AbstractThe unpredictability that is characteristic of emergency hospital care poses particular challenges for interprofessional working. In this paper we explore the tension between unpredictability and control that arises in this context and the strategies that are developed to deal with it. In particular, nurses' work gives them a guardianship role in attending to patient throughput, which fosters an approach to patients as a collective. Junior doctors' work, in contrast, orients them to patients as individuals. We consider a number of rather ironic contrasts which flow from this, notably the construction of many nurses' work as task-based and fragmented, and many junior doctors' work as having greater potential for continuity of care.Key Words: Emergency health carework patternsdoctorsnursesqualitative research
While several studies have documented the various barriers that caretakers of children under five routinely confront when seeking healthcare in Uganda, few have sought to capture the ways in which caretakers themselves prioritize their own barriers to seeking services. To that end, we asked focus groups of caretakers to list their five greatest challenges to seeking care on behalf of children under five. Using qualitative content analysis, we grouped responses according to four categories: (1) geographical access barriers; (2) facility supplies, staffing, and infrastructural barriers; (3) facility management and administration barriers (e.g. health worker professionalism, absenteeism and customer care); and (4) household barriers related to financial circumstances, domestic conflicts with male partners and a stated lack of knowledge about health-related issues. Among all focus groups, caretakers mentioned supplies, staffing and infrastructure barriers most often and facility management and administration barriers the least. Caretakers living furthest from public facilities (8-10 km) more commonly mentioned geographical barriers to care and barriers related to financial and other personal circumstances. Caretakers who lived closest to health facilities mentioned facility management and administration barriers twice as often as those who lived further away. While targeting managerial barriers is vitally important-and increasingly popular among national planners and donors-it should be done while recognizing that alleviating such barriers may have a more muted effect on caretakers who are geographically harder to reach - and by extension, those whose children have an increased risk of mortality. In light of calls for greater equity in child survival programming - and given the limited resource envelopes that policymakers often have at their disposal - attention to the barriers considered most vital among caretakers in different settings should be weighed.
The Australian Commission on Safety and Quality in Health Care
implemented a program of work on Recognising and Responding to Clinical
Deterioration, which focuses on ensuring that hospital patients whose clinical
condition deteriorates receive appropriate and timely care and treatment. The
Observation and Response Chart (ORC) project forms an element of this
program. The project objectives were to examine whether the ORCs: 1) were
suitable for observations of adult medical-surgical patients, and prompt a
response for episodes of clinical deterioration; 2) had any sections that
require modifications; and 3) could be introduced and applied in practice with
minimal training.
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