Evaluating an undergraduate nursing student telehealth placement for community-dwelling frail older people during the COVID-19 pandemic.

AIMS AND OBJECTIVES: To evaluate a rapid response student telehealth placement experience implementing interRAI assessments of community-dwelling frail older people during the COVID-19 pandemic. To identify lessons to inform future telehealth clinical placements. BACKGROUND: New Zealand undertakes assessment of older people with disabilities using the interRAI contact assessment tool for less complex conditions and home care assessment tool for complex needs. New Zealand entered lockdown in March 2020 in response to COVID-19. New Zealand's most vulnerable community members required urgent needs assessment. DESIGN: A clinical placement whereby 3rd year undergraduate nursing students trained by interRAI-NZ educators worked remotely from home delivering telehealth assessment for 'at risk' older people across the Waikato District, New Zealand. This represented the first telehealth experience within an undergraduate nursing program approved by the New Zealand Nursing Council. METHODS: A case study evaluation utilising mixed method questionnaire and qualitative techniques within an interpretive paradigm. 19 third year students in the fifth semester of a Bachelor of Nursing program and 5 nursing staff members engaged in delivery of the initiative completed pre- and post-placement short answer questionnaires. Reflective diaries were maintained by students on placement. Post-placement interviews and focus group discussions provided in-depth data. COREQ guidelines informed analysis and reporting. RESULTS: Student and tutor responses showed consistent themes: tackling COVID-19; implementation requirements; nursing competencies; provider relationships; and community insights. These provide insight and highlight lessons learnt from this initiative. CONCLUSIONS: Student confidence in therapeutic engagement and clinical assessment and interest in aged care was increased, confirming the viability and importance of this inaugural telehealth student placement initiative. RELEVANCE TO CLINICAL PRACTICE: Graduate work readiness is enhanced through telehealth placement experience and interRAI assessor training. These are recommended as core components of future nursing education programs.

I speak a little Arabic: Nursing communication in a cross-cultural context.

AIMS AND OBJECTIVES: This study investigated the challenges of cross-cultural communication among internationally qualified nurses, and the impact on nurse-to-nurse and nurse-to-patient relationships. BACKGROUND: Open and authentic communication between nurses and patients is required as a foundation of patient-centred practice; however, this may be a challenge in cross-cultural settings. DESIGN: An exploratory qualitative study with an inductive approach. METHODS: Semi-structured, face-to-face interviews explored the influences on communication and practice of 21 internationally qualified nurses practising in the United Arab Emirates. Manual and software-driven processes guided coding and analysis of data. Caring theory guided the analysis of themes; while COREQ criteria guided research conduct and reporting. RESULTS: Four key themes emerged; (a) Challenges in communication, (b) The science versus art of nursing; (c) The impact of ineffective communication and (d) Strategies for coping. Eleven sub-themes are reported within these themes. Overall, nurses felt they had sufficient language and nursing skills to undertake the technical or scientific aspects of their work; however, they reported experiencing restricted ability to participate in complex cross-cultural conversations, such as providing explanations and reassurance about treatment options or discussing end of life and treatment decisions. This limitation diminished the nurses' ability to engage in the art of nursing and left them unable to employ themselves therapeutically to attain a sense of true presence with patients and their families. CONCLUSION: This article highlights the need for language and communication support, and Arabic-speaking advocates as partners in care for expatriate nurses. RELEVANCE TO PRACTICE: Internationally qualified nurses in this Middle Eastern setting lack cultural orientation and language skills to fully enact the art and true presence of nursing. Findings indicate that health service employers need to increase the employment of Arabic-speaking nurses and provide additional language for other expatriate nurses.

Birth preparedness and complication readiness among women of reproductive age in Kenya and Tanzania: a community-based cross-sectional survey.

BACKGROUND: Delayed health-seeking continues to contribute to preventable maternal and neonatal deaths in low resource countries. Some of the strategies to avoid the delay include early preparation for the birth and detection of danger signs. We aimed to assess the level of practice and factors associated with birth preparedness and complication readiness (BPCR) in Kenya and Tanzania. METHODS: We conducted community-based multi-stage cross-sectional surveys in Kilifi and Kisii counties in Kenya and Mwanza region in Tanzania and included women who delivered two years preceding the survey (2016-2017). A woman who mentioned at least three out of five BPCR components was considered well-prepared. Bivariate and multivariable proportional odds model were used to determine the factors associated with the BPCR. The STROBE guidelines for cross-sectional studies informed the design and reporting of this study. RESULTS: Only 11.4% (59/519) and 7.6% (31/409) of women were well-prepared for birth and its complications in Kenya and Tanzania, respectively, while 39.7 and 30.6% were unprepared, respectively. Level of education (primary: adjusted odds ratio (aOR): 1.59, 95% CI: 1.14-2.20, secondary: aOR: 2.24, 95% CI: 1.39-3.59), delivery within health facility (aOR: 1.63, 95% CI: 1.15-2.29), good knowledge of danger signs during pregnancy (aOR: 1.28, 95% CI: 0.80-2.04), labour and childbirth (aOR: 1.57, 95% CI: 0.93-2.67), postpartum (aOR: 2.69, 95% CI: 1.24-5.79), and antenatal care were associated with BPCR (aOR: 1.42, 95% CI: 1.13-1.78). CONCLUSION: Overall, most pregnant women were not prepared for birth and its complications in Kilifi, Kisii and Mwanza region. Improving level of education, creating awareness on danger signs during preconception, pregnancy, childbirth, and postpartum period, and encouraging antenatal care and skilled birth care among women and their male partners/families are recommended strategies to promote BPCR practices and contribute to improved pregnancy outcomes in women and newborns.

Developing metrics for nursing quality of care for low- and middle-income countries: a scoping review linked to stakeholder engagement.

BACKGROUND: The use of appropriate and relevant nurse-sensitive indicators provides an opportunity to demonstrate the unique contributions of nurses to patient outcomes. The aim of this work was to develop relevant metrics to assess the quality of nursing care in low- and middle-income countries (LMICs) where they are scarce. MAIN BODY: We conducted a scoping review using EMBASE, CINAHL and MEDLINE databases of studies published in English focused on quality nursing care and with identified measurement methods. Indicators identified were reviewed by a diverse panel of nursing stakeholders in Kenya to develop a contextually appropriate set of nurse-sensitive indicators for Kenyan hospitals specific to the five major inpatient disciplines. We extracted data on study characteristics, nursing indicators reported, location and the tools used. A total of 23 articles quantifying the quality of nursing care services met the inclusion criteria. All studies identified were from high-income countries. Pooled together, 159 indicators were reported in the reviewed studies with 25 identified as the most commonly reported. Through the stakeholder consultative process, 52 nurse-sensitive indicators were recommended for Kenyan hospitals. CONCLUSIONS: Although nurse-sensitive indicators are increasingly used in high-income countries to improve quality of care, there is a wide heterogeneity in the way indicators are defined and interpreted. Whilst some indicators were regarded as useful by a Kenyan expert panel, contextual differences prompted them to recommend additional new indicators to improve the evaluations of nursing care provision in Kenyan hospitals and potentially similar LMIC settings. Taken forward through implementation, refinement and adaptation, the proposed indicators could be more standardised and may provide a common base to establish national or regional professional learning networks with the common goal of achieving high-quality care through quality improvement and learning.

Maternal healthcare services use in Mwanza Region, Tanzania: a cross-sectional baseline survey.

BACKGROUND: Improving maternal health by reducing maternal mortality/morbidity relates to Goal 3 of the Sustainable Development Goals. Achieving this goal is supported by antenatal care (ANC), health facility delivery, and postpartum care. This study aimed to understand levels of use and correlates of uptake of maternal healthcare services among women of reproductive age (15-49 years) in Mwanza Region, Tanzania. METHODS: A cross-sectional multi-stage sampling household survey was conducted to obtain data from 1476 households in six districts of Mwanza Region. Data for the 409 women who delivered in the 2 years before the survey were analyzed for three outcomes: four or more ANC visits (ANC4+), health facility delivery, and postpartum visits. Factors associated with the three outcomes were determined using generalized estimating equations to account for clustering at the district level while adjusting for all variables. RESULTS: Of the 409 eligible women, 58.2% attended ANC4+, 76.8% delivered in a health facility, and 43.5% attended a postpartum clinic. Women from peri-urban, island, and rural regions were less likely to have completed ANC4+ or health facility delivery compared with urban women. Education and early first antenatal visit were associated with ANC4+ and health facility delivery. Mothers from peri-urban areas and those who with health facility delivery were more likely to attend postpartum check-ups. CONCLUSION: Use of ANC services in early pregnancy influences the number of ANC visits, leading to higher uptake of ANC4+ and health facility delivery. Postpartum check-ups for mothers and newborns are associated with health facility delivery. Encouraging early initiation of ANC visits may increase the uptake of maternal healthcare services.

Nurse-identified patient care and health services research priorities in the United Arab Emirates: a Delphi study.

BACKGROUND: The need for improved research on ill health has been recognized internationally and locally in the United Arab Emirates (UAE). The UAE Nursing and Midwifery Council recently committed to enhancing the status and contributions of nursing in healthcare research across the UAE by establishing a National Committee for Research Development. This study using a Delphi method to identify research priorities from the perspective of nurses delivering frontline healthcare. METHODS: A two-phase Delphi design was implemented with 1032 nurses participating in phase one of the study and 1339 in phase two. RESULTS: The most important priority was patient safety and healthcare professionals' awareness of international patient safety goals (including staffing levels and shift length) and potential effects on patient safety. Other important priorities were infection control practices and management of communicable diseases. CONCLUSIONS: These priorities may inform nursing research programs to improve patient care and health outcomes in the UAE and similar contexts worldwide.

Internationally qualified nurse communication-A qualitative cross country study.

AIMS AND OBJECTIVES: To compare the communication and practice experiences of migrant nurses in geographically distant, culturally dissimilar countries in Eastern and Western contexts. BACKGROUND: Considerable research has focused on the experience of acculturation of migrant nurses into geographically diverse locations. However, there remains scant comparative research which considers the ways in which migrant nurses interpret their experience through making "sense" of events encountered in their practice. DESIGN: An exploratory qualitative study was conducted using face-to-face interviews with 36 migrant nurses currently practising in New Zealand and 20 migrant nurses practising in the United Arab Emirates. METHODS: The same question schedule was used to explore influences on communication and practice in both settings. Thematic analysis and sensemaking theory guided coding and analysis of data. COREQ guidelines informed the reporting of qualitative data. RESULTS: Qualitative analysis resulted in five representative themes, three illustrating similarities across diverse cultures and two that demonstrate the differences migrant nurses require to navigate across contrasting cultural environments successfully. CONCLUSION: Cultural value-based differences in both locales caused both systemic and interpersonal sensemaking challenges for migrant nurses that emphasise the importance of orientation and education programmes for internationally qualified nurses. However, cultural conflicts also exist within groups. Orientation programmes should address culturally patterned responses among different groups of internationally qualified nurses. RELEVANCE TO CLINICAL PRACTICE: Findings demonstrate a need for migrant nurses to be willing to embrace ambiguity in order to acculturate into a collaborative team culture in each of the geographical locations in this study. As registered nurses (RNs) also carry their cultural imprint, orientation interventions targeting the cultural variations of nurses in less standardised orientation programmes may be more beneficial in enhancing acculturation and in turn, staff retention.

Assessing the impact of a partnership-based work/study nursing upgrade programme in a low- and middle-income setting.

AIMS AND OBJECTIVES: To evaluate the 15-year impact of the work/study nursing upgrading programme in East Africa. BACKGROUND: Working nurses in Africa are often primary family income earners, with limited ability to leave jobs and upgrade qualifications. In 2001, the university established a work/study upgrade programme for enrolled- and diploma-level nurses, allowing them to upgrade their qualifications while continuing to work and support families. Donor partnerships provided scholarships to further increase programme access. DESIGN: A mixed-method design was used involving an online alumni survey and 24 interviews and 23 focus groups with 172 purposively selected representatives of nursing graduates, employers, regulatory bodies, professional associations and senior nursing officials. METHOD: Quantitative data were analysed using frequencies and percentages. Inductive thematic analysis was used for qualitative data. Equator guidelines informed reporting of both qualitative and quantitative results. RESULTS: Of the 549 graduates who completed the survey, 81.2% (n = 446) were female, 93.1% were currently employed and 98% worked within East Africa. They reported improved professional competence (69.4%), nursing practice (25.9%) and patient outcomes (4.6%) on graduation. Extracted themes included the following: flexible/accessible programme; friendly learning environment; effective teaching and learning strategies; acquisition of nursing knowledge, skills and competencies; stakeholders' role in the programme; career/professional advancement; and strengthened health systems. CONCLUSION: The work/study programme was an effective nursing workforce capacity development strategy. Programme access was strengthened via the supporting donor partnership. Positive outcomes were achieved with respect to the university's values of quality, access, relevance and impact. RELEVANCE TO CLINICAL PRACTICE: Long-term sustainable development of nurses and midwives is fundamental to achieving sustainable development goals. Work/study programmes and private-public partnerships are effective mechanisms to strengthen the development of nursing and the overall healthcare workforce in low-resource settings.

Nursing as a pathway to women's empowerment and intergenerational mobility.

AIM AND OBJECTIVE: To assess the impact of nursing education on the intergenerational mobility of graduates of nursing upskilling programmes. BACKGROUND: Challenges for low- and middle-income countries include poverty and limited access to health, education and social services compounded by workforce shortages, inequality and female disempowerment. Little is known about the impact of nursing education on women's empowerment and intergenerational mobility in such settings. DESIGN: A cross-sectional study using data collected through an online alumni survey. METHODS: Data were collected March to May 2016 using an online questionnaire, as part of a larger nursing programme alumni survey. Intergenerational mobility was assessed by comparing the respondents' educational qualification with their fathers' and mothers' education levels. Descriptive statistics were analysed using frequencies and percentages. Associations between parental and respondents' education levels were assessed using chi-square tests. RESULTS: Out of 446 female respondents who completed the survey, 379 and 366 indicated their fathers' and mothers' education level, respectively. A third of the respondents' mothers had no formal schooling; lower levels of parental education are significantly associated with increase in respondents age (p < 0.001) and associated shift from Uganda to Kenya and Tanzania (p < 0.001). Respondents had a marked upward intergenerational education mobility with 76% (278/366) and 59% (223/379) of them achieving a qualification two levels above their mothers and fathers, respectively. Tanzanian respondents had significantly higher rates of upward mobility than Kenyan and Ugandan respondents. CONCLUSIONS: Nursing education positively impacted gender, economic factors and health outcomes. Further research is needed to confirm the "triple impact" of nursing education on improving health, gender equality and economic growth in low- and middle-income countries. RELEVANCE TO CLINICAL PRACTICE: Nurses are frontline providers of healthcare services. Provision of high-quality nursing upgrade programmes enhances nursing leadership ability, with aligned improvements in health outcomes while supporting gender empowerment and intergenerational mobility.

Collaborative task-sharing to enhance the Point-Of-Care Ultrasound (POCUS) access among expectant women in Kenya: The role of midwife sonographers.

Unrealized maternal and child health goals continue to challenge Kenya where adverse outcomes remain high and diagnostic services are limited. The acute shortage of doctors and radiographers requires alternate human resources for health (HRH) with the ability to identify risk factors in pregnancy through Point-Of-Care Ultrasound (POCUS). A specialist radiologist and ultrasonography team partnered with midwives to adopt interprofessional task sharing and capacity building. Faculty from the Radiology Department of our hospital designed and implemented the project which was carried out at three outreach health service centres. Designing and implementing a training model to skill midwife sonographers with the capacity to accurately identify risk factors in pregnancy is an effective model to increase POCUS access. A collaborative task sharing model focused on training quality, validation of results, tracking of errors and specialist level clinical supervision yielded a safe and scalable model of HRH capacity building. Programme evaluation, verification of outcomes and dissemination of results were all monitored. The project was a successful HRH task sharing and interprofessional learning initiative involving task sharing a clearly defined suite of sonographer competencies with participating midwives. The programme increased POCUS accessibility at the three outreach clinics with proven outcomes in the early detection and referral of risk factors in pregnancy.

Developing a national competency-based curriculum for technical nurses in Egypt.

Nursing in Egypt has evolved over recent decades. Development has accelerated following recent government recognition of the contribution nurses make to healthcare access, quality and delivery. A vision to enhance nursing capacity resulted in a recent mandate requiring all nursing curricula to be competency based. Concurrently, the Educational Development Fund of the Egyptian Cabinet of Ministers drafted a nursing educational plan including a strategy to develop and implement a contextually congruent educational model with proven success comparable to international standards. This report discusses the 4-year curriculum development project designed to upgrade the current technical-level nursing curriculum to a consistent competency-based model. The competency-based educational model will be trialled in 3 technical institutes before nationwide rollout and implementation. Details of the project plan are described, including an overview of curriculum development considerations. This report provides insights for policy-makers and educators embarking on similar health workforce reform and capacity development initiatives.

Establishing Policy Foundations and Regulatory Systems to Enhance Nursing Practice in the United Arab Emirates.

In 2009, the United Arab Emirates (UAE) established a Nursing and Midwifery Council with a mandate to develop standards for the registration and regulation of nursing and midwifery and to strengthen the nursing and midwifery workforce. Priorities included workforce Emiratization and the development of regulatory standards to support advanced and speciality nursing practice and new models of care-particularly for the management of noncommunicable diseases. This article provides background, context for, and best practice inputs to the effort to provide one unified framework of nursing regulation and licensure across the whole of the UAE. This article is intended for nurse leaders, policy makers, and regulators who are reviewing or developing nursing regulatory processes and advancing nursing workforce capacity building activities; and nurse educators and nurses wishing to work in the UAE.

Responding to health care complexity: suggestions for integrated and interprofessional workplace learning.

This report highlights complexity in health care and the relevance of integrated and interprofessional care and learning. It is proposed that appropriate workforce training in response to complexity should be contextually relevant and workplace integrated, and should focus on building interprofessional capability for reflective practice and critical thinking. This training should be interprofessional and foster systems thinking. It is suggested that the World Health Organization's International Classification of Functioning, Disability and Health (ICF) is a useful integrating framework.

Australian health reforms: enhancing interprofessional practice and competency within the health workforce.

Underpinned by increasing healthcare complexity and ongoing pressures to control the cost of healthcare, governments are increasingly calling for improved health service delivery models. A public policy paradigm of partnership-based, collaborative interprofessional working is central to revised models of health service delivery. Collaborative activity and service re-design do not occur by chance. They are complex and multi-faceted. Increasingly, calls for collaborative style health service re-design activities are being translated to a need to agree on a clear set of interprofessional competencies and develop a culture of interprofessional practice (IPP) across the sector. This report summarizes the requirements for developing a culture of interprofessional practice within the context of Australian healthcare reforms. It also highlights the role of well-developed interprofessional competency frameworks to support envisaged changes in practice. The report expands the discussion in this area by referring to the work of two other nations with prior developments in interprofessional workplace development and reform.

Experiences from an interprofessional student-assisted chronic disease clinic.

Faced with significant health and workforce challenges in the region, the Central Queensland Health Service District (CQHSD) commenced a student-assisted clinical service. The Capricornia Allied Health Partnership (CAHP) is an interprofessional clinical placement program in which pre-entry students from exercise physiology, nutrition and dietetics, occupational therapy, pharmacy, podiatry and social work are embedded in a collaborative chronic disease service delivery model. The model coordinates multiple student clinical placements to: address service delivery gaps for previously underserved people with chronic disease in need of early intervention and management; provide an attractive clinical placement opportunity for students that will potentially lead to future recruitment success, and demonstrate leadership in developing future health workforce trainees to attain appropriate levels of interprofessional capacity. The CAHP clinic commenced student placements and client services in February 2010. This report provides early evaluative information regarding student experiences included self-reported changes in practice.

Capricornia Allied Health Partnership (CAHP): a case study of an innovative model of care addressing chronic disease through a regional student-assisted clinic.

Faced with significant health and workforce challenges, the Central Queensland Hospital and Health Service commenced an innovative student-assisted clinical model of care. The Capricornia Allied Health Partnership (CAHP) in 2010. The clinic supports pre-entry allied health student clinical placements to: (1) address service delivery gaps for previously underserved people with chronic disease; (2) facilitate hospital avoidance and early discharge from the local hospital; (3) provide an attractive clinical placement opportunity for allied health students that will potentially lead to future recruitment success, and (4) demonstrate leadership in developing interprofessional skills of future health workforce trainees. This case study details the conceptual background of the initial model, the key features of the clinical placement and service delivery model, and discusses the current and future evaluation of the clinic.

University Staff Insights on Interprofessional Education and Student-Led Clinic Opportunities at an Australian University.

Purpose: Organizational and university staff buy-in and advocacy are critical considerations in planning successful interprofessional education (IPE) initiatives in healthcare, such as interprofessional student-led clinics (SLCs). This study was designed with the purpose of gaining deeper insight into current views and perspectives of academic and professional staff at an Australian university, as a precursor to planning IPE and SLC activities. Methods: All academic and professional staff from within the School of Health Sciences were invited to participate in the study. In-depth-qualitative interviews were conducted with 16 staff to explore academic and professional staff perspectives on IPE and SLCs. Reflexive thematic analysis was used to analyse the data. Results: Findings are grouped within five themes that incorporate broad perspectives on the tensions and possibilities of IPE and establishment of SLCs: Academic and professional staff commitment; Better/smarter IPE; Student-led clinic potential; Vision and innovation; and Strategy and resourcing. The themes reflect the high value placed on IPE by academic and professional staff and incorporate innovative ideas on how to prepare students for a rapidly changing and evolving healthcare environment. A reticence towards standard models of university based SLCs was expressed. Conclusion: Academic and professional staff insights suggest university leaders need to develop a greater strategic focus on improving IPE. Effective engagement with staff is required to support IPE planning and implementation. If considering implementation of SLCs, contemporary fit-for-purpose models should be explored such as partnerships with primary healthcare providers, community wellness facilities, and hospital clinics rather than traditional university-based clinics.

In their voices: Kenyan women's experiences with cancer treatment-related side effects.

Objective: This article reports on a secondary analysis of a qualitative study conducted in Nairobi, Kenya that reported several initial themes. In this article, the authors explore the theme of treatment-related side effect management by women receiving treatment for breast or cervical cancer. Methods: Women were interviewed at three points during their active treatment trajectory. Participants were purposefully selected and saturation was reached when interviews did not yield any new themes. The interviews were transcribed and analyzed for internal consistency, frequency, extensiveness, intensity and specificity. The Nvivo pro 12 software was used in organizing and managing the data to facilitate analysis. Results: Eighteen women were interviewed. Major side effects reported by participants included fatigue, alopecia, skin and nail changes as well as nausea and vomiting. Women who received information prior to treatment were more comfortable managing side effects. Participants described the impact of side effects on their daily life, body image, and many sought comfort through faith. Some women provided suggestions on strategies for patient education. Conclusions: This study attempted to capture the cancer treatment-related experiences of Kenyan women in their own voices and present strategies for future intervention and research. The care of individuals receiving treatment can be enhanced through the advancement of health human resources, the development of nationally accessible patient education materials and research on regionally relevant strategies to manage cancer treatment-related side effects.

The sociodemographic and health-related characteristics of a regional population with chronic disease at an interprofessional student-assisted clinic in Queensland Capricornia Allied Health Partnership.

OBJECTIVE: This paper describes the sociodemographic and health-related characteristics of people with chronic disease attending an interprofessional student-assisted clinic in regional Queensland. DESIGN: A retrospective review of data collected during the first 10 months of operation of the clinic was conducted. SETTING, PARTICIPANTS AND OUTCOME MEASURES: Data was collected on up to 378 patients during an intake appointment at the Capricornia Allied Health Partnership (CAHP) community-based clinic and compared with normative reference groups where available. Sociodemographic characteristics included age, gender and education level; health-related characteristics included body mass index and hospitalisations in the previous 12 months; and risk factors included prescribed medications, smoking status and general practitioner-diagnosed medical conditions. RESULTS: Patients attending the CAHP clinic had a mean number of chronic conditions of 4.9 ± 2.1 per patient, and 97% of patients had multimorbidities. A high level of socioeconomic disadvantage was found in comparison with normative comparison groups based on employment, highest level of schooling completed and the index of social disadvantage. Patients predominantly lived in inner regional areas (76.7%). The most common diagnoses of patients attending the clinic for the first time were hypertension, osteoarthritis, high cholesterol, diabetes and chronic back pain. CONCLUSIONS: The CAHP clinic offers a unique student-assisted service model for interprofessional management of patients who are socioeconomically disadvantaged, have multimorbid chronic disease and live in regional areas. The description of baseline data in this paper is important to refine clinic services, to guide other chronic disease clinics and to inform future research study designs.