Combining community nursing, midwifery, and school medicine within a single provider organisation is widely advocated as a route to more comprehensive primary care, yet whether multi-domain provision is accompanied by differences in per-domain service output remains untested at population scale. Economic theories predict opposing effects: economies of scope favour joint provision, while specialisation may yield higher per-unit throughput. A nationwide cross-sectional analysis was performed using administrative data of the Polish National Health Fund (NFZ) covering all contracts for community nursing (N), midwifery (M), and school medicine (S) in 2022 and 2023. The unit of observation was the unique provider-year (n = 16,574; 8,302 in 2022 and 8,272 in 2023) from 8,511 providers across all 16 NFZ regional branches. Providers were classified into seven mutually exclusive service-domain combinations. Two primary outcomes were specified ex ante: nurse services per 1,000 nurse declarations and midwife services per 1,000 midwife declarations. Adjusted associations were estimated by negative binomial regression (NB2, dispersion estimated by maximum likelihood) with log(declarations) as offset, fixed effects for regional branch and year, mono-domain providers as reference categories, and standard errors clustered at the provider level. The nursing model included 11,753 provider-years (6,097 providers) and the midwifery model 8,333 provider-years (4,345 providers). Compared with N-only providers, nurse services per declaration were lower in N + M providers (adjusted IRR 0.77; 95
Demand for healthcare is increasing, but workforce shortages are expected to worsen in many professions, including allied health professions. An emerging workforce strategy is transdisciplinary models, which streamline care by redesigning services around local needs. However, evidence on how to translate and implement transdisciplinary models across healthcare settings remains limited. This study aimed to evaluate use of a manual designed for the implementation process of an allied health transdisciplinary assessment model at three Australian hospitals. The multi-site implementation study used a three-phase mixed methods design. Phase 1 used an embedded study design, Phase 2 used a qualitative study design, and Phase 3 integrated the results of the first two phases. The three hospital sites used an implementation manual to design and implement a transdisciplinary assessment model fit for local purpose. Data were collected via staff surveys, minutes of working party meetings, and focus groups. Data were analysed by mapping against the Consolidated Framework for Implementation Research, rating implementation using a utility rubric, and thematic analysis. Across the three hospital sites (two stroke units and one medical ward), 50 surveys were completed and 11 staff participated in online focus groups. Overall, three translation recommendations were identified: (1) prioritise innovation fidelity, (2) focus on adapting the transdisciplinary model to the inner setting, and (3) identify sources of motivation/resistance early and revisit frequently. Implementation of transdisciplinary innovations requires fidelity to core processes alongside adaptation to local context. Translation efforts should be supported by cross-disciplinary communication, alignment with local workflows, protected opportunities for team sense-making, and ongoing reflection on sources of motivation and resistance to change. ACTRN12624001036505 prospectively registered on 27/08/2024.
Globally, there is a shift in the population distribution towards older ages. The trend is towards older adults receiving care and support at home; therefore, the need for home healthcare is expected to increase. Registered nurses lead the nursing care close to older adults in municipal home healthcare. Research indicates that registered nurses face challenges in leading care staff working close to older adults. However, less is known about care staff’s experiences of registered nurses’ leadership, which could contribute to new knowledge about registered nurses’ leadership. Therefore, this study aimed to explore care staff’s experiences of registered nurses’ leadership close to older adults in municipal home healthcare. A qualitative and explorative design with an inductive approach was used. Individual interviews were conducted with care staff (n = 15). Data were analysed using reflexive thematic analysis. Care staff’s experiences of registered nurses’ leadership close to older adults in home healthcare were shown through three themes: Registered nurses’ leadership affect care staff’s sense of security; Registered nurses’ leadership affect care staff’s sense of being included; and Registered nurses’ closeness as leaders affects the establishment of relationships. Registered nurses’ leadership close to older adults in home healthcare can impact care staff’s sense of security and inclusion. Registered nurses’ closeness as leaders affects the establishment of relationships. The results of this study are relevant for registered nurses both in clinical practice and in nursing education to promote registered nurses to be nursing leaders. There is a need for the organizations to promote registered nurses’ opportunities to establish relationships with older adults and care staff to ensure quality, safe home healthcare.
Early pregnancy loss (EPL) includes miscarriage before 14 weeks’ gestation and ectopic pregnancy. Around 20
Effective and efficient blood component use is critical in Uganda’s unique healthcare context. Despite medical advancements enabling tailored blood components use, anecdotal reports suggest a preference for whole blood and packed red blood cells (PRBCs) among healthcare workers, potentially due to knowledge gaps and systemic barriers. This study sought to investigate the current prescribing patterns, healthcare workers’ (HCWs) knowledge of blood component indications and associated factors, and perceived barriers to blood component prescription in Uganda. An online cross-sectional study was conducted among HCWs involved in blood component prescriptions in Uganda. Ethical approval was obtained from Mulago National Referral Hospital’s Research and Ethics Committee. Data were collected through a self-administered questionnaire distributed via WhatsApp. Data analysis was performed in STATA using binary logistic regression model to determine the factors associated with good knowledge (p < 0.05). Of the 306 participants, 213 (69.6
