1
|
Chua KLM, Chan JQV, Tan LLC, Low JA. Facts to Snacks. Evaluating the Effectiveness of Bite-Sized Animations in Teaching Palliative Care to Medical Students. Am J Hosp Palliat Care 2024:10499091241240053. [PMID: 38520168 DOI: 10.1177/10499091241240053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Current palliative care training in medical school is inadequate in preparing doctors to provide quality palliative care. Little attention is paid to determining effective methods of training. OBJECTIVE To assess the use of bite-sized animations in improving the confidence, knowledge and attitudes of medical students towards palliative care. METHODS A mixed methods cohort study was adopted for the study. 50 medical students without prior palliative training completed questionnaires before and after watching a 12-part animated palliative care video series called PowerFacts. Of these participants, 18 underwent semi-structured interviews. RESULTS The quantitative results showed that animations are effective in improving the confidence (P < .001) and knowledge (P < .001), but not the attitudes (P = .183) of medical students. Confidence, knowledge and attitudes were not correlated. Analysis of follow-up interviews of a convenience sample of participants showed that animations can be effective in teaching knowledge and does fill some gaps in palliative education for medical undergraduates. However, the content delivered as a sole learning tool is inadequate in preparing medical students for clinical practice. CONCLUSION All participants achieved level 1 (reaction), some achieved level 2 (learning) but most did not achieve level 3 (behaviour) of the Kirkpatrick's model. There is a need for a multimodal approach in the comprehensive teaching of palliative care in undergraduate medical training to achieve all four levels of the Kirkpatrick Model.
Collapse
Affiliation(s)
- Kai Lin Megan Chua
- Lee Kong Chian School Of Medicine, Nanyang Technological University, Singapore
| | - Jin Qi Valerie Chan
- Lee Kong Chian School Of Medicine, Nanyang Technological University, Singapore
| | - Laurence Lean Chin Tan
- GeriCare, Khoo Teck Puat Hospital, Singapore
- Department of Geriatric Medicine and Palliative Care, Khoo Teck Puat Hospital, Singapore
- Department of Knowledge Translation, Geriatric Education and Research Institute (GERI), Singapore
| | - James Alvin Low
- GeriCare, Khoo Teck Puat Hospital, Singapore
- Department of Geriatric Medicine and Palliative Care, Khoo Teck Puat Hospital, Singapore
- Department of Knowledge Translation, Geriatric Education and Research Institute (GERI), Singapore
| |
Collapse
|
2
|
Schaffler-Schaden D, Stöllinger L, Avian A, Terebessy A, Scott AM, Streit S, Piccoliori G, Zelko E, Huter S, Mergenthal K, Bachler H, Flamm M, Siebenhofer A. Gender Differences in Perceived Working Conditions of General Practitioners During the COVID-19 Pandemic-a Cross-Sectional Study. J Gen Intern Med 2023; 38:1894-1901. [PMID: 36971880 PMCID: PMC10042103 DOI: 10.1007/s11606-023-08166-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The ongoing COVID-19 pandemic has revealed gender-specific differences between general practitioners in adapting to the posed challenges. As primary care workforce is becoming increasingly female, in many countries, it is essential to take a closer look at gender-specific influences when the global health care system is confronted with a crisis. OBJECTIVE To explore gender-specific differences in the perceived working conditions and gender-specific differences in challenges facing GPs at the beginning of the COVID-19 pandemic in 2020. DESIGN Online survey in seven countries. PARTICIPANTS 2,602 GPs from seven countries (Austria, Australia, Switzerland, Germany, Hungary, Italy, Slovenia). Of the respondents, 44.4% (n = 1,155) were women. MAIN MEASURES Online survey. We focused on gender-specific differences in general practitioners' perceptions of working conditions at the beginning of the COVID-19 pandemic in 2020. KEY RESULTS Female GPs rated their skills and self-confidence significantly lower than male GPs (f: 7.1, 95%CI: 6.9-7.3 vs. m: 7.6, 95%CI 7.4-7.8; p < .001), and their perceived risk (concerned about becoming infected or infecting others) higher than men (f: 5.7, 95%CI: 5.4-6.0 vs. m: 5.1, 95%CI: 4.8-5.5; p = .011). Among female GPs, low self-confidence in the treatment of COVID-19 patients appear to be common. Results were similar in all of the participating countries. CONCLUSIONS Female and male GPs differed in terms of their self-confidence when dealing with COVID-19-related issues and their perceptions of the risks arising from the pandemic. To ensure optimal medical care, it is important that GPs realistically assess their own abilities and overall risk.
Collapse
Affiliation(s)
- Dagmar Schaffler-Schaden
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Lena Stöllinger
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Auenbruggerplatz 2/5 8036, Graz, Austria.
| | - András Terebessy
- Department of Public Health - Faculty of Medicine, Semmelweis University Budapest, Budapest, Hungary
| | - Anna M Scott
- Institute for Evidence-Based Healthcare, Bond University Australia, Robina, Australia
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Giuliano Piccoliori
- Institute of General Practice, Institute for Special Training in General Medicine, Claudiana Bozen, Bolzano, Italy
| | - Erika Zelko
- Faculty of Medicine Johannes, Kepler University of Linz, Linz, Austria
| | - Sebastian Huter
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Karola Mergenthal
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
| | - Herbert Bachler
- Institute of General Practice, Medical University Innsbruck, Innsbruck, Austria
| | - Maria Flamm
- Institute for General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Andrea Siebenhofer
- Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
- Institute for General Practice and Evidence Based Health Services Research, Medical University Graz, Graz, Austria
| |
Collapse
|
3
|
Sawyer KE, Carpenter AT, Coleman RD, Tume SC, Crawford CA, Casas JA. Provider Perceptions for Withdrawing Life Sustaining Therapies at a Large Pediatric Hospital. J Pain Symptom Manage 2022; 64:e115-e121. [PMID: 35613688 DOI: 10.1016/j.jpainsymman.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
CONTEXT More than 74% of pediatric deaths occur in an intensive care unit (ICU), with 40% occurring after withdrawal of life-sustaining therapies (WOLST). No needs assessment has described provider needs or suggestions for improving the WOLST process in pediatrics. OBJECTIVES This study aims to describe interdisciplinary provider self-reported confidence, needs, and suggestions for improving the WOLST process. METHODS A convergent parallel mixed-methods design was used. An online survey was distributed to providers involved in WOLSTs in a quaternary children's hospital between January and December 2018. The survey assessed providers' self-reported confidence in their role, in providing guidance to families about the WOLST, experiences with the WOLST process, areas for improvement, and symptom management. Kruskal-Wallis testing was used for quantitative data analysis with P values <0.05 considered significant. Analysis was performed with SPSS v27. Qualitative data were thematically analyzed using Atlas.ti.8 and NVivo. RESULTS A total of 297 surveys were received (48% survey completion) that consisted of multiple choice, Likert-type, and yes/no questions with options for open-ended responses. Mean provider self-rated confidence was high and varied significantly between disciplines. Qualitative analysis identified four areas for refining communication: 1) between the primary team and family, 2) within the primary team, 3) between the primary team and consulting providers, and 4) logistical challenges. CONCLUSIONS While participants' self-rated confidence was high, it varied between disciplines. Participants identified opportunities for improved communication and planning before a WOLST. Future work includes development and implementation of a best practice guideline to address gaps and standardize care delivery.
Collapse
Affiliation(s)
- Kimberly E Sawyer
- St. Jude Children's Research Hospital (K.E.S.), Memphis, Tennessee, USA
| | | | - Ryan D Coleman
- Baylor College of Medicine (R.D.C., S.C.T., J.A.C.), Houston, Texas, USA
| | - Sebastian C Tume
- Baylor College of Medicine (R.D.C., S.C.T., J.A.C.), Houston, Texas, USA
| | | | - Jessica A Casas
- Baylor College of Medicine (R.D.C., S.C.T., J.A.C.), Houston, Texas, USA.
| |
Collapse
|
4
|
Catalisano G, Ippolito M, Marino C, Giarratano A, Cortegiani A. Palliative Care Principles and Anesthesiology Clinical Practice: Current Perspectives. J Multidiscip Healthc 2021; 14:2719-2730. [PMID: 34611408 PMCID: PMC8486274 DOI: 10.2147/jmdh.s240563] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 09/14/2021] [Indexed: 11/24/2022] Open
Abstract
Background Palliative care is a person-centered approach aiming to relieve patient’s health-related suffering and it is often needed when caring for critically ill patients to manage symptoms and identify goals of care. Aim To describe the integration of palliative care principles in anesthesiology clinical practice, within and outside the ICU and to analyze the additional challenges that COVID-19 pandemic is posing in this context. Methods For the purpose of this review, PubMed database was searched for studies concerning palliative care and end of life care, in contexts involving anesthesiologists and intensivists, published in the last 5 years. Results Anesthesiologists and intensivists integrate palliative care within their daily practice providing symptoms management as well as family counseling. High-quality communicational skills are fundamental for anesthesiologists and intensivists especially when interfacing with surrogate decision makers in the ICU or with patients in the preoperative setting while discussing goals of care. Coronavirus disease 2019 (COVID-19) pandemic has challenged many aspects of palliative care delivery: reduced family presence within the ICU, communication with families through phone calls or video calls, patient–physician relationship mediated by bulky personal protective equipment and healthcare workers physical and psychological distress due to the increased workload and limitations in resources are some of the most evident. Conclusion Anesthesiologists and intensivists are increasingly facing challenging clinical situations where principles and practice of palliative care have to be applied. In this sense, increasing knowledge on palliative care and providing specific training would allow to deliver high-quality symptom management, family counseling and end of life guidance in critical care settings. COVID-19 pandemic sets additional difficulties to palliative care delivery.
Collapse
Affiliation(s)
- Giulia Catalisano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Mariachiara Ippolito
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Claudia Marino
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Antonino Giarratano
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| | - Andrea Cortegiani
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, Palermo, Italy.,Department of Anesthesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
| |
Collapse
|
5
|
Runacres F, Poon P, King S, Lustig J, Ugalde A. Examining the role of specialist palliative care in geriatric care to inform collaborations: a survey on the knowledge, practice and attitudes of geriatricians in providing palliative care. Age Ageing 2021; 50:1792-1801. [PMID: 33837769 DOI: 10.1093/ageing/afab058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care has been shown to improve overall care and reduce health care costs, how best to provide this care to older people is internationally significant. AIM To examine the knowledge, attitudes and practices of geriatricians in providing palliative care and working with specialist palliative care services. We also aimed to capture self-reported barriers, confidence and satisfaction in providing palliative care. DESIGN A prospective cross-sectional study surveying Australasian geriatricians was conducted. SETTING/PARTICIPANTS This was a voluntary anonymous online survey, distributed to all full members of the Australian and New Zealand Society of Geriatric Medicine. RESULTS A total of 168 completed responses were received; 58.3% were female and 36.6% had over 20 years of clinical experience. Most geriatricians (85%) reported caring for patients in their last 12 months of life represented a substantial aspect or most of their practice. Geriatricians overwhelmingly believed they should coordinate care (84%) and derived satisfaction from providing palliative care (95%). The majority (69%) believed all patients with advanced illness should receive concurrent specialist palliative care. Regarding knowledge, participants scored an average of 13.5 correct answers out of 18 in a Modified Palliative Care Knowledge Test. CONCLUSIONS Geriatricians find reward in providing generalist palliative care to their patients; however, potential exists for improved collaborations with specialist palliative care services. An evidence base for geriatric patients who benefit most from specialist palliative care services is needed to improve resourcing, collaborative practice and ultimately palliative care delivery.
Collapse
Affiliation(s)
- Fiona Runacres
- Supportive and Palliative Care Unit, Monash Health, Clayton 3168, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
- Department of Palliative Medicine, Calvary Health Care Bethlehem, Parkdale, Victoria, Australia
- The University of Notre Dame, Darlinghurst, New South Wales, Australia
| | - Peter Poon
- Supportive and Palliative Care Unit, Monash Health, Clayton 3168, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
| | - Scott King
- Supportive and Palliative Care Unit, Monash Health, Clayton 3168, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
- Palliative Medicine, Healthecare, Noble Park, Victoria, Australia
| | - Julie Lustig
- Rehabilitation and Aged Care Service, Monash Health, Clayton 3168, Victoria, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
6
|
Schneider F, Schulz CM, May M, Schneider G, Ernst C, Jacob M, Zacharowski K, Hachenberg T, Schmidt M, Kretzschmar M, Graf B, Kees MG, Pawlik M, Sander M, Koch C, Zoller M, Heim M. The association of the anesthesiologist’s academic and educational status with self-confidence, self-rated knowledge and objective knowledge in rational antibiotic application. BMC Res Notes 2020; 13:161. [PMID: 32188509 PMCID: PMC7079461 DOI: 10.1186/s13104-020-05010-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/11/2020] [Indexed: 11/15/2022] Open
Abstract
Objective This study aimed to investigate the association of anesthetists’ academic and educational status with self-confidence, self-rated knowledge and objective knowledge about rational antibiotic application. Therefore, anesthetists in Germany were asked about their self-confidence, self-rated knowledge and objective knowledge on antibiotic therapy via the Multiinstitutional Reconnaissance of practice with Multiresistant bacteria (MR2) survey. Other analysis from the survey have been published elsewhere, before. Results 361 (52.8%) questionnaires were completed by specialists and built the study group. In overall analysis the Certification in Intensive Care (CIC) was significantly associated with self-confidence (p < 0.001), self-rated knowledge (p < 0.001) and objective knowledge (p = 0.029) about antibiotic prescription. Senior consultant status was linked to self-confidence (p < 0.001) and self-rated knowledge (p = 0.005) but not objective knowledge. Likewise, working on Intensive Care Unit (ICU) during the last 12 months was significantly associated with self-rated knowledge and self-confidence (all p < 0.001). In a logistic regression model, senior consultant status was not associated with any tested influence factor. This analysis unveiled that CIC and working on ICU were more associated with anesthesiologists’ self-confidence and self-rated knowledge than senior consultant status. However, neither of the characteristics was thoroughly associated with objective knowledge.
Collapse
|
7
|
Ganz FD, Ben Nun M, Raanan O. Introducing palliative care into the intensive care unit: An interventional study. Heart Lung 2020; 49:915-921. [PMID: 32723616 DOI: 10.1016/j.hrtlng.2020.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many Intensive Care Unit (ICU) deaths include patient and family suffering. While there is a need to include palliative care in the ICU, such care is often unavailable. OBJECTIVES To determine whether a course in ICU Palliative Care was associated with changes in participants' palliative care knowledge, attitudes and practices. METHODS Four cohorts of a national Israeli course in ICU palliative care (N = 122) were followed. Data were collected on the first and last day of a six-month course and 2-5 years later. RESULTS Statistically significant differences were found in palliative care attitudes and practices, with knowledge levels and quality of death and dying stable after course completion. Participants reported obtaining knowledge and skills necessary to introduce palliative care but were thwarted by organizational barriers. CONCLUSIONS The course was successful in building participants capacity to provide palliative care however; barriers made introduction of palliative care into the ICU difficult.
Collapse
Affiliation(s)
- Freda DeKeyser Ganz
- Hadassah Hebrew University School of Nursing, Kiryat Hadassah, PO Box 12000, Jerusalem 91120, Israel and Jerusalem College of Technology, Jerusalem, Israel.
| | - Maureen Ben Nun
- Belinson Medical Center, Surgical Intensive Care Unit, Petach Tikva, Israel.
| | - Ofra Raanan
- Sheba Medical Center, School of Nursing, Tel Hashomer, Israel.
| |
Collapse
|
8
|
Schwill S, Reith D, Walter T, Engeser P, Wensing M, Flum E, Szecsenyi J, Krug K. How to ensure basic competencies in end of life care - a mixed methods study with post-graduate trainees in primary care in Germany. BMC Palliat Care 2020; 19:36. [PMID: 32209073 PMCID: PMC7093985 DOI: 10.1186/s12904-020-00540-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 03/09/2020] [Indexed: 11/12/2022] Open
Abstract
Background Providing end of life care (EoLC) is an important aspect of primary care, which reduces the risk of hospital admission for most patients. However, general practitioners (GPs) seem to have low confidence in their ability to provide EoLC. Little is known about an adequate volume and kind of training in EoLC among GP trainees. Methods We performed a before-after comparison in all post-graduate GP trainees who were registered in the vocational training program (KWBW VerbundweiterbildungPLUS). They were offered participation within a two-day seminar focussing on palliative care in 2017. Those who attended the seminar (intervention group I) completed a paper-based questionnaire directly before the intervention (T1) and 6 months after (T2). None-attendees (group C) were also asked to fill out the questionnaire once. The questionnaire covered previous experiences in palliative care, self-assessment of competencies in EoLC in the organisation of patient care as well as in control of symptoms, attitudes towards death and caring for dying patients and questions about GPs’ role in EoLC. Results In total, 294 GP trainees (I: n = 219; C: n = 75) participated in the study. Of those, more than 90% had previously gained experience in EoLC mainly during vocational training in the hospital rotation. Around a third had previously gained competencies in EoLC in medical school. Between groups I (T1) and C no significant differences were observed in socio-demographic characteristics, pre-existing experience or overall expertise. At T2, 75% of participants of group I declared they have extended their competencies in EoLC after the intervention and 70% classified the intervention as helpful or very helpful. Overall, they rated their competencies significantly higher than at T1 (p < 0.01). In detail, competencies in organisation of EoLC and competencies in handling of symptoms significantly improved (p < 0.01). Due to the intervention, 66% could reflect their attitudes towards dying, death and grief and 18% changed their attitudes. Group I highlighted palliative care as one of GPs tasks (Likert 4.47/5, SD 0.75). Conclusions The intervention fostered personal competencies, understanding and self-confidence in EoLC among GP trainees. This is crucial for the aim to broadly provide EoLC.
Collapse
Affiliation(s)
- Simon Schwill
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany.
| | - Dorothee Reith
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Tobias Walter
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Peter Engeser
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Elisabeth Flum
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| | - Katja Krug
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, INF 130.3, Turm West, 69120, Heidelberg, Germany
| |
Collapse
|
9
|
Schneider F, Schulz CM, May M, Schneider G, Jacob M, Mutlak H, Pawlik M, Zoller M, Kretzschmar M, Koch C, Kees MG, Burger M, Lebentrau S, Novotny A, Hübler M, Koch T, Heim M. [Is the discipline associated with self-confidence in handling rational antibiotic prescription? : Results from the MR2 study in German hospitals]. Anaesthesist 2020; 69:162-169. [PMID: 32055886 DOI: 10.1007/s00101-020-00736-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/12/2019] [Accepted: 01/14/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Besides public awareness and specialist knowledge and training of physicians, their self-confidence plays a key role for clinical decision-making in the respective area. OBJECTIVE This exploratory study investigated the influence of the discipline on differences in self-confidence in dealing with antibiotics and in the self-rated knowledge. METHODS In 2015 the multi-institutional reconnaissance of practice with multiresistant bacteria (MR2) questionnaire containing items on antibiotic prescription and multiresistant pathogens was sent out to 1061 physicians working in departments for internal medicine, general surgery, gynecology and obstetrics and urology. In 2017 a similar MR2 survey was sent to 1268 specialist and assistant physicians in anesthesiology in Germany. Besides demographic data 4 items on self-confidence in the use of antibiotic treatment and 11 items concerning self-rated knowledge about rational antibiotic therapy and multiresistant pathogens were included in the present analysis. Logistic regression analysis, the χ2-test and the Kruskal-Wallis test were used for statistical analysis of the influence of the discipline on these items. RESULTS The response rates were 43% (456 out of 1061) from the non-anesthetists and 56% (705 out of 1268) from the anesthetists. Of the non-anesthetists 44% and 57% of the anesthetists had had no advanced training on antibiotic stewardship during the year before the study. In the overall analysis anesthetists (mean±SD: 2.53±0.54) were significantly less self-confident about antibiotics than colleagues from other departments (internal medicine: 3.10±0.50, general surgery: 2.97±0.44, gynecology and obstetrics: 3.12±0.42 and urology: 3.15±0.44) in the unadjusted (all p<0.001) and adjusted comparison. The analysis of self-rated knowledge about rational antibiotic prescription showed similar results. Senior consultant status and advanced training in infectiology were significantly associated with self-confidence and self-rated knowledge about antibiotics. CONCLUSION Anesthetists showed significantly less self-confidence in dealing with antibiotics than colleagues from other disciplines. Advanced training on a rational prescription of antibiotics was associated with a greater self-confidence, so that the implementation of compulsory courses on rational antibiotic stewardship in the respective residency curriculum needs to be considered.
Collapse
Affiliation(s)
- F Schneider
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland. .,Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - C M Schulz
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - M May
- Urologische Klinik, St. Elisabeth-Klinikum Straubing, Straubing, Deutschland
| | - G Schneider
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| | - M Jacob
- Klinik für Anästhesiologie, Operative Intensivmedizin und Schmerzmedizin, Klinikum St. Elisabeth Straubing, Straubing, Deutschland
| | - H Mutlak
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum Frankfurt, Goethe-Universität, Frankfurt, Deutschland
| | - M Pawlik
- Klinik für Anästhesiologie, Krankenhaus St. Josef Regensburg, Regensburg, Deutschland
| | - M Zoller
- Klinik für Anästhesiologie der Universität München, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - M Kretzschmar
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Magdeburg A.ö.R., Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - C Koch
- Klinik für Anästhesiologie, operative Intensivmedizin und Schmerztherapie, Justus-Liebig-Universität Gießen, Gießen, Deutschland
| | - M G Kees
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - M Burger
- Urologische Klinik, Caritas St. Josef Krankenhaus, Universität Regensburg, Regensburg, Deutschland
| | - S Lebentrau
- Urologische Klinik, Ruppiner Kliniken GmbH, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Deutschland
| | - A Novotny
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Technische Universität München, München, Deutschland
| | - M Hübler
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - T Koch
- Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Deutschland
| | - M Heim
- Fakultät für Medizin, Klinik für Anästhesiologie und Intensivmedizin, Technische Universität München, München, Deutschland
| |
Collapse
|
10
|
Cultural Adaptation, Validation, and Analysis of the Self-Efficacy in Palliative Care Scale for Use with Spanish Nurses. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234840. [PMID: 31810175 PMCID: PMC6926837 DOI: 10.3390/ijerph16234840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 12/12/2022]
Abstract
The aim of the present study is to validate the Self-Efficacy in Palliative Care Scale (SEPC) in Spanish nursing professionals and students, to describe their levels of self-efficacy, and to determine the influencing factors. A validation study and a cross-sectional descriptive study were carried out, with the data analysed using contrast tests and multiple linear regression; 552 nurses and 440 nursing students participated. The Spanish version consists of 23 items and has a high degree of reliability (α = 0.944). Confirmatory factor analysis revealed one additional factor (i.e., management of psychosocial and spiritual aspects) in comparison to the original scale. Contrast tests revealed that the mean SEPC score was higher in professionals than in students (p < 0.001) and that the professionals who had higher levels of self-efficacy were older (p < 0.001), had more previous training (p < 0.001), and had more experience in end-of-life care (p = 0.001). The linear analysis results confirm a significant association between age and previous training in end-of-life care. The Spanish version of the SEPC is a reliable tool for both nursing professionals and students. The level of self-efficacy of both groups is moderate and is influenced by age, experience, and training in end-of-life care.
Collapse
|
11
|
Heim M, Schneider F, Mutlak H, Schulz CM, Hachenberg T, Zoller M, Soukup J, Pawlik M, Schön J, Kees M, Hübler M, Sander M, Ernst C, Jacob M, May M. Rational application of antibiotics-The influence of anaesthetists' gender on self-confidence and knowledge. Acta Anaesthesiol Scand 2019; 63:1037-1047. [PMID: 31012085 DOI: 10.1111/aas.13376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND High rates of multiresistant pathogens require detailed knowledge about rational utilization of antibiotics. Many physicians consider themselves uncertain about the interpretation of microbiological diagnostics. We examined whether self-confidence, self-rated knowledge, and objective knowledge regarding the use of antibiotics are associated with gender. METHODS For this survey study, in 2017, anaesthesiologists and residents of 16 anaesthetic departments in Germany were asked to complete the Multiinstitutional Reconnaissance of practice with Multiresistant bacteria (MR2) survey. It consists of 55 items evaluating self-confidence regarding the practical use of antibiotics (n = 6), self-rated theoretical knowledge (n = 16), and objective knowledge (n = 5). Their answers to these items in relation to their gender were analysed using Chi-square, Kruskal-Wallis-H-Tests, and unadjusted as well as adjusted logistic regression models. RESULTS Six hundred eighty-four (response rate: 53.9 %) questionnaires were returned and were available for analysis. Female doctors (35.5 %) felt less self-confident (P < 0.001). Self-rated knowledge differed in overall mean (P = 0.014) and the unadjusted (odds ratio [OR]: 0.55; P = 0.013) but not in the adjusted logistic regression (OR: 0.84; P = 0.525). Objective knowledge differed after pooling questions (61.2% correct answers vs 65.4%, P = 0.01) but not with respect to single items and the adjusted logistic regression (OR: 0.83, P = 0.356). CONCLUSION Less self-confidence and a lower self-rated knowledge were found in female anaesthetists; this is consistent to the gender phenomena observed by other researchers. Nevertheless, between the 2 groups objective knowledge did not differ significantly in any item.
Collapse
Affiliation(s)
- Markus Heim
- Technical University of Munich TUM School of Medicine, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care München Germany
| | - Frederick Schneider
- Technical University of Munich TUM School of Medicine, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care München Germany
| | - Haitham Mutlak
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy University Hospital Frankfurt, Goethe University Frankfurt Germany
| | - Christian M. Schulz
- Technical University of Munich TUM School of Medicine, Klinikum rechts der Isar, Department of Anesthesiology and Intensive Care München Germany
| | - Thomas Hachenberg
- Department of Anaesthesiology and Intensive Care Medicine Otto‐von‐Guericke‐University Magdeburg Germany
| | - Michael Zoller
- Department of Anesthesiology Hospital of the University of Munich, LMU Munich München Germany
| | - Jens Soukup
- Department of Anaesthesiology, Intensive Care Medicine and Palliative Care Carl‐Thiem‐Hospital Cottbus Cottbus Germany
| | - Michael Pawlik
- Department of Anaesthesiology Caritas St. Josef Medical Center Regensburg Germany
| | - Julika Schön
- Department of Anaesthesiology and Intensive Care Medicine Brandenburg Medical School Theodor Fontane, Ruppiner Kliniken Neuruppin Germany
| | - Martin Kees
- Department of Anaesthesiology University of Regensburg Regensburg Germany
| | - Matthias Hübler
- Department of Anaesthesiology and Intensive Care Medicine University Hospital Carl Gustav Carus, Technische Universität Dresden Dresden Germany
| | - Michael Sander
- Department of Anaesthesia, Operational Intensive Care Medicine and Pain Therapy Justus‐Liebig University Gießen Gießen Germany
| | - Christian Ernst
- Department of Urology St. Elisabeth‐Klinikum Straubing Straubing Germany
| | - Matthias Jacob
- Department of Urology St. Elisabeth‐Klinikum Straubing Straubing Germany
| | - Matthias May
- Department of Urology St. Elisabeth‐Klinikum Straubing Straubing Germany
| | | |
Collapse
|