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University Staff Insights on Interprofessional Education and Student-Led Clinic Opportunities at an Australian University. J Multidiscip Healthc 2024; 17:305-315. [PMID: 38268850 PMCID: PMC10807446 DOI: 10.2147/jmdh.s447690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/28/2023] [Indexed: 01/26/2024] Open
Abstract
Purpose Organizational and university staff buy-in and advocacy are critical considerations in planning successful interprofessional education (IPE) initiatives in healthcare, such as interprofessional student-led clinics (SLCs). This study was designed with the purpose of gaining deeper insight into current views and perspectives of academic and professional staff at an Australian university, as a precursor to planning IPE and SLC activities. Methods All academic and professional staff from within the School of Health Sciences were invited to participate in the study. In-depth-qualitative interviews were conducted with 16 staff to explore academic and professional staff perspectives on IPE and SLCs. Reflexive thematic analysis was used to analyse the data. Results Findings are grouped within five themes that incorporate broad perspectives on the tensions and possibilities of IPE and establishment of SLCs: Academic and professional staff commitment; Better/smarter IPE; Student-led clinic potential; Vision and innovation; and Strategy and resourcing. The themes reflect the high value placed on IPE by academic and professional staff and incorporate innovative ideas on how to prepare students for a rapidly changing and evolving healthcare environment. A reticence towards standard models of university based SLCs was expressed. Conclusion Academic and professional staff insights suggest university leaders need to develop a greater strategic focus on improving IPE. Effective engagement with staff is required to support IPE planning and implementation. If considering implementation of SLCs, contemporary fit-for-purpose models should be explored such as partnerships with primary healthcare providers, community wellness facilities, and hospital clinics rather than traditional university-based clinics.
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Do Regulatory and Curriculum Requirements for Interprofessional Practice Align? J Multidiscip Healthc 2023; 16:3675-3687. [PMID: 38050484 PMCID: PMC10693752 DOI: 10.2147/jmdh.s438791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023] Open
Abstract
Background While interprofessional (IP) competency and Interprofessional Education (IPE) has received increasing attention in health, agreement on specific competencies and teaching approaches is frequently limited by profession-specific understandings. As part of a quality improvement initiative focused on improving delivery of IPE offerings, this enquiry maps current regulatory and curricula requirements for IP practice to health professional students from 12 professions trained across Aotearoa New Zealand's national vocational education provider. Methods Requirements for IP competency in national accreditation documents and in an operative teaching curricula were mapped for 12 professions, namely, clinical exercise physiology, counselling, massage, medical radiology, midwifery, nursing, occupational therapy, osteopathy, paramedicine, physiotherapy, social work, and sport and exercise science. A desk audit was conducted to identify the presence of core IP competencies for each profession. This involved a four-step process 1) Examination of regulatory standards for each profession to confirm IP requirements for each profession; 2) Examination of an operative curricula from each profession to identify the presence and translation of IP regulatory requirements to each of the profession-specific programs of study; 3) Mapping to identify within domains the core (common) IP competencies across the professions, and 4) Consideration of the similarities and differences between accreditation documents and curricula. Results Of 12 professions, 10 clearly identified IP competency as an expectation. Clinical Exercise Physiology and Counselling were exceptions with explicit requirement for IP competency not evident. Coordination and collaboration were the most identified competency domains in accreditation documents and curricula. In descending order of prevalence, communication, shared values, reflexivity, role-understanding, and teamwork were also identified requirements amongst the 10 professions with IP competency requirements. Conclusion The IP competencies identified as common across professions can be used to inform development of teaching and assessment. Greater alignment between teaching curricula and required competency standards in this area is recommended.
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Editorial: Transforming health and social education to include a greater focus on public health education in the curriculum. Front Public Health 2023; 11:1306124. [PMID: 38074725 PMCID: PMC10704497 DOI: 10.3389/fpubh.2023.1306124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023] Open
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Exploring the complex realities of nursing work in Kenya and how this shapes role enactment and practice-A qualitative study. Nurs Open 2023; 10:5670-5681. [PMID: 37221938 PMCID: PMC10333853 DOI: 10.1002/nop2.1812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023] Open
Abstract
AIM We explore how nurses navigate competing work demands in resource-constrained settings and how this shapes the enactment of nursing roles. DESIGN An exploratory-descriptive qualitative study. METHODS Using individual in-depth interviews and small group interviews, we interviewed 47 purposively selected nurses and nurse managers. We also conducted 57 hours of non-participant structured observations of nursing work in three public hospitals. RESULTS Three major themes arose: (i) Rationalization of prioritization decisions, where nurses described prioritizing technical nursing tasks over routine bedside care, coming up with their own 'working standards' of care and nurses informally delegating tasks to cope with work demands. (ii) Bundling of tasks describes how nurses were sometimes engaged in tasks seen to be out of their scope of work or sometimes being used to fill for other professional shortages. (iii) Pursuit of professional ideals describes how the reality of how nursing was practised was seen to be in contrast with nurses' quest for professionalism.
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Exploring the option of student-run free health clinics to support people living with type 2 diabetes mellitus: a scoping review. Front Public Health 2023; 11:1128617. [PMID: 37533530 PMCID: PMC10392832 DOI: 10.3389/fpubh.2023.1128617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 06/27/2023] [Indexed: 08/04/2023] Open
Abstract
Diabetes is a major cause of morbidity and premature mortality worldwide and now identified as a 'public health emergency' and a 'modern and preventable pandemic'. Indigenous populations are disproportionately affected by type 2 diabetes mellitus (T2DM) and associated complications. Student run free clinics (SRFCs) may play an important role in the prevention and management of T2DM. The primary objective of this scoping review was to investigate the opportunity for curriculum enhancement through the role and effectiveness of SRFCs in managing T2DM. Electronic databases such as PubMed, CINAHL, Science Direct and Cochrane Library were searched from inception to October 2022. Identified records from database literature searches were imported into Covidence®. Two independent reviewers screened and extracted the data. The research team collectively created a data charting table/form to standardize data collection. A narrative synthesis was used to summarize the evidence. Six studies (total of 319 participants) that met our eligibility criteria were included in this scoping review. SRFCs can provide high-quality diabetic care, especially for uninsured and economically weaker population. Preliminary evidence further indicate that shared medical appointments and telehealth may facilitate diabetic care especially during times where access to care may be difficult (e.g., COVID lockdown). However, no study included in the review explored or discussed family centred/culturally sensitive interventions. Hence, such interventions should be made part of the curriculum in the future with students in SRFCs exposed to such an approach.
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Tools for faculty assessment of interdisciplinary competencies of healthcare students: an integrative review. Front Med (Lausanne) 2023; 10:1124264. [PMID: 37396887 PMCID: PMC10314362 DOI: 10.3389/fmed.2023.1124264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Increasingly, interprofessional teamwork is required for the effective delivery of public health services in primary healthcare settings. Interprofessional competencies should therefore be incorporated within all health and social service education programs. Educational innovation in the development of student-led clinics (SLC) provides a unique opportunity to assess and develop such competencies. However, a suitable assessment tool is needed to appropriately assess student progression and the successful acquisition of competencies. This study adopts an integrative review methodology to locate and review existing tools utilized by teaching faculty in the assessment of interprofessional competencies in pre-licensure healthcare students. A limited number of suitable assessment tools have been reported in the literature, as highlighted by the small number of studies included. Findings identify use of existing scales such as the Interprofessional Socialization and Valuing Scale (ISVS) and the McMaster Ottawa Scale with Team Observed Structured Clinical Encounter (TOSCE) tools plus a range of other approaches, including qualitative interviews and escape rooms. Further research and consensus are needed for the development of teaching and assessment tools appropriate for healthcare students. This is particularly important in the context of interprofessional, community-partnered public health and primary healthcare SLC learning but will be of relevance to health students in a broad range of clinical learning contexts.
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Learning Outcomes from Participation in Student-Run Health Clinics: A Systematic Review. J Multidiscip Healthc 2023; 16:143-157. [PMID: 36700175 PMCID: PMC9869697 DOI: 10.2147/jmdh.s385709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023] Open
Abstract
Student-run clinics (SRCs) offer unique opportunities for students to engage in healthcare delivery, but the student learning outcomes of such clinics have not yet been systematically examined in a comprehensive manner. The purpose of this review was to appraise and synthesize existing literature pertaining to student learning outcomes associated with participation in SRCs. A systematic review was undertaken using PubMed, CINAHL, and Web of Science databases. The quality of articles that met inclusion criteria articles was appraised using the Mixed Methods Appraisal Tool (MMAT). Study details, such as learning outcomes, were also extracted. Ninety-two studies met inclusion criteria. Most studies were conducted in North America (n = 73, 79.3%), and related to clinics involving solely medical students (n = 35, 38.0%) or multi-professional clinics (n = 34, 37.0%). Demonstrated learning outcomes of SRC participation include clinical skills, interprofessional skills, empathy/compassion for underserved patients, and leadership. SRC participation had little apparent impact on students' future career directions. Quality appraisal via the MMAT found mixed levels of research quality amongst reviewed studies. In summary, while SRC participation appears to offer benefits for student learning, improved study design and research outside of North American contexts would further advance knowledge.
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Determining a common understanding of interprofessional competencies for pre-registration health professionals in Aotearoa New Zealand: A Delphi study. Front Med (Lausanne) 2023; 10:1119556. [PMID: 37035298 PMCID: PMC10079912 DOI: 10.3389/fmed.2023.1119556] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
There is growing awareness that factors such as the growing incidence of co-morbidity and increasing complexity of patient health needs cannot be addressed by health professionals practicing in isolation. Given this, there is an increasing emphasis on preparing students in health-related programs for effective interprofessional practice. Less clear, however, are the specific skills and clinical or learning opportunities necessary for students to develop effectiveness in interprofessional practice. These factors drove a team associated with a tertiary health education provider in Hamilton, New Zealand to transform traditional clinical student experiences in the form of an interprofessional student-assisted clinic. The clinic was intended, in part, to provide students with opportunities to learn and experience interprofessionalism in practice but was hampered by limited information available regarding the specific skill requirements necessary for students in New Zealand to learn in this context. In this Delphi study, we synthesize national expert opinion on student competency indicators necessary for effective interprofessional practice. The resultant set of indicators is presented and opportunities for application and further research discussed. The paper offers guidance to others seeking to innovate health curricula, develop novel service-oriented learning experiences for students, and foster interprofessional practice competence in the future health workforce.
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Patient Outcomes from Student-Run Health Services: An Integrative Review. J Multidiscip Healthc 2022; 15:641-665. [PMID: 35387392 PMCID: PMC8979421 DOI: 10.2147/jmdh.s348411] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Methods Results Conclusion
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Fear, faith and finances: health literacy experiences of English and Swahili speaking women newly diagnosed with breast and cervical cancer. Ecancermedicalscience 2022; 16:1350. [PMID: 35242231 PMCID: PMC8831107 DOI: 10.3332/ecancer.2022.1350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Indexed: 11/20/2022] Open
Abstract
Breast and cervical cancer are among the leading causes of cancer-related deaths globally. In Kenya, delayed presentation and diagnosis contribute to breast and cervical cancer mortality. The Kenyan government acknowledges the cancer burden with estimated 39,000 new cases diagnosed and 27,000 deaths per annum. Mortality can be reduced if cancer is diagnosed early and with appropriate treatment. Health Literacy (HL) about cancer screening, diagnosis and treatment is important in reducing mortality, but there is little understanding about HL levels, experiences of patients diagnosed with breast and cervical cancer and the contexts in which they make decisions. In this study, health literacy is defined as the degree to which individuals have the capacity to obtain, communicate, process and understand basic health information and services needed to make appropriate health decisions. This exploratory qualitative study investigated the HL experiences of accessing and using health information in women with any stage of breast or cervical cancer presenting at the Aga Khan University Hospital (private) or Kenyatta National Hospital (public) in Nairobi, Kenya. Data were gathered through semi-structured interviews from a purposive sample of 18 women. Interviews were transcribed verbatim, and the Consolidated criteria for reporting qualitative studies guidelines guided data analysis. The findings may aid development of patient education tools and determine effective ways of communicating cancer-related health information to improve the knowledge and health-seeking behaviours of Kenyan women. This project identified sociocultural beliefs and factors that influence how women understand information provided by healthcare professionals. Themes that arose included but were not limited to: fear, despair and agony at diagnosis, faith, social support, side effects, cancer-related stigma and financial burden of cancer as a barrier to getting information.
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Evaluation of the Impact of an Education Program on Self-Reported Leadership and Management Competence Among Nurse Managers. SAGE Open Nurs 2022; 8:23779608221106450. [PMID: 35734221 PMCID: PMC9208042 DOI: 10.1177/23779608221106450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
Background Developing leadership and management competencies for nursing managers is critical to the effective leadership of others and driving team and organizational performance. This paper aimed to evaluate the impact of a system-wide nursing leadership quality improvement initiative in a network of four public hospitals and one specialized outpatient center in the United Arab Emirates (UAE). The initiative was designed to enhance nursing middle managers’ leadership and managerial competencies. Methods This is a quantitative evaluation following the Standards for Quality Improvement Reporting Excellence (SQUIRES) guidelines. Secondary Data analysis of a pre- and post-course self-assessment for 105 middle nursing managers who attended a nursing leadership quality improvement training program between December 2017 and April 2019. Results Following participation in this quality improvement initiative, the paired sample t-test analysis demonstrated a statistically significant difference between the pre- and post-assessments total and individual leadership domains mean scores. Conclusion Attending well-structured nursing leadership quality improvement programs positively enhances nurse managers’ professional abilities and perception of their management and leadership competencies. Leadership development programs should equip managers with the skills and tools to achieve their professional goals effectively and support their transition to becoming expert nurse leaders. Healthcare institutions’ ethical obligation is to provide them with the necessary resources and training to achieve this goal.
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‘Every day is a challenge’: Expatriate acculturation in the United Arab Emirates. INTERNATIONAL JOURNAL OF CROSS CULTURAL MANAGEMENT 2021. [DOI: 10.1177/14705958211039071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The United Arab Emirates (UAE) has a very small population of national citizens, so it relies on foreign workers who bring a range of cultures with them, resulting in a unique multi-cultural context. Unlike Western countries, such as the UK, Canada and Australia, workers are unable to permanently migrate to the UAE, so instead they hold temporary, expatriate status. This exploratory study focuses on the experiences of internationally qualified, expatriate nurses in hospitals in Al Ain, gathered by qualitative interviews. Twenty-one registered nurses participated in this study. The nurses faced challenges associated with language requirements and differing cultural expectations, and displayed limited acculturation, which compromised their ability to provide appropriate care for patients. The temporary nature of the work, cultural expectations, language difficulties and potential improvements are discussed. The findings have important implications for organizations that employ large groups of staff from overseas in all sectors. This article contributes to knowledge of expatriates’ challenges in the UAE and highlights the difficulties of working in a diverse environment, leading to a range of actions being recommended for managers.
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Student-Led Clinics in Aotearoa New Zealand: A Scoping Review with Stakeholder Consultation. J Multidiscip Healthc 2021; 14:2053-2066. [PMID: 34376987 PMCID: PMC8349213 DOI: 10.2147/jmdh.s308032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Student-led clinics have gained increasing attention as a mechanism for students across various health professions to gain authentic interprofessional clinical placement experience during their educational programme. Purpose This scoping review is designed to identify and describe experiences relating to student-led clinics in Aotearoa New Zealand. Methods The review involved five key steps: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results. Discussion Student-led health clinics present invaluable educational opportunities for authentic collaborative practice and capacity to improve population health and well-being, especially in marginalised and disadvantaged communities. Clinic establishment and operation require consideration of a complex set of factors. Conclusion Community consultation (including with Indigenous populations) should precede establishment of clinics. There is scope for more reporting and objective evaluation to ensure best practice is being determined, developed, and achieved.
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I speak a little Arabic: Nursing communication in a cross-cultural context. J Clin Nurs 2021; 31:145-157. [PMID: 34263493 DOI: 10.1111/jocn.15891] [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: 02/02/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This study investigated the challenges of cross-cultural communication among internationally qualified nurses, and the impact on nurse-to-nurse and nurse-to-patient relationships. BACKGROUND Open and authentic communication between nurses and patients is required as a foundation of patient-centred practice; however, this may be a challenge in cross-cultural settings. DESIGN An exploratory qualitative study with an inductive approach. METHODS Semi-structured, face-to-face interviews explored the influences on communication and practice of 21 internationally qualified nurses practising in the United Arab Emirates. Manual and software-driven processes guided coding and analysis of data. Caring theory guided the analysis of themes; while COREQ criteria guided research conduct and reporting. RESULTS Four key themes emerged; (a) Challenges in communication, (b) The science versus art of nursing; (c) The impact of ineffective communication and (d) Strategies for coping. Eleven sub-themes are reported within these themes. Overall, nurses felt they had sufficient language and nursing skills to undertake the technical or scientific aspects of their work; however, they reported experiencing restricted ability to participate in complex cross-cultural conversations, such as providing explanations and reassurance about treatment options or discussing end of life and treatment decisions. This limitation diminished the nurses' ability to engage in the art of nursing and left them unable to employ themselves therapeutically to attain a sense of true presence with patients and their families. CONCLUSION This article highlights the need for language and communication support, and Arabic-speaking advocates as partners in care for expatriate nurses. RELEVANCE TO PRACTICE Internationally qualified nurses in this Middle Eastern setting lack cultural orientation and language skills to fully enact the art and true presence of nursing. Findings indicate that health service employers need to increase the employment of Arabic-speaking nurses and provide additional language for other expatriate nurses.
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Birth preparedness and complication readiness among women of reproductive age in Kenya and Tanzania: a community-based cross-sectional survey. BMC Pregnancy Childbirth 2020; 20:636. [PMID: 33076869 PMCID: PMC7574438 DOI: 10.1186/s12884-020-03329-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/09/2020] [Indexed: 12/28/2022] Open
Abstract
Background Delayed health-seeking continues to contribute to preventable maternal and neonatal deaths in low resource countries. Some of the strategies to avoid the delay include early preparation for the birth and detection of danger signs. We aimed to assess the level of practice and factors associated with birth preparedness and complication readiness (BPCR) in Kenya and Tanzania. Methods We conducted community-based multi-stage cross-sectional surveys in Kilifi and Kisii counties in Kenya and Mwanza region in Tanzania and included women who delivered two years preceding the survey (2016–2017). A woman who mentioned at least three out of five BPCR components was considered well-prepared. Bivariate and multivariable proportional odds model were used to determine the factors associated with the BPCR. The STROBE guidelines for cross-sectional studies informed the design and reporting of this study. Results Only 11.4% (59/519) and 7.6% (31/409) of women were well-prepared for birth and its complications in Kenya and Tanzania, respectively, while 39.7 and 30.6% were unprepared, respectively. Level of education (primary: adjusted odds ratio (aOR): 1.59, 95% CI: 1.14–2.20, secondary: aOR: 2.24, 95% CI: 1.39–3.59), delivery within health facility (aOR: 1.63, 95% CI: 1.15–2.29), good knowledge of danger signs during pregnancy (aOR: 1.28, 95% CI: 0.80–2.04), labour and childbirth (aOR: 1.57, 95% CI: 0.93–2.67), postpartum (aOR: 2.69, 95% CI: 1.24–5.79), and antenatal care were associated with BPCR (aOR: 1.42, 95% CI: 1.13–1.78). Conclusion Overall, most pregnant women were not prepared for birth and its complications in Kilifi, Kisii and Mwanza region. Improving level of education, creating awareness on danger signs during preconception, pregnancy, childbirth, and postpartum period, and encouraging antenatal care and skilled birth care among women and their male partners/families are recommended strategies to promote BPCR practices and contribute to improved pregnancy outcomes in women and newborns.
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Developing metrics for nursing quality of care for low- and middle-income countries: a scoping review linked to stakeholder engagement. HUMAN RESOURCES FOR HEALTH 2020; 18:34. [PMID: 32410633 PMCID: PMC7222310 DOI: 10.1186/s12960-020-00470-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The use of appropriate and relevant nurse-sensitive indicators provides an opportunity to demonstrate the unique contributions of nurses to patient outcomes. The aim of this work was to develop relevant metrics to assess the quality of nursing care in low- and middle-income countries (LMICs) where they are scarce. MAIN BODY We conducted a scoping review using EMBASE, CINAHL and MEDLINE databases of studies published in English focused on quality nursing care and with identified measurement methods. Indicators identified were reviewed by a diverse panel of nursing stakeholders in Kenya to develop a contextually appropriate set of nurse-sensitive indicators for Kenyan hospitals specific to the five major inpatient disciplines. We extracted data on study characteristics, nursing indicators reported, location and the tools used. A total of 23 articles quantifying the quality of nursing care services met the inclusion criteria. All studies identified were from high-income countries. Pooled together, 159 indicators were reported in the reviewed studies with 25 identified as the most commonly reported. Through the stakeholder consultative process, 52 nurse-sensitive indicators were recommended for Kenyan hospitals. CONCLUSIONS Although nurse-sensitive indicators are increasingly used in high-income countries to improve quality of care, there is a wide heterogeneity in the way indicators are defined and interpreted. Whilst some indicators were regarded as useful by a Kenyan expert panel, contextual differences prompted them to recommend additional new indicators to improve the evaluations of nursing care provision in Kenyan hospitals and potentially similar LMIC settings. Taken forward through implementation, refinement and adaptation, the proposed indicators could be more standardised and may provide a common base to establish national or regional professional learning networks with the common goal of achieving high-quality care through quality improvement and learning.
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Informal task-sharing practices in inpatient newborn settings in a low-income setting-A task analysis approach. Nurs Open 2020; 7:869-878. [PMID: 32257274 PMCID: PMC7113512 DOI: 10.1002/nop2.463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/10/2020] [Accepted: 02/03/2020] [Indexed: 11/20/2022] Open
Abstract
Aim To describe the complexity and criticality of neonatal nursing tasks and existing task-sharing practices to identify tasks that might be safely shared in inpatient neonatal settings. Design We conducted a cross-sectional study in a large geographically dispersed sample using the STROBE guidelines. Methods We used a task analysis approach to describe the complexity/criticality of neonatal nursing tasks and to explore the nature of task sharing using data from structured, self-administered questionnaires. Data was collected between 26th April and 22nd August 2017. Results Thirty-two facilities were surveyed between 26th April and 22nd August, 2017. Nearly half (42%, 6/14) of the "moderately critical" and "not critical" (41%, 5/11) tasks were ranked as consuming most of the nurses' time and reported as shared with mothers respectively. Most tasks were reported as shared in the public sector than in the private-not-for-profit facilities. This may largely be a response to inadequate nurse staffing, as such, there may be space for considering the future role of health care assistants.
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Religious beliefs, social pressure, and stigma: Rural women's perceptions and beliefs about vasectomy in Pwani, Tanzania. PLoS One 2020; 15:e0230045. [PMID: 32196511 PMCID: PMC7083335 DOI: 10.1371/journal.pone.0230045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 02/20/2020] [Indexed: 11/24/2022] Open
Abstract
Despite being a reliable and cost effective family planning method, vasectomy remains underutilized in many low resource settings such as East Africa. We explored rural women’s perceptions and beliefs regarding barriers to vasectomy use in the low resource setting of Pwani, Tanzania. The qualitative study used in-depth semi-structured interviews to obtain data. Purposive sampling was used to recruit 20 married/cohabiting women with two or more children. Thematic analysis guided the data analysis, with qualitative data reporting informed by COREQ guidelines. Most participants were Muslim and had between two and six children. Most had completed primary-level education and were engaged in small-scale farming. We extracted three main themes with associated sub-themes:1) lack of education, which included men’s education levels and inadequate knowledge and misinformation 2) religious beliefs, social pressure and stigma, which included community stigma and the belief that vasectomy was not good for men with multiple wives; and 3) promoting men’s involvement in family planning which included educating men and the women’s perceived role in promoting vasectomy. Participating women perceived vasectomy uptake to be affected by a lack of low knowledge (among men, women, and the community), misinformation, and various sociocultural barriers. Efforts to promote vasectomy and male involvement in reproductive health services should be directed to addressing deeply-rooted sociocultural barriers. Women may have an essential role in encouraging their partners’ vasectomy uptake. In addition, engaging couples in family planning education is critical to enhance knowledge. Ideally, such community based education should be conducted in partnership with communities and healthcare providers.
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Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya. BMJ Glob Health 2020; 5:e001937. [PMID: 32133169 PMCID: PMC7042598 DOI: 10.1136/bmjgh-2019-001937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 11/02/2022] Open
Abstract
There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses' well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.
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Recently graduated midwives in Uganda: Self-perceived achievement, wellbeing and work prospects. Midwifery 2019; 82:102596. [PMID: 31887471 DOI: 10.1016/j.midw.2019.102596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 10/21/2019] [Accepted: 12/02/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE to investigate how recent graduates from a combined work/study midwifery degree programme in Uganda viewed its effects on their wellbeing and work prospects. DESIGN Using an adapted version of the Qualitative Impact Protocol (QuIP), a phenomenological approach was applied to thematic analysis to examine semi-structured interviews and WhatsApp group discussion. SETTING Introduction of enhanced midwifery training (from Diploma to Degree level) combining study with professional practice within a low income country health system facing extreme capacity constraints. PARTICIPANTS 14 members of the first cohort of graduates from the degree programme. FINDINGS The graduates were overwhelmingly positive about improved professional knowledge, clinical skills, confidence, career commitment and prospects. They also had to contend with resentment from colleagues, increased workload and debt. Counselling training, peer support, and experience of managing stress during the training helped them to cope with these challenges. CONCLUSIONS Qualitative feedback from those receiving advanced midwifery training highlights the importance of addressing social as well as technical skills, including leadership capacity and resilience in handling working relationships.
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Internationally qualified nurse communication—A qualitative cross country study. J Clin Nurs 2019; 28:3669-3679. [DOI: 10.1111/jocn.14968] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 05/30/2019] [Accepted: 06/12/2019] [Indexed: 11/30/2022]
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Missed nursing care in newborn units: a cross-sectional direct observational study. BMJ Qual Saf 2019; 29:19-30. [PMID: 31171710 PMCID: PMC6923939 DOI: 10.1136/bmjqs-2019-009363] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/16/2019] [Accepted: 05/18/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Improved hospital care is needed to reduce newborn mortality in low/middle-income countries (LMIC). Nurses are essential to the delivery of safe and effective care, but nurse shortages and high patient workloads may result in missed care. We aimed to examine nursing care delivered to sick newborns and identify missed care using direct observational methods. METHODS A cross-sectional study using direct-observational methods for 216 newborns admitted in six health facilities in Nairobi, Kenya, was used to determine which tasks were completed. We report the frequency of tasks done and develop a nursing care index (NCI), an unweighted summary score of nursing tasks done for each baby, to explore how task completion is related to organisational and newborn characteristics. RESULTS Nursing tasks most commonly completed were handing over between shifts (97%), checking and where necessary changing diapers (96%). Tasks with lowest completion rates included nursing review of newborns (38%) and assessment of babies on phototherapy (15%). Overall the mean NCI was 60% (95% CI 58% to 62%), at least 80% of tasks were completed for only 14% of babies. Private sector facilities had a median ratio of babies to nurses of 3, with a maximum of 7 babies per nurse. In the public sector, the median ratio was 19 babies and a maximum exceeding 25 babies per nurse. In exploratory multivariable analyses, ratios of ≥12 babies per nurse were associated with a 24-point reduction in the mean NCI compared with ratios of ≤3 babies per nurse. CONCLUSION A significant proportion of nursing care is missed with potentially serious effects on patient safety and outcomes in this LMIC setting. Given that nurses caring for fewer babies on average performed more of the expected tasks, addressing nursing is key to ensuring delivery of essential aspects of care as part of improving quality and safety.
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Nurse-identified patient care and health services research priorities in the United Arab Emirates: a Delphi study. BMC Health Serv Res 2019; 19:77. [PMID: 30696446 PMCID: PMC6350356 DOI: 10.1186/s12913-019-3888-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 01/08/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The need for improved research on ill health has been recognized internationally and locally in the United Arab Emirates (UAE). The UAE Nursing and Midwifery Council recently committed to enhancing the status and contributions of nursing in healthcare research across the UAE by establishing a National Committee for Research Development. This study using a Delphi method to identify research priorities from the perspective of nurses delivering frontline healthcare. METHODS A two-phase Delphi design was implemented with 1032 nurses participating in phase one of the study and 1339 in phase two. RESULTS The most important priority was patient safety and healthcare professionals' awareness of international patient safety goals (including staffing levels and shift length) and potential effects on patient safety. Other important priorities were infection control practices and management of communicable diseases. CONCLUSIONS These priorities may inform nursing research programs to improve patient care and health outcomes in the UAE and similar contexts worldwide.
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My husband will love me more if I give birth to more children: Rural women’s perceptions and beliefs on family planning services utilization in a low resource setting. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2019. [DOI: 10.1016/j.ijans.2019.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Case-Based Insights: Arab Muslim Mothers' Experiences of Managing a Child Newly Diagnosed With Type 1 Diabetes Mellitus. SAGE Open Nurs 2019; 5:2377960819870979. [PMID: 33415251 PMCID: PMC7774390 DOI: 10.1177/2377960819870979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 07/04/2019] [Accepted: 07/28/2019] [Indexed: 12/04/2022] Open
Abstract
Mothers frequently fulfill the role of primary caregiver for children diagnosed with type 1 diabetes mellitus (T1DM). A T1DM diagnosis has a significant impact on the child and the wider family unit. The objective is to develop understanding of mothers' experiences caring for children diagnosed with T1DM in the cultural context of the Middle East to facilitate enhanced health service provision and support. This study used a qualitative design. Data were collected in individual semistructured interviews. Participants were mothers of Arabic descent and Muslim belief who had a child diagnosed with T1DM within the last 12 months. All mothers were registered at the health service where this research was conducted and resident in the United Arab Emirates at the time of this study. COREQ guidelines informed reporting of the research and findings. Participating mothers described initial reactions of shock and disbelief, followed by transition to near ordinary and near normal (85% normal) family functioning. Family, culture, and faith emerged as critical supports in the whirlwind daily challenge of balancing the multiple demands and competing needs of the newly diagnosed child and the broader family. This study is the first of its kind from countries comprising the Gulf Cooperation Council. The findings provide insight into the challenges and support needs of mothers caring for children newly diagnosed with T1DM in an Arab Muslim context. The findings also provide a basis for enhancing health service support and suggest themes to inform further research.
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Assessing the impact of a partnership-based work/study nursing upgrade programme in a low- and middle-income setting. J Clin Nurs 2018; 28:209-220. [PMID: 30039512 DOI: 10.1111/jocn.14630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To evaluate the 15-year impact of the work/study nursing upgrading programme in East Africa. BACKGROUND Working nurses in Africa are often primary family income earners, with limited ability to leave jobs and upgrade qualifications. In 2001, the university established a work/study upgrade programme for enrolled- and diploma-level nurses, allowing them to upgrade their qualifications while continuing to work and support families. Donor partnerships provided scholarships to further increase programme access. DESIGN A mixed-method design was used involving an online alumni survey and 24 interviews and 23 focus groups with 172 purposively selected representatives of nursing graduates, employers, regulatory bodies, professional associations and senior nursing officials. METHOD Quantitative data were analysed using frequencies and percentages. Inductive thematic analysis was used for qualitative data. Equator guidelines informed reporting of both qualitative and quantitative results. RESULTS Of the 549 graduates who completed the survey, 81.2% (n = 446) were female, 93.1% were currently employed and 98% worked within East Africa. They reported improved professional competence (69.4%), nursing practice (25.9%) and patient outcomes (4.6%) on graduation. Extracted themes included the following: flexible/accessible programme; friendly learning environment; effective teaching and learning strategies; acquisition of nursing knowledge, skills and competencies; stakeholders' role in the programme; career/professional advancement; and strengthened health systems. CONCLUSION The work/study programme was an effective nursing workforce capacity development strategy. Programme access was strengthened via the supporting donor partnership. Positive outcomes were achieved with respect to the university's values of quality, access, relevance and impact. RELEVANCE TO CLINICAL PRACTICE Long-term sustainable development of nurses and midwives is fundamental to achieving sustainable development goals. Work/study programmes and private-public partnerships are effective mechanisms to strengthen the development of nursing and the overall healthcare workforce in low-resource settings.
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Nursing as a pathway to women's empowerment and intergenerational mobility. J Clin Nurs 2018; 27:4050-4057. [PMID: 29791745 DOI: 10.1111/jocn.14540] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/30/2018] [Accepted: 05/16/2018] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVE To assess the impact of nursing education on the intergenerational mobility of graduates of nursing upskilling programmes. BACKGROUND Challenges for low- and middle-income countries include poverty and limited access to health, education and social services compounded by workforce shortages, inequality and female disempowerment. Little is known about the impact of nursing education on women's empowerment and intergenerational mobility in such settings. DESIGN A cross-sectional study using data collected through an online alumni survey. METHODS Data were collected March to May 2016 using an online questionnaire, as part of a larger nursing programme alumni survey. Intergenerational mobility was assessed by comparing the respondents' educational qualification with their fathers' and mothers' education levels. Descriptive statistics were analysed using frequencies and percentages. Associations between parental and respondents' education levels were assessed using chi-square tests. RESULTS Out of 446 female respondents who completed the survey, 379 and 366 indicated their fathers' and mothers' education level, respectively. A third of the respondents' mothers had no formal schooling; lower levels of parental education are significantly associated with increase in respondents age (p < 0.001) and associated shift from Uganda to Kenya and Tanzania (p < 0.001). Respondents had a marked upward intergenerational education mobility with 76% (278/366) and 59% (223/379) of them achieving a qualification two levels above their mothers and fathers, respectively. Tanzanian respondents had significantly higher rates of upward mobility than Kenyan and Ugandan respondents. CONCLUSIONS Nursing education positively impacted gender, economic factors and health outcomes. Further research is needed to confirm the "triple impact" of nursing education on improving health, gender equality and economic growth in low- and middle-income countries. RELEVANCE TO CLINICAL PRACTICE Nurses are frontline providers of healthcare services. Provision of high-quality nursing upgrade programmes enhances nursing leadership ability, with aligned improvements in health outcomes while supporting gender empowerment and intergenerational mobility.
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Collaborative task-sharing to enhance the Point-Of-Care Ultrasound (POCUS) access among expectant women in Kenya: The role of midwife sonographers. J Interprof Care 2018; 32:641-644. [DOI: 10.1080/13561820.2018.1470499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Developing a work/study programme for midwifery education in East Africa. Midwifery 2018; 59:74-77. [PMID: 29396383 DOI: 10.1016/j.midw.2018.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/03/2018] [Accepted: 01/08/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND there is extensive evidence to show that skilled midwifery care is crucial in reducing maternal deaths; however, in East Africa, the midwifery profession has been subsumed within the nursing role. This paper highlights issues in the preparation of skilled midwives in three East African countries, specifically, Uganda, Kenya and Tanzania and provides a case study description of a flexible work/study programme designed to develop skilled midwives to meet internationally regarded ICM competency standards in midwifery education and practice. THE MODEL: a flexible, competency-based Bachelor's of Science in Midwifery programme (BScM) has been developed based on fifteen years' experience of running a Bachelor of Science in nursing programme. The new BSCM programme allows licensed diploma midwives the opportunity to study for two days a week towards a bachelor's degree in midwifery, whilst continuing to work and support their families. The model also provides education at degree level thus providing a sound platform for ongoing development of a cadre of midwifery leaders. CONCLUSION the BScM education model for working midwives builds on the success of the BScN work/study model in developing strong leadership, clinical and critical thinking competencies. The newly developed midwifery programme provides a pathway by which to increase the availability of skilled East African midwives educated to the Global Standards for Midwifery Education.
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Research priorities for specialized nursing practice in the United Arab Emirates. Int Nurs Rev 2017; 65:381-391. [DOI: 10.1111/inr.12402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
As the population ages and the incidence of chronic diseases and lifestyle-related conditions rises, nurses are increasingly required to provide care for people with a range of chronic (long-term) conditions. The healthcare needs of patients are often complicated by comorbid conditions. Nurses deliver healthcare in the context of the patient's medical conditions, treatment regimens, the healthcare system, and the individual's socioeconomic, personal and family factors, which may include the challenges of social isolation and geographic distance. In such complex circumstances, patients may be perceived as 'difficult' or 'challenging', however, the challenge is not the patient themselves, but the relationship between the nurse and the patient. Communication difficulties can occur between nurses and patients, which may affect the therapeutic relationship and the quality of care provided. This article discusses the communication skills that nurses require to interact effectively with patients who have complex and chronic comorbid conditions. It focuses on therapeutic communication strategies and the nurse-patient relationship, while emphasising the need for nurses to be self-aware when caring for patients with complex healthcare needs.
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Capricornia Allied Health Partnership (CAHP): a case study of an innovative model of care addressing chronic disease through a regional student-assisted clinic. AUST HEALTH REV 2016; 38:483-6. [PMID: 25099212 DOI: 10.1071/ah13177] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 05/20/2014] [Indexed: 11/23/2022]
Abstract
Faced with significant health and workforce challenges, the Central Queensland Hospital and Health Service commenced an innovative student-assisted clinical model of care. The Capricornia Allied Health Partnership (CAHP) in 2010. The clinic supports pre-entry allied health student clinical placements to: (1) address service delivery gaps for previously underserved people with chronic disease; (2) facilitate hospital avoidance and early discharge from the local hospital; (3) provide an attractive clinical placement opportunity for allied health students that will potentially lead to future recruitment success, and (4) demonstrate leadership in developing interprofessional skills of future health workforce trainees. This case study details the conceptual background of the initial model, the key features of the clinical placement and service delivery model, and discusses the current and future evaluation of the clinic.
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Health professionals in Kenya: strategies to expand reach and reduce brain drain of psychiatric nurses and psychiatrists. BJPsych Int 2016; 13:55-58. [PMID: 29093903 PMCID: PMC5618875 DOI: 10.1192/s2056474000001227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper highlights the extent of the brain drain in relation to human resources for health (HRH) that is currently challenging Kenya, and suggests strategies that have the potential to change current working environments and improve HRH retention rates. Governments in partnership with health professional bodies and regulators could improve the working conditions for psychiatrists and mental health nurses: by promoting career choices in mental health; by providing accessible professional development opportunities; and by easing workload pressures by expanding service reach through thoughtfully planned and delivered task-shifting to primary care. While these strategies have the potential to make a significant difference, the evidence suggests a brain drain will continue as long as working conditions remain sub-optimal and global HRH shortages persist.
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I'll have what they're having. Lancet Diabetes Endocrinol 2015; 3:392. [PMID: 25617946 DOI: 10.1016/s2213-8587(14)70269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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New traditions in Middle Eastern hospitality. Lancet Diabetes Endocrinol 2015; 3:304. [PMID: 25617949 DOI: 10.1016/s2213-8587(14)70254-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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HIV Testing for PMTCT in Tanzania: Time to move from ‘Voluntary’ to ‘Mandatory’? ACTA ACUST UNITED AC 2015. [DOI: 10.14738/assrj.22.895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Public health service options for affordable and accessible noncommunicable disease and related chronic disease prevention and management. J Multidiscip Healthc 2014; 7:543-9. [PMID: 25473294 PMCID: PMC4247142 DOI: 10.2147/jmdh.s72636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Globally, nations are confronted with the challenge of providing affordable health services to populations with increasing levels of noncommunicable and chronic disease. Paradoxically, many nations can both celebrate increases in life expectancy and bemoan parallel increases in chronic disease prevalence. Simply put, despite living longer, not all of that time is spent in good health. Combined with factors such as rising levels of obesity and related noncommunicable disease, the demand for health services is requiring nations to consider new models of affordable health care. Given the level of disease burden, all staff, not just doctors, need to be part of the solution and encouraged to innovate and deliver better and more affordable health care, particularly preventative primary health care services. This paper draws attention to a range of exemplars to encourage and stimulate readers to think beyond traditional models of primary health service delivery. Examples include nurse-led, allied health-led, and student-led clinics; student-assisted services; and community empowerment models. These are reported for the interest of policy makers and health service managers involved in preventative and primary health service redesign initiatives.
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Childhood obesity in Asia: the value of accurate body composition methodology. Asia Pac J Clin Nutr 2014; 23:339-43. [PMID: 25164442 DOI: 10.6133/apjcn.2014.23.3.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Childhood obesity, a significant global public health problem, affects an increasing number of low- and middle-income countries, including in Asia. The obesity epidemic has been fuelled by the rapid nutrition and physical activity transition with the availability of more energy-dense nutrient-poor foods and lifestyles of many children dominated by physical inactivity. During the growing years the pace and quality of grow this best quantified by a combination of anthropometric and body composition measures. However, where normative data are available, this has typically been collected on Caucasian children. To better define and characterise overweight and obesity in Asian children, and to monitor nutrition and physical activity interventions, there is a need to increase the use of standardized anthropometric and body composition methodologies. The current paper reports on initiatives facilitated by the International Atomic Energy Agency (IAEA) and outlines future research needs for the prevention and management of childhood obesity in Asia.
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Teaching basic life support to the digitalgeneration: randomized trial comparing videoassistedversus practical simulation. ACTA ACUST UNITED AC 2014. [DOI: 10.1891/1748-6254.9.3.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Australian health reforms: enhancing interprofessional practice and competency within the health workforce. J Interprof Care 2014; 28:252-3. [DOI: 10.3109/13561820.2014.881790] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Responding to health care complexity: suggestions for integrated and interprofessional workplace learning. J Interprof Care 2013; 28:246-8. [PMID: 23914938 DOI: 10.3109/13561820.2013.821601] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This report highlights complexity in health care and the relevance of integrated and interprofessional care and learning. It is proposed that appropriate workforce training in response to complexity should be contextually relevant and workplace integrated, and should focus on building interprofessional capability for reflective practice and critical thinking. This training should be interprofessional and foster systems thinking. It is suggested that the World Health Organization's International Classification of Functioning, Disability and Health (ICF) is a useful integrating framework.
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ADVANCE CARE PLANNING AND THE LAW: UNINTENDED BARRIERS. BMJ Support Palliat Care 2013. [DOI: 10.1136/bmjspcare-2013-000491.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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The sociodemographic and health-related characteristics of a regional population with chronic disease at an interprofessional student-assisted clinic in Queensland Capricornia Allied Health Partnership. Aust J Rural Health 2013; 21:97-104. [PMID: 23586571 DOI: 10.1111/ajr.12017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This paper describes the sociodemographic and health-related characteristics of people with chronic disease attending an interprofessional student-assisted clinic in regional Queensland. DESIGN A retrospective review of data collected during the first 10 months of operation of the clinic was conducted. SETTING, PARTICIPANTS AND OUTCOME MEASURES: Data was collected on up to 378 patients during an intake appointment at the Capricornia Allied Health Partnership (CAHP) community-based clinic and compared with normative reference groups where available. Sociodemographic characteristics included age, gender and education level; health-related characteristics included body mass index and hospitalisations in the previous 12 months; and risk factors included prescribed medications, smoking status and general practitioner-diagnosed medical conditions. RESULTS Patients attending the CAHP clinic had a mean number of chronic conditions of 4.9 ± 2.1 per patient, and 97% of patients had multimorbidities. A high level of socioeconomic disadvantage was found in comparison with normative comparison groups based on employment, highest level of schooling completed and the index of social disadvantage. Patients predominantly lived in inner regional areas (76.7%). The most common diagnoses of patients attending the clinic for the first time were hypertension, osteoarthritis, high cholesterol, diabetes and chronic back pain. CONCLUSIONS The CAHP clinic offers a unique student-assisted service model for interprofessional management of patients who are socioeconomically disadvantaged, have multimorbid chronic disease and live in regional areas. The description of baseline data in this paper is important to refine clinic services, to guide other chronic disease clinics and to inform future research study designs.
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Older Australians' perceptions and practices in relation to a healthy diet for old age: a qualitative study. J Nutr Health Aging 2013; 17:125-9. [PMID: 23364489 DOI: 10.1007/s12603-012-0371-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore older independently-living Australians' perceptions and practices about what constitutes a healthy diet for older people. DESIGN Qualitative methodology, focus groups. SETTING Independently-living retirees in Northern NSW, Australia. PARTICIPANTS A total of 29 participants in five focus groups, ranging in age from 60-93 years, with a mean age of 73.3 ± 8.8years; the majority (79%) were women. RESULTS Thematic analysis of the focus group interviews revealed four themes that best represent older people's perceptions and practices in relation to healthy eating for old age. These included: 1) healthy foods - participants believed in a hierarchy of perceived healthfulness or importance of foods; 2) quantity - participants believed that ageing was associated with a reduced dietary intake and less need for meat; 3) personal circumstances - participants acknowledged that food costs, social situations and health conditions influenced their food choices; and 4) good intention - participants acknowledged that the desire to regain or maintain wellbeing and to preserve health positively influenced their food choices. Participants were unaware of the national nutrient targets for older Australians. CONCLUSION The trend towards reduced dietary intake of meat and the indifference to dairy products expressed by many participants in this study suggests that they are at risk of not achieving the requirements for protein and calcium in particular. Failure to meet these age-adjusted nutrient targets has important implications for the health and functional capacity of older people.
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International migration of doctors, and its impact on availability of psychiatrists in low and middle income countries. PLoS One 2010; 5:e9049. [PMID: 20140216 PMCID: PMC2816209 DOI: 10.1371/journal.pone.0009049] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 11/10/2009] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration. METHODS In our study, we use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. We also estimate the impact of this migration on the psychiatrist population ratios in the donor countries. FINDINGS We document large numbers of psychiatrists currently registered in the UK, US, New Zealand and Australia originating from India (4687 psychiatrists), Pakistan (1158), Bangladesh (149), Nigeria (384), Egypt (484), Sri Lanka (142), Philippines (1593). For some countries of origin, the numbers of psychiatrists currently registered within high-income countries' professional databases are very small (e.g., 5 psychiatrists of Tanzanian origin registered in the 4 high-income countries we studied), but this number is very significant compared to the 15 psychiatrists currently registered in Tanzania). Without such emigration, many countries would have more than double the number of psychiatrists per 100,000 population (e.g. Bangladesh, Myanmar, Afghanistan, Egypt, Syria, Lebanon); and some countries would have had five to eight times more psychiatrists per 100,000 (e.g. Philippines, Pakistan, Sri Lanka, Liberia, Nigeria and Zambia). CONCLUSIONS Large numbers of psychiatrists originating from key low and middle income countries are currently registered in the UK, US, New Zealand and Australia, with concomitant impact on the psychiatrist/population ratio n the originating countries. We suggest that creative international policy approaches are needed to ensure the individual migration rights of health professionals do not compromise societal population rights to health, and that there are public and fair agreements between countries within an internationally agreed framework.
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RANZCP experiences in establishing and progressing an externally focussed mental health policy and partnership agenda. Australas Psychiatry 2009; 17:82-9. [PMID: 19296267 DOI: 10.1080/10398560802698953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This paper traces the background of involvement and increasing external activity of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) in the policy and project area. CONCLUSIONS Throughout 2008, representatives of the RANZCP paused to review progress and celebrate successes in the implementation of the College's stated aim to develop an externally focussed policy agenda. A summary of key activities across the past 4-5 years is outlined, including the key leadership role undertaken by the RANZCP in the recent formation of the Mental Health Professionals Association's partnership. Tracing the history of the establishment of the RANZCP externally focussed policy functions, the paper provides details of the extensive range of projects and activities undertaken to date. Also highlighted is the broad range of resources that have been developed and are now available for College members including trainees. The progress achieved to date is reflective of RANZCP's deliberate strategic actions and intent to work more closely with others and take an increasingly active role in the development of mental health policy and service delivery standards across the Australian and New Zealand landscape. The functions are now embedded with the College's newly revised Strategic Plan.
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From the chief executive officer. Australas Psychiatry 2009; 17:174-5. [PMID: 19296280 DOI: 10.1080/10398560902756735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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The value of the Australian nutrition screening initiative for older australians--results from a national survey. J Nutr Health Aging 2007; 11:20-5. [PMID: 17315076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND This national investigation of older Australians was conducted to explore the relationship between their health, lifestyle, use of dietary supplements and nutritional risk. OBJECTIVE The objective of this study was to examine the extent of poor health status and nutritional risk among Australians aged 65 years and over, as determined by the Australian Nutrition Screening Initiative. DESIGN The 12 statements that comprise the Australian Nutrition Screening Initiative (ANSI) were incorporated in a comprehensive, self-administered national postal survey designed to elicit information on the health and lifestyle practices of older Australians. In 2001, data were obtained from 1,263 individuals (641 males, 622 females) aged between 65 and 98 years, randomly chosen from the 2000 Australian Electoral roll. RESULTS According to the ANSI, 59% (n=747) of the sample was at risk of poor nutritional status as well as poor health status. The most frequently occurring risk factors were; taking 3 or more different prescription or over-the-counter drugs each day (44%), having an illness that led to changes to the kind and/or amount of food consumed (34%), eating alone most of the time (28%), not eating dairy products most days (18%), and consuming 3 or more alcoholic beverages each day (18%). Gender differences were observed for several ANSI statements. CONCLUSION These results suggest that because the ANSI may exaggerate the true extent of nutritional risk among community living older individuals it is of limited value as a screening tool per se. The future of the ANSI should be dependent on verifying its reliability as a public health measure.
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