Programa de Educação Tutorial na formação de enfermeiros: reflexões de egressos

Search "Educación Interprofesional" - Jue, 07/07/2022 - 05:52
Objetivo: identificar as contribuições do Programa de Educação Tutorial na vida acadêmica e profissional segundo egressos da graduação em Enfermagem. Método: Pesquisa descritiva exploratória de abordagem qualitativa com 11 egressos de um grupo PET Enfermagem de uma universidade pública do Centro-Oeste brasileiro. Os dados foram coletados entre novembro de 2018 e abril de 2019, utilizando-se da entrevista semiestruturada e analisados à luz da modalidade temática da análise de conteúdo. Resultados: a análise dos dados resultou nas seguintes categorias habilidades pessoais e interpessoais, formação profissional e formação cidadã. Entre as habilidades e potencialidades desenvolvidas pelos egressos estão em destaque a comunicação, trabalho em equipe, liderança, construção de currículo promissor e o exercício da cidadania. Conclusão: o Programa de Educação Tutorial, por meio de atividades de ensino, pesquisa e extensão, tem favorecido o desenvolvimento de habilidades e competências imprescindíveis para a atuação do enfermeiro no mercado de trabalho atual. Objective: to identify the contributions of the Tutorial Education Program to academic and professional life according to alumni of the undergraduate course in Nursing. Method: exploratory-descriptive qualitative study with 11 alumni of a Nursing TEP group from a public university in the Brazilian Central-West. The data were collected between November 2018 and April 2019, using a semi-structured interview analyzed according to thematic content analysis. Results: data analysis resulted in the following categories - personal and interpersonal skills, professional formation, and formation for citizenship. Among the strengths and skills developed by the graduates, communication, teamwork, leadership, constructing a promising curriculum, and the exercise of citizenship stand out. Conclusion: through education, research, and extension programs, the Tutorial Education Program favored the development of indispensable skills and competencies for nursing practice in the current job market.

O impacto das Diretrizes Curriculares Nacionais nos cursos de graduação em Odontologia do estado do Rio de Janeiro

Search "Educación Interprofesional" - Jue, 07/07/2022 - 05:52
O objetivo do presente trabalho foi investigar o impacto das Diretrizes Curriculares Nacionais (DCN) de 2002 para os cursos de graduação em Odontologia do estado do Rio de Janeiro avaliando a percepção dos egressos e dos docentes em relação ao perfil profissional do cirurgião-dentista proposto pelas DCN e intercessão com o Sistema Único de Saúde (SUS), considerando a integração ensino-serviço e as experiências na rede SUS, bem como, avaliando a orientação do cuidado em saúde no curso, a abordagem pedagógica do curso, a adequação dos projetos pedagógicos das Instituições de Ensino Superior com as DCN e a prática interprofissional no curso. A avaliação do impacto abordou quatro dimensões: Perfil do Egresso, Orientação do Cuidado em Saúde, Integração Ensino-serviço, e Abordagem Pedagógica, propostas por matriz de critérios e questionário semiestruturado validados no Brasil. Foi realizado um estudo observacional descritivo analítico, multimetodológico, executado em quatro fases. Fase 1, questionário online para avaliar a percepção de egressos com até dois anos de formados em cursos de graduação em Odontologia de quatro instituições previamente sorteadas. Fase 2, questionários online para avaliar a percepção de docentes e coordenadores dos cursos de Odontologia do Estado do Rio de Janeiro. Nas fases 1 e 2 foram utilizados questionários enviados por e-mail e redes sociais. A abordagem envolveu análise de quantitativa para variáveis previamente estipuladas no questionário. Fase 3 foi realizada análise de conteúdo documental utilizando uma matriz de critérios para avaliação quantitativa dos Projetos Pedagógicos de Curso (PPC) de graduação em Odontologia do estado, obtidos através das coordenações ou encontrados nos sítios eletrônicos de cada instituição. E na Fase 4 foi utilizada a metodologia de grupos focais, tendo como público-alvo professores de três cursos da área da saúde (Medicina, Odontologia e Enfermagem) de uma mesma instituição pública. Os resultados demonstraram que na Fase 1 participaram do estudo 121 egressos de quatro instituições, sendo uma pública sem alteração formal do currículo após as DCN, uma pública com alteração do currículo e duas privadas com alteração do currículo. Uma das instituições privadasfoi excluída devido à baixa taxa de respostas. Na Fase 2, participaram 103 docentes e coordenadores/diretores de curso. Foi possível observar que egressos e docentes tiveram uma percepção positiva em relação às atividades propostas pelos cursos para a formação profissional seguindo às resoluções das DCN. Entretanto, foi demonstrado que existe pouca oferta de conteúdo/atividades em gestão de serviços, trabalho em equipes de saúde, trabalho em equipes multiprofissionais e deficiência de vivência no SUS. Na Fase 3, oito PPC foram analisados, e apresentaram adequação de seus textos com as resoluções propostas nas DCN, porém por vezes não houve explicação no PPC como as atividades eram desenvolvidas nos cursos. Na Fase 4, foram realizados 4 grupos focais on-line por Web conferência, com a participação de dez docentes de três cursos da área da saúde de uma instituição pública de ensino. A educação interprofissional foi identificada em iniciativas individuais de grupos ou de professores na Instituição avaliada, não sendo ainda uma diretriz institucional plenamente cumprida. Considerando as limitações do estudo, é possível observar que as DCN têm impacto positivo nos cursos de graduação em Odontologia avaliados, apesar de ainda haver a necessidade de melhorias em alguns pontos acima mencionados The aim of this study was to investigate the impact of the 2002 National Curriculum Guidelines (DCN) for undergraduate courses in Dentistry in the state of Rio de Janeiro, evaluating the perception of graduates and professors in relation to the professional profile of dentists proposed by the DCN and intercession with the Unified Health System (SUS), considering the teachingservice integration and experiences in the SUS network, as well as evaluating the orientation of health care in the course, the pedagogical approach of the course, the adequacy of the pedagogical projects of the High Education Institution with the DCN and the interprofessional practice in the course. The impact assessment addressed four dimensions: Graduate Profile, Health Care Guidance, Teaching-service integration, and Pedagogical approach, proposed by a matrix of criteria and a semi-structured questionnaire validated in Brazil. A descriptive, analytical, multimethodological observational study was carried out in four phases. Phase 1, online questionnaire to assess the perception of graduates with up to 2 years of graduates in undergraduate courses in Dentistry from 4 previously drawn institutions. Phase 2, online questionnaires to assess the perception of teachers and coordinators of Dentistry courses in the State of Rio de Janeiro. In phases 1 and 2, questionnaires sent by email and social networks were used. The approach involved quantitative analysis for variables previously stipulated in the questionnaire. In Phase 3, document content analysis was carried out using a matrix of criteria for quantitative evaluation of Pedagogical Course Projects (PPC) for undergraduate Dentistry in the state, obtained through the coordination or found on the websites of each institution. And in Phase 4, the methodology of focus groups was used, with the target audience of professors from three courses in the health area (Medicine, Dentistry and Nursing) from the same public institution. The results showed that in Phase 1, 121 graduates from four institutions participated in the study, one public with no formal curriculum change after the DCN, one public with curriculum change and two privates with curriculum change. One of the private institutions was excluded due to the low response rate. In Phase 2, 103 teachers and course coordinators/directors participated. It was possible to observe that graduates and teachers had a positive perception in relation to the activities proposed by the courses for professional training, following the resolutions of the DCN. However, it has been shown that there is little offer of content/activities in service management, work in health teams, work in multidisciplinary teams and lack of experience in the SUS. In Phase 3, eight PPC were analyzed, and their texts were adapted to the resolutions proposed in the DCN, but sometimes there was no explanation in the PPC as the activities were developed in the courses. In Phase 4, four online focus groups were carried out via Web conference, with the participation of ten professors from three courses in the health area of a public educational institution. Interprofessional education was identified in individual initiatives by groups or by teachers in the assessed Institution, and it is not yet an institutional guideline fully complied with. Considering the limitations of the study, it is possible to observe that the DCN have a positive impact on the evaluated Dentistry undergraduate courses, although there is still a need for improvements in some points mentioned above.

The determinants of staff retention after Emergency Obstetrics and Newborn Care training in Kenya: a cross-sectional study

Abstract Introduction

Kenya’s maternal mortality ratio is relatively high at 342/100,000 live births. Confidential enquiry into maternal deaths showed that 90% of the maternal deaths received substandard care with health workforce related factors identified in 75% of 2015/2016 maternal deaths. Competent Skilled Health Personnel (SHP) providing emergency obstetric and newborn care (EmONC) in an enabling environment reduces the risk of adverse maternal and newborn outcomes. The study objective was to identify factors that determine the retention of SHP 1 – 5 years after EmONC training in Kenya.

Methods

A cross-sectional review of EmONC SHP in five counties (Kilifi, Taita Taveta, Garissa, Vihiga and Uasin Gishu) was conducted between January–February 2020. Data was extracted from a training database. Verification of current health facilities where trained SHP were deployed and reasons for non-retention were collected. Descriptive data analysis, transfer rate by county and logistic regression for SHP retention determinants was performed.

Results

A total of 927 SHP were trained from 2014–2019. Most SHP trained were nurse/midwives (677, 73%) followed by clinical officers (151, 16%) and doctors (99, 11%). Half (500, 54%) of trained SHP were retained in the same facility. Average trained staff transfer rate was 43%, with Uasin Gishu lowest at 24% and Garissa highest at 50%. Considering a subset of trained staff from level 4/5 facilities with distinct hospital departments, only a third (36%) of them are still working in relevant maternity/newborn/gynaecology departments. There was a statistically significant difference in transfer rate by gender in Garissa, Vihiga and the combined 5 counties (p < 0.05). Interval from training in years (1 year, AOR = 4.2 (2.1–8.4); cadre (nurse/midwives, AOR = 2.5 (1.4–4.5); and county (Uasin Gishu AOR = 9.5 (4.6- 19.5), Kilifi AOR = 4.0 (2.1–7.7) and Taita Taveta AOR = 1.9 (1.1–3.5), p < 0.05, were significant determinants of staff retention in the maternity departments.

Conclusion

Retention of EmONC trained SHP in the relevant maternity departments was low at 36 percent. SHP were more likely to be retained by 1-year after training compared to the subsequent years and this varied from county to county. County policies and guidelines on SHP deployment, transfers and retention should be strengthened to optimise the benefits of EmONC training.

Categorías: Investigaciones

PET-Saúde Interprofissionalidade CER II: narrativas de um grupo sobre ações cotidianas de trabalho frente às alterações provocadas pela Covid-19

Search "Educación Interprofesional" - Lun, 04/07/2022 - 05:49
Este artigo tem por objetivo relatar a experiência de um grupo de estudantes, preceptores e tutoras participantes do Programa Educação pelo Trabalho para a Saúde - PET-Saúde Interprofissionalidade, da Universidade Federal de São Paulo, no contexto de pandemia de Covid-19. Foram construídas narrativas coletivas das estudantes, preceptoras e tutoras. As narrativas explicitam as dificuldades pessoais, o sofrimento decorrente do distanciamento social, as mudanças no trabalho e na universidade e a preocupação em ofertar novas formas de cuidado aos usuários. Pôde-se constatar que as atividades on-line exigem muito mais dos atores envolvidos e os conduzem a uma reflexão sobre o fazer interprofissional. Utilizando a narrativa, contamos o que acontece em um contexto de rupturas, como o grupo se fortaleceu e reinventou estratégias de cuidado. Ao narrar as experiências do grupo, que nos tocam, de forma grupal elas tornam-se coletivas e compartilham um modo de vivenciar o mundo. This article recounts the experiences of a group of students, preceptors and tutors participating in the Education through Work for Health Program- PET-Health Interprofessionality at the Federal University of Sao Paulo in the context of the Covid-19 pandemic. We constructed collective narratives based on the students', preceptors' and tutors' accounts. The narratives reveal personal difficulties, distress caused by social distancing, changes at work and the university, and concern with offering new forms of care to service users. The findings demonstrate that online activities demand much more from the actors involved, prompting them to reflect on interprofessional education. Using narratives, we recount what happens in a context of ruptures and how the group became stronger and reinvented care strategies. By narrating touching group experiences as a group, these experiences become collective and share a way of experiencing the world. El objetivo de este artículo es relatar la experiencia de un grupo de estudiantes, preceptores y tutoras participantes del PET-Salud Interprofesionalidad, de la Universidad Federal de São Paulo, en el contexto de la pandemia de Covid-19. Se construyeron narrativas colectivas de las estudiantes, preceptoras y tutoras. Las narrativas muestran las dificultades personales, el sufrimiento proveniente del distanciamiento social, los cambios en el trabajo y en la universidad y la preocupación de ofrecer nuevas formas de cuidado a los usuarios. Se puede constatar que las actividades on-line exigen mucho más de los actores envueltos y los conduce a una reflexión sobre el quehacer interprofesional. Utilizando la narrativa, contamos lo que sucede en un contexto de rupturas, cómo el grupo se fortaleció y reinventó estrategias de cuidado. Al narrar las experiencias del grupo, que nos son próximas, de forma grupal, ellas se convierten en colectivas y comparten una forma de experimentar el mundo.

Resistance to interprofessional collaboration in in-service training in primary health care

Search "Educación Interprofesional" - Lun, 04/07/2022 - 05:49
ABSTRACT Objective: to analyze the resistance to interprofessional collaboration in the professional practices of residents in primary health care. Method: Social and clinical qualitative research with 32 residents of a Multiprofessional Residency, carried out from 2017 to 2018. Data production included Institutional Analysis of Professional Practices, document analysis; investigator's diary; and observation. Data were analyzed based on Institutional Analysis concepts. Results: There were contradictions between the reproduction of uniprofessional education with a focus on the specialty and interprofessional collaborative practices. The resistance analysis pointed to two axes: not-knowing as an analyzer of resistance to collaboration; interprofessional interference and knowledge-power relations. Residents' practices were characterized as resistant to interprofessional collaboration. Conclusion: The resistance analysis in the Multiprofessional Residency showed integrative movements of assimilation and disputes with physician-centered power, with damage to the sharing of care and interprofessional communication. The collective analysis questioned health professionals education, revisiting the perspective of comprehensive care guided by the users' needs. RESUMEN Objetivo: Hacer un análisis por medio de las resistencias a la colaboración interprofesional en las prácticas profesionales de residentes médicos en la atención primaria a la salud. Método: Investigación cualitativa socio clínica con 32 residentes de una Residencia Multiprofesional, realizada entre 2017 y 2018. La producción de datos incluyó Análisis Institucional de las Prácticas Profesionales, análisis documental; apuntes diarios del investigador; y observación. Los datos fueron analizados a partir de conceptos del Análisis Institucional. Resultados: Se revelaron contradicciones entre la reproducción de la educación uniprofesional con énfasis en la especialidad y prácticas colaborativas interprofesionales. El análisis de la resistencia destacó dos ejes: el no saber cómo método de análisis de resistencias a la colaboración; interferencias interprofesionales y relaciones de saber y de poder. Las prácticas de los residentes fueron caracterizadas por la resistencia a la colaboración interprofesional. Conclusión: El análisis de resistencia en la Residencia Multiprofesional evidenció movimientos integrativos de asimilación y disputas con el poder médico centrado, con daños a la división del cuidado y a la comunicación interprofesional. El análisis colectivo cuestionó la formación de profesionales de salud, revisitando la perspectiva del cuidado integral orientado por las necesidades de los pacientes. RESUMO Objetivo: fazer uma análise pelas resistências à colaboração interprofissional nas práticas profissionais de residentes na atenção primária à saúde. Método: Pesquisa qualitativa Sócio-clínica com 32 residentes de uma Residência Multiprofissional, realizada de 2017 a 2018. A produção de dados incluiu Análise Institucional das Práticas Profissionais, análise documental; diário do pesquisador; e observação. Os dados foram analisados a partir de conceitos da Análise Institucional. Resultados: Revelaram-se contradições entre a reprodução da educação uniprofissional com foco na especialidade e práticas colaborativas interprofissionais. A análise resistencial apontou dois eixos: não-saber como analisador de resistências à colaboração; interferências interprofissionais e relações de saber-poder. As práticas dos residentes foram caracterizadas pela resistência à colaboração interprofissional. Conclusão: A análise resistencial na Residência Multiprofissional evidenciou movimentos integrativos de assimilação e disputas com o poder médico-centrado, com prejuízos ao compartilhamento do cuidado e à comunicação interprofissional. A análise coletiva questionou a formação de profissionais de saúde, revisitando a perspectiva do cuidado integral orientado pelas necessidades dos usuários.

Inclusión de la práctica colaborativa interprofesional para la promoción y prevención de la salud bucal

Search "Educación Interprofesional" - Lun, 04/07/2022 - 05:49
Resumen Las actividades de promoción y prevención en Salud son relevantes en la Atención Primaria; no obstante, las relacionadas con el Programa de Salud Oral, en Chile, aparecen asociadas a los programas preventivos y no formando parte de ellos, situación que también ocurre en otros países. La presente revisión tiene como objetivos evidenciar las actuales políticas y lineamientos internacionales que indican que se debe propender a una Práctica Colaborativa Interprofesional para una mejor calidad en la atención; y proponer un trabajo interprofesional donde las acciones de promoción y prevención en Salud Bucal se incluyan en los programas preventivos existentes. La Práctica Colaborativa Interprofesional ocurre cuando los miembros del equipo de salud se organizan, planifican, gestionan y proporcionan servicios integrales de salud, evitando la fragmentación de los cuidados. Esto se logra estructurando las competencias comunes, colaborativas y específicas. El trabajo interdependiente permite complementar conocimientos y habilidades que contribuyen a cumplir con las políticas de Calidad de la Atención y Triple Meta en salud. De modo que, se proponen estrategias de trabajo en promoción y prevención de Salud Bucal a incorporar y ejecutar en los diversos programas preventivos ya existentes a lo largo del ciclo vital. En conclusión, es necesario un cambio de paradigma en la atención bucodental donde el foco ya no esté en el programa sino en el individuo, familia y comunidad para lograr una salud integral. Resulta relevante compartir experiencias de atención interprofesional y a incorporar la Educación Interprofesional y Practica Colaborativa en el proceso formativo de las futuras generaciones. Abstract Health prevention and promotion actions are relevant in primary care; nevertheless, those related to the Oral Health Program in Chile are associated with preventive programs and are not part of them, which occurs in other countries as well. The objectives of this review are to display the current international policies and guidelines that indicate that an Interprofessional Collaborative Practice should be promoted for a better quality of care as well as to propose interprofessional work including promotion and prevention actions in Oral Health in the existing preventive programs. Interprofessional Collaborative Practice occurs when members of the health team organize, plan, manage and provide integral health services, avoiding fragmentation of care. This is achieved by structuring common, collaborative, and specific competencies. Interdependent work allows complementing knowledge and skills that contribute to comply with the policies of Quality of Care and Triple Aim in health. Therefore, work strategies in oral health promotion and prevention are proposed to be incorporated and implemented in the various preventive programs already in place throughout the life cycle. In conclusion, there is a need for a paradigm shift in oral health care, where the focus is no longer on the program but on the individual, family, and community to achieve comprehensive health. Finally, it becomes relevant to share experiences of interprofessional care, and incorporating Interprofessional Education and Collaborative Practice in the formative process of future generations. Resumo As atividades de promoção e prevenção da saúde são relevantes na Atenção Básica; no entanto, aqueles relacionados ao Programa de Saúde Bucal no Chile aparecem associados aos programas preventivos e não fazem parte deles, situação que também ocorre em outros países. A presente revisão visa demonstrar as atuais políticas e diretrizes internacionais que indicam que uma Prática Interprofissional Colaborativa deve ser promovida para uma melhor qualidade de atendimento; e propor um trabalho interprofissional onde as ações de promoção e prevenção em Saúde Bucal estejam incluídas nos programas preventivos existentes. A Prática Colaborativa Interprofissional ocorre quando os membros da equipe de saúde organizam, planejam, gerenciam e prestam serviços de saúde integrais, evitando a fragmentação do cuidado. Isso é conseguido através da estruturação de competências comuns, colaborativas e específicas. O trabalho interdependente permite complementar conhecimentos e competências que contribuem para o cumprimento das políticas de Qualidade da Assistência e Triplo Objetivo em saúde. Assim, são propostas estratégias de trabalho na promoção e prevenção da Saúde Bucal a serem incorporadas e executadas nos diversos programas preventivos já existentes ao longo do ciclo vital. Conclui-se que é necessária uma mudança de paradigma na higiene bucal, onde o foco não seja mais o programa, mas sim o indivíduo, a família e a comunidade para o alcance da saúde integral. É relevante compartilhar experiências de cuidado interprofissional e incorporar a Educação Interprofissional e a Prática Colaborativa no processo de formação das futuras gerações.

Towards the achievement of universal health coverage in the Democratic Republic of Congo: does the Country walk its talk?

Abstract

In 2009, the Democratic Republic of Congo (DRC) started its journey towards achieving Universal Health Coverage (UHC). This study examines the evolution of financial risk protection and health outcomes indicators in the context of the commitment of DRC to UHC. To measure the effects of such a commitment on financial risk protection and health outcomes indicators, we analyse whether changes have occurred over the last two decades and, if applicable, when these changes happened. Using five variables as indicators for the measurement of the financial risk protection component, there as well retained three indicators to measure health outcomes. To identify time-related effects, we applied the parametric approach of breakpoint regression to detect whether the UHC journey has brought change and when exactly the change has occurred.

Although there is a slight improvement in the financial risk protection indicators, we found that the adopted strategies have fostered access to healthcare for the wealthiest quantile of the population while neglecting the majority of the poorest. The government did not thrive persistently over the past decade to meet its commitment to allocate adequate funds to health expenditures. In addition, the support from donors appears to be unstable, unpredictable and unsustainable. We found a slight improvement in health outcomes attributable to direct investment in building health centres by the private sector and international organizations. Overall, our findings reveal that the prevention of catastrophic health expenditure is still not sufficiently prioritized by the country, and mostly for the majority of the poorest. Therefore, our work suggests that DRC’s UHC journey has slightly contributed to improve the financial risk protection and health outcomes indicators but much effort should be undertaken.

Categorías: Investigaciones

Correlates of turnover intention among nursing staff in the COVID-19 pandemic: a systematic review

Abstract Background

During the COVID-19 pandemic, shortage of nursing staff became even more evident. Nurses experienced great strain, putting them at risk to leave their jobs. Individual and organizational factors were known to be associated with nurses’ turnover intention before the pandemic. The knowledge of factors associated with turnover intention during the pandemic could help to foster nurses’ retention. Therefore, this review aims to identify factors associated with nurses’ turnover intention during the COVID-19 pandemic.

Methods

After a systematic search of six databases, the resulting records were screened in a two-step process based on pre-defined inclusion and exclusion criteria. The included quantitative studies were synthesized qualitatively due to their methodological heterogeneity.

Results

A total of 19 articles were included in the analysis. Individual factors such as health factors or psychological symptoms and demographic characteristics were associated with nurses’ turnover intention. Organizational factors associated with turnover intention were e.g., caring for COVID-19 patients, low job control or high job demands, and moral distress. Resilience and supporting leadership could mitigate adverse associations with turnover intention.

Conclusions

The results help to identify high-risk groups according to individual factors and to develop possible interventions, such as trainings for nurses and their superiors, addressing individual and organizational factors. Future research should focus on longitudinal designs applying carefully defined concepts of turnover intention.

Categorías: Investigaciones

The global health workforce stock and distribution in 2020 and 2030: a threat to equity and 'universal' health coverage?

OBJECTIVE: The 2016 Global Strategy on Human Resources for Health: Workforce 2030 projected a global shortage of 18 million health workers by 2030. This article provides an assessment of the health workforce stock in 2020 and presents a revised estimate of the projected shortage by 2030. METHODS: Latest data reported through WHO's National Health Workforce Accounts (NHWA) were extracted to assess health workforce stock for 2020. Using a stock and flow model, projections were computed for the year 2030. The global health workforce shortage estimation was revised. RESULTS: In 2020, the global workforce stock was 29.1 million nurses, 12.7 million medical doctors, 3.7 million pharmacists, 2.5 million dentists, 2.2 million midwives and 14.9 million additional occupations, tallying to 65.1 million health workers. It was not equitably distributed with a 6.5-fold difference in density between high-income and low-income countries. The projected health workforce size by 2030 is 84 million health workers. This represents an average growth of 29% from 2020 to 2030 which is faster than the population growth rate (9.7%). This reassessment presents a revised global health workforce shortage of 15 million health workers in 2020 decreasing to 10 million health workers by 2030 (a 33% decrease globally). WHO African and Eastern Mediterranean regions' shortages are projected to decrease by only 7% and 15%, respectively. CONCLUSIONS: The latest NHWA data show progress in the increasing size of the health workforce globally as more jobs are and will continue to be created in the health economy. It however masks considerable inequities, particularly in WHO African and Eastern Mediterranean regions, and alarmingly among the 47 countries on the WHO Support and Safeguards List. Progress should be acknowledged with caution considering the immeasurable impact of COVID-19 pandemic on health workers globally.
Categorías: Investigaciones

Uso de la simulación clínica para entrenar equipos en el manejo de conflictos durante los cuidados en salud: una revisión sistemática exploratoria

Search "Educación Interprofesional" - Lun, 27/06/2022 - 05:41
Objetivo:Explorar y analizar el uso de la simulación clínica para la formación y/o capacitación de equipos clínicos en el manejo y resolución de conflictos en salud, mediante una revisión sistemática exploratoria.Método:Se realizó una búsqueda con los términos: clinical simulation OR patientsimulation OR simulation training OR high fidelity simulation training AND conflict OR conflict resolution en las bases de datos MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS y DOCUMED. Los límites fueron el uso de la simulación clínica orientado a la formación en el manejo de conflictos en estudiantes o profesionales de la salud, con uso de escenarios clínicos, excluyendo aquellos con más de 20 años. No se consideró excluyente el uso o no de debriefing, ni el uso de simulación junto a otras metodologías. Se realizó un análisis cualitativo.Resultados:Se obtuvieron diez artículos, mayoritariamente cuasi-experimentales, en los cuales la simulación clínica se utiliza prioritariamente de forma interprofesional para la capacitación en manejo de conflictos clínicos, en conjunto con otras metodologías tales como role play, práctica reflexiva y uso de recursos audiovisuales, lo cual sugiere aumentar su efectividad. Se han recreado situaciones como discrepancia en la toma de decisiones y manejo de errores médicos, buscando aplicar competencias de mediación, comunicación y habilidades emocionales, entre otras, seguidas de debriefing. La aplicación de escalas validadas y métodos convencionales revelan un impacto positivo en la satisfacción, percepción y aprendizaje de los participantes, así como en la transferencia y disminución de errores atribuidos a la atención. Objective:To assess and analyze the impact of clinical simulation as a training tool in healthcare teams ability to resolve and manage conflicts, through an exploratory systematic review.Methods:A structured literature review was performed with the terms clinical simulation OR patientsimulation OR simulation training OR high fidelity simulation training AND conflict OR conflict resolution in the following databases: MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS and DOCUMED. Articles were considered if they involved clinical simulation oriented to training of healthcare professionals or trainees in conflict management, using clinical scenarios, and excluding those studies older than 20 years. Absence of debriefing was not considered an exclusion criterion, neither the use of simulation along with other methodologies. A quantitative analysis was performed.Results:10 articles were retrieved, mostly with quasi-experimental designs, in which clinical simulation was designed as an interprofessional training and was used with multiple other methodologies like roleplay, reflexive practice and audiovisual aids, strategy that suggest an increase its effectivity. Different scenarios have been recreated, like decision-making divergences and management of medical errors, in order to apply the competences of mediation, communication, emotional skills among others, and followed by debriefing. The use of validated scales and conventional assessment methods reveal a positive impact on satisfaction, perception and learning of students, as well as transfer to clinical practice and decrease in errors.

Educación interprofesional y seguridad del paciente: una revisión sistemática

Search "Educación Interprofesional" - Lun, 27/06/2022 - 05:41
Introducción: la educación interprofesional (EIP) se define como una iniciativa educativa, formativa o docente que involucra a más de una profesión en el aprendizaje conjunto e interactivo. La formación del recurso humano en salud tiene como desafío plantear soluciones a la escasez de personal sanitario en el mundo y formar profesionales que tengan un desempeño óptimo. Objetivo: caracterizar las publicaciones relacionadas con la implementación de modelos en educación interprofesional y el impacto generado en algunos aspectos relacionados con la seguridad del paciente. Método: se realizó una revisión sistemática de la literatura científica en Pubmed, Science Direct, Scielo, LILACS y Google Scholar con siete estrategias de búsqueda garantizando la exhaustividad y reproducibilidad en las fases de la guía PRISMA. Resultados: se incluyeron n = 33 estudios de los cuales n = 19 (57,5%) fueron aplicados en el contexto hospitalario, n = 14 (42,4%) utilizaron metodologías cuasiexperimentales, de estos n = 4 estudios miden desenlaces directos relacionados con la seguridad del paciente, y en los otros n = 29 (87,8%) se encontró una mejora en la comunicación, percepción y conocimiento en los equipos de trabajo. Conclusión: el aprendizaje interprofesional mejora la comunicación y la interacción entre los profesionales de salud. No obstante, es difícil generalizar los resultados debido a la diversidad de metodologías de interacción interprofesional aplicadas en los estudios. Introduction: interprofessional education (IPE) is an educational, training, or teaching initiative involving more than one profession in joint and interactive learning. The challenge of training human resources in health is to propose solutions to the shortage of health personnel globally and to train professionals who have optimal performance. Objective: characterize the publications related to the implementation of interprofessional education models and the impact generated in aspects related to patient safety. Method: a systematic review of the scientific literature was carried out in PubMed, Science Direct, SciElo, LILACS, and Google Scholar with seven search strategies guaranteeing completeness and reproducibility in the phases of the PRISMA guide. Results: n = 33 studies were included, of which n = 19 (57.5%) were applied in the hospital context, n = 14 (42.4%) used quasi-experimental methodologies, of these n = 4 studies measure direct outcomes related to patient safety, and in the other n = 29 (87.8%) an improvement was found in communication, perception, and knowledge in in the work teams. Conclusion: interprofessional learning improves communication and interaction between health professionals. However, it is difficult to generalize the results due to the diversity of interprofessional interaction methodologies applied in the studies. Introdução: a educação interprofissional (EIP) é definida como uma iniciativa educacional, de treinamento ou de ensino que envolve mais de uma profissão na aprendizagem conjunta e interativa. O desafio da formação de recursos humanos em saúde é propor soluções para a carência de pessoal de saúde no mundo e formar profissionais com ótimo desempenho. Objetivo:caracterizar as publicações relacionadas à implantação de modelos na educação interprofissional e o impacto gerado em alguns aspectos relacionados à segurança do paciente. Método: foi realizada uma revisão sistemática da literatura científica no Pubmed, Science Direct, Scielo, LILACS e Google Scholar com sete estratégias de busca garantindo completude e reprodutibilidade nas fases do guia PRISMA. Resultados: n = 33 estudos foram incluídos, dos quais n = 19 (57,5%) foram aplicados no contexto hospitalar, n = 14 (42,4%) utilizaram metodologias quase-experimentais, destes n = 4 estudos medem resultados diretos relacionados com a segurança do paciente, e nos demais n = 29 (87,8%) houve melhora na comunicação, percepção e conhecimento nas equipes de trabalho. Conclusão: a aprendizagem interprofissional melhora a comunicação e a interação entre os profissionais de saúde. No entanto, é difícil generalizar os resultados devido à diversidade de metodologias de interação interprofssional aplicadas nos estudos

Limitations and Recommendations for Advancing the Occupational Therapy Workforce Research Worldwide: Scoping Review and Content Analysis of the Literature.

Occupational therapy workforce research can help determine whether occupational therapists exist in sufficient supply, are equitably distributed, and meet competency standards. Advancing the value of occupational therapy workforce research requires an understanding of the limitations and recommendations identified by these investigations. This scoping review and content analysis synthesizes the study limitations and recommendations reported by the occupational therapy research worldwide. Two independent reviews included 57 papers from the past 25 years. Stated limitations included: focus on cross-sectional studies with small and convenience samples; participants from single settings or regions; local markets or preferences not specified; focus on self-reported data and intentions (rather than behaviors or occurrences); challenges in aggregating or synthesizing findings from descriptive data; lack of statistical adjustment for testing multiple associations; and the lack of detailed, up-to-date, and accessible workforce data for continuous monitoring and secondary research. Stated recommendations included: strengthening routine workforce data collection; developing longitudinal studies that include interventions (e.g., recruitment or retention packages); developing context-sensitive comparisons; studying the impact on ultimate outcomes; promoting nation-wide, coordinated workforce plans and requirements; and fostering international coalitions for workforce research and developments at scale. These study limitations and recommendations reported by the literature must be considered in the design of a local and global occupational therapy workforce research agenda.
Categorías: Investigaciones

Patient experiences and preferences for antiretroviral therapy service provision: implications for differentiated service delivery in Northwest Ethiopia

Abstract Background

Understanding the experiences, needs, preferences, and behaviors of people living with HIV (PLHIV) are critical to tailor HIV treatment. However, there is limited empirical evidence in Ethiopia on the views of PLHIV regarding their experiences with current antiretroviral therapy (ART) services and preferred models of HIV treatment. Hence, this study aimed to explore the patients’ experiences of taking medications and preferences for ART service provision in Northwest Ethiopia.

Methods

A phenomenological study design was employed. In this study, stable and 18 years old and above PLHIVs, who had been using ART service at four public hospitals and two health centers in East Gojjam, West Gojjam and Awi zones, and Bahir Dar city administration of Amhara National Regional State, Northwest Ethiopia, were purposively selected. Fifteen in-depth interviews were conducted from July 2021 to September 2021 to collect data. ATLAS.ti version 9 software was used for coding translated transcripts. A thematic analysis approach was employed.

Findings

Participants in this study had reported positive and negative experiences in receiving ART services and also varied preferences toward ART service features. The study identified five themes on experiences for ART service and 15 attributes of ART service characteristics. The identified themes were stigma, time, availability of drugs and providers, costs for clinic visits, and provider-patient interaction. The fifteen attributes were buddy system, ART refill (individualized or group), ART packaging and labeling, drug formulation and administration, ART room labeling, distance, location of service, preferences on involvement in treatment decision-making, the person providing ART refills, provider’s attitude, spatial arrangement of ART room, time of health facility operation, time spent at clinics, and total cost of the visit.

Conclusions

The results raise awareness for the positive and negative experiences of patients informing us about barriers and supporting factors in ART service provision. They open up the potential for HIV treatment service improvement. The preferences of PLHIVs toward ART service delivery features were heterogeneous. Policy and program efforts should tailor ART services that suit patients’ needs and priorities in Ethiopia. Future research should further assess the reasons for patients’ distrust of the community ART delivery models.

Categorías: Investigaciones

“Not shifting, but sharing”: stakeholders' perspectives on mental health task-shifting in Indonesia

Abstract Background

Task-shifting, the distribution of tasks among health workers to address health workforce shortage, has been widely used to tackle mental health treatment gaps. However, its implementation in Indonesia has still been rarely explored. This study aimed to explore stakeholders’ perspectives on the implementation of mental health task-shifting to nurses in Indonesia's primary health care.

Methods

An exploratory descriptive approach using in-depth interviews and focused group discussions (FGDs) was used. The study involved 19 stakeholders from the government's ministry directorates, professional organisations, and mental health practitioners. Thematic analysis was used to analyse the data.

Results

Three themes emerged namely, task-shifting feasibility and acceptability, shared task implementation, and nurse role enhancement issues, with 14 sub-themes.

Conclusions

Task-shifting on mental health issues in the eye of Indonesian stakeholders is viewed as a matter of sharing and collaboration. Implementation of task-shifting in Indonesia may require policies in place and political will across stakeholders. Further scrutiny on task-shifting implementation is needed by considering the local context and national environment.

Categorías: Investigaciones

‘You say you are a TB doctor, but actually, you do not have any power’: health worker (de)motivation in the context of integrated, hospital-based tuberculosis care in eastern China

Abstract Background

In China, tuberculosis (TB) care, traditionally provided through the Centre for Disease Control (CDC), has been integrated into ‘designated’ public hospitals at County level, with hospital staff taking on delivery of TB services supported by CDC staff. Little is known about the impact of this initiative on the hospital-based health workers who were delegated to manage TB. Drawing on a case study of two TB ‘designated’ hospitals in Zhejiang province, we explored factors influencing hospital-based health workers’ motivation in the context of integrated TB service delivery.

Methods

We conducted 47 in-depth interviews with health officials, TB/hospital managers, clinicians, radiologists, laboratory staff and nurses involved in the integrated model of hospital-based TB care. Thematic analysis was used to develop and refine themes, code the data and assist in interpretation.

Results

Health workers tasked with TB care in ‘designated’ hospitals perceived their professional status to be low, related to their assessment of TB treatment as lacking need for professional skills, their limited opportunities for professional development, and the social stigma surrounding TB. In both sites, the integrated TB clinics were under-staffed: health workers providing TB care reported heavy workloads, and expressed dissatisfaction with a perceived gap in their salaries compared with other clinical staff. In both sites, health workers were concerned about poor infection control and weak risk management assessment systems.

Conclusions

Inadequate attention to workforce issues for TB control in China, specifically the professional status, welfare, and development as well as incentivization of infectious disease control workers has contributed to dissatisfaction and consequently poor motivation to serve TB patients within the integrated model of TB care. It is important to address the failure to motivate health workers and maximize public good-oriented TB service provision through improved government funding and attention to the professional welfare of health workers providing TB care in hospitals.

Categorías: Investigaciones

Work-related factors affecting the retention of medical officers in the preventive health sector in Sri Lanka

Abstract Background

Retention of human resources in the healthcare system, particularly doctors at district level is a great challenge faced by the decentralized health systems in poorly resourced countries. Medical Officers of Health (MOH), medical doctors who provide preventive health services, are a particularly important human resource in the preventive health sector in Sri Lanka. This study explores the relative importance of different factors affecting the retention of MOHs in the preventive health sector of Sri Lanka.

Methods

A descriptive cross-sectional study was carried out among Medical Officers of Health in the Colombo district with 18 MOH Offices with 74 medical officers. A pre-tested self-administered questionnaire was used as the study instrument. Data were analyzed using descriptive statistics, correlation and regression analyses.

Results

Of the 74 medical officers 64 responded with a response rate of response rate of 86.5%. Regression analysis showed that all four variables; recognition, work schedule, remuneration and responsibility are positively and significantly correlated with retention of Medical Officers of Health in the preventive health sector. The variable ‘work schedule’ showed the highest impact on the retention of Medical Officers of Health.

Conclusions

In order to retain trained Medical Officers of Health in the Sri Lankan preventive health sector, health authorities should address the factors identified in this study. If policymakers fail to address these factors, preventive health services will face negative implications due to the shortage of key service providers.

Categorías: Investigaciones

Assessing the contribution of immigrants to Canada's nursing and health care support occupations: a multi-scalar analysis.

BACKGROUND: The World Health Organization adopted the Global Strategy on Human Resources for Health Workforce 2030 in May 2016. It sets specific milestones for improving health workforce planning in member countries, such as developing a health workforce registry by 2020 and ensuring workforce self-sufficiency by halving dependency on foreign-trained health professionals. Canada falls short in achieving these milestones due to the absence of such a registry and a poor understanding of immigrants in the health workforce, particularly nursing and healthcare support occupations. This paper provides a multiscale (Canada, Ontario, and Ontario's Local Health Integration Networks) overview of immigrant participation in nursing and health care support occupations, discusses associated enumeration challenges, and the implications for health workforce planning focusing on immigrants. METHODS: Descriptive data analysis was performed on Canadian Institute for Health Information dataset for 2010 to 2020, and 2016 Canadian Census and other relevant data sources. RESULTS: The distribution of nurses in Canada, Ontario, and Ontario's Local Health Integration Networks reveal a growth in Nurse Practitioners and Registered/Licensed Practical Nurses, and contraction in the share of Registered Nurses. Immigrant entry into the profession was primarily through the practical nurse cadre. Mid-sized communities registered the highest growth in the share of internationally educated nurses. Data also pointed towards the underutilization of immigrants in regulated nursing and health occupations. CONCLUSION: Immigrants comprise an important share of Canada's nursing and health care support workforce. Immigrant pathways for entering nursing occupations are complex and difficult to accurately enumerate. This paper recommends the creation of an integrated health workforce dataset, including information about immigrant health workers, for both effective national workforce planning and for assessing Canada's role in global health workforce distribution and utilization.
Categorías: Investigaciones

[Pillars and lines of action for integrated and people- and community-centered health systemsPilares e linhas de ação para sistemas integrados de saúde centrados nas pessoas e nas comunidades].

This paper presents the position of the Latin American working group of the International Foundation for Integrated Care (IFIC). The working group brings together various Latin American actors and organizations in support of actions that facilitate the transformation of health systems in the region towards integrated systems that focus on people not as isolated individuals but as subjects of law in the complex social and environmental contexts where they live and interact. The working group proposes nine pillars of integrated care to be used as a conceptual framework for policy development and changes in practices: 1) shared vision and values; 2) population health; 3) people and communities as partners; 4) resilient communities; 5) capacities of human resources for health; 6) governance and leadership; 7) digital solutions; 8) aligned payment systems; and 9) public transparency. Based on these pillars, lines of work are proposed to strengthen alliances and networks, advocacy, research, and capacity-building, in order to help develop health and social systems that are effectively integrated and focused not only on people but also on communities in Latin America. Este artigo apresenta o posicionamento do grupo de trabalho latino-americano da Fundação Internacional de Cuidados Integrados (1) (IFIC, na sigla em inglês). A IFIC reúne diversos atores e organizações da América Latina com o fim de apoiar ações que facilitem a transformação dos sistemas de saúde na região para sistemas integrados e centrados nas pessoas, não como indivíduos isolados, mas como sujeitos de direito, nos complexos contextos sociais e ambientais em que vivem e participam. O grupo de trabalho propõe nove pilares de atenção integrada a serem utilizados como marco conceitual na elaboração de políticas e de mudanças nas práticas: 1) visão e valores compartilhados, 2) saúde das populações, 3) pessoas e comunidades como parceiros, 4) comunidades resilientes, 5) capacitação de talento humano em saúde, 6) governança e liderança, 7) soluções digitais, 8) sistemas de pagamento alinhados e 9) transparência perante a população. Com base nesses pilares, são propostas linhas de trabalho nas áreas de fortalecimento de alianças e redes, incidência política, pesquisa e capacitação, que contribuam para materializar na América Latina sistemas sociais e de saúde efetivamente integrados e centrados não só nas pessoas, como também nas comunidades.
Categorías: Investigaciones

[Implementation of the plan of action for human resources for health and the COVID-19 pandemic responseImplementação do plano de ação sobre recursos humanos para a saúde e a resposta à pandemia de COVID-19].

Objectives: Systematize and analyze the response actions related to human resources for health during the pandemic, reported by 20 countries of the Region of the Americas in the mid-term evaluation of the Plan of Action on Human Resources for Universal Access to Health and Universal Health Coverage 2018-2023 (Pan American Health Organization, 2018), and assess the importance of the policies on human resources for health (HRH) and on HRH management expressed in the Plan of Action and in the Strategy on Human Resources for Universal Access to Health and Universal Health Coverage during health emergencies and in normal times. Methods: Reports on actions taken in 20 countries of the Region against COVID-19 and for HRH were selected and systematized. These were classified as immediate contingency actions, actions related to installed capacities, and emerging actions. Results: The capacity to plan and manage HRH in countries depends on their installed, functional structures and competencies. The pandemic highlighted the need to have new job profiles, improve precarious working and contractual conditions, emphasize the gender perspective, and address numerical gaps in certain areas and levels of care. Conclusions: Linking the monitoring of the Plan of Action with the COVID-19 response demonstrated the importance of HRH governance, management, and installed capacities when responding to health emergencies and in normal times. The analysis suggests a need to review existing public policies, models of care that can guide current and future needs in HRH, the profiles required, working conditions, and ways to close numerical gaps, among other issues. The pandemic enabled countries to innovate in response to demands. The Strategy and the Plan of Action remain in place to guide and strengthen the performance of human resources for health. Objetivos: Sistematizar e analisar as ações de resposta relacionadas aos recursos humanos para a saúde durante a pandemia, relatadas por 20 países da Região das Américas na avaliação intermediária do Plano de ação sobre recursos humanos para o acesso universal à saúde e a cobertura universal de saúde 2018-2023 (Organização Pan-Americana da Saúde, 2018), e avaliar a importância das políticas e da gestão de recursos humanos expressas na estratégia e no plano durante emergências de saúde e em tempos normais. Métodos: Foram selecionados e sistematizados relatórios sobre ações contra a COVID-19 e recursos humanos para a saúde de 20 países da Região. As ações foram classificadas em ações imediatas de contingência, ações relacionadas às capacidades instaladas e ações emergentes. Resultados: As capacidades de planejamento e gestão de recursos humanos para a saúde nos países dependem das estruturas e das competências instaladas e funcionais. A pandemia tornou visível a necessidade de ter novos perfis de trabalho, melhorar as precárias condições de trabalho e contratuais, tornar visível a perspectiva de gênero e solucionar lacunas numéricas em determinadas áreas e níveis de atenção. Conclusões: A vinculação das ações contra a COVID-19 com o monitoramento do plano demonstrou a importância da governança, da gestão e das capacidades instaladas relacionadas aos recursos humanos para a saúde, para responder a emergências de saúde e em tempos normais. A análise convida à revisão das políticas públicas existentes, dos modelos de atenção necessários para orientar as necessidades atuais e futuras dos recursos humanos para a saúde, os perfis exigidos, as condições de trabalho e a cobertura das lacunas numéricas existentes, entre outras questões. A pandemia permitiu inovações nos países para responder à demanda. A estratégia e o plano continuam vigentes para orientar e fortalecer o desempenho dos recursos humanos para a saúde.
Categorías: Investigaciones

Lessons learned from the history of postgraduate medical training in Japan: from disease-centred care to patient-centred care in an aging society.

BACKGROUND: Health workers, the core of health service delivery and a key driver of progress towards universal health coverage, must be available in sufficient numbers and distributed fairly to serve the entire population. In addition, the planning and management of the health workforce must be responsive to the changing needs of society, including changes in age structure and epidemiology. Considering these issues, this paper examines in historical perspective the evolution of postgraduate medical training and practice in Japan, from the late nineteenth century to the present. MAIN TEXT: When the first medical schools were established in the country towards the end of the nineteenth century, Japan was a largely agrarian society, with a population of about 30 million and an average life expectancy of 30-40 years. During the twentieth century, life expectancy and the national population continued to increase in a context of rapid economic growth. Since the 1980s, another demographic transition has occurred: low fertility rates and an aging society. As a result, the inputs and skills required from health professionals have changed considerably over time, posing new challenges to the national health sector and the management of human resources for health. CONCLUSIONS: The case of Japan offers valuable lessons for other countries experiencing a rapid epidemiological and demographic transition. To provide medical care that meets health priorities in the communities, we must consider not only the training of specialists, but also ensure the availability of a large cadre of physicians who possess basic skills and can provide patient-centred care. Furthermore, the Japanese experience shows that a highly hierarchical system and organisational culture are ill-suited to respond quickly to the changing demands of society.
Categorías: Investigaciones

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