (3) societal contribution and recognition; and (4) regulatory aspects. Strategies identified include professional guidelines, accreditation systems, and competency-based training programmes.

Conclusion: The review indicates a need for Indonesian pharmacists to enhance their competencies to provide high-quality services. A multi-sectoral approach is recommended to address challenges. Providing decent working conditions for pharmacists in conjunction with workplace accreditation can support best practices of pharmaceutical care and ensure patient safety.

Background: The decrease in the number of healthcare workers and the resulting deterioration in healthcare quality and availability have been subjected to intensive discussion in Czechia in recent years. Estimating future healthcare worker capacities requires a detailed analysis of their "movement" within the healthcare system. This study focuses on exits of the primary care physicians from the healthcare system in Czechia.

Methods: Using anonymised data obtained from the largest Czech health insurance company (2012-2022), we constructed working life tables and calculated working life expectancy, which indicates the expected average number of remaining years of work at the exact age of the physician. The study focuses on primary care physicians, who are crucial for the effective functioning of the healthcare system.

Results: At age 50, working life expectancy was 20 years for female physicians and approximately 21 years for male physicians. Over the monitored period, working life expectancy decreased by 1 year for both genders. Gynaecologists had the longest working life expectancy, while dentists had the shortest.

Conclusions: The decrease in the working life expectancy and the length of tenure indicates the need to create favourable conditions for the extension of the working lives of physicians to avoid early exits from the system.

Background: Understanding the dynamics of SARS-CoV-2 viral infection and factors associated with in-hospital transmission rates among healthcare workers (HCW) is crucial for their protection. Brazil experienced high mortality rates due to COVID-19, and limited data are available on transmission of SARS-CoV-2 infection among HCW. This cohort study aimed to assess the dynamic of SARS-CoV-2 infections in HCW from two tertiary hospitals in central Brazil, one of them a Reference Hospital for COVID-19.

Methods: From May 2020 to January 2021, 554 HCW directly involved with COVID-19 care were followed through 12 biweekly visits. During these visits, blood, nasal, and oropharyngeal samples were collected, and participants underwent interviews. SARS-CoV-2 detection was carried out using RT-qPCR, while the assessment of seroprevalence was based on IgG detection. Additionally, 35 positive samples underwent viral whole-genome sequencing.

Results: The infection prevalence, as per RT-qPCR, was 28.5% (24.9-32.4), reflecting an overall attack rate ranging from 0.5% to 9.5%, marked by two peaks in August and December 2020. Oligosymptomatic and asymptomatic infections accounted for 14% of prevalent infections. The seroprevalence rate stood at 25.8%. The hospitalization rate was 8.2%, with a fatality rate of 1.3%. Risk factors associated with a positive diagnosis of COVID-19 included being male, working at the referral hospital, having a graduate-education level, and using hydroxychloroquine and zinc for prevention or treatment. One reinfection was identified. Absenteeism was 56.6%. The infection dynamics mirrored the pattern observed in the general population.

Conclusion: One-third of the professionals in the followed cohort were infected. Being male, working in a COVID-19 referral center, having a low level of education, and using medications for preventive treatment represented risk factors. Healthcare workers at the COVID-19 referral hospital exhibited a higher incidence rate compared to those at the non-referral hospital, increasing the plausibility that some of the infections occur in the hospital environment.

Background: This research investigates micro-credentialing as an approach to recognise learning achievements in health. Establishing international standards can ensure consistency, promote equity, and enhance quality of recognition systems. Achieving stakeholder consensus on the key topic areas is an important precursor to lead to relevant topics from which to build appropriate standards. This research supports the efforts by UN agency representatives and experts in qualification systems, medical education, the health and care sector, regulation, and accreditation, to build foundations from which to launch normative work on the application of micro-credentials to award learning achievements for health and care workers.

Methods: A modified Delphi study following methodological steps was conducted. From April to May 2021, a literature review investigated existing standards in continuing professional development and the use of micro-credentialing in health. Results from the review informed the initial draft of statements that were then refined through three iterative Delphi rounds between May to September 2021. The process culminated in a final workshop in March 2023.

Results: A total of 53 participants completed the Delphi, with results analysed by researchers using qualitative analysis. Consensus was achieved on the core principles to recognise learning achievements. The expert panel agreed on the need for standards that are competency-based, and require evidence of learning indicating what a learner can do. There was also consensus that the characteristics of a valid digital award or micro-credential should be portable, standardised, secure, interoperable, stackable and verifiable.

Conclusions: The growing body of literature on micro-credentialing highlights its potential as a method to recognise learning achievements. The interest in alternative pathways to award health practitioners, through short competency-based micro-learning opportunities, has spurred discussions on the practical application of micro-credentials. This research outlines the categories and principles for a proposed framework to implement micro-credentialing to recognise learning achievements within the health and care sector.

Background: There is a dearth of evidence on the scale, scope and quality of midwifery education programs in conflict-affected settings. This study sought to assess the extent to which midwifery pre-service education programs meet national and global standards, and to explore how conflict affects pre-service midwifery education in Yobe State Nigeria and the Benadir and Galgaduud regions of Somalia.

Methods: A rapid assessment of midwifery education programs was conducted in the two midwifery education programs in Yobe State, Nigeria and in seven purposively selected programs in Somalia using an adaptation of the Midwifery Education Rapid Assessment Tool. Information was collected through interviews with program leadership, teachers, students, and clinical preceptors during school and clinical practice site visits. Researchers adapted the tool to reflect national and international standards, incorporating supplementary questions to capture considerations specific to conflict-affected contexts. Data were analyzed by program and country using Stata and Excel.

Results: In Nigeria, each school met 17 and 18 standards, respectively, out of 22 across assessment domains (77.3%-81.8%). In contrast, in Somalia, schools met between 6 and 10 standards out of the 18 standards for which data were available (33.3%-55.6%). The biggest gaps in Somalia were in leadership, infrastructure and resources. No schools in either setting had sufficient space or clinical practice sites that met International Confederation of Midwives (ICM) criteria, and only two were led by midwives. In Nigeria, all infrastructure, curriculum and student- and regulatory-related standards examined were met, but gaps were identified in program staffing and preceptor capacity, and support for faculty and clinical practice sites. In both countries, none of the programs met the average number of clinical practice experiences stipulated in the ICM guidelines due to a lack of teaching hospitals. Students in both countries felt safe on campus but did not feel safe traveling to and from the schools and clinical practice sites.

Conclusions: More investment in midwifery education is needed to ensure international standards for quality education are met. Proactive measures are needed to enhance student safety between school and practice settings in conflict-affected settings. By addressing these gaps, we can strive toward improving midwifery education.

Background: The prevalence of patient (and their relatives/friends) aggression and violence against healthcare professionals in general, and physicians in particular, is a recognized problem worldwide. While numerous risk factors for such aggression and violence from patients (and their relatives/friends) have been identified, little is known about which risk factors are perceived as relatively most important in a specific context and among a particular group, and about the potentially differing views on the relative importance. This lack of insight prohibits preventive measures being tailored to address the main risk factors.

Method: We conducted a Q-methodology study to investigate physicians' perspectives on risk factors for aggression and violence from patients (and their relatives/friends) against physicians in Chinese hospitals. A total of 33 physicians from public Chinese hospitals participated in this study and were asked to rank 30 risk factors according to their importance in triggering violent incidents. In addition, respondents were asked to explain their ranking of most and least important risk factors.

Results: By employing a by-person factor analysis, four distinct perspectives on the importance of risk factors were identified: (1) unmet expectations of treatment and lack of resources; (2) perpetrator's educational background and personal characteristics; (3) distrust and limited protection measures; and (4) perpetrator's emotional well-being and poor interaction. There was a consensus across perspectives that failure to meet perpetrator's expectations is one of the most important risk factors and that physician's gender is one of the least important risk factors in the occurrence of patient (and their relatives/friends) aggression and violence against physicians in Chinese hospitals.

Conclusions: This study has identified four distinct perspectives held among physicians on the risk factors for patient aggression and violence against physicians in Chinese hospitals. These insights enable the development and prioritization of targeted measures to address specific risk factors according to the dominant views among physicians.

Background: Health systems across Europe are facing a workforce crisis, with some experiencing severe shortages of doctors. In response, many are exploring greater task-sharing, across established professions, such as doctors, nurses, and pharmacists, with patients and carers, and with new occupational groups, in particular ones that can assist doctors and relieve their workload.

Case presentation: In the early 2000s the United Kingdom created a new occupational role, that of physician assistant. They had a science degree and then underwent a 2-year postgraduate training course. The name soon changed, to physician associate, and the range of roles and responsibilities expanded greatly, although in a largely unregulated manner; by 2024, some were undertaking complex procedures or managing undifferentiated patients in primary care. Catalysed by some high-profile failings, this expansion has generated major concerns, over patient safety and consent, the scope of practice and preferential employment conditions of this group, the adverse consequences for medical training, and the additional medical workload involved in supervision. This has led to a widespread grassroots backlash by the medical profession, often challenging their leaders who had supported this idea. As a consequence, professional bodies that were initially in favour are now expressing serious concerns and it seems likely that the roles and responsibilities of physician associates (and related occupations) will be curtailed. We review published literature and official documentation about this policy to understand the drivers of its development, its benefits, and risks.

Conclusions: The experience in the UK offers cautionary lessons for other European countries contemplating similar ideas. It underscores the importance of maintaining trust with those affected by change, undertaking a detailed systems analysis with attention to risks of unintended consequences, agreeing clear role definitions, providing adequate regulatory oversight, and the need to avoid damaging training of future doctors. This case study highlights the need for a carefully thought-out approach that considers both the potential benefits and pitfalls of integrating new roles like physician associates into a healthcare system. The failure to do so has created a new occupational group with unrealistic expectations and has further demoralised an already unhappy medical profession.