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1.
Recurso de Internet en Inglés | LIS - Localizador de Información en Salud | ID: lis-LISBR1.1-47275

RESUMEN

Since onset of the Novel Coronavirus (COVID-19) the Pan American Health Organization/World Health Organization (PAHO/WHO) Office for Barbados and Eastern Caribbean Countries (ECC) has actively assisted countries to prepare and respond to the virus.


Asunto(s)
Barbados/epidemiología , Juego de Reactivos para Diagnóstico/normas , Betacoronavirus , Capacitación en Servicio/métodos
2.
J Nurs Adm ; 50(4): 209-215, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32175936

RESUMEN

Workplace violence is highly prevalent for nurses, often going unreported. Regrettably, the very patients and visitors being cared for often perpetrate the majority of violence. This article's purpose is to describe how an institution implemented a workplace violence prevention training program designed to increase nurses' perception and confidence with aggressive and violent events. Evaluation of this quality improvement program posttraining was positive, suggesting this approach may influence nurses' abilities to prevent and manage these events.


Asunto(s)
Agresión , Capacitación en Servicio , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/estadística & datos numéricos , Violencia Laboral/prevención & control , Lugar de Trabajo/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Personal de Enfermería en Hospital/psicología
3.
J Nurs Adm ; 50(4): 185-186, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32195910

RESUMEN

Despite increased onboarding and training for new graduate RNs, it is taking longer for nurses to develop clinical competence in today's complex care environment. At the same time, hospitals and health systems are facing a shortage of experienced nurses. If left unaddressed, patient quality and safety could be at risk.


Asunto(s)
Competencia Clínica/normas , Capacitación en Servicio/organización & administración , Mentores , Rol de la Enfermera , Bachillerato en Enfermería , Humanos
4.
BMC Health Serv Res ; 20(1): 76, 2020 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-32013946

RESUMEN

BACKGROUND: Interventions targeting community health workers (CHWs) aim to optimise the delivery of health services to underserved rural areas. Whilst interventions are evaluated against their objectives, there remains limited evidence on the economic costs of these interventions, and the practicality and value of scale up. The aim of this paper is to undertake a cost analysis on a CHW training and supervision intervention using exclusive breastfeeding rates amongst mothers as an outcome measure. METHODS: This is a retrospective cost analysis, from an implementer's perspective, of a cluster randomised controlled trial investigating the effectiveness of a continuous quality improvement (CQI) intervention aimed at CHWs providing care and support to pregnant women and women with babies aged < 1 year in South Africa. RESULTS: One of the outcomes of the RCT revealed that the prevalence of exclusive breastfeeding (EBF) significantly improved, with the cost per mother EBF in the control and intervention arm calculated at US$760,13 and US$1705,28 respectively. The cost per additional mother practicing EBF was calculated to be US$7647, 88, with the supervision component of the intervention constituting 64% of the trial costs. In addition, women served by the intervention CHWs were more likely to have received a CHW visit and had significantly better knowledge of childcare practices. CONCLUSION: Whilst the cost of this intervention is high, adapted interventions could potentially offer an economical alternative for achieving selected maternal and child health (MCH) outcomes. The results of this study should inform future programmes aimed at providing adapted training and supervision to CHWs with the objective of improving community-level health outcomes.


Asunto(s)
Lactancia Materna/estadística & datos numéricos , Agentes Comunitarios de Salud/economía , Agentes Comunitarios de Salud/organización & administración , Capacitación en Servicio/economía , Madres/psicología , Costos y Análisis de Costo , Femenino , Humanos , Lactante , Embarazo , Mejoramiento de la Calidad , Estudios Retrospectivos , Sudáfrica
5.
Nurs Clin North Am ; 55(1): 39-49, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32005364

RESUMEN

As novice nurses enter the workforce, they are supported by their organizations in multiple ways. During the transition period, they are developing efficiencies that are important as they become advanced beginner nurses and then competent nurses. It is important for nurses to receive support in their journey to competency to gain efficiency while providing quality patient outcomes. This article explores opportunities to develop efficiencies as nurses enter practice. There are opportunities in personal support and with system support. Nurse leaders support novice nurses by facilitating proper professional experiences and proper system support.


Asunto(s)
Competencia Clínica/normas , Eficiencia Organizacional , Capacitación en Servicio/normas , Liderazgo , Mentores , Personal de Enfermería en Hospital/normas , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
6.
BMC Health Serv Res ; 20(1): 60, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31973765

RESUMEN

BACKGROUND: Improving the training of physicians about communication skills and patient health literacy (HL) is a major priority that remains an open question. We aimed to examine the effectiveness of communication skills training for physicians on the hypertension outcomes and the health literacy skills, self-efficacy and medication adherence in patients with uncontrolled blood pressure (BP). METHODS: A randomized, controlled trial method was conducted on 240 hypertensive patients and 35 physicians presenting to healthcare clinics in the Mashhad, Iran, from 2013 to 2014. Using stratified blocking with block sizes of 4 and 6, eligible patients with uncontrolled blood pressure were randomly allocated to the intervention and control groups. Physicians in the intervention group received educational training over 3 sessions of Focus -Group Discussion and 2 workshops. The control group received the routine care. The primary outcome was a reduction in systolic and diastolic BP from baseline to 6 months. The secondary outcome was promoting HL skills in hypertensive patients. Data were analyzed using the regression model and bivariate tests. RESULTS: After the physician communication training, there was a significant improvement in physicians-patient communication skills, hypertension outcomes, medication adherence, and self-efficacy among the patients being managed by the physicians receiving training, compared to the control group. CONCLUSION: The educational intervention leads to better BP control; it may have been sufficient training of physicians change to impact counseling, HL and self-efficacy and adherence. The quality of physician-patient communication is an important modifiable element of medical communication that may influences health outcomes in hypertensive Iranian patients. TRIAL REGISTRATION: Iranian Registry of Clinical Trials (IRCT), IRCT20160710028863N24. Registered April 4, 2018 [retrospectively registered].


Asunto(s)
Comunicación , Alfabetización en Salud/estadística & datos numéricos , Hipertensión/tratamiento farmacológico , Capacitación en Servicio , Relaciones Médico-Paciente , Médicos/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Grupos Focales , Humanos , Irán , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Médicos/estadística & datos numéricos , Autoeficacia , Resultado del Tratamiento , Adulto Joven
7.
Am J Forensic Med Pathol ; 41(1): 11-17, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31977347

RESUMEN

Errors in death certification can directly affect the decedent's survivors and the public register. We assessed the effectiveness of an educational seminar targeting frequent and important errors identified by local death certificate (DC) evaluation. Retrospective review of 1500 DCs categorized errors and physician specialty. A 60-minute didactic/case-based seminar was subsequently designed for family medicine physician (FAM) participants, with administration of presurvey, immediate post, and 2-month postsurveys. Most DCs were completed by FAM (73%), followed by internists (18%) and surgeons (3%). Error occurrence (EO) rate ranged between 32 and 75% across all specialities. Family medicine physician experienced in palliative care had the lowest EO rate (32%), significantly lower (P < 0.001) than FAM without interest in palliative care (62%), internal medicine (62%), and surgery (75%). Common errors were use of abbreviations (26%), mechanism as underlying cause of death (23%), and no underlying cause of death recorded (22%). Presurvey participants (n = 72) had an overall EO rate of 72% (64% excluding formatting errors). Immediate postsurvey (n = 75) and 2-month postsurvey (n = 24) participants demonstrated significantly lower overall EO (34% and 24%, respectively), compared with the Pre-S (P < 0.05). A 60-minute seminar on death certification reduced EO rate with perceived long-term effects.


Asunto(s)
Certificado de Defunción , Documentación/normas , Capacitación en Servicio , Médicos de Familia/educación , Alberta , Causas de Muerte , Evaluación Educacional , Docentes Médicos/estadística & datos numéricos , Humanos , Internado y Residencia , Evaluación de Necesidades , Estudios Retrospectivos
8.
Rev. enferm. UFPE on line ; 14: [1-7], 2020. ilus, tab
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1095924

RESUMEN

Objetivo: levantar o conhecimento sobre a ressuscitação cardiopulmonar no adulto em Suporte Básico de Vida, com o uso do desfibrilador externo automático, em profissionais de enfermagem que atuam em uma Unidade de Pronto Atendimento antes e após um programa de capacitação, utilizando a estratégia da videoaula. Método: trata-se de um estudo quantitativo, descritivo, quase-experimental, com 40 profissionais de enfermagem de uma Unidade de Pronto Atendimento. Realizou-se a coleta de dados por meio de um questionário específico sobre o tema, previamente validado, com 12 questões de múltipla escolha. Analisaram-se os dados por meio da estatística descritiva simples. Resultados: observou-se que 51,6% dos entrevistados responderam corretamente ao questionário antes da capacitação e, após a capacitação, evidenciou-se um acerto de 59,3%. Conclusão: percebeu-se a insuficiência do conhecimento sobre a ressuscitação cardiopulmonar pelos participantes e que a estratégia da videoaula não pode ser considerada efetiva para o ensino desse procedimento para os profissionais de enfermagem que atuam em Unidades de Pronto Atendimento. Aponta-se que estes dados também demonstram a importância de se dar continuidade à capacitação com outras estratégias, a fim de se obter melhores resultados na assistência ao paciente.(AU)


Objective: to raise knowledge about cardiopulmonary resuscitation in adults in Basic Life Support, with the use of automatic external defibrillator, in Nursing professionals who work in a Emergency Care Unit before and after a training program, using the video class strategy. Method: this is a quantitative, descriptive, quasi-experimental study conducted with 40 Nursing professionals from a Emergency Care Unit. Data was collected through a previously validated specific questionnaire with 12 multiple choice questions. Data were analyzed using simple descriptive statistics. Results: It was observed that 51.6% of respondents correctly answered the questionnaire before the training and after training, it was found a correctness of 59.3%. Conclusion: it was noticed the insufficient knowledge about cardiopulmonary resuscitation by the participants and that the strategy of the video lesson cannot be considered effective for teaching this procedure to Nursing professionals working in Emergency Care Units. It is pointed out that these data also demonstrate the importance of continuing training with other strategies in order to obtain better results in patient care.(AU)


Objetivo: aumentar el conocimiento sobre la reanimación cardiopulmonar en adultos en Soporte Vital Básico, utilizando el desfibrilador externo automático, en profesionales de Enfermería que trabajan en una Unidad de Atención de Emergencia antes y después de un programa de capacitación, utilizando la estrategia de videoclase. Método: este es un estudio cuantitativo, descriptivo, cuasi experimental realizado con 40 profesionales de Enfermería de una Unidad de Atención de Emergencia. Los datos fueron recolectados a través de un cuestionario específico previamente validado con 12 preguntas de opción múltiple. Los datos se analizaron mediante estadísticas descriptivas simples. Resultados: se observó que el 51.6% de los encuestados respondieron el cuestionario correctamente antes del entrenamiento y después del entrenamiento, se evidenció una precisión del 59.3%. Conclusión: los participantes notaron un conocimiento insuficiente sobre la reanimación cardiopulmonar y que la estrategia de la lección en video no puede considerarse efectiva para enseñar este procedimiento a los profesionales de Enfermería que trabajan en las Unidades de Atención de Emergencia. Se señala que estos datos también demuestran la importancia de continuar el entrenamiento con otras estrategias, a fin de obtener mejores resultados en la atención al paciente.(AU)


Asunto(s)
Humanos , Masculino , Femenino , Recursos Audiovisuales , Conocimientos, Actitudes y Práctica en Salud , Reanimación Cardiopulmonar , Paro Cardíaco , Capacitación en Servicio , Grupo de Enfermería , Epidemiología Descriptiva
9.
Anesth Analg ; 130(3): 777-786, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31880629

RESUMEN

BACKGROUND: Electroencephalographic (EEG) brain monitoring during general anesthesia provides information on hypnotic depth. We hypothesized that anesthesia clinicians could be trained rapidly to recognize typical EEG waveforms occurring with volatile-based general anesthesia. METHODS: This was a substudy of a trial testing the hypothesis that EEG-guided anesthesia prevents postoperative delirium. The intervention was a 35-minute training session, summarizing typical EEG changes with volatile-based anesthesia. Participants completed a preeducational test, underwent training, and completed a posteducational test. For each question, participants indicated whether the EEG was consistent with (1) wakefulness, (2) non-slow-wave anesthesia, (3) slow-wave anesthesia, or (4) burst suppression. They also indicated whether the processed EEG (pEEG) index was discordant with the EEG waveforms. Four clinicians, experienced in intraoperative EEG interpretation, independently evaluated the EEG waveforms, resolved disagreements, and provided reference answers. Ten questions were assessed in the preeducational test and 9 in the posteducational test. RESULTS: There were 71 participants; 13 had previous anesthetic-associated EEG interpretation training. After training, the 58 participants without prior training improved at identifying dominant EEG waveforms (median 60% with interquartile range [IQR], 50%-70% vs 78% with IQR, 67%-89%; difference: 18%; 95% confidence interval [CI], 8-27; P < .001). In contrast, there was no significant improvement following the training for the 13 participants who reported previous training (median 70% with IQR, 60%-80% vs 67% with IQR, 67%-78%; difference: -3%; 95% CI, -18 to 11; P = .88). The difference in the change between the pre- and posteducational session for the previously untrained versus previously trained was statistically significant (difference in medians: 21%; 95% CI, 2-28; P = .005). Clinicians without prior training also improved in identifying discordance between the pEEG index and the EEG waveform (median 60% with IQR, 40%-60% vs median 100% with IQR, 75%-100%; difference: 40%; 95% CI, 30-50; P < .001). Clinicians with prior training showed no significant improvement (median 60% with IQR, 60%-80% vs 75% with IQR, 75%-100%; difference: 15%; 95% CI, -16 to 46; P = .16). Regarding the identification of discordance, the difference in the change between the pre- and posteducational session for the previously untrained versus previously trained was statistically significant (difference in medians: 25%; 95% CI, 5-45; P = .012). CONCLUSIONS: A brief training session was associated with improvements in clinicians without prior EEG training in (1) identifying EEG waveforms corresponding to different hypnotic depths and (2) recognizing when the hypnotic depth suggested by the EEG was discordant with the pEEG index.


Asunto(s)
Anestesia por Inhalación , Anestesiólogos/educación , Anestesiología/educación , Estado de Conciencia/efectos de los fármacos , Educación Médica Continua , Electroencefalografía , Capacitación en Servicio , Monitorización Neurofisiológica Intraoperatoria/métodos , Anestesiólogos/psicología , Competencia Clínica , Evaluación Educacional , Escolaridad , Conocimientos, Actitudes y Práctica en Salud , Humanos , Variaciones Dependientes del Observador , Ensayos Clínicos Pragmáticos como Asunto , Valor Predictivo de las Pruebas , Evaluación de Programas y Proyectos de Salud , Reconocimiento en Psicología
10.
Am J Hosp Palliat Care ; 37(1): 19-26, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31122034

RESUMEN

BACKGROUND: The Physician Orders for Life-Sustaining Treatment (POLST) Paradigm is an effective advance care planning tool. However, barriers to implementation persist. In the United States, POLST program development occurs at the state-level. Substantial differences between states has left POLST implementation largely unstandardized. No peer-reviewed studies to date have evaluated state-based POLST program development over time. OBJECTIVE: To assess and learn from the successes and barriers in state-based POLST program development over time to improve the reach of POLST or similar programs across the United States. DESIGN: An exploratory, prospective cohort study that utilized semistructured telephone interviews was conducted over a 3-year period (2012-2015). Stakeholder representatives from state POLST coalitions (n = 14) were repeatedly queried on time-relevant successes, barriers, and innovations during POLST program development with levels of legislative and medical barriers rated 1 to 10. Interviews were transcribed and analyzed using techniques grounded in qualitative theory. RESULTS: All coalition representatives reported continuous POLST expansion with improved outreach and community partnerships. Significant barriers to expansion included difficulty in securing funding for training and infrastructure, lack of statewide metric systems to adequately assess expansion, lack of provider support, and legislative concerns. Medical barriers (mean [standard deviation]: 5.0 [0.2]) were rated higher than legislative (3.0 [0.6]; P < .001). CONCLUSION: POLST programs continue to grow, but not without barriers. Based on the experiences of developing coalitions, we were able to identify strategies to expand POLST programs and overcome barriers. Ultimately the "lessons learned" in this study can serve as a guide to improve the reach of POLST or similar programs.


Asunto(s)
Planificación Anticipada de Atención/organización & administración , Cuidados para Prolongación de la Vida/organización & administración , Cuidado Terminal/organización & administración , Planificación Anticipada de Atención/economía , Planificación Anticipada de Atención/legislación & jurisprudencia , Actitud del Personal de Salud , Humanos , Capacitación en Servicio/organización & administración , Entrevistas como Asunto , Cuidados para Prolongación de la Vida/economía , Cuidados para Prolongación de la Vida/legislación & jurisprudencia , Estudios Longitudinales , Estudios Prospectivos , Cuidado Terminal/normas , Estados Unidos
12.
South Med J ; 112(12): 605-609, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-31796968

RESUMEN

OBJECTIVE: To determine the impact of implementing a musculoskeletal in-service educational intervention for emergency medicine (EM) residents on the use of point-of-care ultrasound (POCUS) to diagnose and manage shoulder dislocations in the emergency department (ED). METHODS: This study was conducted in the ED of an academic teaching hospital in Miami, Florida. It consisted of a short in-service educational intervention on how to perform and interpret POCUS, followed by an open, prospective convenience sample study in patients with clinical suspicion of shoulder dislocation. Twenty EM residents, with no prior shoulder scanning training, participated in the study. In all of the cases, the findings of the shoulder US were compared with radiographs, which were considered the reference standard. EM residents enrolled patients, and obtained and interpreted the shoulder US images. RESULTS: Seventy-eight patients were evaluated to rule out shoulder dislocation and/or fracture. Diagnosis of the dislocated shoulder was made in 55 of 78 patients, 53 of whom had anterior dislocations. Resident-driven POCUS had a sensitivity and specificity of 100% to diagnose and rule out, respectively, shoulder dislocations and relocations. There were no differences in the number of dislocations diagnosed and relocated by early and advanced EM residents. Results from a POCUS were available 22 ± 2.8 minutes sooner than x-ray for initial diagnosis and 27 ± 2.9 minutes (P < 0.0001) sooner than x-ray for assessment of reduction. CONCLUSIONS: EM resident physicians, with no previous training in shoulder US imaging, exposed to a brief in-service musculoskeletal education intervention, were able to diagnose shoulder dislocations via POCUS with high sensitivity and specificity. Shoulder US for dislocation should be a core component in EM training.


Asunto(s)
Medicina de Emergencia/educación , Capacitación en Servicio , Internado y Residencia , Sistemas de Atención de Punto , Luxación del Hombro/diagnóstico por imagen , Centros Médicos Académicos , Servicio de Urgencia en Hospital , Femenino , Florida , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Muestreo , Sensibilidad y Especificidad , Ultrasonografía
13.
J Forensic Nurs ; 15(4): 242-249, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31764528

RESUMEN

BACKGROUND: Engaging in trauma-informed approaches in nonforensic mental health settings improves therapeutic relationships, promotes healing, promotes posttraumatic growth, improves staff well-being, and fosters hope and empowerment, yet little is known of its influences in forensic settings. This literature review explores trauma-informed education and its training implications for nurses working in forensic mental health. METHOD: Using a range of electronic databases, a systematic search of literature was carried out focusing on trauma-informed practice in adult forensic mental health settings. Before searching, predefined inclusion and exclusion criteria were agreed. FINDINGS: After duplication removal, abstract review, and full screening, nine articles met review criteria for inclusion. A thematic analysis of the literature identified two key themes: "education for trauma-informed practice" and "applying theory into practice." Each had several subordinate themes. IMPLICATIONS FOR FORENSIC PRACTICE: Organizations and their staff must recognize that operational change and ongoing training will be required. By adopting a trauma-informed approach, forensic mental health nurses can better understand their patients' traumatic experiences, improve their therapeutic relationships, and engage patients in collaborative care. Training in trauma-informed care should start with nurses who will change their personal practice and can support and train their colleagues.


Asunto(s)
Capacitación en Servicio , Enfermería Psiquiátrica/educación , Trauma Psicológico/enfermería , Actitud del Personal de Salud , Humanos , Liderazgo , Política Organizacional , Influencia de los Compañeros
14.
Med Educ Online ; 24(1): 1555435, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31671284

RESUMEN

Effective mentoring enhances the personal and professional development of mentees and mentors, boosts the reputation of host organizations and improves patient outcomes. Much of this success hinges upon the mentor's ability to nurture personalized mentoring relationships and mentoring environments, provide effective feedback and render timely, responsive, appropriate, and personalized support. However, mentors are often untrained raising concerns about the quality and oversight of mentoring support.To promote effective and consistent use of mentor training in medical education, this scoping review asks what mentor training programs are available in undergraduate and postgraduate medicine and how they may inform the creation of an evidenced-based framework for mentor training.Six reviewers adopted Arksey and O'Malley's approach to scoping reviews to study prevailing mentor-training programs and guidelines in postgraduate education programs and in medical schools. The focus was on novice mentoring approaches. Six reviewers carried out independent searches with similar inclusion/exclusion criteria using PubMed, ERIC, EMBASE, SCOPUS, Google Scholar, and grey literature databases. Included were theses and book chapters published in English or had English translations published between 1 January 1990 and 31 December 2017. Braun and Clarke's approach to thematic analysis was adopted to circumnavigate mentoring's and mentor training's evolving, context-specific, goal-sensitive, learner-, tutor- and relationally dependent nature that prevents simple comparisons of mentor training across different settings and mentee and mentor populations.In total, 3585 abstracts were retrieved, 232 full-text articles were reviewed, 68 articles were included and four themes were identified including the structure, content, outcomes and evaluation of mentor training program.The themes identified provide the basis for an evidence-based, practice-guided framework for a longitudinal mentor training program in medicine and identifies the essential topics to be covered in mentor training programs.


Asunto(s)
Capacitación en Servicio/organización & administración , Mentores/educación , Facultades de Medicina/organización & administración , Educación Médica/organización & administración , Humanos
15.
Medicine (Baltimore) ; 98(46): e17898, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31725637

RESUMEN

This study demonstrated a training program of the suction-assisted laryngoscopy assisted decontamination (S.A.L.A.D.) technique for emergency medical technician paramedic (EMT-P). The effectiveness of the training program on the improvements of skills and confidence in managing soiled airway was evaluated.In this pilot before-after study, 41 EMT-P participated in a training program which consisted of 1 training course and 3 evaluation scenarios. The training course included lectures, demonstration, and practice and focused on how to perform endotracheal intubation in soiled airway with the S.A.L.A.D technique. The first scenario was performed on standard airway mannequin head with clean airway (control scenario). The second scenario (pre-training scenario) and the third scenario (post-training scenario) were performed in airway with simulated massive vomiting. The post-training scenario was applied immediately after the training course. All trainees were requested to perform endotracheal intubation for 3 times in each scenario. The "pass" of a scenario was defined as more than twice successful intubation in a scenario. The intubation time, count of successful intubation, pass rate, and the confidence in endotracheal intubation were evaluated.The intubation time in the post-training scenario was significantly shorter than that in the pre-training scenario (P = .031). The pass rate of the control, pre-training, and post-training scenario was 100%, 82.9%, and 92.7%, respectively. The proportion of trainees reporting confident or very confident in endotracheal intubation in soiled airway increased from 22.0% to 97.6% after the training program. Kaplan-Meier analysis revealed that the adjusted hazard ratio of successful intubation for post-training versus pre-training scenario was 2.13 (95% confidence interval of 1.57-2.91).The S.A.L.A.D. technique training could efficiently help EMT-P performing endotracheal intubation during massive vomiting simulation.


Asunto(s)
Auxiliares de Urgencia/educación , Intubación Intratraqueal/métodos , Laringoscopía/educación , Succión/educación , Vómitos/terapia , Adulto , Competencia Clínica , Estudios Controlados Antes y Después , Descontaminación , Diseño de Equipo , Femenino , Humanos , Capacitación en Servicio , Laringoscopía/métodos , Masculino , Maniquíes , Persona de Mediana Edad , Proyectos Piloto , Succión/métodos
16.
Clin Interv Aging ; 14: 1515-1525, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692560

RESUMEN

Introduction: Paternalism, assuming control of aged care, is a widespread orientation in older adults care. Paternalistic attitudes and practices are commonly understood as a threat to the freedom and autonomy of a person, making patients more dependent. Therefore, the reduction of these attitudes and behaviors is a primary goal for any older adult health and social care situation. The aim of this preliminary study is to develop a behavioral intervention to decrease paternalistic behaviors in formal caregivers and to increase those care behaviors which promote autonomy at post-intervention (1 week) and at follow-up (14 weeks). Methods: A sample of 118 professional caregiver volunteers working in day care centers and nursing homes were assigned to quasi-experimental (N=47) and control (N=71) conditions. The intervention consisted of 3 weekly group sessions. Individual and contextual measures were collected: 1) the primary outcome variable was the type of care (paternalistic versus autonomist) measured through the self-report Paternalist/Autonomist Care Assessment (PACA); 2) A 10-item caregiver self-register of paternalistic behaviors was carried out, 3) Finally, in order to assess the potential effects on observed behavior both in caregiver and older adult functioning at a contextual level, the five institutions were assessed through the SERA-RS. Results: Compared with the control group, caregivers in the behavioral intervention group displayed significantly lower paternalistic appraisals at posttest and follow-up. Regarding the intervention group, caregivers at posttest and follow-up showed significantly greater occurrence of autonomist behaviors being promoted and lower paternalistic appraisal. The results regarding the effect on the institutions showed better personnel performance and older adult functioning. Conclusion: Caregivers who followed the intervention learned to better identify older adult needs; although we did not find significant differences in autonomy occurrence compared with the control group, a behavioral intervention may promote more autonomist environments and, therefore, better personnel and older adult functioning.


Asunto(s)
Terapia Conductista , Cuidadores/educación , Capacitación en Servicio , Paternalismo , Autonomía Personal , Adulto , Centros de Día para Mayores , Anciano , Actitud del Personal de Salud , Curriculum , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados no Aleatorios como Asunto , Casas de Salud , España
17.
West Afr J Med ; 36(3): 232-238, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31622485

RESUMEN

BACKGROUND: Pain is a public health problem requiring serious attention. One major barrier to the provision of quality pain treatment in many countries is lack of training for healthcare workers. The aim of this study was to evaluate the impact of pain education on the knowledge and attitude of healthcare workers, and opioid utilization in a university teaching hospital. METHODS: Pain management workshops were conducted for healthcare workers over a 12-month period. The modified "Knowledge and Attitudes Survey Regarding Pain" questionnaire was administered to participants pre- and post- training for each of the workshops. The total mark by each participant was entered into the Statistical Package for Social Sciences (SPSS) software version 16 software for windows (SPSS Inc., Chicago, Illinois, USA) for comparison of means for pre- and post-test. Changes in opioid utilization were evaluated. RESULTS: The pre-test and post-test questionnaires were filled by 715 and 700 participants respectively. The mean post-test score was significantly higher than the pre-test score (68% versus 49% respectively, p = 0.00001). The doctors scored significantly higher than the other groups (p < 0.0001) in the pre-test. The mean post-test scores were significantly higher than the corresponding mean pre-test scores for the various groups (p < 0.0001). Sustained increase (up to 60.4%) in total morphine utilization was observed during the training. CONCLUSION: There is a wide knowledge gap requiring regular training and re-training to achieve improved pain management and opioid utilization among healthcare workers. Inclusion of robust pain curricula in medical training programs will significantly improve pain management.


Asunto(s)
Analgésicos Opioides/efectos adversos , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/educación , Manejo del Dolor/métodos , Dolor/tratamiento farmacológico , Competencia Profesional , Adulto , Evaluación Educacional , Femenino , Hospitales de Enseñanza , Humanos , Capacitación en Servicio , Masculino , Persona de Mediana Edad , Nigeria , Evaluación de Programas y Proyectos de Salud , Encuestas y Cuestionarios
18.
Artículo en Inglés | MEDLINE | ID: mdl-31614952

RESUMEN

Background: Smoking is among the most preventable causes of death globally. Tobacco cessation can lessen the number of potential deaths. The China Tobacco Cessation Guidelines encourage medical staff to perform the 5As (Ask, Advise, Assess, Assist, Arrange) when delivering tobacco dependence treatments to patients. Nursing students will develop to be nurses in the future and they have to finish 9 months of clinical practicum study in the last year at hospitals or care centers. However, the frequency of behaviors used to help smokers quit among Chinese nursing internship students is unclear. This study analyzed the rate of nurse interns' performance of the 5As and which demographic characteristics, perceptions of smoking and knowledge predicted higher performance of the 5As. Methods: The cluster sampling method was used to select 13 teaching hospitals among 29. All nursing intern students were expected to finish the questionnaire about their 5As behaviors to help patients quit smoking. Their 5As performances were scored from one to five with 5 being the best and scores were summed. A multivariate linear mixed-effect model was employed to test the differences between their 5As. Results: Participating in the survey were 1358 interns (62.4% response rate). The average scores were as follows-Ask-3.15, Advise-2.75, Assess-2.67, Assist-2.58 and Arrange-2.42. A total of 56.3% students perceived that medical staff should perform the 5As routinely to help patients quit smoking. On the other hand, 52.1% viewed clinical preceptors as role models of the 5As. School education regarding tobacco control, smoking dependence treatment, self-efficacy and positive intentions were predictors of higher performance of the 5As (p < 0.001). Conclusions: Nursing internship students seldom administered tobacco dependence treatments to patients. It is essential to improve the corresponding education, skills and self-efficacy of the 5As. Meanwhile, clinical preceptors should procure more training in the responsibilities and skills related to tobacco cessation. In this way, clinical preceptors can be role models of the 5As and impart positive influences on interns.


Asunto(s)
Internado y Residencia , Fumadores/psicología , Cese del Hábito de Fumar/métodos , Estudiantes de Enfermería , Tabaquismo/terapia , Adulto , China , Estudios Transversales , Femenino , Humanos , Capacitación en Servicio , Masculino , Autoeficacia , Fumar , Encuestas y Cuestionarios , Fumar Tabaco
19.
AANA J ; 87(2): 7-14, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31587730

RESUMEN

First responders need hands-on experience with pediatric airway management, but the impact of a learner program in the operating room (OR) is unknown. We developed, implemented, and evaluated a pediatric airway "rotator" (PAR) program for 8 multidisciplinary groups to obtain this experience. This quality improvement pilot was conducted in the pediatric ORs from November 2017 to January 2018. We surveyed learner group leaders and anesthesia teachers about their PAR airway management expectations and developed a universal set of prerequisites, objectives, and simulation experiences. Airway management skills were assessed in a group of PARs at baseline. During implementation, another group of PARs completed prerequisites and reviewed objectives before coming to the OR for simu-lation using an infant mannequin. Then they entered the OR for "live" airway management. A comparison of preintervention and postintervention skills suggested an improvement in performance for most airway management domains except laryngeal mask airway insertion, which stayed about the same, and intubation, which decreased in the postintervention group. In the postassessment surveys, the PARs indicated that the interventions were helpful to their learning, and the anesthesia teachers' responses indicated that the primary goals to improve PARs' preparedness, airway management, and communication skills were achieved.


Asunto(s)
Manejo de la Vía Aérea/normas , Socorristas/educación , Capacitación en Servicio , Intubación Intratraqueal/instrumentación , Enfermeras Anestesistas/educación , Anestesiología/educación , Anestesiología/normas , Preescolar , Humanos , Lactante , Recién Nacido , Mid-Atlantic Region , Quirófanos , Pediatría , Proyectos Piloto , Mejoramiento de la Calidad , Encuestas y Cuestionarios
20.
AANA J ; 87(1): 11-18, 2019 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31587738

RESUMEN

Patients wait an average of 23 hours for a peripherally inserted central catheter (PICC) in our hospital. Long waits lead to delays in discharge and medication administration. For quality improvement, development of a Certified Registered Nurse Anesthetist (CRNA) PICC line backup service was proposed. This project collected benchmarking data about the current PICC line service over 3 months. The Intravenous (IV) Nursing Unit and the Interventional Radiology Division teams insert an average of 8.1 PICC lines daily, but the demand for PICC lines is 12 insertions per day; thus, the current, combined PICC service meets 66% of its demand. The CRNAs insert IV catheters daily and are eligible to insert PICC lines. A PICC training pro-gram was developed to train a CRNA in a standardized curriculum with simulation using a partial-task trainer. Using an N-of-1 method, the CRNA inserted 10 PICCs over 3 weeks under the guidance of an IV team PICC nurse. The CRNA reached a level of competence in PICC insertion after 10 attempts, with a 70% success rate, in intervals equivalent to those of IV PICC RNs. A CRNA can be trained in a short timeframe as a resource to decrease waiting for patients needing PICC lines.


Asunto(s)
Cateterismo Periférico/economía , Capacitación en Servicio , Enfermeras Anestesistas/educación , Listas de Espera , Cateterismo Periférico/enfermería , Análisis Costo-Beneficio , Humanos , Pennsylvania , Mejoramiento de la Calidad
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