Human Resources for Health最新文献

Background: Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by introducing a health system and governance approach to identify capacities that may help respond effectively to the HCWF crisis in health system contexts.

Methods: A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England.

Results: Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark, the Netherlands, and to a lesser extent Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation.

Conclusions: Aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas.

Background: The recent announcement of the next WHO State of the World's Nursing and Midwifery Reports calls for a review of the state of nursing and midwifery worldwide. In the WHO European region, a broad set of health system reforms have been introduced in Central Asian countries (CACs), namely, the Republic of Kazakhstan, the Kyrgyz Republic, the Republic of Tajikistan, Turkmenistan and the Republic of Uzbekistan. These reforms have become the focus of a series of sub-regional policy dialogs between CACs, led by government chief nursing and midwifery officers, to accelerate the implementation of a package of policies to strengthen the capacity of nurses and midwives and build health system resilience. This study reviews the current state of nursing and midwifery capacity and documents future actions that can be taken in CACs.

Case presentation: A systematic approach was used to describe trends, capacity and gaps in CACs' education, practice, regulation, leadership, and working conditions of nurses and midwives. Currently, CACs face challenges in increasing the level, quality and evidence-base of nursing and midwifery education, require efforts to expand the role of nurses, with emphasis on PHC and particular attention is required to decent working conditions, including fair income and security in the workplace. The GCNMOs have demonstrated experience in the oversight of both workforces and require support for effective work in making policies. To build health systems resilience in CACs through nursing and midwifery, a strategic package of evidence-informed actions that addresses education, practice, regulation, leadership, and working conditions of nurses and midwives is suggested for the period up to 2030.

Conclusions: Current educational reforms and curricular development, combined with innovations in clinical practice and working environment can be pursued to foster better access to quality of care, enhance workplace satisfaction and improve recruitment and retention of nurses and midwives. However, to fully achieve this, CACs will require increased institutional capacity; strengthened data for nursing and midwifery planning in the context of health workforce policy and health priorities, and financial and non-financial investment in the nursing and midwifery workforce.

Background: Despite the rising representation of women in the physician workforce, gender-based income disparities persist. In this study, we explore the role of representation of women in the work environment in physicians' income from Medicare Part B fee-for-service payments and the income gender gap.

Methods: Our main analytic sample is a balanced panel of 371,472 physicians over 9 years, obtained from the Medicare Part B fee-for-service (FFS) Provider Utilization and Payment Data (2012-2020) from the Centers for Medicare and Medicaid Services (CMS). We use panel regressions with physician and year fixed effects to quantify how total Medicare Part B FFS payments to physicians patient volume, and per-patient payments respond to gender composition changes at the specialty and practice level, controlling for other practice characteristics. We allow the gender composition to have differential impacts on women and men by interacting it with the physician's gender. In addition, we examined the subsample of physicians who have not switched specialties or practices and explored differences in the effects by practice size.

Results: Increasing women's representation in physician work environments impacts men's and women's Medicare Part B FFS payments received differently. We find that for women physicians, a 1% increase in the share of women in the same specialty leads to 1.634% higher annual payment, 1.147% more patients, and 0.297% more per-patient payment. Conversely, these effects are reversed for men. Changes in women's share at the practice level have qualitatively similar effects. Among physicians who have not switched specialties or practices, we still find positive effects for women but no negative effects for men. Furthermore, these effects are stronger in solo or small practices than in large practices.

Conclusions: Increasing women's representation in the work environment helps increase the amount of Medicare Part B FFS payments received for women physicians but may reduce payments received for men physicians. Our findings support the efforts in increasing women's representation in the physician workforce to mitigate gender income disparities and demonstrate the nuanced differences in its impact by gender and the size of the practice to refine policy recommendations.

Background: Respiratory therapy services commenced in Saudi Arabia (SA) in the mid-1970s. Since then, respiratory therapists have become integral members of the healthcare team. However, data about the characteristics and distribution of the respiratory therapy workforce in SA are limited. Therefore, the primary objective of this investigation is to examine the characteristics and distribution of respiratory therapy practitioners in SA.

Methods: This is a cross-sectional study. Data were obtained from the Saudi Commission for Health Specialties (SCFHS) database as of January 10, 2024. This includes all registered respiratory therapy practitioners. The available data include age, gender, highest qualification, professional ranking, geographical distribution, and employment status of respiratory therapy practitioners.

Results: The SCFHS database reveals that there are 5462 respiratory therapy practitioners registered with SCFHS. Females constitute 48% of respiratory therapy practitioners, and 85% of the entire workforce is under the age of 40. A Bachelor of Science degree is the highest academic qualification for 90% of these practitioners, with 75% professionally classified as specialists. The geographical distribution of the respiratory therapy workforce is uneven, with approximately 65% located in two regions: Riyadh and the Eastern province. Employment within this field is high, with 92% of practitioners currently employed.

Conclusion: The respiratory therapy workforce is witnessing steady growth, with the majority of respiratory therapy practitioners possessing a bachelor's degree and classified as specialists professionally. Importantly, there is a clear imbalance in the distribution of these professionals across regions in SA.

Background: The 2019 coronavirus disease (COVID-19) pandemic brings critical health problems to workers in many occupations, particularly healthcare providers. The aim of the study was to examine the feasibility and effectiveness of the mindfulness-based stress reduction (MBSR) program on relieving burnout of healthcare providers during the pandemic. The roles of positive and negative emotion as well as emotion regulation strategy in the intervention effects were also investigated.

Methods: A sample of 112 healthcare providers in China were recruited and randomly assigned to the MBSR (n = 56) or the control condition (n = 56). Measures were collected at pre-intervention, mid-intervention, and post-intervention, assessing mindfulness level, emotion regulation strategy, positive and negative emotion, and burnout.

Results: The MBSR program showed acceptable feasibility. Compared to the control group, healthcare providers in the MBSR group showed significant increase in personal accomplishment and decrease in emotional exhaustion after the intervention. No significant difference was detected on the dimension of depersonalization. Results of mediation analyses implied that cognitive reappraisal and positive affect partially mediated the intervention effects on personal accomplishment.

Conclusions: The study provided preliminary evidence that the MBSR programs might be effective in reducing healthcare providers' burnout, even during the pandemic. Cognitive reappraisal and positive emotion might be important mechanisms of how the training took effect.

Background: The global nursing shortage was a well-known issue before the Covid-19 pandemic, but the Covid-19 pandemic has exacerbated the current nursing workforce shortage and reduced nursing retention. This systematic review aimed to explore factors affecting retention of nurses.

Methods: The PubMed, Web of Science, Scopus and Proquest databases were searched for relevant primary studies published on nurses retention during Covid-19 pandemic. Finally, Google Scholar was searched for retrieving more related documents that may not be indexed in other searched databases. Inclusion criteria were research articles and gray literature related to nursing retention in Covid-19 pandemic, articles published in English, access to the full-texts, and without time limitation. Both qualitative and quantitative studies focusing on factors affecting the nurses retention were included. The Joanna Briggs Institute checklists were used for assessing quality of quantitative and qualitative studies. Qualitative and thematic content analysis methods based on Braun and Clark's model were used to analyze the data.

Results: Eighteen studies were identified through a systematic search of the literature. The results showed that seven factors include personal, interpersonal, organizational, social media, educational, emotional, and protective factors are the factors affect the nurses retention.

Conclusion: The findings of this study showed that retention of nurse is complex and multi-factorial issue that factors from micro to macro-level affect it. Managers and health policy-makers based on the results obtained from this study can plan appropriate measures to increase the retention of nurses.

Background: The deteriorating psychosocial work environment among healthcare workers in Sweden, influenced by demanding working conditions and resource constraints, affects individual well-being and patient care quality. Healthcare workers, including physicians, registered nurses, and nursing assistants, often work interdependently and share workplaces, yet are three completely different professions. Nonetheless, comprehensive studies comparing their psychosocial work environments are scarce; often focusing on healthcare workers either separately or as a homogenous group, but rarely comparative.

Aim: Utilising the job demands-resources model, this study investigated variations in the psychosocial work environment among Swedish healthcare workers. We wanted to identify how the antecedents of individual well-being, in the form of demands and resources, differed between healthcare workers.

Method: Data from the 2022 Longitudinal Occupational Health Survey for Health Care in Sweden were analysed; the participants included 7589 physicians, registered nurses, and nursing assistants. The analysis involved descriptive statistics, including measures of means and analysis of covariance (ANCOVA), employing the Bonferroni correction for multiple post hoc comparisons. The ANCOVA was also stratified by working factors, including years of work experience and employment within the private/public sector.

Results: The study revealed significant variations in how healthcare workers perceive their psychosocial work environment. Physicians faced the highest level of Quantitative Demands (mean (x̄) 3.15; 95% CI 3.11-3.19), while registered nurses reported the most Emotional Demands (x̄ 3.37; 95% CI 3.32-3.41). Nursing assistants had the highest grand means for the imbalance between Efforts and Rewards (Effort Reward Imbalance) (x̄ 1.49; 95% CI 1.49-1.49) and an imbalance between Work and Private Life (Work-Life Interference) (x̄ 3.20, 95% CI 3.15-3.25), along with limited resources. The stratified analysis showed that years of experience and the sector affected healthcare workers' perceptions of their psychosocial working environment. For example, registered nurses working in the private sector reported better working conditions than registered nurses working in the public sector. The situation for nursing assistants was reversed.

Conclusion: Psychosocial work environments are experienced differently between and within healthcare professions in Sweden. This study provides crucial insights for improving workplace conditions and consequently enhancing healthcare professionals' well-being and quality of patient care.

Background: Healthcare practice environment plays a vital role in evaluation and the development of health sector in China. However, there are few comprehensive reviews and studies focusing on its state and changing trends. This study aimed to examine the dynamic trends in Chinese healthcare professionals' perceptions of their practice environment from 2008 to 2023 using age period cohort (APC) analysis.

Methods: Four national cross-sectional surveys of healthcare professionals were conducted in 2008, 2013, 2018, and 2023. APC analysis was performed to distinguish effects of age, period and cohort. Covariates like gender, department, job satisfaction, and doctor-patient relationships were also analyzed.

Results: Between 2008 and 2023, healthcare professionals' perceptions of their practice environment first declined and then improved. Those aged 28-38 during 2013-2018 and born between 1978 and 1988 had the most negative perceptions. After 2018, perceptions improved, peaking in 2023. Those under 23 and over 43 exhibited larger age effects. Birth cohorts after 1993 also had more positive effects. Controlling for covariates attenuated APC effects. Females, those in obstetrics and emergency medicine, nurses, technicians, and administrators perceived better environments. Higher job satisfaction and doctor-patient relationship harmony are also associated with more positive perceptions. Income matching efforts and perceptions of promotion fairness had positive impacts, while increasing severity of physical fatigue and psychological anxiety negatively influenced perceptions of the practice environment.

Conclusions: The APC analysis provided nuanced insights into evolving practitioner perceptions amid healthcare reforms in China. Tailored policies focused on career stage and generation are needed to address disruptions and sustain improvements. Monitoring feedback on reforms and changes is essential for optimizing the practice environment over time.

Background: Adult caregiving can be demanding and stressful, especially when the caregiver is employed. As the age of the U.S. population and workforce increases, more adults are providing care to aging family members.

Objective: To understand the prevalence and aspects of the caregiving experience and caregiving strain among department of medicine faculty members, and to gauge their awareness and utilization of caregiving resources.

Design: We used a cross-sectional survey design. A questionnaire survey was developed and launched in Redcap in October, 2022, and an invitation was emailed followed by two reminders to all full-time and part-time faculty members (N = 1053) in our department of medicine.

Main measures: Faculty demographics, caregiver status, caregiving details, degree of mental or emotional strain, and knowledge of and use of employer and external caregiver resources.

Key results: Of the 1053 faculty members who received up to three email survey invitations, 209 (20%) responded of which 76 (36%) were current caregivers and 117 (56%) were non-caregivers. Among the 76 current caregivers, 53 (70%) reported providing care for parents or parent-in-laws and 9 (12%) reported caring for a spouse. One-third of current caregivers reported caring for individuals with Alzheimer's disease or dementia/memory problems. Ninety-five% of current caregivers reported some or a lot of caregiving strain. A wide variation in knowledge of and use of employer and external caregiver resources was reported.

Conclusions: Department of medicine faculty who provide adult caregiving report a high prevalence of strain and wide variation in knowledge of and use of employer and external caregiver support services, suggesting opportunity to better understand where gaps exist in providing support for caregivers.

Background: Task-shifting from primary care physicians (PCPs) to nurses is a means of overcoming PCP shortages and meeting the needs of patients receiving primary care. The aim of this overview of systematic reviews is to assess the effects of delegation or substitution of PCPs' activities by nurses on patient relevant, clinical, professional and health services-related outcomes.

Methods: We conducted a systematic literature search for secondary literature in Medline, Embase, Pubmed, the Cochrane Library, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL). We included systematic reviews and meta-analyses that analysed randomised controlled trials (RCTs) and controlled, prospective trials in English and German. Abstracts and full-text articles were screened independently by two reviewers. Full-text articles were assessed using the Overview Quality Assessment Questionnaire. After data extraction a narrative synthesis was performed. We defined patient-relevant outcomes as our primary outcomes.

Results: We included six systematic reviews. The interventions included first contact, history taking and assessment, patient education, review of drug treatment, referrals to GPs and other health professionals, ordering further investigations and ongoing care. Two meta-analyses showed a relative risk reduction of mortality in favour of nurse-led care, whereby the reduction in one analysis was significant. The effect was highest in the group of more highly qualified nurse practitioners (RR 0.19), as opposed to nurse practitioners (RR 0.76) and registered nurses (RR 0.92). Two meta-analyses showed a relative risk reduction in hospital admissions and patient satisfaction. Whereas care conducted by physicians and registered nurses led to the same outcomes, care conducted by nurse practitioners led to better outcomes (RR 0.74). An analysis according to nursing group showed that patients were more satisfied with treatment by registered nurses (SMD 1.37) than with treatment conducted by nurse practitioners and more qualified nurse practitioners (SMD 0.17). In terms of patient-relevant outcomes, no differences were observed between physician-led care and nurse-led care in terms of physical function, quality of life and pain.

Conclusion: Nurse-led care is probably as safe or safer than physician-led care in terms of mortality and hospital admissions. However, the impact of nursing staff training has not been sufficiently examined.