The COVID-19 pandemic posed numerous challenges experienced by healthcare organizations. Nursing professional practice plays a crucial leadership role in supporting nursing staff and leaders in developing policies, parameters and philosophical approaches for delivering safe patient care. The professional practice leadership at Humber River Hospital, a large Canadian community hospital, implemented three key interventions in this hospital-based case study: (1) proactive workforce planning, (2) increased nursing student placements and (3) novel \"stretch model of care\" in the intensive care unit (ICU). The overall results following the implementation of these interventions resulted in substantial improvements. For example, proactive nursing workforce planning supported both a 98% reduction in agency utilization and an accelerated ICU certification program with an 84% certificate completion rate. Through innovative strategies, there was a significant increase (33-67%) in the number of nursing student placements during the first two years of the pandemic compared with previous years. Within the ICU setting, we maintained optimum ICU capacity that resulted in stronger partnership-driven relationships between nurses and physicians through an interprofessional \"stretch model of care.\" Finally, we avoided emergency department closures and Code Orange calls during peaks of the pandemic.

OBJECTIVE: to describe the \"On-site inspection\" sub-process of the macroprocess \"Supervision\" conducted at the headquarters unit of the Regional Nursing Council of São Paulo.
METHODS: an exploratory descriptive research, in a single case study modality using data reported by the Headquarters Unit Inspection Management leaders.
RESULTS: the description of the \"On-Site inspection\" sub-process, initial and return, showed how the activities/tasks pre-established in the inspection roadmap and inserted in the respective inspection terms need to be accurately and sequentially executed to comply with the current legislation and provided the identification of activities that add value to the inspection process.
CONCLUSIONS: the results obtained give visibility to the activities/tasks developed by the inspectors and will provide the Inspection Management with subsidies for the rational allocation of the required human resources; and, to the technical managers and legal representatives of the inspected institutions, the knowledge of the activities developed during the performance of the sub-process \"On-site inspection\".

Experiential learning supervised by a qualified preceptor has been an enduring requirement for accredited allied health academic programs.1 Data show that students benefit from participating in experiential learning activities, such as an internship.2 Further, studies show organizations are eager to hire new graduates who took part in some type of external hands-on experience.3Health information management (HIM) programs accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) require students to complete a supervised professional practice experience (PPE) before graduation to show proficiency of the curriculum requirements.4This study explored the challenges and barriers of professional practice experience for placing local and online baccalaureate students in hospital-based HIM departments from the preceptors\' viewpoint. This study focused on the hospital setting for several reasons: gaining site approval is complicated, the centralized HIM department poses unique problems for hosting students, and to narrow the research focus to a setting commonly used among HIM academic programs.
The PPE problems with placing and precepting students have been a long-standing concern in HIM education;5 however, there was limited literature available directly related to this problem of practice. An extensive literature search was conducted that yielded only a few research-based articles that provided limited information about the problem. Therefore, the literature review included related works from other allied health disciplines with similar issues with experiential learning.The overarching findings for allied health academic programs centered on issues at the healthcare organizational level, including legal concerns, cost, time, and productivity.6 Geographic location was yet another issue that prevented student placement. Additional concerns focused on lack of student or preceptor preparation for the experience.7.
This was a qualitative multi-case study conducted in 2021. A total of six cases, or participants, took part in this study. Participants completed a pre-interview survey to obtain demographic information before conducting semi-structured interviews online with health information management preceptors. The survey data were compiled and analyzed to inform the interviews.
The study results indicate that HIM preceptors are challenged with placing and precepting students at their hospitals. Lack of support from senior leadership is a contributing factor. Additional issues center on planning and preparation. Keeping students engaged with the learning experience was another key finding. Lastly, this research uncovered an anecdotal finding about the lack of preceptor training provided to HIM professionals.
A variety of issues contribute to the problem of placing and precepting students at the organizational level. Despite these challenges, the participants in this study expressed dedication to serving in the preceptor role. Further, this study identified plausible solutions for improving the PPE by incorporating creative ways to deliver learning activities. Finally, this study was carried out during the pandemic at a time when preceptors had to employ innovative strategies for precepting HIM students.

暂无摘要。

Health care workers (HCWs) are particularly exposed to COVID-19 and therefore it is important to study preventive measures in this population.
To investigate socio-demographic factors and professional practice associated with the risk of COVID-19 among HCWs in health establishments in Normandy, France.
A cross-sectional and 3 case-control studies using bootstrap methods were conducted in order to explore the possible risk factors that lead to SARS-CoV2 transmission within HCWs. Case-control studies focused on risk factors associated with (a) care of COVID-19 patients, (b) care of non COVID-19 patients and (c) contacts between colleagues.
2,058 respondents, respectively 1,363 (66.2%) and 695 (33.8%) in medical and medico-social establishments, including HCW with and without contact with patients.
301 participants (14.6%) reported having been infected by SARS-CoV2. When caring for COVID-19 patients, HCWs who declared wearing respirators, either for all patient care (ORa 0.39; 95% CI: 0.29-0.51) or only when exposed to aerosol-generating procedures (ORa 0.56; 95% CI: 0.43-0.70), had a lower risk of infection compared with HCWs who declared wearing mainly surgical masks. During care of non COVID-19 patients, wearing mainly a respirator was associated with a higher risk of infection (ORa 1.84; 95% CI: 1.06-3.37). An increased risk was also found for HCWs who changed uniform in workplace changing rooms (ORa 1.93; 95% CI: 1.63-2.29).
Correct use of PPE adapted to the situation and risk level is essential in protecting HCWs against infection.

OBJECTIVE: New Public Management (NPM) has increased fragmentation in municipal health and social care organizations. In response, post-NPM reforms aim to enhance integration through service integration. Integration of municipal services is important for people with complex health and social challenges, such as concurrent substance abuse and mental health problems. This article explores the conditions for service integration in municipal health and social services by studying how public management values influence organizational and financial structures and professional practices.
METHODS: This is a case study with three Norwegian municipalities as case organizations. The study draws on observations of interprofessional and interagency meetings and in-depth interviews with professionals and managers. The empirical field is municipal services for people with concurrent substance abuse and mental health challenges. The data were analyzed both inductively and deductively.
RESULTS: The study reveals that opportunities to assess, allocate and deliver integrated services were limited due to organizational and financial structures as the most important aim was to meet the financial goals. The authors also find that economic and frugal values in NPM doctrines impede service integration. Municipalities with integrative values in organizational and financial structures and in professional approaches have greater opportunities to succeed in integrating services.
CONCLUSIONS: Applying a public management value perspective, this study finds that the values on which organizational and financial structures and professional practices are based are decisive in enabling and constraining service integration.

Practical methods for facilitating process improvement are needed to support high quality, safe care. How best to specify (identify and define) process improvements - the changes that need to be made in a healthcare process - remains a key question. Methods for doing so collaboratively, rapidly and remotely offer much potential, but are under-developed. We propose an approach for engaging diverse stakeholders remotely in a consensus-building exercise to help specify improvements in a healthcare process, and we illustrate the approach in a case study.
Organised in a five-step framework, our proposed approach is informed by a participatory ethos, crowdsourcing and consensus-building methods: (1) define scope and objective of the process improvement; (2) produce a draft or prototype of the proposed process improvement specification; (3) identify participant recruitment strategy; (4) design and conduct a remote consensus-building exercise; (5) produce a final specification of the process improvement in light of learning from the exercise. We tested the approach in a case study that sought to specify process improvements for the management of obstetric emergencies during the COVID-19 pandemic. We used a brief video showing a process for managing a post-partum haemorrhage in women with COVID-19 to elicit recommendations on how the process could be improved. Two Delphi rounds were then conducted to reach consensus.
We gathered views from 105 participants, with a background in maternity care (n = 36), infection prevention and control (n = 17), or human factors (n = 52). The participants initially generated 818 recommendations for how to improve the process illustrated in the video, which we synthesised into a set of 22 recommendations. The consensus-building exercise yielded a final set of 16 recommendations. These were used to inform the specification of process improvements for managing the obstetric emergency and develop supporting resources, including an updated video.
The proposed methodological approach enabled the expertise and ingenuity of diverse stakeholders to be captured and mobilised to specify process improvements in an area of pressing service need. This approach has the potential to address current challenges in process improvement, but will require further evaluation.

In orthopedics, as in all surgical specialties, procedures are described in an operative report. This is an essential and mandatory part of the medical file (Article R.1112-2 of the French Public Health Code) and a fully codified medicolegal document comprising precise items determined by the Health Authority (HAS) and the ORTHORISQ risk management and accreditation organization.
Information on the rules for filling out operative reports could improve their level of conformity, especially if provided early in surgical training.
A prospective comparative study was conducted with 6 groups of junior or senior surgeons, in the public or private sector, who had or had not been given specific information on the criteria for filling out the operative report. A conformity score was designed, based on the HAS-ORTHORISQ criteria (SCHOCRO, out of 100 points) for comparison between groups.
Scores did not differ between junior and senior surgeons, whether informed or not. Private-sector surgeons had better scores than university hospital surgeons when not informed (p=0.016). The information improved conformity. The earlier residents were informed, the better their conformity.
Harmonization of operative reporting improves report quality and should be standard practice for all, and especially for residents as soon as they enter the foundation phase. The SCHOCRO score seemed well suited for assessing operative report quality, being simple and reproducible.
II; prospective study.

Despite the substantial investment by Australian health authorities to improve the health of rural and remote communities, rural residents continue to experience health care access challenges and poorer health outcomes. Health literacy and community engagement are both considered critical in addressing these health inequities. However, the current focus on health literacy can place undue burdens of responsibility for healthcare on individuals from disadvantaged communities whilst not taking due account of broader community needs and healthcare expectations. This can also marginalize the influence of community solidarity and mobilization in effecting healthcare improvements.
The objective is to present a conceptual framework that describes community literacy, its alignment with health literacy, and its relationship to concepts of community engaged healthcare.
Community literacy aims to integrate community knowledge, skills and resources into the design, delivery and adaptation of healthcare policies, and services at regional and local levels, with the provision of primary, secondary, and tertiary healthcare that aligns to individual community contexts. A set of principles is proposed to support the development of community literacy. Three levels of community literacy education for health personnel have been described that align with those applied to health literacy for consumers. It is proposed that community literacy education can facilitate transformational community engagement. Skills acquired by health personnel from senior executives to frontline clinical staff, can also lead to enhanced opportunities to promote health literacy for individuals.
The integration of health and community literacy provides a holistic framework that has the potential to effectively respond to the diversity of rural and remote Australian communities and their healthcare needs and expectations. Further research is required to develop, validate, and evaluate the three levels of community literacy education and alignment to health policy, prior to promoting its uptake more widely.

The digital revolution is disrupting the ways in which health research is conducted, and subsequently, changing healthcare. Direct-to-consumer wellness products and mobile apps, pervasive sensor technologies and access to social network data offer exciting opportunities for researchers to passively observe and/or track patients \'in the wild\' and 24/7. The volume of granular personal health data gathered using these technologies is unprecedented, and is increasingly leveraged to inform personalized health promotion and disease treatment interventions. The use of artificial intelligence in the health sector is also increasing. Although rich with potential, the digital health ecosystem presents new ethical challenges for those making decisions about the selection, testing, implementation and evaluation of technologies for use in healthcare. As the \'Wild West\' of digital health research unfolds, it is important to recognize who is involved, and identify how each party can and should take responsibility to advance the ethical practices of this work. While not a comprehensive review, we describe the landscape, identify gaps to be addressed, and offer recommendations as to how stakeholders can and should take responsibility to advance socially responsible digital health research.