Perceptions and factors associated with COVID Appropriate Behavior (CAB) obedience among general public in India: A mixed methods research.

BACKGROUND: The purpose of the study was to analyze the public perception toward COVID Appropriate Behavior (CAB) obedience and to identify the factors associated with declining CAB. MATERIALS AND METHODS: It is a mixed methods study conducted from November 2021 to September 2022 in Pune city, India. A set of 15-CAB guidelines published by the Ministry of Health and Family Welfare, Government of India (GoI), were used as a base document to design the instruments of qualitative and quantitative study. Using a one-sample Kolmogorov-Smirnov test, CAB scores were tested for normality and distribution. Comparisons of various parameters were done using z test for proportion and paired t-test (statistical significance level was 0.05). Thematic content analysis was conducted for qualitative data analysis and verbatims are reported where applicable. RESULTS: The main motivation for people to get vaccinated was family and personal safety and a higher proportion of people felt safer post-vaccination which was linked to a reduced likelihood of CAB obedience. Qualitative results showed that people's lack of empathy and concern for others leads to undesirable personal behaviors such as spitting in public places, not wearing masks, etc., The need for socialization is high but discomfort with the use of masks/face shields and habituation with the disease were prominent causes of CAB disobedience. CONCLUSION: We conclude that reduced fear and gradual habituation have led to reduced CAB obedience. There is a need to reinforce empathy and concern for others to improve adherence to CAB like maintaining social distancing and wearing masks in public places for personal and social safety from the disease.

Impact of Structured Training Program about Cadaver Organ Donation and Transplantation on Knowledge and Perception of Nursing Students at Public and Private Nursing Teaching Institute of Northern India - An Interventional Study.

Background: "Donation gap" refers to the shortage of organ donors worldwide. The medical/nursing students and various healthcare workers have poor awareness and attitude toward organ donation. Objective: We conducted this study to assess the current level of knowledge and perception regarding cadaver organ donation and transplantation among nursing students and to evaluate the impact of structured training interventions on their baseline knowledge and perception level. Methods: It was a single-group pre-post interventional study done by nursing students of one government and one private nursing college.A pre-tested questionnaire was used as a study tool. Statistical Analysis: Various statistical tests like one-way repeated measure ANOVA, Mauchly's test of sphericity, and Greenhouse-Geisser correction were used. Pairwise comparisons used Bonferroni corrections. Results: The pre-test group had the lowest mean knowledge (50.2346, SD = 15.35188), and immediately after training group had the highest (57.3900, SD = 14.34626). After one month, knowledge decreased but was still higher than pretraining (mean = 52.3607, SD = 13.28141). Conclusions: The positive attitude of nursing students may augment cadaver organ donation and transplantation in the future. The study has also highlighted the further training needs of the participants.

Impact of structured training program about Hospital Infection Control practices on Knowledge and Perception of nursing students at public and private nursing teaching institute of Northern India- An interventional study.

BACKGROUND: Hospital-acquired infections (HAIs) are a primary cause of illness and death and increased expenditure due to prolonged hospitalization and poor prognosis. HAI is a global safety concern, according to World Health Organization (WHO). This study assesses the current level of knowledge and perception regarding hospital infection control practices among nursing students and evaluates the impact of structured training interventions on their baseline knowledge and perception level. METHODS AND MATERIALS: It was a single group, a pre-post interventional study done on nursing students of one government and one private nursing college in the year 2021. A pretested questionnaire consisting of was used as a study tool. Various statistical tests like one repeated-measure ANOVA, Mauchly's Test of Sphericity, and Greenhouse-Geisser correction were used. RESULTS: The mean knowledge was minimum in the pretest group (Mean = 79.4430, SD = 17.49746) and maximum immediately after the training group (Mean = 96.5443, SD = 25.42322). But after one month, knowledge decreased; however, it was more than pre-training Knowledge (Mean = 84.4937, SD = 22.40313). CONCLUSIONS: Annual educational/training modules help retain knowledge in hospital infection control practices and HAI prevention. All healthcare workers need regular training.

To assess the impact of training about hospital infection control measures related to hemodialysis services on the knowledge of healthcare providers (HCPs) at the teaching institution of Haryana.

Background: Adequate knowledge among nursing professionals toward hospital infection control measures related to hemodialysis (HD) services is essential to decrease infection among patients. Objective: This study assessed nursing professionals' knowledge about hospital infection control measures related to HD services and the effect of training interventions. Settings and Designs: It was a single group, a pre-post-interventional study conducted on nursing professionals of a single apex medical college of Haryana. Materials and Methods: A pretested questionnaire consisting of two parts was used as a study tool. Statistical Analysis: Various statistical tests such as paired t-test and Pearson's correlation were used. Results: The pre-intervention group had a lower mean knowledge score (mean knowledge = 90.2786, strongly disagree [SD] = 15.52682, standard error [SE] = 1.09518) and then the post-intervention mean knowledge score (mean knowledge = 137.5622, SD = 9.72252, SE = 0.68577). Conclusions: The training program or educational intervention proved very useful for enhancing nursing professional's knowledge about hospital infection control measures related to HD services.

Perception of healthcare workers towards ethical aspects of responsiveness of COVID 19 outbreak: A cross-sectional study.

Introduction: COVID-19 has spread all over the world and most of the countries are still grappled with the Pandemic. Health-care-workers (HCWs) being the frontlines during such pandemics have different beliefs and faiths with regards to ethical aspects of preparations. Methodology: In order to study the perception of HCW about ethical aspects of COVID-19, a cross-sectional study was done in a tertiary-care-teaching hospital. A pretested questionnaire was circulated among the participants on a digital platform. Results: The HCWs were divided over many statements, like if COVID-19 was more hype than reality (45.77% disagreed and 43.25% agreed). 57.44% of participants either agreed or strongly agreed that the treatment of non-COVID-19 cases suffered due to arrangements made for COVID-19 cases. When the responses received against individual statements were compared with various other socio-demographic variables as a denominator, various interesting results were revealed. There was a significant difference of opinion among the participating HCWs (P < 0.05). Conclusion: Differences of the opinions had their relationships to demographic characteristics of the subjects as well as related to perceived knowledge of COVID-19.

Supply chain management with cost-containment & financial-sustainability in a tertiary care hospital.

Financial crunch in the present recession results in the non-availability of the right materials at the right time in large hospitals. However due to insufficient impetus towards systems development, situation remains dismal even when funds are galore. Cost incurred on materials account for approximately one-third of the total recurring expenditures in hospitals. Systems development for effective and efficient materials management is thus tantamount to cost-containment and sustainability. This scientific paper describes an innovative model, Hospital Revolving Fund (HRF), developed at a tertiary care research institute in Asia. The main idea behind inception of HRF was to ensure availability of all supplies in the hospital so that the quality of healthcare delivery was not affected. The model was conceptualized in the background of non-availability of consumables in the hospital leading to patient as well as staff dissatisfaction. Hospital supplies have been divided into two parts, approximately 3250 unit items and 1750 miscellaneous items. This division is based on cost, relative-utility and case-specific utilization. 0.1 Million USD, separated from non-planned budget, was initially used as seed money in 1998. HRF procures supplies from reputed firms on concessional rates (8-25%) and make them available to patients at much lesser rates vis-à-vis market rates, levying minimal maintenance charges. In 2009-10, total annual purchases of 14 Million USD were made. The balance sheet reflected 1.4 Million USD as fixed deposit investment. The minimal maintenance charges levied on the patients along with the interest income were sufficient to pay for all recurring expenses related to HRF. Even after these expenses, HRF boosted of 0.2 Million USD as cash-in-hand in financial year 2009-10. In-depth analysis of 'balance sheet' and 'Income and Expenditure' statement of the fund for last five financial years affirms that HRF is a self-sustainable and viable supply chain mechanism to ensure availability of the right materials at the right time at a reasonable cost. Thus innovations like HRF will prove robust in rendering quality healthcare at an affordable cost.

Augmenting nursing care quality and implementing change management in India: an amalgamated approach.

BACKGROUND AND AIM: High dependency on nursing care in healthcare delivery systems in recent times has made the quality appraisal of nursing care even more imperative for nursing administrators. This study demonstrates the utility of a two-phase technique to identify the most significant shortcomings pertaining to nursing care delivery in general wards of a tertiary care hospital. The same could be used to set priorities. METHODS: The first phase involved the use of the Delphi technique facilitating the experts to identify the major problems. The mean rank score was used for grading the problems. The second phase of the study involved getting direct feedback from the ward nurses. The sample size was 147 at a level of significance of 5%. RESULTS: Consensus was reached among experts on four problems that should galvanize nursing administration vis-à-vis quality improvement. The responses of ward nurses in the second phase gave a better insight into these problems. CONCLUSION AND IMPLICATIONS FOR NURSING MANAGEMENT: Identifying the existing problems and fostering a team spirit among all stakeholders hold the key in strategizing quality improvement in nursing care. Nursing administrators worldwide, after making suitable situation-specific customizations, may use this approach to realize both these objectives.

Gauging Skills of Hospital Security Personnel: a Statistically-driven, Questionnaire-based Approach.

OBJECTIVES: This study aims to gauge the technical and soft skills of the hospital security personnel so as to enable prioritization of their training needs. METHODOLOGY: A cross sectional questionnaire based study was conducted in December 2011. Two separate predesigned and pretested questionnaires were used for gauging soft skills and technical skills of the security personnel. Extensive statistical analysis, including Multivariate Analysis (Pillai-Bartlett trace along with Multi-factorial ANOVA) and Post-hoc Tests (Bonferroni Test) was applied. RESULTS: The 143 participants performed better on the soft skills front with an average score of 6.43 and standard deviation of 1.40. The average technical skills score was 5.09 with a standard deviation of 1.44. The study avowed a need for formal hands on training with greater emphasis on technical skills. Multivariate analysis of the available data further helped in identifying 20 security personnel who should be prioritized for soft skills training and a group of 36 security personnel who should receive maximum attention during technical skills training. CONCLUSION: This statistically driven approach can be used as a prototype by healthcare delivery institutions worldwide, after situation specific customizations, to identify the training needs of any category of healthcare staff.

Quality of care as a determinant of health-related quality of life in ill-hospitalized adolescents at a tertiary care hospital in North India.

OBJECTIVE: To evaluate if quality of care (QoC) provided by hospital is a determinant of ill-hospitalized adolescent's health-related quality of life (HRQoL) from parent's perspective. DESIGN: Prospective cross-sectional study conducted at a tertiary care hospital of Northern India after institutional ethical approval. SETTING: Hospital in pediatric department of a tertiary care, teaching medical University in Lucknow, northern India. PARTICIPANTS: Sick adolescents aged between 10 and 19 years and hospitalized for four categories of illnesses, namely, acute infective; chronic infective, non-hemopoetic; hemopoetic disorders and miscellaneous. INTERVENTION: QOC assessment was done using 'Pyramid instrument' and HRQoL by culturally modified WHOQOL-BREF (World Health Organization Quality of Life-BREF). The Pyramid instrument comprises 43 questions to collect information about awareness of eight indices: namely illness, routines, accessibility, medical treatment, care processes, staff attitude, participation and staff work environment and scored on 1-4 Likert scale. WHOQOL-BREF has four domains: physical, psychological, social relations and environment and scored on 1-5 Likert scale. RESULTS: From January 2008 to December 2008, 300 adolescents with a mean age of 12.5 ± 2.6 years and 61.3% males were included. The pyramid instrument showed a substantial internal consistency (α = 0.88, P-value < 0.0001). The mean QoC was highest for medical treatment (0.76 ± 0.13) and lowest for participation (0.54 ± 0.16). The mean parent's report of child's HRQoL was highest for physical (42.8 ± 7.4) and lowest for environment domain (37.2 ± 7.1). Four QoC indices namely, medical treatment, care processes, staff attitude and participation had significant associations with the mean HRQoL. In a hierarchical linear regression, staff attitude was the only significant determinant of HRQoL (ß coefficient: 23.16, 95% confidence interval: 15.8-30.5, P-value < 0.0001). CONCLUSION: The Pyramid instrument is a reliable instrument for assessing parent's perception of QoC provided to hospitalized adolescents in Indian context. QoC was positively associated with HRQoL, thus, an increased focus on QoC especially staff attitude is likely to enhance adolescent's overall HRQoL.

Determinants of health related quality of life in school-going adolescents in Northern India.

OBJECTIVE: To identify determinants of good Health Related Quality of Life (HRQoL) in school going adolescents. METHODS: This Cross-sectional study was conducted in public and private schools in Lucknow, Northern India after obtaining institutional ethical clearance. Children aged 10 to 19 years were included after obtaining parental written informed consent. HRQoL was assessed using culturally appropriate WHOQOL-BREF version. RESULTS: From 1900 schools in Lucknow, 10 public and 10 private schools were selected. Within schools, random selection of the subjects was done. Dropout rate was 7.2% (525/566). Mean age of participants was 14.04 ± 2.09 years, of which 52.4% (275/525) were boys and 48.5% (255/525) were from private schools. Good HRQoL was a score ≥83, which corresponded to third quartile, and 33.7% and 16.6% of subjects, from private and public schools, respectively, fell in this category (p-value <0.0001). Determinants of good HRQoL on multivariate analysis were age <14 years (OR: 2.11, 95%CI 1.39-3.02, p < 0.0001) and studying in private school (OR = 2.04, 95%CI 1.18-3.51, p < 0.0001). CONCLUSIONS: Younger adolescent age and enrolment in private schools are determinants of good HRQoL in school-going adolescents. Further research is needed to identify measures to improve HRQoL among older adolescents and those studying in public schools.

A study of concordance between adolescent self-report and parent-proxy report of health-related quality of life in school-going adolescents.

OBJECTIVES: The purpose of the study was to determine the degree of concordance between the self-report and the parent's proxy report of health-related quality of life (HRQoL) in school-going adolescents using the World Health Organization Quality of Life (WHOQOL)-BREF instrument in India. METHODS: Twenty schools were purposively selected out of the 1900 schools in Lucknow, India. About 5% adolescents (between 10-19 years) per school were randomly selected by lottery system. Subjects, whose parents consented for child's participation, completed the WHOQOL-BREF self-report and their parents filled the WHOQOL-BREF proxy-report for adolescent's HRQoL. Degree of concordance and association were assessed using Cohen's κ and Spearman's correlation, respectively. RESULTS: Five hundred fifteen adolescents (mean age=14 years with a standard deviation of ± 2 years; 48.2% females) were included. κ Statistic values ranged from fair to moderate for all facets and dimensions of HRQoL between adolescent and parent report (κ=0.31-0.58, P<.01). There were moderate to very strong correlations between adolescent self and parent proxy report (r=0.62-0.81, P<.01) which declined with age of adolescent. The mother's scores correlated best in psychological dimension (r=0.81-0.88, P<.01) while that of father correlated best in environment dimension (r=0.81-0.79, P<.01), irrespective of child's gender. CONCLUSION: Our study illustrated that fair to moderate agreement existed between parent proxy and subject's self-report for adolescent's HRQoL. That may be an indicator for suitability of parent's proxy report in certain dimensions, if a child is unavailable or unable to respond. However, further research may provide new insights into the determinants of concordance between subject self and parent proxy report of adolescent HRQoL.

Validation of WHO QOL-BREF instrument in Indian adolescents.

OBJECTIVE: This study attempts to test the psychometric properties of World Health Organization Quality of Life (WHOQOLBREF) instrument in Indian adolescents. METHODS: Of 1900 schools in Lucknow city, 20 schools were invited for participation. To make WHOQOL-BREF instrument culturally appropriate for Indian adolescents, a minor modification was done by replacing one item in Social domain "Are you satisfied with your sex life?" with "Are you satisfied with the respect you receive from others?". The revised WHOQOL-BREF was administered to subjects in school after obtaining written parental consent. RESULTS: From August 2007-January 2008, 525 adolescents were recruited (mean age 14.04+/-2.09 yr; 52.38 % males). Adolescents reported highest HRQoL in social relations and lowest in environment domain. The instrument showed good internal consistency (Cronbach's a=0.87; p-value<0.01) as well as good content, construct and predictive validity (p-values<0.05). Psychological domain had best predictive validity, whereas, social relations domain had best content validity. CONCLUSION: The study provides evidence that revised WHOQOL-BREF is a reliable and valid instrument and can be used in Indian adolescents.

Rules and management of biomedical waste at Vivekananda Polyclinic: a case study.

Hospitals and other healthcare establishments have a "duty of care" for the environment and for public health, and have particular responsibilities in relation to the waste they produce (i.e., biomedical waste). Negligence, in terms of biomedical waste management, significantly contributes to polluting the environment, affects the health of human beings, and depletes natural and financial resources. In India, in view of the serious situation of biomedical waste management, the Ministry of Environment and Forests, within the Government of India, ratified the Biomedical Waste (Management and Handling) Rules, in July 1998. The present paper provides a brief description of the biomedical waste (Management and Handling) Rules 1998, and the current biomedical waste management practices in one of the premier healthcare establishments of Lucknow, the Vivekananda Polyclinic. The objective in undertaking this study was to analyse the biomedical waste management system, including policy, practice (i.e., storage, collection, transportation and disposal), and compliance with the standards prescribed under the regulatory framework. The analysis consisted of interviews with medical authorities, doctors, and paramedical staff involved in the management of the biomedical wastes in the Polyclinic. Other important stakeholders that were consulted and interviewed included environmental engineers (looking after the Biomedical Waste Cell) of the State Pollution Control Board, and randomly selected patients and visitors to the Polyclinic. A general survey of the facilities of the Polyclinic was undertaken to ascertain the efficacy of the implemented measures. The waste was quantified based on random samples collected from each ward. It was found that, although the Polyclinic in general abides by the prescribed regulations for the treatment and disposal of biomedical waste, there is a need to further build the capacity of the Polyclinic and its staff in terms of providing state-of-the-art facilities and on-going training in order to develop a model biomedical waste management system in the Polyclinic. There is also a need to create awareness among all other stakeholders about the importance of biomedical waste management and related regulations. Furthermore, healthcare waste management should go beyond data compilation, enforcement of regulations, and acquisition of better equipment. It should be supported through appropriate education, training, and the commitment of the healthcare staff and management and healthcare managers within an effective policy and legislative framework.

Level of awareness about transplantation, brain death and cadaveric organ donation in hospital staff in India.

A questionnaire was distributed in a group of randomly selected hospital staff to ascertain the level and factors associated with awareness regarding organ transplantation, brain death, and cadaveric organ donation. Between October and December 2000, a total of 166 paramedical (nurses, technologists, medical physicists) and 100 nonmedical (administrative, clerical, engineering, social scientists, and miscellaneous) staff of a tertiary referral academic hospital in northern India received this questionnaire. Ninety-seven percent had good to excellent awareness about transplantation, 17.3% of the hospital staff thought that brain death was a reversible process, and 59.4% had misconceptions about the retrieval of cadaveric organs. A significant positive correlation (r = 0.147, P = .01) was observed between the awareness of transplantation, brain death, and organ donation. A significant association was also observed between the workplace (operating room and intensive care unit vs other areas) and awareness of transplantation (P = .048), and brain death and organ donation (P = .030).