1
|
Mangla M, Kumar N, Jarathi A, Patnaik N, Nimmala LB, Roy S, Singla D. Effectiveness of Simulation-Based Training of Undergraduate Medical Students Regarding the Management of Eclampsia: A Randomized Controlled Educational Trial. Cureus 2024; 16:e58898. [PMID: 38800234 PMCID: PMC11116925 DOI: 10.7759/cureus.58898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Obstetric emergencies, like eclampsia, need a quick and accurate response from the treating physician coming into first contact with the patient. Therefore, all doctors, even primary care physicians, interns, and resident doctors, need training to handle such cases proficiently, leaving minimal chances of error. Providing training for the management of these critical conditions on actual patients is not practically feasible. Clinical simulation in obstetrics can be used for the improvement of these skills for undergraduate and postgraduate students. We conducted a non-blinded randomized controlled trial with the primary aim of developing and implementing a module for training undergraduate medical students on the assessment and management of eclampsia and to evaluate and compare it with traditional didactic lectures or case-based learning. Methods The present randomized controlled educational trial was conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India. The undergraduate medical students (Phase 3, Part 1) posted in the department during their clinical postings or tutorials were randomized into two groups. A total of 62 students were randomly divided into two groups, Group A and Group B, each consisting of 31 students. However, only 24/31 (77.42%) in Group A and 19/31 (61.3%) in Group B finally agreed to participate in the study. One group (Group A, with 24 participants) was taught the diagnosis and management of antepartum eclampsia through simulation-based training, and the other group (Group B, with 19 participants) was taught the same topic through conventional teaching, which consisted of didactic lectures through PowerPoint presentations and case-based discussion. Learning objectives were kept identical for both groups. Pre- and post-test scores were compared for both groups. Results The mean pre-test score of the simulation group was 6.13 ± 1.39, and that of the conventional teaching group was 6.05 ± 1.54. The post-test score of the simulation group was 9.17 ± 1.34, and that of the conventional teaching group was 7.37 ± 1.70. The simulation group showed an extremely significant (two-tailed p < 0.0001) improvement in their post-test scores when compared to their scores before the module was taught. The difference in the scores of simulated teaching (Group A) and conventional teaching (Group B) was also statistically significant (p = 0.005). Simulation-based learning was found to be more interactive, helpful in providing real-life-like experiences, led to better retention and understanding, and motivated the students for self-directed learning. Conclusion Although both conventional and simulation-based teaching were useful, simulation-based training was more effective in teaching undergraduate medical students regarding the diagnosis and management of eclampsia. Simulation-based learning is more interactive, provides real-life-like experiences, leads to better retention and understanding, and motivates the students for self-directed learning.
Collapse
Affiliation(s)
- Mishu Mangla
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Hyderabad, IND
| | - Naina Kumar
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Hyderabad, IND
| | - Aparna Jarathi
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Hyderabad, IND
| | - Nabnita Patnaik
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Hyderabad, IND
| | - Lalita B Nimmala
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Hyderabad, IND
| | - Subhrajyoti Roy
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Hyderabad, IND
| | - Deepak Singla
- Anesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, IND
| |
Collapse
|
2
|
Furr S, Martin DR, Schmaldinst K, Daugherty L. Utilizing Simulation-Based Training to Increase Preeclampsia Recognition in Undiagnosed Patients. J Perinat Educ 2023; 32:213-218. [PMID: 37974665 PMCID: PMC10637312 DOI: 10.1891/jpe-2022-0018] [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: 08/01/2022] [Accepted: 01/10/2023] [Indexed: 11/19/2023] Open
Abstract
Research suggests that simulation in nursing education is a learning strategy that promotes critical thinking and utilization of clinical judgment in a safe environment without fear of retribution if errors are made. Senior nursing students in a small liberal arts university participated in a complex simulation that involved a pregnant patient with preeclampsia. The students were charged with doing a complete assessment of the patient and unborn baby. Upon completion of the assessment, the students utilized their critical thinking skills to determine the best treatment for the patient and baby that rendered the best outcomes. The goal of the exercise was to provide the students with a realistic scenario that advanced quickly into an emergent situation. The majority of students will not work in labor and delivery, but they will experience situations in their respective units that require quick thinking and critical decision-making. This simulation was a strategy to help facilitate these students into their transition to practice.
Collapse
Affiliation(s)
- Susan Furr
- Correspondence regarding this article should be directed to Susan Furr, DNP, RN. E-mail:
| | | | | | | |
Collapse
|
3
|
Madlala ST, Mvandaba AN. Experiences of nurse educators regarding the use of the clinical skills laboratory at the School of Nursing in the Free State province. Health SA 2023; 28:2077. [PMID: 36873779 PMCID: PMC9982460 DOI: 10.4102/hsag.v28i0.2077] [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: 07/01/2022] [Accepted: 11/15/2022] [Indexed: 02/05/2023] Open
Abstract
Background Integration of theory to practice by student nurses is a challenge in most training institutions accredited by the South African Nursing Council (SANC). Nurse educators require a fully equipped and functional clinical skills laboratory to impart clinical competency knowledge to student nurses. Aim The purpose of this study was to understand the experiences of the nurse educators in teaching clinical skills to student nurses using the clinical skills laboratories. Setting The study was conducted at the School of Nursing in the Free State province in 2021. Methods A qualitative descriptive design was employed. Purposive sampling was used to select participants for the study. Unstructured one-on-one interviews were conducted with 17 nurse educators until data saturation was reached. Data were analysed thematically. Results The three major themes that emerged during data analysis and were discussed to make recommendations of the study are as follows: clinical skills laboratory environment; human and material resources; financial constraints. Conclusion This study revealed that there is a need for the use of the clinical skills laboratory by nurse educators to teach clinical practice to student nurses. Therefore, it is imperative that the study recommendations be considered for implementation to improve the use of the clinical skills laboratory. Contribution The importance of integrating theory to practice by using the clinical skills laboratory during clinical practice teaching by nurse educators will be understood.
Collapse
Affiliation(s)
- Siphiwe T Madlala
- Department of Nursing Science, Faculty of Science, Agriculture and Engineering, University of Zululand, KwaDlangezwa, South Africa
| | - Agnes N Mvandaba
- Department of Nursing Science, Free State School of Nursing, Eastern Campus, Phuthaditjhaba, South Africa
| |
Collapse
|
4
|
Ghosh R, Cohen S, Spindler H, Vincent D, Sterling M, Das A, Gore A, Mahapatra T, Walker D. Simulation and nurse-mentoring in a statewide nurse mentoring program in Bihar, India: diagnosis of postpartum hemorrhage and intrapartum asphyxia. Gates Open Res 2022; 6:70. [PMID: 37915730 PMCID: PMC10616110 DOI: 10.12688/gatesopenres.13490.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/03/2023] Open
Abstract
Background: Mentoring programs that include simulation, bedside mentoring, and didactic components are becoming increasingly popular to improve quality. These programs are designed with little evidence to inform the optimal composition of mentoring activities that would yield the greatest impact on provider skills and patient outcomes. We examined the association of number of maternal and neonatal emergency simulations performed with the diagnosis of postpartum hemorrhage (PPH) and intrapartum asphyxia in real patients. Methods: We used a prospective cohort and births were compared between- and within-facility over time. Setting included 320 public facilities in the state of Bihar, India May 2015 - 2017. The participants were deliveries and livebirths. The interventions carried out were mobile nurse-mentoring program with simulations, teamwork and communication activities, didactic teaching, demonstrations of clinical procedures and bedside mentoring including conducting deliveries. Nurse mentor pairs visited each facility for one week, covering four facilities over a four-week period, for seven to nine consecutive months. The outcome measures were diagnosis of PPH and intrapartum asphyxia. Results:Relative to the bottom one-third facilities that performed the fewest maternal simulations, facilities in the middle one-third group diagnosed 26% (incidence rate ratio [IRR] = 1.26, 95% confidence interval [CI]: 1.00, 1.59) more cases of PPH in real patients. Similarly, facilities in the middle one-third group, diagnosed 25% (IRR = 1.25, 95% CI: 1.04, 1.50) more cases of intrapartum asphyxia relative to the bottom third group that did the fewest neonatal simulations. Facilities in the top one-third group (i.e., performed the most simulations) did not have a significant difference in diagnosis of both outcomes, relative to the bottom one-third group. Results:Relative to the bottom one-third facilities that performed the fewest maternal simulations, facilities in the middle one-third group diagnosed 26% (incidence rate ratio [IRR] = 1.26, 95% confidence interval [CI]: 1.00, 1.59) more cases of PPH in real patients. Similarly, facilities in the middle one-third group, diagnosed 25% (IRR = 1.25, 95% CI: 1.04, 1.50) more cases of intrapartum asphyxia relative to the bottom third group that did the fewest neonatal simulations. Facilities in the top one-third group (i.e., performed the most simulations) did not have a significant difference in diagnosis of both outcomes, relative to the bottom one-third group. Conclusions: Findings suggest a complex relationship between performing simulations and opportunities for direct practice with patients, and there may be an optimal balance in performing the two that would maximize diagnosis of PPH and intrapartum asphyxia.
Collapse
Affiliation(s)
- Rakesh Ghosh
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, San Francisco, 94158, USA
| | - Susanna Cohen
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Hilary Spindler
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, San Francisco, 94158, USA
| | - Divya Vincent
- Obstetrics and Neonatal, PRONTO India, State RMNCH, AG Colony, Patna, 800025, India
| | - Mona Sterling
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, San Francisco, 94158, USA
| | - Aritra Das
- Concurrent Monitoring learning and Evaluation, CARE India, 14 Patliputra Colony, Patna, Bihar, 800013, India
| | - Aboli Gore
- Capacity Building, CARE India, 14 Patliputra Colony, Patna, Bihar, 800013, India
| | - Tanmay Mahapatra
- Concurrent Monitoring learning and Evaluation, CARE India, 14 Patliputra Colony, Patna, Bihar, 800013, India
| | - Dilys Walker
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, San Francisco, 94158, USA
- Department of Obstetrics and Gynecology and Reproductive Services, University of California, San Francisco, San Francisco, CA, 94110, USA
| |
Collapse
|
5
|
Kalra A, Siju M, Jenny A, Spindler H, Madriz S, Baayd J, Handu S, Ghosh R, Cohen S, Walker D. Super Divya to the rescue! Exploring Nurse Mentor Supervisor perceptions on a digital tool to support learning and engagement for simulation educators in Bihar, India. BMC MEDICAL EDUCATION 2022; 22:206. [PMID: 35346172 PMCID: PMC8959557 DOI: 10.1186/s12909-022-03270-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Since 2014, the Government of Bihar and CARE India have implemented a nurse mentoring program that utilizes PRONTO International's simulation and team trainings to improve obstetric and neonatal care. Together they trained simulation educators known as Nurse Mentor Supervisors to conduct simulation trainings in rural health facilities across the state. Sustaining the knowledge and engagement of these simulation educators at a large-scale has proven difficult and resource intensive. To address this, the University of Utah with PRONTO International and with input from the University of California San Francisco, created an interactive, virtual education module based on a comic superhero named Super Divya to reinforce simulation educator concepts. This study examined the perceptions of Nurse Mentor Supervisors on Super Divya's accessibility, usefulness, and potential after implementation of Super Divya: Origin Story. METHODS We conducted qualitative interviews with 17 Nurse Mentor Supervisors in Bihar, India. In light of the COVID-19 pandemic, interviews were conducted virtually via Zoom™ using a semi-structured interview guide in Hindi and English. Participants were identified with strict inclusion criteria and convenience sampling methods. Interviews were analyzed using a framework analysis. RESULTS Nurse Mentor Supervisors found Super Divya to be engaging, innovative, relatable, and useful in teaching tips and tricks for simulation training. Supervisors thought the platform was largely accessible with some concerns around internet connectivity and devices. The majority reacted positively to the idea of distributing Super Divya to other simulation educators in the nurse mentoring program and had suggestions for additional clinical and simulation educator training topics. CONCLUSIONS This study demonstrates the potential of Super Divya to engage simulation educators in continuous education. At a time when virtual education is increasingly important and in-person training was halted by the COVID-19 pandemic, Super Divya engaged Supervisors in the nurse mentoring program. We have incorporated suggestions for improvement of Super Divya into future modules. Further research can help understand how knowledge from Super Divya can improve simulation facilitation skills and behaviors, and explore potential for reinforcing clinical skills via this platform. ETHICAL APPROVAL This study was approved by the institutional review board at the University of California San Francisco (IRB # 20-29902).
Collapse
Affiliation(s)
- Anika Kalra
- Institute for Global Health Sciences, University of California San Francisco, 550 16th St, San Francisco, CA, 94158, USA.
| | - Manju Siju
- PRONTO India Foundation, State RMNCH+A Unit, C-16 Krishi Nagar, A.G. Colony, Patna, Bihar, 800013, India
| | - Alisa Jenny
- Institute for Global Health Sciences, University of California San Francisco, 550 16th St, San Francisco, CA, 94158, USA
| | - Hilary Spindler
- Institute for Global Health Sciences, University of California San Francisco, 550 16th St, San Francisco, CA, 94158, USA
| | - Solange Madriz
- Institute for Global Health Sciences, University of California San Francisco, 550 16th St, San Francisco, CA, 94158, USA
| | - Jami Baayd
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Seema Handu
- PRONTO India Foundation, State RMNCH+A Unit, C-16 Krishi Nagar, A.G. Colony, Patna, Bihar, 800013, India
| | - Rakesh Ghosh
- Institute for Global Health Sciences, University of California San Francisco, 550 16th St, San Francisco, CA, 94158, USA
| | - Susanna Cohen
- Department of Obstetrics and Gynecology, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - Dilys Walker
- Department of Obstetrics, Gynecology and Reproductive Services, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| |
Collapse
|
6
|
Nader M, Tasdelen-Teker G, DeStephens AJ, Lampotang S, Prelipcean I, Smith RD, Bortcosh WH, Chiriboga Salazar NR, Martinez Schlurmann NI, Hamdan US, Munoz Pareja JM. Simulation Use in Outreach Setting: A Novel Approach to Building Sustainability. Simul Healthc 2022; 17:e136-e140. [PMID: 33600139 DOI: 10.1097/sih.0000000000000555] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
SUMMARY STATEMENT Simulation is a well-studied teaching tool for multidisciplinary teamwork, crisis resource management, and communication skills. These attributes are essential for successful international medical missions, which include healthcare providers with different familiarities with the outreach environment and each team member's role. However, immersive simulation remains underused in similar settings. Our team designed a simulation-based curriculum that focuses on multidisciplinary teamwork and crisis resource management skills. In this commentary, we describe its implementation during high-risk cleft care outreach missions conducted by the Global Smile Foundation. We discuss the importance of a simple, feasible, and flexible platform to successfully overcome the limitations of time and resources inherent to outreach mission work while addressing the clinical and geographic needs specific to each site. We highlight challenges, including unpredictability of the outreach environment, a language barrier, and the short duration of missions. Finally, we offer a roadmap for groups involved in similar global health efforts.
Collapse
Affiliation(s)
- Marie Nader
- From the Department of Pediatrics (M.N.), University of Florida College of Medicine, Gainesville, FL; Department of Medical Education and Informatics, Hacettepe University, Ankara, Turkey (G.T.-T.); Center for Safety, Simulation & Advanced Learning Technologies, University of Florida College of Medicine (A.J.D., S.L.); Department of Anesthesiology, University of Florida College of Medicine (A.J.D., S.L.); Office of Educational Affairs/Office of Medical Education (S.L.); Division of Neonatology, University of Florida College of Medicine (I.P.), Department of Pediatrics; Division of Pediatric Critical Care, University of Florida College of Medicine (R.D.S., W.H.B., N.R.C.S., N.I.M.S., J.M.M.P.), Department of Pediatrics; and the Global Smile Foundation (U.S.H.), Norwood, MA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Eddy KE, Vogel JP, Zahroh RI, Bohren MA. Factors affecting use of magnesium sulphate for pre-eclampsia or eclampsia: a qualitative evidence synthesis. BJOG 2021; 129:379-391. [PMID: 34520111 PMCID: PMC9291451 DOI: 10.1111/1471-0528.16913] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
Background Hypertensive disorders account for 14% of global maternal deaths. Magnesium sulphate (MgSO4) is recommended for prevention and treatment of pre‐eclampsia/eclampsia. However, MgSO4 remains underused, particularly in low‐ and middle‐income countries (LMICs). Objective This qualitative evidence synthesis explores perceptions and experiences of healthcare providers, administrators and policy‐makers regarding factors affecting use of MgSO4 to prevent or treat pre‐eclampsia/eclampsia. Search strategy We searched MEDLINE, EMBASE, Emcare, CINAHL, Global Health and Global Index Medicus, and grey literature for studies published between January 1995 and June 2021. Selection criteria Primary qualitative and mixed‐methods studies on factors affecting use of MgSO4 in healthcare settings, from the perspectives of healthcare providers, administrators and policy‐makers, were eligible for inclusion. Data collection and analysis We applied a thematic synthesis approach to analysis, using COM‐B behaviour change theory to map factors affecting appropriate use of MgSO4. Main results We included 22 studies, predominantly from LMICs. Key themes included provider competence and confidence administering MgSO4 (attitudes and beliefs, complexities of administering, knowledge and experience), capability of health systems to ensure MgSO4 availability at point of use (availability, resourcing and pathways to care) and knowledge translation (dissemination of research and recommendations). Within each COM‐B domain, we mapped facilitators and barriers to physical and psychological capability, physical and social opportunity, and how the interplay between these domains influences motivation. Conclusions These findings can inform policy and guideline development and improve implementation of MgSO4 in clinical care. Such action is needed to ensure this life‐saving treatment is widely available and appropriately used. Tweetable abstract Global qualitative review identifies factors affecting underutilisation of MgSO4 for pre‐eclampsia and eclampsia. Global qualitative review identifies factors affecting underutilisation of MgSO4 for pre‐eclampsia and eclampsia. This article includes Author Insights, a video abstract available at https://vimeo.com/manage/videos/623192027 Linked article This article is commented on by LA Magee, p. 392 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.16971.
Collapse
Affiliation(s)
- K E Eddy
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia.,Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - J P Vogel
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - R I Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - M A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| |
Collapse
|
8
|
Goswami G, Sharma SK, Sharma R, Rani R. Simulation and Skill Training Facilities in Nursing Institutes at Uttarakhand: A Cross-Sectional Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:449-454. [PMID: 34703785 PMCID: PMC8491820 DOI: 10.4103/ijnmr.ijnmr_325_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 12/21/2020] [Accepted: 05/26/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Simulation and skill development facilities are essential for the training and preparation of nursing students, which aids in their clinical readiness and professional development. The aim of the study was to assess simulation and skill training facilities, their utility in selected nursing institutes at Uttarakhand. MATERIALS AND METHODS This descriptive cross-sectional study was conducted in conveniently selected 16 nursing institutes at Uttarakhand (India). Data were collected from Nov. to Dec. 2019, through a face-to-face interview using a validated self-structured questionnaire. Descriptive and inferential statistics were used to analyze the data. RESULTS There were 16 institutes from four districts that participated in the study. Of these, five (31%) were government, and 11 (69%) were private. All nursing institutes (100%) had a nursing foundation lab, midwifery, and child health nursing lab, while only 44% of institutes had a medical surgical nursing skill lab. Among skill development facilities, the overall average number [mean (SD)] of mannequins was 3.90 (7.10); and high-fidelity simulators were 2.47 (7.1). In private institutes, the average period [mean (SD)] of laboratory usage was significantly higher than in government institutes [35.82 (6.57) vs 27.40 (5.22); p = 0.025]. The duration of lab usages was significantly associated with the age of the institute (p = 0.04). CONCLUSIONS This study found inadequate simulation and skills training facilities and less utilization of those facilities. There is a great need to find out the key issues that lead to the unavailability and limited use of the required nursing skill development facilities.
Collapse
Affiliation(s)
- Garima Goswami
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Suresh K. Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rakesh Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India,Address for correspondence: Dr. Rakesh Sharma, College of Nursing, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand, India. E-mail:
| | - Ritu Rani
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
9
|
Kane S, Dayal P, Mahapatra T, Kumar S, Bhasin S, Gore A, Das A, Reddy S, Mahal A, Krishnan S, Kermode M. Enabling change in public health services: Insights from the implementation of nurse mentoring interventions to improve quality of obstetric and newborn care in two North Indian states. Gates Open Res 2021; 4:61. [PMID: 34046557 PMCID: PMC8126785 DOI: 10.12688/gatesopenres.13134.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Few studies have explicitly examined the implementation of change interventions in low- and middle-income country (LMIC) public health services. We contribute to implementation science by analyzing the implementation of an organizational change intervention in a large, hierarchical and bureaucratic public service in a LMIC health system. Methods: Using qualitative methods, we critically interrogate the implementation of an intervention to improve quality of obstetric and newborn services across 692 facilities in Uttar Pradesh and Bihar states of India to reveal how to go about making change happen in LMIC public health services. Results: We found that focusing the interventions on a discreet part of the health service (labour rooms) ensured minimal disruption of the status quo and created room for initiating change. Establishing and maintaining respectful, trusting relationships is critical, and it takes time and much effort to cultivate such relationships. Investing in doing so allows one to create a safe space for change; it helps thaw entrenched practices, behaviours and attitudes, thereby creating opportunities for change. Those at the frontline of change processes need to be enabled and supported to: lead by example, model and embody desirable behaviours, be empathetic and humble, and make the change process a positive and meaningful experience for all involved. They need discretionary space to tailor activities to local contexts and need support from higher levels of the organisation to exercise discretion. Conclusions: We conclude that making change happen in LMIC public health services, is possible, and is best approached as a flexible, incremental, localised, learning process. Smaller change interventions targeting discreet parts of the public health services, if appropriately contextualised, can set the stage for incremental system wide changes and improvements to be initiated. To succeed, change initiatives need to cultivate and foster support across all levels of the organisation.
Collapse
Affiliation(s)
- Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| | - Prarthna Dayal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| | | | - Sanjiv Kumar
- Uttar Pradesh Technical Support Unit, India Health Action Trust, Lucknow, India
| | | | - Aboli Gore
- Bihar Technical Support Unit, CARE India, Patna, Bihar, India
| | - Aritra Das
- Bihar Technical Support Unit, CARE India, Patna, Bihar, India
| | - Sandeep Reddy
- School of Medicine, Deakin University, Melbourne, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| | | | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| |
Collapse
|
10
|
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.
Collapse
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.)
| |
Collapse
|
11
|
Alves VH, Pereira AV, Dulfe PAM, Vieira BDG, Silva LAD, Fontoura AMT, Branco MBLR. Preceptorship in nursing-midwifery: a training-intervention in health work. Rev Bras Enferm 2020; 73:e20190661. [PMID: 33338134 DOI: 10.1590/0034-7167-2019-0661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/26/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to analyze how certified nurse-midwives identify preceptorship in a nursing-midwifery enhancing course conducted by the Universidade Federal Fluminense as a possibility of training to promote institutional support and intervention. METHODS a descriptive, exploratory research with qualitative approach. Six certified nurse-midwife preceptors from the Nursing-Midwifery Enhancing Course participated in the study in 2019. Two public maternity hospitals in Rio de Janeiro were settings of the research. Individual interview and thematic content analysis were used to collect and analyze data. RESULTS exchange of knowledge between preceptors and trainees encouraged learning and reflection stemming from delivery and birth, contributing to expansion of autonomy and professional leading role in training, health care, and management. FINAL CONSIDERATIONS collective meetings that promote work analysis and value the performance of certified nurse-midwives have led to intervention processes and institutional support in maternity hospitals in Rio de Janeiro, Brazil.
Collapse
|
12
|
Nkamba DM, Vangu R, Elongi M, Magee LA, Wembodinga G, Bernard P, Ditekemena J, Robert A. Health facility readiness and provider knowledge as correlates of adequate diagnosis and management of pre-eclampsia in Kinshasa, Democratic Republic of Congo. BMC Health Serv Res 2020; 20:926. [PMID: 33028310 PMCID: PMC7542875 DOI: 10.1186/s12913-020-05795-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertensive disorders in pregnancy are the second most common cause of maternal mortality in the Democratic Republic of Congo (DRC), accounting for 23% of maternal deaths. This study aimed to assess facility readiness, and providers' knowledge to prevent, diagnose, and treat pre-eclampsia. METHODS A facility-based cross-sectional study was conducted in 30 primary health centres (PHCs) and 28 referral facilities (hospitals) randomly selected in Kinshasa, DRC. In each facility, all midwives and physicians involved in maternal care provision (n = 197) were included. Data on facility infrastructure and providers' knowledge about pre-eclampsia were collected using facility checklists and a knowledge questionnaire. Facility readiness score was defined as the sum of 13 health commodities needed to manage pre-eclampsia. A knowledge score was defined as the sum of 24 items about the diagnosis, management, and prevention of pre-eclampsia. The score ranges from 0 to 24, with higher values reflecting a better knowledge. The Mann-Witney U test was used to compare median readiness scores by facility type and ownership; and median knowledge scores between midwives in hospitals and in PHCs, and between physicians in hospitals and in PHCs. RESULTS Overall, health facilities had 7 of the 13 commodities, yielding a median readiness score of 53.8%(IQR: 46.2 to 69.2%). Although all provider groups had significant knowledge gaps about pre-eclampsia, providers in hospitals demonstrated slightly more knowledge than those in PHCs. Midwives in public facilities scored higher than those in private facilities (median(IQR): 8(5 to 12) vs 7(4 to 8), p = 0.03). Of the 197 providers, 91.4% correctly diagnosed severe pre-eclampsia. However, 43.9 and 82.2% would administer magnesium sulfate and anti-hypertensive drugs to manage severe pre-eclampsia, respectively. Merely 14.2 and 7.1% of providers were aware of prophylactic use of aspirin and calcium to prevent pre-eclampsia, respectively. CONCLUSION Our study showed poor availability of supplies to diagnose, prevent and treat pre-eclampsia in Kinshasa. While providers demonstrated good knowledge regarding the diagnosis of pre-eclampsia, they have poor knowledge regarding its prevention and management. The study highlights the need for strengthening knowledge of providers toward the prevention and management of pre-eclampsia, and enhancing the availability of supplies needed to address this disease.
Collapse
Affiliation(s)
- Dalau Mukadi Nkamba
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
- Pôle d'Épidémiologie et Biostatistique, Université catholique de Louvain (UCLouvain), Institut de Recherche Expérimentale et Clinique (IREC), Clos Chapelle-aux-champs, 30 bte B1.30.13, 1200, Brussels, Belgium.
| | - Roland Vangu
- Department of Gynecology and Obstetrics, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Moyene Elongi
- Department of Gynecology and Obstetrics, University Clinics of Kinshasa, Kinshasa, Democratic Republic of Congo
- Department of Gynecology and Obstetrics, Provincial General Hospital of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Gilbert Wembodinga
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Pierre Bernard
- Pôle de Gynécologie et Obstétrique, Université Catholique de Louvain (UCLouvain), Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium
| | - John Ditekemena
- Kinshasa School of Public Health, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Annie Robert
- Pôle d'Épidémiologie et Biostatistique, Université catholique de Louvain (UCLouvain), Institut de Recherche Expérimentale et Clinique (IREC), Clos Chapelle-aux-champs, 30 bte B1.30.13, 1200, Brussels, Belgium
| |
Collapse
|
13
|
Kane S, Dayal P, Mahapatra T, Kumar S, Bhasin S, Gore A, Das A, Reddy S, Mahal A, Krishnan S, Kermode M. Enabling change in public health services: Insights from the implementation of nurse mentoring interventions to improve quality of obstetric and newborn care in two North Indian states. Gates Open Res 2020; 4:61. [PMID: 34046557 PMCID: PMC8126785 DOI: 10.12688/gatesopenres.13134.2] [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: 09/15/2020] [Indexed: 04/03/2024] Open
Abstract
Background: Few studies have explicitly examined the implementation of change interventions in low- and middle-income country (LMIC) public health services. We contribute to implementation science by analyzing the implementation of an organizational change intervention in a large, hierarchical and bureaucratic public service in a LMIC health system. Methods: Using qualitative methods, we critically interrogate the implementation of an intervention to improve quality of obstetric and newborn services across 692 facilities in Uttar Pradesh and Bihar states of India to reveal how to go about making change happen in LMIC public health services. Results: We found that focusing the interventions on a discreet part of the health service (labour rooms) ensured minimal disruption of the status quo and created room for initiating change. Establishing and maintaining respectful, trusting relationships is critical, and it takes time and much effort to cultivate such relationships. Investing in doing so allows one to create a safe space for change; it helps thaw entrenched practices, behaviours and attitudes, thereby creating opportunities for change. Those at the frontline of change processes need to be enabled and supported to: lead by example, model and embody desirable behaviours, be empathetic and humble, and make the change process a positive and meaningful experience for all involved. They need discretionary space to tailor activities to local contexts and need support from higher levels of the organisation to exercise discretion. Conclusions: We conclude that making change happen in LMIC public health services, is possible, and is best approached as a flexible, incremental, localised, learning process. Smaller change interventions targeting discreet parts of the public health services, if appropriately contextualised, can set the stage for incremental system wide changes and improvements to be initiated. To succeed, change initiatives need to cultivate and foster support across all levels of the organisation.
Collapse
Affiliation(s)
- Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| | - Prarthna Dayal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| | | | - Sanjiv Kumar
- Uttar Pradesh Technical Support Unit, India Health Action Trust, Lucknow, India
| | | | - Aboli Gore
- Bihar Technical Support Unit, CARE India, Patna, Bihar, India
| | - Aritra Das
- Bihar Technical Support Unit, CARE India, Patna, Bihar, India
| | - Sandeep Reddy
- School of Medicine, Deakin University, Melbourne, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| | | | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| |
Collapse
|
14
|
Garti I, Gray M, Tan JY, Bromley A. Midwives' knowledge of pre-eclampsia management: A scoping review. Women Birth 2020; 34:87-104. [PMID: 32928690 DOI: 10.1016/j.wombi.2020.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Pre-eclampsia is a multi-organ disease affecting pregnant women from the second trimester onwards resulting in multiple adverse outcomes. Sub-optimal treatment of pre-eclampsia is linked with unfavorable outcomes. It is critical for midwives as primary providers to be competent in the diagnosis and management of pre-eclampsia especially in low-and middle-income countries. AIM To identify what midwives' around the world know about pre-eclampsia management. METHODS A scoping review using the JBI three-step search strategy was used to identify relevant research articles and grey literature on the subject. Database searches in PubMed, CINAHL, Cochrane Databases, Web of Science, and Scopus yielded twenty papers in addition to nine guidelines from Google Scholar. The findings were synthesised using a metasynthesis approach and presented as themes. FINDINGS Four themes were identified from the extracted data: Foundational knowledge of pre-eclampsia; Knowledge and management of a woman with pre-eclampsia according to guidelines; Knowledge of being prepared for emergency procedures and management of emergencies; Factors influencing knowledge. The first three themes addressed diagnosis and management whilst the last theme described how contextual factors led to either increased or decreased knowledge of pre-eclampsia. CONCLUSION Worldwide, practicing midwives lack knowledge on several aspects of pre-eclampsia diagnosis and care. Policies on in-service training should be oriented to include innovative non-traditional methods that have the potential to increase midwives' knowledge.
Collapse
Affiliation(s)
- Isabella Garti
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia.
| | - Michelle Gray
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| | - Jing-Yu Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| | - Angela Bromley
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Australia
| |
Collapse
|
15
|
Flaherty KE, Zakariah AN, Vescio VA, Osei-Ampofo M, Mahama MN, Agongo V, Becker TK. The state of emergency medical technician education in Ghana. Afr J Emerg Med 2020; 10:107-110. [PMID: 32923318 PMCID: PMC7474231 DOI: 10.1016/j.afjem.2020.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/17/2019] [Accepted: 01/29/2020] [Indexed: 12/05/2022] Open
Abstract
Objective The National Ambulance Service (NAS) provides emergency medical services throughout Ghana and trains emergency medical technicians (EMTs) at the NAS Prehospital Emergency Care Training School (PECTS). Currently the majority of EMT training occurs primarily in a traditional didactic format. Students and faculty were interviewed to better understand their views of the current curriculum. Additionally, any barriers to integration of simulation-based learning were assessed. Following the interviews, the faculty was trained to conduct obstetric and neonatal simulations. The faculty was then observed introducing the simulations to the EMT students. Methods A standardized list of questions developed in consultation with an education expert was used to elicit student and faculty expression of opinion. Interviews were conducted in-person in small group settings. Training sessions were conducted in-person in large group settings. Results Students and faculty alike expressed pride in their work and 14/25 groups felt that teaching efforts were high. However, students verbalized concern involving their lack of rest (12/18) and the high volume of lectures per day (11/18). Both students and faculty felt limited by the lack of simulation tools (17/25), library resources (14/25), internet access (17/25), and infrastructure (20/25). All groups felt favorably towards the integration of simulation-based learning (25/25). Conclusion The faculty and students of PECTS support the transition from a curriculum based on traditional didactic learning to one based on simulation learning.
Collapse
Affiliation(s)
| | | | - Vicki A. Vescio
- School of Teaching and Learning, University of Florida, Gainesville, FL, USA
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Vitus Agongo
- National Ambulance Service, Ministry of Health, Accra, Ghana
| | - Torben K. Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
- Corresponding author.
| |
Collapse
|
16
|
Hoover J, Koon AD, Rosser EN, Rao KD. Mentoring the working nurse: a scoping review. HUMAN RESOURCES FOR HEALTH 2020; 18:52. [PMID: 32727573 PMCID: PMC7388510 DOI: 10.1186/s12960-020-00491-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/09/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Mentoring programs for nurses already in the health workforce are growing in importance. Yet, the settings, goals, scale, and key features of these programs are not widely known. OBJECTIVE To identify and synthesize research on in-service nurse mentoring programs. METHODS We reviewed nurse mentoring research from six databases. Studies either referred explicitly to in-service nurse mentoring programs, were reviews of such programs, or concerned nurse training/education in which mentoring was an essential component. RESULTS We included 69 articles from 11 countries, published from 1995 to 2019. Most articles were from high-income countries (n = 46) and in rural areas (n = 22). Programs were developed to strengthen clinical care (particularly maternal and neonatal care), promote evidence-based practice, promote retention, support new graduate nurses, and develop nurse leaders. Of the articles with sufficient data, they typically described small programs implemented in one facility (n = 23), with up to ten mentors (n = 13), with less than 50 mentees (n = 25), meeting at least once a month (n = 27), and lasting at least a year (n = 24). While over half of the studies (n = 36) described programs focused almost exclusively on clinical skills acquisition, many (n = 33) specified non-clinical professional development activities. Reflective practice featured to a varying extent in many articles (n = 29). Very few (n = 6) explicitly identified the theoretical basis of their programs. CONCLUSIONS Although the literature about in-service nurse mentoring comes mostly from small programs in high-income countries, the largest nurse mentoring programs in the world are in low- and middle-income countries. Much can be learned from studying these programs in greater detail. Future research should analyze key features of programs to make models of mentoring more transparent and translatable. If carefully designed and flexibly implemented, in-service nurse mentoring represents an exciting avenue for enhancing the role of nurses and midwives in people-centered health system strengthening. The contents in this article are those of the authors and do not necessarily reflect the view of the U.S. President's Emergency Plan for AIDS Relief, the U.S. Agency for International Development or the U.S. Government.
Collapse
Affiliation(s)
- Jerilyn Hoover
- Credence Management Solutions, LLC, the Global Health Technical Professionals, USAID, 8609 Westwood Center Drive, Suite 300, Vienna, VA 22192 USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Adam D. Koon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Erica N. Rosser
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Krishna D. Rao
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| |
Collapse
|
17
|
Angelina JA, Kibusi SM, Mwampagatwa I, Ernest A. Knowledge on Prevention and Management of Preeclampsia and Eclampsia among Nurses in Primary Health Settings: Baseline Findings from an Interventional Study in Dodoma Region, Tanzania. East Afr Health Res J 2020; 4:33-40. [PMID: 34308218 PMCID: PMC8279161 DOI: 10.24248/eahrj.v4i1.619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 05/20/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Preeclampsia and eclampsia are conditions which increase maternal and foetal morbidity and mortality worldwide. These conditions are ranked as the second leading cause of maternal deaths. Nurses have a critical role in preventing and managing preeclampsia. However, their knowledge has not been evaluated particularly among those working in primary health facilities, where opportunities for continue education is limited. Objective: To assess knowledge on prevention and management of preeclampsia and eclampsia among nurses working in the primary health care settings. Methods: Analysis of baseline data from an intervention study which test the effectiveness of simulation-based training on obstetric and neonatal emergencies among nurses in managing maternal and newborn emergencies in primary health care settings. A total of 39 primary health centres within 7 districts in Dodoma Region were selected to take part in the interventional study. Individual participants were nurses working in maternity units were involved. 172 nurses were selected using a simple random method. Nurses' knowledge on prevention and management of PEE and its predictors were assessed using a self-administered questionnaire. Descriptive statistics analysis was done to determine the distribution of the background characteristics of nurses and logistic regression analysis was performed to explore predictors of nurses' knowledge Results: Overall knowledge on preeclampsia and eclampsia was 88 (51.2%). Professional qualification was a predictor associated with a nurse's knowledge about preeclampsia and eclampsia. Registered nurses were more knowledgeable compared to enrolled nurses (AOR3.311; CI, 1.62 to 6.768; P value =.001), years of working experience showed no association with knowledge on preeclampsia and eclampsia (AOR 0.98; CI: 0.39-2.47; P values = 0.970) Conclusion: This study showed there is a critical knowledge deficiency in the prevention and management of preeclampsia and eclampsia among nurses working in maternal units of primary health care setting. Effective regular training on prevention and management of preeclampsia and eclampsia for frontline nurses is required in order to improve maternal and neonatal survival.
Collapse
Affiliation(s)
- Joho A Angelina
- Department of Nursing and Midwifery, College of Health Sciences, University of Dodoma
| | - Stephen M Kibusi
- Department of Public Health, College of Health Sciences, University of Dodoma
| | - Ipyana Mwampagatwa
- Department of Clinical Medicine, College of Health Sciences, University of Dodoma
| | - Alex Ernest
- Department of Clinical Medicine, College of Health Sciences, University of Dodoma
| |
Collapse
|
18
|
Akalin A, Sahin S. The impact of high‐fidelity simulation on knowledge, critical thinking, and clinical decision‐making for the management of pre‐eclampsia. Int J Gynaecol Obstet 2020; 150:354-360. [DOI: 10.1002/ijgo.13243] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/02/2020] [Accepted: 05/25/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Ayse Akalin
- Nursing Department Faculty of Health Sciences Duzce University Duzce Turkey
| | - Sevil Sahin
- Nursing Department Faculty of Health Sciences Ankara Yildirim Beyazit University Ankara Turkey
| |
Collapse
|
19
|
Kane S, Dayal P, Mahapatra T, Kumar S, Bhasin S, Gore A, Das A, Reddy S, Mahal A, Krishnan S, Kermode M. Enabling change in public health services: Insights from the implementation of nurse mentoring interventions to improve quality of obstetric and newborn care in two North Indian states. Gates Open Res 2020; 4:61. [PMID: 34046557 PMCID: PMC8126785 DOI: 10.12688/gatesopenres.13134.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 04/03/2024] Open
Abstract
Background: Few studies have explicitly examined the implementation of change interventions in low- and middle-income country (LMIC) public health services. We contribute to implementation science by adding to the knowledge base on strategies for implementing change interventions in large, hierarchical and bureaucratic public services in LMIC health systems. Methods: Using a mix of methods, we critically interrogate the implementation of an intervention to improve quality of obstetric and newborn services across 692 facilities in Uttar Pradesh and Bihar states of India to reveal how to go about making change happen in LMIC public health services. Results: We found that focusing the interventions on a discreet part of the health service (labour rooms) ensured minimal disruption of the status quo and created room for initiating change. Establishing and maintaining respectful, trusting relationships is critical, and it takes time and much effort to cultivate such relationships. Investing in doing so allows one to create a safe space for change; it helps thaw entrenched practices, behaviours and attitudes, thereby creating opportunities for change. Those at the frontline of change processes need to be enabled and supported to: lead by example, model and embody desirable behaviours, be empathetic and humble, and make the change process a positive and meaningful experience for all involved. They need discretionary space to tailor activities to local contexts and need support from higher levels of the organisation to exercise discretion. Conclusions: We conclude that making change happen in LMIC public health services, is possible, and is best approached as a flexible, incremental, localised, learning process. Smaller change interventions targeting discreet parts of the public health services, if appropriately contextualised, can set the stage for incremental system wide changes and improvements to be initiated. To succeed, change initiatives need to cultivate and foster support across all levels of the organisation.
Collapse
Affiliation(s)
- Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| | - Prarthna Dayal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| | | | - Sanjiv Kumar
- Uttar Pradesh Technical Support Unit, India Health Action Trust, Lucknow, India
| | | | - Aboli Gore
- Bihar Technical Support Unit, CARE India, Patna, Bihar, India
| | - Aritra Das
- Bihar Technical Support Unit, CARE India, Patna, Bihar, India
| | - Sandeep Reddy
- School of Medicine, Deakin University, Melbourne, Australia
| | - Ajay Mahal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| | | | - Michelle Kermode
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melblourne, Victoria, Australia
| |
Collapse
|
20
|
Molina RL, Neal BJ, Bobanski L, Singh VP, Neville BA, Delaney MM, Lipsitz S, Karlage A, Shetye M, Semrau KEA. Nurses' and auxiliary nurse midwives' adherence to essential birth practices with peer coaching in Uttar Pradesh, India: a secondary analysis of the BetterBirth trial. Implement Sci 2020; 15:1. [PMID: 31900167 PMCID: PMC6941293 DOI: 10.1186/s13012-019-0962-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 12/22/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The BetterBirth trial tested the effect of a peer coaching program around the WHO Safe Childbirth Checklist for birth attendants in primary-level facilities in Uttar Pradesh, India on a composite measure of perinatal and maternal mortality and maternal morbidity. This study aimed to examine the adherence to essential birth practices between two different cadres of birth attendants-nurses and auxiliary nurse midwives (ANMs)-during and after a peer coaching intervention for the WHO Safe Childbirth Checklist. METHODS This is a secondary analysis of birth attendant characteristics, coaching visits, and behavior uptake during the BetterBirth trial through birth attendant surveys, coach observations, and independent observations. Descriptive statistics were calculated overall, and by staffing cadre (staff nurses and ANMs) for demographic characteristics. Logistic regression using the Pearson overdispersion correction (to account for clustering by site) was used to assess differences between staff nurses and ANMs in the intervention group during regular coaching (2-month time point) and 4 months after the coaching program ended (12-month time point). RESULTS Of the 570 birth attendants who responded to the survey in intervention and control arms, 474 were staff nurses (83.2%) and 96 were ANMs (16.8%). In the intervention arm, more staff nurses (240/260, 92.3%) received coaching at all pause points compared to ANMs (40/53, 75.5%). At baseline, adherence to practices was similar between ANMs and staff nurses (~ 30%). Overall percent adherence to essential birth practices among ANMs and nurses was highest at 2 months after intervention initiation, when frequent coaching visits occurred (68.1% and 64.1%, respectively, p = 0.76). Practice adherence tapered to 49.2% among ANMs and 56.1% among staff nurses at 12 months, which was 4 months after coaching had ended (p = 0.68). CONCLUSIONS Overall, ANMs and nurses responded similarly to the coaching intervention with the greatest increase in percent adherence to essential birth practices after 2 months of coaching and subsequent decrease in adherence 4 months after coaching ended. While coaching is an effective strategy to support some aspects of birth attendant competency, the structure, content, and frequency of coaching may need to be customized according to the birth attendant training and competency. TRIAL REGISTRATION ClinicalTrials.gov: NCT2148952; Universal Trial Number: U1111-1131-5647.
Collapse
Affiliation(s)
- Rose L Molina
- Division of Global and Community Health, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA.
| | - Brandon J Neal
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | - Lauren Bobanski
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | - Vinay Pratap Singh
- Community Empowerment Lab, 26/11 Wazir Hasan Road, Lucknow, Uttar Pradesh, 226001, India
| | - Bridget A Neville
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | | | - Stuart Lipsitz
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | - Ami Karlage
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
| | - Mrunal Shetye
- Bill & Melinda Gates Foundation, Capital Court, 5th Floor, Olof Palme Marg, Munirka, Delhi, India
| | - Katherine E A Semrau
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Ariadne Labs, 401 Park Drive, 3rd Floor East, Boston, MA, 02215, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA
| |
Collapse
|
21
|
Serra G, Miceli V, Albano S, Corsello G. Perinatal and newborn care in a two years retrospective study in a first level peripheral hospital in Sicily (Italy). Ital J Pediatr 2019; 45:152. [PMID: 31783883 PMCID: PMC6884854 DOI: 10.1186/s13052-019-0751-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/21/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Two hundred seventy-five thousand maternal deaths, 2.7 million neonatal deaths, and 2.6 million stillbirths have been estimated in 2015 worldwide, almost all in low-income countries (LICs). Moreover, more than 20 million severe disabilities result from the complications of pregnancy, childbirth or its management each year. A significant decrease of mortality/morbidity rates could be achieved by providing effective perinatal and newborn care also in high-income countries (HICs), especially in peripheral hospitals and/or rural areas, where the number of childbirths per year is often under the minimal threshold recognized by the reference legislation. We report on a 2 years retrospective cohort study, conducted in a first level peripheral hospital in Cefalù, a small city in Sicily (Italy), to evaluate care provided and mortality/morbidity rates. The proposed goal is to improve the quality of care, and the services that peripheral centers can offer. METHODS We collected data from maternity and neonatal records, over a 2-year period from January 2017 to December 2018. The informations analyzed were related to demographic features (age, ethnicity/origin area, residence, educational level, marital status), diagnosis at admission (attendance of birth training courses, parity, type of pregnancy, gestational age, fetal presentation), mode of delivery, obstetric complications, the weight of the newborns, their feeding and eventual transfer to II level hospitals, also through the Neonatal Emergency Transport Service, if the established criteria were present. RESULTS Eight hundred sixteen women were included (age 18-48 years). 179 (22%) attended birth training courses. 763 (93%) were Italian, 53 foreign (7%). 175 (21%) came from outside the province of Palermo. Eight hundred ten were single pregnancies, 6 bigeminal; 783 were at term (96%), 33 preterm (4%, GA 30-41 WG); 434 vaginal deliveries (53%), 382 caesarean sections (47%). One maternal death and 28 (3%) obstetric complications occurred during the study period. The total number of children born to these women was 822, 3 of which stillbirths (3.6‰). 787 (96%) were born at term (>37WG), 35 preterm (4%), 31 of which late preterm. Twenty-one newborns (2.5%) were transferred to II level hospitals. Among them, 3 for moderate/severe prematurity, 18 for mild prematurity/other pathology. The outcome was favorable for all women (except 1 hysterectomy) and the newborns transferred, and no neonatal deaths occurred in the biennium under investigation. Of the remaining 798 newborns, 440 were breastfed at discharge (55%), 337 had a mixed feeding (breastfed/formula fed, 42%) and 21 were formula fed (3%). CONCLUSIONS Although the minimal standard of adequate perinatal care in Italy is >500 childbirths/year, the aims of the Italian legislation concern the rationalization of birth centers as well as the structural, technological and organizational improvement of health facilities. Therefore, specific contexts and critical areas need to be identified and managed. Adequate resources and intervention strategies should be addressed not only to perinatal emergencies, but also to the management of mild prematurity/pathology, especially in vulnerable populations for social or orographic reasons. The increasing availability and spread of health care offers, even in HICs, cannot be separated from the goal of quality of care, which is an ethic and public health imperative.
Collapse
Affiliation(s)
- Gregorio Serra
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy. .,"G. Giglio" Hospital Institute Foundation, Cefalù, Italy.
| | | | | | - Giovanni Corsello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| |
Collapse
|
22
|
Rao KD, Srivastava S, Warren N, Mayra K, Gore A, Das A, Ahmed S. Where there is no nurse: an observational study of large-scale mentoring of auxiliary nurses to improve quality of care during childbirth at primary health centres in India. BMJ Open 2019; 9:e027147. [PMID: 31289071 PMCID: PMC6615817 DOI: 10.1136/bmjopen-2018-027147] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE Clinician scarcity in Low and Middle-Income Countries (LMIC) often results in de facto task shifting; this raises concerns about the quality of care. This study examines if a long-term mentoring programme improved the ability of auxiliary nurse-midwives (ANMs), who function as paramedical community health workers, to provide quality care during childbirth, and how they compared with staff nurses. DESIGN Quasi-experimental post-test with matched comparison group. SETTING Primary health centres (PHC) in the state of Bihar, India; a total of 239 PHCs surveyed and matched analysis based on 190 (134 intervention and 56 comparison) facilities. PARTICIPANTS Analysis based on 335 ANMs (237 mentored and 98 comparison) and 42 staff nurses (28 mentored and 14 comparison). INTERVENTION Mentoring for a duration of 6-9 months focused on nurses at PHCs to improve the quality of basic emergency obstetric and newborn care. PRIMARY OUTCOME MEASURES Nurse ability to provide correct actions in managing cases of normal delivery, postpartum haemorrhage and neonatal resuscitation assessed using a combination of clinical vignettes and Objective Structured Clinical Examinations. RESULTS Mentoring increased correct actions taken by ANMs to manage normal deliveries by 17.5 (95% CI 14.8 to 20.2), postpartum haemorrhage by 25.9 (95% CI 22.4 to 29.4) and neonatal resuscitation 28.4 (95% CI 23.2 to 33.7) percentage points. There was no significant difference between the average ability of mentored ANMs and staff nurses. However, they provided only half the required correct actions. There was substantial variation in ability; 41% of nurses for normal delivery, 60% for postpartum haemorrhage and 45% for neonatal resuscitation provided less than half the correct actions. Ability declined with time after mentoring was completed. DISCUSSION Mentoring improved the ability of ANMs to levels comparable with trained nurses. However, only some mentored nurses have the ability to conduct quality deliveries. Continuing education programmes are critical to sustain quality gains.
Collapse
Affiliation(s)
- Krishna D Rao
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Swati Srivastava
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Division Health Economics Health Financing, Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Nicole Warren
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | - Aboli Gore
- CARE India Solutions for Sustainable Development, Patna, India
| | - Aritra Das
- CARE India Solutions for Sustainable Development, Patna, India
| | - Saifuddin Ahmed
- Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|