Midwife Educators' perceptions of the efficacy of the Objective Structured clinical assessment of life-saving interventions - a qualitative interview study in Bangladesh.

INTRODUCTION: Objective Structured Clinical Assessment (OSCA) is a way of evaluating students or clinicians in how they are carrying out their duties. The aim of this study was to examine how midwifery educators in Bangladesh perceived using OSCA as an assessment device in midwifery education for student performance in life-saving midwifery interventions. METHOD: Individual interviews were conducted with 47 academic midwives and clinical midwives using purposive sampling at 38 education institutions in Bangladesh. Content analysis inspired by Elo and Kyngas was used to analyze the data. RESULTS: The ability of students to perform effectively in the OSCA-evaluated simulation of life-saving skills was related to the educators' understanding of the concept of midwifery. The overarching main category of this study showed that for midwifery educators to be able to effectually teach professional, evidence-based midwifery, they need to be able to synthesize the delivery of practical and theoretical skills with pedagogical skills and knowledge. To implement the OSCA tool more effectively, midwifery educators need to understand the underpinning principles of midwifery values and philosophy including leadership, ownership, responsibility, and personal engagement. CONCLUSION: There is potential to improve the efficacy of using OSCA to deliver the teaching of life-saving skills. Team sessions with midwives and physicians aiming to practice teamwork and role divisions in life-saving interventions are recommended.

Degree of Implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) Quality Improvement Program Associated with Number of Hospitalizations.

OBJECTIVES: To determine whether degree of implementation of the Interventions to Reduce Acute Care Transfers (INTERACT) program is associated with number of hospitalizations and emergency department (ED) visits of skilled nursing facility (SNF) residents. DESIGN: Secondary analysis from a randomized controlled trial. SETTING: SNFs from across the United States (N=264). PARTICIPANTS: Two hundred of the SNFs from the randomized trial that provided baseline and intervention data on INTERACT use. INTERVENTIONS: During a 12-month period, intervention SNFs received remote training and support for INTERACT implementation; control SNFs did not, although most control facilities were using various components of the INTERACT program before and during the trial on their own. MEASUREMENTS: INTERACT use data were based on monthly self-reports for SNFs randomized to the intervention group and pre- and postintervention surveys for control SNFs. Primary outcomes were rates of all-cause hospitalizations, potentially avoidable hospitalizations (PAHs), ED visits without admission, and 30-day hospital readmissions. RESULTS: The 65 SNFs (32 intervention, 33 control) that reported increases in INTERACT use had reductions in all-cause hospitalizations (0.427 per 1,000 resident-days; 11.2% relative reduction from baseline, p<.001) and PAHs (0.221 per 1,000 resident-days; 18.9% relative reduction, p<.001). The 34 SNFs (12 intervention, 22 control) that reported consistently low or moderate INTERACT use had statistically insignificant changes in hospitalizations and ED visit rates. CONCLUSION: Increased reported use of core INTERACT tools was associated with significantly greater reductions in all-cause hospitalizations and PAHs in both intervention and control SNFs, suggesting that motivation and incentives to reduce hospitalizations were more important than the training and support provided in the trial in improving outcomes. Further research is needed to better understand the most effective strategies to motivate SNFs to implement and sustain quality improvement programs such as INTERACT.

Health-Related Decisions for Serious Illness Among Ethnically Diverse Older Adults.

We investigated the influence of sociodemographic factors, acculturation, ethnicity, health status, and spirituality on older adults' health-related decisions when confronted with a choice between competing options. The sample included 451 participants: African Americans (15.74%), Afro-Caribbeans (25.5%), European Americans (36.36%), and Hispanic Americans (22.4%). Compared with others, European Americans and Hispanic Americans favored quality of life over a lengthy life. Sociodemographic factors, acculturation, ethnicity, health status, and spirituality accounted for variations of decisions. The variability of decisions calls for multiple care options to explore the value of different trade-offs in order to avoid predetermined clinical practice guidelines, especially in nursing.

Barriers and Facilitators to Implementing a Change Initiative in Long-Term Care Using the INTERACT® Quality Improvement Program.

Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.

Rates and factors associated with falls in older European Americans, Afro-Caribbeans, African-Americans, and Hispanics.

PURPOSE: To evaluate rates and factors associated with older adult falls in different ethnic groups. PARTICIPANTS AND METHODS: Information on demographics, medical and falls history, and pain and physical activity levels was collected from 550 community-dwelling older adults (75±9 years old, 222 European Americans, 109 Afro-Caribbeans, 106 African-Americans, and 113 Hispanics). RESULTS: Taking medications for anxiety (risk ratio [RR] =1.4, 95% confidence interval [CI] =1.1-2.0), having incontinence (RR =1.4, 95% CI =1.1-1.8, P=0.013), back pain (RR =1.4, 95% CI =1.0-1.8), feet swelling (RR =1.3, 95% CI =1.1-1.7), and age ≥75 years (RR =1.3, 95% CI =1.0-1.6) were associated with falls. The associations were stronger for Afro-Caribbeans, but they presented approximately 40% lower prevalence of falls than the other groups. CONCLUSION: Taking anxiety medication, incontinence, back pain, feet swelling, and age ≥75 years were associated with falls, and Afro-Caribbeans presented lower prevalence of falls. These findings need to be taken into consideration in clinical interventions in aging.

Costs associated with recruitment and interviewing of study participants in a diverse population of community-dwelling older adults.

BACKGROUND: America's racial and ethnic composition is changing so rapidly that minority groups are expected to constitute almost half of the U.S. population by 2060. Special efforts are needed to effectively recruit and retain members of racial and ethnic minority groups in health-related research studies, but the information available on time and costs associated with their recruitment is limited. OBJECTIVES: The aim of this study was to describe and compare the time and monetary costs associated with recruiting and interviewing a diverse sample of older adults living in south Florida. METHODS: Men and women aged 60 years and older from four ethnic groups-African American, Afro-Caribbean, Hispanic American, and European American-were recruited to participate in a longitudinal study of healthy aging. Costs for study activities (including recruitment, scheduling sessions, interviewing, file scoring, log updating, blood specimen analysis and storage, data analysis, and monetary compensation to participants) were determined after 100 weeks of data collection. RESULTS: Altogether, 483 participants completed the study in the first 100 weeks. The total cost for each participant ranged from $265 to $576. Each successful enrollment required an average of 1.83 hours for recruitment and scheduling of the interviews. The time to interview African American and Afro-Caribbeans was greater than the time needed to interview Hispanic American and European American participants. DISCUSSION: To develop more accurate budgets for recruitment of minority individuals into research studies and to use the limited resources in an effective way, careful planning and ongoing monitoring of costs are essential.

Self-assessed health, sadness and happiness in relation to the total burden of symptoms from the lower urinary tract.

OBJECTIVES: To evaluate the effect of lower urinary tract symptoms (LUTS) on self-assessed health, sadness and happiness of men. SUBJECTS AND METHODS: The study included 504 men (aged 40-80 years) in the rural community of Surahammar, Sweden, who a year earlier had reported stress incontinence, urgency or postvoid dribbling in answer to a postal questionnaire, and 504 age-matched control men from the same community. The occurrence of 12 specific LUTS was rated using the Danish Prostatic Symptom Score. Health, sadness and happiness were measured by three questions from the Medical Outcomes Study Short-Form 36 health survey questionnaire. RESULTS: Completed questionnaires were returned by 74.2% of men (748/1008). A low score for health was reported by 34% of men with one to four LUTS, by 67% with five to eight, and by 75% with nine or more LUTS. The total LUTS burden correlated with lower scores for happiness and with higher scores for sadness. For each of the 12 specific LUTS, men with the symptom had lower scores for health and happiness, and higher scores for sadness, than men without the symptom. Comparing men with the symptom of 'other incontinence' to men with no 'other incontinence', the relative risk (95% confidence interval) of impaired health was 2.2 (1.8-2.8), while that of a high score for happiness was 0.5 (0.3-0.7) and that of greater sadness was 2.3 (1.7-3.3). Social status, marital status, education, smoking, physical activity and urinary tract infection all affected the impact of LUTS. CONCLUSIONS: The total burden of LUTS is related to self-assessed health, sadness and happiness.