Continuous Professional Development in Rwanda: The Experience of Midwives who Participated in the Advanced Life Support in Obstetrics (ALSO) Educational Program

High maternal and newborn mortality rates remain a global health issue. Every day approximately 800 women die from complications related to pregnancy. Ninety-nine percent of maternal deaths occur in low and middle income countries. In 2013, 62% of maternal deaths took place in Sub-Saharan Africa. The Advanced Life Support in Obstetrics Educational Program (ALSO) is an internationally recognized continuous professional development course aimed at increasing the knowledge, skills, competence and confidence of health professionals to manage obstetric emergencies. The purpose of this qualitative descriptive study was to explore midwives’ experiences of translating the knowledge and skills acquired from participating in the ALSO program into their professional practice in Rwanda. A purposive sample of nine midwives was recruited and participated in semi-structured interviews directed at understanding their experience of implementing new knowledge and skills into practice. All interviews were audio-recorded and transcribed verbatim. Content analysis revealed five themes: improved midwifery practice, availability of resources, inter-professional collaboration, job satisfaction and autonomy for midwifery practice. The results indicated that although midwives reported increased knowledge, skills and confidence in management of obstetric emergencies, their ability to change practice was often hampered by non-conducive work environments, a shortage of health care providers, and insufficient equipment and materials. These findings can serve to inform ALSO course module review and development, midwifery education development, and health human resources policy and planning that will address obstetrical and newborn education needs and health service delivery in Rwanda

Strategies to Reduce Effects of Organizational Stress in Health Care Workplaces

Workplace stress has become a frequent occurrence in the race for competitive business advantage. This stress leads to negative physiological consequences in the workplace, causing productivity and profitability to suffer. The purpose of this single case study was to explore the stress management strategies that some health care business leaders used to reduce the effects of work-related stress on their employees to improve productivity. The interview process included 3 managers employed at a health care institution in Houston, Texas, with records of implementing successful strategies for mitigating the effects of workplace stress. The conceptual framework was job demands-resources model, pertinent to the research question to shape this study. Data collection occurred through: (a) face-to-face semistructured interviews, (b) document reviews including the policy and procedure manual, employee annual evaluations, returned satisfaction surveys; and (c) direct observations, using observational protocol. Using the exploratory standard data analysis process, coded input of interview transcripts produced emergent themes to reduce workplace stress including: (a) adequate work resources, (b) work-life balance, and (c) sound management responsibilities. Findings from this study indicate that business managers using these themes could mitigate some of the negative consequences of organizational stress. The data from this study may contribute to social change through conveying to healthcare functionaries anti-stress strategies, increasing community awareness, and making members of the communities healthier

Exploration of factors which influence the involvement of specialist registered nurses in clinical teaching of advanced midwifery students in a tertiary hospital in Gauteng

Dissertation (Med (Nursing ))--University of Pretoria, 2022.Background: The involvement of specialist registered nurses in the clinical teaching of advanced midwife students remain unmet. When registered nurses with a midwifery qualification enter the advanced midwifery course, they are not regarded as students but perceived as knowledgeable and skilled to do more than what are expected from an undergraduate student who is a novice in maternal and childcare. This study explored and described the factors influencing the involvement of specialist registered nurses in clinical teaching of advanced midwifery students in a tertiary hospital in Gauteng. Method: A qualitative descriptive exploratory research design was employed to conduct the study. A non-probability purposive sampling method was used to select the participants that include specialist registered nurses with three years’ experience and more. Semi-structured interviews were conducted with ten specialist registered nurses between August and September 2021. Data collected were analysed using the thematic analysis method. Factors influencing the involvement of specialist registered nurses in clinical teaching of advanced midwifery students in a tertiary hospital in Gauteng were explored and described. Significance of the study: Using the results of the study may benefit nursing education in curriculum and policy development and nursing practices in particular and in research by its narrative methods. The study findings revealed that the collaboration will openly communicate the biomedical practitioner’s concerns and referrals which can result in improved outcomes Conclusion: Nursing education institutions should create a platform to enhance communication between clinical facilities and themselves. Likewise, advanced Abstract v Ramathabathe Vinolia Muroa 2022 midwifery nursing students should be encouraged to improve communication between specialist registered nurses and themselves. Keywords; Clinical teaching, clinical supervision, midwifery, specialist registered nurse, post-graduate advanced midwife student.noneNursing ScienceMasters in Nursing (MNUR)Unrestricte

Optimising the residential aged care workforce: leadership & management study

This report is the result of a systematic narrative review of the black and grey literature that aimed to: examine what is known about the issues of leadership and management for the residential aged care workforce; and develop relevant policy options and strategies to improve leadership and management within the social, economical, and political context of Australian residential aged care.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Exploring the telemedicine implementation challenges through the process innovation approach: A case study research in the French healthcare sector

Telemedicine is not a simple technology but a context-dependent innovation implying significant process modifications. Despite the growing interest in telemedicine implementation, it still does not form part of the healthcare organizations' recurrent activities due to several obstacles. The neglect of process change is one of the renowned barriers. This work's originality lies in using the “process innovation” concept as an analytical tool to understand the telemedicine implementation issues from the process change perspective. The qualitative method is chosen based on five telemedicine acts through two case studies in France, a university hospital, and a network of expertise. Findings indicate that implementation requires context adaptation at the level of technology, culture, and strategy. The interaction of these determinants with change enablers and hinders creates the implementation paradigm. In conclusion, we should emphasize the implementation as a whole rather than distinct elements. Managers may prepare the context and integrate the enablers, but the main task is defining an implementation strategy benefiting the stakeholders. This work fills the literature gap in using the process innovation concept to analyze telemedicine implementation challenges and contributes to understanding the context adaptation. It also provides practical implications about the implementation conditions from the process change perspective. © 2021 Elsevier Lt

Association of Hypertension Perceptions and Antihypertensive Medication Adherence among Black Hypertensive Adults in Primary Care Settings

Background: Black adults with hypertension are more likely to have uncontrolled hypertension, suffer more complications and have poorer medication adherence than Whites. Poor medication adherence has been identified as a contributing factor to the high burden of uncontrolled hypertension among Blacks. Several studies have found that Black adults with hypertension have numerous misconceptions about it and its management; however, very few studies have examined hypertension perceptions in relation to antihypertensive medication adherence. Purpose: The primary aim was to investigate the relationship between hypertension perceptions and medication adherence among Black hypertensive adults 35 to 65 years old in primary care settings. Additional aims were to examine the factor structure of hypertension causal attributions and to explore gender differences in hypertension perceptions and medication adherence. Method: The Common-sense Illness model of perception and self-regulation served as the theoretical framework for this cross-sectional study. A nonprobability sample of 118 Black hypertensive adults 35 to 65 years old was selected as they presented in four primary care clinics. Instruments included the revised Illness Perception Questionnaire (IPQ-R) and the Hill-Bone Blood Pressure Therapy Compliance scale. Results: The sample was middle aged (M=53.9; SD = 7.9 years); 52.5% male; and mostly educated, with 51% having four-year college degree or higher. Using principal components factor analysis, two factors emerged, which explained 40.8% variance in hypertension causal attributions. Factor 1 contains items related to unhealthy lifestyle choices and factors outside the individual’s control. Factor 2 contains items related to life stressors and known hypertension predisposing factors. Using multiple regression while controlling for covariates, three IPQ-R subscales (Timeline-cyclical, Consequences and Emotional representation together explained 23.9% variance in medication adherence, F (6, 111) = 5.82, P \u3c .001); however only “Consequences” had a statistically significant relationship with medication adherence (p = .022). Using ANCOVA, only one of nine subscales had a significant gender difference; males had higher (p = .034) adjusted mean scores (M= 16.2, s.e.=.64.) than females (M = 14.2, s.e.=.67) on the perception that hypertension is caused by factors related to unhealthy lifestyle choices and factors outside an individual’s control. Conclusion: Two reliable factors of causal attributions emerged. Perception that hypertension induces burden on life (Consequences) was the only perception that significantly predicted medication adherence. Males and females were very similar in their perceptions of hypertension. Although these findings could be applied to similar patient populations in primary care, variation in antihypertensive medication adherence is largely unexplained and needs further research. A longitudinal study with a larger sample size may be needed to further examine and clarify hypertension beliefs among Black hypertensive adults

Strategies to Improve Quality of Care and Increase Medicare Payments in Hospitals

The difficulty that nurse leaders experience in administrating quality of care while increasing Medicare payments threatens the hospital\u27s patient well-being and financial stability. Health care administrators should be concerned about these issues to ensure their hospitals meet patient and community needs. Grounded in the performance improvement model, the purpose of this qualitative single case study was to explore strategies that hospital managers use to improve the quality of care and increase Medicare payments. The participants were six nurse leaders of a medium size hospital based in Houston, Texas. Data were collected using semistructured virtual interviews and a review of company documents. Through thematic analysis, five themes were identified: (a) leaders shaped the organizational culture, (b) leaders empowered staff through evidence-based workflows to mitigate potential issues, (c) leaders provide appropriate resources to improve patient care outcomes, (d) leaders’ proactive engagement motivate employees to improve patient care, and (e) leaders use of innovative tools to measure and monitor the quality-of-care outcomes. A key recommendation is for nurse leaders to identify the gaps in the process and develop appropriate corrective actions to improve the quality of care and increase Medicare payments in hospitals. The implications for positive social change include the potential to improve the quality of health care, decrease mortality, and increase revenue for surrounding communities

Hospital Administrators\u27 Strategies for Reducing Delayed Hospital Discharges and Improving Profitability

Inefficiencies in leadership and limited leadership strategies in hospitals contribute to delayed hospital discharges and an increased financial burden on a hospital. Three administrators from 2 hospitals who are part of a hospital conglomerate in Chicago, Illinois were selected for interview in this qualitative multiple case study to explore how hospital discharge strategies reduce delayed hospital discharges and improve profitability. Contingency was the primary theoretical theory for this study. The purposive sampling consisted of the selections of individual who were knowledgeable and had experience to organize, manage, and implement processes in an organization. Data collection occurred using face-to-face semistructured interviews, direct observation, and a review of discharge documents. Data analysis took place using the modified van Kaam method. Two emergent themes were identified relating to strategies for efficient communications and facilitating effective leadership. Implications for positive social change include the potential to improve health services within the community where access to health care is limited or the need exists for additional hospital beds. Positive leadership strategies in hospitals tend to contribute to the success and wellbeing of employees, patients, communities, and the economy

A realist evaluation of the roles of opinion leaders in the diffusion of innovations in primary care in Florianopolis, Brazil

Local opinion leaders are people with credibility and influence within social groups. Therefore, they are often used as part of strategies to promote adoption of innovations in healthcare settings. Evidence from trials show that opinion leaders are an effective strategy to promote behaviour change, but the outcomes of their use are variable and unpredictable across studies. There is a need for better understanding of how and why opinion leaders work or not in different circumstances to improve the design of behaviour change interventions. This study addressed this knowledge gap by analysing the roles of opinion leaders during the implementation of two innovations in a primary care system of Brazil. Using a realist evaluation, I developed, tested and refined programme theories about the roles of the opinion leaders. First, I developed initial theories from documents, literature review, stakeholders’ consultation and my experience in the setting. Second, I tested and refined those initial theories drawing on 18 interviews with managers and practitioners and a reassessment of the literature. The three programme theories focused on how recognising opinion leaders motivates buy-in to innovations; how involving opinion leaders in implementation gives credibility to innovations; and how the practice of opinion leaders with innovations promotes adoption. The analytical framework was based on the programme theories and the Context-Mechanism-Outcome configuration. The causal processes identified in data analysis were compared to the initial theories to generate refined programme theories. The key findings across refined theories were summarised in a middle-range theory. The findings suggested causal processes that might explain some of the variability in opinion leaders’ interventions. Key mechanisms included ownership of innovations, trust, and reinforcement of group norms and modelling. Key contextual factors included interest in the innovations, similarity between opinion leader and peers, and informal relationships. The initial mobilisation of opinion leaders is a separate component of the intervention, leading to contradictory outcomes across system levels. Ultimately, there is a trade-off between harnessing the influence of opinion leaders as a resource for implementation and jeopardising their credibility