Empowering medicine residents to order labs mindfully to improve patient-centered care.

BACKGROUND: Unnecessary laboratory testing of hospitalized patients is prevalent. OBJECTIVE: We conducted a study focused on "mindful ordering" to decrease unnecessary laboratory ordering within an Internal Medicine residency program. DESIGNS, SETTINGS AND PARTICIPANTS: We collected survey data on resident/faculty perceptions of laboratory ordering as well as order information from the electronic medical record (EMR). INTERVENTION: Interventions focused on resident-identified barriers such as knowledge, EMR, habit and faculty expectations. Interventions were cumulative and included resident/faculty education and EMR optimization. MAIN OUTCOMES AND MEASURES: We assessed basic and complete metabolic panels (BMP, CMP) and complete blood counts with and without differential (CBC w/diff, w/o diff). Primary outcomes included: total labs ordered per week, lab and frequency, and resident perception of ordering practices. Secondary outcomes included: length-of stay (LOS) and venipuncture utilization. RESULTS: Survey data demonstrated increased resident perception of both mindful ordering and team discussion. Total labs ordered per week decreased 20% in the first year (1944 to 1500 labs/week). Residents' use of the "one-time draw" option increased; use of "daily" frequency decreased. Trends showed an increase in BMP relative to CMP, and an increase in CBC w/o diff relative to CBC w/diff. These changes were sustained through 127 weeks. There was an approximately 10% decrease in monthly average of patients undergoing venipuncture each day (86.7% to 74.2%). The shifts in laboratory ordering in conjunction with increased discussion about labs suggest a sustained change in resident lab ordering behavior. This study shows the impact of focusing interventions on resident-identified barriers to mindful ordering to create a sustained decrease laboratory orders.

O cuidado das enfermeiras no parto e no nascimento após a inserção do projeto Apice On / Cuidado de enfermería durante el parto y el nacimiento tras la implementación del proyecto Apice On / Nursing care during childbirth after the insertion of the Apice On Project

Objetivo: descrever os saberes e cuidados realizados pelas enfermeiras no campo do parto e do nascimento, a partir da inserção do projeto "Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia" (Apice On). Materiais e método: estudo descritivo, com abordagem qualitativa, com aplicação de entrevistas semiestruturadas com 13 enfermeiras atuantes em uma maternidade de risco habitual na região metropolitana II do estado do Rio de Janeiro, Brasil. As entrevistas foram transcritas e submetidas à análise de conteúdo na modalidade temática. Resultados: foram identificadas duas categorias temáticas: "Saberes do cotidiano da enfermeira no cuidado à mulher no processo do parto e do nascimento" e "Modo de cuidar da enfermeira à mulher no processo do parto e do nascimento após a inserção do Apice On". A sustentação de um cuidado contínuo, integral e embasado em evidências científicas valoriza a fisiologia da parturição, além de ser decisivo para as mudanças institucionais. Conclusões: as enfermeiras têm potencializado mudanças práticas no cotidiano da assistência na maternidade, influenciadas pelo compromisso de manter um cuidado centrado na mulher com aceno para as práticas interprofissionais.

Objetivo: describir los conocimientos y cuidados que practican los profesionales de enfermería durante el parto y el nacimiento tras la implementación del proyecto Perfeccionamiento e Innovación en el Cuidado y Enseñanza en Obstetricia y Neonatología (Apice On, en su sigla en portugués). Materiales y método: estudio descriptivo de abordaje cualitativo, con base en la aplicación de entrevistas semiestructuradas a 13 enfermeras que laboran en un área de maternidad de riesgo estándar en la II Región Metropolitana del Estado de Rio de Janeiro, Brasil. Estas entrevistas fueron transcritas y sometidas a análisis de contenido en la modalidad temática. Resultados: se identificaron dos categorías temáticas: "Conocimiento cotidiano del enfermero en el cuidado de la mujer en el trabajo de parto y el alumbramiento" y "Enfoque del cuidado del enfermero a la mujer en proceso de parto y alumbramiento tras la implementación de Apice On". Se observa que una atención continua, integral y basada en evidencia científicas valoriza la fisiología del parto, además de ser determinante para la adopción de cambios a nivel institucional. Conclusiones: los profesionales de enfermería han potencializado cambios prácticos en el cuidado diario de la maternidad, influenciados por el compromiso de mantener un cuidado centrado en la mujer y la adopción de prácticas interprofesionales.

Objective: To describe the knowledge and care practices applied by nursing professionals during labor and birth after the insertion of the project Enhancement and Innovation in Care and Teaching of Obstetric and Neonatology (Apice On, in Portuguese). Materials and method: Descriptive study with a qualitative approach, based on semi-structured interviews with 13 nurses working at maternity hospital of usual risk at the II metropolitan region of Rio de Janeiro State, Brazil, which were transcript and submitted to content analysis under thematic modality. Results: Two thematic categories were identified: "Common knowledge by nurses in labor and delivery care towards women" and "Nursing care towards women in the process of labor and delivery after the insertion of Apice On". Findings show that a continuous and comprehensive care based on scientific evidence values the physiology of childbirth, being also decisive for institutional changes. Conclusions: Nursing professionals have promoted practical changes in daily maternity care, influenced and compromised to sustaining a woman-centered approach in health care and the adoption of interprofessional practices.

Educação permanente no sistema único de saúde: concepções de profissionais da gestão e dos serviços / Continuing permanent education in the brazilian national health system: conceptions from management and care professionals / Educación continua en el sistema único de salud brasileño: concepciones de los profesionales de gestión y servicios

Este artigo pretende compreender as concepções de profissionais da gestão e dos serviços do Sistema Único de Saúde (SUS) sobre Educação Permanente em Saúde (EPS), bem como seus desafios e potencialidades. Utilizou-se de grupo focal para coleta, seguido de análise lexical do tipo classificação hierárquica descendente com auxílio do software Iramuteq. Os resultados delinearam quatro classes: a) EPS - entendimentos e expectativas; b) entraves à EPS; c) ETSUS e EPS por meio de cursos e capacitações; e d) dispositivos de EPS: potencialidades e desafios. Os participantes apontaram equívocos de entendimentos acerca da EPS ao equipará-la à Educação Continuada (EC) voltada à transferência de conteúdo, com repercussões negativas na prática de EPS. Discute-se o risco em centralizar o responsável pela concretização dessa proposta, que deveria ser coletiva e compartilhada entre diferentes atores. Reivindica-se, portanto, uma produção colaborativa, que possa circular entre os envolvidos, de modo que cada um experimente esse lugar e se aproprie da complexidade de interações propiciadas pela Educação Permanente em Saúde.(AU)

This article aims to understand the conceptions of professionals from the management and services of the Unified Health System (SUS) on Permanent Education in Health (EPS), as well as its challenges and potential. A focus group was used for data collection, followed by a lexical analysis of the descending hierarchical classification type using the Iramuteq software. The results delineated four classes: a) EPS - understandings and expectations; b) obstacles to EPS; c) ETSUS and EPS by courses and training; and d) EPS devices: potentialities and challenges. Participants pointed out misunderstandings about EPS, when equating it with Continuing Education (CE) focused on content transfer, with negative repercussions on EPS practice. The risk of centralizing the person responsible for implementing this proposal, which should be collective and shared among different actors, is discussed. Therefore, a collaborative production is claimed for, which can circulate among those involved, so that each one experiences this place and appropriates the complexity of interactions provided by Permanent Education in Health.(AU)

Este artículo tiene por objetivo comprender las concepciones de los profesionales de la gestión y servicios del Sistema Único de Salud (SUS) sobre Educación Continua en Salud (EPS), así como sus desafíos y potencialidades. Se utilizó un grupo focal para la recolección de datos, seguido por un análisis léxico del tipo clasificación jerárquica descendente con la ayuda del software Iramuteq. Los resultados delinearon cuatro clases: a) EPS: entendimientos y expectativas, b) Barreras para EPS, c) ETSUS y EPS a través de cursos y capacitación, y d) Dispositivos EPS: potencialidades y desafíos. Los participantes informaron que existen malentendidos sobre EPS al equipararla a Educación Continua, con repercusiones negativas en la práctica de EPS, orientada a la transferencia de contenidos. Se discute el riesgo de elegir a un solo organismo como responsable de implementar esta propuesta colectiva, que debería ser colectiva y compartida entre los diferentes actores. Se aboga por un liderazgo colaborativo, que pueda circular entre los involucrados, para que cada uno experimente este lugar y se apropie de la complejidad de interacciones que brinda la Educación Continua en Salud.(AU)

Licentîa hypomnema: reflections and perceptions in teacher education / Licentîa hypomnema: reflexões e percepções na formação de educadoras(es) / Licentîa hypomnema: reflexiones y percepciones en la formación del profesorado

Student protagonism is paramount in the knowledge construction process. In this paper, we discuss a didactic-pedagogical resource called licentîa hypomnema (LH), inspired in portfolios and learning diaries in which student-teachers record their understandings and reflections regarding pedagogical topics learned at University in a meta-learning process on learning about teaching. The initial context of the research was a Psychological Development and Teaching course, offered in the Teacher Education program at Universidade de Brasília (UnB). Two of the authors, then Literacy and Languages Teaching students, produced their LH and peer assessed each other during the course. In their annotations, the student-authors recorded two pedagogical situations related to the use of LH in their own teaching practices, causing an impact on their formative path. These materials consist of the data for analysis and discussion. Moreover, we discuss possible uses of reflexive writing in teacher education and other learning contexts. Producing a LH supports knowledge production and allows students to connect theory and practice, which consequently influences the student's teaching practice. Since LH is a didactic-pedagogical resource and not a close-ended tool, both the context and individuals who use it should be considered.(AU)

O protagonismo de estudantes tem grande importância no processo de construção do conhecimento. Neste artigo, discutimos um recurso didático-pedagógico chamado licentîa hypomnema (LH), inspirado em portfólios e diários de aprendizagem, isto é, estudantes de licenciatura escrevem suas compreensões e reflexões acerca de assuntos pedagógicos vistos na universidade em um processo de meta-aprendizagem sobre aprender a ensinar. O contexto inicial da pesquisa foi um curso de Desenvolvimento Psicológico e Ensino, ministrado em cursos de Licenciatura da Universidade de Brasília (UnB). Duas das autoras eram estudantes do curso de Letras, elas produziram seus LH, realizando avaliação por pares entre si durante o curso. As estudantes-autoras trouxeram em seus registros duas situações pedagógicas relacionadas ao uso desse recurso em suas próprias práticas de ensino que causaram um impacto em suas trajetórias formativas. São esses relatos que compõem os dados para análise e discussão. Além disso, procuramos discutir possíveis desdobramentos para o uso do recurso da escrita reflexiva na formação docente e em outros contextos de aprendizagem. A produção do LH fornece suporte para a produção de conhecimento e permite ao aluno conectar teoria e prática, o que, consequentemente, reverbera na prática de ensino do aluno. O LH é um recurso didático-pedagógico e não uma ferramenta fechada, portanto, tanto o contexto quanto as pessoas que o utilizam devem ser considerados.(AU)

El protagonismo de los estudiantes tiene gran importancia en el proceso de construcción del conocimiento. En este trabajo, discutimos un recurso didáctico-pedagógico llamado licentîa hypomnema (LH), que se inspira en diarios de aprendizaje, es decir, estudiantes de profesorado escriben sus comprensiones y reflexiones sobre temas pedagógicos aprendidos en la universidad, produciendo un proceso de meta-aprendizaje sobre aprender a enseñar. El contexto inicial de la investigación fue un curso de Desarrollo Psicológico y Enseñanza, impartido en el programa de Formación de Profesores de la Universidade de Brasília (UnB). Dos de las autoras eran alumnas de la carrera de Letras que produjeron sus LH y realizaron una evaluación por pares mutua durante el curso. Las estudiantes autoras plantearon en su LH dos situaciones pedagógicas relacionadas con el uso de este recurso en sus propias prácticas de enseñanza, causando un impacto en su trayectoria formativa. Estos materiales constituyen los datos para el análisis y la discusión en esta investigación. Buscamos discutir posibles desdoblamientos para el uso del recurso de la escritura reflexiva en la formación docente y en otros contextos de aprendizaje. La producción de este recurso da soporte a la producción de conocimiento y permite al estudiante conectar teoría y práctica, lo que consecuentemente repercute en su práctica docente. El LH es un recurso didáctico-pedagógico y no una herramienta cerrada, por lo tanto, se debe considerar tanto el contexto como las personas que lo utilizan.(AU)

Superación del médico general para la atención integral a niños con necesidades educativas especiales / Knowledge improvement of the general practitioner for comprehensive care for children with special educational needs

Fundamento: la superación especializada del médico general integral debe de estar encaminada a elevar su nivel profesional en la atención primaria de salud, particularizando en las características individuales de cada paciente. Objetivo: diagnosticar el estado actual de preparación de los médicos generales de la atención primaria de salud en cuanto al conocimiento para brindar atención integral y especializada a los niños con necesidades educativas especiales, pertenecientes al Policlínico Universitario "Ignacio Agramonte", de Camagüey. Métodos: se realizó un estudio descriptivo transversal entre los meses septiembre-diciembre de 2021. Se aplicaron métodos teóricos: histórico-lógico, análisis-síntesis e inducción-deducción; y empíricos, revisión documental y cuestionario a los médicos que laboran en los consultorios médicos del área. Resultados: el diagnóstico realizado permitió identificar falencias en la formación profesional del médico general desde su programa de formación en la especialidad Medicina General Integral, las que dificultan el trabajo exitoso en cuanto a la atención integral a niños con necesidades especiales, en aras de promover su inclusión social y el beneficio de su desarrollo individual. Conclusiones: las deficiencias encontradas ratifican la necesidad de implementar una estrategia de superación en cuanto al tema para perfeccionar el distintivo trabajo comunitario del médico general integral.

Background: the specialized improvement of the comprehensive general practitioner must be aimed at raising their professional level in primary health care, particularizing the individual characteristics of each patient. Objective: to diagnose the current state of preparation of general practitioners in primary health care in terms of knowledge to provide comprehensive and specialized care to children with special educational needs, belonging to the "Ignacio Agramonte" University Polyclinic in Camagüey. Methods: a cross-sectional descriptive study was carried out between from September to December 2021. Theoretical methods were applied: historical-logical, analysis-synthesis and induction-deduction; and empirical ones, documentary review and questionnaire to the doctors who work in the doctor´s offices of the area. Results: the diagnosis made possible to identify shortcomings in the professional training of the general practitioner from his training program in the Comprehensive General Medicine specialty, which hinder successful work in terms of comprehensive care for children with special needs, in order to promote their social inclusion and the benefit of their individual development. Conclusions: the deficiencies found ratify the need to implement an improvement strategy regarding the subject to improve the distinctive community work of the comprehensive general practitioner.

Do in-service training materials for midwifery care providers in sub-Saharan Africa meet international competency standards? A scoping review 2000-2020.

BACKGROUND: Levels of maternal and neonatal mortality remain high in sub-Saharan Africa, with an estimated 66% of global maternal deaths occurring in this region. Many deaths are linked to poor quality of care, which in turn has been linked to gaps in pre-service training programmes for midwifery care providers. In-service training packages have been developed and implemented across sub-Saharan Africa in an attempt to overcome the shortfalls in pre-service training. This scoping review has aimed to summarize in-service training materials used in sub-Saharan Africa for midwifery care providers between 2000 and 2020 and mapped their content to the International Confederation of Midwives (ICM) Essential Competencies for Midwifery Practice. METHODS: Searches were conducted for the years 2000-2020 in Cumulative Index of Nursing and Allied Health Literature, PubMed/MEDLINE, Social Science Citation Index, African Index Medicus and Google Scholar. A manual search of reference lists from identified studies and a search of grey literature from international organizations was also performed. Identified in-service training materials that were accessible freely on-line were mapped to the ICM Essential Competencies for midwifery practice. RESULTS: The database searches identified 1884 articles after removing duplicates. After applying exclusion criteria, 87 articles were identified for data extraction. During data extraction, a further 66 articles were excluded, leaving 21 articles to be included in the review. From these 21 articles, six different training materials were identified. The grey literature yielded 35 training materials, bringing the total number of in-service training materials that were reviewed to 41. Identified in-service training materials mainly focused on emergency obstetric care in a limited number of sub-Saharan Africa countries. Results also indicate that a significant number of in-service training materials are not readily and/or freely accessible. However, the content of in-service training materials largely met the ICM Essential Competencies, with gaps noted in the aspect of woman-centred care and shared decision making. CONCLUSION: To reduce maternal and newborn morbidity and mortality midwifery care providers should have access to evidence-based in-service training materials that include antenatal care and routine intrapartum care, and places women at the centre of their care as shared decision makers.

Superación profesional sobre uso racional de medicamentos dirigida a los médicos generales integrales / Professional improvement on the rational use of medications intended comprehensive general practitioners

RESUMEN Fundamento: el vertiginoso avance de la industria farmacéutica exige al médico general integral un proceso de superación continuo que favorezca el uso racional de los medicamentos. Objetivo: caracterizar la superación de estos profesionales relacionada con el uso racional de medicamentos en la Facultad de Medicina 1 de Santiago de Cuba. Métodos: se realizó un estudio descriptivo transversal en el que se analizaron las actividades de superación profesional de cinco cursos académicos desde el 2014 al 2019 a través de la revisión documental de los planes de superación profesional, así como los programas correspondientes. Resultados: las actividades relacionadas con el uso racional de medicamentos eran insuficientes y con tendencia a la disminución de un curso a otro; la forma de organización del posgrado más empleada fueron los cursos, seguidas de los talleres. Para incorporar los contenidos de uso racional de medicamentos se utilizaron, con más frecuencia, elementos de terapéutica de una enfermedad o grupo de estas así como la introducción de la medicina natural y tradicional. En las actividades se abordaron aspectos novedosos, pero no se hizo referencia a la terapéutica razonada. Conclusiones: se caracterizó la superación profesional para los médicos generales integrales relacionada con el uso racional de medicamentos la cual fue valorada como insuficiente por lo que urge retomar los aspectos que resultaron deficitarios en esta caracterización.

ABSTRACT Background: the vertiginous advance of the pharmaceutical industry demands from the comprehensive general practitioner a continuous improvement process that favors the rational use of medications. Objective: to characterize the improvement of these professionals related to the rational use of medications in the Faculty of Medicine 1 of Santiago de Cuba. Methods: a cross-sectional descriptive study was carried out in which the professional improvement activities of five academic courses from 2014 to 2019 were analyzed through the documentary review of the professional improvement plans, as well as the corresponding programs. Results: the activities related to the rational use of medications were insufficient and tended to decrease from one course to another; the most used form of postgraduate organization were courses, followed by workshops. To incorporate the contents of rational use of medications, therapeutic elements of a disease or group of diseases were used, as well as the introduction of Herbal and Folk medicine. In the activities, novel aspects were addressed, but no reference was made to reasoned therapy. Conclusions: professional improvement for comprehensive general practitioners related to the rational use of medications was characterized, which was assessed as insufficient, so it is urgent to retake the aspects that were deficient in this characterization.

Integrated Management of Neonatal and Childhood Illness Training in Lao PDR: A Pilot Study of an Adaptable Approach to Training and Supervision.

Integrated Management of Neonatal and Childhood Illness (IMNCI) has been part of the national strategy for child health in Lao Peoples Democratic Republic since 2003. The program, while running for an extended period, has faced multiple challenges including maintaining the teaching quality for the implementation of the IMNCI guidelines and a structure to enable and support healthcare workers trained to apply the training in their workplace. A revised training model that focused on building skills for teaching according to adult learning principles in a pool of facilitators, a practical and hands-on training workshop for healthcare workers, and the establishment of a program of health center supervision was developed and implemented in three provinces. Participants in the revised model reported increased confidence in implementing IMNCI guidelines, they demonstrated competence in the steps of IMNCI and on follow-up assessment at a supervision visit were found to have improved patient care through the measurement of pediatric case management scores. This study highlights the importance of a focus on education to ensure the translation of guidelines into practice and thereby lead to improvements in the quality of pediatric care. The IMNCI training approach is acceptable and valued by healthcare worker participants.

Training women's pelvic floor muscles during pregnancy and postpartum at primary health centers: a best practice implementation project.

INTRODUCTION AND AIMS: Pelvic floor muscle training (PFMT) enhances muscle strength and coordination, and prevents urinary incontinence associated with giving birth. The goal was to improve women's PFMT during pregnancy and postpartum in La Rioja, Spain. METHODS: This evidence implementation project used the JBI evidence implementation framework. First, we conducted the PFMT baseline audit: to assess the criteria for midwife training, we sent a questionnaire to all midwives. To measure the criteria for PFMT and urinary incontinence risk assessment, we reviewed the medical records of 60 women selected through consecutive sampling and 15 other women at risk of urinary tract infections (UTIs) for the inclusion criteria in a PFMT program. Second, we used the Getting Research into Practice guidelines to identify barriers to the fulfillment of each criterion and design and implement strategies to improve compliance. Finally, we repeated the audit to measure compliance and verify the changes. RESULTS: The midwives received updated PFMT, optimizing compliance with the first criterion from 67 to 100%. The remaining criteria -- providing PFMT for pregnant women, identifying women at high risk of incontinence, and facilitating a supervised PFMT program for women at high risk of UTIs -- went from 0% compliance to 17, 96, and 67%, respectively. CONCLUSION: This project was effective in building consensus, improving midwives' practice, and facilitating mothers' PFMT. The project continued during the novel coronavirus [coronavirus disease 2019 (COVID-19)] epidemic in Spain as the midwives, women, and managers were involved in the change because of a well designed registration system and the use of online tools for communication between midwives and women.

Applying a Human Factors Approach to Improve Patient Experience with Sacral Neuromodulation.

OBJECTIVES: To apply a human factors approach, the study of interactions between humans and complex systems, to investigate patient preparedness, satisfaction, and perceived usability with sacral neuromodulation (SNM) and develop interventions aimed at improving patient experience. MATERIALS AND METHODS: Ten patients with overactive bladder undergoing staged SNM were observed, and data including pre-operative preparedness, satisfaction, perceived usability and barriers impacting patient experience were collected. Interventions were developed and an additional ten patients were observed. All patients were English-speaking and at least 18 years of age. RESULTS: Pre-intervention patients had difficulty understanding the risks of the procedure, did not know what to expect post-operatively and were unsatisfied with pre-operative materials. Interventions included: A pre-procedure educational video and informational sheet, detailed discharge instructions; and a nursing inservice. Pre-operative preparedness (Stage I: U = 100, z = 3.785, P = .000; Stage II: U = 80, z = 2.864, P = .003), post-operative satisfaction (Stage I: U = 100, z = 3.788, P = .000; Stage II: U = 77.5, z = 2.665, P = .006.) and perceptions of usability (Stage I: U = 77.00, z = 2.056, P = .043.; Stage II: U = 80.50, z = 2.308, P = .019) increased significantly after the intervention. CONCLUSION: Our observations highlight the value of implementing a human factors approach to identify and mitigate barriers impacting patient experiences with SNM. Through the implementation of systems-level interventions (ie, interventions that impact the non-clinical aspects of surgery such as patient and/or staff education), significant improvements can be made.

An Aboriginal and Torres Strait Islander Cardiac Rehabilitation program delivered in a non-Indigenous health service (Yeddung Gauar): a mixed methods feasibility study.

BACKGROUND: There is limited evidence of Aboriginal and Torres Strait Islander people attending cardiac rehabilitation (CR) programs despite high levels of heart disease. One key enabler for CR attendance is a culturally safe program. This study evaluates improving access for Aboriginal and Torres Strait Islander women to attend a CR program in a non-Indigenous health service, alongside improving health workforce cultural safety. METHODS: An 18-week mixed-methods feasibility study was conducted, with weekly flexible CR sessions delivered by a multidisciplinary team and an Aboriginal and/or Torres Strait Islander Health Worker (AHW) at a university health centre. Aboriginal and Torres Strait Islander women who were at risk of, or had experienced, a cardiac event were recruited. Data was collected from participants at baseline, and at every sixth-session attended, including measures of disease risk, quality-of-life, exercise capacity and anxiety and depression. Cultural awareness training was provided for health professionals before the program commenced. Assessment of health professionals' cultural awareness pre- and post-program was evaluated using a questionnaire (n = 18). Qualitative data from participants (n = 3), the AHW, health professionals (n = 4) and referrers (n = 4) was collected at the end of the program using yarning methodology and analysed thematically using Charmaz's constant comparative approach. RESULTS: Eight referrals were received for the CR program and four Aboriginal women attended the program, aged from 24 to 68 years. Adherence to the weekly sessions ranged from 65 to 100%. At the program's conclusion, there was a significant change in health professionals' perception of social policies implemented to 'improve' Aboriginal people, and self-reported changes in health professionals' behaviours and skills. Themes were identified for recruitment, participants, health professionals and program delivery, with cultural safety enveloping all areas. Trust was a major theme for recruitment and adherence of participants. The AHW was a key enabler of cultural authenticity, and the flexibility of the program contributed greatly to participant perceptions of cultural safety. Barriers for attendance were not unique to this population. CONCLUSION: The flexible CR program in a non-Indigenous service provided a culturally safe environment for Aboriginal women but referrals were low. Importantly, the combination of cultural awareness training and participation in the program delivery improved health professionals' confidence in working with Aboriginal people. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) 12618000581268, http://www.ANZCTR.org.au/ACTRN12618000581268.aspx , registered 16 April 2018.

Acceptability and efficacy of a communication skills training for nursing students: Building empathy and discussing complex situations.

Nurses must demonstrate effective communication across complex interpersonal domains, as emphasized by numerous professional healthcare organizations. However, formal communication skills training has been only modestly integrated into baccalaureate nursing programs, and of those studied systematically, there are notable methodological concerns. The current study focused on application of a well-researched communication program (Comskil) to student nurses completing summer internships at a comprehensive cancer center as part of their clinical education. The Comskil training program for student nurses is an in-person, day-long training that includes three sections: responding empathically to patients; discussing death, dying, and end-of-life goals of care; and responding to challenging family interactions. Student nurse participants provided strongly favorable perceptions of the program, with 90% indicating that they agreed or strongly agreed with all perception items. A significant pre-to post-training improvement in self-reported confidence was observed (p < .01). Additionally, pre- and post-training observational coding of standardized patient assessments indicated significant improvements in usage of the following skill categories: total skill use, information organization, and empathic communication (p < .001). Overall, these results suggest that communication skills training for student nurses is a feasible, acceptable, and effective way of increasing confidence and skills usage in complex clinical scenarios.

Capacitação sobre cuidados paliativos oncológicos: análise de intervenção com profissionais da saúde da atenção básica de um município do Nordeste / Training on palliative oncologic care: analysis of intervention with primary care health professionals in a town in the Brazilian Northeast

INTRODUÇÃO: cuidado paliativo é uma abordagem multidisciplinar que propõe uma melhoria na forma de cuidar do paciente e de seus familiares, que enfrentam doenças que ameacem a manutenção da vida. Os profissionais precisam estar aptos a prestar uma assistência holística. OBJETIVO: analisar as ações de intervenção sobre cuidados paliativos oncológicos na capacitação de profissionais de saúde da atenção básica, de um município do Nordeste. MÉTODO: estudo quantitativo realizado com enfermeiros e médicos, com aplicação de formulário semiestruturado. Na análise dos dados foi utilizado o teste de McNemar-Bowker, para avaliação das proporções pré e pós-curso. Estudo qualitativo realizado com cuidadores de pacientes em cuidados paliativos da atenção básica do município de Juazeiro-BA, através de entrevistas com roteiro norteador e análise de conteúdo temático. RESULTADOS: incluíram-se 69 profissionais (56% da população estimada), sendo 29 (42%) médicos e 40 (58%) enfermeiros. A maioria dos participantes (71%) era do sexo feminino, tinha idade entre 31 e 40 anos (62%), era casada/união estável (64%) e se declarou católica (65%). Destes, 71% possuíam algum tipo de pós-graduação, apenas 3% tinham capacitação em cuidados paliativos, sendo todos enfermeiros. E 10 cuidadoras familiares, todas do sexo feminino, idade entre 20 e 70 anos, 60% eram casadas e 40 % cursaram o ensino fundamental. Destas, 50% eram esposas, 30% filhas e 10% irmãs e mães. Quanto à compreensão dos profissionais sobre cuidados paliativos, antes da capacitação, 80% dos profissionais responderam correto; após, esse número subiu para 99%, o que representa um aumento de 19% depois do curso. Em habilidades, a maior parte dos profissionais optou pela alternativa 'ter a visão integral do paciente'. O percentual de respostas afirmativas variou de 82%, antes da capacitação para 95% depois, representando um aumento de 13% nas respostas. Os profissionais consideraram que devem ser disponibilizados os cuidados paliativos oncológicos, 100% dos profissionais responderam que seria por meio do plano de cuidados orientado pelo médico, antes da capacitação e após 99%. Quanto aos aspectos prioritários para disponibilizar os cuidados paliativos oncológicos, antes da capacitação, 47% responderam físicos, espirituais e emocionais e após 58% responderam o mesmo item, havendo um aumento de 11% no item correto. Com relação à percepção das cuidadoras familiares, apresentada por meio da parte qualitativa do estudo, demonstrou-se que as equipes prestam, mesmo com escassez de recursos humanos e materiais, uma assistência humana com disponibilização do acesso ao serviço e satisfação no atendimento. CONCLUSÃO: os resultados evidenciam que a capacitação foi efetiva em relação aos conhecimentos sobre cuidados paliativos, o que pode ser corroborado através da percepção das cuidadoras familiares sobre a modificação de condutas da equipe

INTRODUCTION: Palliative care is a multidisciplinary approach that proposes an improvement in the way of caring for patients and their relatives, who face diseases that threaten the maintenance of life. Professionals need to be able to provide holistic care. OBJECTIVE: To analyze the intervention actions about palliative oncologic care in the training of primary care health professionals, in a town in the Brazilian Northeast. METHOD: Quantitative study performed with nurses and physicians, using a semi-structured form. For data analysis, the McNemar-Bowker test was used in order to assess the pre- and post-course proportions. Qualitative study conducted with caregivers of pacients in palliative care in primary care patients from the town of Juazeiro-BA, through interviews with guiding script and thematic content analysis. RESULTS: A total of 69 professionals (56% of the estimated population) were included, 29 (42%) physicians and 40 (58%) nurses. Most participants (71%) were female, aged between 31 and 40 years old (62%), were married/in a stable relationship (64%) and declared themselves Catholic (65%). Of these, 71% had some kind of graduate degree, only 3% had training in palliative care, being all nurses. Moreover, 10 family caregivers, all female, aged between 20 and 70 years, where 60% were married and 40% attended elementary school. Of these, 50% were wives, 30% daughters and 10% sisters and mothers. As for the professionals' understanding of palliative care, before training, 80% of the professionals answered appropriately; after that, that number rose to 99%, which represents an increase of 19% after the course. In terms of skills, most professionals opted for the alternative 'having a comprehensive view of the patient'. The percentage of affirmative answers ranged from 82% before training to 95% afterwards, representing a 13% increase in answers. The professionals considered that palliative oncologic care should be made available, Where 100% of the professionals answered that it would be through the care plan guided by the physicians, before training and 99% after. Regarding the priority aspects to provide palliative oncologic care, before training, 47% answered physical, spiritual and emotional and after 58% answered the same item, with an increase of 11% in the correct item. Regarding the perception of family caregivers, introduced through the qualitative part of the study, it was proved that the teams provide, even with a shortage of human and material resources, a human care, thus providing access to the service and satisfaction in the service. CONCLUSION: The results show that the training was effective in relation to knowledge about palliative care, which can be corroborated through the perception of family members about the modification of the team's conduct.

Estratégias de ensino na abordagem dos cuidados paliativos com profissionais de enfermagem: revisão integrativa / Teaching strategies in addressing palliative care with nursing professionals: integrative review / Estrategias de enseñanza para abordar los cuidados paliativos con profesionales de enfermería: revisión integradora

Objetivo: Identificar, nas produções científicas, as estratégias de ensino utilizadas na abordagem dos cuidados paliativos com profissionais de enfermagem. Método: Revisão integrativa realizada em cinco bases de dados. Resultados: Foram analisados 12 artigos, todos internacionais. Várias estratégias de ensino foram utilizadas como: oficinas, simulação, discussão em grupos, dramatizações, aula expositiva. A metodologia ativa foi a mais utilizada, com a associação de várias estratégias de ensino, sendo o estudo de caso a mais frequente. Conclusão: A associação da teoria com a simulação da prática clínica é uma boa estratégia de ensino. Maior ênfase tem que ser dada na capacitação dos profissionais de enfermagem através de atividades de educação permanente em cuidados paliativos visando fornecer uma assistência segura e qualificada para o paciente e sua família

Objective: To identify, in scientific productions, the teaching strategies used to approach palliative care with nursing professionals. Method: Integrative review made in five databases. Results: 12 articles were analyzed, all international. Several teaching strategies were used as: workshops, simulation, group discussion, role plays, lecture. The active methodology was the most used, with the association of several teaching strategies, being the case study the most frequent. Conclusion: The association of theory with the simulation of clinical practice is a good teaching strategy. Greater emphasis has to be placed on training nursing professionals through continuing education activities in palliative care to provide safe and qualified care for the patient and their family

Objetivo: Identificar, en producciones científicas, las estrategias de enseñanza utilizadas para abordar los cuidados paliativos con profesionales de enfermería. Método: Revisión integradora realizada en cinco bases de datos. Resultados: Se analizaron 12 artículos, todos internacionales. Se utilizaron varias estrategias de enseñanza como: talleres, simulación, discusión grupal, juegos de roles, conferencias. La metodología activa fue la más utilizada, con la asociación de varias estrategias de enseñanza, siendo el estudio de caso el más frecuente. Conclusión: La asociación de la teoría con la simulación de la práctica clínica es una buena estrategia de enseñanza. Se debe hacer mayor hincapié en la capacitación de profesionales de enfermería a través de actividades de educación continua en cuidados paliativos para proporcionar atención segura y calificada para el paciente y su familia

Percepção dos técnicos de enfermagem sobre o cuidado em terapia nutricional enteral: simulação clínica / Perception of nursing technicians about care in enteral nutritional therapy: clinical simulation / Percepción de los técnicos de enfermería sobre el cuidado en terapia nutricional enteral: simulación clínica

Objetivo: analisar a percepção dos técnicos de enfermagem sobre o cuidado em terapia nutricional enteral, durante um cenário de simulação clínica. Método: estudo qualitativo, com base em um cenário de simulação clínica, realizado com 64 técnicos de enfermagem, em um hospital universitário do Sul do Brasil, em agosto de 2017. As falas foram audiogravadas, transcritas e, posteriormente, submetidas a análise de conteúdo. Resultados: foram evidenciadas quatro categorias sobre o cuidado em terapia nutricional enteral nas etapas de: administração da TNE; manutenção da sonda nasoenteral; registros de enfermagem e orientações ao paciente em uso de TNE. Conclusão: refletir sobre o cuidado prestado, por meio de um cenário de simulação clínica, pode colaborar com melhorias acerca do processo de trabalho da equipe de enfermagem e com o fortalecimento e segurança dos cuidados prestados

Objective: to analyze the perception of nursing technicians about care in enteral nutritional therapy, during a clinical simulation scenario. Method: qualitative study, based on a clinical simulation scenario, carried out with 64 nursing technicians, at a university hospital in southern Brazil, in August 2017. The statements were audio-recorded, transcribed and, subsequently, submitted to content analysis. Results: four categories were highlighted regarding care in enteral nutritional therapy in the stages of: administration of NET; maintenance of the nasoenteral tube; nursing records and guidelines for patients using NET. Conclusion: reflecting on the care provided, through a clinical simulation scenario, can collaborate with improvements regarding the work process of the nursing team and with the strengthening and safety of the care provided

Objetivo: analizar la percepción de los técnicos de enfermería sobre el cuidado en la terapia nutricional enteral, durante un escenario de simulación clínica. Método: estudio cualitativo, basado en un escenario de simulación clínica, realizado con 64 técnicos de enfermería, en un hospital universitario del sur de Brasil, en agosto de 2017. Las declaraciones fueron grabadas en audio, transcritas y, posteriormente, sometidas a análisis de contenido. Resultados: se destacaron cuatro categorías con respecto a la atención en terapia nutricional enteral en las etapas de: administración de TNE; mantenimiento de la sonda nasoenteral; registros y pautas de enfermería para pacientes que utilizan NET. Conclusión: Reflexionar sobre el cuidado brindado, a través de un escenario de simulación clínica, puede colaborar con mejoras en el proceso de trabajo del equipo de enfermería y con el fortalecimiento y seguridad del cuidado brindado

Capacitação sobre cuidados paliativos oncológicos: análise de intervenção com profissionais da saúde da atenção básica de um município do Nordeste / Training on palliative oncologic care: analysis of intervention with primary care health professionals in a town in the Brazilian Northeast

INTRODUÇÃO: cuidado paliativo é uma abordagem multidisciplinar que propõe uma melhoria na forma de cuidar do paciente e de seus familiares, que enfrentam doenças que ameacem a manutenção da vida. Os profissionais precisam estar aptos a prestar uma assistência holística. OBJETIVO: analisar as ações de intervenção sobre cuidados paliativos oncológicos na capacitação de profissionais de saúde da atenção básica, de um município do Nordeste. MÉTODO: estudo quantitativo realizado com enfermeiros e médicos, com aplicação de formulário semiestruturado. Na análise dos dados foi utilizado o teste de McNemar-Bowker, para avaliação das proporções pré e pós-curso. Estudo qualitativo realizado com cuidadores de pacientes em cuidados paliativos da atenção básica do município de Juazeiro-BA, através de entrevistas com roteiro norteador e análise de conteúdo temático. RESULTADOS: incluíram-se 69 profissionais (56% da população estimada), sendo 29 (42%) médicos e 40 (58%) enfermeiros. A maioria dos participantes (71%) era do sexo feminino, tinha idade entre 31 e 40 anos (62%), era casada/união estável (64%) e se declarou católica (65%). Destes, 71% possuíam algum tipo de pós-graduação, apenas 3% tinham capacitação em cuidados paliativos, sendo todos enfermeiros. E 10 cuidadoras familiares, todas do sexo feminino, idade entre 20 e 70 anos, 60% eram casadas e 40 % cursaram o ensino fundamental. Destas, 50% eram esposas, 30% filhas e 10% irmãs e mães. Quanto à compreensão dos profissionais sobre cuidados paliativos, antes da capacitação, 80% dos profissionais responderam correto; após, esse número subiu para 99%, o que representa um aumento de 19% depois do curso. Em habilidades, a maior parte dos profissionais optou pela alternativa 'ter a visão integral do paciente'. O percentual de respostas afirmativas variou de 82%, antes da capacitação para 95% depois, representando um aumento de 13% nas respostas. Os profissionais consideraram que devem ser disponibilizados os cuidados paliativos oncológicos, 100% dos profissionais responderam que seria por meio do plano de cuidados orientado pelo médico, antes da capacitação e após 99%. Quanto aos aspectos prioritários para disponibilizar os cuidados paliativos oncológicos, antes da capacitação, 47% responderam físicos, espirituais e emocionais e após 58% responderam o mesmo item, havendo um aumento de 11% no item correto. Com relação à percepção das cuidadoras familiares, apresentada por meio da parte qualitativa do estudo, demonstrou-se que as equipes prestam, mesmo com escassez de recursos humanos e materiais, uma assistência humana com disponibilização do acesso ao serviço e satisfação no atendimento. CONCLUSÃO: os resultados evidenciam que a capacitação foi efetiva em relação aos conhecimentos sobre cuidados paliativos, o que pode ser corroborado através da percepção das cuidadoras familiares sobre a modificação de condutas da equipe

INTRODUCTION: Palliative care is a multidisciplinary approach that proposes an improvement in the way of caring for patients and their relatives, who face diseases that threaten the maintenance of life. Professionals need to be able to provide holistic care. OBJECTIVE: To analyze the intervention actions about palliative oncologic care in the training of primary care health professionals, in a town in the Brazilian Northeast. METHOD: Quantitative study performed with nurses and physicians, using a semi-structured form. For data analysis, the McNemar-Bowker test was used in order to assess the pre- and post-course proportions. Qualitative study conducted with caregivers of pacients in palliative care in primary care patients from the town of Juazeiro-BA, through interviews with guiding script and thematic content analysis. RESULTS: A total of 69 professionals (56% of the estimated population) were included, 29 (42%) physicians and 40 (58%) nurses. Most participants (71%) were female, aged between 31 and 40 years old (62%), were married/in a stable relationship (64%) and declared themselves Catholic (65%). Of these, 71% had some kind of graduate degree, only 3% had training in palliative care, being all nurses. Moreover, 10 family caregivers, all female, aged between 20 and 70 years, where 60% were married and 40% attended elementary school. Of these, 50% were wives, 30% daughters and 10% sisters and mothers. As for the professionals' understanding of palliative care, before training, 80% of the professionals answered appropriately; after that, that number rose to 99%, which represents an increase of 19% after the course. In terms of skills, most professionals opted for the alternative 'having a comprehensive view of the patient'. The percentage of affirmative answers ranged from 82% before training to 95% afterwards, representing a 13% increase in answers. The professionals considered that palliative oncologic care should be made available, Where 100% of the professionals answered that it would be through the care plan guided by the physicians, before training and 99% after. Regarding the priority aspects to provide palliative oncologic care, before training, 47% answered physical, spiritual and emotional and after 58% answered the same item, with an increase of 11% in the correct item. Regarding the perception of family caregivers, introduced through the qualitative part of the study, it was proved that the teams provide, even with a shortage of human and material resources, a human care, thus providing access to the service and satisfaction in the service. CONCLUSION: The results show that the training was effective in relation to knowledge about palliative care, which can be corroborated through the perception of family members about the modification of the team's conduct

Partograph utilization as a decision-making tool and associated factors among obstetric care providers in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Globally, a total of 13.6 million women have died due to maternal causes from 1990 to 2015. Majority of these deaths occurred in resource-limited countries. Among the causes of these deaths, obstructed and prolonged labor covers the highest percentage, which could be prevented by cost-effective and affordable health interventions like partograph use. Therefore, this systematic review and meta-analysis aimed to assess the level of partograph utilization among obstetric care providers and its associated factors in Ethiopia. METHOD: For this review, we used the standard PRISMA checklist guideline. Different online databases were used for the review: PubMed/Medline, Google Scholar, EMBASE, Cochrane Library, HINARI, WHO Afro Library Databases, and African Online Journals. Based on the adapted PICO principles, different search terms were applied to achieve and access all the essential articles. Microsoft Excel was used for data entry and Stata version 11.0 (Stata Corporation, College Station, TX, USA) for data analysis. RESULT: Nineteen studies were included in this systematic review and meta-analysis with a total of 6237 obstetric care providers. The overall pooled prevalence of partograph utilization was 59.95% (95% CI 46.8-73.09, I2 = 99.4%, P < 0.001). Being in midwifery profession (adjusted odds ratio (AOR) 3.97; 95% confidence interval (CI) 2.63-5.99, I2 = 28.8%, P = 0.198), presence of supervision (AOR = 3.21; 95% CI 2.22-4.66, I2 = 0.0%, P = 0.742), Basic Emergency Obstetric and Newborn Care (BEmONC) training (AOR = 2.90; 95% CI 2.19-3.84, I2 = 36.9%, P = 0.13), knowledge of partograph (AOR = 2.5; 95% CI 1.6-3.8, I2 = 64.58%, P = 0.024), on-the-job refresher training on partograph (AOR = 5.7; 95% CI 2.5-12.9, I2 = 87.8%, P < 0.001), favorable attitude (AOR = 2.12; 95% CI 1.48-3.04, I2 = 0.0%, P = 0.58), and working at health center (AOR = 3.50; 95% CI 2.49-4.92, I2 = 49.1%, P = 0.08) were the determinant factors for partograph use among obstetric care providers in Ethiopia. CONCLUSION: The overall pooled prevalence of partograph utilization among obstetric care providers was low. Therefore, supportive supervision, providing Basic Emergency Obstetric and Newborn Care training, on-the-job refresher training on partograph, and promoting midwifery profession are strongly recommended to increase the use of partograph.

Assessing the impact of mentorship on nurses' and midwives' knowledge and self-efficacy in managing postpartum hemorrhage.

Background Despite medical technology advancement, postpartum hemorrhage remains the top universal cause of maternal mortality. Factors note the inconsistency in recognition and timely treatment of women experiencing it, which suggests healthcare professionals' mentorship about postpartum hemorrhage. Methods The study recruited 141 nurses and midwives and used instruments adapted to knowledge and self-efficacy to assess the impact of mentorship on nurses' and midwives' knowledge and self-efficacy in managing postpartum hemorrhage. Results There was an increase in knowledge from 68% prior to mentorship up to 87% and self-efficacy from 6.9 to 9.5 average score out of 10. Knowledge and self-efficacy correlated moderately positive at pre-mentorship (r=0.214) and strongly positive at post-mentorship (r=0.585). The number of mentorship visits attended was associated with post-mentorship knowledge scores (r=0.539) and post-mentorship self-efficacy (r=0.623). Conclusions Mentorship about management of postpartum hemorrhage increases nurses' and midwives' knowledge and self-efficacy in managing postpartum hemorrhage.

Predictors of change of health workers' knowledge and skills after the Helping Mothers Survive Bleeding after Birth (HMS BAB) in-facility training in Tanzania.

BACKGROUND: Our study aimed to assess the effect of Helping Mothers Survive Bleeding after Birth on knowledge and skills of health workers and whether such effect varies by health workers characteristics. METHODS: Nested in a cluster-randomised trial to assess the effect of the training on health outcomes, we assessed changes in knowledge and simulated skills in 61 facilities. The assessments were done i) before, ii) immediately-after training session and iii) at 10-month follow-up for subset of health-workers of implementation facilities as defined by the trial. We used a self-administered questionnaire and Objective Structures Clinical Examinations to assess three skill sets: Active Management of Third Stage of Labour, removal of retained placenta and management of severe postpartum haemorrhage. We computed summary statistics and used the paired t-test to assess change of knowledge and skills immediately post-training and at 10-month follow-up. Linear regression was done to assess association of scores and health worker characteristics. RESULTS: Of the 636 health workers included, 606 (96.7%) and 591 (91.4%) completed the knowledge and skills assessments, respectively. Majority of the participants (68%) were nurse-midwives. Knowledge scores increased by 15 percentage-points from 77.5% to 93% (95% CI 14.3, 16.3, p-value <0.000), and skills scores by 47 percentage-points (95% CI 46.5, 49.2, p-value <0.000) from 37.5% to 83%. There was a 4.0% decline of skills at 10-month follow-up. The decline was higher in auxiliary staff (-11.8%) and least in nurse-midwives (-2.1%) p-value <0.001. Health workers who assisted less than 5 deliveries in the last month, those who never attended postpartum haemorrhage in-service training and profession experience >8 years were associated with lower mean skill change immediately post-training. CONCLUSION: Our study supports the potential of the Helping Mothers Survive Bleeding after Birth training to increase knowledge and skills of postpartum haemorrhage among all professional groups. Auxiliary staff benefited most from the training but also showed higher skill decline at 10-month. Our study highlights the importance to disaggregate knowledge and skills by health workers characteristics.