Dataset Information

Family participation to enhance care and tackle health worker shortages in resource-limited hospitals: A systematic review.

ABSTRACT:

Background

A growing global shortage of health workers is limiting access to health care, especially in resource-limited countries. Family participation in hospital care could enhance care while tackling health worker shortages. With the same resources, it might deliver additional and more personalised care. This review assessed the effect and safety of family participation interventions in the care of hospitalised adults in resource-limited settings and, ultimately, if it is a viable strategy to tackle health worker shortages.

Methods

For this systematic review, Medline, Embase, CINAHL and the Global Health Library were searched from inception till April 7, 2022. Clinical studies were included if they described a family participation intervention for hospitalised adults, were performed in a low- or middle-income country and reported on a patient-related outcome. Data were collected on patient, family, staff and health service-related outcomes. Risk of bias was assessed with the ROB2 and ROBINS-I tool.

Results

From 4444 studies, six were included for narrative synthesis, with a total of 1794 participants. Four studies were performed in Asia and two in Africa; all were published between 2017 and 2022. In-hospital family participation interventions aimed at medication administration and adherence, delirium prevention, and palliative cancer care were successful in significantly improving patient outcomes. Involving family in post-stroke rehabilitation interventions showed no significant effect on mortality and long-term disability. Few data were reported on participating family members' outcomes or hospital staffing issues. None of the included studies showed harm from family participation.

Conclusions

The limited data suggest that family participation can be effective and safe in specific contexts. However, more research is needed to determine the effect of family participation and justify further implementation. Family participation research for enhancing care while tackling health worker shortages should be a collaborative priority of researchers, health care professionals, funding agencies and policymakers.

Registration

PROSPERO registration No. CRD42020205878.

SUBMITTER: Determeijer JJ

PROVIDER: S-EPMC9853090 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Publications

Family participation to enhance care and tackle health worker shortages in resource-limited hospitals: A systematic review.

Determeijer Jim J JJ Leopold Stije J SJ Spijker René R Agyemang Charles C van Vugt Michèle M

Journal of global health 20230120

<h4>Background</h4>A growing global shortage of health workers is limiting access to health care, especially in resource-limited countries. Family participation in hospital care could enhance care while tackling health worker shortages. With the same resources, it might deliver additional and more personalised care. This review assessed the effect and safety of family participation interventions in the care of hospitalised adults in resource-limited settings and, ultimately, if it is a viable st ...[more]

PMID: 36655879

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Project description:BackgroundIn many resource-limited settings, understaffed hospitals rely on patients' families to provide care during admission. These care tasks are often performed informally, untrained and unsupported. The WHO has called for innovative approaches to tackle health worker shortages globally. Family participation interventions could be such an innovation, but current family participation should be understood before implementation. This review explored the barriers and facilitators family caregivers experience participating in resource-limited adult hospital care.MethodsFor this qualitative systematic review, MEDLINE, Embase, CINAHL and the Global Health Library were searched from inception to 17 February 2023. Studies were included if they described experiences of family caregivers participating in hospital-like environments, were performed in a low- or middle-income country and included qualitative data. Open coding was performed, followed by thematic analysis. The risk of bias was assessed using the Joanna Briggs Institute Qualitative Assessment and Review Instrument.Results3099 studies were screened, and 16 were included, involving 466 participants. All studies were published between 2009 and 2023. Three studies were performed in Africa, three in South America and 10 in Asia. 13 main themes were identified, seven for barriers and six for facilitators, including 50 subthemes. The main barriers identified were caregiver burden, a discouraging hospital environment, economic burden, ineffective collaboration with health workers, lack of support, sacrificing personal life to care and unpreparedness for caregiving. The main facilitators identified were a caregiving mindset, competence for caregiving, effective collaboration with health workers, encouraging hospital environment, sufficient financial means and supportive caregiving systems.DiscussionThis review presents the first overview of barriers and facilitators experienced by family caregivers participating in resource-limited hospital care. Research in more contexts and among other stakeholders is necessary to comprehend family participation holistically. To improve family participation, this review suggests prioritising educational interventions.Prospero registration numberCRD42023384414.

Project description:BackgroundThe escalating global scarcity of skilled health care professionals is a critical concern, further exacerbated by rising stress levels and clinician burnout rates. Artificial intelligence (AI) has surfaced as a potential resource to alleviate these challenges. Nevertheless, it is not taken for granted that AI will inevitably augment human performance, as ill-designed systems may inadvertently impose new burdens on health care workers, and implementation may be challenging. An in-depth understanding of how AI can effectively enhance rather than impair work conditions is therefore needed.ObjectiveThis research investigates the efficacy of AI in alleviating stress and enriching work conditions, using intensive care units (ICUs) as a case study. Through a sociotechnical system lens, we delineate how AI systems, tasks, and responsibilities of ICU nurses and physicians can be co-designed to foster motivating, resilient, and health-promoting work.MethodsWe use the sociotechnical system framework COMPASS (Complementary Analysis of Sociotechnical Systems) to assess 5 job characteristics: autonomy, skill diversity, flexibility, problem-solving opportunities, and task variety. The qualitative analysis is underpinned by extensive workplace observation in 6 ICUs (approximately 559 nurses and physicians), structured interviews with work unit leaders (n=12), and a comparative analysis of data science experts' and clinicians' evaluation of the optimal levels of human-AI teaming.ResultsThe results indicate that AI holds the potential to positively impact work conditions for ICU nurses and physicians in four key areas. First, autonomy is vital for stress reduction, motivation, and performance improvement. AI systems that ensure transparency, predictability, and human control can reinforce or amplify autonomy. Second, AI can encourage skill diversity and competence development, thus empowering clinicians to broaden their skills, increase the polyvalence of tasks across professional boundaries, and improve interprofessional cooperation. However, careful consideration is required to avoid the deskilling of experienced professionals. Third, AI automation can expand flexibility by relieving clinicians from administrative duties, thereby concentrating their efforts on patient care. Remote monitoring and improved scheduling can help integrate work with other life domains. Fourth, while AI may reduce problem-solving opportunities in certain areas, it can open new pathways, particularly for nurses. Finally, task identity and variety are essential job characteristics for intrinsic motivation and worker engagement but could be compromised depending on how AI tools are designed and implemented.ConclusionsThis study demonstrates AI's capacity to mitigate stress and improve work conditions for ICU nurses and physicians, thereby contributing to resolving health care staffing shortages. AI solutions that are thoughtfully designed in line with the principles for good work design can enhance intrinsic motivation, learning, and worker well-being, thus providing strategic value for hospital management, policy makers, and health care professionals alike.

Dataset Information

Family participation to enhance care and tackle health worker shortages in resource-limited hospitals: A systematic review.

Background

Methods

Results

Conclusions

Registration

Publications

Family participation to enhance care and tackle health worker shortages in resource-limited hospitals: A systematic review.

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