Development of PARcific Approach: Participatory Action Research Methodology for Collectivist Health Research.

This article explores the evolution of a novel approach designed to advance qualitative methods in cross-cultural health research. This methodology was developed by synthesising several research methods and involved in-depth stakeholder consultation with participants of a Pacific-based nursing and midwifery health leadership program. Many of these participants played a crucial role in creating, exploring and evaluating several research methods and implementing and evaluating this co-designed research methodology. Starting with a Participatory Action Research framework, the research methodology evolved as it was informed by the local Pacific methodologies (in particular Talanoa and Kakala frameworks), where researchers, co-researchers and participants alike, working from within their own collectivist/individualist paradigms, negotiated cultural differences. Finally, a methodological framework of 'best practice' for future health research methods was developed for use with capacity building research. The new methodology could provide a foundation for future co-designed cross-cultural research in collectivist cultures.

Development Practices in Senior Nursing and Midwifery Leadership: Pathways to Improvement in South Pacific Health Policy.

The Pacific Islands countries consist of thousands of isolated islands with a combined population of over 10 million people. It is a heterogeneous and diverse region culturally, linguistically economically and politically. Health challenges are considerable and healthcare systems are often overstretched. Framed in the context of the World Health Organisation's strategic directions and policy priorities, this paper describes an account of collaboration across these countries to develop leadership skills in the nursing and midwifery professions. It outlines lessons for nursing leadership, healthcare policy development and the valuable role of Government Chief Nursing and Midwifery Officers. The South Pacific Chief Nursing and Midwifery Officers Alliance (SPCNMOA) is a cooperative partnership, which was formed to improve the quality of healthcare in the region. It acts as an enabler to promote leadership skills and provide a safe space for learning, developing policy and the sharing of good practice. Through mentorship programs, international meetings and strong relationship-building, the SPCNMOA has strengthened partnerships within the region and improved community health services in even the most remote areas. By strengthening leadership and collaboration, these health professionals are now recognised by key policy makers as knowledgeable experts who have a legitimate role in guiding policy development, changing practice and delivering health policy improvements at local, country and international levels.

Development and implementation of the Bachelor of Nursing (Conversion) course in Vanuatu.

CONTEXT: Vanuatu, a Pacific Island nation in the Western Pacific region, has to date educated its nurses by diploma program. Research evidence in developed countries has consistently shown that nurses educated by bachelor degree improve patient health outcomes and reduce hospital length of stay. In seeking to improve health outcomes, the Vanuatu Ministry of Health decided to introduce a new Bachelor of Nursing degree to provide a skilled, safe nursing workforce for the provision of health care to its peoples{1-3}. The curriculum for this degree was to be developed by Ni-Vanuatu nurse educators with the collaboration of educators from the WHO Collaborating Centre, University of Technology Sydney. However, it was first necessary to upgrade (from diploma to bachelor level) the qualifications of teachers and senior nursing practitioners who would lead the new degree course by introducing a Bachelor of Nursing (Conversion) course. ISSUES: In order to design and implement a Bachelor of Nursing (Conversion) course that would be relevant for the educational and healthcare context in Vanuatu and that would meet qualification requirements of the local regulatory bodies, it was essential to build collaborative relationships with key stakeholders in Vanuatu. A second key concern was to design a program that would cater for participants who were working full time, who were not all living in the same physical location, and who had limited access to internet technology and resources. The course also needed to take into account that participants were multilingual, and that English was not their first language. LESSONS LEARNED: Lessons learned included the importance of coming to understand the sociocultural nexus within which this course was developed and implemented, as well as appreciating the constraints that affect nursing education within the Pacific.

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.

Qualitative evaluation of a public-private partnership for reproductive health training in Papua New Guinea.

INTRODUCTION: The recent policy environment in both Papua New Guinea and Australia for partnering with private entities to address health issues has led to a public-private partnership (PPP) between the National Department of Health in Papua New Guinea, the Australian Government and the Oil Search Foundation. A reproductive health training unit was formed to provide health worker training in essential obstetric care and emergency obstetric care. This article provides a qualitative evaluation of the PPP, looking at facilitating features and barriers to the PPP's target of improving the competence of frontline health workers in obstetric care service provision in Papua New Guinea. METHOD: A qualitative methodology gathered data since the PPP's inception in 2012. A dataset of 85 interviews with partners and relevant stakeholders from across Papua New Guinea was analysed using thematic analysis. RESULTS: Themes of facilitating features of the PPP were (1) understanding and agreeing with the national plan for PPPs and maternal and child health; (2) having strong champions, strong relationships and a formal decision-making body; and (3) creating autonomy and branding. Themes outlining the barriers to the PPP's effectiveness were (1) lacking governance framework creating confusion in decision making and roles and responsibilities; (2) differing institutional cultures and ownership struggles; and (3) lacking capacity within the institutes themselves, particularly the National Department of Health. CONCLUSION: The findings of this service provision case study confirm what has been found in other infrastructure-led PPPs. Further research into how to overcome power imbalances between partners in a PPP as well as setting up a governance framework in a dynamic environment could inform this growing area of collaboration between the private and public sectors.

A qualitative examination of the health workforce needs during climate change disaster response in Pacific Island Countries.

BACKGROUND: There is a growing body of evidence that the impacts of climate change are affecting population health negatively. The Pacific region is particularly vulnerable to climate change; a strong health-care system is required to respond during times of disaster. This paper examines the capacity of the health sector in Pacific Island Countries to adapt to changing disaster response needs, in terms of: (i) health workforce governance, management, policy and involvement; (ii) health-care capacity and skills; and (iii) human resources for health training and workforce development. METHODS: Key stakeholder interviews informed the assessment of the capacity of the health sector and disaster response organizations in Pacific Island Countries to adapt to disaster response needs under a changing climate. The research specifically drew upon and examined the adaptive capacity of individual organizations and the broader system of disaster response in four case study countries (Fiji, Cook Islands, Vanuatu and Samoa). RESULTS: 'Capacity' including health-care capacity was one of the objective determinants identified as most significant in influencing the adaptive capacity of disaster response systems in the Pacific. The research identified several elements that could support the adaptive capacity of the health sector such as: inclusive involvement in disaster coordination; policies in place for health workforce coordination; belief in their abilities; and strong donor support. Factors constraining adaptive capacity included: weak coordination of international health personnel; lack of policies to address health worker welfare; limited human resources and material resources; shortages of personnel to deal with psychosocial needs; inadequate skills in field triage and counselling; and limited capacity for training. CONCLUSION: Findings from this study can be used to inform the development of human resources for health policies and strategic plans, and to support the development of a coordinated and collaborative approach to disaster response training across the Pacific and other developing contexts. This study also provides an overview of health-care capacity and some of the challenges and strengths that can inform future development work by humanitarian organizations, regional and international donors involved in climate change adaptation, and disaster risk reduction in the Pacific region.

Evaluation of a Culturally Adapted Online Basic Psychosocial Skills Training Program for International Frontline Workers in Under-Resourced Contexts During the COVID-19 Pandemic.

OBJECTIVE: Frontline workers report negative mental health impacts of being exposed to the risk of COVID-19, and of supporting people struggling with the effects of the virus. Uptake of psychological first-aid resources is inconsistent, and they may not meet the needs of frontline workers in under-resourced contexts. This study evaluates a culturally adapted basic psychosocial skills (BPS) training program that aimed to meet the needs of frontline workers in under-resourced settings. METHODS: A cross-sectional survey administered to frontline workers who completed the program between 2020 and 2022, investigated their perceived confidence, satisfaction, and skill development, as well as their views on relevance to context and accessibility of the program. RESULTS: Out of the 1000 people who had undertaken the BPS program, 118 (11.8%) completed the survey. Participants reported high levels of satisfaction and improved confidence in, and knowledge of, psychosocial skills. Participants reported that the BPS program was culturally and contextually relevant, and some requested expansion of the program, including more interactivity, opportunities for anonymous participation, and adaption to other cultural contexts, including translation into languages other than English. CONCLUSION: Findings indicate a need for free, online, and culturally adapted psychosocial skills training program that is designed with key stakeholders to ensure relevance to social and cultural contexts.

Achieving Universal Health Care in the Pacific: The need for nursing and midwifery leadership. Review Paper.

The quality of healthcare services and outcomes in the Pacific vary widely, with some countries enjoying some of the world's longest life expectancies, others have high rates of maternal and child mortality and relatively low life expectancy. Nurses and midwives make up more than two thirds of the regional regulated healthcare workforce. This paper argues that if countries are to meet Universal Health Coverage  nursing and midwifery leaders need to be explicitly involved in shaping policy  at the highest levels of government to optimise individual and community health both now and in the future. Using United Nations 2019  declaration towards building a healthier world, this paper provides a rationale for inclusion of these leaders  into national and regional decisionmaking forums related to health policy to provide an informed voice in ministerial deliberations on health policy. We suggest that following several comprehensive regional and global studies, South Pacific Chief Nursing and Midwifery Officer Alliance  and the newly developed Pacific Heads of Nurses and Midwifery provide a vehicle for this to occur. As outlined in the WHO Strategic Directions, it is now time to embed Chief Nurses in national and regional health policy development.

The state of midwifery in small island Pacific nations.

BACKGROUND: Strengthening midwifery is a global priority. Recently, global evidence has provided momentum toward developing the midwifery workforce. In 2014, the State of the World's Midwifery 2014 Report explored midwifery services in 73 low to middle income countries. In the South Pacific region, only Papua New Guinea and the Solomon Islands were included. This means that there is little known on the state of midwifery in the small island countries in the South Pacific. AIM: To explore the current situation of the education, regulation and association of midwives in 12 small island nations of the South Pacific and determine the gaps in these areas. METHODS: A descriptive study was undertaken. Data were collected through a survey completed by key representatives (usually the Chief Nursing and Midwifery Officer) from each of the 12 countries. Ethical approval was received from the relevant Human Research Ethics Committee. FINDINGS: Many of the countries had few midwives, in some instances, only two midwives for the whole country. Midwifery education programs included post-graduate diploma, certificates and bachelor degrees. Midwives were required to be registered nurses in all countries. Regulation and licensing also varied - most countries did not have a separate licensing system for midwives. Only three countries have a specific professional association for midwives. CONCLUSION: The variation and the small number of midwives poses challenges for workforce planning. Consideration could be given to developing regional standards and potentially a shared curriculum framework. Ongoing collaboration and networking between countries is a critical part of future developments.

The consequences of English language testing for international health professionals and students: An Australian case study.

AIM: To discuss the perceptions about the International English Language Testing System (IELTS) and its impact on migration and practice of migrant health professionals in Australia. METHODS: Thematic analysis of interviews with 14 health industry participants and 35 migrated health professionals in Australia. RESULTS AND DISCUSSION: Language testing is a barrier to health professional registration for migrant health workers in Australia. While two English language tests are recognised by the registration authorities in Australia, it is the International English Language Testing System that is most commonly used. This paper reports that study participants had underlying negative perceptions of the International English Language Testing System which they report, affect their move to Australia. These negative perceptions are caused by: frustration due to changes to processes for migration and registration; challenges regarding the structure of IELTS including timing of when test results expire, scoring requirements, cost, and suitability; and the resulting feelings of inadequacy caused by the test itself. CONCLUSION: This study has shown that some respondents have experienced difficulties in relation to the International English Language Testing System as part of their migration process. It was found that there is very little research into the effectiveness of the IELTS as it is currently administered for overseas health care professionals. Several recommendations are provided including areas for further research.

Midwifery capacity building in Papua New Guinea: Key achievements and ways forward.

BACKGROUND: Papua New Guinea has some of the poorest health outcomes in the Asia-Pacific region. Maternal mortality is unacceptably high and there is a severe midwifery shortage requiring a quadrupling of the workforce. AIM: This paper outlines the findings of an evaluation of the Maternal Child Health Initiative (MCHI) (2012-2013) to determine key factors contributing to maternal health workforce strengthening. METHOD: A descriptive mixed methods study was undertaken. Data were gathered through interviews, focus group discussions and surveys with clinicians, midwifery students and staff from nursing and midwifery schools and National Department of Health staff. Documentation from stakeholder meetings and regular site reports were reviewed. Each data set was analysed separately and meta-inferences were drawn across all data. FINDINGS: Learning opportunities were found to have increased for midwifery educators and improvements were described in midwifery educators teaching capacity and student clinical education experience. There was an increase in the number of midwifery graduates and improvements were noted in the working environment and skills of clinical staff. Education challenges were described including the lack of clinical preceptoring and limited continuing education for clinical educators. Participants recommended increasing clinical education hours and extending the length of the midwifery program. Ongoing efforts to accredit the midwifery curricula and regulate midwifery graduates were noted. CONCLUSION: The MCHI has contributed to strengthening the midwifery workforce nationally. However, scaling-up and sustaining these achievements requires leadership and funding commitments from the midwifery schools and government alongside the accreditation of midwifery curricula and regulation of new graduates.

Education, employment and practice: Midwifery graduates in Papua New Guinea.

BACKGROUND: Papua New Guinea has a very high maternal mortality rate (773/100,000), low rates of supervised births and a critical shortage of skilled midwives. A midwifery education initiative commenced in 2012, funded by the Australian Government and led by the National Department of Health. One specific objective of the initiative was to improve the standard of clinical teaching and practice in four schools of midwifery. There were 394 midwives educated over the 4 year period (2012-2015) representing half of all midwives in Papua New Guinea. A study was undertaken to describe the educational programme, employment, practices and experiences of graduates who studied midwifery in 2012 and 2013 as part of the initiative. OBJECTIVE: the aim of this paper is to explore the education, employment and practice of newly graduated midwives in Papua New Guinea. DESIGN: a mixed methods descriptive study design was used. Surveys and focus groups were used to gather data. Ethical approval was granted by the relevant Human Research Ethics Committees. SETTING AND PARTICIPANTS: all midwifery graduates in 2012 and 2013 from the four midwifery schools in Papua New Guinea were included in the study and almost 80% were contacted. FINDINGS: nearly 90% of graduates were working as midwives, with an additional 3% working as midwifery or nursing educators. This study discovered that graduates exhibited increased skills acquisition and confidence, leadership in maternal and newborn care services and a marked improvement in the provision of respectful care to women. The graduates faced challenges to implement evidence based care with barriers including the lack of appropriate resources and differences of opinion with senior staff. CONCLUSIONS: factors affecting the quality of midwifery education will need to be addressed if Papua New Guinea is to continue to improve the status of maternal and newborn health. Specifically, the length of the midwifery education, the quality of clinical practice and the exposure to rural and remote area practice need addressing in many contexts like Papua New Guinea.

Collaborative approaches towards building midwifery capacity in low income countries: a review of experiences.

OBJECTIVE: to explore collaborative approaches undertaken to build midwifery education, regulation and professional association in low income countries and identify evidence of strategies that may be useful to scale-up midwifery to achieve MDG 5. DESIGN: an integrative review involving a mapping exercise and a narrative synthesis of the literature was undertaken. The search included peer reviewed research and discursive literature published between 2002 and 2012. FINDINGS: fifteen papers were found that related to this topic: 10 discursive papers and five research studies. Collaborative approaches to build midwifery capacity come mainly from Africa and involve partnerships between low income countries and between low and high income countries. Most collaborations focus on building capacity across more than one area and arose through opportunistic and strategic means. A number of factors were found to be integral to maintaining collaborations including the establishment of clear processes for communication, leadership and appropriate membership, effective management, mutual respect, learning and an understanding of the context. Collaborative action can result in effective clinical and research skill building, the development of tailored education programmes and the establishment of structures and systems to enhance the midwifery workforce and ultimately, improve maternal and child health. KEY CONCLUSIONS: between country collaborations are one component to building midwifery workforce capacity in order to improve maternal health outcomes. IMPLICATIONS FOR PRACTICE: the findings provide insights into how collaboration can be established and maintained and how the contribution collaboration makes to capacity building can be evaluated.

Traditional coping strategies and disaster response: examples from the South Pacific region.

The Pacific Islands are vulnerable to climate change and increased risk of disasters not only because of their isolated and often low lying geographical setting but because of their economic status which renders them reliant on donor support. In a qualitative study exploring the adaptive capacity of Pacific Island Countries (PICs) across four countries, Cook Islands, Fiji, Samoa, and Vanuatu, it was clear that traditional coping strategies are consistently being applied as part of response to disasters and climate changes. This paper describes five common strategies employed in PICs as understood through this research: recognition of traditional methods; faith and religious beliefs; traditional governance and leadership; family and community involvement; and agriculture and food security. While this study does not trial the efficacy of these methods, it provides an indication of what methods are being used and therefore a starting point for further research into which of these traditional strategies are beneficial. These findings also provide important impetus for Pacific Island governments to recognise traditional approaches in their disaster preparedness and response processes.

Advice from the Royal College of Nursing.

Q What is RCN Congress, and how can I get involved? The Royal College of Nursing's annual Congress debates recommendations, resolutions and matters for discussion, which are submitted by RCN branches, national membership groups (which include the ANS), the RCN's governing Council, and other constituent parts of the College.