Parental Role Changes in Romanian Transnational Families: Consequences of Migration

Even if there are consistent studies on the issue of transnational families, research is still needed to address the parental role changes in these families. The aim of this article was to identify the main changes in the parental roles of Romanian transnational families as a result of the parents’ labor migration. We used interviewing as the research method and directed content analysis to analyze the data. Purposive sampling was conducted in order to identify the interviewees. The results captured important role changes regarding the income provider role of the parent, but especially the role of emotional support provider that the parent should take on for the children. These findings highlight the need to develop specific measures to address the possible negative effects that affect these transnational families.

117. How Does Antimicrobial Stewardship Provider Role Affect Prospective Audit and Feedback Acceptance by the Attending Physician?

Background Antimicrobial stewardship (AMS) teams are commonly multidisciplinary. The effect of AMS provider role on prospective audit and feedback (PAF) acceptance has previously been investigated with mixed results. PAF of restricted antimicrobials (carbapenems, linezolid, daptomycin, and tigecycline) in adult inpatients at our large Canadian academic centre has been performed since 2018. Actionable feedback is communicated via chart note plus one of a phone call, direct message, or in-person discussion with the most responsible physician of the attending team in order to optimize the prescription if deemed necessary. The objective of this study was to assess the effect of AMS provider role on PAF acceptance. Methods A 3 year retrospective review of all PAF events was undertaken. All audited prescriptions were included. Logistic regression was used to determine odds ratios for acceptance for individual AMS provider roles of pharmacist, physician, and supervised post-graduate physician trainee. Results Out of 1896 prescriptions audited, actionable feedback was provided to the most responsible physician in 731 (39%) cases. 677/731 (93%) of audited antibiotics were carbapenems. The overall acceptance rate was 82% (598/731). Acceptance rate and odds of acceptance based on AMS provider role were as follows: pharmacist alone 171/208 (82%), OR 1.04, 95% CI 0.70-1.59, physician alone 141/160 (88%), OR 1.85, 95% CI 1.12-3.20, pharmacist-physician duo 211/268 (79%), OR 0.73, 95% CI 0.50-1.07, and supervised post-graduate physician trainee 75/95 (79%), OR 0.81, 95% CI 0.48-1.41. Conclusion The overall acceptance rate was high. There was a higher odds of acceptance if an AMS physician was providing PAF alone, highlighting the importance of physician involvement. Disclosures Dima Kabbani, MD, AVIR Pharma (Grant/Research Support, Other Financial or Material Support, Speaker)Edesa Biotech (Scientific Research Study Investigator)Merck (Scientific Research Study Investigator)

Exploring expanded interdisciplinary roles in goals of care conversations in a national goals of care initiative: A qualitative approach

Background: The United States Veterans Health Administration National Center for Ethics in Health Care implemented the Life-Sustaining Treatment Decisions Initiative throughout the Veterans Health Administration health care system in 2017. This policy encourages goals of care conversations, referring to conversations about patient’s treatment and end-of-life wishes for life-sustaining treatments, among Veterans with serious illnesses. A key component of the initiative is expanding interdisciplinary provider roles in having goals of care conversations. Aim: Use organizational role theory to explore medical center experiences with expanding interdisciplinary roles in the implementation of a goals of care initiative. Design: A qualitative thematic analysis of semi-structured interviews. Setting/participants: Initial participants were recruited using purposive sampling of local medical center champions. Snowball sampling identified additional participants. Participants included thirty-one interdisciplinary providers from 12 geographically diverse initiative pilot and spread medical centers. Results: Five themes were identified. Expanding provider roles in goals of care conversations (1) involves organizational culture change; (2) is influenced by medical center leadership; (3) is supported by provider role readiness; (4) benefits from cross-disciplinary role agreement; and (5) can “overwhelm” providers. Conclusions: Organizational role theory is a helpful framework for exploring interdisciplinary roles in a goals of care initiative. Support and recognition of provider role expansion in goals of care conversations was important for the adoption of a goals of care initiative. Actionable strategies, including multi-level leadership support and the use of interdisciplinary champions, facilitate role change and have potential to strengthen uptake of a goals of care initiative.

Using Patient Voice to Personalize the Opioid Epidemic: An Evaluation of 2 Educational Interventions

Despite rising opioid fatalities, attitudes remain indifferent toward those with opioid use disorder (OUD). Utilizing patient voice may be one way to move providers to action. We included persons with OUD in 2 educational sessions as an important tool of attitude change. Post-session surveys demonstrate increased compassion, deeper understanding of challenges, and positive change in attitude. Inclusion of patient voice was identified as the most useful feature of both educational sessions. Four themes emerged: value of patient voice; change in attitude; barriers to change; and enhanced provider role. Future educational sessions should include the voice of persons living with OUD.

Resisting the commodification of intimate life? Paternal love, emotional bordering and narratives of ambivalent family consumerism from Scottish and Romanian fathers

Romantic love has been conceptualised as an emotional resource that promotes consumerism, by deeply affecting the creation of the modern self (Illouz, 2012). Simultaneously, both research and media discourses present the modern ‘good’ father’s role as one of enhanced intimacy (Dermott, 2008), and one in which fathers’ experiences of paternal love are routinely overlooked. I argue that paternal love as a different form of love than romantic love can resist commodification to a certain extent. Based on data from 47 qualitative interviews with Scottish and Romanian fathers, I argue that involved fathers have an ambivalent relationship to consumerism. Far from uniformly adopting it, data reveal that fathers resist it by focusing on the emotional value of gifts and developing their children’s warmth and confidence (încredere in sine).1 This happens in a social context where fathers shift emotionally between love and stoicism as they flexibly adopt either an intimate or provider role according to different contexts. Exploring paternal love is important in understanding how fathers, in relation to their children, not only participate but can also resist the commodification of their intimate lives, and can contest the general discourse of the commodification of love.

Independence and relationality in notions of adulthood across generations, gender and social class

The adult person is in sociological literature often referred to as a genderless and classless being. As a life course phase it is implicitly viewed as a static destination after a dynamic transition period of youth. The aim of this article is to empirically examine perceptions of adulthood in biographical interviews in three-generation Norwegian families. A case-based biographical approach related to gender and social class across historical periods is at the core of the analysis. Thoughts on independence and the Mead-inspired concept of relationality are used as sensitising concepts to examine general ideals and personal considerations in notions of adulthood. The analyses indicate variations over historical periods, generations and life course phases wherein relationality or independence become significant. Relationality may take on different meanings with reference to period-specific gender expectations such as the male provider role and women as the primary carer in families in the oldest generations. Ideals of individual independence as choice or necessity vary according to life course phase, social class and period-specific conditions.

Patient and Provider Comfort and Concerns in Mobile Health Application Use in Healthcare

Early implementation of telehealth and mHealth technologies have illustrated the positive potential impact these technologies can have on the healthcare domain. Leveraging mobile device capabilities has the potential to facilitate patient engagement and improve provider-to-patient communication, thus improving patient outcomes. A cross-sectional study surveyed provider and patients to gauge mobile use regarding current mHealth activities as well as concerns and comfort of both parties when using this technology. Results revealed that age, income, type of insurance, and employment mediated either patient comfort and concerns; whereas provider role was the only factor mediating provider concerns. Patients had significantly higher levels of concern when compared to providers. These results can be leveraged to focus effort in implementing and developing telehealth and mHealth technologies.