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'Don't show that you're scared': resilience in providing healthcare in a UK low-to-medium secure hospital.

ABSTRACT: Background: Healthcare provision within specialist hospitals is associated with heightened levels of stress and burnout, risking negative implications for employees, organisations, and patients. Minimal research has focused on lower-skilled worker experiences. This study explores frontline care workers' experience and perceptions of providing care within a low-to-medium secure hospital within the UK. Method: Eight semi-structured interviews were conducted with healthcare assistants and mental health nurses (18-65 years) at a low-to-medium secure hospital. Thematic analysis (Braun & Clarke, 2006) was used to analyse the data. Results: Three main themes are proposed: 'Resilience to threat' capturing the daily occurrence and normalisation of threat; 'Need for support' shows peer to peer talk as the primary coping mechanism but importantly, a possible disconnect between perceptions, and provision, of organisational support; finally, 'Unique environment' highlights the dual aspect of providing care and correction whilst coping with common challenges e.g. staff shortages. Conclusions: Results provide insight into the pressures experienced by frontline healthcare workers alongside staff motivation to 'make a difference'. Findings highlight some unique challenges of working in low-to-medium secure hospitals which contributes to negative outcomes for worker engagement, performance, and individuals' mental and physical health. Implications for organisations and future practice are discussed.

SUBMITTER: Husted M

PROVIDER: S-EPMC8158232 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background: The COVID-19 pandemic has highlighted health care systems' vulnerabilities. Hospitals face increasing risk of periods of scarcity of life-sustaining resources such as ventilators for mechanical respiratory support, as has been the case in Italy as of March, 2020. The National Academy of Medicine has provided guidance on crisis standards of care, which call for the reallocation of scarce medical resources to those who will benefit most during extreme situations. Given that this will require a departure from the usual fiduciary duty of the bedside clinician, we determined and mapped potential barriers to the implementation of the guidelines from stakeholders using an implementation science framework. Methods: A protocol was created to operationalize national and state guidelines for triaging ventilators during crisis conditions. Focus groups and key informant interviews were conducted from July-September 2018 with clinicians at three acute care hospitals of an urban academic medical center. Respiratory therapists, intensivists, nursing leadership and the palliative care interdisciplinary team participated in focus groups. Key informant interviews were conducted with emergency management, respiratory therapy and emergency medicine. Subjects were presented the protocol and their reflections were elicited using a semi-structured interview guide. Data from transcripts and notes were categorized using a coding strategy based on the Theoretical Domains Framework. Results: Participants anticipated that implementing this protocol would challenge their roles and identities as clinicians including both their fiduciary duty to the patient and their decision-making autonomy. Despite this, many participants acknowledged the need for such a protocol to standardize care and minimize bias as well as to mitigate potential consequences for individual clinicians. Participants identified the question of considering patient quality of life in triage decisions as an important and unresolved ethical issue in disaster triage. Conclusion: Clinicians' discomfort with shifting roles and obligations could pose implementation barriers for crisis standards of care.

Project description:BackgroundIn 2017, roughly 540 women in Sub-Saharan Africa died every day from preventable causes related to pregnancy and childbirth. To stem this public-health crisis, the WHO recommends a standard continuity of maternal healthcare, yet most women do not receive this care. Surveys suggest that illiteracy limits the uptake of the recommended care, yet little is understood about why this is so. This gap in understanding why healthcare is not sought by illiterate women compromises the ability of public health experts and healthcare providers to provide culturally relevant policy and practice. This study consequently explores the lived experiences related to care-seeking by illiterate women of reproductive age in rural Tanzania to determine why they may not access maternal healthcare services.MethodsAn exploratory, qualitative study was conducted in four communities encompassing eight focus group discussions with 81 illiterate women, 13 in-depth interviews with illiterate women and seven key-informant interviews with members of these communities who have first-hand experience with the decisions made by women concerning maternal care. Interviews were conducted in the informant's native language. The interviews were coded, then triangulated.ResultsTwo themes emerged from the analysis: 1) a communication gap arising from a) the women's inability to read public-health documents provided by health facilities, and b) healthcare providers speaking a language, Swahili, that these women do not understand, and 2) a dependency by these women on family and neighbors to negotiate these barriers. Notably, these women understood of the potential benefits of maternal healthcare.ConclusionsThese women knew they should receive maternal healthcare but could neither read the public-health messaging provided by the clinics nor understand the language of the healthcare providers. More health needs of this group could be met by developing a protocol for healthcare providers to determine who is illiterate, providing translation services for those unable to speak Swahili, and graphic public health messaging that does not require literacy. A failure to address the needs of this at-risk group will likely mean that they will continue to experience barriers to obtaining maternal care with detrimental health outcomes for both mothers and newborns.

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'Don't show that you're scared': resilience in providing healthcare in a UK low-to-medium secure hospital.

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