A comparison of the CAM-ICU and the NEECHAM Confusion Scale in intensive care delirium assessment: an observational study in non-intubated patients

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Non-medical prescribing behaviour in midwifery practice: a mixed-methods review

Background: Non-medical prescribing is a new skill in midwifery practice. Information is needed on whether this is an activity that is feasible, appropriate, meaningful and effective. Aim: To report on the determinants of midwife prescribing behaviour to inform midwifery practice. Method: A mixed-methods review using an integrated approach combining methodologically diverse data into a single mixed-methods synthesis. A systematic search of the literature was conducted. Data were categorised according the feasibility-appropriateness-meaningfulness-effectiveness (FAME) scale and thematised according the attitude, social-influence, self-efficacy (ASE) model. A thematic analysis, a Bayesian descriptive analysis and Bayesian Pearson correlations of the FAME-categories and ASE-themes were performed. Findings: Seven studies showing moderate to good quality were included for synthesis. The FAME categories feasibility and appropriateness tended to affect the utility of midwife prescribing; meaningfulness and effectiveness were related to non-utility of prescribing. There were weak to moderate correlations between the FAME categories and the ASE themes social influence, intention, barriers and supportive factors and perceived knowledge (r-.41 to-.34 and r.37 to .56). ASE themes showed a strong negative correlation between attitude and self-efficacy (r-.70); weak positive correlations between attitude and social influence (r.31) and perceived knowledge (r.30); a weak positive correlation between self-efficacy and social influence (r.30), and a weak negative correlation with intention (r-.31); a moderate negative correlation between social influence and barriers/ supportive factors (r-.50); a weak negative correlation between barriers/supportive factors and perceived knowledge (r-.38). Conclusion: Prescribing fits the midwife's professional role and maternity services and is enhanced by the midwife's willingness and supportive practice. Prescribing requires collaborative practice, meaningful relationships with women, (applied) knowledge, expertise, and theoretical, practical and logistic support in the clinical area. Implications. Midwives who consider prescribing or who are autonomous prescribers should be aware of their role and position as autonomous prescriber. They should reflect on their willingness to prescribe, self-efficacy, perceived knowledge, their cognitive beliefs about prescribing and the effect of prescribing on women in their care

Do tourists' preferences match the host community's initiatives? : a study of sustainable tourism in one of Africa's oldest conservation areas

Involvement of stakeholders in sustainable tourism, particularly in developing countries, is crucial for the success of tourism development. However, its implementation is often criticized for not considering stakeholders' needs. This study explores tourists' preferences for tourism activities, designed by local stakeholders, in one of the oldest conserved parks in East Africa-the Menagesha Suba Forest, in the Central Highlands of Ethiopia. The study area is endowed with natural, cultural and historical, yet undeveloped, tourist attractions. The host community benefits little from tourism and is in continual conflict with the park administration. This study aims to provide new insights on potential engagement of stakeholders in sustainable tourism planning. In particular, we explored tourists' preferences for activities designed by local stakeholders, as well as their preferences concerning the improvement of the park infrastructure. The local community has been engaged in group discussions to design community involvement activities in tourism, while park guest books have been consulted to identify infrastructure improvements suggested by tourists. A survey that embedded a discrete choice experiment was conducted among tourists that visited the Menagesha Suba Forest. Data were analyzed with mixed logit and latent class models. We identified preferences for infrastructure improvement in the park. Tourists' preferences are heterogeneous and vary with their profile as foreigners, foreign residents, and locals. Furthermore, the study indicates that there is a mismatch between tourists' preferences and activities designed by the host community for their engagement in tourism. Tourists might be unaware of the importance of such activities for local communities. On the other hand, the findings also imply that increasing host residents' awareness of tourism and tourists' preferences is required, prior to tourism activities planning. Hence, sustainable tourism planning and development needs to understand perception gaps between host residents and tourists for its smooth implementation

Developing a competence framework for nurses in pharmaceutical care: A Delphi study

Background: Nurses play an important role in pharmaceutical care. They are involved in: detecting clinical change; communicating/discussing pharmacotherapy with patients, their advocates, and other healthcare professionals; proposing and implementing medication-related interventions; and ensuring follow-up of patients and medication regimens. To date, a framework of nurses' competences on knowledge, skills, and attitudes as to interprofessional pharmaceutical care tasks is missing. Objectives: To reach agreement with experts about nurses' competences for tasks in interprofessional pharmaceutical care. Methods: A two-phase study starting with a scoping review followed by five Delphi rounds was performed. Competences extracted from the literature were assessed by an expert panel on relevance by using the RAND/UCLA method. The experts (n = 22) involved were healthcare professionals, nurse researchers, and educators from 14 European countries with a specific interest in nurses' roles in interprofessional pharmaceutical care. Descriptive statistics supported the data analysis. Results: The expert panel reached consensus on the relevance of 60 competences for 22 nursing tasks. 41 competences were related to 15 generic nursing tasks and 33 competences were related to seven specific nursing tasks. Conclusions: This study resulted in a competence framework for competency-based nurse education. Future research should focus on imbedding these competences in nurse education. A structured instrument should be developed to assess students' readiness to achieve competence in interprofessional pharmaceutical care in clinical practice.The research was supported by the Erasmus+ Programme of the European Union (grant number 2018–1-BE02-KA203–046861) and MDMJ accountants, an accountancy service in Belgium that financially supported the Belgian authors, without any conflicts of interest

Nurse students’ competences in interprofessional pharmaceutical care in Europe: cross-sectional evaluation

Background: Safe pharmaceutical care requires competent nurses with specific knowledge, skills and attitudes. It is unclear whether nursing students are adequately prepared to perform pharmaceutical care in practice. Mapping their pharmaceutical care competences can lead to a better understanding of the extent to which curricula fit expectations of the labour market. Objectives: To assess pharmaceutical care competences of final-year nursing students of different educational levels. Design: A cross-sectional survey design. Settings: In 14 European countries, nursing schools who offer curricula for level 4 to 7 students, were approached. Participants: Through convenience sampling 1741 final-year student nurses of level 4 to 7 were included. Sampling strategies were country-specific. Methods: A web-platform was developed with an assessment of the level in which students mastered pharmaceutical care competences. Knowledge questions, case studies (basic/advanced level), self-reported practical skills and attitudes were evaluated. Results: Mean scores for knowledge questions differed significantly (p<0.001) between level 5 (56/100), level 6 (68/100) and level 7 students (72/100). For basic cases level 5 students reached lower scores (64/100) compared with level 6 (71/100) and level 7 (72/100) students (p=0.002 and p=0.005). For more advanced cases no difference between levels was observed (overall mean 61/100). Most students (63-90%) considered themselves skilled to perform pharmaceutical care and had positive attitudes towards their participation in pharmaceutical care (65-97%). Conclusions: Relatively low knowledge scores were calculated for final-year student nurses. In some domains, lower levels of students might be insufficiently prepared to take up responsibilities in pharmaceutical care. Our assessment can be used as a tool for educators to evaluate how prepared nursing students are for pharmaceutical care. Its further implementation for students of different educational levels will allow benchmarking between the levels, both within and between countries.This work was supported by the Erasmus+ Programme of the European Union [grant number 2018-1-BE02-KA203-046861] and Consensus accountants, an accountancy service in Belgium that financially supported the Belgian authors, without any conflicts of interest