The use of vaccines in the cattle industry is widespread; however, there is limited published guidance for use by decision-makers such as farmers and vets. To best support vets in advising dairy farmers on the optimisation of vaccination strategies, it is important to understand how and why vets make decisions about recommending the vaccination of cattle. The objective of this study was to explore in-depth farm animal vets' motivators and barriers to the implementation of vaccination strategies on British dairy farms. Semistructured interviews were conducted with 15 vets. Results indicated that vets have a positive attitude towards the use of vaccination and have few barriers to advising its implementation. Vets appear to group farmers into three 'character types'. This characterisation influences the vet-farmer relationship and how the vet communicates with the farmer. Vets required evidence of disease or a risk of disease as a motivator to advise vaccination. However, this seemed to be sometimes overruled by a risk-averse attitude; resulting in vaccination being advised 'just in case'. Crucially, the need for resources to support and build on the vet-farmer relationship is highlighted as an area requiring further exploration in order to optimise vaccination strategies on farm.
Background
Ambulatory oncology practices treat thousands of Americans on a daily basis with high-risk and high-cost antineoplastic agents. However, we know relatively little about these diverse practices and the organizational structures influencing care delivery.
Objective
The aim of this study was to examine clinician-reported factors within ambulatory oncology practices that affect care delivery processes and outcomes for patients and clinicians.
Methods
Survey data were collected in 2017 from 298 clinicians (nurses, physicians, nurse practitioners, and physician assistants) across 29 ambulatory practices in Michigan. Clinicians provided written comments about favorable and unfavorable aspects of their work environments that affected their ability to deliver high-quality care. We conducted inductive content analysis and used the Systems Engineering Initiative for Patient Safety work system model to organize and explain our findings.
Results
Clinicians reported factors within all 5 work-system components of the Systems Engineering Initiative for Patient Safety model that affected care delivery and outcomes. Common themes surfaced, such as unfavorable aspects including staffing inadequacy and high patient volume, limited physical space, electronic health record usability issues, and order entry. Frequent favorable aspects focused on the skills of colleagues, collaboration, and teamwork. Some clinicians explicitly reported how work system factors were relational and influenced patient, clinician, and organizational outcomes.
Conclusions
These findings show how work-system components are interactive and relational reflecting the complex nature of care delivery.
Implications for Nursing Practice
Data obtained from frontline clinicians can support leaders in making organizational changes that are congruent with clinician observations of practices’ strengths and opportunities for improvement.
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