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Saiki M, Nishimiya G, Gotoh T, Hirota K, Sakai I. Experiences and attitudes of task-shifting and task-sharing of physicians, nurses, and nursing assistants in hospitals: a qualitative systematic review protocol. JBI Evid Synth 2024; 22:856-863. [PMID: 37997847 DOI: 10.11124/jbies-23-00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
OBJECTIVE The objective of this review is to explore the experiences and attitudes of physicians, nurses, and nursing assistants regarding task-shifting and task-sharing in hospitals. INTRODUCTION Despite multiple health care professionals performing overlapping tasks, the need for effective task-shifting and task-sharing remains a concern. Understanding task-shifting and task-sharing experiences, as well as the attitudes of health care providers in hospitals, is essential for providing safe and patient-appropriate care with limited human resources. INCLUSION CRITERIA Qualitative studies that examine the experiences and attitudes of physicians, nurses, and nursing assistants in hospitals regarding task-shifting and task-sharing will be included. The review will include physicians, advanced practice nurses who are nurse practitioners or clinical nurse specialists, registered nurses, and nursing assistants. Midwives, pharmacists, occupational therapists, physical therapists, and students will be excluded. METHODS PubMed, MEDLINE, CINAHL, PsycINFO, Cochrane Database, and Web of Science will be searched as part of a 3-step search strategy. We will search for unpublished research and gray literature using Google Scholar and ProQuest Dissertations and Theses. Studies published in English or Japanese from the time each database was established to the present will be considered for inclusion. The methodological quality of all studies will be evaluated by screening against the inclusion criteria and by at least 2 critical evaluations using the standardized JBI checklist. Synthesized results will be pooled by meta-aggregation and published as a ConQual Summary of Findings. REVIEW REGISTRATION PROSPERO CRD42023409612.
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Affiliation(s)
- Masatoshi Saiki
- Department of Advanced Clinical Nursing, Frontier Clinical Nursing, Graduate School of Nursing, Chiba university, Chiba, Japan
| | - Gaku Nishimiya
- Nursing Department, Chiba University Hospital, Chiba, Japan
| | - Tomomi Gotoh
- Graduate School of Nursing, Chiba University, Chiba, Japan
| | | | - Ikuko Sakai
- Department of Advanced Clinical Nursing, Frontier Clinical Nursing, Graduate School of Nursing, Chiba university, Chiba, Japan
- The Chiba University Centre for Evidence Based Practice: A JBI Centre for Excellence, Chiba University, Chiba, Japan
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Lawlor S, Leech M. Established advanced practice roles in radiation therapy: A scoping review. J Med Imaging Radiat Oncol 2024; 68:342-352. [PMID: 38450863 DOI: 10.1111/1754-9485.13634] [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: 08/09/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024]
Abstract
Advanced practitioners are healthcare professionals that are highly skilled with a particular area of expertise. These roles have been successfully implemented in many healthcare settings, improving efficiency of the service, as well as enhancing the standard of care received by patients. Although advanced practice roles have been implemented in some radiation therapy departments, their implementation have yet to be facilitated in the majority of countries. The purpose of this review is to scope the literature available regarding established advanced practice roles in radiation therapy. The PRISMA strategy for the identification of relevant literature was adhered to. Two data bases, EMBASE and PubMed, were searched using combinations of the key words 'Advanced', 'Practice', 'APRT', 'Radiation', 'Therapy' and 'Radiotherapy'. Exclusion criteria were applied, and citation lists were also screened for additional relevant sources, including grey literature sources. A total of 35 relevant sources were identified that discussed advanced practice radiation therapy roles in the United Kingdom, Singapore, Canada, Australia and the USA. Means of role establishment and scope of practice were defined, and a number of advantages and challenges for advanced practice radiation therapist roles were identified. There are many benefits of implementing advanced practice roles in radiation therapy departments. Though the implementation of these roles can be challenging, the existing evidence indicates that it would be beneficial for the patient, the radiation therapist and the department as a whole. A more systematic approach, including reporting of quantitative outcomes may assist in the more widespread implementation of these roles.
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Affiliation(s)
- Sarah Lawlor
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity St. James's Cancer Institute, Trinity College Dublin, Dublin, Ireland
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Hällås E, Skoglund I, Nordeman L. "That's probably how you would want care to be" - experiences of sick leave teams at a health center, a mixed method study. BMC PRIMARY CARE 2023; 24:243. [PMID: 37978438 PMCID: PMC10655286 DOI: 10.1186/s12875-023-02192-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The health center where this study was performed the management wanted to test whether a sick leave team provided the physicians with better conditions for the task of assessing sick leave. The goals were to ensure the quality of the assessment of patients with sick leave needs and to improve the work environment. The aim of this study was to take part in the staff's experiences of having access to and working in sick leave teams and how the working method affected the number of sick leave patients and sick leave pattern. METHODS A mixture of qualitative and quantitative methods. Two focus groups were conducted with a total of 11 participants. The head of the health center formed the focus groups, which consisted of 6 doctors, 3 district nurses, 1 rehab coordinator and 1 psychologist. Aggregated sick leave data for full-time and part-time sick leave of more than 90, 180 and 360 days, respectively, were obtained and compiled at project start and end, and from the corresponding period 18 months before project start. RESULTS The introduction of sick leave teams with physicians and rehabilitation coordinator for patients who turn to the health center for mental illness and / or musculoskeletal problems emerged three main categories from the analysis of the focus group discussions: working environment, clear roles and in-depth competence. The total number of people who were on sick leave more than 365 days decreased by 27% between start and the end of the project, and the proportion of women increased by 11%. CONCLUSIONS The study shows that the complex task of sick leave can be perceived as positive by physicians with the support of teamwork. The working method is similar to that applied in occupational health care, where the physician is not alone with this task. This can also be a way to make primary care a more attractive workplace.
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Affiliation(s)
- E Hällås
- Research Education Development and Innovation Primary Health Care Region Västra Götaland, Borås, Sweden.
| | - I Skoglund
- Research Education Development and Innovation Primary Health Care Region Västra Götaland, Borås, Sweden
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - L Nordeman
- Research Education Development and Innovation Primary Health Care Region Västra Götaland, Borås, Sweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Ba MF, Bassoum O, Camara MD, Faye A. Predictors of cessation of exclusive breastfeeding according to the Cox regression model: survey of mothers of children aged 6-12 months, Thiès, Senegal. Pan Afr Med J 2023; 46:12. [PMID: 38035156 PMCID: PMC10683180 DOI: 10.11604/pamj.2023.46.12.39603] [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: 03/09/2023] [Accepted: 08/19/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction even though exclusive breastfeeding (EBF) for up to six months is recognised as essential infant care, it is still insufficiently practiced. The objective of this study was to identify predictors of EBF cessation in Thiès. Methods this was a survival analysis of data collected using a cross-sectional procedure. Data collection took place from 2nd December 2019 to 21st January 2020. The study population consisted of mothers of children aged 6 to 12 months residing in Thiès and seen at the reference health centre of the Thiès Health District during infant vaccination sessions. The number of subjects was 400 mothers recruited using a systematic survey, with a sampling interval equal to two. Data were collected through a face-to-face interview. Predictive factors were identified using the Cox regression model. The adjusted hazard ratio (AHR) and its 95% confidence interval (95% CI) are calculated. Results the average age of the mothers was 27.08 ± 6.34 years. The proportion of mothers who breastfed their child within one hour of birth was 29.25%. The proportion of those who practiced EBF was 41.50%. The incidence density of EBF cessation was 14 person-months per 100 breastfeeding mothers. The median duration of EBF was 5 months. Lack of advice on EBF during antenatal care (AHR=1.42; 95% CI =1.08-1.85), sources of information other than health professionals (AHR =1.51; 95% CI =1.05-2.19), late initiation of EBF, i.e. breastfeeding beyond 24 hours after birth (AHR =1.53; 95% CI =1.02-2.28) and low level of knowledge about EBF (AHR =1.46; 95% CI =1.11-1.92) were significantly associated with early termination of EBF. Conclusion the promotion of EBF for up to six months will necessarily involve the promotion of prenatal consultations during which professionals should raise awareness among future mothers.
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Affiliation(s)
- Mouhamadou Faly Ba
- Institute of Health and Development, Cheikh Anta Diop University, Dakar, Senegal
| | - Oumar Bassoum
- Institute of Health and Development, Cheikh Anta Diop University, Dakar, Senegal
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Senegal
| | - Maty Diagne Camara
- Institute of Health and Development, Cheikh Anta Diop University, Dakar, Senegal
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Senegal
| | - Adama Faye
- Institute of Health and Development, Cheikh Anta Diop University, Dakar, Senegal
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Pharmacy and Odontology, Cheikh Anta Diop University, Dakar, Senegal
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Mbouamba Yankam B, Adeagbo O, Amu H, Dowou RK, Nyamen BGM, Ubechu SC, Félix PG, Nkfusai NC, Badru O, Bain LE. Task shifting and task sharing in the health sector in sub-Saharan Africa: evidence, success indicators, challenges, and opportunities. Pan Afr Med J 2023; 46:11. [PMID: 38035152 PMCID: PMC10683172 DOI: 10.11604/pamj.2023.46.11.40984] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/26/2023] [Indexed: 12/02/2023] Open
Abstract
This review explores task shifting and task sharing in sub-Saharan African healthcare to address workforce shortages and cost-effectiveness. Task shifting allocates tasks logically, while task sharing involves more workers taking on specific duties. Challenges include supply chain issues, pay inadequacy, and weak supervision. Guidelines and success measures are lacking. Initiating these practices requires evaluating factors and ensuring sustainability. Task shifting saves costs but needs training and support. Task sharing boosts efficiency, enabling skilled clinicians to contribute effectively. To advance task shifting and sharing in the region, further research is needed to scale up effective initiatives. Clear success indicators, monitoring, evaluation, and learning plans, along with exploration of sustainability and appropriateness dimensions, are crucial elements to consider.
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Affiliation(s)
- Brenda Mbouamba Yankam
- Department of Statistics, Faculty of Physical Sciences, University of Nigeria, Nsukka, Nigeria
| | - Oluwafemi Adeagbo
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa, USA
- Department of Sociology, Faculty of Humanities, University of Johannesburg, Johannesburg, Auckland Park, South Africa
| | - Hubert Amu
- Department of Population and Behavioral Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Robert Kokou Dowou
- Department of Epidemiology and Biostatistics, Fred N. Binka School of Public Health, University of Health and Allied Science, Hohoe, Ghana
| | | | - Samuel Chinonso Ubechu
- Yale School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | | | - Ngwayu Claude Nkfusai
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Oluwaseun Badru
- Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
- Institute of Human Virology, Abuja, Nigeria
| | - Luchuo Engelbert Bain
- Department of Sociology, Faculty of Humanities, University of Johannesburg, Johannesburg, Auckland Park, South Africa
- International Development Research Centre, IDRC, Ottawa, Canada
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Akiyama N, Kajiwara S, Shiroiwa T, Akiyama T, Morikawa M. Reported Incidents Involving Non-medical Care Workers and Nursery Teachers in Hospitals in Japan: An Analysis of the Japan Council for Quality Health Care Nationwide Database. Cureus 2022; 14:e22589. [PMID: 35355538 PMCID: PMC8957718 DOI: 10.7759/cureus.22589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/25/2022] Open
Abstract
Objective With the shortage of medical staff, the birth rate decline, and aging populations in some countries, task shifting from specific medical staff to non-medical care workers in hospitals has been implemented as a short-term solution. Incident reporting reduces preventable patient errors, improves the quality of healthcare services, and contributes to patient safety. However, research focused on the expanding roles of non-medical staff who provide direct care for patients is lacking. The present study aimed to bridge this gap by examining reported incidents involving non-medical care workers and nursery teachers in hospitals in Japan. Methodology A retrospective mixed-methods study was conducted using data published by the Japan Council for Quality Health Care. A total of 21,876 cases were reported between 2016 and 2020, and 97 out of 21,876 cases were analysed, after excluding incidents involving workers or staff other than care workers/nursery teachers. Descriptive statistics were used to examine the incidents, and textual data included in the incident reports were analysed by two registered nurses. Results The occupations of the people involved were care worker (n=80, 82.5%) and nursery teacher (n=17, 17.5%). There were two reports of worker injuries (n=2, 2.1%), which were excluded. A total of 95 cases were included in the final analysis to examine the effects on patients. Among the remaining 95 cases, there were five severe patient incidents (death, n=2, 2.1%; cerebral hemorrhage, n=3, 3.2%), and the most frequent incident was bone fracture (n=64, 67.4%). Some patients had cognitive impairment (n=29, 30.5%) and osteoporosis (n=25, 26.3%). We divided the factors related to incident occurrence into software (procedures and protocols), environment (wards and theaters), and liveware (people, including care workers, nursery teachers, and patients). Regarding the reasons for the incidents, the percentages for the three factors were as follows: education/training 34.7% (n=33), in software; patient state 4.1% (n=39), in environment; and neglect to observe 45.3% (n=43), in liveware. Conclusion Our study involved a secondary analysis of published data, and the sample size was small. However, incident reports from care workers and nursery teachers working in hospitals included serious errors. The role of non-medical care staff in hospitals is broad and diverse, and has been shifting from direct care for patients with mild illnesses to direct care for patients with severe illnesses. An efficient clinical environment that ensures quality of care and service is lacking. By focusing on patient safety outcomes, policymakers and hospital teams should consider adjusting the working environment.
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Thulesius H, Sandén U, Petek D, Hoffman R, Koskela T, Oliva-Fanlo B, Neves AL, Hajdarevic S, Harrysson L, Toftegaard BS, Vedsted P, Harris M. Pluralistic task shifting for a more timely cancer diagnosis. A grounded theory study from a primary care perspective. Scand J Prim Health Care 2021; 39:486-497. [PMID: 34889704 PMCID: PMC8725826 DOI: 10.1080/02813432.2021.2004751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To explore how cancer could be diagnosed in a more timely way. DESIGN Grounded theory analysis of primary care physicians' free text survey responses to: 'How do you think the speed of diagnosis of cancer in primary care could be improved?'. Secondary analysis of primary care physician interviews, survey responses, literature. SETTING Primary care in 20 European Örenäs Research Group countries. SUBJECTS Primary care physicians: 1352 survey respondents (2013-2016), 20 Spanish and 7 Swedish interviewees (2015-2019). MAIN OUTCOME MEASURES Conceptual explanation of how to improve timeliness of cancer diagnosis. RESULTS Pluralistic task shifting is a grounded theory of a composite strategy. It includes task sharing - among nurses, physicians, nurse assistants, secretaries, and patients - and changing tasks with cancer screening when appropriate or cancer fast-tracks to accelerate cancer case finding. A pluralistic dialogue culture of comprehensive collaboration and task redistribution is required for effective pluralistic task shifting. Pluralistic task shifting relies on cognitive task shifting, which includes learning more about slow analytic reasoning and fast automatic thinking initiated by pattern recognition; and digital task shifting, which by use of eHealth and telemedicine bridges time and place and improves power symmetry between patients, caregivers, and clinicians. Financial task shifting that involves cost tracking followed by reallocation of funds is necessary for the restructuring and retraining required for successful pluralistic task shifting. A timely diagnosis reduces expensive investigations and waiting times. Also, late-stage cancers are costlier to treat than early-stage cancers. Timing is central to cancer diagnosis: not too early to avoid overdiagnosis, and never too late. CONCLUSIONS We present pluralistic task shifting as a conceptual summary of strategies needed to optimise the timeliness of cancer diagnosis.Key pointsCancer diagnosis is under-researched in primary care, especially theoretically. Thus, inspired by classic grounded theory, we analysed and conceptualised the field:Pluralistic task shifting is a conceptual explanation of how the timeliness of cancer diagnosis could be improved, with data derived mostly from primary care physicians.This includes task sharing and changing tasks including screening and cancer fast-tracks to accelerate cancer case finding, and requires cognitive task shifting emphasising learning, and digital task shifting involving the use of eHealth and telemedicine.Financial task shifting with cost tracking and reallocation of funds is eventually necessary for successful pluralistic task shifting to happen.
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Affiliation(s)
- Hans Thulesius
- Department of Clinical Sciences Malmö, Family Medicine, Lund University, Lund, Sweden
- Research and Development Centre, Region Kronoberg, Växjö, Sweden
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
- CONTACT Hans Thulesius
| | - Ulrika Sandén
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
| | - Davorina Petek
- Department of Family Medicine, Faculty of medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Robert Hoffman
- Departments of Family Medicine & Medical Education, Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Tuomas Koskela
- Department of General Practice, School of Medicine, University of Tampere, Tampere, Finland
| | | | - Ana Luísa Neves
- Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, London, UK
- Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Lars Harrysson
- Department of Design Sciences, Faculty of Engineering, Lund University, Lund, Sweden
- School of Social Work, Faculty of Social Sciences, Lund University, Lund, Sweden
| | | | - Peter Vedsted
- Department of Clinical Medicine, Research Unit for General Practice, The Research Centre for Cancer Diagnosis in Primary Care, Aarhus University, Aarhus, Denmark
| | - Michael Harris
- College of Medicine & Health, University of Exeter, Exeter, UK
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
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Bolme S, Austeng D, Gjeilo KH. Task shifting of intravitreal injections from physicians to nurses: a qualitative study. BMC Health Serv Res 2021; 21:1185. [PMID: 34717603 PMCID: PMC8557571 DOI: 10.1186/s12913-021-07203-8] [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: 05/04/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022] Open
Abstract
Background Intravitreal injections of anti-vascular endothelial growth factor are high-volume procedures and represent a considerable workload on ophthalmology departments. Several departments have tried to meet this increase by shifting the task to nurses. To maintain high-quality patient care, we developed a training program for nurses that certifies them to administer injections. This qualitative study aimed to evaluate whether the nurses were confident and in control after participating in the training program and whether they were satisfied with the training and the new task. Methods Between 2014 and 2018, 12 registered nurses were trained in a tertiary hospital in central Norway. All the nurses were interviewed, either individually (n = 7) or in a group (n = 5). We analysed the interviews using Graneheim and Lundman’s qualitative content analysis. Results Eight subthemes were clustered within four main themes: 1) procedure and challenges, 2) motivation, 3) cooperation and confidence, and 4) evaluation. The nurses felt confident and in control when administering injections but experienced moments of insecurity. The new task gave the nurses a sense of achievement, and they highlighted improvement of patients’ lives as positive. A greater level of responsibility gave the nurses pride in their profession. They had suggestions that could improve training efficiency but were overall satisfied with the training program. Conclusions Our study showed that the nurses were satisfied with the training and that learning a new task led to higher self-esteem and increased respect from patients and colleagues. Suggestions to improve the training were identified; these should be considered before implementation by other departments.
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Affiliation(s)
- Stine Bolme
- Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. .,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), N-7489, Trondheim, Norway.
| | - Dordi Austeng
- Department of Ophthalmology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), N-7489, Trondheim, Norway
| | - Kari Hanne Gjeilo
- Department of Public Health and Nursing, Faculty of Medicine, NTNU, Trondheim, Norway.,Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cardiothoracic Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Vinayak S, Temmerman M, Villeirs G, Brownie SM. A Curriculum Model for Multidisciplinary Training of Midwife Sonographers in a Low Resource Setting. J Multidiscip Healthc 2021; 14:2833-2844. [PMID: 34675531 PMCID: PMC8505681 DOI: 10.2147/jmdh.s331371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
In many low-resource settings, less than 5% of pregnant women can access ultrasound during pregnancy. Thus, gestational age is often difficult to determine, multiple pregnancies are diagnosed late and foetal and pregnancy-related anomalies can go undetected. A pilot solution was designed beyond the traditional approach of increasing numbers of qualified radiologists, gynaecologists and sonographers. An innovative Human Resource for Health (HRH) task sharing, and maternal child health (MCH) workforce training and capacity building initiative was designed, involving development and testing of a curriculum to train midwife sonographers via a teleradiology innovation platform and a partnership between specialist radiologists, sonographers and midwives. The setting was a tertiary-level private university hospital in Nairobi with implementation in three outreach locations. Direct oversight, support and supervision of specialist radiologists and ultrasonographers effectively addressed issues of quality and safety across the 3-week training period and project implementation. Concepts from sociocultural learning theory informed an initial interactive e-learning module for each midwife at their respective site. Midwives were introduced to ultrasound equipment with a series of didactic and interactive lectures delivered by an expert sonographer at the tertiary hospital teaching site. Lectures were supported by hands-on practical experience, role modelling and mentoring over a four-week period. Assessments included both written examination and practical assessment with an exit examination requiring demonstration of competency in both written and practical format. Final confirmation of scanning accuracy was confirmed with post-delivery verification of results. The pilot was highly successful with an image interpretation accuracy of 99.63% for the midwives. Lessons from this initiative provides guidance in the curriculum development process along with a curriculum outline; pedagogical framework; teaching methods; assessment processes; credentialing; resourcing; and other considerations in scaling up the program. Importantly, the paper details processes for maintaining a high level of quality control and patient safety.
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Affiliation(s)
- Sudhir Vinayak
- Department of Medical Imaging, Aga Khan University Hospital, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Obstetrics & Gynaecology, Aga Khan University Hospital, Nairobi, Kenya.,Department of Obstetrics & Gynaecology, Ghent University, Ghent, Belgium
| | - Geert Villeirs
- Department of Diagnostics, Ghent University Hospital, Ghent, Belgium
| | - Sharon M Brownie
- School of Nursing, Midwifery and Public Health, University of Canberra, Canberra, ACT, Australia.,School of Medicine, Griffith University, Queensland, Australia.,Centre for Health and Social Practice, Wintec, Hamilton, New Zealand
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DeStigter K, Pool KL, Leslie A, Hussain S, Tan BS, Donoso-Bach L, Andronikou S. Optimizing integrated imaging service delivery by tier in low-resource health systems. Insights Imaging 2021; 12:129. [PMID: 34529166 PMCID: PMC8444174 DOI: 10.1186/s13244-021-01073-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
Access to imaging diagnostics has been shown to result in accurate treatment, management, and optimal outcomes. Particularly in low-income and low-middle-income countries (LICs, LMICs), access is limited due to a lack of adequate resources. To achieve Sustainable Development Goal (SDG) 3, access to imaging services is critical at every tier of the health system. Optimizing imaging services in low-resource settings is best accomplished by prescriptive, integrated, and coordinated tiered service delivery that takes contextual factors into consideration. To our knowledge, this is the first recommendation for optimized, specific imaging care delivery by tier. A model for tier-based essential imaging services informs and guides policymakers as they set priorities and make budgetary decisions. In this paper, we recommend a framework for tiered imaging services essential to reduce the global burden of disease and attain universal health coverage (UHC). A lack of access to basic imaging services, even at the lowest tier of the health system, can no longer be justified by cost. Worldwide, affordable modalities of modern ultrasound and X-ray are becoming an accessible mainstay for the investigation of common conditions such as pregnancy, pneumonia, and fractures, and are safely performed and interpreted by qualified professionals. Finally, given the vast gap in access to imaging resources between LMICs and high-income countries (HICs), a scale-up of tiered imaging services in low-resource settings has the potential to reduce health disparities between, and within countries. As the access to appropriately integrated imaging services improves, UHC may be achieved.
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Affiliation(s)
- Kristen DeStigter
- Department of Radiology, Larner College of Medicine, University of Vermont, 111 Colchester Avenue Main Campus, McClure, Level 1, Burlington, VT, 05401, USA
| | - Kara-Lee Pool
- RAD-AID International, 8004 Ellingson Drive, Chevy Chase, MD, 20815, USA.
| | - Abimbola Leslie
- Department of Radiology, Larner College of Medicine, University of Vermont, 111 Colchester Avenue Main Campus, McClure, Level 1, Burlington, VT, 05401, USA
| | - Sarwat Hussain
- Department of Radiology, University of Massachusetts, 55 North Lake Ave, Worcester, MA, 01655, USA
| | - Bien Soo Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Lluis Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Kamvura TT, Turner J, Chiriseri E, Dambi J, Verhey R, Chibanda D. Using a theory of change to develop an integrated intervention for depression, diabetes and hypertension in Zimbabwe: lessons from the Friendship Bench project. BMC Health Serv Res 2021; 21:928. [PMID: 34488732 PMCID: PMC8421086 DOI: 10.1186/s12913-021-06957-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 08/26/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are projected to become the leading cause of disability and mortality in sub-Saharan Africa by 2030; a vast treatment gap exists. There is a dearth of knowledge on developing evidence-based interventions that address comorbid NCDs using a task-shifting approach. The Friendship Bench, a brief psychological intervention for common mental disorders delivered by trained community grandmothers, is a promising intervention for comorbid NCDs. Although task-shifting appears to be a rational approach, evidence suggests that it may bring about tension between existing professionals from whom tasks are shifted. A Theory of Change approach is an effective way of managing the unintended tension by bringing together different stakeholders involved to build consensus on how to task shift appropriately to the parties involved. We aimed to use a theory of change approach to formulating a road map on how to successfully integrate diabetes and hypertension care into the existing Friendship Bench in order to come up with an integrated care package for depression, hypertension and diabetes aimed at strengthening NCD care in primary health care systems in Zimbabwe. METHOD A theory of change workshop with 18 stakeholders from diverse backgrounds was carried out in February 2020. Participants included grandmothers working on the Friendship Bench project (n = 4), policymakers from the ministry of health (n = 2), people with lived experience for the three NCDs (n = 4), health care workers (n = 2), and traditional healers (n = 2). Findings from earlier work (situational analysis, desk review, FGDs and clinic-based surveys) on the three NCDs were shared before starting the ToC. A facilitator with previous experience running ToCs led the workshop and facilitated the co-production of the ToC map. Through an iterative process, consensus between the 18 stakeholders was reached, and a causal pathway leading to developing a framework for an intervention was formulated. RESULTS The ToC singled out the need to use expert clients (people with lived experience) to promote a patient-centred care approach that would leverage the existing Friendship Bench approach. In the face of COVID-19, the stakeholders further endorsed the use of existing digital platforms, notably WhatsApp, as an alternative way to reach out to clients and provide support. Leveraging existing community support groups as an entry point for people in need of NCD care was highlighted as a win-win by all stakeholders. A final framework for an NCD care package supported by Friendship Bench was presented to policymakers and accepted to be piloted in five geographical areas. CONCLUSIONS The ToC can be used to build consensus on how best to use using an existing intervention for common mental disorders to integrate care for diabetes and hypertension. There is a need to evaluate this new intervention through an adequately powered study.
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Affiliation(s)
- Tiny Tinashe Kamvura
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
| | - Jean Turner
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Ephraim Chiriseri
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Jermaine Dambi
- Rehabilitation Sciences Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Ruth Verhey
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Dixon Chibanda
- Research Support Centre, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
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O'Reilly D, Brady AM, Bryant-Lukosius D, Varley J, Daly L, Cotter P, Elliot N, Lehane E, Fleming S, Savage E, Hegarty J, Drennan J. Patient-reported experiences of consultation with an advanced nurse practitioner: Factor structure and reliability analysis of the patient enablement and satisfaction survey. J Adv Nurs 2021; 77:4279-4289. [PMID: 34449917 DOI: 10.1111/jan.15026] [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: 10/20/2020] [Revised: 07/13/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
AIM The aim was to analyse the psychometric properties of a patient-reported-experience measure, the Patient Enablement and Satisfaction Survey (PESS), when used to evaluate the care provided by Advanced Nurse Practitioners (ANPs) in terms of factor structure and internal consistency. The PESS is a 20-item, patient-completed data collection tool that was originally developed to measure patient experience and enablement following consultation with nurses in general practice. DESIGN Cross-sectional survey; validity and reliability analysis. METHODS The sample in this study consisted of 178 patients who consulted with 26 ANPs working in four different specialities. Data were collected between June and December 2019. An exploratory factor analysis of the PESS was conducted to determine convergent validity which was supported by parallel analysis and the traditional Kaiser criterion. The internal consistency of individual PESS items was determined via Cronbach's alpha, McDonald's omega, the Average Variance Extracted tests and item-subscale/total score correlations. RESULTS A three-factor structure (PESS-ANP) was found through exploratory factor analysis and this was supported by parallel analysis, the traditional Kaiser criterion and the percentage of variance explained criterion. A high degree of internal consistency was reported across all factors. One question was omitted from the analysis ('Overall Satisfaction') following the identification of problematic cross-loadings. The three factor solution was identified as: patient satisfaction, quality of care provision and patient enablement. CONCLUSION The findings of this study propose a three-factor model that is sufficiently reliable for analysing the experience and enablement of patients following consultation with an ANP. IMPACT Increasingly, patient-reported experience measures are being used to evaluate patients' experience of receiving care from a healthcare professional. The PESS was identified to be reliable in evaluating the experience of patients who receive care from an ANP while a three-factor structure was proposed that can capture specific attributes of this care.
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Affiliation(s)
- David O'Reilly
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Anne-Marie Brady
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Jarlath Varley
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Louise Daly
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Patrick Cotter
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Naomi Elliot
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Elaine Lehane
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Sandra Fleming
- School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Eileen Savage
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Josephine Hegarty
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
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Orkin AM, Rao S, Venugopal J, Kithulegoda N, Wegier P, Ritchie SD, VanderBurgh D, Martiniuk A, Salamanca-Buentello F, Upshur R. Conceptual framework for task shifting and task sharing: an international Delphi study. HUMAN RESOURCES FOR HEALTH 2021; 19:61. [PMID: 33941191 PMCID: PMC8091141 DOI: 10.1186/s12960-021-00605-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/21/2021] [Indexed: 05/13/2023]
Abstract
BACKGROUND Task shifting and sharing (TS/S) involves the redistribution of health tasks within workforces and communities. Conceptual frameworks lay out the key factors, constructs, and variables involved in a given phenomenon, as well as the relationships between those factors. Though TS/S is a leading strategy to address health worker shortages and improve access to services worldwide, a conceptual framework for this approach is lacking. METHODS We used an online Delphi process to engage an international panel of scholars with experience in knowledge synthesis concerning TS/S and develop a conceptual framework for TS/S. We invited 55 prospective panelists to participate in a series of questionnaires exploring the purpose of TS/S and the characteristics of contexts amenable to TS/S programmes. Panelist responses were analysed and integrated through an iterative process to achieve consensus on the elements included in the conceptual framework. RESULTS The panel achieved consensus concerning the included concepts after three Delphi rounds among 15 panelists. The COATS Framework (Concepts and Opportunities to Advance Task Shifting and Task Sharing) offers a refined definition of TS/S and a general purpose statement to guide TS/S programmes. COATS describes that opportunities for health system improvement arising from TS/S programmes depending on the implementation context, and enumerates eight necessary conditions and important considerations for implementing TS/S programmes. CONCLUSION The COATS Framework offers a conceptual model for TS/S programmes. The COATS Framework is comprehensive and adaptable, and can guide refinements in policy, programme development, evaluation, and research to improve TS/S globally.
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Affiliation(s)
- Aaron M Orkin
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Li Ka Shing Knowledge Institute, Unity Health, Toronto, Toronto, Canada.
| | - Sampreeth Rao
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Natasha Kithulegoda
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Women's College Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Canada
| | | | - Stephen D Ritchie
- School of Kinesiology and Health Sciences, Faculty of Health, Laurentian University; Sudbury, Toronto, Canada
| | - David VanderBurgh
- Department of Family Medicine, McMaster University, Hamilton, Canada
| | - Alexandra Martiniuk
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Fabio Salamanca-Buentello
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Ross Upshur
- Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Anh NTK, Yen LM, Nguyen NT, Nhat PTH, Thuy TTD, Phong NT, Tuyen PT, Yen NH, Chambers M, Hao NV, Rollinson T, Denehy L, Thwaites CL. Feasibility of establishing a rehabilitation programme in a Vietnamese intensive care unit. PLoS One 2021; 16:e0247406. [PMID: 33657158 PMCID: PMC7928504 DOI: 10.1371/journal.pone.0247406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
Increasing numbers of people are surviving critical illness throughout the world, but survivorship is associated with long-term disability. In high-income settings physical rehabilitation is commonly employed to counter this and improve outcomes. These utilize highly-trained multidisciplinary teams and are unavailable and unaffordable in most low and middle income countries (LMICs). We aimed to design a sustainable intensive care unit (ICU) rehabilitation program and to evaluate its feasibility in a LMIC setting. In this project patients, care-givers and experts co-designed an innovative rehabilitation programme that can be delivered by non-expert ICU staff and family care-givers in a LMIC. We implemented this programme in adult patient with patients with tetanus at the Hospital for Tropical Diseases, Ho Chi Minh City over a 5-month period, evaluating the programme's acceptability, enablers and barriers. A 6-phase programme was designed, supported by written and video material. The programme was piloted in total of 30 patients. Rehabilitation was commenced a median 14 (inter quartile range (IQR) 10-18) days after admission. Each patient received a median of 25.5 (IQR 22.8-34.8) rehabilitation sessions out of a median 27 (22.8-35) intended (prescribed) sessions. There were no associated adverse events. Patients and staff found rehabilitation to be beneficial, enhanced relationships between carers, patients and staff and was deemed to be a positive step towards recovery and return to work. The main barrier was staff time. The programme was feasible for patients with tetanus and viewed positively by staff and participants. Staff time was identified as the major barrier to ongoing implementation.
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Affiliation(s)
| | - Lam Minh Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | - Pham Thi Tuyen
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Yen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Mary Chambers
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Nguyen Van Hao
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | | | - C. Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Nath A, Shalini MAJ, Mathur P. Health systems challenges and opportunities in tackling non-communicable diseases in rural areas of India. NATIONAL MEDICAL JOURNAL OF INDIA 2021; 34:29-35. [PMID: 34397002 DOI: 10.4103/0970-258x.323661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The increasing burden of non-communicable diseases in rural areas poses new challenges to an already overburdened health systems. We detail these challenges and identify opportunities to address them. The major challenges in service delivery in rural areas include poor accessibility, shortage of adequate manpower especially specialists in rural areas, irregular supply of medicines and lack of adequate diagnostic facilities. This has led to an increased dependency on the private sector resulting in high out-of-pocket and catastrophic health expenditure. The challenges are amplified by lower health literacy, large pool of informal or untrained healthcare practitioners, and lack of proper referral and follow up. The health system opportunities identified include task-shifting by training of mid-level healthcare providers and practitioners from Indian systems of medicine, widening use of e-health and m-health, community engagement and public-private partnerships. Participatory health governance through community engagement has been shown to improve accountability and quality in health systems. Civil society organizations (CSO) can also improve awareness and health-seeking behaviour. New and evidence-based strategies need to be implemented to address health system challenges for tackling non-communicable diseases in rural areas.
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Affiliation(s)
- Anita Nath
- National Centre for Disease Informatics and Research (Indian Council of Medical Research), Nirmal Bhawan, ICMR Complex, Poojanhalli Road, off NH-7, adjacent to Trumpet Flyover of BIAL, Kannamangala Post, Bengaluru 562110, Karnataka, India
| | - Martina A J Shalini
- National Centre for Disease Informatics and Research (Indian Council of Medical Research), Nirmal Bhawan, ICMR Complex, Poojanhalli Road, off NH-7, adjacent to Trumpet Flyover of BIAL, Kannamangala Post, Bengaluru 562110, Karnataka, India
| | - Prashant Mathur
- National Centre for Disease Informatics and Research (Indian Council of Medical Research), Nirmal Bhawan, ICMR Complex, Poojanhalli Road, off NH-7, adjacent to Trumpet Flyover of BIAL, Kannamangala Post, Bengaluru 562110, Karnataka, India
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English M, Gathara D, Nzinga J, Kumar P, Were F, Warfa O, Tallam-Kimaiyo E, Nandili M, Obengo A, Abuya N, Jackson D, Brownie S, Molyneux S, Jones COH, Murphy GAV, McKnight J. Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya. BMJ Glob Health 2020; 5:e001937. [PMID: 32133169 PMCID: PMC7042598 DOI: 10.1136/bmjgh-2019-001937] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/13/2019] [Accepted: 12/22/2019] [Indexed: 11/02/2022] Open
Abstract
There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses' well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.
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Affiliation(s)
- Mike English
- Health Services Unit, KEMRI – Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, Oxford, Oxfordshire, UK
| | - David Gathara
- Health Services Unit, KEMRI – Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacinta Nzinga
- Health Services Unit, KEMRI – Wellcome Trust Research Programme, Nairobi, Kenya
| | - Pratap Kumar
- Institute of Healthcare Management, Strathmore University Strathmore Business School, Nairobi, Nairobi Area, Kenya
- Health-E-Net Limited, Nairobi, Kenya
| | - Fred Were
- Department of Paediatrics, University of Nairobi, Nairobi, Nairobi, Kenya
| | - Osman Warfa
- Neonatal, Child and Adolescent Health Unit, Kenya Ministry of Health, Nairobi, Kenya
| | | | - Mary Nandili
- Neonatal, Child and Adolescent Health Unit, Kenya Ministry of Health, Nairobi, Kenya
| | - Alfred Obengo
- National Nurses Association of Kenya, Nairobi, Kenya
| | | | - Debra Jackson
- University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sharon Brownie
- Griffith University Menzies Health Institute Queensland, Nathan, Queensland, Australia
| | - Sassy Molyneux
- Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, Oxford, UK
| | - Caroline Olivia Holmes Jones
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
- Department of Health System and Research Ethics, KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Jacob McKnight
- Center for Tropical Medicine and Global Health, University of Oxford Centre for Tropical Medicine, Oxford, UK
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Kavita K, Thakur J, Vijayvergiya R, Ghai S. Nurses role in cardiovascular risk assessment and communication: Indian nurses perspective. INTERNATIONAL JOURNAL OF NONCOMMUNICABLE DISEASES 2020. [DOI: 10.4103/jncd.jncd_29_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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