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Regmi S, Bertone MP, Shrestha P, Sapkota S, Arjyal A, Martineau T, Raven J, Witter S, Baral S. Understanding health system resilience in responding to COVID-19 pandemic: experiences and lessons from an evolving context of federalization in Nepal. BMC Health Serv Res 2024; 24:428. [PMID: 38575933 PMCID: PMC10996157 DOI: 10.1186/s12913-024-10755-0] [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: 05/11/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024] Open
Abstract
INTRODUCTION The COVID-19 pandemic has tested the resilience capacities of health systems worldwide and highlighted the need to understand the concept, pathways, and elements of resilience in different country contexts. In this study, we assessed the health system response to COVID-19 in Nepal and examined the processes of policy formulation, communication, and implementation at the three tiers of government, including the dynamic interactions between tiers. Nepal was experiencing the early stages of federalization reform when COVID-19 pandemic hit the country, and clarity in roles and capacity to implement functions were the prevailing challenges, especially among the subnational governments. METHODS We adopted a cross-sectional exploratory design, using mixed methods. We conducted a desk-based review of all policy documents introduced in response to COVID-19 from January to December 2020, and collected qualitative data through 22 key informant interviews at three tiers of government, during January-March 2021. Two municipalities were purposively selected for data collection in Lumbini province. Our analysis is based on a resilience framework that has been developed by our research project, ReBUILD for Resilience, which helps to understand pathways to health system resilience through absorption, adaptation and transformation. RESULTS In the newly established federal structure, the existing emergency response structure and plans were utilized, which were yet to be tested in the decentralized system. The federal government effectively led the policy formulation process, but with minimal engagement of sub-national governments. Local governments could not demonstrate resilience capacities due to the novelty of the federal system and their consequent lack of experience, confusion on roles, insufficient management capacity and governance structures at local level, which was further aggravated by the limited availability of human, technical and financial resources. CONCLUSIONS The study findings emphasize the importance of strong and flexible governance structures and strengthened capacity of subnational governments to effectively manage pandemics. The study elaborates on the key areas and pathways that contribute to the resilience capacities of health systems from the experience of Nepal. We draw out lessons that can be applied to other fragile and shock-prone settings.
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Affiliation(s)
| | - Maria Paola Bertone
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | | | | | | | - Tim Martineau
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joanna Raven
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sophie Witter
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
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Njuguna C, Tola H, Maina BN, Magambo KN, Namukose S, Kamau S, Tegegn YW. Roles of health system leadership under emergency in drought-affected districts in northeast Uganda: a mixed-method study. BMJ Open 2024; 14:e080374. [PMID: 38503408 PMCID: PMC10953004 DOI: 10.1136/bmjopen-2023-080374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
OBJECTIVE Health system leadership plays a critical role in sustaining healthcare delivery during emergencies. Thus, we aimed to assess the contribution of health system leadership in sustaining healthcare delivery under emergency conditions based on adaptive leadership theoretical framework. DESIGN We employed a concurrent mixed-methods study approach to assess health system leadership roles during emergency. This involved a quantitative survey administered to 150 health facilities managers/service focal persons selected via multistage sampling method from 15 districts, and qualitative interviews with 48 key informants who purposively selected. PARTICIPANTS We interviewed health facility managers, services focal persons, district health officers and residential district commissioners. We also reviewed weekly emergency situation reports and other relevant documents related to the emergency response. We used structured questionnaire, observation checklist and semistructured questionnaire to collect data. We employed descriptive statistics to analyse quantitative data and thematic analysis for qualitative data. MAIN OUTCOME Health system leadership contributions in sustaining healthcare delivery during emergencies. RESULTS Health system leadership was effective in leading emergency response and ensuring the continuity of health service during emergencies. Community engagement, partners coordination and intersectoral collaboration were effectively used in the emergency response and ensuring continuity of healthcare delivery. Deployment of experienced personnel and essential medical and non-medical supplies played a critical role in the continuity of health service. Availability of incidence management teams across health system significantly contributed to health system leadership. Participation of village health teams in community engagement and information communication helped in the success of health system leadership under emergency. CONCLUSION Adaptive health system leadership played a crucial role in managing health services delivery under emergency conditions. Effective partnership coordination and collaboration across sectors, frequent information communication, building local actor capacity and implementing scheduled supportive supervisions emerged as key strategies for sustaining health services during emergencies.
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Affiliation(s)
- Charles Njuguna
- World Health Organization Country Office for Uganda, Kampala, Uganda
- Kenyatta University, School of Business, Nairobi, Nairobi, Kenya
| | - Habteyes Tola
- World Health Organization Country Office for Uganda, Kampala, Uganda
| | | | | | | | - Sarah Kamau
- Kenyatta University, School of Business, Nairobi, Nairobi, Kenya
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Basij-Rasikh M, Dickey ES, Sharkey A. Primary healthcare system and provider responses to the Taliban takeover in Afghanistan. BMJ Glob Health 2024; 9:e013760. [PMID: 38382976 PMCID: PMC10882370 DOI: 10.1136/bmjgh-2023-013760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Existing health system challenges in Afghanistan were amplified by the Taliban's August 2021 government takeover during which the country faced an evolving security situation, border closures, banking interruptions, donor funding disruptions and international staff evacuations. We investigated factors that influenced health sector and health service delivery following the takeover. METHODS We purposively sampled individuals knowledgeable about Afghanistan's health sector and health professionals working in underserved areas of the country. We identified codes and themes of the data using framework analysis. RESULTS Factors identified as supporting continued health service delivery following August 2021 include external funding and operational flexibilities, ongoing care provision by local implementers and providers, health worker motivation, flexible contracting out arrangements and improved security. Factors identified as contributing to disruptions include damaged infrastructure, limited supplies, ineffective government implementation efforts and changes in government leadership and policies resulting in new coordination and capacity challenges. There were mixed views on the role pay-for-performance schemes played. Participants also shared concerns about the new working environment. These included loss of qualified health professionals and the associated impact on quality of care, continued dependency on external funding, women's inability to finish their studies or take on any leadership positions, various impacts of the Mahram policy, mental stress, the future of care provision for female patients and widespread economic hardship which impacts nearly every aspect of Afghan life. CONCLUSION Afghanistan's health sector presents a compelling case of adaptability in the face of crisis. Despite the anticipated and reported total collapse due to the country's power shift, various factors enabled health services to continue in some settings while others acted as barriers. The potential role of these factors should be considered in the context of future service delivery in Afghanistan and other settings at risk of political and societal disruption.
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Affiliation(s)
- Mustafa Basij-Rasikh
- Center for Health and Wellbeing, Princeton University School of Public and International Affairs, Princeton, New Jersey, USA
| | - Elisa S Dickey
- Princeton University School of Public and International Affairs, Princeton, New Jersey, USA
| | - Alyssa Sharkey
- Center for Health and Wellbeing, Princeton University School of Public and International Affairs, Princeton, New Jersey, USA
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Accoe K, Criel B, Ag Ahmed MA, Buitrago VT, Marchal B. Conditions for health system resilience in the response to the COVID-19 pandemic in Mauritania. BMJ Glob Health 2023; 8:e013943. [PMID: 38050409 PMCID: PMC10693853 DOI: 10.1136/bmjgh-2023-013943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/15/2023] [Indexed: 12/06/2023] Open
Abstract
INTRODUCTION A country's ability to manage a crisis depends on its level of resilience. Efforts are made to clarify the concept of health system resilience, but its operationalisation remains little studied. In the present research, we described the capacity of the local healthcare system in the Islamic Republic of Mauritania, in West Africa, to cope with the COVID-19 pandemic. METHODS We used a single case study with two health districts as units of analysis. A context analysis, a literature review and 33 semi-structured interviews were conducted. The data were analysed using a resilience conceptual framework. RESULTS The analysis indicates a certain capacity to manage the crisis, but significant gaps and challenges remain. The management of many uncertainties is largely dependent on the quality of the alignment of decision-makers at district level with the national level. Local management of COVID-19 in the context of Mauritania's fragile healthcare system has been skewed to awareness-raising and a surveillance system. Three other elements appear to be particularly important in building a resilient healthcare system: leadership capacity, community dynamics and the existence of a learning culture. CONCLUSION The COVID-19 pandemic has put a great deal of pressure on healthcare systems. Our study has shown the relevance of an in-depth contextual analysis to better identify the enabling environment and the capacities required to develop a certain level of resilience. The translation into practice of the skills required to build a resilient healthcare system remains to be further developed.
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Affiliation(s)
- Kirsten Accoe
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Khirekar J, Badge A, Bandre GR, Shahu S. Disaster Preparedness in Hospitals. Cureus 2023; 15:e50073. [PMID: 38192940 PMCID: PMC10771935 DOI: 10.7759/cureus.50073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/06/2023] [Indexed: 01/10/2024] Open
Abstract
Disaster preparedness in hospitals is a critical global concern that involves proactive measures to mitigate the impact of natural or artificial disasters. The review emphasizes the role of organizations such as India's National Disaster Management Authority in the development of response strategies. Hospitals face challenges in protecting facilities and healthcare workers during disasters, highlighting the need for effective training, equipment, and communication access. Differentiating disasters into natural, technological, and artificial types showcases the varied challenges each presents. Key challenges include resource allocation, interoperability of the communication system, evacuation strategies, and ethical considerations. Essential strategies include risk assessment, staff training, communication, and collaboration with external partners. Hospital disaster preparedness requires a comprehensive approach that involves strategies, training, and community participation to ensure safety during emergencies.
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Affiliation(s)
- Janhavi Khirekar
- Hospital Administration, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| | - Ankit Badge
- Microbiology, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
| | - Gulshan R Bandre
- Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Wardha, IND
| | - Shivani Shahu
- Hospital Administration, School of Allied Health Sciences, Datta Meghe Institute of Higher Education and Research (Deemed to Be University), Nagpur, IND
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Santos-Cebrián M, Morales-Moya MÁ, De-Pablos-Heredero C, Pacheco-Olivares MDR. How Much Dialogic Coordination Practices Matter to Healthcare Professionals-A Delphi Approach towards a Tool for Identification and Measurement. Healthcare (Basel) 2023; 11:2961. [PMID: 37998453 PMCID: PMC10671251 DOI: 10.3390/healthcare11222961] [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: 10/13/2023] [Revised: 11/07/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023] Open
Abstract
The study of coordination practices in health policy is a central aspect. The need for further research has been recently highlighted because of COVID-19. In this sense, dialogic practices (DP) have been identified but not validated yet. The purpose of this study is to develop and validate a DP questionnaire for healthcare teams. Items were identified based on a literature review, and the content validation was carried out by means of a Delphi study. A total of 10 experts assessed the clarity and appropriateness of the items and their corresponding measurement scales. After two rounds, a high level of consensus was reached, with agreement of 90% or higher on all items, and a high degree of stability and concordance in the results. This study resulted in a questionnaire consisting of four items, one for each identified DP initially proposed to the experts, as no other practices were revealed. From a practical perspective, the validation of these items constitutes a methodological innovation that responds to the call in the literature to open new avenues for comparative studies, and the possibility of generalising the findings and bringing together different approaches to the problem of coordination, which is key in health policy where unforeseen situations emerge.
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Affiliation(s)
- Mónica Santos-Cebrián
- Financial Economy and Accounting Department, Rey Juan Carlos University, 28032 Madrid, Spain; (M.S.-C.);
| | - Miguel-Ángel Morales-Moya
- Financial Economy and Accounting Department, Rey Juan Carlos University, 28032 Madrid, Spain; (M.S.-C.);
| | - Carmen De-Pablos-Heredero
- Department of Business Economics (Administration, Management, and Organization), Applied Economics II and Fundamentals of Economic Analysis, Rey Juan Carlos University, 28032 Madrid, Spain;
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Orhierhor M, Pringle W, Halperin D, Parsons J, Halperin SA, Bettinger JA. Lessons learned from the experiences and perspectives of frontline healthcare workers on the COVID-19 response: a qualitative descriptive study. BMC Health Serv Res 2023; 23:1074. [PMID: 37805603 PMCID: PMC10559616 DOI: 10.1186/s12913-023-10062-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/25/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, healthcare systems and healthcare workers (HCWs) faced significant demands and unique challenges. In this qualitative study, we explore the effects of the COVID-19 public health policies on British Columbia's frontline HCWs, describe what worked in the management of the pandemic, and elucidate the lessons learned that could be applied to future pandemic preparedness, recovery and response. METHODS This qualitative descriptive study is part of a larger, national multi-case study on pandemic policy communication and uptake. Semi-structured interviews were conducted from November 2020- June 2021 with fourteen HCWs working in long-term care (LTC), acute care and public health settings. Data were inductively coded, and analyzed following a resilience framework for public health emergency preparedness, which emphasizes the essential elements of a public health system, vital to all phases of health emergency management, readiness, response and recovery. RESULTS HCWs experienced confusion, frustration, uncertainty, anxiety, fatigue and stress, during the pandemic and detailed challenges that affected policy implementation. This included communication and coordination inconsistencies between the province and regional health authorities; lack of involvement of frontline staff in pandemic planning; inadequate training and support; inadequate personal protective equipment resource capacity and mobilization; and staffing shortages. HCWs recommended increased collaboration between frontline staff and policy makers, investment in preparing and practicing pandemic plans, and the need for training in emergency management and infection prevention and control. CONCLUSIONS Pandemic planning, response and recovery should include inputs from actors/key stakeholders at the provincial, regional and local levels, to facilitate better coordination, communication and outcomes. Also, given the critical roles of frontline HCWs in policy implementation, they should be adequately supported and consideration must be given to how they interpret and act on policies. Bi-directional communication channels should be incorporated between policymakers and frontline HCWs to verify the appropriate adoption of policies, reflective learning, and to ensure policy limitations are being communicated and acted upon by policy makers.
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Affiliation(s)
- Marian Orhierhor
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, A5-950 West 28th Street, Vancouver, BC, V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Wendy Pringle
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, A5-950 West 28th Street, Vancouver, BC, V5Z 4H4, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Donna Halperin
- Rankin School of Nursing, St. Francis Xavier University, 4130 University Ave, Antigonish, Nova Scotia, B2G 2W5, Canada
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Nova Scotia, B3K 6R8, Canada
| | - Janet Parsons
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, M5B 1W8, Canada
- Department of Occupational Science & Occupational Therapy, Department of Physical Therapy, and the Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology, Dalhousie University, IWK Health, Nova Scotia Health, Halifax, Nova Scotia, B3K 6R8, Canada
- Departments of Pediatrics and Microbiology & Immunology, Dalhousie University, 5850/5980 University Ave, Halifax, Nova Scotia, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, University of British Columbia, A5-950 West 28th Street, Vancouver, BC, V5Z 4H4, Canada.
- Department of Pediatrics, University of British Columbia, Vancouver, Canada.
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Konteh SA, Bangura (Turay) FI, Leno A, Satyanarayana S, Nair D, Bah MA, Saidu S, Sellu-Sallu D, Gborie SR, Kamara SM, Jalloh AT, Kanu JS, Kamara KN, Moiwo MM, Dsani E, Nantima N. Improvement in the Surveillance System for Livestock Diseases and Antimicrobial Use Following Operational Research Studies in Sierra Leone January-March 2023. Trop Med Infect Dis 2023; 8:408. [PMID: 37624345 PMCID: PMC10459562 DOI: 10.3390/tropicalmed8080408] [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: 06/27/2023] [Revised: 07/29/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
In Sierra Leone, two operational research (OR) studies in 2019 and 2021 showed deficiencies in the data being captured by the Integrated Animal Disease Surveillance and Reporting (IADSR) system. This third OR study was conducted in 2023 to assess whether the second OR study's results and recommendations were disseminated with the key stakeholders, the uptake of the recommendations, improvements in data capture in the IADSR system, and to describe the data on livestock disease and antimicrobial use. In 2022, on seven occasions, the authors of the second OR study disseminated the study's findings. Of the four recommendations, the one on improving laboratory infrastructure for confirmation of animal disease was not implemented. The district animal health weekly surveillance reports received through the IADSR system were sustained at 88% between the second (2021) and third (2023) studies. In both studies, the proportion of sick animals receiving antibiotics (25%) remained the same, but the use of "critically important antimicrobials for veterinary use" declined from 77% (in 2021) to 69% (in 2023). The IADSR system has improved considerably in providing information on animal health and antibiotic use, and sequential OR studies have played a key role in its improvement.
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Affiliation(s)
- Samuel Alie Konteh
- Livestock and Veterinary Services Division, Ministry of Agriculture and Forestry, Youyi Building, Brooked, Freetown 00232, Sierra Leone (A.L.); (M.A.B.); (S.S.); (D.S.-S.); (S.R.G.); (S.M.K.); (A.T.J.)
| | - Fatmata Isatu Bangura (Turay)
- Livestock and Veterinary Services Division, Ministry of Agriculture and Forestry, Youyi Building, Brooked, Freetown 00232, Sierra Leone (A.L.); (M.A.B.); (S.S.); (D.S.-S.); (S.R.G.); (S.M.K.); (A.T.J.)
| | - Amara Leno
- Livestock and Veterinary Services Division, Ministry of Agriculture and Forestry, Youyi Building, Brooked, Freetown 00232, Sierra Leone (A.L.); (M.A.B.); (S.S.); (D.S.-S.); (S.R.G.); (S.M.K.); (A.T.J.)
| | - Srinath Satyanarayana
- Center for Operational Research, International Union Against TB and Lung Disease (The Union), 75006 Paris, France; (S.S.); (D.N.)
| | - Divya Nair
- Center for Operational Research, International Union Against TB and Lung Disease (The Union), 75006 Paris, France; (S.S.); (D.N.)
| | - Mohamed Alpha Bah
- Livestock and Veterinary Services Division, Ministry of Agriculture and Forestry, Youyi Building, Brooked, Freetown 00232, Sierra Leone (A.L.); (M.A.B.); (S.S.); (D.S.-S.); (S.R.G.); (S.M.K.); (A.T.J.)
| | - Salam Saidu
- Livestock and Veterinary Services Division, Ministry of Agriculture and Forestry, Youyi Building, Brooked, Freetown 00232, Sierra Leone (A.L.); (M.A.B.); (S.S.); (D.S.-S.); (S.R.G.); (S.M.K.); (A.T.J.)
| | - David Sellu-Sallu
- Livestock and Veterinary Services Division, Ministry of Agriculture and Forestry, Youyi Building, Brooked, Freetown 00232, Sierra Leone (A.L.); (M.A.B.); (S.S.); (D.S.-S.); (S.R.G.); (S.M.K.); (A.T.J.)
| | - Sahr Raymond Gborie
- Livestock and Veterinary Services Division, Ministry of Agriculture and Forestry, Youyi Building, Brooked, Freetown 00232, Sierra Leone (A.L.); (M.A.B.); (S.S.); (D.S.-S.); (S.R.G.); (S.M.K.); (A.T.J.)
| | - Sorie Mohamed Kamara
- Livestock and Veterinary Services Division, Ministry of Agriculture and Forestry, Youyi Building, Brooked, Freetown 00232, Sierra Leone (A.L.); (M.A.B.); (S.S.); (D.S.-S.); (S.R.G.); (S.M.K.); (A.T.J.)
| | - Amadu Tejan Jalloh
- Livestock and Veterinary Services Division, Ministry of Agriculture and Forestry, Youyi Building, Brooked, Freetown 00232, Sierra Leone (A.L.); (M.A.B.); (S.S.); (D.S.-S.); (S.R.G.); (S.M.K.); (A.T.J.)
| | - Joseph Sam Kanu
- National Disease Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Sierra Leone National Public Health Emergency Operations Centre, Cockerill, Wilkinson Road, Freetown 00232, Sierra Leone; (J.S.K.); (K.N.K.)
- College of Medicine and Allied Health Sciences (COMAHS), University of Sierra Leone (USL), Tower Hill, Freetown 00232, Sierra Leone
| | - Kadijatu Nabie Kamara
- National Disease Surveillance Program, Directorate of Health Security and Emergencies, Ministry of Health and Sanitation, Sierra Leone National Public Health Emergency Operations Centre, Cockerill, Wilkinson Road, Freetown 00232, Sierra Leone; (J.S.K.); (K.N.K.)
| | - Matilda Mattu Moiwo
- Joint Medical Unit, Ministry of Defense, Republic of Sierra Leone Armed Forces, Freetown 00232, Sierra Leone
| | - Esther Dsani
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Freetown 00232, Sierra Leone; (E.D.)
| | - Noelina Nantima
- Emergency Center for Transboundary Animal Diseases (ECTAD), Food and Agriculture Organization of the United Nations (FAO), Freetown 00232, Sierra Leone; (E.D.)
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张 娣, 张 利. [Disaster Literacy Status and the Influencing Factors: A National Survey of 107997 Chinese Nurses]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:824-830. [PMID: 37545081 PMCID: PMC10442629 DOI: 10.12182/20230760101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Indexed: 08/08/2023]
Abstract
Objective To study the level of disaster literacy among nurses in China and the influcing factors and to provide scientific basis for developing effective interventions to improve the disaster literacy among Chinese nurses. Methods Between September 2021 and October 2021, an online survey was conducted among nurses from health care institutions in eastern, central, western, and northeastern China by using a cross-sectional survey design and convenience sampling. The content of the survey included the surveyed nurses' sociodemographic characteristics, occupational characteristics, disaster relief characteristics, self-efficacy, and disaster literacy level. A disaster literacy model developed previously was used to assess the nurses' disaster literacy. Results A total of 107997 nurses were covered in the survey and their disaster literacy score was found to be 255.62±53.92. According to the findings of multiple linear regression, the protective factors for disaster literacy among Chinese nurses included the following, being based in Eastern region (non-standardized regression coefficient [ B]=2.365, 95% confidence interval [ CI]: 1.647-3.082), male sex ( B=9.418, 95% CI: 7.892-10.944), bachelor's degree or higher level of education ( B=3.822, 95% CI: 3.195-4.450), tertiary-level hospitals ( B=3.569, 95% CI: 3.000-4.138), military/local public hospitals ( B=2.606, 95% CI: 1.750-3.463), emergency department ( B=2.921, 95% CI: 2.149-3.694), intermediate professional title ( B=2.918, 95% CI: 2.209-3.627), senior professional title ( B=5.801, 95% CI: 4.448-7.155), participation in disaster rescue ( B=5.566, 95% CI: 5.020-6.112), the institution being previously involved in disaster emergency rescue ( B=3.257, 95% CI: 2.429-4.084), the institution having set up disaster rescue team ( B=5.967, 95% CI: 5.103-6.831), having received nursing education in disaster preparedness in school ( B=6.205, 95% CI: 5.621-6.790), having received on-the-job disaster preparedness education and training ( B=8.776, 95% CI: 8.027-9.525), and self-efficacy ( B=5.117, 95% CI: 5.069-5.165). Conclusions In China, disaster literacy among nurses is at a medium to low level and needs to be improved. For the next step, efforts should be focused on nurses with the following features, being based in the central and western regions, female sex, having completed junior college education or less, no nursing education in disaster preparedness in school, having junior professional titles, being from gynecology, pediatrics, and auxiliary departments, working in grassroots medical and health institutions and primary and secondary-level hospitals, neither the individual respondent nor her institution having any experience in disaster rescue, the institution having no disaster rescue team, not having any on-the-job nursing education and training in disaster preparedness, and having low self-efficacy. Measures should be taken to improve their disaster literacy level.
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Affiliation(s)
- 娣 张
- 苏州大学 (苏州 215031)Soochow University, Suzhou 215031, China
| | - 利岩 张
- 苏州大学 (苏州 215031)Soochow University, Suzhou 215031, China
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Sultan MAS, Khorram-Manesh A, Sørensen JL, Berlin J, Carlström E. Disaster Collaborative Exercises for Healthcare Teamwork in a Saudi Context. INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE 2023; 14:183-193. [PMCID: PMC10088626 DOI: 10.1007/s13753-023-00484-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 07/10/2024]
Abstract
This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises, through observation and interview methods. Integration and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power, hierarchies, and fragmentation. Using three-level collaboration tabletop exercises and the Command and control, Safety, Communication, Assessment, Treatment, Triage, Transport (CSCATTT) instrument, 100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated scenarios. The results show a lack of integration and team maturity among participants in the first scenario, leading to the delayed start of the activity, task distribution, and decision making. These shortcomings were improved in the second scenario. In-depth interviews with 20 participants in the second phase of the study revealed improved knowledge and practical skills, self-confidence, and ability in team building within trans-professional groups in the second scenario, which in concordance with the integration theory, was due to the attempts made in the first scenario. Additionally, there was an improvement in the team’s maturity, which in concordance with the maturity theory, was due to the knowledge and practical skills during scenario plays. These results indicate the importance of continuous tabletop training, and the use of CSCATTT as a collaborative instrument, to promote the development of collaboration and to test the concept of preparedness.
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Affiliation(s)
- Mohammed Ali Salem Sultan
- Model of Care, Healthcare Transformation, Regional Health Directorate, Najran, 66255 Saudi Arabia
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
| | - Amir Khorram-Manesh
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45 Gothenburg, Sweden
| | - Jarle Løwe Sørensen
- USN School of Business, University of South-Eastern Norway, 3199 Borre, Norway
| | - Johan Berlin
- Department of Social and Behavioural Studies, University West, 461 86 Trolhättan, Sweden
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45 Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3199 Borre, Norway
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