Implementing the organizational readiness for change survey during a novel midwifery preceptor program in Sierra Leone: stakeholder results.

BACKGROUND: Sierra Leone has one of the world's highest maternal and infant mortality rates and suffers from a shortage of well-trained health professionals, including midwives. Prior to engaging in systematic interventions, it is critical to measure organizational readiness to gauge members' psychological and behavioral preparedness to implement change. We aimed to measure the organizational readiness for implementing change and compare results among midwives and administrative leaders at two schools of midwifery in Sierra Leone prior to the rollout of a midwifery preceptor program. METHODS: The Organizational Readiness for Implementing Change (ORIC) survey is a validated 12-item questionnaire designed to assess two domains of organizational readiness for change: change commitment (motivation) and change efficacy (capacity). All survey items begin with the same prompt and a five-item Likert scale response, with seven questions about change commitment and five about change efficacy. Data collection occurred in two schools of midwifery in Sierra Leone during two day-long meetings with stakeholders. Statistical analysis was conducted using descriptive statistics and Wilcoxon rank-sum test to compare independent samples: School 1 versus School 2 (site), midwife versus other roles (role). RESULTS: Participants included 42 respondents (mean age 41 years, 95% female). Surveys were distributed evenly between the two sites. Occupations included midwifery faculty (n = 8), administrators (n = 5), clinicians (n = 25), and clinical educators (n = 4). Domain 1 (change commitment) had a mean score of 4.72 (SD 0.47) while Domain 2 (change efficacy) had a mean score of 4.53 (SD 0.54) out of a total potential score of five. There were no statistically significant differences between site responses for Domain 1 (p = 0.5479) and Domain 2 (p = 0.1026) nor role responses for Domain 1 (p = 0.0627) and Domain 2 (p = 0.2520). CONCLUSION: Stakeholders had very high overall readiness for change across all ORIC questions for both change commitment and change efficacy. Mean scores for change commitment were slightly higher which is not surprising given the low-resourced settings stakeholders work in while training students. High mean scores across sites and roles is encouraging as this novel preceptor program is currently being rolled out.

Development and initiation of a preceptor program to improve midwifery and nursing clinical education in sub-saharan Africa: protocol for a mixed methods study.

BACKGROUND: Expanding the quality and quantity of midwifery and nursing clinical preceptors is a critical need in many sub-Saharan educational settings to strengthen students' clinical learning outcomes, and ultimately to improve maternal and child mortality. Therefore, this study protocol was developed to establish a year-long, four step, precepting program to (1) improve partnership building and program development (2) provide an evidence-based course to expand competency and confidence in precepting students (3) select preceptors to become train the trainers and (4) secure accreditation for the program, ultimately to engage and support cohorts of preceptors and continue to monitor and evaluate the effectiveness of the program over five years. METHODS: Qualitative and quantitative approaches will be used including evaluation of preceptors, faculty and leadership involved with the program, as well as students taught by preceptors. Data will include validated self-assessment scales, objective structured clinical examinations (OSCEs), satisfaction surveys, and direct clinical observation, in-depth interviews and/or focus group discussions (preceptors); feedback forms (students); process mapping and organizational readiness for implementing change surveys (faculty and leadership). Median change in scores will be the primary outcome for quantitative data. Content analysis within a deductive framework to identify key implementation and adoption themes will be used for qualitative data analysis. DISCUSSION: This study aims to assess the readiness and early effectiveness for implementing a preceptor program for midwifery and nursing in Sierra Leone and Malawi. Determining the effectiveness of this program will guide future adaptations in order to strengthen the program for sustainability and potential scale-up.

The impact of clinical placement site, community clinic versus tertiary hospital, on midwifery students' clinical learning experience in Sierra Leone: a cohort study.

BACKGROUND: In midwifery education, the clinical learning experience (CLE) is a critical component to gaining competency and should comprise greater than 50% of a student's education. Many studies have identified positive and negative factors affecting students' CLE. However, few studies have directly compared the difference in CLE based on placement at a community clinic versus a tertiary hospital. METHODS: The aim of this study was to examine how clinical placement site, clinic or hospital, impacts students' CLE in Sierra Leone. A once 34-question survey was given to midwifery students attending one of four public midwifery schools in Sierra Leone. Median scores were compared for survey items by placement site using Wilcoxon tests. The relationship between clinical placement and student's experience were assessed using multilevel logistic regression. RESULTS: Two-hundred students (hospitals students = 145 (72.5%); clinic students = 55 (27.5%) across Sierra Leone completed surveys. Most students (76%, n = 151) reported satisfaction with their clinical placement. Students placed at clinics were more satisfied with opportunities to practice/develop skills (p = 0.007) and more strongly agreed preceptors treated them with respect (p = 0.001), helped improve their skills (p = 0.001), provided a safe environment to ask questions (p = 0.002), and had stronger teaching/mentorship skills (p = 0.009) than hospital students. Students placed at hospitals had greater satisfaction in exposure to certain clinical opportunities including completing partographs (p < 0.001); perineal suturing (p < 0.001); drug calculations/administration (p < 0.001) and estimation of blood loss (p = 0.004) compared to clinic students. The odds of students spending more than 4 h per day in direct clinical care were 5.841 (95% CI: 2.187-15.602) times higher for clinic students versus hospital students. There was no difference between clinical placement sites in regards to number of births students attended (OR 0.903; 95% CI: 0.399, 2.047) or number of births students managed without a preceptor/clinician present (OR 0.729; 95% CI: 0.285, 1.867). CONCLUSION: The clinical placement site, hospital or clinic, impacts midwifery students' CLE. Clinics offered students significantly greater attributes of a supportive learning environment and access to direct, hands-on opportunities for patient care. These findings may be helpful for schools when using limited resources to improve the quality of midwifery education.

Creating a culture of respect and interprofessional teamwork on a labor and birth unit: a multifaceted quality improvement project.

Interprofessional teamwork is essential to high-quality healthcare, however disrespect and incivility amongst team members is a challenge to creating and sustaining effective teams. We describe and assess the impact of a multifaceted improvement project with the primary intervention being a Compassionate Communication (CC) training on a Labor and Birth unit. Our hypothesis was this improvement project would increase staff members' capacity for perspective-taking and self-reflection, which would in turn correlate with positive interpersonal interactions, respect and teamwork. Secondly, we hypothesized that enhanced respect and teamwork would correlate with enhanced affective commitment to the organization. Staff was surveyed midway through the project and 6 months after the CC training. A total of 74 (57%) staff completed the initial pre-training surveys and 50 (38%) staff completed post-training surveys. At 6 months post-CC training we saw changes in self-reflection and an awakening of self-awareness. There were no significant changes in perspective-taking. However, we did see changes in staffs' perceptions of respect and teamwork. Team members' affective commitment to the organization increased. In this Labor and Birth setting, a multifaceted improvement project with the primary intervention being CC training was beneficial in improving a culture of respect and interprofessional teamwork.

Process Mapping Midwifery Students' Clinical Placement in Sierra Leone: Identifying Facilitators and Barriers.

Background: Improving midwifery education is critical to improving maternal and infant health outcomes in Sierra Leone. A significant priority within midwifery education is to strengthen the clinical teaching and students' hands-on experience in the clinical setting. Objectives: To identify facilitators and challenges within midwifery students' clinical placements and to highlight areas to strengthen the clinical midwifery education system as well as the role of preceptors. Methods: We conducted a participatory process mapping with two schools of midwifery in Sierra Leone to detail steps taken by practicing midwives and midwifery faculty when students are placed in clinical settings for midwifery rotations. Findings: There were 42 participants from the Bo and Makeni regions of Sierra Leone. Participants included midwifery faculty from the Schools of Midwifery in Makeni and Bo, clinical midwives from two regional government hospitals, clinical midwives from two affiliated community health centers, and midwives from the District Health Management Teams. Three recurring themes emerged in the process. First, there was always some element of preparing or teaching the student. Second, there were administrative tasks to coordinate between the schools, clinical sites, and students, before, during, and after clinical placements. And third, there were elements of communication and collaboration between schools and clinical sites/preceptors that could be improved through shared understanding and standardization. Additional themes were inconsistencies across activities before, during, and after students' clinical placement and limited opportunities and confusion around systems of evaluating all components of the clinical placement experience. Conclusions: This study provides insight into the process of midwifery students' clinical placement and highlights facilitators to be standardized and some modifiable barriers to be addressed. As Sierra Leone and many other similar countries in sub-Saharan Africa attempt to strengthen students' clinical education through educating and developing preceptors, processing mapping can be a useful tool.

Effectiveness of a pediatric critical care pilot preceptor program: Improved confidence and competency outcomes among a cohort of professional nurses in Blantyre, Malawi.

BACKGROUND: Availability of high-level pediatric training for nurses in Malawi is limited. To address this gap, a novel pediatric critical care nurse preceptor program was developed and implemented by pediatric nurse specialists. AIM: Evaluate the effectiveness of a pediatric critical care nurse preceptor program, via change in nurses' knowledge, skills, confidence, and precepting competence. DESIGN: A 12-month pediatric critical care nurse preceptor program with assessments at baseline, end of intensive (3 months), and end of program (6 months). SETTING: Blantyre, Malawi. PARTICIPANTS: Nurses with two or more years of pediatric nursing experience (N = 20) nominated by unit managers. METHODS: Quantitative data were collected throughout program implementation. Assessments included: (1) multiple choice knowledge test, (2) Objective Structured Clinical Examinations in two areas (vital signs and airway, breathing, circulation, disability, exposure assessments; and blood gas and electrolyte analysis), (3) group simulations (cardiopulmonary resuscitation or respiratory distress), (4) Likert-scale clinical confidence survey, and (5) Likert-scale precepting competence survey. Data were analyzed using repeated measures ANOVA with pairwise comparisons. For Likert-scale surveys, median confidence scores were compared using a Friedman test with post hoc pairwise comparisons using Wilcoxon signed-rank tests. RESULTS: Participants demonstrated significant improvement in clinical knowledge (p < .001), vital signs and airway, breathing, circulation, disability, exposure assessment (p = .001), blood gas and electrolyte analysis (p = .001), CPR (p < .001) and respiratory distress (p < .001) simulations, clinical confidence (p = .002), and precepting competence (p = .041). CONCLUSION: This pediatric critical care nurse preceptor program was effective in improving participants' confidence and competence (knowledge and skills) in pediatric critical care nursing and precepting. Results suggest the program's potential to address the shortage of highly trained pediatric critical care nurses in Malawi. This lays groundwork for refining and expanding preceptorship, ultimately improving pediatric critical care nursing education in resource-limited settings.

Attributes and barriers to care of pelvic pain in university women.

STUDY OBJECTIVE: To describe rates of pelvic pain in university women ages 18 and older and to explore the barriers to adequate health care for pelvic pain in this population. DESIGN: A cross-sectional study (Canadian Task Force classification II-2). SETTING: University of Florida, Gainesville, FL. PATIENTS: A total of 2000 female students at the University of Florida were randomly selected for participation. INTERVENTIONS: The 2000 sample members were sent a questionnaire to be completed online. MEASUREMENTS AND MAIN RESULTS: The online questionnaire was hosted through the REDCap electronic data capture tool hosted at the University of Florida. This questionnaire included demographic items, general health and health behavior questions, measures to assess different types of pelvic pain (e.g., dysmenorrheal; dyspareunia; urinary, bowel, and vulvar pain), items regarding barriers to care for pelvic pain problems, and quality of life measures. Data were exported to SAS software (SAS Institute Inc., Cary, NC) for analysis. Of the 2000 subjects who received the questionnaire invitation, 390 filled out the questionnaire, yielding a response rate of 19.5%. Respondents' ages ranged from 18 to 62 with a mean of 23 years. A total of 72.8% of respondents reported experiencing pelvic pain over the past 12 months. Dysmenorrhea was reported by nearly 80% of participants, over one third of participants noted deep dyspareunia, and a significant proportion of participants reported symptoms related to bowel movements. Vulvar symptoms, including superficial dyspareunia, were reported by 21.5% of participants. Most participants with pelvic pain (78.8%) have not received any diagnosis for their pain, whereas 73.6% reported not yet having visited a doctor. Significant barriers to receiving adequate medical care were reported, including difficulty with insurance coverage and physicians' lack of time and knowledge or interest in chronic pelvic pain conditions. CONCLUSION: Pelvic pain in younger women is a critical public health issue experienced by a significant portion of the population. Significant awareness deficits and barriers to care exist. Careful study of the barriers to receiving adequate medical care reported by these women will allow researchers to describe how best to improve care for these syndromes.

A Sierra Leone 2021 Midwifery Clinical Training Needs Assessment: A Call to Action to Augment Clinical Precepting.

Objective: Sierra Leone has one of the highest maternal mortality and infant mortality rates globally. We share findings from a Midwifery Clinical Training Needs Assessment, conducted in 2021 as a collaboration between the Government of Sierra Leone and Seed Global Health. The assessment identified existing needs and gaps in midwifery clinical training at health facilities in Sierra Leone from various stakeholders' perspectives. Methods: The descriptive needs assessment utilized mixed methods, including surveys, focus group discussions (FGDs), interviews, and reviews of maternal medical records. Results: The following showed needs and gaps in labor and delivery management; record keeping; triage processes; clinical education for students, recent graduates, and preceptors; and lack of infrastructure and resources. Conclusion: The knowledge gained from this needs assessment can further the development of midwifery clinical training programs in Sierra Leone and other low-income countries facing similar challenges. We discuss the implication of our findings.

Empowering medical students as agents of curricular change: a value-added approach to student engagement in medical education.

One area in which medical students can add significant value is medical education, and involving them as key stakeholders in their education can have a profound impact on students and the institutions that serve them. However, detailed descriptions of the structure, implementation and quality of programs facilitating student engagement are lacking. We describe the structure of a novel student engagement program at the University of Illinois College of Medicine-Chicago (UICOM-Chicago) known as the Student Curricular Board (SCB). We surveyed 563 medical students across all levels of training at our institution in order to examine the impact of this program, including its strengths and potential areas of improvement. The SCB serves as a highly structured and collaborative student group that has far-reaching involvement from course-level program evaluation to longitudinal curriculum design. Medical students overwhelmingly valued opportunities to be involved in their curriculum. Students with the greatest exposure to the SCB were more aware of specific program initiatives and expressed increased interest in academic medicine as a career. By highlighting this innovative student engagement program, we aim to share best practices for a highly structured, value-added approach to medical student engagement in medical education that is applicable to other medical schools and student leaders.

Cacao seeds are a "Super Fruit": A comparative analysis of various fruit powders and products.

BACKGROUND: Numerous popular media sources have developed lists of "Super Foods" and, more recently, "Super Fruits". Such distinctions often are based on the antioxidant capacity and content of naturally occurring compounds such as polyphenols within those whole fruits or juices of the fruit which may be linked to potential health benefits. Cocoa powder and chocolate are made from an extract of the seeds of the fruit of the Theobroma cacao tree. In this study, we compared cocoa powder and cocoa products to powders and juices derived from fruits commonly considered "Super Fruits". RESULTS: Various fruit powders and retail fruit products were obtained and analyzed for antioxidant capacity (ORAC (µM TE/g)), total polyphenol content (TP (mg/g)), and total flavanol content (TF (mg/g)). Among the various powders that were tested, cocoa powder was the most concentrated source of ORAC and TF. Similarly, dark chocolate was a significantly more concentrated source of ORAC and TF than the fruit juices. CONCLUSIONS: Cocoa powder and dark chocolate had equivalent or significantly greater ORAC, TP, and TF values compared to the other fruit powders and juices tested, respectively. Cacao seeds thus provide nutritive value beyond that derived from their macronutrient composition and appear to meet the popular media's definition of a "Super Fruit".

Overseas processing of dried blood spots for timely diagnosis of HIV in Haitian infants.

OBJECTIVE: To determine the feasibility of sending dried blood spots (DBS) to an overseas processing center for the diagnosis of HIV infection in infants in rural Haiti. METHODS: The program took place in the Central Department of Haiti. Children under 18 months of age who were born to an HIV-infected mother or who had a positive HIV antibody test had blood collected on filter paper. Once dry, specimens were labeled with a unique identifying number, placed in sealed gas-impermeable envelopes containing a desiccant, stored at room temperature, and mailed to a commercial laboratory in The Netherlands, where blood was eluted from the filter paper and analyzed by the Retina(trade mark) rainbow HIV-1 RNA assay. Infants were tested at 1 month of age and again at 4 months of age. RESULTS: The DBS protocol was easily scaled up. During the study period, 138 infants had HIV status confirmed; 15 of them were found to be HIV infected and were enrolled in appropriate HIV care, and 123 were confirmed to be HIV uninfected, avoiding unnecessary prophylactic antibiotics and providing reassurance to caregivers. CONCLUSION: Central, overseas processing of DBS is a feasible solution for the timely diagnosis of HIV infection in infants where local capacity is unavailable. Regional processing centers for DBS could improve the access of millions of children in Latin America and the Caribbean to timely diagnosis of HIV infection.

Overseas processing of dried blood spots for timely diagnosis of HIV in Haitian infants

OBJECTIVE: To determine the feasibility of sending dried blood spots (DBS) to an overseas processing center for the diagnosis of HIV infection in infants in rural Haiti. METHODS: The program took place in the Central Department of Haiti. Children under 18 months of age who were born to an HIV-infected mother or who had a positive HIV antibody test had blood collected on filter paper. Once dry, specimens were labeled with a unique identifying number, placed in sealed gas-impermeable envelopes containing a desiccant, stored at room temperature, and mailed to a commercial laboratory in The Netherlands, where blood was eluted from the filter paper and analyzed by the RetinaTM rainbow HIV-1 RNA assay. Infants were tested at 1 month of age and again at 4 months of age. RESULTS: The DBS protocol was easily scaled up. During the study period, 138 infants had HIV status confirmed; 15 of them were found to be HIV infected and were enrolled in appropriate HIV care, and 123 were confirmed to be HIV uninfected, avoiding unnecessary prophylactic antibiotics and providing reassurance to caregivers. CONCLUSION: Central, overseas processing of DBS is a feasible solution for the timely diagnosis of HIV infection in infants where local capacity is unavailable. Regional processing centers for DBS could improve the access of millions of children in Latin America and the Caribbean to timely diagnosis of HIV infection.

Overseas processing of dried blood spots for timely diagnosis of HIV in Haitian infants / Diagnóstico oportuno del VIH en niños haitianos mediante el procesamiento en el extranjero de muestras de sangre seca

OBJECTIVE: To determine the feasibility of sending dried blood spots (DBS) to an overseas processing center for the diagnosis of HIV infection in infants in rural Haiti. METHODS: The program took place in the Central Department of Haiti. Children under 18 months of age who were born to an HIV-infected mother or who had a positive HIV antibody test had blood collected on filter paper. Once dry, specimens were labeled with a unique identifying number, placed in sealed gas-impermeable envelopes containing a desiccant, stored at room temperature, and mailed to a commercial laboratory in The Netherlands, where blood was eluted from the filter paper and analyzed by the RetinaTM rainbow HIV-1 RNA assay. Infants were tested at 1 month of age and again at 4 months of age. RESULTS: The DBS protocol was easily scaled up. During the study period, 138 infants had HIV status confirmed; 15 of them were found to be HIV infected and were enrolled in appropriate HIV care, and 123 were confirmed to be HIV uninfected, avoiding unnecessary prophylactic antibiotics and providing reassurance to caregivers. CONCLUSION: Central, overseas processing of DBS is a feasible solution for the timely diagnosis of HIV infection in infants where local capacity is unavailable. Regional processing centers for DBS could improve the access of millions of children in Latin America and the Caribbean to timely diagnosis of HIV infection.

OBJETIVO: Determinar la factibilidad de enviar muestras de sangre seca (MSS) a un centro en el extranjero para el diagnóstico de la infección por el VIH en niños de zonas rurales de Haití. MÉTODOS: El programa se realizó en el Departamento Central de Haití. Se tomó una muestra de sangre en papel de filtro de los niños menores de 18 meses nacidos de madres infectadas con el VIH o que tuvieran una prueba positiva de anticuerpos contra el VIH. Una vez secas, las muestras se etiquetaron con un número de identificación único, se colocaron en sobres sellados impermeable a gases con desecante, se almacenaron a temperatura ambiente y se enviaron por correo a un laboratorio comercial en los Países Bajos, donde se eluyó la sangre del papel de filtro y se analizó mediante el sistema RetinaTM Rainbow para la detección de ARN del VIH-1. Las pruebas se realizaron a los niños de 1 mes y se repitió a los 4 meses de edad. RESULTADOS: El procedimiento de MSS se llevó fácilmente a una escala mayor. En el período de estudio se confirmó el diagnóstico de 138 niños: 15 de ellos estaban infectados y recibieron los cuidados apropiados; 123 niños no tenían la infección, lo que evitó aplicar innecesariamente el tratamiento antibiótico profiláctico y el personal de salud sintió mayor confianza. CONCLUSIONES: El procesamiento centralizado de MSS en el extranjero es una solución factible para el diagnóstico oportuno de la infección por el VIH en niños cuando no hay capacidad local de diagnóstico. Centros regionales para el procesamiento de MSS podrían mejorar el acceso de millones de niños de América Latina y el Caribe al diagnóstico oportuno de esta infección.