An ethnographic exploration of diarrheal disease management in public hospitals in Bangladesh: From problems to solutions.
An ethnographic exploration of diarrheal disease management in public hospitals in Bangladesh: From problems to solutions.
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DOI：
10.1016/j.socscimed.2020.113185
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发表时间：
2020-09
期刊：
影响因子：
--
通讯作者：
Nelson EJ
中科院分区：
文献类型：
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作者：
Biswas D;Hossin R;Rahman M;Bardosh KL;Watt MH;Zion MI;Sujon H;Rashid MM;Salimuzzaman M;Flora MS;Qadri F;Khan AI;Nelson EJ
腹泻病是全球最常见的入院原因之一。在资源有限的医院，影响遵循指南的治疗的障碍定义不清，特别是在腹泻疾病爆发期间。本研究的目的是表征面临的挑战，在资源有限的医院，并确定机会，以改善care.MethodsThe研究期间进行了一个疟疾疾病爆发期间分布在孟加拉国的10个公立地区医院。一个快速的人种学方法包括观察和非正式采访临床医生，护士和病人。在第一阶段，通过观察确定了十个地点在森林管理方面的共同和独特挑战。在第二阶段，有目的地选择了四家医院进行额外的人种志研究。从患者-临床医生互动（n = 76）和非正式访谈（n = 138）中收集了超过420小时的系统观察结果。应用专题分析确定影响医院腹泻management.ResultsNormalization的准则偏差的因素，观察在所有10个网站，包括处方的非指示性抗生素和静脉（IV）液体。“应该做什么”和“可以做什么”之间的冲突是最常见的挑战。在入院时在中位数2分钟内（n = 76）建立临床评估和患者治疗计划，通常不进行体格检查（57%; n=43/76）。阻止遵守临床指南的因素包括人力资源的限制，利益冲突，过度拥挤，卫生和环境卫生不足，在急诊科和wards.ConclusionThis研究确定的挑战，以医院为基础的管理，以提高护理看似变化弹性的医院环境中的肺部疾病和机会。研究结果揭示了干预和政策参与的重要领域，这些领域可能对医院和患者都有额外的好处。这些干预措施包括针对清洁水、环境卫生和个人卫生方面的障碍，这些障碍阻止临床医生出于对医院获得性感染的担忧而采用指导方针。
IntroductionDiarrheal disease is one of the most common causes of hospital admission globally. The barriers that influence guideline-adherent care at resource limited hospitals are poorly defined, especially during diarrheal disease outbreaks. The objective of this study was to characterize challenges faced in diarrheal disease management in resource-limited hospitals and identify opportunities to improve care.MethodsThe study was conducted during a diarrheal disease outbreak period at ten public district hospitals distributed across Bangladesh. A rapid ethnographic approach included observations and informal interviews with clinicians, staff nurses and patients. In the first phase, observations identified common and unique challenges in diarrheal management at the ten sites. In the second phase, four hospitals were purposively selected for additional ethnographic study. Systematic observations over 420 total hours were collected from patient-clinician interactions (n = 76) and informal interviews (n = 138). Applied thematic analysis identified factors that influenced hospitalbased diarrhea management.ResultsNormalization of guideline deviation was observed at all ten sites, including prescription of non-indicated antibiotics and intravenous (IV) fluids. Conflict between ‘what should be done’ and ‘what can be done’ was the most common challenge identified. Clinical assessments and patient treatment plans were established at admission in a median of 2 minutes (n = 76), often without a physical examination (57%; n=43/76). Factors that prevented adherence to clinical guidelines included human resource constraints, conflicts of interests, overcrowding, and inadequate hygiene and sanitation in the emergency department and wards.ConclusionThis study identified challenges in hospital-based management of diarrheal disease and opportunities to improve care in seemingly change-resilient hospital settings. The results reveal important areas for intervention and policy engagement that may have additive benefit for both hospitals and their patients. These interventions include targeting barriers to clean-water, sanitation and hygiene that prevent clinicians from adopting guidelines out of concern for hospital acquired infections.
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影响因子：
3.8
作者：
Farmer P;Almazor CP;Bahnsen ET;Barry D;Bazile J;Bloom BR;Bose N;Brewer T;Calderwood SB;Clemens JD;Cravioto A;Eustache E;Jérôme G;Gupta N;Harris JB;Hiatt HH;Holstein C;Hotez PJ;Ivers LC;Kerry VB;Koenig SP;Larocque RC;Léandre F;Lambert W;Lyon E;Mekalanos JJ;Mukherjee JS;Oswald C;Pape JW;Gretchko Prosper A;Rabinovich R;Raymonville M;Réjouit JR;Ronan LJ;Rosenberg ML;Ryan ET;Sachs JD;Sack DA;Surena C;Suri AA;Ternier R;Waldor MK;Walton D;Weigel JL
通讯作者：
Weigel JL
影响因子：
11.8
作者：
George CM;Monira S;Sack DA;Rashid MU;Saif-Ur-Rahman KM;Mahmud T;Rahman Z;Mustafiz M;Bhuyian SI;Winch PJ;Leontsini E;Perin J;Begum F;Zohura F;Biswas S;Parvin T;Zhang X;Jung D;Sack RB;Alam M
通讯作者：
Alam M
影响因子：
3.8
作者：
Haque, Farhana;Ball, Robyn L.;Nelson, Eric Jorge
通讯作者：
Nelson, Eric Jorge
影响因子：
5.4
作者：
Howteerakul, N;Higginbotham, N;Dibley, MJ
通讯作者：
Dibley, MJ
影响因子：
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作者：
Leech, Nancy L.;Onwuegbuzie, Anthony J.
通讯作者：
Onwuegbuzie, Anthony J.