Building capacities of Auxiliary Nurse Midwives (ANMs) through a complementary mix of directed and self-directed skill-based learning-A case study in Pune District, Western India.

Auxiliary nurse midwives (ANMs) play a pivotal role in provision of maternal and newborn health at primary level in India. Effective in-service training is crucial for upgrading their knowledge and skills for providing appropriate healthcare services. This paper aims at assessing the effectiveness of a complementary mix of directed and self-directed learning approaches for building essential maternal and newborn health-related skills of ANMs in rural Pune District, India. METHODS: During directed learning, the master trainers trained ANMs through interactive lectures and skill demonstrations. Improvement and retention of knowledge and skills and feedback were assessed quantitatively using descriptive statistics. Significant differences at the 0.05 level using the Kruskal-Wallis test were analysed to compare improvement across age, years of experience, and previous training received. The self-directed learning approach fulfilled their learning needs through skills mall, exposure visits, newsletter, and participation in conference. Qualitative data were analysed thematically for perspectives and experiences of stakeholders. The Kirkpatrick model was used for evaluating the results. RESULTS: Directed and self-directed learning was availed by 348 and 125 rural ANMs, respectively. Through the directed learning, ANMs improved their clinical skills like maternal and newborn resuscitation and eclampsia management. Less work experience showed relatively higher improvement in skills, but not in knowledge. 56.6% ANMs either improved or retained their immediate post-training scores after 3 months. Self-directed learning helped them for experience sharing, problem-solving, active engagement through skill demonstrations, and formal presentations. The conducive learning environment helped in reinforcement of knowledge and skills and in building confidence. This intervention could evaluate application of skills into practice to a limited extent. CONCLUSIONS: In India, there are some ongoing initiatives for building skills of the ANMs like skilled birth attendance and training in skills lab. However, such a complementary mix of skill-based 'directed' and 'self-directed' learning approaches could be a plausible model for building capacities of health workforce. In view of the transforming healthcare delivery system in India and the significant responsibility that rests on the shoulder of ANMs, a transponder mechanism to implement skill building exercises at regular intervals through such innovative approaches should be a priority.

Comparison Between Quality of Care Provided by Trained Feeding Assistants and Certified Nursing Assistants During Between-Meal Supplementation in Long-Term Care Settings.

The purpose of this study was to compare the quality of feeding assistance provided by trained non-nursing staff with care provided by certified nursing assistants (CNAs). Research staff provided an 8-hr training course that met federal and state requirements to non-nursing staff in five community long-term care facilities. Trained staff were assigned to between-meal supplement and/or snack delivery for 24 weeks. Using standardized observations, research staff measured feeding assistance care processes between meals across all study weeks. Trained staff, nurse aides, and upper level staff were interviewed at 24 weeks to assess staff perceptions of program impact. Trained staff performed significantly better than CNAs for 12 of 13 care process measures. Residents also consumed significantly more calories per snack offer from trained staff ( M = 130 ± 126 [ SD] kcal) compared with CNAs ( M = 77 ± 94 [ SD] kcal). The majority of staff reported a positive impact of the training program.

Long-term effects of a computer-based nutritional training program for inpatient hospital care.

RATIONALE: A previous short-term study showed that a computer-based training in eating and nutrition increased the probability for hospital inpatients at undernutrition (UN) risk to receive nutritional treatment and care without increasing overtreatment (providing nutritional treatment to those not at UN risk). The aim of this study was to investigate if a computer-based training in eating and nutrition influences the precision in nutritional treatment and care in a longer-term perspective. METHOD: A preintervention and postintervention study was conducted with a cross-sectional design at each time points (baseline and 7 months postintervention). Hospital inpatients >18 years old at baseline (2013; n = 201) and follow-up (2014; n = 209) were included. A computer-based training was implemented during a period of 3 months with 297 (84%) participating registered nurses and nurse assistants. Undernutrition risk was screened for using the minimal eating observation and nutrition form-version II. Nutritional treatment and care was recorded using a standardized protocol. RESULTS: The share of patients at UN risk that received energy-dense food (+25.2%) and dietician consultations (+22.3%) increased between baseline and follow-up, while fewer received oral nutritional supplements (-18.9%). "Overtreatment" (providing nutritional treatment to those not at UN risk) did not change between baseline and follow-up. CONCLUSION: The computer-based training increased the provision of energy-dense food and dietician consultations to patients at UN risk without increasing overtreatment of patients without UN risk.

Changes in self-efficacy, collective efficacy and patient outcome following interprofessional simulation training on postpartum haemorrhage.

AIMS AND OBJECTIVES: To examine whether interprofessional simulation training on management of postpartum haemorrhage enhances self-efficacy and collective efficacy and reduces the blood transfusion rate after birth. BACKGROUND: Postpartum haemorrhage is a leading cause of maternal morbidity and mortality worldwide, although it is preventable in most cases. Interprofessional simulation training might help improve the competence of health professionals dealing with postpartum haemorrhage, and more information is needed to determine its potential. DESIGN: Multimethod, quasi-experimental, pre-post intervention design. METHODS: Interprofessional simulation training on postpartum haemorrhage was implemented for midwives, obstetricians and auxiliary nurses in a university hospital. Training included realistic scenarios and debriefing, and a measurement scale for perceived postpartum haemorrhage-specific self-efficacy, and collective efficacy was developed and implemented. Red blood cell transfusion was used as the dependent variable for improved patient outcome pre-post intervention. RESULTS: Self-efficacy and collective efficacy levels were significantly increased after training. The overall red blood cell transfusion rate did not change, but there was a significant reduction in the use of ≥5 units of blood products related to severe bleeding after birth. CONCLUSION: The study contributes to new knowledge on how simulation training through mastery and vicarious experiences, verbal persuasion and psychophysiological state might enhance postpartum haemorrhage-specific self-efficacy and collective efficacy levels and thereby predict team performance. The significant reduction in severe postpartum haemorrhage after training, indicated by reduction in ≥5 units of blood transfusions, corresponds well with the improvement in collective efficacy, and might reflect the emphasis on collective efforts to counteract severe cases of postpartum haemorrhage. RELEVANCE TO CLINICAL PRACTICE: Interprofessional simulation training in teams may contribute to enhanced prevention and management of postpartum haemorrhage, shown by a significant increase in perceived efficacy levels combined with an indicated reduction of severe postpartum haemorrhage after training.

Doctors or mid-level providers for abortion.

BACKGROUND: The World Health Organization recommends that abortion can be provided at the lowest level of the healthcare system. Training mid-level providers, such as midwives, nurses and other non-physician providers, to conduct first trimester aspiration abortions and manage medical abortions has been proposed as a way to increase women's access to safe abortion procedures. OBJECTIVES: To assess the safety and effectiveness of abortion procedures administered by mid-level providers compared to doctors. SEARCH METHODS: We searched the CENTRAL Issue 7, MEDLINE and POPLINE databases for comparative studies of doctor and mid-level providers of abortion services. We searched for studies published in any language from January 1980 until 15 August 2014. SELECTION CRITERIA: Randomised controlled trials (RCTs) (clustered or not clustered), prospective cohort studies or observational studies that compared the safety or effectiveness (or both) of any type of first trimester abortion procedure, administered by any type of mid-level provider or doctors, were eligible for inclusion in the review. DATA COLLECTION AND ANALYSIS: Two independent review authors screened abstracts for eligibility and double-extracted data from the included studies using a pre-tested form. We meta-analysed primary outcome data using both fixed-effect and random-effects models to obtain pooled risk ratios (RR) with 95% confidence intervals (CIs). We carried out separate analyses by study design (RCT or cohort) and type of abortion procedure (medical versus surgical). MAIN RESULTS: Eight studies involving 22,018 participants met our eligibility criteria. Five studies (n = 18,962) assessed the safety and effectiveness of surgical abortion procedures administered by mid-level providers compared to doctors. Three studies (n = 3056) assessed the safety and effectiveness of medical abortion procedures. The surgical abortion studies (one RCT and four cohort studies) were carried out in the United States, India, South Africa and Vietnam. The medical abortion studies (two RCTs and one cohort study) were carried out in India, Sweden and Nepal. The studies included women with gestational ages up to 14 weeks for surgical abortion and nine weeks for medical abortion.Risk of selection bias was considered to be low in the three RCTs, unclear in four observational studies and high in one observational study. Concealment bias was considered to be low in the three RCTs and high in all five observational studies. Although none of the eight studies performed blinding of the participants to the provider type, we considered the performance bias to be low as this is part of the intervention. Detection bias was considered to be high in all eight studies as none of the eight studies preformed blinding of the outcome assessment. Attrition bias was low in seven studies and high in one, with over 20% attrition. We considered six studies to have unclear risk of selective reporting bias as their protocols had not been published. The remaining two studies had published their protocols. Few other sources of bias were found.Based on an analysis of three cohort studies, the risk of surgical abortion failure was significantly higher when provided by mid-level providers than when procedures were administered by doctors (RR 2.25, 95% CI 1.38 to 3.68), however the quality of evidence for this outcome was deemed to be very low. For surgical abortion procedures, we found no significant differences in the risk of complications between mid-level providers and doctors (RR 0.99, 95% CI 0.17 to 5.70 from RCTs; RR 1.38, 95% CI 0.70 to 2.72 from observational studies). When we combined the data for failure and complications for surgical abortion we found no significant differences between mid-level providers and doctors in both the observational study analysis (RR 1.36, 95% CI 0.86 to 2.14) and the RCT analysis (RR 3.07, 95% CI 0.16 to 59.08). The quality of evidence of the outcome for RCT studies was considered to be low and for observational studies very low. For medical abortion procedures the risk of failure was not different for mid-level providers or doctors (RR 0.81, 95% CI 0.48 to 1.36 from RCTs; RR 1.09, 95% CI 0.63 to 1.88 from observational studies). The quality of evidence of this outcome for the RCT analysis was considered to be high, although the quality of evidence of the observational studies was considered to be very low. There were no complications reported in the three medical abortion studies. AUTHORS' CONCLUSIONS: There was no statistically significant difference in the risk of failure for medical abortions performed by mid-level providers compared with doctors. Observational data indicate that there may be a higher risk of abortion failure for surgical abortion procedures administered by mid-level providers, but the number of studies is small and more robust data from controlled trials are needed. There were no statistically significant differences in the risk of complications for first trimester surgical abortions performed by mid-level providers compared with doctors.

A study on self concept and adjustment of auxiliary nursing and midwifery (revised) students in a selected school of nursing, Purulia, West Bengal.

Nursing students are exposed to different types of stress, with which they have to make adjustments. Self concept Influences their capability of adjustment. The study was done to find out the levels of self concept in different dimensions and levels of adjustment in different spheres of the auxiliary nursing and midwifery (revised) [ANM(R)] students, to find out the association between their self concept and adjustment with different sociodemographic factors and to assess the correlation between self concept and adjustment of these students. An observational cross-sectional study was conducted on the ANM(R) students of School of Nursing, Purulia, West Bengal from October 2008 to January 2009 with sample size 50. Chi-square test was done to find out statistical association. Majority of students (64%) had self concept above average category (145-192). Considering levelsof adjustment, majority of the students (56%) fell in the above average category (5572). Mean score of adjustment was highest in the health dimension (9.96) and lowest in the area of education (6.88). No significant association was found between self concept and age, education and family income. The associations of marital status and type of family with self concept are statistically significant. No significant association was found between adjustment and sociodemographic characteristics. Positive correlation was found between self concept and adjustment (correlation co-efficient r = 0.6109). This study has various implications for nursing administration, nursing education, nursing practice and nursing research.

An analysis of the palliative care education needs of RGNs and HCAs in nursing homes in Ireland.

AIM: To identify the palliative care education needs of registered general nurses (RGNs) and health-care assistants (HCAs) working in care of the older person units (nursing homes). METHOD: A questionnaire was sent to all RGNs and HCAs working in nursing homes run by the Health Service Executive (HSE) in one health-care region in Ireland. RESULTS: RGNs identified eight specific educational needs: understanding of the dying process; pain and symptom management; improved communication skills; nutritional assessment issues; practical skills; the appropriate use and management of syringe drivers; and the role of complementary therapies. HCAs identified a need to improve their communication skills and clarify their role. Both groups identified the need for support when caring for dying patients and the need to improve their understanding of palliative care and the role of specialist palliative care (SPC) services. There was a significant difference between the RGNs' and the HCAs' level of understanding of palliative care (P = 0.00). CONCLUSION: This study demonstrated that RGNs and HCAs working in care of the older person settings have palliative care educational needs. It also established a difference in the educational background and palliative care understanding of RGNs and HCAs. This study therefore identified the need to develop separate education programmes.

The nursing workforce in Kuwait to the year 2020.

BACKGROUND: The study addresses the supply and demand for nurses in Kuwait in the light of emerging variables such as increasing population, economic growth, changes in healthcare strategies and expansion of healthcare facilities. OBJECTIVE: To project the future demand for nurses in Kuwait for the years 2007-2020 based on the period 1994-2006. METHODS: Population projections were derived using the average annual natural increase rate of the 1994-2006 populations. The future demand for nurses was projected using the average nurse to population ratios for the years 1994-2006. FINDINGS: The number of Kuwaiti indigenous nurses is declining at an average decrement rate of 3.3% per annum. There is a gap between the numbers of native and migrant nurses, which will be wider with time. In 2006, native nurses constituted only 6.6% of the nursing workforce; this affects the quality of provided health care owing to language, religions and socio-cultural barriers between foreign nurses and patients. CONCLUSIONS: The supply of indigenous nurses in Kuwait should be increased in order to deliver effective nursing care with shared culture and language in the modern healthcare system of Kuwait. This can be achieved through an improvement in recruitment and retention of indigenous nurses and nursing students.

Know thy residents: an exploration of long-term care nursing staff's knowledge.

Nursing staff's knowledge of residents' lives in long-term care is critical to the provision of quality care, the formation of strong relationships between staff and residents, and the promotion of psychosocial well-being for residents. This study examines the degree to which nursing staff in assisted living facilities and nursing homes know residents in terms of their lives and occupations, family members, tastes and interests, and medical conditions. Quantitative surveys were administered to nursing staff-resident dyads (N = 199) as part of a larger study on quality of life in long-term care. Results indicated that while nursing staff generally knew residents fairly well, a significant percentage of nursing staff reported knowing nothing at all in each of the categorical areas of residents' lives. Implications center on eliminating barriers to knowledge attainment and implementing educational interventions that may augment nursing staff's knowledge of residents.

The changing face of long-term care: looking at the past decade.

Baby boomers on the verge of retirement who are considering future long-term care needs are searching for options that will promote comfort and quality of life in an environment comparable to the home left behind. Culture change is taking on different faces throughout long-term care, moving from a traditional medical model towards a holistic approach. New models of care address individual needs of the aging population. This article has three aims: (1) to evaluate the current state of culture change throughout long-term care, (2) to describe models of change seen among the long-term care industry, and (3) to report on existing work comparing the Green House Model of Care to two traditional nursing homes in Tupelo, Mississippi.

Training of healthcare personnel to improve performance of community-based antenatal care program.

BACKGROUND: The present study was performed to evaluate the effectiveness of a training course designed to improve the knowledge, skills, and attitudes of healthcare personnel to allow them to provide a comprehensive community-based antenatal care (ANC) program in rural Paraguay. METHODS: Sixty-eight of 110 healthcare personnel in the Caazapa Region of Paraguay participated in a nine-day training course between November 1997 and March 1998. The knowledge of the participants related to maternal healthcare services was assessed both before and after the training course, and enrollment rates of pregnant women in ANC before and after the training were compared as a measure of patient satisfaction. The participants were also asked to evaluate the appropriateness of each individual method used in the training course. RESULTS: The average scores of the participants' knowledge increased significantly from 41.0 before to 60.1 after training (p<0.001). The enrollment rates of pregnant women in ANC increased from 2.2 times per pregnancy in 1996 to 3.4 times in 1998 (p<0.001). The participants reported that role-playing, demonstrations using visual information, and hands-on practice at a hospital were useful training methods. CONCLUSIONS: Continuous training for healthcare personnel in rural Paraguay contributes to an increase in their capacity to carry out community-based ANC program. The participants reported that learning through peer-educators, interactive communications, role-playing, and supervision provided in actual community services were beneficial. Continuous supervision should be provided to enable healthcare personnel to maintain the knowledge and skills acquired in the training.

Using experiential techniques for staff development: liking, learning, and doing.

Experiential techniques, such as role plays and simulations, are recommended to achieve nursing home staff training and development objectives. Experiential techniques can be customized to match the learning styles and preferences of all levels of nursing staff. Nursing staff's reactions to and benefits from such techniques are a necessary first step in the evaluation of a skills training program. Project RELATE (Research and Education for Living with Alzheimer's Disease: Therapeutic Eldercare) measured reactions to and knowledge gained by nursing staff using such techniques in training person-centered care. Findings suggest experiential techniques are efficacious as learning methods.

Attitudes to spiritual care among nursing staff in a Swedish oncology clinic.

AIMS AND OBJECTIVES: To identify factors which may influence attitudes to spiritual care, test the relevance of these identified influencing factors in a Swedish nursing context, and replicate a part of a previous study by Strang et al. (Journal of Clinical Nursing 2002;11:48-57) dealing with attitudes to spiritual care in a holistic perspective. A questionnaire was handed out to all nursing staff at a Swedish oncology clinic (n=93) excluding the radiation therapy ward. Data were obtained from 68 nurses or nursing auxiliaries. DESIGN AND METHODS: (i) Literature review of international research reports concerning spiritual care in a nursing context. (ii) Construction of a questionnaire comprising 17 questions with given alternatives based on the previous literature study. (iii) Operationalization of the concept 'attitudes to spiritual care' into some more easily measurable questions through identification in earlier research reports of conceivable indicators of attitudes to spiritual care. (iv) Construction of a suggestion for a definition of the concept 'spiritual care' from the results of Strang et al. (2002) to be used in the questionnaire. (v) Statistical analysis of the data from the questionnaire and a comparison with previous studies. RESULTS AND CONCLUSIONS: The replicating part of the study are mainly in accordance with Strang et al. (2002) and lead to the conclusions that holistic care (i) is desirable, (ii) should include spiritual needs of the patients and (iii) is not yet realized in Swedish health care. The identified influencing factors are relevant in a Swedish nursing context. The factors influencing the largest number of indicators of attitudes to spiritual care are 'non-organized religiousness' and 'degree of comfort while providing spiritual care'. Other influencing factors are: 'belief in God', 'belief in life after death', 'organized religiousness', 'profession', and 'the perceived degree of education in spiritual care'. RELEVANCE TO CLINICAL PRACTICE: Knowledge of attitudes towards spiritual care among nursing staff and factors influencing these attitudes will improve the possibilities of meeting the spiritual needs of patients.

Can they or can they not? Nurses' ability to quantify stool in superabsorbent diapers.

Estimates of stool output in diapers is not an appropriate guideline to use in determining fluid loss through stool. This study was conducted to determine the accuracy of the ability of the nurses (RNs) and patient care technicians (PCTs) to quantify stool volume in diapers. Size 3 diapers, baby food (green peas), and water were used to simulate combinations of stool and urine and differing degrees of water loss in stool. The results indicated that RNs' and PCTs' assessments of stool volume became less accurate as water loss increased. There were no differences in estimation accuracy between RN and PCTs, and years of experience for RNs or PCTs did not influence accuracy of estimation. It is important to use a holistic approach for determining hydration status in patients, particularly knowledge of signs and symptoms of dehydration.

A brief mindfulness-based stress reduction intervention for nurses and nurse aides.

Whereas the causes and negative consequences of stress among nurses are well known, less is known about effective ways to reduce or prevent this growing problem. Mindfulness-based stress reduction programs are proving to be effective in reducing stress and improving health in a variety of clinical populations. A smaller body of evidence suggests that these programs are also effective for nonclinical populations at risk for stress-related health problems. This study involved the development and evaluation of a brief 4-week mindfulness intervention for one such group-nurses and nurse aides. In comparison with 14 wait-list control participants, 16 participants in the mindfulness intervention experienced significant improvements in burnout symptoms, relaxation, and life satisfaction. The results of this pilot study, together with a natural fit between mindfulness philosophy and nursing practice theory, suggest that mindfulness training is a promising method for helping those in the nursing profession manage stress, even when provided in a brief format.