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What are Chinese nurses’ experiences whilst working overseas? A narrative scoping review

Vie, 23/06/2017 - 08:20
Publication date: Available online 22 June 2017
Source:International Journal of Nursing Studies

Author(s): Yaping Zhong, Lisa McKenna, Beverley Copnell

Background Transnational nurse migration has become an apparent attribute of the global nurse shortage and it is foreseeable that China will play an increasingly significant role in nurse exports. These nurses have unique cultural and professional needs throughout their journey of migration and in-depth analysis of Chinese migrant nurses’ experiences is urgently required to manage and empower an ethnically diverse workforce. Objective To synthesise Chinese migrant nurses’ experiences by examining the findings of existing studies. Design Scoping review methods incorporating narrative synthesis were conducted. Method Arksey and O’Malley’s five-stage scoping review framework was utilised to identify Chinese migrant nurses’ experiences. 13 databases were searched, and 5009 articles were retrieved. After screening the titles and abstracts, 169 articles were assessed in full text for eligibility, and finally 22 articles plus 2 manually included ones, representing 19 discrete studies, were further analysed and synthesised with a three-step narrative synthesis. Results 13 qualitative studies, 5 quantitative studies and 1 mixed- methods study met inclusion criteria. Two main themes were identified. “Contexts and migration” comprised three subthemes: perceptions of nursing, original culture and nursing differences. “The self and migration” included four subthemes: initiating, transition, reality and future. Conclusion This scoping review revealed the literature on Chinese migrant nurses and provided insight into their stories and circumstances. There were external factors which affected Chinese nurses’ interpretations and choices. Throughout their migration journeys, they encountered various challenges and also successes. They responded with positive or negative behavioural and psychosocial changes.





Categorías: Investigaciones

The SELFIE Framework for Integrated Care for Multi-Morbidity: development and description

Mié, 21/06/2017 - 08:08
Publication date: Available online 20 June 2017
Source:Health Policy

Author(s): Fenna R.M. Leijten, Verena Struckmann, Ewout van Ginneken, Thomas Czypionka, Markus Kraus, Miriam Reiss, Apostolos Tsiachristas, Melinde Boland, Antoinette de Bont, Roland Bal, Reinhard Busse, Maureen Rutten-van Mölken

Background The rise of multi-morbidity constitutes a serious challenge in health and social care organisation that requires a shift from disease- towards person-centred integrated care. The aim of the current study was to develop a conceptual framework that can aid the development, implementation, description, and evaluation of integrated care programmes for multi-morbidity. Methods A scoping review and expert discussions were used to identify and structure concepts for integrated care for multi-morbidity. A search of scientific and grey literature was conducted. Discussion meetings were organised within the SELFIE research project with representatives of five stakeholder groups (5Ps): patients, partners, professionals, payers, and policy makers. Results In the scientific literature 11,641 publications were identified, 92 were included for data extraction. A draft framework was constructed that was adapted after discussion with SELFIE partners from 8 EU countries and 5P representatives. The core of the framework is the holistic understanding of the person with multi-morbidity in his or her environment. Around the core, concepts were grouped into adapted WHO components of health systems: service delivery, leadership & governance, workforce, financing, technologies & medical products, and information & research. Within each component micro, meso, and macro levels are distinguished. Conclusion The framework structures relevant concepts in integrated care for multi-morbidity and can be applied by different stakeholders to guide development, implementation, description, and evaluation.





Categorías: Investigaciones

An International Collaboration for the Training of Medical Chief Residents in Rwanda

Mar, 13/06/2017 - 06:50
Publication date: March–April 2017
Source:Annals of Global Health, Volume 83, Issue 2

Author(s): Tim Walker, Vincent Dusabejambo, Janet J. Ho, Claudine Karigire, Bradley Richards, Andre N. Sofair

Background The year-long position of chief medical resident is a time-honored tradition in the United States that serves to provide the trainee with an opportunity to gain further skills as a clinician, leader, teacher, liaison, and administrator. However, in most training programs in the developing world, this role does not exist. Objectives We sought to develop a collaborative program to train the first medical chief residents for the University of Rwanda and to assess the impact of the new chief residency on residency training, using questionnaires and qualitative interviews with Rwandan faculty, chief residents, and residents. Methods The educational context and the process leading up to the appointment of Rwandan chief residents, including selection, job description, and necessary training (in the United States and Rwanda), are described. One year after implementation, we used a parallel, mixed methods approach to evaluate the new chief medical resident program through resident surveys as well as semistructured interviews with key informants, including site chief residents, chief residents, and faculty. We also observed chief residents and site chief residents at work and convened focus groups with postgraduate residents to yield additional qualitative information. Results Rwandan faculty and residents generally felt that the new position had improved the educational and administrative structure of the teaching program while providing a training ground for future academicians. Conclusions A collaborative training program between developing and developed world academic institutions provides an efficient model for the development of a new chief residency program in the developing world.





Categorías: Investigaciones

Recurrent failings of medical humanitarianism: intractable, ignored, or just exaggerated?

Vie, 09/06/2017 - 06:13
Publication date: Available online 8 June 2017
Source:The Lancet

Author(s): Sandro Colombo, Enrico Pavignani

Humanitarian health workers operate in dangerous and uncertain contexts, in which mistakes and failures are common, often have severe consequences, and are regularly repeated, despite being documented by many reviews. This Series paper aims to discuss the failures of medical humanitarianism. We describe why some of these recurrent failings, which are often not identified until much later, seem intractable: they are so entrenched in humanitarian action that they cannot be addressed by simple technical fixes. We argue that relief health-care interventions should be contextualised. Perhaps medical humanitarianism deserves a better reputation than the one at times tarnished by unfair criticism, resulting from inapplicable guiding principles and unrealistic expectations. The present situation is not conducive to radical reforms of humanitarian medicine; complex crises multiply and no political, diplomatic, or military solutions are in sight. Relief agencies have to compete for financial resources that do not increase at the same pace as health needs. Avoiding the repetition of failures requires recognising previous mistakes and addressing them through different policies by donors, stronger documentation and analysis of humanitarian programmes and interventions, increased professionalisation, improved, opportunistic relationships with the media, and better ways of working together with local health stakeholders and through indigenous institutions.





Categorías: Investigaciones

Cervical cancer screening at a tertiary care center in Rwanda

Sáb, 27/05/2017 - 04:33
Publication date: Available online 26 May 2017
Source:Gynecologic Oncology Reports

Author(s): George Ruzigana, Lisa Bazzet-Matabele, Stephen Rulisa, Allison N. Martin, Rahel Ghebre

In limited resource settings such as Rwanda, visual inspection with acetic acid (VIA) is the primary model for cervical cancer screening. The objective of this study was to describe clinical characteristics and outcomes for women presenting for cervical cancer screening. A prospective, observational study was conducted between September 2015 and February 2016 at Kigali University Teaching Hospital (CHUK). Women referred to the VIA clinic were enrolled and completed a semi-structured questionnaire. During the six-month study period, 150 women were enrolled and evaluated with VIA followed by colposcopy directed biopsy for VIA positive. The median age was 42years (IQR 36–49). Only 20 (13.3%) asymptomatic women presented for screening exam, whereas 126 (84%) were symptomatic. Among symptomatic patients, more than one-third had never had a speculum exam prior to referral (n=43). Twenty-two (14.7%) women were VIA positive, and 8 (5.3%) had lesions suspicious for cancer, while 120 (80%) were found to be VIA negative. Among women undergoing biopsy (n=30), 11 were normal (36.7%), 5 cases showed CIN 1 (16.6%), 4 cases showed CIN 2 (13.3%), 2 cases showed CIN 3 (6.7%) and 8 were confirmed cervical cancers (26.7%). In Rwanda, VIA is the current method for cervical cancer screening. In this study, few asymptomatic patients presented for cervical cancer screening. Increasing knowledge about cervical cancer screening and expanding access are key elements to improving cervical cancer control in Rwanda.





Categorías: Investigaciones

Explaining regional variation in home care use by demand and supply variables

Sáb, 27/05/2017 - 04:33
Publication date: Available online 26 May 2017
Source:Health Policy

Author(s): Olivier van Noort, Fredo Schotanus, Joris van der Klundert, Jan Telgen

In the Netherlands, home care services like district nursing and personal assistance are provided by private service provider organizations and covered by private health insurance companies which bear legal responsibility for purchasing these services. To improve value for money, their procurement increasingly replaces fee-for-service payments with population based budgets. Setting appropriate population budgets requires adaptation to the legitimate needs of the population, whereas historical costs are likely to be influenced by supply factors as well, not all of which are necessarily legitimate. Our purpose is to explain home care costs in terms of demand and supply factors. This allows for adjusting historical cost patterns when setting population based budgets. Using expenses claims of 60 Dutch municipalities, we analyze eight demand variables and five supply variables with a multiple regression model to explain variance in the number of clients per inhabitant, costs per client and costs per inhabitant. Our models explain 69% of variation in the number of clients per inhabitant, 28% of costs per client and 56% of costs per inhabitant using demand factors. Moreover, we find that supply factors explain an additional 17 to 23% of variation. Predictors of higher utilization are home care organizations that are integrated with intramural nursing homes, higher competition levels among home care organizations and the availability of complementary services.





Categorías: Investigaciones

SY-10 Status of SRHR in Africa - Examining Commitments, Policy and Actions (Africa Symposium by AFSHR & ACCPD)

Sáb, 27/05/2017 - 04:33
Publication date: May 2017
Source:The Journal of Sexual Medicine, Volume 14, Issue 5, Supplement 4









Categorías: Investigaciones

Education, Practice, and Competency Gaps of Anesthetists in Ethiopia: Task Analysis

Vie, 26/05/2017 - 04:25
Publication date: Available online 25 May 2017
Source:Journal of PeriAnesthesia Nursing

Author(s): Sharon Kibwana, Mihereteab Teshome, Yohannes Molla, Catherine Carr, Leulayehu Akalu, Jos van Roosmalen, Jelle Stekelenburg

Purpose This study assessed the needs and gaps in the education, practice and competencies of anesthetists in Ethiopia. Design A cross-sectional study design was used. Methods A questionnaire consisting of 74 tasks was completed by 137 anesthetists who had been practicing for 6 months to 5 years. Findings Over half of the respondents rated 72.9% of the tasks as being highly critical to patient outcomes, and reported that they performed 70.2% of all tasks at a high frequency. More than a quarter of respondents reported that they performed 15 of the tasks at a low frequency. Nine of the tasks rated as being highly critical were not learned during pre-service education by more than one-quarter of study participants, and over 10% of respondents reported that they were unable to perform five of the highly critical tasks. Conclusions Anesthetists rated themselves as being adequately prepared to perform a majority of the tasks in their scope of practice.





Categorías: Investigaciones

Performance of the Antiretroviral Treatment Program in Ethiopia, 2005-2015: strengths and weaknesses toward ending AIDS

Sáb, 20/05/2017 - 03:27
Publication date: Available online 19 May 2017
Source:International Journal of Infectious Diseases

Author(s): Yibeltal Assefa, Charles F. Gilks, Lutgarde Lynen, Owain Williams, Peter S. Hill, Taye Tolera, Alankar Malvia, Wim Van Damme

Background Ethiopia is one of the countries which has scaled up antiretroviral treatment (ART) over the past decade. This study reviews the performance of the ART program in Ethiopia during the past decade, and identifies successes and weaknesses toward ending AIDS in the country. Methods A review and synthesis of data was conducted using multiple data sources: reports from all health facilities in Ethiopia to the Federal Ministry of Health, HIV/AIDS estimates and projections, and retrospective cohort and cross-sectional studies conducted between 2005/6 and 2014/15. Findings The ART program has been successful over several critical areas: (1) ART coverage improved from 4% to 54%; (2) the median CD4 count/mm3 at the time of ART initiation increased from 125 in 2005/6 to 231 in 2012/13; (3) retention in care after 12 months on ART has increased from 82% to 92%. In spite of these successes, important challenges also remain: (1) ART coverage is not equitable: among regions (5.6%-93%), between children (25%) and adults (60%), and between female (54%) and male patients (69%); (2) retention in care is variable among regions (83%-94%); and, (3) the shift to second-line ART is slow and low (0·58%). Interpretation The findings suggest that the ART program should sustain the successes and reflect on the shortcomings toward the goal of ending AIDS. It is important to capitalize on and calibrate the interventions and approaches utilized to scale up ART in the past. Analysis of the treatment cascade, in order to pinpoint the gaps and identify appropriate solutions, is commendable in this regard.





Categorías: Investigaciones

Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the Global Burden of Disease Study 2015

Vie, 19/05/2017 - 03:16
Publication date: Available online 18 May 2017
Source:The Lancet

Author(s): GBD 2015 Healthcare Access and Quality CollaboratorsRyan MBarberNancyFullmanReed J DSorensenThomasBollykyMartinMcKeeEllenNolteAmanuel AlemuAbajobirKalkidan HassenAbateCristianaAbbafatiKaja MAbbasFoadAbd-AllahAbdishakur MAbdulleAhmed AbdulahiAbdurahmanSemaw FeredeAberaBijuAbrahamGirmatsion FissehaAbrehaKelemeworkAdaneAdemola LukmanAdelekanIfedayo Morayo OAdetifaAshkanAfshinArnavAgarwalSanjay KumarAgarwalSunilkumarAgarwalAnuragAgrawalAliasghar AhmadKiadaliriAlirezaAhmadiKedir YimamAhmedMuktar BeshirAhmedRufus OlusolaAkinyemiTomi FAkinyemijuNadiaAkseerZiyadAl-AlyKhurshidAlamNooreAlamSayed SaidulAlamZewdie AderawAlemuKefyalew AddisAleneLilyAlexanderRaghibAliSyed DanishAliRezaAlizadeh-NavaeiAla'aAlkerwiFrançoisAllaPeterAllebeckChristineAllenRajaaAl-RaddadiUbaiAlsharifKhalid AAltirkawiElena AlvarezMartinNelsonAlvis-GuzmanAzmeraw TAmareErfanAminiWalidAmmarJoshuAmo-AdjeiYaw AmpemAmoakoBenjamin OAndersonSofiaAndroudiHosseinAnsariMustafa GeletoAnshaCarl Abelardo 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SantosSilvaDayane Gabriele AlvesSilveiraShireenSindiAbhishekSinghJasvinder ASinghOm PrakashSinghPrashant KumarSinghVirendraSinghAbiy HiruyeSinkeAklilu EndalamawSinshawVegardSkirbekkKarenSliwaAlisonSmithEugeneSobngwiSamirSonejiJoan BSorianoTatiane Cristina MoraesSousaLuciano ASposatoChandrashekhar TSreeramareddyVasilikiStathopoulouNicholasSteelCaitlynSteinerSabineSteinkeMark AndrewStokesSaverioStrangesMarkStrongKonstantinosStroumpoulisLelaSturuaMuawiyyah BabaleSufiyanRizwan AbdulkaderSuliankatchiJiandongSunPatrickSurSoumyaSwaminathanBryan LSykesRafaelTabarés-SeisdedosKaren MTabbGetachew RedaeTaffereRoberto TchioTalongwaMusharafTarajiaMohammadTavakkoliNunoTaveiraStephanieTeepleTeketo KassawTegegneArashTehrani-BanihashemiTesfalidetTekelabDejen YemaneTekleGirma TemamShifaAbdullah SuliemanTerkawiAzeb GebresilassieTesemaJSThakurAlan JThomsonTaaviTillmannTenaw YimerTiruyeRuoyanTobe-GaiMarcelloTonelliRomanTopor-MadryMiguelTortajadaChristopherTroegerThomasTruelsenAbera KenayTuraUche SUchenduKingsley NUkwajaEduardo AUndurragaChigozie JesseUnekeOlalekan AUthmanJob F Mvan BovenRitaVan DingenenSantoshVarugheseTommiVasankariNarayanaswamyVenketasubramanianFrancesco SViolanteSergey KVladimirovVasiliy VictorovichVlassovStein EmilVollsetTheoVosJoseph AWagnerTolassaWakayoStephen GWallerJudd LWalsonHaidongWangYuan-PangWangDavid AWatkinsElisabeteWeiderpassRobert GWeintraubChi-PangWenAndreaWerdeckerJoshuaWesanaRonnyWestermanHarvey AWhitefordJames DWilkinsonCharles SheyWiysongeBelete GetahunWoldeyesCharles D AWolfeSunghoWonAbdulhalikWorkichoShimelash BitewWorkieMamoWubshetDenisXavierGelinXuAjit KumarYadavMohsenYaghoubiBereketYakobLijing LYanYuichiroYanoMehdiYaseriHassen HamidYimamPaulYipNaohiroYonemotoSeok-JunYoonMustafa ZYounisChuanhuaYuZoubidaZaidiMaysaaEl Sayed ZakiCarlosZambrana-TorrelioTomasZapataZerihun MenlkalewZenebeSanjayZodpeyLeoZoecklerLiesl JoannaZuhlkeChristopher J LMurray

Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure–the Healthcare Quality and Access (HAQ) Index–on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0–42·8) in 1990 to 53·7 (52·2–55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Funding Bill & Melinda Gates Foundation.





Categorías: Investigaciones

Processes and experiences of Portugal’s international recruitment scheme of Colombian physicians: did it work?

Jue, 18/05/2017 - 03:03
Publication date: Available online 17 May 2017
Source:Health Policy

Author(s): Erika Masanet

The Portuguese Ministry of Health performed five international recruitment rounds of Latin American physicians due to the need for physicians in certain geographic areas of the country and in some specialties, as a temporary solution to shortages. Among these recruitments is that of Colombian physicians in 2011 that was the largest of the five groups. This paper presents an evaluation of the international recruitment procedure of Colombian physicians based on the criteria of procedural outcomes and health system outcomes. The methodology used is qualitative, based on semi-structured interviews with key informants and Colombian physicians recruited in Portugal and also on documentary analysis of secondary sources. International recruitment of Colombian physicians coincided with a period of political change and severe economic crisis in Portugal that caused some problems in the course of this recruitment, mainly family reunification in the later group of Colombian physicians and non-compliance of the salary originally agreed upon. Furthermore, due to the continuous resignations of Colombian physicians throughout the 3-year contract, procedural outcomes and health system outcomes of this international recruitment were not fulfilled and therefore the expected results to meet the temporary needs for medical personnel in some areas of the country were not accomplished.





Categorías: Investigaciones

Towards Reinforcing Telemedicine Adoption amongst Clinicians in Nigeria

Jue, 18/05/2017 - 03:03
Publication date: Available online 17 May 2017
Source:International Journal of Medical Informatics

Author(s): Kayode I. Adenuga, Noorminshah A. Iahad, Suraya Miskon

Telemedicine systems have been considered as a necessary measure to alleviate the shortfall in skilled medical specialists in developing countries. However, the obvious challenge is whether clinicians are willing to use this technological innovation, which has aided medical practice globally. One factor which has received little academic attention is the provision of suitable encouragement for clinicians to adopt telemedicine, in the form of rewards, motivation or incentives. A further consideration for telemedicine usage in developing countries, especially sub-Saharan Africa and Nigeria in particular, are to the severe shortage of available practising clinicians. The researchers therefore explore the need to positively reinforce the adoption of telemedicine amongst clinicians in Nigeria, and also offer a rationale for this using the UTAUT model. Data were collected using a structured paper-based questionnaire, with 252 physicians and nurses from six government hospitals in Ondo state, Nigeria. The study applied SmartPLS 2.0 for analysis to determine the relationship between six variables. Demographic moderating variables, age, gender and profession, were included. The results indicate that performance expectancy (p <0.05), effort expectancy (p <0.05), facilitating condition (p <0.01) and reinforcement factor (p <0.001) have significant effects on clinicians’ behavioural intention to use telemedicine systems, as predicted using the extended UTAUT model. Our results showed that the use of telemedicine by clinicians in the Nigerian context is perceived as a dual responsibility which requires suitable reinforcement. In addition, performance expectancy, effort expectancy, facilitating condition and reinforcement determinants are influential factors in the use of telemedicine services for remote-patient clinical diagnosis and management by the Nigerian clinicians.





Categorías: Investigaciones

Quality improvement in emergency service delivery: Assessment of knowledge and skills amongst emergency nurses at Connaught Hospital, Sierra Leone

Mié, 17/05/2017 - 02:45
Publication date: Available online 16 May 2017
Source:African Journal of Emergency Medicine

Author(s): Hedda Bøe Nyhus, Michael M. Kamara

Introduction The ability to deliver quality emergency care services is reliant on a well-trained workforce. Since Sierra Leone was declared Ebola free in December 2015, the country has now moved into the post-Ebola reconstructive phase focusing on specialty training of healthcare workers. This development aligns well to the growing momentum for improved emergency medicine as a speciality in other regions of Sub-Saharan Africa. The first stage in assessing how to develop an emergency nursing speciality in Sierra Leone is to conduct an assessment of what is needed in terms of educational interventions. Concurrently enhancing emergency nursing capacity requires a comprehensive understanding of the role, function and emergency nurse educational requirements. This study was conducted to fully understand the current context, elucidate current nursing functions and gain knowledge of the educational desires and needs of nurses in the emergency centre at Connaught Hospital, the largest referral hospital in Sierra Leone. Methods This mixed-methods study comprised self-assessment, one multiple-choice questionnaire, focus group interviews and observational methods. Results Emergency nurses scored relatively low on the multiple-choice questionnaire, indicating through the self-assessment that they aspired to learn more about several topics within emergency care, and identified several themes which were considered to be barriers to delivery of care through focus group discussions and observations in the emergency centre. Conclusion This study has identified key aspects of emergency nursing speciality training to be developed through theoretical and skill-based education provided by the nursing schools and hospital clinical facilities in Sierra Leone.





Categorías: Investigaciones

The Triple Impact of Nursing

Vie, 12/05/2017 - 01:35
Publication date: Available online 11 May 2017
Source:International Journal of Nursing Studies

Author(s): Lord Crisp, Mary Watkins







Categorías: Investigaciones

Barriers and facilitators in providing oral care to nursing home residents, from the perspective of care aides: a systematic review and meta-analysis

Vie, 12/05/2017 - 01:35
Publication date: Available online 11 May 2017
Source:International Journal of Nursing Studies

Author(s): Matthias Hoben, Alix Clarke, Kha Tu Huynh, Nadia Kobagi, Angelle Kent, Huimin Hu, Raissa A.C. Pereira, Tianyuan Xiong, Kexin Yu, Hongjin Xiang, Minn N. Yoon

Background Oral health of nursing home residents is generally poor, with severe consequences for residents’ general health and quality of life and for the health care system. Care aides in nursing homes provide up to 80% of direct care (including oral care) to residents, but providing oral care is often challenging. Interventions to improve oral care must tailor to identified barriers and facilitators to be effective. This review identifies and synthesizes the evidence on barriers and facilitators care aides perceive in providing oral care to nursing home residents. Methods We systematically searched the databases MEDLINE, Embase, Evidence Based Reviews—Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. We also searched by hand the contents of key journals, publications of key authors, and reference lists of all studies included. We included qualitative and quantitative research studies that assess barriers and facilitators, as perceived by care aides, to providing oral care to nursing home residents. We conducted a thematic analysis of barriers and facilitators, extracted prevalence of care aides reporting certain barriers and facilitators from studies reporting quantitative data, and conducted random-effects meta-analyses of prevalence. Results We included 45 references that represent 41 unique studies: 15 cross-sectional studies, 13 qualitative studies, 7 mixed methods studies, 3 one-group pre-post studies, and 3 randomized controlled trials. Methodological quality was generally weak. We identified barriers and facilitators related to residents, their family members, care providers, organization of care services, and social interactions. Pooled estimates (95% confidence intervals) of barriers were: residents resisting care=45% (15%–77%); care providers’ lack of knowledge, education or training in providing oral care=24% (7%–47%); general difficulties in providing oral care=26% (19%–33%); lack of time=31% (17%–47%); general dislike of oral care=19% (8%–33%); and lack of staff=22% (13%–31%). Conclusions We found a lack of robust evidence on barriers and facilitators that care aides perceive in providing oral care to nursing home residents, suggesting a need for robust research studies in this area. Effective strategies to overcome barriers and to increase facilitators in providing oral care are one of the most critical research gaps in the area of improving oral care for nursing home residents. Strategies to prevent or manage residents’ responsive behaviors and to improve care aides’ oral care knowledge are especially needed.





Categorías: Investigaciones

Health Information Needs and Reliability of Sources Among Nondegree Health Sciences Students: A Prerequisite for Designing eHealth Literacy

Jue, 11/05/2017 - 01:23
Publication date: Available online 11 May 2017
Source:Annals of Global Health

Author(s): Hussein Haruna, Ndumiso Tshuma, Xiao Hu

Background Understanding health information needs and health-seeking behavior is a prerequisite for developing an electronic health information literacy (EHIL) or eHealth literacy program for nondegree health sciences students. At present, interest in researching health information needs and reliable sources paradigms has gained momentum in many countries. However, most studies focus on health professionals and students in higher education institutions. Objective The present study was aimed at providing new insight and filling the existing gap by examining health information needs and reliability of sources among nondegree health sciences students in Tanzania. Method A cross-sectional study was conducted in 15 conveniently selected health training institutions, where 403 health sciences students were participated. Thirty health sciences students were both purposely and conveniently chosen from each health-training institution. The selected students were pursuing nursing and midwifery, clinical medicine, dentistry, environmental health sciences, pharmacy, and medical laboratory sciences courses. Involved students were either in their first year, second year, or third year of study. Results Health sciences students' health information needs focus on their educational requirements, clinical practice, and personal information. They use print, human, and electronic health information. They lack eHealth research skills in navigating health information resources and have insufficient facilities for accessing eHealth information, a lack of specialists in health information, high costs for subscription electronic information, and unawareness of the availability of free Internet and other online health-related databases. Conclusion This study found that nondegree health sciences students have limited skills in EHIL. Thus, designing and incorporating EHIL skills programs into the curriculum of nondegree health sciences students is vital. EHIL is a requirement common to all health settings, learning environments, and levels of study. Our future intention is to design EHIL to support nondegree health sciences students to retrieve and use available health information resources on the Internet.





Categorías: Investigaciones

The challenges of physician retirement

Mié, 10/05/2017 - 01:08
Publication date: 16 January 2017
Source:Canadian Medical Association Journal, Volume 189, Issue 2

Author(s): Roger Collier







Categorías: Investigaciones

Trainers’ perception of the learning environment and student competency: A qualitative investigation of midwifery and anesthesia training programs in Ethiopia

Lun, 01/05/2017 - 23:12
Publication date: Available online 1 May 2017
Source:Nurse Education Today

Author(s): Sharon Kibwana, Rachel Haws, Adrienne Kols, Firew Ayalew, Young-Mi Kim, Jos van Roosmalen, Jelle Stekelenburg

Background Ethiopia has successfully expanded training for midwives and anesthetists in public institutions. This study explored the perceptions of trainers (instructors, clinical lab assistants and preceptors) towards the adequacy of students’ learning experience and implications for achieving mastery of core competencies. Methods In-depth interviews with 96 trainers at 9 public universities and 17 regional health science colleges across Ethiopia were conducted to elicit their opinions about available resources, program curriculum suitability, and competence of graduating students. Using Dedoose, data were thematically analyzed using grounded theory. Results Perceptions of anesthesia and midwifery programs were similar. Common challenges included unpreparedness and poor motivation of students, shortages of skills lab space and equipment, difficulties ensuring students’ exposure to sufficient and varied enough cases to develop competence, and lack of coordination between academic training institutions and clinical attachment sites. Additional logistical barriers included lack of student transport to clinical sites. Informants recommended improved recruitment strategies, curriculum adjustments, increased time in skills labs, and better communication across academic and clinical sites. Conclusions An adequate learning environment ensures that graduating midwives and anesthetists are competent to provide quality services. Minimizing the human resource, infrastructural and logistical gaps identified in this study requires continued, targeted investment in health systems strengthening.





Categorías: Investigaciones

Community health workers: emerging from the shadows?

Sáb, 08/04/2017 - 19:07
Publication date: May 2017
Source:The Lancet Global Health, Volume 5, Issue 5

Author(s): The Lancet Global Health







Categorías: Investigaciones

The strategic geographies of global health partnerships

Vie, 07/04/2017 - 19:01
Publication date: May 2017
Source:Health & Place, Volume 45

Author(s): Clare Herrick

Global health partnerships have been hailed as a means of addressing the global health worker shortage, bringing forth health systems strengthening and, therefore, the universal health coverage aspirations of the Sustainable Development Goals. In contrast to other critical engagements with partnerships which have tended to focus on experiences and effects of these partnerships in situ; this paper draws on the example of the UK to explore how partnership working and development agendas have become entwined. Moreover, this entwinement has ensured that GHPs are far from the "global" endeavour that might be expected of global health and instead exhibit geographies that are far more representative of the geopolitics of overseas development assistance than biomedical need.





Categorías: Investigaciones

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