Evaluation of nursing process competencies, nursing quality, and patient safety using virtual simulation with debriefing: A quasi-experimental study.

Background: Investing in clinical education is important for adult urgent and emergency surgery and traumatology as it promotes registered nurses' competencies by providing professional development training to respond to urgent or emergency surgeries. Objective: To examine registered nurses' self-assessment of the effects of virtual video simulation with an immediate debriefing approach on nursing process competencies, nursing care quality, incomplete care, and patient safety in surgical units. Methods: This study used a quasi-experimental two-group pre- and post-test design. The study was conducted at two provincial hospitals in Cambodia. Participants included registered nurses employed in surgical units. The experimental group (n = 46) completed a virtual video simulation and immediate debriefing. The control group (n = 35) completed virtual training on the nursing process. Data were collected two months after a successful second-week follow-up using Competency of Nursing Process, Cambodian Nursing Care Quality, Care Left Undone, and Patient Safety scales. Wilcoxon signed-rank test and Mann-Whitney U test were used to evaluate the differences before and after the sessions. Generalized linear model was used to compare the differences between the two groups. Results: The results showed statistically significant improvements in the experimental group on competency, nursing care quality, patient safety, and reducing care left undone after the intervention. However, the control group revealed statistically insignificant differences. In addition, the experimental group provided positive feedback, such as experiencing a real patient scenario, developing critical-thinking, improving communication skills, and having an opportunity to ask questions. Conclusion: Our study showed that VVS and immediate debriefing have the potential to support in-service training of RNs from diverse backgrounds. Particularly, integrating virtual video simulation and immediate debriefing may to promote competency in the nursing process and improve care outcomes.

Development and psychometric testing of a competency of nursing process questionnaire.

Objectives: This study aimed to develop and evaluate a competency of nursing process questionnaire (CNPQ) for registered nurses in Cambodia. Methods: Guided by the nursing process, an initial questionnaire was generated through focus group discussion, literature review, and the expert consultation. Finally, the validity and reliability of the questionnaire were validated through a questionnaire survey online of 260 registered nurses selected from Complimentary Package Activities 1, 2, 3, and national hospitals from January to February 2022 in five geographic areas of Cambodia. Results: The content validity index was 1.00. The Cronbach's α coefficient for the whole questionnaire was 0.963, and the range for the five dimensions was 0.963-0.964, which shows that the questions were consistent. The test-retest reliability was 0.769. The exploratory factor analysis led to a list of 24 items that were grouped into five dimensions: assessment, diagnosis, planning, implementation, and evaluation. The cumulative variance contribution rate was 70.08%. Conclusions: The CNPQ developed in this study showed good reliability and validity and can be used to assess the competency of registered nurses by themselves and help nursing managers to develop the relevant policies.

Nursing workforce characteristics and effect on life expectancy and under-five mortality in the ASEAN.

AIM: To assess the effects of the nursing workforce and advanced nursing practice on the outcomes of patients and life expectancy, including mortality rates of under-five children in Cambodia, and to develop policy recommendations to increase the influence of the nursing workforce. BACKGROUND: In low-middle-income nations, life expectancy and under-five mortality are important measures of public health. However, there is still a dearth of literature related to the nursing workforce in Southeast Asia. METHOD: The authors retrieved the data from the World Nursing Report produced by the World Health Organization 2020 for 10 member states. The transparent reporting of a multivariable prediction model for individual prognosis or diagnosis checklist has guided this study. The univariate linear regression model was applied to categorize the potential predictors for each outcome assessment. In addition, the Spearman rank correlation test was selected to assess the potential predictors, and a multivariate statistical analysis was carried out for each of the five outcomes. RESULTS: According to the study's findings, nurse density and advanced practice nursing improve both female and male life expectancy. The existence of advanced nursing roles is associated with decreased under-five mortality. CONCLUSIONS: There are great opportunities to improve the nursing workforce within Cambodia and other Association of Southeast Asian Nations member states to increase patient outcomes. Investment in nursing is essential for improved patient outcomes. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Health policy investments in these projects and future initiatives intended to advance nurse density, education, and practice are based on this study's results. Policy initiatives should focus on increasing density because nursing appears to impact life expectancy and other outcomes.

Candidates' and policymakers' perspectives on the needs for a master's program in nursing.

BACKGROUND: Quality and safe care requires nurses with advanced knowledge and skills. Cambodia does not have a graduate-level nursing program; therefore, nurses are required to pursue advanced degrees in other countries. However, a master's degree nursing program is being established in this country. OBJECTIVES: To explore the needs of stakeholders in the master's nursing program in Cambodia to establish the curriculum. DESIGN: Students and graduates of Bachelor of Sciences in Nursing were surveyed, and policymakers were interviewed face-to-face. PARTICIPANTS: As candidates for the master's nursing program, 94 undergraduates and 37 graduates participated in the survey, and four policymakers working at the Ministry of Health and Cambodian Council of Nurses were interviewed. METHODS: Descriptive statistics and frequency analyses were utilized for quantitative data and qualitative data were thematically analyzed. RESULTS: All 131 undergraduates and graduates were willing to apply to the master's program in nursing mainly to improve their knowledge and skills. They cited financial burden as a challenge for their study. Their educational demands were closely related to Cambodia's social situation and reflected their aspiration for advanced degrees and to become nursing leaders. The policymakers unanimously agreed on the need for the program and suggested policies and strategies to operate the course and recognize the role of graduates with this qualification. They reinforced that the curriculum should be based on the law, regulation, and policy and reflect Cambodia's current situation by identifying the needs of students and hospital officials and investigating available resources. Their perspectives revealed their expectations for graduates to plan healthcare policies and support them as their coworkers. CONCLUSIONS: The establishment of nursing master's course should be accompanied by a policy to support nursing students. Nursing educators and experienced senior nurses should be included in this policymaking and they must participate in the development of the curriculum. It is suggested to develop an eclectic master's program in nursing that aggregates all opinions of stakeholders.

Saving babies' lives (SBL) - a programme to reduce neonatal mortality in rural Cambodia: study protocol for a stepped-wedge cluster-randomised trial.

BACKGROUND: Neonatal mortality remains unacceptably high. Many studies successful at reducing neonatal mortality have failed to realise similar gains at scale. Effective implementation and scale-up of interventions designed to tackle neonatal mortality is a global health priority. Multifaceted programmes targeting the continuum of neonatal care, with sustainability and scalability built into the design, can provide practical insights to solve this challenge. Cambodia has amongst the highest neonatal mortality rates in South-East Asia, with rural areas particularly affected. The primary objective of this study is the design, implementation, and assessment of the Saving Babies' Lives programme, a package of interventions designed to reduce neonatal mortality in rural Cambodia. METHODS: This study is a five-year stepped-wedge cluster-randomised trial conducted in a rural Cambodian province with an estimated annual delivery rate of 6615. The study is designed to implement and evaluate the Saving Babies' Lives programme, which is the intervention. The Saving Babies' Lives programme is an iterative package of neonatal interventions spanning the continuum of care and integrating into the existing health system. The Saving Babies' Lives programme comprises two major components: participatory learning and action with community health workers, and capacity building of primary care facilities involving facility-based mentorship. Standard government service continues in control arms. Data collection covering the whole study area includes surveillance of all pregnancies, verbal and social autopsies, and quality of care surveys. Mixed methods data collection supports iteration of the complex intervention, and facilitates impact, outcome, process and economic evaluation. DISCUSSION: Our study uses a robust study design to evaluate and develop a holistic, innovative, contextually relevant and sustainable programme that can be scaled-up to reduce neonatal mortality. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04663620 . Registered on 11th December 2020, retrospectively registered.

Barriers and facilitators to neonatal health and care-seeking behaviours in rural Cambodia: a qualitative study.

OBJECTIVES: Neonatal mortality remains persistently high in low-income and middle-income countries. In Cambodia, there is a paucity of data on the perception of neonatal health and care-seeking behaviours at the community level. This study aimed to identify influencers of neonatal health and healthcare-seeking behaviour in a rural Cambodian province. DESIGN: A qualitative study using focus group discussions and thematic content analysis. SETTING: Four health centres in a rural province of Northern Cambodia. PARTICIPANTS: Twenty-four focus group discussions were conducted with 85 community health workers in 2019. RESULTS: Community health workers recognised an improvement in neonatal health over time. Key influencers to neonatal health were identified as knowledge, sociocultural behaviours, finances and transport, provision of care and healthcare engagement. Most influencers acted as both barriers and facilitators, with the exception of finances and transport that only acted as a barrier, and healthcare engagement that acted as a facilitator. CONCLUSION: Understanding health influencers and care-seeking behaviours is recognised to facilitate appropriate community health programmes. Key influencers and care-seeking behaviours have been identified from rural Cambodia adding to the current literature. Where facilitators have already been established, they should be used as building blocks for continued change.

Development and Implementation of Cornerstone Documents to Support Nursing Practice in Cambodia.

Cornerstone, or guiding documents, for nursing and healthcare support the profession of nursing throughout the world. This article describes the impact of the civil war and instability in Cambodia that led to poverty and destruction of the healthcare system and provides a brief overview of nursing in Cambodia today. Since the 1990s, the Cambodian healthcare system has been recovering from war. Nurses have been transitioning from task oriented roles to more sophisticated roles that incorporate the nursing process. In addition to significant changes in nursing education and other advances in the healthcare system during the last five years, the Ministry of Health (MoH) has strongly encouraged the development of cornerstone documents to guide nursing practice for patient care provided in Cambodia. Standards and competencies have been developed based on the American Nurses Association (ANA) template for Scope and Standards of Practice. Cornerstone documents for nursing that have been implemented by the MoH, many at the Angkor Hospital for Children, include evidence based protocols, the nursing process framework, the Code of Ethics for Nurses and development of the Scope of Practice and Standards of Care for Cambodian Nurses.

Assessment of the effect of Advanced Paediatric Life Support training on level of self-perceived preparedness among health-care workers in Cambodia.

OBJECTIVE: The objective of this study was to survey the self-perceived preparedness of Cambodia's Advanced Paediatric Life Support (APLS) providers towards their APLS training and accreditation 5 years post-implementation. METHODS: A cross-sectional survey was administered in December 2009 to APLS providers who had been trained throughout the 5 year period from December 2005 to May 2009. RESULTS: One hundred and two (93%) APLS providers responded. The median rating for their original APLS learning experience was 6 out of 10, and the reported median recall of the APLS teaching content was 7 out of 10. Since their training, 80% had managed a child in cardiac arrest, 85% a child with serious illness and 72% with serious injury. Their subjective preparedness from APLS training for each of the three resuscitation types, on a scale of 1-10, were medians of 7, 7 and 6, respectively. For all groups, perceived preparedness for all three resuscitation types did not differ despite varying lengths of time from their original training. CONCLUSION: APLS training has increased the self-perceived preparedness of paediatric health-care workers in Cambodia. RESULTS indicate moderate relevance to real patient resuscitations experienced by health workers, and the perceived recall of the teachings and sense of preparation from APLS training does not significantly decline over time. However, our results suggest subsequent further APLS instructor courses might maintain resuscitation preparedness.

Global partnerships for professional development: a Cambodian exemplar.

Nurses have been volunteering to provide direct patient care in developing countries for several decades. As a result, countries have begun to develop their health care workforce capacity and standards of care, but educational and professional development needs have emerged. Global partnerships involving volunteers can assist developing countries to fulfill these needs, but little literature focuses on maximizing volunteers' experiences. Through global partnerships and collaboration, the leadership and academic capacity of nurses and other health care professionals in developing countries can be enhanced. In Cambodia specifically, the Khmer Rouge executed many educated health care personnel in the late 1970s, effectively eliminating a generation of mentors and leaders that could facilitate the professional development of the current workforce. One outcome may be the dearth of baccalaureate and graduate nursing programs in Cambodia. Two teams of U.S. volunteers and one of their Cambodian partners, a nursing education coordinator at a nongovernmental children's hospital, offer their experiences in collaborating, including the mutual benefits to both of such a partnership and the lessons learned. The authors will delineate several exemplars from their experiences of teaching and professional development.