Factors affecting the delivery of healthcare on a humanitarian operation in West Africa: A qualitative study

UN peacekeeper health and risk factors --- a systematic scoping review

BACKGROUND

Conflicts, natural disasters, and complex emergencies present substantial health challenges to United Nations (UN) peacekeepers deployed in mission areas. This scoping review aims at summarizing previous research on the health of UN peacekeepers and identifies issues for further investigation.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews, we systematically searched Web of Science, PubMed, EMBASE, Scopus and China National Knowledge Infrastructure (CNKI) for English and Chinese literature published from April 1997 to November 2023. A data charting form was developed by two reviewers to extract relevant themes and provided narrative descriptions.

RESULTS

We screened 1079 de-duplicated records and included 143 studies in this scoping review. There were 112 studies on the health status of UN peacekeepers, with more than half on mental health problems such as stress and anxiety. Many studies explored the health status of UN peacekeepers in African countries deployed from mainly U.S., Canada, U.K., China, Australia and Norway. There were 39 studies on the health risk factors of UN peacekeepers, including natural environmental, social environmental, psychological, behavioral lifestyle, biological factors and health service factors. There were 62 articles on the health protection of UN peacekeepers, mainly based on previous deployment experience, with a lack of theoretical guidance from global health perspectives. This scoping review found that health problems of UN peacekeepers are complicated, and whose impacts are cross-border. Social environmental factors were explored the most among health risk factors. Disease prevention measures, medical and health measures, and psychosocial measures were the main health protection for UN peacekeepers.

CONCLUSIONS

This scoping review highlighted that health problems of UN peacekeepers were typical global health issues with complicated and cross-border health risk factors. Therefore, comprehensive strategies could be taken from global health perspectives, including multi-phases (before-deployment, during-deployment, and post-deployment), multi-disciplines (public health, medicine, politics, health diplomacy, and others), and multi-levels (the UN, host countries, troop-contributing countries, the UN peacekeeping team, and UN peacekeepers).

The human side of humanitarian supply chains: a research agenda and systematization framework

Humanitarian operations are increasingly receiving attention due to the numerous recent disasters and crises caused by both natural and man-made events, from mass human exodus to pandemics such as COVID-19. The successful management of humanitarian supply chains requires the effective use of human resource practices, which in turn requires strong leadership in the so-called 'soft side' of management. This study aims to investigate the current status of research on the human aspects of humanitarian supply chains. Through a systematic and comprehensive literature review, encompassing an original codification and in-depth analysis of journal articles, this work provides a research agenda and a number of lessons concerning human resource management (HRM) in humanitarian operations. The main findings reveal that: (i) HRM impacts the ability of humanitarian organizations to adequately prevent, prepare for and respond to disasters; (ii) training programs for aid personnel are a vital aspect of humanitarian responsiveness; (iii) humanitarian operations require a workforce with a variety of soft and hard skills; (iv) lack of trained staff is one of the main challenges in this field; and (v) building relationships and strengthening networks can enlarge the human resource pool available. Therefore, the findings of this study and its proposed research agenda have implications for both theory and practice. In terms of theory, this work provides seven recommendations, representing opportunities for scholars to advance this body of knowledge. For humanitarian practitioners, this paper offers insightful lessons to guide them in the management of human resources in humanitarian operations.

Midwives' perception of advantages of health care at a distance during the COVID-19 pandemic in Switzerland

OBJECTIVE

To explore midwives' perceptions of the advantages of telemedicine during the COVID-19 pandemic in Switzerland.

DESIGN

Cross-sectional study based on an online survey using quantitative methods.

SETTING

Midwives working in Switzerland.

PARTICIPANTS

Self-selected convenience sample of 630 members of the Swiss Federation of Midwives.

MEASUREMENT

Open questions on advantages of health care at a distance and workrelated characteristics were used in the online questionnaire. The information was coded and integrative content analysis was applied.

FINDINGS

A good half of the respondents associated telemedicine with either an advantage beyond the pandemic ("Reduced workload", "Improved health care provision", "Greater self-care of clients"), while the others saw a pandemic-related advantage ("Protection from COVID-19", "Maintaining care/counseling in an exceptional situation"), or no advantage at all. Older, more experienced midwives were less likely to see an advantage beyond the pandemic. The motive "Reduced workload" was positively associated with professionals aged younger than 40 years and midwives with up to 14 years of professional experience, and "Protection from COVID-19" was more likely cited by midwives aged 50 and more and by midwives working solely in hospitals. Midwives who stated "Maintaining care" and "Improved health care provision" as motives to embrace telemedicine were more likely to experience health care at a distance as a positive treatment alternative.

KEY CONCLUSION

Midwives' perceptions of the advantages of health care at a distance vary substantially with age and years of professional experience, as well as workrelated characteristics. Further research is necessary to acquire a sound understanding of underlying reasons, including the sources of the general attitudes involved.

IMPLICATION FOR PRACTICE

Understanding the differences in perceptions of health care at a distance is important in order to improve the work situation of midwives and the health care they provide to women and families. Different sensitivities represent an important source in the ongoing discussion about the future use of telemedicine in health care.

Experiences of frontline healthcare workers and their views about support during COVID-19 and previous pandemics: a systematic review and qualitative meta-synthesis

BACKGROUND

Healthcare workers across the world have risen to the demands of treating COVID-19 patients, potentially at significant cost to their own health and wellbeing. There has been increasing recognition of the potential mental health impact of COVID-19 on frontline workers and calls to provide psychosocial support for them. However, little attention has so far been paid to understanding the impact of working on a pandemic from healthcare workers' own perspectives or what their views are about support.

METHODS

We searched key healthcare databases (Medline, PsychINFO and PubMed) from inception to September 28, 2020. We also reviewed relevant grey literature, screened pre-print servers and hand searched reference lists of key texts for all published accounts of healthcare workers' experiences of working on the frontline and views about support during COVID-19 and previous pandemics/epidemics. We conducted a meta-synthesis of all qualitative results to synthesise findings and develop an overarching set of themes and sub-themes which captured the experiences and views of frontline healthcare workers across the studies.

RESULTS

This review identified 46 qualitative studies which explored healthcare workers' experiences and views from pandemics or epidemics including and prior to COVID-19. Meta-synthesis derived eight key themes which largely transcended temporal and geographical boundaries. Participants across all the studies were deeply concerned about their own and/or others' physical safety. This was greatest in the early phases of pandemics and exacerbated by inadequate Personal Protective Equipment (PPE), insufficient resources, and inconsistent information. Workers struggled with high workloads and long shifts and desired adequate rest and recovery. Many experienced stigma. Healthcare workers' relationships with families, colleagues, organisations, media and the wider public were complicated and could be experienced concomitantly as sources of support but also sources of stress.

CONCLUSIONS

The experiences of healthcare workers during the COVID-19 pandemic are not unprecedented; the themes that arose from previous pandemics and epidemics were remarkably resonant with what we are hearing about the impact of COVID-19 globally today. We have an opportunity to learn from the lessons of previous crises, mitigate the negative mental health impact of COVID-19 and support the longer-term wellbeing of the healthcare workforce worldwide.

Caring for the carers: a COVID-19 psychological support programme

The outbreak of COVID-19 and the subsequent pandemic brought unprecedented worldwide challenges born out of a rapidly escalating health and economic crisis. From emergency planners to healthcare workers on the front line, and everyone in between, the pandemic, and the uncertainty surrounding it, was likely to become a significant stressor, one with no immediate solution but with the potential to cause enduring distress beyond its conclusion. The UK Defence Medical Services recognised the need to provide an evidence-based programme of care intended to support personnel transitioning from assisting the national response back to normal duties. This was informed by a narrative review that targeted literature exploring strategies for supporting the mental health and well-being of healthcare workers during 21st-century infectious disease outbreaks. The literature identified the experiences most likely to cause enduring distress, which comprised morally challenging decisions, vulnerability, death and suffering, professional and personal challenges, and expectations. The opportunity to find meaning in these experiences, by discussing them with peers who share a contextual understanding, is important to limit the longer-term psychosocial impact of such events. This paper will discuss the design considerations and planned implementation strategy of the Recovery, Readjustment and Reintegration Programme to limit the incidence of distress or longer-term mental ill health among military personnel.

A qualitative study to investigate the psychosocial effects of operational deployments on Medical Emergency Response Team personnel

The stressors associated with emergency medical teams responding to critical incidents are well documented; however, the impact of such duties on the UK military personnel had never been investigated. This study explored the psychosocial effects of Medical Emergency Response Teams (MERT) operating in Afghanistan to inform the development of a Resilience Model. A structured and contextually relevant process could then be applied for a team's preparation for, delivery of and recovery from, their duties. A qualitative cross-sectional design used semi-structured interviews and 15 multidisciplinary team members participated. Interviews were transcribed verbatim and data were systematically analysed using grounded theory. Emergent theory poses that developing resilience against the demands of this role is dependent upon personnel having a realistic understanding of the deployed environment by phased immersion within it. This preparatory training generates situational awareness, trust and strong team cohesion, which together with peer and organizational support are necessary factors to effectively cope with the role. To limit the costs of caring, there is a need for MERT personnel to segregate the physiological and emotional aspects of delivering care to the injured; those unable to do so may be at greater risk of poor mental health outcomes. The preparatory training of MERT personnel must be further developed to provide an immersive environment that more closely matches the reality of the role. A period of stability is required post deployment with the support of peers to enable personnel to more efficiently transition back to their home life.

[Psychological stress caused by epidemics among health care workers and implications for coping with the corona crisis: a literature review]

Psychological stress caused by epidemics among health care workers and implications for coping with the corona crisis: a literature review Objectives: COVID-19 has significantly changed the working and living conditions within a short period. Despite the milder course of the disease in comparison to other countries, employees in the German health care system are particularly affected by the massive impact of the disease on their professional and private lives. From a scientific point of view, summarized empirical evidence made during other epidemics and at the beginning of the COVID-19-pandemic is largely missing. Methods: Narrative review article, literature search on PubMed database. Results: A total of 56 studies were included, 35 of them on the SARS epidemic and seven on COVID-19; included studies reported overall increased stress levels, anxiety and PTSD symptoms due to health care work during various epidemics. Direct contact with patients, quarantine experiences and perceived health risks were further stress factors in epidemics. Participation in intervention studies enabled better management of epidemic-related situations. Conclusions: Healthcare workers are exposed to high workloads because of epidemics, which can have a variety of adverse effects. Recommendations are made for dealing with periods of high exposure during the COVID-19-pandemic.