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Purpose: Global ophthalmology educational activities often include the ability of ophthalmology residents to partake in low?resource clinical care at home and abroad. Low?resource surgical techniques have become a pillar of education during formalized global ophthalmology fellowships. A formal manual small?incision cataract surgery (MSICS) curriculum was started in the University of Colorado’s residency training program to meet the growing demand for this surgical skill and to allow for more sustainable outreach work from our graduates. The survey was conducted to collect evaluations on the value of formal MSICS training within a United States–based residency program. Methods: This was a survey study in a US ophthalmology residency program. A formal MSICS curriculum was created that included didactic lectures on epidemiology of global blindness, MSICS technique, and how MISCS compared to phacoemulsification in terms of cost and sustainability in low?resource settings, followed by a formal wet lab experience. Residents were then exposed to MSICS procedures in the operating room (OR) under supervision of an experienced MSICS surgeon. An anonymous online survey was conducted on three consecutive cohorts of recently graduated senior ophthalmology residents from 2019 to 2021 with the aim of eliciting opinions about and outcomes from the new curriculum. Results: Fifteen graduating senior residents comprised the three cohorts with a 100% survey response rate. All residents agreed or strongly agreed that “MSICS is a valuable skill to have”. Eighty percent of respondents agreed or strongly agreed that “exposure to MSICS has increased my likelihood of doing any type of outreach work in the future” and 86.67% agreed or strongly agreed that “exposure to MSICS increased my understanding about sustainable outreach work”. The average number of cases assisted or performed per resident was 8.2 (SD 2.7, range 4–12). Conclusion: A formal MSICS curriculum for US?based ophthalmology residents was well?received by the trainees. The majority felt it increased their likelihood of pursuing and improved their understanding of sustainable outreach work. The curriculum, which included lectures, wet lab training, and formal teaching in the OR, could add value to a residency program’s curriculum. Furthermore, a formal domestic program can avoid ethical pitfalls that can be seen with resident teaching during international mission work.
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Background: E-learning is becoming an important approach to teaching and learning in higher education institutions, including nursing training. Despite that, there are students who were never introduced to e-learning prior to the coronavirus disease 2019 (COVID-19) pandemic. Their challenges in relation to e-learning could differ from those of other students who had experienced the platform before, especially against the backdrop of the COVID-19 pandemic that brought an abrupt change in the approach to teaching, learning and assessment. Objectives: This study explored and described university nursing students' challenges in relation to e-learning during the early stages of the COVID-19 pandemic in a resource-constrained setting. Method: Qualitative exploratory and contextual design was used. The sample consisted of 17 participants who were conveniently selected, and data were collected by means of two focus groups and five individual interviews. Data analysis followed a qualitative content analysis process. Results: The five categories emanated from analysis are e-learning mode not suitable for practical components, challenges related to assessment of learning, connectivity issues, e-learning is a lonely journey and computer illiteracy and limited skills for the use of e-learning. Conclusion: Nursing students' challenges regarding e-learning during the early stages of the COVID-19 pandemic related to the learning of practical components, assessment, connectivity, a lack of interaction with peers and a lack of the skills required to operate e-learning tools.
Subject(s)
Pandemics , Data Analysis , COVID-19 , Students, Nursing , Teaching , Education, DistanceABSTRACT
Background@#Midwives have been frontline health professionals at the grassroots level, especially in rural communities. Their role was expanded from maternal and child healthcare providers to primary healthcare services providers. Despite their expanded functions, there have been limited studies investigating the professional practice of midwifery in the Philippines in a rural setting.@*Objective@#This study aimed to investigate the professional practice of midwives in selected rural areas in the Cordillera Administrative Region, Philippines.@*Methods@#This research is a qualitative pilot study using a semi-structured interview guide to collect the data. Key informant interviews were conducted through mobile phone calls convenient for the participants from September to October 2021. Data were analyzed through qualitative content analysis.@*Results@#A total of seven rural health midwives participated in this study. From the data analysis, six themes emerged related to the professional functions of rural Filipino midwives: 1) antenatal and postnatal care, 2) basic emergency obstetrical and newborn care, 3) health education and counseling, 4) treating common children and adult infections, 5) health promotion, and 6) beyond midwifery role.@*Conclusion@#Rural midwives play a role in providing several primary healthcare services mandated by the government and the profession. They also offer health services beyond their scope as midwives because of geographical difficulties and logistic issues. The findings inform the policymaker to review and amend the expanded roles of practicing midwives so that they will be empowered in providing quality and legal healthcare services. The study results will also be important in preparing midwives for rural midwifery practice.
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Midwifery , Professional PracticeABSTRACT
Objective:To analyse the settings of sub-campus of public hospitals directly under the National Health Commission, so as to provide research reference and suggestions for further promoting the scientific and standardized construction of sub-campuses of public hospitals.Methods:Data before August 30, 2022 were collected from the official websites of the hospitals in question including their introduction, overview, navigation, news and other categories of information.Relevant literatures on multi-campus published by hospitals under the direct management of the National Health Commission were obtained from the China National Knowledge Network, which was identified by searching the keywords " sub or multi-campus hospital" with " author affiliation", using such search conditions as " MeSH major topic" or " title/keywords/abstract" of the studied hospitals in advanced search builder. Descriptive analysis and frequency analysis were conducted on the numbers, the construction reasons, geographical location, operation scale, characteristics and positioning of the sub-campuses in the studied hospitals.Results:Of the 44 such hospitals, 30 had a total of 50 sub-campuses in operation. Generally there were two modes of construction. 35 were newly constructed and 15 formed by mergers; 37 sub-campuses were built and put into operation since 2010. Sub-campuses were usually located in the same area of the main campus, with 11 in the same area of the same city and areas, 35 in different areas of the same city, and 4 in different cities; the average geographical distance between the sub-campus and the main hospital campus was 31.18 kilometers; 27 sub-campuses had beds ≤ 500, 12 sub-campuses had beds between 501-1 000, 11 had beds>1 000; 14 specialized sub-campuses and 31 out of the 35 comprehensive sub-campuses clearly indicating their characteristics of specialized departments, and 1 other (research institute areas with research beds).Conclusions:Future proofing is characteristic of these public hospitals in terms of their sub-campus construction, regional setting, planning and positioning, and functional layout. However, both government regulatory departments and public hospitals should comprehensively consider and make prudent decisions on the planning, investment, demonstration, layout, and other aspects of the construction of sub-campuses of hospitals.
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Obstetric spinal anaesthesia is routinely used in South African district hospitals for caesarean sections, providing better maternal and neonatal outcomes than general anaesthesia in appropriate patients. However, practitioners providing anaesthesia in this context are usually generalists who practise anaesthesia infrequently and may be unfamiliar with dealing with complications of spinal anaesthesia or with conversion from spinal to general anaesthesia. This is compounded by challenges with infrastructure, shortages of equipment and sundries and a lack of context-sensitive guidelines and support from specialised anaesthetic services for district hospitals. This continuous professional development (CPD) article aims to provide guidance with respect to several key areas related to obstetric spinal anaesthesia, and to address common concerns and queries. We stress that good clinical practice is essential to avoid predictable, common complications, and hence a thorough preoperative preparation is essential. We further discuss clinical indications for preoperative blood testing, spinal needle choice, the use of isobaric bupivacaine, spinal hypotension, failed or partial spinal block and pain during the caesarean section. Where possible, relevant local and international guidelines are referenced for further reading and guidance, and a link to a presentation of this topic is provided.Keywords: anaesthesia; resource-limited settings; emergency surgery; obstetric spinal anaesthesia; anaesthetic complications; caesarean section.
Subject(s)
General Surgery , Anesthesia, Cardiac Procedures , Intraoperative Complications , Cesarean Section , HypotensionABSTRACT
Background: Persons living with HIV (PLWH) are more likely to develop hypertension and cardiovascular disease than the HIV-negative population. The new hypertension guidelines by the American Heart Association (AHA) and the American College of Cardiology (ACC) lowered the definition of hypertension from systolic and diastolic blood pressure (BP) of ≥ 140/90mmHg to ≥ 130/80, respectively. This study was aimed at determining the prevalence and factors associated with hypertension in PLWH in Livingstone using the new hypertension diagnostic criteria. Methods: This was a cross-sectional study. We recruited 226 antiretroviral treated PLWH attending routine visits. Socio-demographic, health and clinical data including BP readings were collected. Interviewer-structured questionnaires adapted from the World Health Organization Stepwise approach to Surveillance ( WHO STEPs) and the international physical activity questionnaire (IPAQ) were used to collect data. Statistical evaluations were employed to elucidate relationships between hypertension and all response variables. Results: The prevalence of hypertension using the old and new guidelines was 16% and 42%, respectively. Factors significantly associated with increased and reduced odds of developing hypertension after adjustments in multivariate logistic regression were age, body mass index (BMI), employment status, fasting blood sugar (FBS) and table salt consumption, respectively (p<0.05 for all). Using the new AHA/ACC criteria for hypertension shifted the prevalence from 16% (old criteria) to 42%.Conclusion: The prevalence of hypertension in PLH in Livingstone was 42% and the major risk factors associated with hypertension in PLWH were increasing age, BMI and FBS. We recommend the inclusion of FBS in routine measurements in PLWH. The AHA/ ACC new guidelines should be reenforced in low-cost settings to increase the treatment of hypertension among PLWH.
Subject(s)
HIV Infections , Anti-Retroviral Agents , Hypertension , Blood Glucose , PrevalenceABSTRACT
Objective: To examine the contribution of lower-level health facilities in increasing access to cervical cancer screening in the North Tongu District. Design: A descriptive cross-sectional study design was used. The Cervical Cancer Prevention and Training Centre (CCPTC) of the Catholic Hospital, Battor, served as the hub, and six health facilities (3 health centres and 3 CHPS compounds) served as the spokes. From April 2018 to September 2019, the well-resourced CCPTC trained 6 nurses at selected Community-based Health Planning and Services (CHPS) / Health Centres (HCs) (spokes) to provide cervical cancer screening services. The nurses, after training, started screening with VIA and HPV DNA testing. Participants: A total of 3,451women were screened by the trained nurses. This comprised 1,935 (56.1%) from the hub and 1,516 (43.9%) from the spokes. Main outcome measure: The detection of screen positives Results: The screen positives were 19.4% (375/1935) at the hub and 4.9% (74/1516) at the spokes. Conclusion: We have demonstrated that a hub and spokes model for cervical cancer screening is possible in limited resource settings. Designating and resourcing a 'hub' that supports a network of 'spokes' could increase women's access to cervical cancer screening. This approach could create awareness about cervical cancer screening services and how they can be accessed
Subject(s)
Uterine Cervical Neoplasms , Disease Prevention , Early Detection of Cancer , ELAV-Like Protein 2 , Epidemiological Models , Ghana , Health FacilitiesABSTRACT
Background: COVID-19 remains a major public health threat globally, and has challenged healthcare systems and services including oral health Objective: This study examines the key public health challenges posed by the COVID-19 pandemic in low resource settings. While healthcare services are learning to cope with the COVID-19 pandemic, dental care services, in particular restorative dental practice have been adversely impacted because of the closeness of caregivers to the patient's mouth as well as the generation of aerosols during most restorative procedures. This presents a challenge for low-and-middle-income countries (LMICs) such as Nigeria where weak and poor governance structures characterize healthcare systems in addition to paucity of economic resources. Another challenge in the form of COVID-19 conspiracy theories has threatened to undermine public health efforts designed to control the pandemic. Conclusion: The implementation of optimal guidelines and safety protocols for effective COVID -19 infection prevention and control is a major challenge for restorative dental care practice in low resource settings owing to paucity of key material resources and inappropriate behaviour associated with lingering doubts about COVID-19 reality among the majority of the populace. The Safer Aerosol-Free Emergent Dentistry concept offers a viable practical approach for restorative dental practice in LMICs during and in the post COVID-19 pandemic era. There is a need to deploy all resources, human and material, in the education and enlightenment of the populace regarding the reality of COVID-19.
Subject(s)
Humans , Occupational Exposure , Dental Care , Developing Countries , COVID-19 , Public Health , Dentists , General Practice, DentalABSTRACT
Aim To investigate the effects of TRPV4-Nox2 complex on ROS production and aortic vasodilatory function in mice fed with high-fat diet.Methods Male C57 BL/6J mice and TRPV4 KO mice were randomly divided into seven groups, with 10 mice in each group: normal diet group(ND), high-fat diet group(HFD), TRPV4 KO mice fed with high-fat diet group(TRPV4 KO-HFD), HFD+AAV-Flt1-Vector/Nox2 ▵3 group, TRPV4 KO-HFD+AAV-Flt1 -Vector/Nox2 ▵3 group.Body weight and blood pressure were recorded.14 weeks later primary aortic endothelial cells were isolated for CM-H2DCFDA staining and immuno-FRET assay, and aortic rings were isolated for vascular tone assay.Results ① Obesity significantly increased ROS production, triggered vasodilatory dysfunction and increased the strength of physical coupling between TRPV4-Nox2 complex(P<0.05); ② Decreasing the physical association of TRPV4-Nox2 complex could help reduce obesity-induced increased ROS production and vasodilatory dysfunction(P<0.05); ③ Entrectinib had no effect on the expression and function of TRPV4 and Nox2, but only decreased the physical association of the TRPV4-Nox2, which in turn improved obesity-induced oxidative stress and restored vasodilatory function.Conclusions Reducing the physical association of TRPV4 and Nox2 through Entrectinib can help reduce obesity-induced increase in ROS production and improve vasodilatory function of obese mice.
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Abnormality of glycogen synthase kinase-3 (3 ( GSK- 3(i) triggers a deleterious consequence of disorder of bone me¬tabolism , contributing to osteoporosis.Osteoporosis is character¬ized by bone loss and destruction of bone microstmcture, which often leads to the increase of incidence rate of fracture.Natural products derived from plants can be used as potential dmgs to prevent and treat osteoporosis.In this review, we elaborates on the intimate connection between GSK-3p and bone metabolism.and summarizes natural products of flavonoids, isoflavoncs, pol¬ysaccharides and saponins, phenols, alkaloids and amine deriv¬atives regulating GSK-3(3 pathway in the prevention and treat¬ment of osteoporosis, which may provide scientific evidence for further development of drugs that may effectively prevent and treat osteoporosis.
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Objective: This study aimed to identify and classify the needs of caregivers of children with disabilities living in resource-limited settings and develop a framework for need assessment.Participants and Methods: This study was conducted in the Maha Sarakham Province, Thailand, with 15 caregivers caring for children with disabilities recruited from hospitals, the Association for the Disabled, and primary health centers. Semi-structured interviews were conducted in local dialects, recorded, transcribed, converted into standard Thai, and then into English for thematic analysis. Meaning units corresponding to caregivers’ needs were extracted, interpreted, coded, and hierarchically organized into subcategories by comparing similarities and differences among the extracted codes. The subcategories were further grouped and abstracted into categories, and then domains of caregivers’ needs were formed.Results: Nineteen categories were identified across five domains of caregivers’ needs: health and medical, welfare, educational, social, and informational. Although basic medical treatment was covered, specific support, such as referral to a specialist, rehabilitation, or psychological support, was limited. Financial support and relief from the care burden are the main welfare needs. Educational needs were identified to provide knowledge to children and to offer respite to their caregivers. Social needs revealed ethical problems that arose because of strong rural community ties, making it difficult to maintain privacy. Informational needs were intertwined with the other four domains. In rural areas, where parents of children with disabilities migrate to cities to find work, the special needs of grandparents who were primary caregivers of the children needed to be addressed.Conclusion: This study provides a conceptual framework for comprehensive needs assessment and policy development for caregivers of children with disabilities living in resource-limited settings.
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A proposta deste artigo é refletir sobre as diversidades sexuais e as configurações familiares presentes no mundo contemporâneo e na clínica psicanalítica atual, enfatizando a necessidade da desconstrução da lógica binária e da despatologização. A autora ressalta a importância da alteridade como uma função ética, considerando a singularidade do ser humano e a tolerância ao diferente. Transita brevemente pelo pensamento de alguns autores e utiliza flashes ilustrativos cinematográfico, literário e clínico.
The purpose of this article is to reflect on sexual diversity and family configurations present in the contemporary world and the current psychoanalytic clinic, emphasizing the need to deconstruct binary logic and depathologization. The author emphasizes the importance of otherness as an ethical function, considering the uniqueness of the human being and the tolerance to the different. She transits briefly through the thoughts of some authors and uses cinematographic, literary and clinical illustrative flashes.
El propósito de este artículo es reflexionar sobre la diversidad sexual y las configuraciones familiares presentes en el mundo contemporáneo y en la clínica psicoanalítica actual, enfatizando la necesidad de deconstruir la lógica binaria y despatologizar. La autora destaca la importancia de la alteridad como función ética, considerando la singularidad del ser humano y la tolerancia a los diferentes. Transita brevemente por el pensamiento de algunos autores y utiliza flashes ilustrativos cinematográfico, literario y clínico.
La proposition de cet article est de réfléchir sur les diversités sexuelles et les configurations familiales présentes au monde contemporain et dans la clinique psychanalytique actuelle, en remarquant le besoin de la déconstruction de la logique binaire et de la dépathologisation. L'auteure remarque l'importance de l'altérité comme une fonction étique et considère la singularité de l'être humain et la tolérance au différent. Marche légèrement aux pensées de quelques auteurs et utilise des flashs illustrés cinématographiques, littéraires et clinique.
Subject(s)
Psychoanalysis , Sexuality , Gender Identity , Family , Gender DiversityABSTRACT
ABSTRACT The contexts of sports practice are important elements that influence the sports development of children and young people. Thus, the aim of this study was to analyze the contexts of sports practice of elite Brazilian volleyball athletes, based on the verification of practice contexts and sociodemographic variables (gender, development stage and training category) that could influence the insertion on these environments. In this retrospective study, 121 athletes, members and former members of Brazilian national teams participated in the male and female suits. Data were collected from the Instrument for Analysis of Sports Development in Volleyball (IAFEV) and analyzed by descriptive statistics (gross and relative frequency) and inferential statistics (Multinomial Logistic Regression). The results revealed a significant association between practice sites and development stage [X2 (6) = 52,709; p <0,001), sex [X2 (3) = 8,387; p = 0.039] and category [X2 (9) = 22,297; p = 0.008], showing that the athletes practiced, throughout their sports development, physical and sports activities in more structured environments, such as clubs and gyms, especially during the specialization and investment years. In addition, the practice in clubs stood out among female athletes and among athletes belonging to the younger categories, revealing specific aspects that can influence the choice of practice environments.
RESUMO Os contextos de prática esportiva são importantes elementos que influenciam na formação esportiva de crianças e jovens. Assim, o objetivo desse estudo foi analisar os contextos de prática esportiva de atletas de elite do voleibol brasileiro, a partir da verificação dos locais de prática e de variáveis sociodemográficas (sexo, estágio da formação esportiva, categoria de formação) que pudessem influenciar na inserção a esses ambientes. Participaram desse estudo retrospectivo 121 atletas, integrantes e ex-integrantes das seleções brasileiras nos naipes masculino e feminino. Os dados foram coletados a partir do Instrumento de Análise da Formação Esportiva no Voleibol (IAFEV) e analisados pela estatística descritiva (frequência bruta e relativa) e inferencial (Regressão Logística Multinomial). Os resultados revelaram associação significativa dos locais de prática com o sexo [X2(3)=8.387;p=0,039], os estágios [X2(6)=52.709;p<0,001) e as categorias de formação [X2(9)=22.297;p=0,008], evidenciando-se que os atletas investigados praticavam, ao longo de sua formação esportiva, as atividades físicas e esportivas em ambientes mais estruturados, como clubes e academias, principalmente durante os anos de especialização e de investimento. Além disso, a prática nos clubes destacou-se entre as atletas do sexo feminino e entre os atletas pertencentes às categorias mais jovens, revelando aspectos específicos que podem influenciar na escolha dos ambientes de prática.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Professional Training , Volleyball , Athletes , Sports , Training Support , Exercise , Fitness Centers , Athletic PerformanceABSTRACT
Abstract Introduction In order to centralise occupation in challenging settings, therapists need a supportive process and distinct strategies to assist them as they re-design and implement services which are truly occupation centred, based and focussed. Objectives The aim of this article is to illuminate the strategies utilised by a group of occupational therapists working to centralise occupation in a forensic mental health service in Australia. It also highlights the subsequent professional rewards they experienced from being more occupation centred in everyday practice. Method A Community of Practice Scholars was formed by participants. They then used a Practice Based Enquiry (PBE) approach - a type of action methods research - involving iterative cycles of data collection, analysis, critique and implementation of practice innovations. Results Seven major themes emerged from the study. The theme of Strategies in, and Rewards of, Occupation Centred Practice is the focus of this article, with inclusion of data from the theme of Communicating with Certainty. Additional themes are discussed through other, related publications. Conclusion This article highlights the process of moving beyond "knowing that" occupation centred practice is important, to "knowing how" to re-design an occupational therapy service to achieve this aim. Becoming more occupation centred in practice can be experienced as more professionally rewarding for occupational therapists, especially those working in challenging settings.
Resumo Introdução A fim de centralizar a ocupação em ambientes desafiadores, os terapeutas precisam de um processo de apoio e estratégias distintas para auxiliá-los enquanto eles redesenham e implementam serviços que são verdadeiramente centrados na ocupação, baseados e focalizados. Objetivos O objetivo deste artigo é enfocar as estratégias utilizadas por um grupo de terapeutas ocupacionais que trabalhou para centralizar a ocupação em um serviço de saúde mental forense na Austrália. Destaca também as recompensas profissionais subsequentes que experimentaram por estarem mais centradas na ocupação na prática cotidiana. Método Uma Comunidade de Acadêmicos de Prática foi formada pelos participantes. Eles então usaram uma abordagem de Investigação Baseada na Prática (PBE) - um tipo de pesquisa de métodos de ação - envolvendo ciclos iterativos de coleta de dados, análise, crítica e implementação de inovações práticas. Resultados Sete temas principais emergiram do estudo. O tema Estratégias e Recompensas da Prática Centrada na Ocupação é o foco deste artigo, com inclusão de dados do tema Comunicação Acertada. Temas adicionais serão discutidos em outras publicações relacionadas. Conclusão Este artigo destaca o processo de ir além de "saber que" a prática centrada na ocupação é importante, para "saber como" redesenhar um serviço de terapia ocupacional para atingir esse objetivo. Tornar-se mais centrado na ocupação na prática pode ser visto como profissionalmente mais gratificante para os terapeutas ocupacionais, especialmente aqueles que trabalham em ambientes desafiadores.
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Abstract Introduction In order to centralise occupation in challenging settings, therapists need a supportive process and distinct strategies to assist them as they re-design and implement services which are truly occupation centred, based and focussed. Objectives The aim of this article is to illuminate the strategies utilised by a group of occupational therapists working to centralise occupation in a forensic mental health service in Australia. It also highlights the subsequent professional rewards they experienced from being more occupation centred in everyday practice. Method A Community of Practice Scholars was formed by participants. They then used a Practice Based Enquiry (PBE) approach - a type of action methods research - involving iterative cycles of data collection, analysis, critique and implementation of practice innovations. Results Seven major themes emerged from the study. The theme of Strategies in, and Rewards of, Occupation Centred Practice is the focus of this article, with inclusion of data from the theme of Communicating with Certainty. Additional themes are discussed through other, related publications. Conclusion This article highlights the process of moving beyond "knowing that" occupation centred practice is important, to "knowing how" to re-design an occupational therapy service to achieve this aim. Becoming more occupation centred in practice can be experienced as more professionally rewarding for occupational therapists, especially those working in challenging settings.
Resumo Introdução A fim de centralizar a ocupação em ambientes desafiadores, os terapeutas precisam de um processo de apoio e estratégias distintas para auxiliá-los enquanto eles redesenham e implementam serviços que são verdadeiramente centrados na ocupação, baseados e focalizados. Objetivos O objetivo deste artigo é enfocar as estratégias utilizadas por um grupo de terapeutas ocupacionais que trabalhou para centralizar a ocupação em um serviço de saúde mental forense na Austrália. Destaca também as recompensas profissionais subsequentes que experimentaram por estarem mais centradas na ocupação na prática cotidiana. Método Uma Comunidade de Acadêmicos de Prática foi formada pelos participantes. Eles então usaram uma abordagem de Investigação Baseada na Prática (PBE) - um tipo de pesquisa de métodos de ação - envolvendo ciclos iterativos de coleta de dados, análise, crítica e implementação de inovações práticas. Resultados Sete temas principais emergiram do estudo. O tema Estratégias e Recompensas da Prática Centrada na Ocupação é o foco deste artigo, com inclusão de dados do tema Comunicação Acertada. Temas adicionais serão discutidos em outras publicações relacionadas. Conclusão Este artigo destaca o processo de ir além de "saber que" a prática centrada na ocupação é importante, para "saber como" redesenhar um serviço de terapia ocupacional para atingir esse objetivo. Tornar-se mais centrado na ocupação na prática pode ser visto como profissionalmente mais gratificante para os terapeutas ocupacionais, especialmente aqueles que trabalham em ambientes desafiadores.
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Objective:This study aims to investigate Mental health nurses′ perceptions of patient safety culture in different levels of hospitals, so as to provide the basis for understanding the perceptions of patients' safety culture among psychiatric nurses in different levels of hospitals.Methods:The self-designed general data questionnaire and the Hospital Patient Safety Culture Questionnaire were used to collect and analyze the data of 2 624 psychiatric nurses from level 3, level 2 and Level 1 hospitals in the seven administrative regions of China.Results:The scores of nurses in primary and secondary hospitals were 132.74±1.35 and 151.99±1.74, lower than 154.76±1.85 in tertiary hospitals ( χ2 value was 19.228, P < 0.01). There were statistically significant differences in the non-punitive response to error, feedback and communications about error, communication openness, hospital management support for patient safety, and frequency of events reported, overall perception of patient safety among psychiatric nurses at different levels of hospitals ( χ2 value was 7.997-37.681, P<0.05). Conclusions:The mental health nurses′ perceptions of patient safety culture in different levels of hospitals need to be improved, and hospital managers at all levels should focus on the non-punitive response to errors and personnel allocation. In addition, managers of primary and secondary hospitals also need to strengthen the training of nurses in such dimensions as feedback and communication of errors, openness of communication, management support for patient safety, frequency of adverse event reports, and overall sense of patient safety.
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@#<p style="text-align: justify;"><strong>Background and Introduction.</strong> The RxBox is a telemedicine device that measures and transmits vital signs to remote experts. It has been deployed to primary care health centers (PCHC) in the Philippines serving disadvantaged populations, to decrease morbidity and mortality due to common diseases and poor access to care. Factors affecting its adoption by healthcare workers is unknown.</p><p style="text-align: justify;"><strong>Materials and Methods.</strong> The study determined social and behavioral factors that affect adoption of a telemedicine device into the clinical workflow using the Unified Theory of Acceptance and Use of Technology (UTAUT) framework. This is a mixed methods research using review of records, survey and focused group discussions.</p><p style="text-align: justify;"><strong>Results and Discussion.</strong> RxBox telemedicine devices were installed in 79 primary care health centers (PCHC) and were used a total of 15,705 times within the study period. An ordinary least squares regression analysis using the combined site and individual-level data showed that among the UTAUT parameters, only compatibility, facilitating conditions, and social factors have significant relationships with intent-to-use of the RxBox. The innovation assisted primary care health workers in their clinical responsibilities, improved the stature of their PCHC in the community, and helped in the care for patients. Training and technology support after deployment as well as encouragement by peer and champions (the PCHC physician, local government leaders) reinforced continuous use after training. Users described the experienced improvements in quality of services provided by the PCHC and the consequent benefits to their patients.</p><p style="text-align: justify;"><strong>Conclusions.</strong> These factors should be accounted for in designing strategies to reinforce health workers' attitudes and enhance support towards acceptance and use of novel telemedicine devices into clinical routine in local health centers. Lessons are immediately useful for local leaders in low- and lower middle-income countries that suffer disproportionately from unnecessary maternal deaths and mortality due to non-communicable diseases. This contributes to the body of knowledge and should bolster national-level advocacy to institute an enabling policy on telehealth Information Communication Technology (ICT) and use of Filipino innovations towards health systems strengthening. Results can be used by implementers, evaluators, and regulators of health ICT, especially in resource-poor settings. Likewise, the study can encourage more research in the field to spur more dynamic local health ICT and biomedical device industries.</p>
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Primary Health CareABSTRACT
Esse artigo tem como objetivo compreender as fontes de apoio social utilizadas pelos moradores de comunidades rurais nas regiões Nordeste, Norte e Sul do Brasil, analisadas como estratégias de enfrentamento às situações de opressão decorrentes da pobreza. Foram realizados 14 grupos focais, analisados em quatro dimensões: apoio familiar, apoio comunitário, apoio religioso e apoio institucional, com a utilização do software Atlas ti 5.2. Os resultados apontam que a família é o apoio diante de situações de angustia e privações decorrentes dos contextos de pobreza, reiterando a sua função no suporte emocional e na segurança material. O apoio comunitário se relaciona também ao apoio emocional e à partilha dos bens disponíveis, com poucas referências às lutas comunitárias. A espiritualidade, analisada como apoio religioso, é um campo de consolo existencial que se amplia a partir da precarização do apoio institucional. Esse apoio institucional, advindo das políticas públicas de saúde, educação e assistência social, apareceu na realidade dessas comunidades, no entanto com algumas dificuldades de funcionamento. Estudar o apoio social em comunidades rurais pobres busca superar os estudos que identificam a pobreza apenas como ausência, carência ou limitações, esquecendo a existência de espaços de potencialidades e enfrentamento.
This article aims to understand the sources of the social support used by residents of rural communities in the Northeast, North, and South regions of Brazil, analyzed as strategies to confront situations of oppression resulting from poverty. A total of 14 focus groups were analyzed in four dimensions: family support, community support, religious support, and institutional support using the Atlas software 5.2. The results indicate that the family is supportive of situations of distress and deprivation arising from the contexts of poverty, reiterating its role in emotional support and material security. Community support also relates to emotional support and the sharing of available assets, with few references to community struggles. Spirituality, analyzed as religious support, is a field of existential consolation that expands from the precariousness of institutional support. This institutional support, coming from the public policies of health, education, and social assistance, has appeared in the reality of these communities, but with some difficulties in functioning. Studying social support in poor rural communities seeks to overcome studies that identify poverty only as an absence, lack, or limitations, forgetting the existence of spaces of potentialities and coping
ABSTRACT
A liderança é uma competência que precisa ser desenvolvida durante a vida acadêmica e aprimorada ao longo da carreira profissional dos enfermeiros, propiciada pelas organizações de saúde ou pela busca individual planejada. O processo de coaching integrativo pode contribuir para o desenvolvimento da competência liderança e ocorre por meio de sessões com interação colaborativa, estimulando as potencialidades dos profissionais, o autodesenvolvimento e o autoconhecimento. Objetivo: analisar a competência liderança exercida por enfermeiros que atuam no ambiente hospitalar antes e após um processo de coaching integrativo. Método: estudo misto incorporado, por meio de um estudo quase experimental (QUANT), e coleta de dados qualitativos de forma complementar (qual). A primeira etapa (antes) consistiu na aplicação do Questionário de Autopercepção do Enfermeiro no Exercício da Liderança (QUAPEEL) para 46 enfermeiros e do Questionário de Percepção do Técnico/Auxiliar de Enfermagem do Exercício da Liderança (QUEPTAEEL) para 157 auxiliares e técnicos de enfermagem de um hospital do Sul do Brasil. Em seguida, realizou-se a intervenção, por meio de um processo de coaching integrativo, com enfermeiros selecionados pelas respostas dos questionários. A segunda etapa (após) ocorreu três meses após a intervenção e incluiu a aplicação dos mesmos questionários para os oito enfermeiros que completaram a intervenção, e com 36 auxiliares e técnicos de enfermagem de suas equipes. Realizou-se também uma entrevista semiestruturada com esses enfermeiros. Os resultados quantitativos foram processados por meio do software Statistica versão 7.0 e analisados por estatística descritiva e analítica. As entrevistas foram transcritas e analisadas pela análise de conteúdo, com apoio do software MAXQDA. Resultados: Na primeira etapa, identificou-se dificuldade na comunicação, e enfermeiros que não se autopercebiam como líderes. Após a intervenção, com o processo de coaching integrativo, as respostas dos questionários e das entrevistas mostraram que os oito enfermeiros passaram a se perceber como líderes, que desenvolveram habilidades e modificaram atitudes que levaram a uma liderança mais efetiva. O escore da avaliação da prática da liderança passou de uma média de 79 (DP=4.84) para 84,38 (DP=5.66) na percepção dos enfermeiros, e de uma média de 73,69 (DP=23.03) para 81,92 (DP=19.75) na percepção dos auxiliares e técnicos de enfermagem. Na análise qualitativa, evidenciou-se melhor prática da liderança com as categorias: Comunicação efetiva; Interação com o supervisor; Desenvolvimento de vínculo e confiança com a equipe; Autoconhecimento e autodesenvolvimento para a melhor prática da liderança. Considerações Finais: o processo de coaching integrativo proporcionou o desenvolvimento da competência liderança entre enfermeiros assistenciais. Estes profissionais, que antes demonstravam dificuldade na comunicação com a equipe, que por vezes apresentavam medo de experienciar atitudes novas para o enfrentamento e resolução das situações adversas, tornaramse encorajados, obtiveram melhor autoconhecimento e, por meio deste, desenvolveram habilidades e atitudes que implicaram em uma liderança mais reconhecida pela equipe e por eles mesmos.
Leadership is a competence that needs to be developed during the academic life, and refined along nurses' professional career, fostered by health organizations or planned individual search. The integrative coaching process takes place with sessions of collaborative interaction, and may contribute to the development of the leadership competence, encouraging professionals' potentialities, their selfdevelopment and self-knowledge. Objective: to analyze the leadership competence performed by nurses, who work at hospital settings, before and after a process of integrative coaching. Method: incorporated, mixed study, by means of a quasiexperimental study (quantitative), and qualitative data collection, in a complementary way. The first step (before) comprised the application of the Questionnaire on Nurse Self-Perception of the Exercise of Leadership (QUAPEEL, in Portuguese) to 46 nurses, and the Questionnaire on the Perception of the Nursing Technicians/Nurse Aides on the Exercise of Leadership (QUEPTAEEL, in Portuguese) to 157 nurse aides and nursing technicians of a hospital in Southern Brazil. Subsequently, an intervention was held, by means of a process of integrative coaching with nurses selected by their questionnaire responses. The second step (after) was held three months from the end of the intervention, entailing the application of the same questionnaires to 8 nurses who went through the intervention, and 36 nurse aides/nursing technicians from their teams. A semi-structured interview was also conducted with those nurses. The quantitative results from the questionnaires were processed by means of the Statistica 7.0 software, and analyzed by descriptive and analytical Statistics. The interviews were transcribed and analyzed by content analysis using the MAXQDA software. Results: In the first step, difficulty in communication and nurses who did not self-perceived as leaders were identified. After the intervention, using the process of integrative coaching, the questionnaire responses and interviews showed that those eight nurses started perceiving themselves as leaders, who developed skills, and changed attitudes, which led them to a more effective leadership. The score for the assessment of the leadership practice increased to an average of 84.38 (SD=5.66) from 79 (SD=4.84) in the nurses' perception, and an average of 81.92 (SD=19.75) from 73.69 (SD=23.03) in the nurse aides and nursing technicians' perception. Regarding the qualitative analysis, better practice of leadership was evidenced with the categories, as follows: Effective communication; Interaction with the supervisor; Development of bond and trust with the team; Self-knowledge and self-development for best leadership practice. Final Considerations: the process of integrative coaching resulted in the development of the leadership competence among the health care nurses. Such professionals, who formerly showed difficulty communicating with their team, sometimes evidencing fear of trying, of experiencing new attitudes to cope with and solve adverse situations, they became encouraged, with better self-knowledge, which made them develop skills and attitudes, resulting in better-recognized leadership by their team and themselves.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Professional Competence , Nursing Administration Research , Mentoring , Leadership , Nurses , Licensed Practical Nurses , Leadership and Governance CapacityABSTRACT
Resumen Este artículo es producto de una investigación de mixta donde predominó el énfasis en la descripción de los resultados, con características cuantitativas de la información obtenida a través del cuestionario aplicado. El diseño descriptivo permitió observar y reflexionar sobre las mediaciones pedagógicas que se dan en los contextos familiares frente a la recepción y consumo de productos y servicios ofertados por la televisión, internet y las redes sociales on line. Los participantes fueron estudiantes universitarios (16 y 24 años de edad) a los que se les aplicó un cuestionario y un diario de observación. Se realizó una triangulación de los resultados de la observación participante y de los cuestionarios aplicados. Se encontró que existía un tipo de mediación familiar frente a los contenidos televisivos. Sin embargo, no se encontró un indicador que aclare si las familias están mediando los contenidos que circulan en internet. Esto permite una oportunidad para plantear estrategias de comunicación familiar, que posibiliten una injerencia de los padres / cuidadores o acompañantes sobre estos contenidos, teniendo en cuenta el ciclo vital individual y familiar.
Abstract This article was based on a mixed methods research where the predominant emphasis was placed on the description of the results, with quantitative characteristics obtained through the applied questionnaire. The descriptive design made it possible to observe and reflect on the pedagogical mediations that occur in family contexts with regard to the reception and consumption of products and services offered by television, the internet, and online social networks. The participants were university students (16 and 24-year-old) who responded the questionnaire and kept an observational diary. A triangulation of the results of both the participants' observations and the questionnaires was used. We found that there is a type of family mediation with regard to television contents. However, no indicator was found to clarify if the families are mediating the contents and information circulating on the internet. This opens up an opportunity to propose family communication strategies that allow for a more direct influence of the parents/caregivers or companions on these contents, taking into account the individual and family life cycles.