In-service training programme for health and social care workers in the Philippines to strengthen interprofessional collaboration in caring for older adults: a mixed-methods study.

BACKGROUND: A growing number of older adults require complex care, but coordination among professionals to provide comprehensive and high-quality care is perceived to be inadequate. Opportunities to gain the knowledge and skills important for interprofessional collaboration in the context of geriatric care are limited, particularly for those already in the workforce. A short-term training programme in interprofessional collaboration for health and social care workers in the Philippines was designed and pilot tested. The programme was devised following a review of the literature about geriatric care education and group interviews about training needs. The objectives of this paper are to introduce the training programme and to evaluate its influence on attitudes and readiness to collaborate among participants using both quantitative and qualitative methodologies. METHODS: A total of 42 community health workers and 40 health institution workers participated in the training in July 2019. Quantitative indicators were used to evaluate attitudes towards and readiness for collaboration before and after the training. Content analysis was performed of responses to open-ended questions asking participants to evaluate the training. A convergent parallel mixed-methods design was applied to determine the patterns of similarities or differences between the quantitative and qualitative data. RESULTS: Significant improvements were seen in scores on the Attitudes Towards Health Care Teams Scale among community health (P < 0.001) and health institution (P < 0.001) staff after the training. Scenario-based case studies allowed participants to work in groups to practise collaboration across professional and institutional boundaries; the case studies fostered greater collaboration and continuity of care. Exposure to other professionals during the training led to a deeper understanding of current practices among health and social care workers. Use of the scenario-based case studies followed by task-based discussion in groups was successful in engaging care professionals to provide patient-centred care. CONCLUSIONS: This pilot test of in-service training in interprofessional collaboration in geriatric care improved community and health institution workers' attitudes towards such collaboration. A 3-day training attended by health and social care workers from diverse healthcare settings resulted in recommendations to enhance collaboration when caring for older adults in their current work settings.

Nurses in advanced roles as a strategy for equitable access to healthcare in the WHO Western Pacific region: a mixed methods study.

BACKGROUND: The Western Pacific region constitutes one-quarter of the world's population and has diverse health needs. While dialogue on and promotion of advanced practice nurses are ongoing, this study investigated the current responsibilities of nurses in advanced roles, future healthcare needs, and the implications of these components for nurses' professional development within the Western Pacific region. METHODS: This study employed three phases, a descriptive survey on the current status of nurses in advanced roles in the Western Pacific region, followed by a Delphi survey, and exploratory interviews. A total of 55 national experts with clinical, academic, and/or government-related backgrounds from 18 countries participated from December 2017 - December 2018. The descriptive survey via email to identify the status of nurses in advanced roles and a working definition was developed. This formed the basis for the Delphi survey, which identified key barriers and challenges for enhancing the development of nurses in advanced roles within the country (round 1) and for the region (rounds 2 and 3). Lastly, semi-structured individual interviews were conducted to identify strategies for establishing nurses in advanced roles to improve equitable access to healthcare. RESULTS: Thirty-seven roles and characteristics were identified and categorized for nurses performing advanced roles. Emergency care, critical care, elderly health, child health, and rural/remote communities were identified as fields with particular need for nurses in advanced roles in the Western Pacific region. Providing effective services, influencing government leadership, and advocating for health system sustainability were deemed necessary to improve equitable healthcare access. We found that nurses in advanced roles are not limited to clinical tasks within the hospital but are poised for active participation in primary healthcare, education/teaching, professional leadership, quality management, and research. CONCLUSIONS: Demand for nurses in advanced roles is high in the Western Pacific region and 15 items were identified across five core strategic areas to enhance development of nurses in advanced roles. Governmental-level recommendations include establishing legislative protection, improving systems for remuneration, strengthening supportive channels, and conducting national needs assessments.

Formative Evaluation of the Implementation of eHealth in the Philippines: A Qualitative Study.

Background and Objective: The utilization of information and communications technology (ICT) to support health, known as eHealth, is a crucial enabler of universal healthcare. It is important to identify various aspects that could support or hinder eHealth, especially in limited-resource settings. This study determined the factors influencing the implementation of eHealth solutions in the Philippines, in consideration of the development process and initial outputs of the Philippine eHealth Strategic Framework and Plan 2014-2020. Methods: The descriptive-qualitative study was conducted among 15 municipalities/cities in the Philippines, recognized as early adopters of eHealth programs. Records review of eHealth solutions and key informant interviews among stakeholders (i.e., physicians and nurses) per study site were facilitated to gather data. Using directed content analysis, contextual, process, and content factors influencing eHealth implementation in the country were synthesized. Results: Results showed a range of eHealth solutions in the selected facilities, majority of which involved electronic medical records. Various contextual, process, and content-related factors could serve as facilitators or barriers to eHealth implementation in the country. Particularly, contextual factors include individual characteristics (ICT experience/training, organizational commitment, readiness for change), perceived need/urgency for eHealth (provisions, policies, regulatory issues), and third-party involvement for financial/technical support. Meanwhile, process-related factors involve implementation team practices, appropriate top-down and bottom-up approaches in leader/member engagement, and resource management (ICT equipment, stable internet connection, power supply). Content-specific factors mainly include the eHealth design (complexity, adaptability to local context and service demands, interoperability or the capacity to connect or exchange information with other platforms/systems). Notably, limitations across the three dimensions could make eHealth implementation more complicated, which could lead to poor time management and resource wastage. Conclusion: This study highlighted the importance of a multidimensional understanding of factors that influence the utility of eHealth in the health system. There is a need for leadership and governance, stakeholder engagement, resource and funding, implementation readiness, appropriate design of eHealth solutions, and proper training to ensure the successful implementation of eHealth in the country.

Development of an Online Nursing Leadership Program for Global Health in the Western Pacific Region.

Background and Objective: Global health highlights the transnational determinants, issues, and possible solutions for improving health outcomes. Addressing global health issues requires population-based approaches coupled with individualized healthcare across settings, including strategies for achieving health equity. Designing and implementing global health solutions requires competent nurse leaders who can facilitate multi-disciplinary collaborations, engage in policy development, and lead advocacies that support the global health agenda. Thus, this paper examined the stakeholder perspectives that informed the development of a leadership program on global health for nurse leaders in the Western Pacific Region (WPR). Methods: The study used a descriptive qualitative approach to generate key recommendations for a context-appropriate, multi-country capacity-building program for nurse leaders on global health. The Analysis Design, Development, Implementation, and Evaluation (ADDIE) model and reflexive approach were employed to guide the development of the training design. Twenty-five nurse leaders from World Health Organization Collaborating Centers (WHO-CC) in the Western Pacific participated. Qualitative data were collected from participant feedback and post-activity sessions throughout program implementation. Results: Thematic analysis of stakeholder data revealed that the program (1) capitalized on equipping nurse leaders with the concepts related to global health and developing competencies in leadership, policy engagement, and advocacy; (2) ensured learning strategies by having participants from varied contexts and experiences; and (3) reflected on the strengths and limitations of the use of the online platform. Conclusion: This paper contributed to the growing literature on global health and programs that support addressing global health issues. The findings underscored the urgent need to capacitate nurses in leadership positions who contribute to addressing emerging issues in global health. The paper recommended improvements in the design and implementation of the Global Health Nursing Leadership Program to engage more nurse leaders across the region and enhance content and delivery.

Towards Health Promoting Schools: Pilot Training and Evaluation of the Updated Urbani School Health Kit (USHK) among School Teachers in Manila.

Background and Objective: Committed to enhancing healthy living, learning, and working conditions, a health-promoting school is a potent influencer of behaviors and habits, reaching families and communities effectively. In the Western Pacific region, the Urbani School Health Kit (USHK) is one of the tools developed to integrate health promotion in schools; however, it needs to be updated to adapt to the evolving health challenges of lifestyle-related diseases. Hence, this study aimed to conduct a pilot training and evaluation of the updated USHK among school teachers in Manila. Methods: The USHK was updated with new materials on (1) health-enhancing physical activity; (2) healthy nutrition; and (3) family and community engagement. A two-day training-workshop with 30 school teachers was then conducted to facilitate the integration of the updated USHK in their class activities. We used a multi method evaluation design to assess the implementation of the USHK. Particularly, quantitative data were obtained from the participants' feedback on the toolkit and their knowledge of health-related practices. One month later, field visits were conducted to assess the participants' abilities in utilizing the toolkit into their classes or school activities. Qualitative interviews and classroom observations were also collected post-implementation to determine potential facilitators and barriers to program delivery, and suggestions for improvement. Descriptive statistics were used to summarize participant feedback, while Wilcoxon signed rank test was utilized to determine changes in participant knowledge pre- and post-training. Qualitative data were synthesized through content analysis. Results: Participants provided high satisfaction ratings for the training they received, as well as high scores for the updated USHK, in terms of its appropriateness and acceptability. Significant improvements in participants' overall health promotion knowledge were also noted (Z = -4.456, p <0.001), particularly involving the domains of nutrition (Z = -2.972, p = 0.003), physical activity (Z = -3.564, p <0.001), and family/community engagement (Z = -2.531, p = 0.011). Meanwhile, participants also suggested further improvements in the toolkit to enhance its utilization in the local context. Administrative support was a crucial facilitator for implementing the USHK, while resource limitations were identified as significant barriers. Conclusion: The updated USHK, which provides a more comprehensive health promotion approach for schools, is potentially feasible for implementation in educational institutions in Manila. The toolkit can be utilized by teachers and school nurses to integrate health promotion activities into the school environment and classroom activities. To facilitate its wider uptake and implementation in other schools, government support and resource availability are crucial.

Perceived Competencies and Training Needs of Public Health Nurses in the Philippines: Basis for the Development of NurseLEAD: A Leadership Course on Advanced Practice Nursing in Public Health.

Background and Objective: Public health nurses (PHNs) perform more than the provision of direct care to clients. They are also expected to perform roles as leaders, managers, and collaborators in different settings, especially in areas where there are no physicians. Their continuous professional development must be facilitated to empower them to lead the delivery of health programs and services in pursuit of universal healthcare. This study aims to determine the perceived competencies of public health nurses and describe their training needs. Methods: A descriptive, cross-sectional study was utilized, where an online survey was administered to PHNs across the Philippines to determine their self-perceived competencies and training needs based on the eight domains of core competencies of public health professionals. Descriptive statistics was used to summarize the data. Results: A total of 330 PHNs answered the survey. The results showed that at baseline, PHNs perceived themselves to be competent (from most to least) in the following: communication, analytical/assessment, community dimensions of practice, policy development/ program planning, leadership and systems thinking, cultural competency skills, public health science, and financial planning and management. In terms of training needs, the enablers mentioned include a supportive work environment that can provide a work schedule that is inclusive of time for professional development and work-life balance; a learning environment where colleagues and supervisors support the need for training and innovation; strong internet connection; and enough equipment to participate and submit deliverables for courses taken. Conclusion: Filipino public health nurses perceived themselves to be competent in the areas of communication and community practice, but less competent in public health science, and financial planning and management. Future capacity-building programs must be designed to meet this demand. Furthermore, to make training programs truly responsive to the needs of nurses, steps must be taken to promote capacity-building enablers.

Care Needs of Parents of Children With Cancer in a Low-Middle-Income Country.

Background: Mapping out actual supportive care needs assists nurses in providing holistic individualized care. This study aimed to explore the care needs of parents of children with cancer in the Philippines. Method: Guided by the Supportive Care Needs Framework (SCNF), this study used an embedded mixed-method design with the quantitative revised Cancer Patient Needs Questionnaire and qualitative semistructured interviews to describe parents' care needs and priorities. Results: Filipino parents (N = 156) of children with cancer have various care needs which could be classified along the SCNF categories-practical, informational, spiritual, physical, emotional, and physical needs as ranked from highest to lowest. A number of variables were significantly associated with care needs. Solid tumor diagnosis was associated with greater practical, emotional, and psychosocial care needs; having a child who had undergone surgery was associated with more practical and spiritual care needs; and being within one year of the child's diagnosis was associated with practical, psychosocial, and spiritual care needs. Parent priority needs included (a) addressing financial needs; (b) access to temporary housing to minimize treatment-related costs; (c) support groups among parents of children with cancer as a source of information; (d) financial and social support between members of family and partners of parents of children with cancer; and (e) using prayer to facilitate acceptance. Conclusions: Supportive care needs of parents of children with cancer are important components of care that should be given recognition to enhance holistic individualized care throughout the childhood cancer experience.

Salutogenesis and COVID-19 pandemic impacting nursing education across SEANERN affiliated universities: A multi-national study.

BACKGROUND: The COVID-19 pandemic has disrupted the lives of many. Particularly, nursing students experience greater stress as their normal curriculum is interrupted and some of them face the risk of being infected as frontline workers. Nursing faculty members may face similar struggles, in addition to developing teaching materials for online learning. Thus, it is important to examine the faculty members' and students' views on their ability to adapt during the pandemic to obtain a holistic view of how learning and training has been affected. DESIGN: The descriptive cross-sectional quantitative design was used. SETTINGS: Data were collected from Southeast and East Asian Nursing Education and Research Network (SEANERN) affiliated nursing institutions from January 2021 to August 2021. PARTICIPANTS: A total of 1897 nursing students and 395 faculty members from SEANERN-affiliated nursing institutions in Cambodia, Hong Kong, Indonesia, Japan, Laos, Malaysia, Philippines, Singapore, Thailand and Vietnam were recruited for this study. METHODS: Quantitative surveys were used to explore the satisfaction levels in education modalities, confidence levels, psychosocial well-being, sense of coherence and stress levels of nursing students and faculty members during the COVID-19 pandemic. RESULTS: Participants were mostly satisfied with the new education modalities, although most students felt that their education was compromised. Both groups showed positive levels of psychosocial well-being, despite scoring low to medium on the sense of coherence scale and experiencing great stress. The participants' sense of coherence was positively correlated with their psychosocial well-being and negatively correlated with stress levels. CONCLUSIONS: While the COVID-19 pandemic had negatively impacted the lives of nursing students and faculty members, most of them had a healthy level of psychosocial well-being. Having a strong sense of coherence was associated with better psychosocial health and lower stress levels. As such, it may be helpful to develop interventions aimed at improving the sense of coherence of nursing students and staff to help them manage stressors better.

Improving Community Health Workers' Attitudes toward Collaborative Practice in the Care of Older Adults: An In-Service Training Intervention Trial in the Philippines.

The objective of this study was to evaluate the efficacy of an in-service, short-term training program in improving the attitudes toward, and readiness and activities for collaboration among community health workers (CHWs) in a primary care setting in the Philippines. A randomized controlled trial was adopted dividing participants into an intervention (n = 42) and a control group (n = 39). Attitudes toward, and readiness and activities for collaboration were measured using three standardized scales before and at 6 months after the training. A significant difference (p < 0.001) was observed in the Attitudes Toward Health Care Teams Scale (ATHCTS) scores between pre- and post-test in the intervention (6.3 ± 8.3 [Mean ± SD]) and control groups (0.7 ± 8.2). Multivariate linear regression analysis showed an independent positive association between the intervention and greater improvement in the ATHCTS score (Coefficient ß = 6.17; 95% CI = 0.82, 11.53; p = 0.03) at follow-up, after adjustment for age, years in current occupation, and social support role of participants. The results demonstrated the efficacy of the intervention for improving the attitudes of CHWs toward collaborative practice in the care of older adults.

The usefulness of case studies in a Virtual Clinical Environment (VCE) multimedia courseware in nursing.

Clinical practicum is a major component in nursing education. Students are able to apply their classroom learning to the actual care setting. The clinical practicum setting must provide an authentic environment where students can maximize learning opportunities and demonstrate knowledge, skills, and attitude in caring for patients. Herein lies the challenge. The real world setting and timing may not be enough for students to learn the many complex tasks demanded as course outcomes and expected competencies. The purpose of this study was to describe the usefulness of using multimedia case study courseware in facilitating learning among students. The Virtual Clinical Environment multimedia courseware was structured around five case studies featuring major health concerns among adults, namely : chronic heart failure, stroke, breast cancer, chronic obstructive pulmonary disease, and dementia. Students were asked to use case studies in developing nursing care plans which facilitated authentic learning and encouraged active and reflective learning. Students were also encouraged to critically think and effectively solve problems. The case studies in the courseware helped in demonstrating the scope and processes of the clinical practicum, illustrating the setting, and stimulating critical thinking and decision-making in doing patient assessment and care. J. Med. Invest. 66 : 38-41, February, 2019.