Training nurses in task-shifting strategies for the management and control of hypertension in Ghana: a mixed-methods study

Background: Nurses in Ghana play a vital role in the delivery of primary health care at both the household and community level. However, there is lack of information on task shifting the management and control of hypertension to community health nurses in low- and middle-income countries including Ghana. The purpose of this study was to assess nurses\u27 knowledge and practice of hypertension management and control pre- and post-training utilizing task-shifting strategies for hypertension control in Ghana (TASSH). Methods: A pre- and post- test survey was administered to 64 community health nurses (CHNs) and enrolled nurses (ENs) employed in community health centers and district hospitals before and after the TASSH training, followed by semi-structured qualitative interviews that assessed nurses\u27 satisfaction with the training, resultant changes in practice and barriers and facilitators to optimal hypertension management. Results: A total of 64 CHNs and ENs participated in the TASSH training. The findings of the pre- and post-training assessments showed a marked improvement in nurses\u27 knowledge and practice related to hypertension detection and treatment. At pre-assessment 26.9% of the nurses scored 80% or more on the hypertension knowledge test, whereas this improved significantly to 95.7% post-training. Improvement of interpersonal skills and patient education were also mentioned by the nurses as positive outcomes of participation in the intervention. Conclusions: Findings suggest that if all nurses receive even brief training in the management and control of hypertension, major public health benefits are likely to be achieved in low-income countries like Ghana. However, more research is needed to ascertain implementation fidelity and sustainability of interventions such as TASSH that highlight the potential role of nurses in mitigating barriers to optimal hypertension control in Ghana. Trial registration: Trial registration for parent TASSH study: NCT01802372 . Registered February 27, 2013

Determinantes dos honorários de auditoria para Portugal e Espanha

A liberalização dos serviços de auditoria em Portugal , com a eliminação em 2005, da tabela que fixava honorários mínimos baseados em padrões de dimensão da empresa auditada desperta o interesse em percecionar quais são os fatores que originam a determinação dos honorários de auditoria. Em Espanha, o conjunto de escândalos fina nceiros de que tem sido alvo tem colocado os honorários de auditoria no foco principal. A análise inclui uma amostra de 40 empresas cotadas em Portugal e 113 empresas cotadas em Espanha p ara o ano de 2013 utilizando a regressão dos mínimos quadrados (OSL). Os resultados indicam que em Espanha, os honorários são fixados principalmente em função da dimensão, complexidade e risco de auditoria, sendo que quanto maior a dimensão, a complexidade e o risco da empresa auditada, maiores os honorários de auditoria. E m Portugal, a dimensão da empresa auditada foi considerado o único fator que contribui para a determinação dos honorários em Portugal. Os resultados obtidos permitem - nos assim concluir que a determinação dos honorários de auditoria em Portugal é muito dife rente da dos honorários das empresas cotadas em Espanh

Exploring stakeholders’ perceptions of a task-shifting strategy for hypertension control in Ghana: a qualitative study

Abstract Background The purpose of this study was to explore stakeholders' perception of an on-going evidence-based task-shifting strategy for hypertension (TASSH) in 32 community health centers and district hospitals in Ghana. Methods Using focus group discussions and in-depth interviews, qualitative data were obtained from 81 key stakeholders including patients, nurses, and site directors of participating community health centers involved in the TASSH trial. Qualitative data were analyzed using open and axial coding techniques. Results Analysis of the qualitative data revealed three themes that illustrate stakeholders' perceptions of the ongoing task-shifting strategy for blood pressure control in Ghana and they include: 1) awareness and understanding of the TASSH program; 2) reasons for participation and non-participation in TASSH; and 3) the benefit and drawbacks to the TASSH program. Conclusion The findings support evidence that successful implementation of any task-shifting strategy must focus not only on individual patient characteristics, but also consider the role contextual factors such as organizational and leadership factors play. The findings also demonstrate the importance of understanding stakeholder's perceptions of evidence-based task-shifting interventions for hypertension control as it may ultimately influence the sustainable uptake of these interventions into "real world" settings

Site Characteristic Data

Site Characteristic Dat

Clinical Data

Clinical Dat

Demographic Data

Demographic Dat

Baseline patient characteristics by treatment group.

<p>Baseline patient characteristics by treatment group.</p

Observed Outcome Data

Observed Outcome Dat

Observed and adjusted mean systolic and diastolic blood pressure in the HIC and TASSH + HIC groups.

<p>Observed and adjusted mean systolic and diastolic blood pressure in the HIC and TASSH + HIC groups.</p