District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study.

BACKGROUND: In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). METHODS: This study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews. RESULTS: The eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs. CONCLUSIONS: The incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

Professional practice models for nurses in low-income countries: an integrative review.

BACKGROUND: Attention is turning to nurses, who form the greatest proportion of health personnel worldwide, to play a greater role in delivering health services amidst a severe human resources for health crisis and overwhelming disease burden in low-income countries. Nurse leaders in low-income countries must consider essential context for nurses to fulfill their professional obligation to deliver safe and reliable health services. Professional practice models (PPMs) have been proposed as a framework for strategically positioning nurses to impact health outcomes. PPMs comprise 5 elements: professional values, patient care delivery systems, professional relationships, management approach and remuneration. In this paper, we synthesize the existing literature on PPMs for nurses in low-income countries. METHODS: An integrative review of CINAHL-EBSCO, PubMed and Scopus databases for English language journal articles published after 1990. Search terms included nurses, professionalism, professional practice models, low-income countries, developing countries and relevant Medical Subject Heading Terms (MeSH). RESULTS: Sixty nine articles published between 1993 and 2014 were included in the review. Twenty seven articles examined patient care delivery models, 17 professional relationships, 12 professional values, 11 remuneration and 1 management approach. One article looked at comprehensive PPMs. CONCLUSIONS: Adopting comprehensive PPMs or their components can be a strategy to exploit the capacity of nurses and provide a framework for determining the full expression of the nursing role.

In their own words: The experience of professional nurses in a Northern Vietnamese women's hospital.

UNLABELLED: Abstract Background: Nurses in Vietnam, as is typical of many low-income countries, are hampered from impacting health outcomes by low occupational status, overcrowded hospitals and few career development opportunities. In order to understand the current practice environment encountered by nurses in Vietnam in the most realistic way, we listened to the voices of nurses currently performing nursing roles in Vietnam. PURPOSE: The purpose of this study was to explore the emic (insider) perspectives on cultural meaning applied by nurses at a northern Vietnamese women's hospital to influence professional practice and interpret experience. DESIGN: A micro-ethnography approach was used. METHODS: Seven nurses and one Vice Dean of a school of nursing were interviewed. Data collection consisted of open-ended interviews, participant observation and journal recordings. Spradley's (1979, 1980) Development Research Sequence was used to guide data collection and analysis. RESULTS/FINDINGS: Five themes emerged. These were the big number of patients is a burden for nurses; nurses do not, cannot make their own decisions (but they can and do); my feeling depends on doctor's feeling; nurses learn more from doctor; and just a few nurses can attend the [Vietnamese Nurses Association] meeting. CONCLUSION: The experiences described by the nurses and the Vice Dean of a nursing school reflect the challenges of practicing nursing in one Vietnamese hospital and the resourcefulness of nurses in overcoming those challenges. Recurrent themes highlight the need to better position nurses in Vietnam to advance toward full expression of the professional nursing role.

Converging Streams of Opportunity for Prison Nursery Programs in the United States.

Prison nursery programs allow departments of correction to positively intervene in the lives of both incarcerated mothers and their infant children. The number of prison nurseries in the United States has risen dramatically in the past decade, yet there remains a significant gap between predominant correctional policy in this area and what is known about parenting and infant development. Using Kingdon's streams metaphor, this article examines the recent convergence of problem, policy, and political events related to incarcerated women with infant children and argues that this has created a window of opportunity for development of prison nursery programs. Aday's policy analysis criteria are also used to analyze available evidence regarding the effectiveness, efficiency, and equity of prison nursery programs as policy alternatives for incarcerated women with infant children.

Healthy Weight and Cardiovascular Health Promotion Interventions for Adolescent and Young Adult Males of Color: A Systematic Review.

Cardiovascular disease is the leading cause of mortality in the United States, accounting for one fourth of deaths. Higher rates of obesity put Hispanic and Black men at increased risk. The American Heart Association cites diet quality, physical activity, and body weight as alterations responsive to health promotion intervention. Prevention strategies need to begin in adolescence and the emerging adulthood years to impact cumulative risk factors. A scoping review identified search terms and this was followed by a systematic review of Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PubMed databases for articles published in English from January 1, 2002, through May 11, 2017. This review explores community-based content, delivery, recruitment, or retention strategies used with young men of color aged 15 to 24 years. Of 17 articles describing 16 individual interventions and 1 describing multiple interventions (with samples ranging from 37 to 4,800), 13 reported significant results in one or more domains. No studies specifically targeted the needs of young men and only three had more than 50% male participants. There was a gap in studies that addressed young men in the ages of interest with most interventions reaching participants aged 11 to 19 years. Cultural tailoring was addressed through recruitment setting, interventionist characteristics, community involvement, and theoretical frameworks such as motivational interviewing that allow individual goal setting. Because young men seek access to preventive health services less than young women, it is suggested that interventions that are community based or use push technology (send information directly to the user) be increased.

Health-related quality of life of HIV-infected children on complex antiretroviral therapy at home.

The study describes quality of life as perceived by parents and measured by the Child Health Questionnaire (CHQ-28) for a convenience sample of 33 HIV-infected children age 5 to 18 years cared for at home on complex antiretroviral drug regimens. When compared with normative data on healthy U.S. children, parent reports for the HIV-infected children did not differ significantly on the following CHQ concepts: role/social related to emotional, behavioral or physical problems; bodily pain; behavior; mental health; self-esteem; impact on parental time; family activities; and family cohesion. Parents perceived their children to be functioning at a level significantly lower than the norm in general health (t -6.47, p = .000), physical functioning (t -2.37, p = .024), and physical summary (t -3.80, p = .001). Parental impact-emotional was impressively higher than the norm (t -3.74, p = .001). Differences were independent of gender, primary language, ethnicity, and Centers for Disease Control and Prevention clinical classifications for pediatric HIV disease.

Conducting research as a visiting scientist in a women's prison.

Incarcerated populations have disparities in health risks and illness conditions meriting study, but the history of prison research is marred by unethical conduct. Ethical participation strategies are discussed in the context of studies implemented by the author in a state prison system. This study used ethnographic approaches, observed adherence to federal and institutional review board regulations and corrections department directives, and maintained continuous communication with vested interests to provide entry and long-term access for studies on female prisoners and their civilian infants. A culture clash between the punitive restrictive environment that serves the custody-control-care mission of corrections systems and the open inquiry environment needed for conduct of health research exists. Federal regulations protect prisoners as human subjects but additional vigilance and communication by researchers are required. Gaining and maintaining access to prison inmates for nursing research are leadership challenges that can be met within the caring and collaborative paradigm of nursing.

Reliability of transportable instruments for assessment of infant length.

Transportable instruments for use in home and field settings have been used for decades on the basis of assumed reliability. This article describes a study that compares two portable devices for measuring length, the tape measure and the Measure Mat, against a clinical standard stadiometer with two convenience samples of Hispanic and African-American infants in an urban general pediatrics practice setting. Mean net difference between the stadiometer and the tape measure was 1.68 inches in the first sample and 0.92 inches in the second; the difference between the stadiometer and the Measure Mat was 0.92 inches. The least variability and random error (SD = 0.57 inch) was shown in the paired measurements using the stadiometer and the Measure Mat. Bland-Altman plots showed positive bias for both portable devices across the range of measurements.

Original research: using guided imagery to manage pain in young children with sickle cell disease.

BACKGROUND: Despite innovations in treatment, disease-related pain is still the primary cause of hospitalization for children with sickle cell disease. Pharmacologic pain management relieves pain temporarily, but adverse effects are increasingly a concern. Cognitive behavioral therapies, which include the use of guided imagery, have shown promise in changing pain perception and coping patterns in people with chronic illnesses. Few studies have been done in children with sickle cell disease. OBJECTIVES: The purposes of this study were to test the effects of guided imagery training on school-age children who had been diagnosed with sickle cell disease, and to describe changes in pain perception, analgesic use, self-efficacy, and imaging ability from the month before to the month after training. METHODS: A quasi-experimental interrupted time-series design was used with a purposive sample of 20 children ages six to 11 years enrolled from one sickle cell disease clinic, where they had been treated for at least one year. Children completed pain diaries daily for two months, and investigators measured baseline and end-of-treatment imaging ability and self-efficacy. RESULTS: After training in the use of guided imagery, participants reported significant increases in self-efficacy and reductions in pain intensity, and use of analgesics decreased as well. CONCLUSIONS: Guided imagery is an effective technique for managing and limiting sickle cell disease-related pain in a pediatric population.

Psychometrics of Child Health Questionnaire parent short form (CHQ-28) used to measure quality of life in HIV-infected children on complex anti-retroviral therapy.

The purpose of this report is to expand the psychometric properties of the Child Health Questionnaire parent report short form (CHQ-28) as a measure of well-being for children with chronic illness. The purposive sample included 33 HIV-infected children ages 5-18 years who were patients of a comprehensive specialty clinic in an urban Northeast medical center and were cared for at home on complex anti-retroviral drug regimens. Parents reported the children's functioning in multiple domains using the American Spanish (one-third) or English (two-thirds) versions of the CHQ-28. Internal consistencies ranged from Cronbach's alpha of 0.62-0.83. Correlations between the physical and psychosocial summary scores and their components supported the instrument's conceptualization of health although some overlap between domains was demonstrated. Differences between the CHQ profile for healthy norm children and this clinical sample were logically consistent with the disease characteristics. Individual scales of the CHQ-28 show promise as research outcome measures for health related quality of life in children living in the community with HIV disease and perhaps could be useful for studies of children with other chronic illness.

Comparison of two measures of parent-child interaction.

BACKGROUND: The numerous parent-child interaction measures available include few that are appropriate to brief clinical encounters or to research settings where time, cost, space, and subject burden are critical factors. OBJECTIVES: This study compares the newer Mother-Infant Communication Screening (MICS) with the established Nursing Child Assessment Satellite Training (NCAST) Teaching Scale (NCAT). METHODS: Theoretical foundations, development, administration, support, and published psychometrics for the two scales are contrasted. Videotapes of 171 caregiver-child interactions in an urban, Hispanic, high-risk sample (children aged 5 months to 36 months) were scored by two trained coders who had established inter-rater reliabilities of.90 (NCAT) and.85 (MICS). RESULTS: Validity correlation coefficients were r =.504, p <.001 for total scores and r =.492, p <.001 for the two most comparable subscales. Distress was defined more narrowly by the MICS. Internal consistencies were.89 to.94 (MICS total scores) (depending on choice of subscales used) and.79 (NCAT). CONCLUSIONS: The NCAT has established strengths for use in clinical practice and research and provides dyadic and separate mother and child scores. The MICS is more feasible for brief clinical screening and performed in this study with promising correlate validity and internal consistency across ages (infancy through 3 years). Interpretation would be strengthened if more clinical studies verifying scores with risk categories were performed and if normative data were established.