Supporting the implementation of guidelines to prevent mother-to-child-transmission of HIV in Malawi: a multi-case study

BackgroundHigh HIV infection and fertility rates contributed to over 12,000 children acquiring HIV from their mothers in 2011 in Malawi. To prevent mother-to-child transmission of HIV, Malawi adopted the Option B+ guidelines, and for three years, the University of North Carolina (UNC) Project provided support to strengthen guideline implementation in 134 health centres. Little is known about how implementation support strategies are delivered in low resource countries or contextual factors that may influence their delivery. The limited descriptions of support strategies and salient contextual factors limits efforts to replicate, target, and further refine strategies. Guided by the Interactive Systems Framework for Dissemination and Implementation, this study describes factors influencing implementation of support strategies and how they impacted health center staff capacity to implement Option B+ in Malawi. MethodsA qualitative multi-case study design was applied. Data were collected through site visits to 4 heath centres (2 low- and 2-high performing centres). We interviewed 18 support providers and recipients between October 2014 and October 2015. Data were analysed using content, thematic, and cross-case analysis.ResultsFour categories of strategies were used to support Option B+ guidelines implementation: training, technical assistance (TA), tools, and resources. All heath-centres implemented Option B+ guidelines for care provided between the antenatal and labor and delivery periods. Gaps in Option B+ implementation occurred during community activities and during post-delivery care, including gaps in testing of children to ascertain their HIV status at 6 weeks, 12 months, and 24 months. Salient contextual factors included staffing shortages, transportation challenges, limited space and infrastructure, limited stocks of HIV testing kits, and large patient populations.ConclusionsUnderstanding factors that influence implementation support strategies and delivery of the Option B+ guidelines, such as availability of staff and other materials/drug resources, is critical to designing effective implementation support for low resource settings

手术后患者疼痛控制满意度状况及影响因素的研究

目的描述手术后患者对疼痛控制的满意度状况,探讨影响疼痛控制满意度的因素。方法采用多阶段抽样方法,随机抽取北京地区5家综合性三级甲等医院,对符合入选标准的304例手术后第2天的住院疼痛患者进行了调查,问卷由休斯顿疼痛情况调查表、疼痛治疗指数和病历资料核查表3个部分组成。结果术后患者对疼痛控制总体满意度平均评分为7.3。疼痛控制教育、医生对疼痛的处理、疼痛减轻、患者受到的所有针对疼痛的照料、医生或护士是否告诉患者要优先有效地控制疼痛以及手术次数共6个因素进入回归方程,是影响疼痛控制满意度的主要因素。结论患者对术后疼痛控制较为满意;疼痛控制服务因素是影响手术后患者疼痛控制满意度的主要因素。建议制订术后疼痛控制制度和标准,采取针对性措施,改善术后疼痛控制质量,提高术后患者对疼痛控制的满意度

Quality and Safety Education for Nurses

Quality and Safety Education for Nurses (QSEN) addresses the challenge of preparing nurses with the competencies necessary to continuously improve the quality and safety of the health care systems in which they work. The QSEN faculty members adapted the Institute of Medicine competencies for nursing (patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics), proposing definitions that could describe essential features of what it means to be a competent and respected nurse. Using the competency definitions, the authors propose statements of the knowledge, skills, and attitudes (KSAs) for each competency that should be developed during pre-licensure nursing education. Quality and Safety Education for Nurses (QSEN) faculty and advisory board members invite the profession to comment on the competencies and their definitions and on whether the KSAs for pre-licensure education are appropriate goals for students preparing for basic practice as a registered nurse

Inter-professional Service Learning to Increase Students\u27 Understanding of Migrant Latino Health

Learning Objectives At the end of this seminar participants will be able to: 1.Explain the relevance of inter-professional, cultural competent, global health approaches to health assessment and interventions at home and abroad. 2.Identify evidence-based programs to improve target population health, utilizing the CLAS standards to advance health equity, improve quality and help eliminate health disparities. 3.Design a service learning inter-professional health education course with teaching strategies for cultural competency training that utilizes academic and clinical partnerships

Measuring the influence of a mutual support educational intervention within a nursing team

Background: Teamwork is essential to provide the highest quality of care for patients. Feeling supported within a nursing unit is a significant factor in nursing satisfaction, intention to remain in the job, and the capacity to provide safe patient care by Aiken et al [1]. Purpose: This study examined mutual support among a nursing team to measure the influence of an educational intervention focusing on Mutual Support from the Team STEPPS curriculum by Agency for Healthcare Research and Quality, AHRQ [2]. Methods: The study design used a Likert scale survey, the Nursing Teamwork Survey, before and following an education intervention adapted from the Team STEPPS curriculum on Mutual Support. Demographic data from the 41 participants were analyzed for impact on educational background, roles and responsibilities, age, and other factors. Results: Pre- Post education intervention results varied among the survey items, although scores demonstrated heightened awareness of teamwork following the educational intervention. The subscale of Backup illustrated the strongest improvement. Conclusion: The study demonstrates that education can have an impact on perceptions and awareness of mutual support among nursing team members. The survey instrument can be used effectively to inform leadership areas for improvement and staff development in the effort to improve team coordination and mutual support

International Texbook of Reflective Practice in Nursing

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Reflection in Clinical Contexts: Learning, Collaboration, and Evaluation

Reflective practice is based on the fundamental principle of continuous learning through a process of self-assessment and integration of knowledge with experience. As such, it highlights the responsibility of professional nurses to adopt an open attitude and lifelong commitment to assessing and continuously improving their work. Helping professional nurses develop these qualities requires educational approaches that include open, interactive dialogue between learners and teachers. Learners need opportunities to tell their stories, especially about clinical events, in order to meld experiential learning with theoretical learning. Reflective exercises in clinical learning environments can build mental habits that carry over into professional nurse roles, whether as a clinical nurse, nurse educator, or nurse leader. Fostering a reflective philosophy of self-assessment and learning from all experiences is a habit of the mind essential to sense-making in practice and establishes lifelong learning. There is little evidence to guide nursing clinical curricula to best implement reflective learning. Reflective learning shifts from a teaching paradigm to a learning paradigm. Traditional clinical evaluative methods that rely on objective measures might not reveal the changes in attitude and behavior that derive from reflective learning. In reflective paradigms, the learner engages in self-monitoring, so there is an assessment value even within the learning experience. Educators and learners maintain openness and flexibility in the dialogue that emerges from reflective journaling and other means of feedback. This chapter will explore ways to facilitate reflection, primarily in the clinical learning context, and provide feedback to learners that is consistent with reflective learning. We will discuss how the increasing application of reflection in higher education challenges us to rethink clinical assessment and evaluation. The philosophy of learner-centered education promotes co-creating the learning environment in a partnership between learners and educators. We will explore ways to develop a reflective clinical learning environment open to inquiry and continuous learning as the foundation of self-monitoring and evaluation