The impact of care competency training for primary care nurses in South Africa

Includes bibliographical references (leaves 184-200).To effectively support the primary health care transformation of the South African health system, human resource development is needed. Nurses, at the forefront of primary care service delivery, urgently need support and advancement to fulfill their role. This study aimed to investigate the impact of core competency training on primary care nurse competence. To begin this investigation, a framework or core competencies was generated through two reference group meetings. This work was followed by a Delphi study to further define core competence in primary care nursing and how best to measure such competence. Nine core competencies were defined which led to the development and piloting of a core competency evaluation tool including a self-lest and observation tool. This early work was followed by the implementation and evaluation of a novel core-competency training program. This program was implemented within district health systems with working clinic nurses. It involved tour distinct sites in three different provinces. A total of 162 nurses took part in the study, including an intervention and reference group. The goal was to assess the impact of training in a real world setting. Using the self-lest and observation tools, this study showed that competence does improve with this type of training. Additionally, competence is most reliably assessed through observation since test familiarity and possible contamination decrease the usefulness of repeated self-test measures. Further assessment or this novel training program and ref1nement of the measurement tool are recommended. This study can serve to inform health policies, particularly regarding human resource development within emerging district health systems. It provides a practical and effective training approach for increasing nurse performance of primary care core competencies

The impact of care competency training for primary care nurses in South Africa

Includes bibliographical references (leaves 184-200).To effectively support the primary health care transformation of the South African health system, human resource development is needed. Nurses, at the forefront of primary care service delivery, urgently need support and advancement to fulfill their role. This study aimed to investigate the impact of core competency training on primary care nurse competence. To begin this investigation, a framework or core competencies was generated through two reference group meetings. This work was followed by a Delphi study to further define core competence in primary care nursing and how best to measure such competence. Nine core competencies were defined which led to the development and piloting of a core competency evaluation tool including a self-lest and observation tool. This early work was followed by the implementation and evaluation of a novel core-competency training program. This program was implemented within district health systems with working clinic nurses. It involved tour distinct sites in three different provinces. A total of 162 nurses took part in the study, including an intervention and reference group. The goal was to assess the impact of training in a real world setting. Using the self-lest and observation tools, this study showed that competence does improve with this type of training. Additionally, competence is most reliably assessed through observation since test familiarity and possible contamination decrease the usefulness of repeated self-test measures. Further assessment or this novel training program and ref1nement of the measurement tool are recommended. This study can serve to inform health policies, particularly regarding human resource development within emerging district health systems. It provides a practical and effective training approach for increasing nurse performance of primary care core competencies

Bridging the Divide White Paper on Medication Abortion: Overview of Research & Policy in the United States

Medication abortion (also called medical abortion) is a safe method of abortion available for the past 15 years in the US. The Bridging the Divide white paper summarizes the scientific evidence related to the current medication abortion process and potential changes to the process that could make it even safer and more accessible for patients, as well as policy considerations and directions for future research. In the fall of 2000, the US Food & Drug Administration (FDA) approved the drug Mifeprex© (generic: mifepristone) for use in medication abortions. That approval included requirements that affect both patients and providers and that are far more specific than typical requirements for prescription drugs. The package insert (also known as the product label) indicated procedures for mifepristone prescribers to follow, based on the regimen used during the drug’s pre-approval clinical trials. FDA has not approved any other abortion drugs besides Mifeprex. Fifteen years later, in March 2016, the FDA approved an updated label for Mifeprex, marking an important step forward for access to abortion care and for evidence-based policy. Although the new label is progress toward policy that is informed and driven by scientific research, the change came many years after research data had demonstrated the safety and efficacy of widely used evidence-based protocols. In the intervening years, some states took advantage of the outdated requirements in the product label and implemented restrictive policy measures that prevented their residents from accessing care based on the latest evidence and best practice. The Bridging the Divide white paper on the current state of medication abortion evidence and policy can be found below, along with a shorter summary document for policy-makers and a recently published commentary from the journal Women’s Health Issues

Bridging the Divide White Paper: Long-Acting Reversible Contraception (LARC) in the United States

Long-acting reversible contraceptive (LARC) methods – specifically, intrauterine devices (IUDs) and subcutaneous hormone-releasing implants – demonstrate great potential in reducing unintended pregnancy. Although LARC methods have had a rocky history in the US and use rates have remained low here in comparison to other countries where the methods are available, there has been a significant increase in uptake of newer LARC products in recent years. Researchers have identified this change as a likely contributor to the declines seen in unintended pregnancy, abortion, and teen pregnancy rates. Decades of research have shown that current LARC methods are highly safe and effective, yet research has identified many barriers that may prevent a woman who chooses a LARC as the contraceptive method that best meets her needs and preferences from getting it. These include inadequate provider knowledge and training, lack of awareness and education among potential users, and financial and health system barriers. There are also, however, encouraging research findings from assessments of interventions designed to reduce these barriers. Despite the recent advances, some barriers to full, voluntary, and successful use of LARC methods remain but have the potential to be addressed through policy: implementation of insurance coverage for LARC insertion and removal, both under private plans and public programs, such as Medicaid; development of clinical performance measures for clinicians and/or health centers; and establishment of practices that ensure confidentiality and non-coercive provision of LARC methods, particularly for vulnerable populations

Evaluating the clinical management of severely malnourished children- a study of two rural district hospitals

Background. Severe malnutrition is an important cause of preventable mortality in most South African hospitals. Work recently done in two rural Eastern Cape hospitals supports the literature which shows that many deaths occur as a result of outdated clinical practices and that improving these practices reduces case fatality rates. Rapid assessment of clinical management in paediatric wards is necessary to highlight areas for improvement.Objective. To assess the management of severely malnourished children in two rural district hospitals and to recommend improvements for their care.Methods. Based on draft World Health Organisation (WHO) guidelines for inpatient care of children with severe malnutrition, data collection instruments were developed in conjunction with the district nutrition team to assess the quality of care given to malnourished children in two Mount Frere hospitals, Eastern Cape. Data were collected through retrospective review of case records, with detailed studies of selected cases, structured observations of the paediatric wards, and interviews with ward sisters and doctors.Results. The combined case fatality rate for severe malnutrition was 32%. Inadequate feeding, poor management of rehydration and infection, lack of resources, and a lack of  knowledge and motivation among staff were identified as areas that need attention.Conclusion. The clinical management of severely malnourished children can be rapidly assessed to highlight areas for improvement. Involving staff in the assessment process has led to their active involvement in improving the management of malnourished children in their hospitals

Addressing human resources for health needs to support HIV epidemic control: prioritizing site-level interventions in Democratic Republic of the Congo, 2018-2020

Introduction: The United States President's Emergency Plan for AIDS Relief (PEPFAR) in Democratic Republic of the Congo (DRC) continues to fund programs aimed at achieving epidemic control in three provinces where 30 percent of people living with HIV/AIDS in the country reside. Challenges around human resources for health impede the delivery of quality HIV/AIDS services in DRC. Methods: In partnership with the United States Health Resources and Services Administration (HRSA), PEPFAR, and DRC Ministry of Health (MoH), Columbia University's International Center for AIDS Prevention (ICAP at Columbia University) worked with 16 PEPFAR-identified high-priority health facilities and developed specific interventions to address challenges in achieving PEPFAR 95-95-95 targets. Once interventions were selected and prioritized using a collaborative, criteria-driven approach, implementation of these human resources for health improvements began alongside care and treatment efforts already underway. This study began in October 2018, and high-priority interventions were launched in July 2019. Monthly reporting of key PEPFAR metrics continues for evaluation purposes. Results: All 16 high-priority health facilities participated fully. Of several hypothesized interventions, 12 were selected as highest priority, and budgets and task plans were developed for each. The interventions were launched for implementation and evaluation within six months of Ministry of Health approval. Conclusion: This assessment delineated necessary interventions to address site-specific human resources for health challenges/deficiencies. Downstream reporting of key PEPFAR 95-95-95 metrics, including Monitoring, Evaluation, and Reporting indicators, will allow intervention teams to conduct program evaluations and their impacts on targets

Strengthening the Quality and Quantity of the Nursing and Midwifery Workforce: Report on Eight Years of the NEPI Project

In response to the urgent need to scale up access to antiretroviral therapy, the Global Nursing Education Partnership Initiative (GNCBP), a PEPFAR program administered by the U.S. Department of Health Resources and Services Administration (HRSA), was implemented from 2011 to 2018 by ICAP at Columbia University. Working closely together, HRSA and ICAP partnered with local nursing leaders and ministries of health to strengthen the nursing and midwifery workforce across 11 countries. This multi-country project, developed to address critical gaps in nursing education and training worked across six building blocks of health workforce strengthening: infrastructure improvement, curricula revision, clinical skills development, in-service training, faculty development and building partnerships for policy and regulation to increase the quality and quantity of the nursing and midwifery workforce. As a result, 13,387 nursing and midwifery students graduated from schools supported under GNCBP. A total of 5,554 nurses received critical in-service training and 4,886 faculty, clinical mentors and preceptors received training in key clinical care areas and modern teaching methodologies. ICAP completed 43 infrastructure enhancements to ensure environments conducive to learning and strengthened nursing leaders as best evidenced by the election and formation of Mozambique’s first national nursing council and the NEPI Network. Going forward, efforts to strengthen nursing and midwifery can build on the results of the GNCBP project. Going forward, a new group of African nursing leaders are being supported to advocate for high quality patient-care led through inter-professional collaboration and participation in international efforts championing the critical role of nurses in achieving universal health coverage

Larvisida Dan Pupisida Isotearil Alkohol Etoksilat Terhadap Larva Dan Pupa Aedes Aegypti

Isotearil alkohol etoksilat merupakan larvasida yang bekerja sebagai barier fisik bagi pertumbuhan nyamuk. Larvasida ini membentuk lapisan yang sangat tipis (monomolecular surface film) dan menurunkan tegangan permukaan air. Permasalahan penelitian adalah bagaimana efektifitas isotearil alkohol etoksilat dalam membunuh larva dan pupa nyamuk vektor DBD Ae. aegypti. Tujuan penelitian ingin mengetahui efektifitas isotearil alkohol etoksilat dalam membunuh larva dan pupa nyamuk vektor DBD Ae. aegypti. Metode penelitian dengan pengujian efikasi isotearil alkohol etoksilat terhadap larva Aedes aegypti. Penelitian menggunakan 5 dosis, yaitu 0,5 ml/m2, 0,75 ml/m2, 1,0 ml/m2, 1,5 ml/m2 dan 2 ml/m2 serta kontrol. Hasil penelitian menunjukkan bahwa isotearil alkohol etoksilat selama satu minggu membunuh larva dan pupa Ae. aegypti ± 75%. Hasil analisis data menggunakan Anova menunjukkan tidak ada perbedaan jumlah kematian larva Ae. aegypti pada dosis yang berbeda (p=0,999). Simpulan penelitian adalah isotearil alkohol etoksilat dosis 0,5, 0,75, 1,0, 1,5 dan 2 ml/m2 kurang efektif digunakan untuk membunuh larva dan pupa nyamuk vektor DBD Ae. aegypti. Isotearil alcohol ethoxylate is larvicide who works as a physical barrier to mosquito\u27s growth. This larvicides form is very thin layer (monomolecular surface film) and lowers the surface tension of water. The research problem was how effectiveness of alcohol ethoxylate isotearil for killing mosquito larvae and pupae dengue vector Aedes aegypti. Research purpose was to determine the effectiveness of alcohol ethoxylate isotearil for killing larvae and pupae of dengue mosquitoes vector Aedes aegypti. Research methods used to test the efficacy of alcohol ethoxylate isotearil against Aedes aegypti larvae. Research used 5 doses, 0.5ml/m2, 0.75ml/m2, 1.0ml/m2, 1.5ml/m2, and 2ml/m2, and control. The results showed that the alcohol ethoxylate isotearil for a week to kill the larvae and pupae of Aedes aegypti ± 75 %. Data analysis using ANOVA showed no difference in mortality of larvae of Aedes aegypti at different doses (p=0.999). Therefore, isotearil alcohol ethoxylate dose of 0.5 , 0.75 , 1.0 , 1.5 and 2 ml/m2 were not effective used to kill mosquito larvae and pupae dengue vector Aedes aegypti

What do measures of patient satisfaction with the doctor tell us?

Objective: To gain an understanding of how patient satisfaction (PS) with the doctor (PSD) is conceptualized through an empirical review of how it is currently being measured. The content of PS questionnaire items was examined to (a) determine the primary domains underlying PSD, and (b) summarize the specific doctor-related characteristics and behaviors, and patient-related perceptions, composing each domain. Methods: A scoping review of empirical articles that assessed PSD published from 2000 to November 2013. MEDLINE and PsycINFO databases were searched. Results: The literature search yielded 1726 articles, 316 of which fulfilled study inclusion criteria. PSD was realized in one of four health contexts, with questions being embedded in a larger questionnaire that assessed PS with either: (1) overall healthcare, (2) a specific medical encounter, or (3) the healthcare team. In the fourth context, PSD was the questionnaire's sole focus. Five broad domains underlying PSD were revealed: (1) Communication Attributes; (2) Relational Conduct; (3) Technical Skill/Knowledge; (4) Personal Qualities; and (5) Availability/Accessibility. Conclusions: Careful consideration of measurement goals and purposes is necessary when selecting a PSD measure. Practice implications: The five emergent domains underlying PSD point to potential key areas of physician training and foci for quality assessment

Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo

Background Many challenges exist in providing equitable access to rural healthcare in the Democratic Republic of the Congo (DRC). WHO recommends student exposure to rural clinical rotations to promote interest in rural healthcare. Challenges to rural engagement include lack of adequate infrastructure and staff to lead rural education. This case report highlights key steps in developing a rural rotation program for DRC nursing students. Case presentation To implement a rural rotation (RR) program, ICAP at Columbia University (ICAP) consulted with students, the Ministries of Health (MoH) and Education (MoE), and nursing schools to pilot and expand a rural rotation program. Nursing schools agreed to place students in rural clinics and communities. Key stakeholders collaborated to assess and select rural sites based on availability of nursing mentors, educational resources, security, accessibility, and patient volume. To support this, 85 preceptors from 55 target schools and 30 rural health facilities were trained of which 30 were selected to be “master trainers”. These master trainers led the remaining 55 preceptors implementing the rural rotation program. We worked with rural facilities to engage community leaders and secure accommodation for students. A total of 583 students from five Lubumbashi schools and two rural schools outside Kinshasa participated across 16 rural sites (298 students in 2018–2019 school year and 285 in 2019–2020). Feedback from 274 students and 25 preceptors and nursing school leaders was positive with many students actively seeking rural assignments upon graduation. For example, 97% agreed or strongly agreed that their RR programs had strengthened their educational experience. Key challenges, however, were long-term financial support (35%) for rural rotations, adequate student housing (30%) and advocacy for expanding the rural workforce. Conclusions With nearly 600 participants, this project showed that a RR program is feasible and acceptable in resource-limited settings yet availability of ample student accommodation and increasing availability of rural jobs remain health system challenges. Using a multipronged approach to rural health investment as outlined by WHO over two decades ago remains essential. Attracting future nurses to rural health is necessary but not sufficient to achieve equitable health workforce distribution