Training healthcare providers to respond to intimate partner violence against women.

BACKGROUND: Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors. OBJECTIVES: To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language. SELECTION CRITERIA: All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach. MAIN RESULTS: We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review. AUTHORS' CONCLUSIONS: Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.

Exploring preceptorship programmes: Implications for future design.

AIMS AND OBJECTIVES: To review and analyse current preceptorship programmes within NHS trusts in the North West of England. To evaluate the pedagogic rigour of the programme and suggest recommendations to inform the future design of preceptorship programmes. BACKGROUND: Enhancing the retention of newly qualified staff is of particular importance given that the journey from a new registrant to a competent healthcare professional poses a number of challenges, for both the individual staff member and organisations. DESIGN: A mixed methods evaluative approach was employed, using online questionnaires and content analysis of preceptorship documentation. METHODS: Forty-one NHS trusts across the North West region employing newly qualified nurses were invited to participate in the completion of an online questionnaire. In addition, preceptorship programme documentation was requested for inclusion in the content analysis. This study used the SQUIRE (Standards for Quality Improvement Reporting Excellence) guidelines. RESULTS: The response rate for the questionnaire was 56.1% (n = 23). Eighteen trusts (43.9%) forwarded their programme documentation. Findings highlighted the wide variation in preceptorship programmes across the geographical footprint. CONCLUSIONS: There were instances of outstanding preceptorship and preceptorship programmes where there was a clear link between the strategic vision, that is, trust policy, and its delivery, that is, preceptorship offering. There was no one framework that would universally meet the needs of all trusts; yet, there are key components which should be included in all preceptorship programmes. Therefore, we would encourage innovation and creativity in preceptorship programmes, cognisant of local context. RELEVANCE TO CLINICAL PRACTICE: The significant shortage of nursing staff in England is an ongoing issue. Recruitment and retention are key to ameliorating the shortfall, and formal support mechanisms like preceptorship, can improve the retention of newly qualified staff. Understanding current preceptorship programmes is an important first step in establishing the fundamental building blocks of successful preceptorship programmes and enabling the sharing of exemplary good practice across organisations.

Fundamento pedagógico del cuidado humano en la práctica de enfermería / Pedagogical basis of human care in nursing practice

El cuidado constituye una herramienta fundamental en la praxis de enfermería, el cual debe estar centrado en una práctica pedagógica para consolidar una formación universitaria que garantice el desarrollo de un perfil de estudiantes comprometidos con la construcción de una sociedad en la que prive el humanismo y la justicia social. La coexistencia de la educación y la pedagogía para el cuidado de la salud son de trascendental importancia a partir de la efectividad de los procesos de la enseñanza, el aprendizaje, el método y el quehacer docente, en donde se advierte que el contexto sociopolítico y cultural influyen decididamente en las formas de educación y la reflexión de sus procesos. Luego de una revisión bibliográfica sobre el tema, se concluye que los fundamentos pedagógicos son cruciales en el cuidado que provee el profesional de enfermería, en cualquier situación de salud. El cuidado de enfermería, se cristaliza en una esencia trascendente, que implica una acción holísticamente humana. El currículo de pregrado del sector salud y particularmente de enfermería debe ser coherente con las nuevas tendencias de la pedagogía moderna para garantizar el mejor cuidado humano(AU)

Care is a fundamental tool in nursing practice, which should be focused on a pedagogical practice to consolidate a university education that guarantees the development of a profile of students committed to the construction of a society in which humanism and social justice education are deprived. The coexistence of education and pedagogy for health care are of transcendental importance based on the effectiveness of the teaching, learning, method and teaching processes, where it is noted that the sociopolitical and cultural context strongly influence the forms of education and the reflection of their processes. After a bibliographic review on the subject, it is concluded that the pedagogical foundations are crucial in the care provided by the nursing professional, in any health situation. Nursing care is crystallized in a transcendent essence, which implies a holistically human action. The undergraduate curriculum of the health and particularly nursing sector must be consistent with the new trends of modern pedagogy to ensure the best human care(AU)

Evaluation of an assessment instrument for a sexual health curriculum for nurses and midwifery students in Tanzania: The sexual health education for professionals scale (SHEPS).

We assessed the structure and content of a new scale, the SHEPS, to assess change in sexual health confidence, knowledge and attitudes in nursing and midwifery students following an intervention (a 2-day standardized workshop on sexual health). Students were 78 Tanzanian nursing and midwifery students attending a University of Health Sciences, who were assessed immediately before and after the workshop on matched pre- and post-workshop questionnaires. Data confirmed significant changed pre- and post-test on knowledge and confidence on topics taught in the workshop, with the effect also extending to some topics not or minimally covered, suggesting that there was a general increase in confidence and a perception of increased knowledge following the workshop. There was power to detect differences even with a moderate sized matched sample. Correlations between knowledge and confidence on the same content items were between 0.52 and 0.63, suggesting that respondents could clearly distinguish between knowledge and confidence. There were no significant differences pre- and post-test on several controversial cultural and religious attitudes including on abortion and non-vaginal penetrative sex. Alpha coefficients were 0.93 for pre-test and 0.90 for post-test. This field test demonstrates the preliminary appropriateness of the SHEPS as a tool for evaluating sexual health interventions in health care workers.

A process evaluation of a Psychomotor Dance Therapy Intervention (DANCIN) for behavior change in dementia: attitudes and beliefs of participating residents and staff.

BACKGROUND: In a previous paper, we presented results from a 12-week study of a Psychomotor DANCe Therapy INtervention (DANCIN) based on Danzón Latin Ballroom that involves motor, emotional-affective, and cognitive domains, using a multiple-baseline single-case design in three care homes. This paper reports the results of a complementary process evaluation to elicit the attitudes and beliefs of home care staff, participating residents, and family members with the aim of refining the content of DANCIN in dementia care. METHODS: An external researcher collected bespoke questionnaires from ten participating residents, 32 care home staff, and three participants' family members who provided impromptu feedback in one of the care homes. The Behavior Change Technique Taxonomy v1 (BCTTv1) provided a methodological tool for identifying active components of the DANCIN approach warranting further exploration, development, and implementation. RESULTS: Ten residents found DANCIN beneficial in terms of mood and socialization in the care home. Overall, 78% of the staff thought DANCIN led to improvements in residents' mood; 75% agreed that there were improvements in behavior; 56% reported increased job satisfaction; 78% of staff were enthusiastic about receiving further training. Based on participants' responses, four BCTTv1 labels-Social support (emotional), Focus on past success and verbal persuasion to boost self-efficacy, Restructuring the social environment and Habit formation-were identified to describe the intervention. Residents and staff recommended including additional musical genres and extending the session length. Discussions of implementing a supervision system to sustain DANCIN regularly regardless of management or staff turnover were suggested. CONCLUSIONS: Care home residents with mild to moderate dementia wanted to continue DANCIN as part of their routine care and staff and family members were largely supportive of this approach. This study argues in favor of further dissemination of DANCIN in care homes. We provide recommendations for the future development of DANCIN based on the views of key stakeholder groups.

Nurse's perceptions of barriers to optimal nutritional therapy for hospitalized patients.

BACKGROUND & AIMS: Nurses have crucial roles in optimizing nutritional therapy for patients. The aim of this study was to explore nurses' perceptions regarding barriers to effective nutritional therapy. METHODS: Hospital-based nurses completed a questionnaire regarding various aspects of malnutrition/risk identification and barriers to effective nutritional treatment. The study was conducted at Rambam Health Care Campus with 100 nurses completing the questionnaire. RESULTS: Eighty-eight percent of those surveyed perceived identification of patients at risk for malnutrition as the nurse's responsibility. Significant differences were found when comparing head vs. bedside nurses regarding recognition of barriers to optimal nutritional therapy. More than 40% of the nurses found that the following issues were significant barriers to optimal patient treatment: the time it takes to prescribe nutritional therapy, lack of protocols, and awareness of the staff of the nutritional therapy. Overall bedside nurses found significantly more barriers preventing optimal nutritional therapy than did head nurses. CONCLUSIONS: Barriers to optimal nutrition are often remediable. Head nurses set ward policies but had a significantly different perception of barriers to nutritional care than bedside nurses. Collaboration is imperative for all sectors and authorities involved in patient care, including bedside nurses, to ensure that workable policies are implemented for the patients' benefit.

Creating Healing Environments Through the Theory of Caring.

We describe the journey of personnel at one hospital to create a healing environment for patients and staff members at all levels through the implementation of Watson's Theory of Human Caring and her Caritas Processes (ie, loving kindness, authentic presence, spirituality, being the environment, believing in miracles). We used experiential teaching and learning to explore the nursing theory with staff members. Positive outcomes include using Caritas Processes care plans in our electronic medical record, greater ease in the understanding and application of Watson's theory, integrating a blessing for nurses during National Nurses Week, inclusion of ministry formation courses to extend the mission of the hospital's founding religious order to current and future employees, and positive patient feedback. As a result of theory application, our nurses are more open to discussing caring, authentic presence and, when appropriate, prayer in their clinical narratives and how it is affecting patients and themselves.

University of Salford's £1.7m training facilities recreate real hospital environment.

The next generation of nurses and midwives will be honing their skills on manikins that can breathe, 'speak', sweat and blink at a £1.7 million training suite at the University of Salford.

Learning to aid learning.

The National Health Service (NHS) is one of the largest employers in the world and, with 1.3 million staff, the biggest employer in Europe. With over three hundred different careers on offer (NHS 2015), the acquisition of skills and qualifications, through academic and clinical training, is an integral part of day-to-day life in the health service. As such, mentoring has become a significant feature in the preparation of healthcare professionals, to support students and ensure learning needs and experiences are appropriate to competency. This article examines the mentor's role, in relation to a teaching innovation designed to address students' identified learning needs to meet the requirements of the multi-professional learning and assessment in practice course NM6156. The effectiveness of the aids to learning will be assessed through an online quiz, and its usefulness will be analysed with reference to educational theories of learning and development.

A69/36: Personal de salud: información actualizada. Informe de Secretaría / A69 / 36: Health personnel: updated information. Secretariat Report

En el presente informe se describen los progresos logrados en la aplicación de tres resoluciones de la Asamblea Mundial de la Salud sobre el desarrollo profesional del personal de salud: la resolución WHA64.6, sobre Fortalecimiento del personal sanitario (2011); la resolución WHA64.7, sobre Fortalecimiento de la enfermería y la partería (2011); y la resolución WHA66.23, titulada «Transformar la formación de la fuerza de trabajo sanitaria para apoyar la cobertura sanitaria universal¼ (2013). En las tres resoluciones se pedía a la Secretaría que, por conducto del Consejo Ejecutivo, informara a la 69.ª Asamblea Mundial de la Salud sobre los progresos logrados. El Consejo Ejecutivo, en su 138.ª reunión, examinó una versión anterior del presente informe y tomó nota de ella. (AU)

Faith, Hope, and Spirituality: SUPPORTING PARENTS WHEN THEIR CHILD HAS A LIFE-LIMITING ILLNESS.

When a child has a life-limiting illness, parents' goals and strategies for their child's life may need to be drastically altered, especially if early death looms. This article reviews literature and research about how families employ faith, hope, spirituality, and biblical perspectives as their child becomes critically ill and faces death. Suggestions are made for best caring practices for families and children encountering this difficult journey.