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Adeleye A, Wirihana L, Jennings B, Ferguson B, Capper T, Chee R, Ritchie K, Smith R, Williamson M. Supporting Timor-Leste midwives and nurses through an educational program: An evaluative study. Women Birth 2024; 37:101673. [PMID: 39151377 DOI: 10.1016/j.wombi.2024.101673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/04/2024] [Accepted: 08/08/2024] [Indexed: 08/19/2024]
Abstract
Little is currently known about the impacts of participation in a five-week Australian maternal and newborn health training program for Timorese midwives and nurses. BACKGROUND The maternal mortality rate in Timor-Leste is estimated to be around 204 per 100,000 live births, and there is a correlation between safe and quality maternal and newborn health services. Hence, there is a need to develop the nation's maternity workforce. Whilst numerous training programs have been geared towards improving the knowledge and skills of Timorese midwives and nurses, to date, no published study has evaluated their impact on participants. AIM To describe satisfaction of an Australian maternal and newborn health training program for Timorese midwives and nurses and its impact based upon the participants survey and qualitative evaluations. METHODS An evaluative study was conducted using a survey to explore the impacts of a five-week Australian residential training program on 12 Timorese midwives and one nurse. FINDINGS The survey data demonstrated an increase in the participants knowledge and skills required to provide enhanced maternal and newborn care; post-training, most participants demonstrated increased knowledge of obstetric emergencies. The participants showed the most pronounced increase in Advanced Clinical Skills in the subjects of fetal assessment, neonatal resuscitation and obstetric emergencies. The qualitative data identified two main themes and six subthemes related to professionalism, communication, and connections. CONCLUSION An Australian residential training program, provided in collaboration with local Rotary clubs can enhance the development of maternal and newborn healthcare skills for midwives and nurses from Timor-Leste.
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Affiliation(s)
- Adeniyi Adeleye
- School of Nursing, Midwifery and Social Sciences, Mackay City Campus, CQUniversity, 90-92 Sydney Street, Mackay, Queensland 4740, Australia.
| | - Lisa Wirihana
- School of Nursing, Midwifery and Social Sciences, Rockhampton Campus, CQUniversity, 554-700 Yaamba Road, North Rockhampton, Queensland 4702, Australia
| | - Belinda Jennings
- College of Medicine and Public Health, Darwin campus, Flinders University, University Drive North, Darwin, Northern Territory 0909, Australia
| | - Bridget Ferguson
- School of Nursing, Midwifery and Social Sciences, Rockhampton Campus, CQUniversity, 554-700 Yaamba Road, North Rockhampton, Queensland 4702, Australia
| | - Tanya Capper
- School of Nursing, Midwifery and Paramedicine, Brisbane, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland 4014, Australia; School of Nursing, Midwifery and Social Sciences, Brisbane, CQUniversity, Level 20, 160 Ann Street, Brisbane, Queensland 4000, Australia
| | - Rachelle Chee
- School of Nursing, Midwifery and Social Sciences, Brisbane, CQUniversity, Level 20, 160 Ann Street, Brisbane, Queensland 4000, Australia
| | - Kathryn Ritchie
- CQUniversity Library Service, Rockhampton campus, CQUniversity, 554-700 Yaamba Road, North Rockhampton, Queensland 4702, Australia
| | - Rachel Smith
- Burnet Institute, Melbourne, Victoria, Australia
| | - Moira Williamson
- School of Nursing, Midwifery and Social Sciences, Brisbane, CQUniversity, Level 20, 160 Ann Street, Brisbane, Queensland 4000, Australia
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Yalley AA, Jarašiūnaitė-Fedosejeva G, Kömürcü-Akik B, de Abreu L. Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality. Front Public Health 2024; 12:1388858. [PMID: 38979044 PMCID: PMC11228167 DOI: 10.3389/fpubh.2024.1388858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
Background The mistreatment and abuse of women during childbirth have been recognized as a major global health challenge, impeding facility-based delivery and contributing to the high maternal mortalities globally. The World Health Organization has specifically called for interventions to deal with obstetric violence. This scoping review consolidates the existing literature on interventions aimed at reducing obstetric violence and synthesizes existing knowledge on their impact in promoting respectful maternity care. Methodology Thirteen electronic databases were searched for relevant articles from January 2001 to March 2023. A total of 863 records were identified, and 72 full-text articles were retrieved for further screening. The review includes 16 studies, particularly from low- and middle-income countries, with interventions implemented at medical facilities and involving both women and healthcare providers. Eight of the studies were quantitative, three were qualitative and five used a mixed-methods approach. Findings The results reveal a promising trend in reducing obstetric violence through various interventions. Ten different types of interventions were identified, highlighting strategies to improve the quality of maternity care and enhance patient-centered care. Improved patient-provider communication skills, increased privacy measures, and reduced abuse and mistreatment emerged as common themes. Enhanced communication skills, including open discussions and the right to be informed, were crucial in reducing obstetric violence. Privacy measures, such as separate rooms, curtains, and birth companions effectively decreased incidents of non-confidential care. General abuse and mistreatment, including physical abuse and neglect, were also reduced, leading to improved perceptions of respectful care during childbirth. Conclusion Overall, the interventions had a favorable impact on obstetric violence reduction and women's childbirth experiences. However, despite promising results, obstetric violence remains prevalent worldwide, necessitating more efforts to implement effective interventions. To the best of our knowledge, this is the first scoping review on obstetric violence interventions, providing a comprehensive overview of the state of the art. We suggest that further research is needed to explore new interventions, particularly gender-sensitive interventions, to contribute to a growing body of knowledge on the prevention of obstetric violence.
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Affiliation(s)
- Abena Asefuaba Yalley
- Zukunftskolleg, University of Konstanz, Konstanz, Germany
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | | | | | - Liliana de Abreu
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
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Ismail FW, Ajani K, Baqir SM, Nadeem A, Qureshi R, Petrucka P. Challenges and opportunities in the uptake of simulation in healthcare education in the developing world: a scoping review. MEDEDPUBLISH 2024; 14:38. [PMID: 39257565 PMCID: PMC11384200 DOI: 10.12688/mep.20271.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2024] [Indexed: 09/12/2024] Open
Abstract
Background Simulation is increasingly being adopted by healthcare educators throughout the developed world as it offers a safe environment to practice skills. While there is literature on learning via simulation in healthcare in the developed world, more studies are required to investigate the factors influencing this approach in the developing world. Objective This scoping review highlights the key factors that act as deterrents as well as encouragement to the uptake of simulation as a teaching methodology in healthcare education in developing countries. Design The MEDLINE (via OVID, using keywords and MeSH in OVID), and PubMed (via NCBI using MeSH), and CINAHL databases were searched between January 2000 and January 2024 for research articles published in peer reviewed English language journals using a combination of keywords. Results A total of 48 articles were included in the final analysis. Challenges and opportunities were divided into professional, academic, and resource-based factors, and their individual sub-themes. The main challenges reported were the lack of a contextual curriculum, content heavy curricula, dearth of trained simulationists and cost of simulators. Performance anxiety was an important challenge reported by both trainers and trainees. Main opportunities were an interest in adopting simulation-based education from both trainers and trainees, and the opportunity to improve patient safety and quality of education. Other findings were that academic leadership and faculty show interest and urgency to adopt simulation in curricula and allocate funds for this. Facilitators need to be provided with protected time to become simulationists. Local manufacturers need to be sourced for simulators, and transfer of technology and expertise needs to be negotiated. Conclusion Simulation needs to be looked at from the lens of not only education, but more importantly of patient safety in developing countries to allow simulation-based education to be mainstreamed in health professions education in low- and middle-income contexts.
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Affiliation(s)
- Faisal W Ismail
- Centre for innovation and Medical Education, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Khairulnissa Ajani
- Department of Nursing, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Syed Mujtaba Baqir
- Department of Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Ahmed Nadeem
- Department of Medicine, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Rayyan Qureshi
- Medical College, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Pammla Petrucka
- Department of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Afulani PA, Getahun M, Ongeri L, Aborigo R, Kinyua J, Ogolla BA, Okiring J, Moro A, Oluoch I, Dalaba M, Odiase O, Nutor J, Mendes WB, Walker D, Neilands TB. A cluster randomized controlled trial to assess the impact of the 'Caring for Providers to Improve Patient Experience' intervention on person-centered maternity care in Kenya and Ghana: Study Protocol. RESEARCH SQUARE 2024:rs.3.rs-4344678. [PMID: 38766153 PMCID: PMC11100884 DOI: 10.21203/rs.3.rs-4344678/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Poor person-centered maternal care (PCMC) contributes to high maternal mortality and morbidity, directly and indirectly, through lack of, delayed, inadequate, unnecessary, or harmful care. While evidence on poor PCMC prevalence, as well as inequities, expanded in the last decade, there is still a significant gap in evidence-based interventions to address PCMC. We describe the protocol for a trial to test the effectiveness of the "Caring for Providers to Improve Patient Experience" (CPIPE) intervention, which includes five strategies for provider behavior change, targeting provider stress and bias as intermediate factors to improve PCMC and to address inequities. Methods The trial will assess the effect of CPIPE on PCMC, as well as on intermediate and distal outcomes, using a two-arm cluster randomized controlled trial in 40 health facilities in Migori and Homa Bay Counties in Kenya and Upper East and Northeast Regions in Ghana. Twenty facilities in each country will be randomized to 10 intervention and 10 control sites. The primary intervention targets are all healthcare workers who provide maternal health services. The intervention impact will also be assessed first among providers, and then among women who give birth in health facilities. The primary outcome is PCMC measured with the PCMC scale, via multiple cross-sectional surveys of mothers who gave birth in the preceding 12 weeks in study facilities at baseline (prior to the intervention), midline (6 months after intervention start), and endline (12 months post-baseline) (N = 2000 across both countries at each time point). Additionally, 400 providers in the study facilities across both countries will be followed longitudinally at baseline, midline, and endline, to assess intermediate outcomes. The trial incorporates a mixed-methods design; survey data alongside in-depth interviews (IDIs) with healthcare facility leaders, providers, and mothers to qualitatively explore factors influencing the outcomes. Finally, we will collect process and cost data to assess intervention fidelity and cost-effectiveness. Discussion This trial will be the first to rigorously assess an intervention to improve PCMC that addresses both provider stress and bias and will advance the evidence base for interventions to improve PCMC and contribute to equity in maternal and neonatal health.
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Afulani PA, Oboke EN, Ogolla BA, Getahun M, Kinyua J, Oluoch I, Odour J, Ongeri L. Caring for providers to improve patient experience (CPIPE): intervention development process. Glob Health Action 2023; 16:2147289. [PMID: 36507905 PMCID: PMC9754039 DOI: 10.1080/16549716.2022.2147289] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022] Open
Abstract
A growing body of research has documented disrespectful, abusive, and neglectful treatment of women in facilities during childbirth, as well as the drivers of such mistreatment. Yet, little research exists on effective interventions to improve Person-Centred Maternal Care (PCMC)-care that is respectful and responsive to individual women's preferences, needs, and values. We sought to extend knowledge on interventions to improve PCMC, with a focus on two factors - provider stress and implicit bias - that are driving poor PCMC and contributing to disparities in PCMC. In this paper we describe the process towards the development of the intervention. The intervention design was an iterative process informed by existing literature, behaviour change theory, formative research, and continuous feedback in consultation with key stakeholders. The intervention strategies were informed by the Social Cognitive Theory, Trauma Informed System framework, and the Ecological Perspective. This process resulted in the 'Caring for Providers to Improve Patient Experience (CPIPE)' intervention, which has 5 components: provider training, peer support, mentorship, embedded champions, and leadership engagement. The training includes didactic and interactive content on PCMC, stress, burnout, dealing with difficult situations, and bias, with some content integrated into emergency obstetric and neonatal care (EmONC) simulations to enable providers apply concepts in the context of managing an emergency. The other components create an enabling environment for ongoing individual behavior and facility culture change. The pilot study is being implemented in Migori County, Kenya. The CPIPE intervention is an innovative theory and evidence-based intervention that addresses key drivers of poor PCMC and centers the unique needs of vulnerable women as well as that of providers. This intervention will advance the evidence base for interventions to improve PCMC and has great potential to improve equity in PCMC and maternal and neonatal health.
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Affiliation(s)
- Patience A. Afulani
- Epidemiology and Biostatistics Department, University of California, San Francisco (UCSF), San Francisco, CA, USA
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco CA, USA
| | - Edwina N. Oboke
- Research Department, Global Programs for Research and Training, Nairobi, Kenya
| | - Beryl A. Ogolla
- Research Department, Global Programs for Research and Training, Nairobi, Kenya
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco CA, USA
| | - Joyceline Kinyua
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - James Odour
- Migori County Referral Hospital, Migori, Kenya
| | - Linnet Ongeri
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
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van Tetering AAC, Ntuyo P, Martens RPJ, Winter N, Byamugisha J, Oei SG, Fransen AF, van der Hout-van der Jagt MB. Simulation-Based Training in Emergency Obstetric Care in Sub-Saharan and Central Africa: A Scoping Review. Ann Glob Health 2023; 89:62. [PMID: 37780839 PMCID: PMC10540704 DOI: 10.5334/aogh.3891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/24/2023] [Indexed: 10/03/2023] Open
Abstract
Background Every day approximately 810 women die from complications related to pregnancy and childbirth worldwide. Around two thirds of these deaths happen in sub-Saharan Africa. One of the strategies to decrease these numbers is improving the quality of care by emergency obstetric simulation-based training. The effectiveness of such training programs depends on the program's instructional design. Objective This review gives an overview of studies about emergency obstetric simulation-based training and examines the applied instructional design of the training programs in sub-Saharan and Central Africa. Methods We searched Medline, Embase and Cochrane Library from inception to May 2021. Peer-reviewed articles on emergency obstetric, postgraduate, simulation-based training in sub-Saharan and Central Africa were included. Outcome measures were categorized based on Kirkpatrick's levels of training evaluation. The instructional design was evaluated by using the ID-SIM questionnaire. Findings In total, 47 studies met the inclusion criteria. Evaluation on Kirkpatrick level 1 showed positive reactions in 18 studies. Challenges and recommendations were considered. Results on knowledge, skills, and predictors for these results (Kirkpatrick level 2) were described in 29 studies. Retention as well as decay of knowledge and skills over time were presented. Results at Kirkpatrick level 3 were measured in 12 studies of which seven studies demonstrated improvements of skills on-the-job. Improvements of maternal and neonatal outcomes were described in fifteen studies and three studies reported on cost-estimations for training rollout (Kirkpatrick level 4). Instructional design items were heterogeneously applied and described. Conclusions Results of 47 studies indicate evidence that simulation-based training in sub-Saharan and Central Africa can have a positive impact across all four levels of Kirkpatrick's training evaluation model. However, results were not consistent across all studies and the effects vary over time. A detailed description of instructional design features in future publications on simulation-based training will contribute to a deeper understanding of the underlying mechanisms that determine why certain training programs are more effective in improving maternal and neonatal healthcare outcomes than other.
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Affiliation(s)
- Anne A. C. van Tetering
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, NL
- Department of Obstetrics and Gynaecology, Amphia Hospital, Breda, NL
| | - Peter Ntuyo
- Department of Obstetrics and Gynaecology, Mulago Specialised Women and Neonatal Hospital, UG
| | | | - Naomi Winter
- Department of Obstetrics and Gynaecology, St. Antonius Hospital, Utrecht, NL
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, UG
| | - S. Guid Oei
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, NL
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, NL
| | | | - M. Beatrijs van der Hout-van der Jagt
- Department of Obstetrics and Gynaecology, Máxima Medical Center, Veldhoven, NL
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, NL
- Department of Biomedical Engineering Eindhoven University of Technology, Eindhoven, NL
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Baayd J, Lloyd M, Garcia G, Smith S, Sylvester H, Clark E, Cross B, Gero A, Cohen S. Catalyzing Collaboration Among Interprofessional Birth Transfer Teams Through Simulation. J Midwifery Womens Health 2023; 68:458-465. [PMID: 37114662 DOI: 10.1111/jmwh.13497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 02/13/2023] [Accepted: 03/06/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Planned home or birth center births sometimes require emergency transfers to a hospital. Poor communication among members of the birth care team during a transfer can lead to unfavorable outcomes for the birthing person and newborn. To improve the quality of birth transfers in Utah, the Utah Women and Newborns Quality Collaborative partnered with the LIFT Simulation Design Lab to develop and pilot an interprofessional birth transfer simulation training. METHODS We engaged community stakeholders to identify learning objectives and co-design the simulation trainings using principles of participatory design. We conducted 5 simulation trainings featuring birth transfers during a postpartum hemorrhage. The LIFT Lab evaluated the trainings to determine if they were feasible, acceptable, and effective. Measures included a post-training form asking participants to evaluate the quality of the training and a 9-question pre- and post-training survey measuring changes in participants' self-efficacy regarding components of birth transfer. The changes were assessed for significance using a paired t test. RESULTS A total of 102 participants attended the 5 trainings; all health care provider groups were well represented. Most participants felt the simulations were similar to real situations and would benefit others in their professions. All participants said the trainings were a good use of their time. Following the training, participants had significantly higher levels of self-efficacy regarding their ability to manage birth transfers. DISCUSSION Birth transfer simulation trainings are an acceptable, feasible, and effective method for training interprofessional birth care teams.
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Affiliation(s)
- Jami Baayd
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
| | - Mikelle Lloyd
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
| | - Gabriela Garcia
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
| | | | | | - Erin Clark
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
| | - Brett Cross
- Handtevy Pediatric Emergency Standards, Inc., Davie, Florida
| | - Alexandra Gero
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
| | - Susanna Cohen
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake, Utah
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Watt MH, Minja LM, Barabara M, Mlay P, Stephens MJ, Olomi G, Mlay J, Marchand V, Mmbaga BT, Hanson OR, Cohen SR. A simulation and experiential learning intervention for labor and delivery providers to address HIV stigma during childbirth in Tanzania: study protocol for the evaluation of the MAMA intervention. BMC Pregnancy Childbirth 2023; 23:181. [PMID: 36927460 PMCID: PMC10018883 DOI: 10.1186/s12884-023-05482-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The experience of HIV stigma during intrapartum care can impact women's trust in the health care system and undermine their long-term commitment to HIV care engagement. Delivery of respectful maternity care (RMC) to women living with HIV (WLHIV) can improve quality of life and clinical outcomes. The goal of this study is to conduct an evaluation of MAMA (Mradi wa Afya ya Mama Mzazi, Project to Support the Health of Women Giving Birth), a simulation team-training curriculum for labor and delivery providers that addresses providers' instrumental and attitudinal stigma toward WLHIV and promotes the delivery of evidence-based RMC for WLHIV. METHODS The MAMA intervention will be evaluated among healthcare providers across six clinics in the Kilimanjaro Region of Tanzania. To evaluate the impact of MAMA, we will enroll WLHIV who give birth in the facilities before (n = 103 WLHIV) and after (n = 103 WLHIV) the intervention. We will examine differences in the primary outcome (perceptions of RMC) and secondary outcomes (postpartum HIV care engagement; perceptions of HIV stigma in the facility; internal HIV stigma; clinical outcomes and evidence-based practices) between women enrolled in the two time periods. Will also assess participating providers (n = 60) at baseline, immediate post, 1-month post training, and 2-month post training. We will examine longitudinal changes in the primary outcome (practices of RMC) and secondary outcomes (stigma toward WLHIV; self-efficacy in delivery intrapartum care). Quality assurance data will be collected to assess intervention feasibility and acceptability. DISCUSSION The implementation findings will be used to finalize the intervention for a train-the-trainer model that is scalable, and the outcomes data will be used to power a multi-site study to detect significant differences in HIV care engagement. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov, NCT05271903.
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Affiliation(s)
- Melissa H. Watt
- grid.223827.e0000 0001 2193 0096Intermountain Healthcare, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake, UT 84102 USA
| | - Linda M. Minja
- grid.412898.e0000 0004 0648 0439Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Mariam Barabara
- grid.412898.e0000 0004 0648 0439Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Pendo Mlay
- grid.415218.b0000 0004 0648 072XDepartment of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania
| | - Maya J. Stephens
- grid.223827.e0000 0001 2193 0096Intermountain Healthcare, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake, UT 84102 USA
| | | | - Janeth Mlay
- grid.412898.e0000 0004 0648 0439Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Virginie Marchand
- grid.26009.3d0000 0004 1936 7961School of Medicine, Duke University, Durham NC, USA
| | - Blandina T. Mmbaga
- grid.412898.e0000 0004 0648 0439Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Olivia R. Hanson
- grid.223827.e0000 0001 2193 0096Intermountain Healthcare, Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake, UT 84102 USA
| | - Susanna R. Cohen
- grid.223827.e0000 0001 2193 0096Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT USA
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Dhakal P, Newnham E, Debra K Creedy E, Gamble J. Upskilling nursing students in Nepal: Evaluation of an online education module for promoting respectful maternity care. Midwifery 2023; 117:103576. [PMID: 36527772 DOI: 10.1016/j.midw.2022.103576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore Nepalese nursing student...s evaluation of an online education module on respectful maternity care. DESIGN Cross-sectional study. SETTING A medical college in Chitwan, Nepal. PARTICIPANTS Forty third-year undergraduate nursing students. METHODS Over a three-week time frame, students undertook three, two-hour online education sessions about respectful maternity care. Students were then invited to complete a purposely designed evaluation survey with 13 Likert-scale and yes/no items, and eight open-ended questions about the quality, relevance, impact, and areas for improvement of the education module. Responses were analysed using descriptive statistics and qualitative thematic analysis. FINDINGS Students considered the education module to be useful and informative about respectful maternity care. More than half (60%) of the students agreed that the online delivery was more convenient than face-to-face, and learning was equivalent to a traditional class (87.5%). Most students (92.5%) reported that respectful maternity care is not explicitly covered in their degree. Students recommended that respectful maternity care be included in the curriculum and similar education offered to staff and women. Three themes from open-ended questions revealed: 1) empowerment through respectful maternity care; 2) motivation to initiate change; and 3) becoming a respectful clinician. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Respect is essential in all areas of maternity care for improved experiences and outcomes for women and babies. Participants considered that the brief intervention improved their understanding of respectful maternity care and were inspired to implement change in their own practice to be more respectful to women. Curricula in all Nepalese institutions that offer preregistration education should customarily include respectful maternity care. Further research about respectful maternity care from the standpoint of women, educators, students, and maternity care providers in Nepal is required.
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Affiliation(s)
- Prativa Dhakal
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Elizabeth Newnham
- School of Nursing and Midwifery, University of Newcastle, New South Wales, Australia; Transforming Maternity Care Collaborative
| | - Em Debra K Creedy
- School of Nursing and Midwifery, University of Newcastle, New South Wales, Australia; Transforming Maternity Care Collaborative
| | - Jenny Gamble
- Transforming Maternity Care Collaborative; Professor, School of Nursing, Midwifery and Allied Health, Coventry University, United Kingdom
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Watt MH, Cohen SR, Minja LM, Barabara M, Mlay P, Stephens MJ, Olomi G, Mlay J, Marchand V, Mmbaga BT. A simulation and experiential learning intervention for labor and delivery providers to address HIV stigma during childbirth in Tanzania: Study protocol for the evaluation of the MAMA intervention. RESEARCH SQUARE 2023:rs.3.rs-2285235. [PMID: 36778232 PMCID: PMC9915785 DOI: 10.21203/rs.3.rs-2285235/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background : The experience of HIV stigma during intrapartum care can impact women's trust in the health care system and undermine their long-term commitment to HIV care engagement. Delivery of respectful maternity care (RMC) to WLHIV can improve quality of life and clinical outcomes. The goal of this study is to conduct an evaluation of MAMA (Mradi wa Afya ya Mama Mzazi, Project to Support the Health of Women Giving Birth), a simulation team-training curriculum for labor and delivery providers that addresses providers' instrumental and attitudinal stigma toward WLHIV and promotes the delivery of evidence-based RMC for WLHIV. Methods : The MAMA intervention will be evaluated among healthcare providers across six clinics in the Kilimanjaro Region of Tanzania. To evaluate the impact of MAMA, we will enroll WLHIV who give birth in the facilities before (n=103 WLHIV) and after (n=103 WLHIV) the intervention. We will examine differences in the primary outcome (perceptions of RMC) and secondary outcomes (postpartum HIV care engagement; perceptions of HIV stigma in the facility; internal HIV stigma; clinical outcomes and evidence-based practices) between women enrolled in the two time periods. Will also assess participating providers (n=60) at baseline, immediate post, 1-month post training, and 2-month post training. We will examine longitudinal changes in the primary outcome (practices of RMC) and secondary outcomes (stigma toward WLHIV; self-efficacy in delivery intrapartum care). Quality assurance data will be collected to assess intervention feasibility and acceptability. Discussion : The implementation findings will be used to finalize the intervention for a train-the-trainer model that is scalable, and the outcomes data will be used to power a multi-site study to detect significant differences in HIV care engagement. Trial Registration : The trial is registered at clinicaltrials.gov, NCT05271903.
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Bourret K, Mattison C, Hebert E, Kabeya A, Simba S, Crangle M, Darling E, Robinson J. Evidence-informed framework for gender transformative continuing education interventions for midwives and midwifery associations. BMJ Glob Health 2023; 8:bmjgh-2022-011242. [PMID: 36634981 PMCID: PMC9843202 DOI: 10.1136/bmjgh-2022-011242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/23/2022] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Continuing education for midwives is an important investment area to improve the quality of sexual and reproductive health services. Interventions must take into account and provide solutions for the systemic barriers and gender inequities faced by midwives. Our objective was to generate concepts and a theoretical framework of the range of factors and gender transformative considerations for the development of continuing education interventions for midwives. METHODS A critical interpretive synthesis complemented by key informant interviews, focus groups, observations and document review was applied. Three electronic bibliographic databases (CINAHL, EMBASE and MEDLINE) were searched from July 2019 to September 2020 and were again updated in June 2021. A coding structure was created to guide the synthesis across the five sources of evidence. RESULTS A total of 4519 records were retrieved through electronic searches and 103 documents were included in the critical interpretive synthesis. Additional evidence totalled 31 key informant interviews, 5 focus groups (Democratic Republic of Congo and Tanzania), 24 programme documents and field observations in the form of notes. The resulting theoretical framework outlines the key considerations including gender, the role of the midwifery association, political and health systems and external forces along with key enabling elements for the design, implementation and evaluation of gender transformative continuing education interventions. CONCLUSION Investments in gender transformative continuing education for midwives, led by midwifery associations, can lead to the improvement of midwifery across all United Nations' target areas including governance, health workforce, health system arrangements and education.
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Affiliation(s)
- Kirsty Bourret
- Women and Children's Health, Karolinska Institute, Stockholm, Sweden .,McMaster Midwifery Research Center, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Cristina Mattison
- Women and Children's Health, Karolinska Institute, Stockholm, Sweden,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Emmanuelle Hebert
- Bureau des relations internationales, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Ambrocckha Kabeya
- Société Congolaise de la Pratique Sage-femme, Kinshasa, Democratic Republic of the Congo
| | - Stephano Simba
- Tanzania Midwives Association (TAMA), Dar es Salaam, United Republic of Tanzania
| | - Moya Crangle
- Canadian Association of Midwives, Montreal, Quebec, Canada
| | - Elizabeth Darling
- Obstetrics and Gynecology, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Jamie Robinson
- Canadian Association of Midwives, Montreal, Quebec, Canada
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Tavares W, Piquette D, Luong D, Chiu M, Dyte C, Fraser K, Clark M. Exploring the Study of Simulation as a Continuing Professional Development Strategy for Physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 43:188-197. [PMID: 36728972 DOI: 10.1097/ceh.0000000000000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Practicing physicians have the responsibility to engage in lifelong learning. Although simulation is an effective experiential educational strategy, physicians seldom select it for continuing professional development (CPD) for reasons that are poorly understood. The objective of this study was to explore existing evidence on simulation-based CPD and the factors influencing physicians' engagement in simulation-based CPD. METHODS A scoping review of the literature on simulation-based CPD included MEDLINE, Embase, and CINAHL databases. Studies involving the use of simulation for practicing physicians' CPD were included. Information related to motivations for participating in simulation-based CPD, study objectives, research question(s), rationale(s), reasons for using simulation, and simulation features was abstracted. RESULTS The search yielded 8609 articles, with 6906 articles undergoing title and abstract screening after duplicate removal. Six hundred sixty-one articles underwent full-text screening. Two hundred twenty-five studies (1993-2021) were reviewed for data abstraction. Only four studies explored physicians' motivations directly, while 31 studies described incentives or strategies used to enroll physicians in studies on simulation-based CPD. Most studies focused on leveraging or demonstrating the utility of simulation for CPD. Limited evidence suggests that psychological safety, direct relevance to clinical practice, and familiarity with simulation may promote future engagement. DISCUSSION Although simulation is an effective experiential educational method, factors explaining its uptake by physicians as a CPD strategy are unclear. Additional evidence of simulation effectiveness may fail to convince physicians to participate in simulation-based CPD unless personal, social, educational, or contextual factors that shape physicians' motivations and choices to engage in simulation-based CPD are explored.
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Affiliation(s)
- Walter Tavares
- Dr. Tavares: Assistant Professor and Scientist, Wilson Centre for Health Professions Education, Temerty Faculty of Medicine, Institute for Health Policy Management and Evaluation, University Health Network, University of Toronto, Toronto, Ontario, Canada, and York Region Paramedic and Senior Services, Community Health Services Department, Regional Municipality of York, Newmarket Ontario, Canada. Dr. Piquette: Assistant Professor, Inter-Department Division of Critical Care Medicine, University of Toronto, Staff Physician, Sunnybrook Health Sciences Centre, Centre Researcher, The Wilson Centre, Toronto, Ontario, Canada. Ms. Luong: Research Associate II, KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. Dr. Chiu: Associate Professor, Department of Anesthesiology and Pain Medicine, Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada. Dr. Dyte: Clinical Lecturer and Anesthesiologist, Department of Anesthesia, Perioperative and Pain Medicine, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Fraser: Clinical Professor of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. Dr. Clark: Clinical Associate Professor of Surgery, Cumming School of Medicine University of Calgary, Calgary, Alberta, Canada
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Diamond-Smith N, Lin S, Peca E, Walker D. A landscaping review of interventions to promote respectful maternal care in Africa: Opportunities to advance innovation and accountability. Midwifery 2022; 115:103488. [PMID: 36191382 DOI: 10.1016/j.midw.2022.103488] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In the past decade, global recognition of the need to address disrespect and abuse (also described as mistreatment of women) and promote respectful maternal care in facility-based childbirth has increased. While many studies have documented gaps in respectful maternal care, little is known about the design and implementation of these interventions. Our aim was to summarize and describe respectful maternal care -promoting interventions during childbirth implemented in Africa. DESIGN We identified respectful maternal care -promoting interventions in Africa through a rapid scoping of peer-reviewed articles and gray literature, and a crowdsourcing survey distributed through stakeholder networks. SETTING Africa PARTICIPANTS: NA MEASUREMENTS AND FINDINGS: We identified 43 unique interventions implemented in 16 African countries, gathered from a crowdsourcing survey, gray and published literature between 2010 and 2020. Most interventions were implemented in East Africa (N = 13). The interventions had various targets and were categorized into nine approaches, 60% of interventions focused on training providers about respectful maternal care and practice. About two thirds included multiple intervention approaches, and about two thirds addressed respectful maternal care beyond the period of childbirth. Few publications presented data on the effectiveness of the intervention, and those that did used a wide variety of indicators. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE There is a reliance on provider training approaches to promote respectful maternal care and there are few examples of either engaging women in the community or adopting social accountability approaches. We encourage implementors to develop interventions targeting multiple approaches beyond provider training and consider delivery across pre-pregnancy, pregnancy, birth, and the postnatal periods. Finally, in order to effectively move from documenting respectful maternal care gaps to action and scale, we need global consensus on common indicators and measures of effectiveness for interventions promoting respectful care across the life course.
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Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Sunny Lin
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America.
| | - Emily Peca
- University Research Co., LLC., Chevy Chase, Maryland, United States of America
| | - Dilys Walker
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States of America
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Chou WK, Ullah N, Arjomandi Rad A, Vardanyan R, Shah V, Zubarevich A, Weymann A, Shah N, Miller G, Malawana J. Simulation training for obstetric emergencies in low- and lower-middle income countries: A systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 276:74-81. [PMID: 35820293 DOI: 10.1016/j.ejogrb.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This review aims to systematically evaluate the currently available evidence investigating the effectiveness of simulation-based training (SBT) in emergency obstetrics care (EmOC) in Low- and Lower-Middle Income Countries (LMIC). Furthermore, based on the challenges identified we aim to provide a series of recommendations and a knowledge base for future research in the field. METHODS A systematic database search was conducted of original articles that explored the use of simulation-based training for EmOC in LMIC in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to January 2022. RESULTS The literature search identified 1,957 articles of which a total of 15 studies were included in this review, featuring 8,900 healthcare professionals from 18 countries. The SBT programmes varied in the reviewed studies. The most common training programme consisted of the PRONTO programme implemented by four studies, comprising of 970 participants across four different countries. In general, programmes consisted of lectures, workshops and simulations of emergency obstetric scenarios followed by a debrief of participants. There were thirteen studies, comprising of 8,332 participants, which tested for improvements in clinical knowledge in post-partum haemorrhage, neonatal resuscitation, pre-eclampsia, shoulder dystocia and sepsis. All the included studies reported improvements in clinical knowledge following the simulation of scenarios. Changes in teamwork, improvement in leadership and in communication skills were also widely reported. CONCLUSION The use of SBT programmes is not only sustainable, feasible and acceptable in LMIC, but could also improve clinical knowledge, communication, and teamwork among healthcare providers, thus directly addressing the UN Sustainable Development Goals.
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Affiliation(s)
- Wing Kiu Chou
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Nazifa Ullah
- Faculty of Medicine, University College London, London, United Kingdom
| | - Arian Arjomandi Rad
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom; Research Unit, The Healthcare Leadership Academy, London, United Kingdom.
| | - Robert Vardanyan
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom; Research Unit, The Healthcare Leadership Academy, London, United Kingdom
| | - Viraj Shah
- Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Alina Zubarevich
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Nishel Shah
- Faculty of Medicine, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - George Miller
- Research Unit, The Healthcare Leadership Academy, London, United Kingdom; Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, United Kingdom
| | - Johann Malawana
- Research Unit, The Healthcare Leadership Academy, London, United Kingdom; Centre for Digital Health and Education Research (CoDHER), University of Central Lancashire Medical School, Preston, United Kingdom
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Dhakal P, Creedy DK, Gamble J, Newnham E, McInnes R. Effectiveness of an online education intervention to enhance student perceptions of Respectful Maternity Care: A quasi-experimental study. NURSE EDUCATION TODAY 2022; 114:105405. [PMID: 35598456 DOI: 10.1016/j.nedt.2022.105405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/26/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Childbearing women's relationship with maternity care providers enhance childbirth outcomes. Students need to understand and offer respectful care. OBJECTIVE Evaluate effectiveness and impact of an online education intervention on nursing students' perceptions towards respectful maternity care during labour and childbirth in Nepal. DESIGN A quasi-experimental pre-post design was used. PARTICIPANTS A total of 89 Third Year Bachelor of Nursing students (intervention n = 40; control n = 49) from three participating colleges. METHODS Students completed online pre and post-test surveys using the Students' Perceptions of Respectful Maternity Care scale and questions about impact of the intervention. The intervention group received six hours of education delivered online (three sessions x three weeks). ANCOVA and non-parametric Wilcoxon signed-rank tests measured effects. RESULTS Compared to controls, students in the intervention group reported a significant increase in perceptions towards respectful maternity care (F (1, 86) = 28.19, p < 0.001, ηp2 = 0.25). Participants reported a good understanding of respectful maternity care (75%), positive views about providing such care (82.5%), and a desire to use their new knowledge in practice (65%). CONCLUSION Relatively few intervention studies to promote respectful maternity care in students have been published. This brief online intervention improved students' perceptions. The intervention package can be integrated into nursing or midwifery curricula and in-service training. A larger study with longer follow-up is needed to support current findings.
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Affiliation(s)
- Prativa Dhakal
- School of Nursing and Midwifery, Griffith University, Logan Campus, University Drive, Meadowbrook 4131, Queensland, Australia.
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, Australia; Transforming Maternity Care Collaborative, Australia.
| | - Jenny Gamble
- Transforming Maternity Care Collaborative, Australia; School of Nursing, Midwifery and Allied Health, Coventry University, United Kingdom.
| | - Elizabeth Newnham
- School of Nursing and Midwifery, University of Newcastle, Australia.
| | - Rhona McInnes
- School of Nursing and Midwifery, Griffith University, Australia.
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Dhakal P, Creedy DK, Gamble J, Newnham E, McInnes R. Educational interventions to promote respectful maternity care: A mixed-methods systematic review. Nurse Educ Pract 2022; 60:103317. [DOI: 10.1016/j.nepr.2022.103317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
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Development and Simulation of Cyberdisaster Situation Awareness Models. SUSTAINABILITY 2022. [DOI: 10.3390/su14031133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Cyberdisasters require an organization’s disaster team to be prepared. Disaster events are difficult to predict, but the impact of this risk on an organization is large. However, organizations sometimes struggle in being prepared for disaster situations. Here, awareness of disaster situations when analysing priority disasters (e.g., earthquakes and pandemics) and how to mitigate them can help an organization’s preparedness. Mitigation scenarios need to be determined and simulated so that a disaster team is ready to face disaster. Using Endsley’s situational awareness model and a tabletop exercise, this study aimed to help a disaster team determine cyberdisaster risk priority and assess a team’s preparedness for dealing with a cyberdisaster. The situation awareness model was divided into two stages: awareness of cyberdisaster situations and tabletop evaluations. Awareness of a disaster situation was carried out by determining the highest priority for disaster risk using the fuzzy failure modes and effects analysis (FMEA) method. The results of the first study show that the high-risk category contains ransomware attacks during pandemics and earthquakes. The second study performed a tabletop simulation questionnaire survey of earthquakes and ransomware attacks during a pandemic for several disaster teams with 152 respondents. The results of the survey evaluation of the earthquakes and ransomware attacks simulation survey show that the effect factors of cyberdisaster simulation decisions are 95% system capability (p < 0.05), 90% knowledge (p < 0.05), and 90% awareness of a disaster situation (p < 0.05); these factors show the effect of a disaster team’s decision during a tabletop simulation. The novelty of this research lies in building a model for how an organizational process determines the priority of a cyberdisaster tabletop simulation and the factors that contribute to increasing a disaster team’s awareness in dealing with cyberattacks.
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Afulani PA, Aborigo RA, Nutor JJ, Okiring J, Kuwolamo I, Ogolla BA, Oboke EN, Dorzie JBK, Odiase OJ, Steinauer J, Walker D. Self-reported provision of person-centred maternity care among providers in Kenya and Ghana: scale validation and examination of associated factors. BMJ Glob Health 2021; 6:bmjgh-2021-007415. [PMID: 34853033 PMCID: PMC8638154 DOI: 10.1136/bmjgh-2021-007415] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 11/18/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Person-centred maternity care (PCMC), which refers to care that is respectful and responsive to women's preferences needs, and values, is core to high-quality maternal and child health. Provider-reported PCMC provision is a potentially valid means of assessing the extent of PCMC and contributing factors. Our objectives are to assess the psychometric properties of a provider-reported PCMC scale, and to examine levels and factors associated with PCMC provision. METHODS We used data from two cross-sectional surveys with 236 maternity care providers from Ghana (n=150) and Kenya (n=86). Analysis included factor analysis to assess construct validity and Cronbach's alpha to assess internal consistency of the scale; descriptive analysis to assess extent of PCMC and bivariate and multivariable linear regression to examine factors associated with PCMC. FINDINGS The 9-item provider-reported PCMC scale has high construct validity and reliability representing a unidimensional scale with a Cronbach's alpha of 0.72. The average standardised PCMC score for the combined sample was 66.8 (SD: 14.7). PCMC decreased with increasing report of stress and burnout. Compared with providers with no burnout, providers with burnout had lower average PCMC scores (β: -7.30, 95% CI:-11.19 to -3.40 for low burnout and β: -10.86, 95% CI: -17.21 to -4.51 for high burnout). Burnout accounted for over half of the effect of perceived stress on PCMC. CONCLUSION The provider PCMC scale is a valid and reliable measure of provider self-reported PCMC and highlights inadequate provision of PCMC in Kenya and Ghana. Provider burnout is a key driver of poor PCMC that needs to be addressed to improve PCMC.
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Affiliation(s)
- Patience A Afulani
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, USA .,Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA.,Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | | | - Jerry John Nutor
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, California, USA
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Beryl A Ogolla
- Global Programs for Research and Programs, Nairobi, Kenya
| | - Edwina N Oboke
- Global Programs for Research and Programs, Nairobi, Kenya
| | | | - Osamuedeme J Odiase
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jody Steinauer
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Dilys Walker
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
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Das R, Farzana FD, Sultana Z, Mukherji K, Baayo A, Sultana M, Ali N, Chisti MJ, Sarker SA, Ahmed T, Faruque A. Evaluation of SIMESON, a training program to improve access to quality health care for pregnant women and newborn in different healthcare facilities of northern Bangladesh. Nurs Open 2021; 9:801-815. [PMID: 34784452 PMCID: PMC8685868 DOI: 10.1002/nop2.1131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/21/2021] [Accepted: 10/31/2021] [Indexed: 01/02/2023] Open
Abstract
Aim The study aims to explore the current knowledge and skills of healthcare providers already trained by SIMESON (simulation for essential skills for obstetrical and neonatal care), in reviewing perinatal health situations including current status of healthcare facilities and cost estimation. Design It was an observational study. Methods Cost estimation following both quantitative and qualitative approaches was also attempted. Result Knowledge and skills of 88 healthcare providers about the provision of normal delivery and immediate postpartum care, management of postpartum haemorrhage (PPH), retained placenta and use of bag and mask ventilation to help a baby breathe were found to be considerably strengthened following SIMESON training. During the 6 months after training, there were 477 PPH cases managed successfully with only one death; neonatal deaths observed were 6.6/1,000 live births; twice the number of facility deliveries; and 80% use rate of Ambu bag for helping baby breathe. The estimated cost per trainee was 395.68 USD, and 5.85 USD per beneficiary.
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Affiliation(s)
- Rina Das
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Fahmida Dil Farzana
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Zakia Sultana
- Terre des hommes foundation (Tdh), Dhaka, Bangladesh
| | | | - Adnan Baayo
- Terre des hommes foundation (Tdh), Dhaka, Bangladesh
| | - Marufa Sultana
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Nausad Ali
- Bangladesh Institute of Development Studies, Dhaka, Bangladesh
| | | | - Shafiqul Alam Sarker
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
| | - Asg Faruque
- International Centre for Diarrhoeal Disease Research (icddr,b), Dhaka, Bangladesh
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Ahn B, Mupere E, Irarrázaval B, Opoka RO, Aanyu-Tukamuhebwa H, Bills CB, Gingo D, Glomb NW. Qualitative needs assessment for paediatric emergency care in Kampala, Uganda. Afr J Emerg Med 2021; 11:277-282. [PMID: 33898211 PMCID: PMC8058529 DOI: 10.1016/j.afjem.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/14/2021] [Accepted: 03/07/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Acute childhood illnesses, such as malaria, pneumonia, and diarrhoea, represent the leading causes of under-five mortality in Uganda. Given that most early child deaths are treatable with timely interventions, emergency units dedicated to paediatric populations have been established in the country. In light of recent developments, the department of paediatrics at Makerere University requested a needs assessment in the paediatric acute care unit (PACU) at Mulago National Referral Hospital, which could guide the development of a new training curriculum for medical providers. Methods We administered a survey for medical providers working in the PACU at Mulago Hospital, which assessed their self-rated comfort levels with paediatric assessment, treatment, and teamwork skills. We also conducted focus groups with a smaller subset of medical providers to understand barriers and facilitators to paediatric emergency and critical care. Results Of 35 paediatric assessment, treatment, and teamwork skills, 29 (83%) questions had the median comfort rating of 6 or 7 on a 7-point Likert scale. The remaining 6 (17%) skills had a median comfort rating of 5 or lower. Focus groups identified a number of major barriers to caring for critically ill children, including limited resources and staffing, training gaps, and challenges with interprofessional teamwork. In terms of training development, focus group participants suggested continuous training for all medical providers working in the PACU led by local leaders. Discussion This study identified the need and desirability of continuous trainings in the PACU. Key components include objective skills assessment, simulation-based scenarios, and interprofessional teamwork. Training development should be augmented by increases in resources, staffing, and training opportunities in collaboration with the Uganda Ministry of Health.
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Affiliation(s)
- Boyoung Ahn
- University of California, San Francisco, Institute for Global Health Sciences, San Francisco, CA, USA
- Corresponding author.
| | - Ezekiel Mupere
- Makerere University, College of Health Sciences, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Belén Irarrázaval
- University of California, San Francisco, Institute for Global Health Sciences, San Francisco, CA, USA
| | - Robert O. Opoka
- Makerere University, College of Health Sciences, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Hellen Aanyu-Tukamuhebwa
- Makerere University, College of Health Sciences, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Corey B. Bills
- University of Colorado, School of Medicine, Department of Emergency Medicine, Denver, CO, USA
| | - Dorothy Gingo
- Makerere University, College of Health Sciences, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Nicolaus W. Glomb
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, CA, USA
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Lippke S, Derksen C, Keller FM, Kötting L, Schmiedhofer M, Welp A. Effectiveness of Communication Interventions in Obstetrics-A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2616. [PMID: 33807819 PMCID: PMC7967656 DOI: 10.3390/ijerph18052616] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 01/13/2023]
Abstract
(1) Background: Obstetric work requires good communication, which can be trained through interventions targeting healthcare providers and pregnant women/patients. This systematic review aims to aggregate the current state of research on communication interventions in obstetrics. (2) Methods: Using the PICOS scheme, we searched for studies published in peer-reviewed journals in English or German between 2000 and 2020. Out of 7018 results, 71 studies were included and evaluated in this synthesis using the Oxford Level of Evidence Scale. (3) Results: The 63 studies that included a communication component revealed a positive effect on different proximal outcomes (i.e., communication skills). Three studies revealed a beneficial effect of communication trainings on distal performance indicators (i.e., patient safety), but only to a limited extent. Most studies simultaneously examined different groups, however, those addressing healthcare providers were more common than those with students (61 vs. 12). Only nine studies targeted expectant mothers. Overall, the evidence level of studies was low (only 11 RCTs), with 24 studies with an evidence level I-II, 35 with level III, and 10 with level IV. (4) Conclusions: Communication trainings should be more frequently applied to improve communication of staff, students, and pregnant women and their partners, thereby improving patient safety.
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Affiliation(s)
- Sonia Lippke
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
| | - Christina Derksen
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
| | - Franziska Maria Keller
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
| | - Lukas Kötting
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
| | - Martina Schmiedhofer
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
- Aktionsbündnis Patientensicherheit e.V. (APS), 10179 Berlin, Germany
| | - Annalena Welp
- Department of Psychology and Methods, Jacobs University Bremen, 28759 Bremen, Germany; (C.D.); (F.M.K.); (L.K.); (M.S.); (A.W.)
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