Development and initiation of a preceptor program to improve midwifery and nursing clinical education in sub-saharan Africa: protocol for a mixed methods study.

BACKGROUND: Expanding the quality and quantity of midwifery and nursing clinical preceptors is a critical need in many sub-Saharan educational settings to strengthen students' clinical learning outcomes, and ultimately to improve maternal and child mortality. Therefore, this study protocol was developed to establish a year-long, four step, precepting program to (1) improve partnership building and program development (2) provide an evidence-based course to expand competency and confidence in precepting students (3) select preceptors to become train the trainers and (4) secure accreditation for the program, ultimately to engage and support cohorts of preceptors and continue to monitor and evaluate the effectiveness of the program over five years. METHODS: Qualitative and quantitative approaches will be used including evaluation of preceptors, faculty and leadership involved with the program, as well as students taught by preceptors. Data will include validated self-assessment scales, objective structured clinical examinations (OSCEs), satisfaction surveys, and direct clinical observation, in-depth interviews and/or focus group discussions (preceptors); feedback forms (students); process mapping and organizational readiness for implementing change surveys (faculty and leadership). Median change in scores will be the primary outcome for quantitative data. Content analysis within a deductive framework to identify key implementation and adoption themes will be used for qualitative data analysis. DISCUSSION: This study aims to assess the readiness and early effectiveness for implementing a preceptor program for midwifery and nursing in Sierra Leone and Malawi. Determining the effectiveness of this program will guide future adaptations in order to strengthen the program for sustainability and potential scale-up.

Leveraging tele-mentoring and remote learning to strengthen the emergency care capacity of health workers in Uganda.

Background: A robust emergency care system is a cost-effective method of reducing preventable death and disability, especially in low-and middle-income countries. To scale emergency care expertise across the country, the Uganda Ministry of Health and Seed Global Health established the Emergency Medical Services (EMS) ECHO program. We describe the process of establishing the program in a resource-limited setting, best practices, and lessons learned in Uganda. Methods: Investigators conducted a mixed-methods evaluation to assess the initial 4 months' implementation of the EMS ECHO. We conducted pre/post-program assessments of healthcare worker knowledge, self-efficacy, and professional's satisfaction with the program. The analysis compared the differences between pre/post-test scores descriptively. Results: The EMS ECHO was initiated in November 2021. A phased curriculum was developed with the initial phase focusing on the ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) approach to the emergency patient. This phase reached 2,030 health workers cumulatively across 200 health facilities. The majority of the participants were medical doctors (n = 751, 37%), and nurses (n = 568, 28%). Majority of participants (95%) rated the sessions as informative. On whether the ECHO sessions diminished professional isolation, 66% agreed or strongly agreed. Conclusions: Similar to other ECHO program evaluation results, Uganda's EMS ECHO program improved knowledge, skills, and the development of a virtual community of practice thereby diminishing professional isolation. It also demonstrates that through a planned stepwise process, virtual learning and telementorship can be used efficiently to improve healthcare worker knowledge,skills and multiply the limited number of emergency care experts available in the country.

A Sierra Leone 2021 Midwifery Clinical Training Needs Assessment: A Call to Action to Augment Clinical Precepting.

Objective: Sierra Leone has one of the highest maternal mortality and infant mortality rates globally. We share findings from a Midwifery Clinical Training Needs Assessment, conducted in 2021 as a collaboration between the Government of Sierra Leone and Seed Global Health. The assessment identified existing needs and gaps in midwifery clinical training at health facilities in Sierra Leone from various stakeholders' perspectives. Methods: The descriptive needs assessment utilized mixed methods, including surveys, focus group discussions (FGDs), interviews, and reviews of maternal medical records. Results: The following showed needs and gaps in labor and delivery management; record keeping; triage processes; clinical education for students, recent graduates, and preceptors; and lack of infrastructure and resources. Conclusion: The knowledge gained from this needs assessment can further the development of midwifery clinical training programs in Sierra Leone and other low-income countries facing similar challenges. We discuss the implication of our findings.

Building Nursing and Midwifery Capacity Through Rwanda's Human Resources for Health Program.

Global disparities in the quantity, distribution, and skills of health workers worldwide pose a threat to attainment of the Sustainable Development Goals by 2030 and deepens already existing global health inequities. Rwanda and other low-resource countries face a critical shortage of health professionals, particularly nurses and midwives. This article describes the Human Resources for Health (HRH) Program in Rwanda, a collaboration between the Ministry of Health of Rwanda and a U.S. consortium of academic institutions. The ultimate goal of the HRH Program is to strengthen health service delivery and to achieve health equity for the poor. The aim of this article is to highlight the HRH nursing and midwifery contributions to capacity building in academic and clinical educational programs throughout Rwanda. International academic partnerships need to align with the priorities of the host country, integrate the strengths of available resources, and encourage a collaborative environment of cultural humility and self-awareness for all participants.

Caregivers' beliefs associated with medication adherence among children and adolescents with epilepsy.

The purpose of this study was to determine the association between adherence to prescribed antiepileptic medication in a convenience sample of caregivers (n = 100) of children diagnosed with epilepsy, ages 2-14 years, and caregivers' beliefs about the medication. Using the Beliefs about Medication Questionnaire and Medication Adherence Report Scale, caregivers were questioned about beliefs of necessity and concerns associated with medication adherence. Using bivariate linear regression, no significant correlation was found between necessity for antiepileptic drug treatment or caregiver's concerns and medication adherence. Nevertheless, although only 28% of the respondents reported complete adherence, the majority of caregivers perceived their child's medication was necessary to maintain good health. Educational aspects and social desirability in this setting may have contributed to the discordance between adherence and caregivers' beliefs.

Relationship of physical and functional independence and perceived quality of life of veteran patients with Alzheimer disease.

Alzheimer disease not only affects the cognitive function but also impacts one's abilities to perform daily tasks. This study evaluated for correlation between the quality of life of patients with Alzheimer disease (QoL-AD) and the level of independence and to evaluate the statistical difference between patients' quality of life and proxy perception of quality of life by utilizing the Katz activities of daily living and QoL-AD on patients and QoL-AD on caregivers. There was a small positive correlation (r = .13) between the levels of physical and functional independence and the perceived QoL. Also, patient consistently had higher QoL-AD than their caregiver counterparts. These findings provide some insight into our need to acknowledge factors that may influence QoL and illustrate the importance of monitoring for executive dysfunction and the safety risk.

SNAP participation in preschool-aged children and prevalence of overweight and obesity.

BACKGROUND: An increased prevalence of overweight and obesity for adults on government-funded nutrition assistance, such as the Supplemental Nutrition Assistance Program (SNAP), has been observed; however, this association among preschool-aged children is not well understood. Longitudinal research designs tracking changes in body mass index-for-age (BMI) in children of low-income households may provide a clearer picture of the association between SNAP participation and overweight and obesity among this age group. To determine if there is a relationship between SNAP participation and overweight and obesity prevalence in low-income, preschool children, we conducted a cross-sectional analysis of children in a Head Start program, and a longitudinal analysis of those children who were enrolled for 2 years. METHODS: Height and weight data and SNAP participation of 386 students (207 male, 179 female, 4.2 ± 0.5 years) enrolled in a Head Start program were analyzed; data for 2 years were available for 167 of the students. Height and weight measures were used to determine BMI percentile per Centers for Disease Control and Prevention guidelines. SNAP participation was obtained through a nutritional questionnaire given to parents at time of Head Start Program enrollment. RESULTS: No significant differences were found between SNAP and non-SNAP participants for BMI percentile in either the cross-sectional or longitudinal analysis. BMI percentile increased for both groups over time, but failed to reach significance (p = .13). CONCLUSION: Future studies are warranted with an inclusion of a larger and more geographically diverse sample to further determine the association between SNAP participation and overweight and obesity in preschool-aged children.

Relative distribution of West Nile virus RNA in blood compartments: implications for blood donor nucleic acid amplification technology screening.

BACKGROUND: Despite implementation of targeted individual-donor nucleic acid test (NAT) screening of blood donors for West Nile virus (WNV), three "breakthrough" WNV transfusion transmission cases were reported (2004-2008), suggesting that current plasma-based assays are unable to detect all WNV-infectious donations. A 2007 report found that 19 of 20 red blood cell components from WNV-infected donors contained 1 log higher viral load than plasma components. This study's aim was to further establish the value of screening whole blood relative to plasma for WNV RNA by generating differential viral loads on paired samples derived from blood screening tubes. STUDY DESIGN AND METHODS: WNV RNA-positive donors identified by routine NAT screening were enrolled and quantitative viral data were generated using cross-sectional (index-donation) and longitudinal (follow-up) specimens. A real-time reverse transcription-polymerase chain reaction viral load assay was used on both study sample sets and replicate qualitative NAT screening assays were also used on the longitudinal study samples. RESULTS: For the cross-sectional study, seronegative index donations (n = 29) had WNV RNA concentrations fourfold higher in plasma than in whole blood, whereas for seropositive donations (n = 13), the WNV RNA concentrations were 10-fold higher in whole blood than in plasma. All 10 longitudinal study participants were seropositive throughout the follow-up study; whole blood viral load was consistently greater than plasma viral load (mean difference, 343 copies; p < 0.001) up to 200 days after index. CONCLUSION: The improved sensitivity of WNV NAT using whole blood instead of plasma was confirmed, but appears to be limited to better detection in seropositive stages. However, the implication of these findings for blood screening requires further study to establish the infectivity of persistent whole blood viremia.

Indigos in Hawai'i: a phenomenological study of the experience of growing up with spiritual intelligence.

There is a special group of children around the world who have high intelligence and intuition, healing abilities, and a strong spiritual connection with God, yet these children are often mislabeled as having behavior disorders. Little is known from scientific research about the Indigo phenomenon in America, although many countries, especially among indigenous populations, are familiar with Indigo-like children. The purpose of studying these children when they are adults is to better understand these children when they are older and advance behavior health sciences by increasing awareness of the Indigo phenomenon and learning about their lived experiences. This phenomenological study explored the lived experiences of 10 adult Indigos (> or = 18+ years old) on the island of Oahu, Hawai'i (7 females, 3 males; mean age = 52.4 + SD). Through in-depth semi-structured personal interviews, the experiences of these adults were analyzed and interpreted to identify the common experiences faced during childhood, what worked for their assimilation into society, and recommendations for parents, educators, and health professionals on how to work with Indigos. Bioenergy field (aura) photographs of each participant were also taken. Statements related to the phenomenon were placed into themes, coded, and categorized as the investigators reached a consensus of common themes. Seven primary themes and nine secondary themes emerged from the findings. The primary themes were: grandmother/mother had a similar gift; guided by a higher power to heal self and others; felt "different" or misunderstood; did not openly share their unique abilities; having challenges with partner relationships; history of abuse/violence or frequently disciplined; and use of intuition at work and/or school. Secondary themes included: Using Hawaiian and cultural healing methods; everyone has a degree of intuition and the use of intuition to know when to see a doctor or not; various unique abilities from body and multiple careers; mental health institutions, and financial struggle. Self reports on participants' life purpose, their unique abilities, and being misunderstood were also collected. It was concluded that Indigos felt mislabeled or misunderstood throughout their lives in spite of their belief that their life purpose was to help humankind.

A spirituality teaching program for depression: a randomized controlled trial.

OBJECTIVE: This randomized controlled trial assessed the efficacy of a Spirituality Teaching Program to treat unipolar major depression. METHOD: A randomized controlled, assessor blinded trial design was used. A total of 84 individuals aged 18 years or older with unipolar major depression of mild to moderate severity were recruited in Calgary, Canada and randomized to two study arms: 1) Spirituality Teaching Program Group (8 week, home-based Spirituality Teaching Program); and 2) Waitlist Control Group (no intervention followed by Spirituality Teaching Program starting at week 9). Outcome measures (depression severity, response rate, remission rate) were assessed at baseline, 8, 16, and 24 weeks using the Hamilton Depression Rating Scale (HAM-D). RESULTS: The two trial groups were similar in their demographic and disease characteristics at baseline. At the 8-week point, the change in depression severity was significantly different between the two groups (change in HAM-D score: 8.5 for the Spirituality Group and 2.3 for the Waitlist Control Group, p < 0.001). The Spirituality Teaching Program Group had significantly higher response (36% vs. 4.4%, p < 0.001) and remission rates (31% vs. 4.4%, p < 0.001) than the Waitlist Control Group. The benefits remained throughout the observation period for the Spirituality Teaching Program Group participants with response rates of 56.4% at 16 weeks and 58.9% at 24 weeks. CONCLUSION: The Spirituality Program significantly reduced depression severity and increased response and remission rates. This non-drug treatment program should be investigated further as a treatment option for depression.