Training teachers to teach bioethics: evaluation using Kirkpatrick model

Bioethics helps define the values and guidelines governing decision making in health profession practice. Teaching ethics to medical students demand teachers trained in bioethics. With this aim, “Teachers Training Workshop on Bioethics†was arranged with the objective to get feedback from the participants on effectiveness of bioethics teaching. Twelve faculty members participated in four days Teachers Training Workshop on Bioethics during Dec 27-30, 2016, at Patan Academy of Health Sciences, Nepal. Sixteen thematic topics were chosen from UNESCO Bioethics Core Curriculum. There were four rounds of presentations, and each round had four topics. Small group discussions, presentations and case scenarios were main methods used in the training. Written feedback was taken on semi-structured questionnaire with items- four closed ended and three open ended. Descriptive analysis was done. The level of confidence of the participants after participation in training workshop enhanced for teaching Bioethics, taking ethical decision and resolving ethical dilemma. As per participants open ended responses, “Active participation of the participants†and “Interactive sessions†were good points whereas “More references required, not only of UNESCO curriculum†was the area for improvement. The training enhanced overall confidence level of the participants.    Keywords: bioethics, feedback, Nepal, teachers’ training, UNESC

Revisit the hospital policy in the era of COVID-19

Key-points Patient with recent history of dry cough, fever and breathlessness (influenza-like or severe acute respiratory illness) without alternative explanation/diagnosis needs to be managed as COVID-19 unless proved otherwise. Suspected COVID-19 patient having fever and recent loss of taste and smell be tested for COVID-19. Patient with severe acute respiratory illness of unknown aetiology be tested for COVID-19. Patient with bilateral consolidation on chest X-ray or ground glass appearance on chest CT or interstitial oedema on chest ultrasound (not fully explained by volume overload) be tested for COVID-19 in moderate to high risk communities/countries. Suspected COVID-19 patients with lymphopenia, high ESR or rise in C-reactive protein and suspected of viral fevers be tested for COVID-19. Screening of pregnant women for COVID-19 with rapid testing preferably with Elisa in moderate to high risk communities/countries. Screening with rapid testing preferably with Elisa prior to invasive interventions, including operations, in moderate to high risk communities/countries. Limit the exposure of hospital staff who are susceptible to develop severe complications of COVID-19. Hospitals provide PPE to staff depending upon exposure as per international/national/local guidelines. Hospitals implement infection prevention control measures meticulously in context of COVID-19

Nepal\u27s response to contain COVID-19 Infection

Nepal is a landlocked country bordering two most populous countries, India and China. Nepal shares open border with India from three sides, east, south and west. And, in north with China, where the novel coronavirus infection (CVOVID-19) began in late December 2019. The first confirmed imported case in Nepal was reported in 2nd week of January 2020. The initial response of Nepal to COVID-19 were comparably slow but country geared efforts after it was declared a \u27global pandemic\u27 by WHO on 11 March, 2020. Government of Nepal\u27s steps from 18 March, 2020 led to partial lock down and countrywide lockdown imposed on 24 March, 2020. Government devised comprehensive plan on 27 March, 2020 for quarantine for peoples who arrived in Nepal from COVID-19 affected countries. This article covers summary of global status, South Asian Association of Regional Cooperation (SAARC) status, and Nepal\u27s response to contain COVID-19 infection discussed under three headings: Steps taken before and after WHO declared COVID-19 a global pandemic and lab services regarding detection of COVID-19. Nepal has documented five confirmed cases of COVID-19 till the end of March 2020, first in second week of 15 January, 2020 and 2nd case 8-weeks thereafter and 3rd case two days later, 4th on 27 March and 5th on 28 March. Four more cases detected during first week of April. Non-Pharmacological interventions like social distancing and excellent personal habits are widely practiced. Country has to enhance testing and strengthen tracing, isolation and quarantine mechanism and care of COVID-19 patients as Nepal is in risk zone because of comparably weak health system and porous borders with India. The time will tell regarding further outbreak and how it will be tackled. Keywords: COVID-19; lockdown; Nepal; pandemic; response

COVID-19 And Lockdown: Be Logical in Relaxing It

Cambridge Dictionary defines ‘lockdown’ as a situation in which people are not allowed to enter or leave a building or area freely because of an emergency. Merriam-Webster outlines three definitions of lockdown: a) the confinement of prisoners to their cell for all or most of the day as a temporary security measure, b) an emergency condition in which people are temporarily prevented from entering or leaving a restricted area during a threat of danger and c) a temporary condition imposed by governmental authorities as during theoutbreak of an epidemic disease in which people are required to stay at their homes and refrain from orlimit activities outside the home involving public contact. Our focus, here, is on lockdown strategy adopted to contain corona virus disease 2019 (COVID-19) pandemic

Does supportive supervision intervention improve community health worker knowledge and practices for community management of childhood diarrhea and pneumonia? Lessons for scale-up from Nigraan and Nigraan plus trials in Pakistan

Background: Lack of programmatic support and supervision is one of the underlying reasons of the poor performance of Pakistan\u27s Lady Health Worker Program (LHWP). This study describes the findings and potential for scale-up of a supportive supervision intervention in two districts of Pakistan for improving LHWs skills for integrated community case management (iCCM) of childhood diarrhea and pneumonia.Methods: The intervention comprised an enhanced supervision training to lady health supervisors (LHSs) and written feedback to LHWs by LHSs, implemented in Districts Badin and Mirpur Khas (MPK). Clinical skills of LHWs and LHSs and supervision skills of LHSs were assessed before, during, and after the intervention using structured tools.Results: LHSs\u27 practice of providing written feedback improved between pre- and mid-intervention assessments in both trials (0% to 88% in Badin and 25% to 75% in MPK) in the study arm. Similarly, supervisory performance of study arm LHSs was better than that in the comparison arm in reviewing the treatment suggested by workers\u27 (94% vs 13% in MPK and 94% vs 69% in Badin) during endline skills assessment in both trials. There were improvements in LHWs\u27 skills for iCCM of childhood diarrhea and pneumonia in both districts. In intervention arm, LHWs\u27 performance for correctly assessing for dehydration (28% to 92% in Badin and 74% to 96% in MPK), and measuring the respiratory rate correctly (12% to 44% in Badin and 46% to 79% in MPK) improved between baseline and endline assessments in both trials. Furthermore, study arm LHWs performed better than those in comparison arm in classifying diarrhea correctly during post-intervention skills assessment (68% vs 40% in Badin and 96% vs 83% in MPK).Conclusion: Supportive supervision including written feedback and frequent supervisor contact could improve the performance of community-based workers in managing diarrhea and pneumonia among children. Positive lessons for provincial scale-up can be drawn. Trial registration Both trials are registered with the \u27Australian New Zealand Clinical Trials Registry\u27. Registration numbers: Nigraan Trial: ACTRN1261300126170; Nigraan Plus: ACTRN12617000309381

Use of mask in COVID-19 era: absence of evidence is not evidence of absence

World Health Organization (WHO) in its interim guidance of 6 April 2020 advises policy makers on the use of masks for healthy people in community settings. The rationale for mask use by healthy person is prevention from COVID-19, when there is risk of exposure, like working in close contact with public, people with comorbidities, where physical distancing cannot be maintained such as travelling in buses, staying in slum areas. Furthermore, WHO says the purpose and reason for mask use should be clear– whether it is to be used for source control (used by infected persons) or prevention of COVID-19 (used by healthy persons).1 Centers for Disease Control (CDC) United States of America (USA) updated its advisory on 4 Apr 2020, and recommended everyone (except some) should wear at least a cloth face covering when they have to go out in public. It will protect other people in case you are infected.2,3 This advisory of no strict demand on use of face masks could be possibly due to unavailability of disposable masks. Previous studies reveal that cloth masks were least effective in preventing flu like illness in healthcare staff.3-5 Studies are not in favor of wearing cloth mask arguing limited evidence of its effectiveness, improper and inconsistent use, and false sense of safety among public that may disregard other essential public health interventions, like hand washing and social distancing.4 &nbsp

Gender-specific psychological and social impact of COVID-19 in Pakistan

Background: COVID-19 has rapidly spread across the world. Women may be especially vulnerable to depression and anxiety as a result of the pandemic.Aims: This study attempted to assess how gender affects risk perceptions, anxiety levels and behavioural responses to the COVID-19 pandemic in Pakistan, to recommend gender-responsive health policies.Methods: A cross-sectional online survey was conducted. Participants were asked to complete a sociodemographic data form, the Hospital Anxiety and Depression Scale, and questions on their risk perceptions, preventive behaviour and information exposure. Multiple logistic regression analysis was used to assess the effects of factors such as age, gender and household income on anxiety levels.Results: Of the 1391 respondents, 478 were women and 913 were men. Women considered their chances of survival to be relatively lower than men (59% v. 73%). They were also more anxious (62% v. 50%) and more likely to adopt precautionary behaviour, such as avoiding going to the hospital (78% v. 71%), not going to work (72% v. 57%) and using disinfectants (93% v. 86%). Men were more likely to trust friends, family and social media as reliable sources of COVID-19 information, whereas women were more likely to trust doctors.Conclusions: Women experience a disproportionate burden of the psychological and social impact of the pandemic compared with men. Involving doctors in healthcare communication targeting women might prove effective. Social media and radio programmes may be effective in disseminating COVID-19-related information to men

Trainings to train nursing teachers helping nursing students learn ethics: feedback of the participants

Introduction: Short-duration trainings for nursing faculty members in different contexts including ethics have been shown positive effect on faculty. The objective of the present study was to assess the feedback of the participant faculty members of “Trainings to train nursing teachers helping nursing students learn ethics.” Methodology: The training of four credits hours to train nursing teachers helping nursing students learn ethics was organized in October 22, 2019 at Universal College of Medical Sciences, Bhairahawa Nepal. Fifteen nursing faculty members participated in the training. At the end of training feedback was taken from the participants using validated semi-structured questionnaire. Descriptive analysis was done using IBM SPSS version 21.Results: The rating of participants on training on scale 1-10 for usefulness (7.33±1.17), content (7.40±1.06), relevance (7.93± 0.70), facilitation (7.67± 0.98) and overall (7.93± 0.70) was notable. Their confidence level to conduct and facilitate “Think-Pair-Share” interactive session (3.68±0.69) and “Scenario-based Group-Work Discussion” (3.76±0.83) enhanced after training rated on Like rt scale 1-5(5= highly confident, 4= very confident, 3=confident, 2= to some extent confident 1= not confident). Participants rated session on “teaching clinical nursing ethics” an extremely important session (3.76±0.83) on Like rt scale 1-4 (4= extremely important, 3= moderately important, 2= slightly important, 1= not important). The participants mentioned that training environment was conducive and friendly, sessions were interactive and content was useful. They suggested to increase credit hours of training, conduct pre and post-test and include more scenario in curriculum of training. They committed for what was learnt will apply for teaching ethics to nursing students and in clinical nursing practice too. Conclusion: The rating of participants on the training was notable; the perception of participants was positive regarding training and training enhanced their confidence to teach ethics to students. This is obvious from their commitment