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Background and Objectives@#Antimicrobial resistance (AMR) is a global public health threat that results from misuse and overuse of antimicrobials. The Department of Health (DOH) institutionalized the Antimicrobial Stewardship (AMS) Program in hospitals, based on the core elements (1) Leadership, (2) Policies, Guidelines, and Pathways, (3) Surveillance Antimicrobial Use (AMU) & AMR, (4) Action, (5) Education, and (6) Performance Evaluation to ensure rational use of antimicrobials and improve patient outcomes. The program implementation will require the involvement of the AMS clinical pharmacist to positively influence the success of the program’s implementation. This study aims to identify the enablers and challenges as perceived by AMS clinical pharmacists in the implementation of an AMS program in a level 3 hospital in Manila.@*Methods@#A quantitative descriptive study design was employed by administering an online 50-item survey questionnaire to AMS pharmacists, who have at least six (6) months of experience as an AMS pharmacist in the hospital. The survey questionnaire was validated by an expert consultant and underwent pre-testing (Cronbach α = 0.983) for acceptable internal consistency. Responses were collated, coded, and analyzed using median values and frequency distributions for each questionnaire item per Department of Health (DOH) Core Element. Items garnering a median of >3.50 up to 5 were considered as perceived enablers, while those ≤3.50 were identified as perceived challenges.@*Results@#Some perceived enablers by the AMS pharmacists include presence of a leader and/or clinician in the AMS team, Information Technology (IT) resource availability, clear roles of AMS pharmacists, readily available hospital AMS guidelines, engagement in AMR and AMU surveillance activities, regular performance of AMS interventions (e.g., IV-to-PO conversion, dose optimization, de-escalation of broad spectrum), regular monitoring and evaluating of prescriptions and prescribing behavior, and continuous education on infection, prevention, and control (IPC) and hygiene. On the other hand, some perceived challenges include insufficient funding, inadequate knowledge in interpreting antibiograms, lack of adequate and specialized training sessions, lack of coordination with medical and nursing staff to ensure timely drug administration and automatic stop order, prescribing of non-Philippine National Formulary (PNF) antimicrobials, lack of time to perform AMS activities, lack of qualified personnel, and lack of hospital management and information technology (IT) support.@*Conclusion@#Empowering AMS clinical pharmacists is vital to addressing the perceived challenges and maximizing the perceived enablers to ensure the successful implementation of the AMS program in the hospital.
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Gestion responsable des antimicrobiensRésumé
Resumen Pocos estudios han documentado la percepción de víctimas y victimarios con respecto a los factores facilitadores e instigadores de la violencia de pareja. El objetivo del presente estudio fue evaluar la percepción de víctimas y victimarios de violencia de pareja con respecto a factores facilitadores e instigadores de la violencia. Participaron 27 víctimas de violencia de pareja con edades entre 18 y 71 años (media = 34.25) y 27 victimarios jurídicamente confirmados, con edades entre 19 y 62 años (media = 40), quienes respondieron un cuestionario integrado por una lista sobre factores facilitadores e instigadores de la violencia de pareja y de datos sociodemográficos. Ambos grupos coincidieron en señalar al estrés y consumo de sustancias como propiciadoras de violencia, así como a la madre de su pareja como instigadoras. El diseño de intervenciones para tratar o prevenir violencia de pareja requieren identificar los factores que la facilitan, incluyendo a las familias circundantes ya que podrían no sólo tolerar o justificar la violencia, sino incluso inducirla. Finalmente, se discuten algunas diferencias notorias entre perpetradores y víctimas respecto de otras variables propiciadoras de violencia en el contexto de la teoría del aprendizaje social.
Abstract Few studies have documented the opinion of victims and perpetrators regarding the facilitating and instigating factors of intimate partner violence. The objective of this study was to evaluate the perception of victims and perpetrators of intimate partner violence regarding facilitating and instigating factors of violence. Participants were 27 victims of intimate partner violence aged between 18 and 71 years (mean = 34.25) and 27 legally confirmed offenders, aged between 19 and 62 years (mean = 40), who answered a questionnaire consisting of a list of facilitating factors and instigators of intimate partner violence and sociodemographic data. Both groups agreed in pointing to stress and substance use as propitiators of violence, as well as the mother of their partner as instigators. The design of interventions to treat or prevent intimate partner violence requires identifying the factors that facilitate it, including the surrounding families, since they may not only tolerate or justify the violence, but even induce it. Finally, some notorious differences between perpetrators and victims are discussed with respect to other variables that promote violence in the context of social learning theory.
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Despite a high prevalence of common mental health concerns, especially among young adults, majority of them do not seek professional help. This study explored perceived barriers and enablers of professional help-seeking for common mental health concerns among distressed non-treatment seeking young adults in the urban Indian context. The study utilized an explanatory sequential mixed methods design. A brief survey was conducted with distressed non-treatment seeking young adults (N=37) to assess their current distress level, duration, perceived severity, effect on functioning, self-help methods, past treatment history, inclination to seek help and barriers to professional help-seeking. Semi-structured interviews were conducted with a sub-sample of 10 participants to explore their perceived barriers and potential enablers of professional help-seeking. Quantitative data were analyzed using descriptive statistics and interviews using thematic analysis. The survey revealed significant distress for 75.7% (N=28) of the total sample. Out of these, 25% were either not inclined or had practical constraints to seek help. The mean score for inclination to seek help was highest for partner/friend (4.7). Qualitative findings have been discussed under personal and general barriers and enablers. This is the first study to highlight the complex interplay of barriers and enablers of professional help-seeking among distressed non-treatment seeking young adults in the urban Indian context. There is an urgent need to incorporate the factors that hinder and facilitate professional help-seeking while devising help-seeking interventions to reduce the treatment gap.
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Background: The coronavirus disease 2019 (COVID-19) pandemic has caused instability in the education system and has compelled higher education institutions (HEIs) to find alternative ways of teaching and learning by making use of the latest online teaching approaches. Aim: The purpose of the study was to explore how COVID-19 could serve as an enabler for the enhancement of online learning and teaching skills for nurse educators at the University of Namibia with specific emphasis on prospects and challenges. Setting: Semi-structured interviews were conducted in English at a public nursing education institution located in the northeast of Namibia. Methods: A qualitative explorative, descriptive and contextual research design was used. Data were collected by means of in-depth semi-structured interviews with 18 nurse educators from the School of Nursing. Data were analysed using thematic analysis. Field notes were simultaneously taken to enrich the data. Results: The study revealed three themes: nurse educators' experiences of the use of online learning and teaching skills, COVID-19 as an enabler for enhancing online learning and teaching skills and strategies to sustain online teaching and learning. Conclusion: Internet technology has generated a surge in demand for web-based teaching and learning. The online learning mode was not effectively utilised during the COVID-19 era because of inadequate technological skills on the part of nurse educators. Contribution: These findings can be used by universities to equip students and academic staff with skills to adapt to e-learning as the new modus operandi in learning and teaching in the post-COVID-19 era.
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Élève infirmier , Enseignement à distance , Enseignement infirmier , COVID-19 , PandémiesRésumé
INTRODUCTION@#In the Philippines, several health policies have been tailored to promote breastfeeding. Statistics show that despite efforts, breastfeeding prevalence remains low. This study aims to determine the demographics and associated barriers and enablers of breastfeeding among mothers living in Metro Manila. @*METHODS@#The study used a cross-sectional analytical design through an online self-administered questionnaire on barriers and enablers answered by mothers between 15-49 years old, residing in Metro Manila.@*RESULTS@#A total of 761 responses were included in the fnal analysis. Only age was found to be signifcantly associated with the practice of breastfeeding. Barriers identifed were 1) seeing breastfeeding as timeconsuming, 2) development of sore or tender nipples, 3) previously failed breastfeeding attempts, 4) poor latching on, and 5) not enough breastmilk production. Enablers identifed were 1) seeing the practice as a good way to bond with the child, 2) presence of breastfeeding areas at work or school, 3) previous success in breastfeeding experience, 4) support from hospital staff or midwives, 5) having knowledge on whom to contact when challenged with breastfeeding, and 6) knowledge of the benefts of breastfeeding on infant and maternal health.@*CONCLUSION@#Barriers and enablers towards breastfeeding may be target points for improvement of interventions aiming to increase prevalence of breastfeeding among mothers in Metro Manila.
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Background: The productivity of healthcare institutions is impacted by the nursing workforce and plays a vital role in the provision of effective and efficient patient care. Knowledge management plays a vital role in nursing practice. This study seeks to extend the frontier of knowledge by addressing the paucity of literature on knowledge management in nursing care delivery in Nigeria. Objectives: The study empirically identified crucial knowledge management enablers from extant literature and investigated their influence on patient care in clinical nursing. Method: A cross-sectional survey design using a stratified sampling method was employed. A self-administered questionnaire was used to collect quantitative data from 196 registered nurses in a selected teaching hospital in South West Nigeria. A total of 186 valid responses were analysed using structural equation modelling (SEM). Result: The result of this study indicated that there is a direct and significant relationship between information technology (IT) and patient care. Organisational structure and organisational culture did not directly affect patient care. However, together with IT support, the knowledge management enablers were found to significantly affect patient care in clinical nursing. Conclusion: There is a need for nursing management to develop a flexible organisational structure and knowledge friendly culture including the implementation of functional technical infrastructure, to leverage knowledge management effectiveness in patient care in teaching hospitals in order to facilitate and strengthen service delivery by nurses.
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Purpose: Visual impairment is a major health concern all over the world. Globally, it has been studied that utilization of low vision care (LVC) services varies from 3% to 15%. This study describes barriers to access the LVC services and suggest enablers to improve the uptake of services in a tertiary eye care hospital. Methods: A snapshot qualitative research design with purposive sampling was adopted. Qualitative part of the study involved 13 eye care practitioners (ECPs) and 7 patients with low vision participated in one to one in-depth interviews. The interviews were audio recorded, transcribed, inductively coded, and analyzed. The barriers to access LVC services were identified and enablers to improve the uptake of services were implemented. The referral rate and utilization of LVC services were analyzed in the quantitative part. Results: Themes emerged out of qualitative part of the study were barriers, perceived benefits, and enablers to improve the uptake of LVC services. Barriers among ECPs included lack of awareness on referral criteria and available LVC. Barriers among patients were lack of knowledge and understanding about the need for services. The enablers included development of referral criteria and referral pathway to LVC services, creating awareness of LVC services to patients and ECPs, stratification levels of LVC services, and implementation of LVC counseling chamber. Referral rate improved from 25.6% to 51.2% and the utilization of services increased from 67.9% to 81.7% after implementation of the recommended enablers. Conclusion: Execution of stratified enablers increased the uptake of LVC services benefiting more number of people with low vision in this study.
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Prevention of disease is one of the key functions ofprimary care. Vaccines have earned their place inpreventing communicable diseases. The rate of uptake ofvaccines does not always match with knowledge.There are barriers which the healthcare professionalsneed to address. In the new era of IT, innovation andpolicy change, many ideas can be pursued to improvevaccination uptake in the community.There is a group of our population who will need ourspecial attention to vaccinate. They are the healthcareworkers, caregivers, the foreign domestic helpers, theimmunocompromised, and the pregnant mothers.There are many areas we need to work on to improve ourvaccination rate. Primary Care Research will provide theevidence and guide the refinement of these programmes.
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Prevention of disease is one of the key functions ofprimary care. Vaccines have earned their place inpreventing communicable diseases. The rate of uptake ofvaccines does not always match with knowledge.There are barriers which the healthcare professionalsneed to address. In the new era of IT, innovation andpolicy change, many ideas can be pursued to improvevaccination uptake in the community.There is a group of our population who will need ourspecial attention to vaccinate. They are the healthcareworkers, caregivers, the foreign domestic helpers, theimmunocompromised, and the pregnant mothers.There are many areas we need to work on to improve ourvaccination rate. Primary Care Research will provide theevidence and guide the refinement of these programmes.
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OBJECTIVES: This research aimed to investigate the effects of knowledge management enablers, such as organizational structure, leadership, learning, information technology systems, trust, and collaboration, on the knowledge management process of creation, storage, sharing, and application. METHODS: Using data from self-administered questionnaires in four Korean tertiary hospitals, this survey investigated the main organizational factors affecting the knowledge management process in these organizations. A total of 779 questionnaires were analyzed using SPSS 18.0 and AMOS 18.0. RESULTS: The results showed that organizational factors affect the knowledge management process differently in each hospital organization. CONCLUSION: From a managerial perspective, the implications of these factors for developing organizational strategies that encourage and foster the knowledge management process are discussed.
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Comportement coopératif , Gestion des connaissances , Leadership , Apprentissage , Centres de soins tertiairesRésumé
Background: Pelvic organ prolapse (POP) is a major reproductive health problem in Nepal, though many women delay seeking treatment. To address this, the Nepalese government has been providing free vaginal hysterectomies with pelvic floor repair to women in mobile surgical camps. Studies exploring factors that enable women to attend these camp settings are limited. This study aimed to identify factors that affected women seeking surgical treatment for POP at mobile surgical camps. Methods: The study used a qualitative approach. Twenty-one women with POP were recruited in two week-long mobile surgical camps held in two remote districts in Nepal during April and May 2013. Data were collected from individual face-toface interviews and were analysed thematically. Results: Three themes and six subthemes emerged from the analysis. The first theme, “health-system factors”, suggests that accessibility and affordability of the treatment, and the supportive role of female community health volunteers facilitate women to seek treatment in the camp. The second theme, “factors related to sociocultural norms”, reveals that reaching the end of reproductive years and approval by relevant influential family members empowers women to take up surgical treatment in the mobile surgical camp. Similarly, the third theme, “individual-level factors”, includes women’s experience of POP, such as worsening symptoms and fear of development of cancer, as factors enabling women to seek treatment. Conclusion: Enablers to seeking treatment at mobile surgical camps for women are related to the Nepalese health system, sociocultural norms and individual experiences of women. Each of these factors should be considered when conducting mobile surgical camps, if women’s uptake of treatment is to be enhanced.
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PURPOSE: The purpose of this study was to explore nurses' experience of evidence-based nursing practice in general hospitals. METHODS: Data were collected from 13 nurses through in-depth interviews about their experiences with evidence-based practice. The research questions were "What kind of evidence are you using in your practice?" and "What are the barriers to and enablers of evidence-based practice that you have experienced?" Qualitative data from field and transcribed notes were analyzed using qualitative content analysis methodology. RESULTS: Major themes of using evidence were identified as 'research as primary valid evidence', 'information from local context and internet as realistic evidence', and 'clinical experience as pragmatic evidence'. Patient experience was not used as evidence in solving nursing problems. Barriers to and enablers of evidence-based practice were linked. They included both external, organizational factors and individual factors. Main issues were 'lack of evidence and poor work environment', and major facilitating factors were 'improving knowledge and skills related to evidence-based practice' and 'communicating and sharing evidence'. CONCLUSION: The study findings provide useful information for understanding nurses' experience of using external and internal evidence along with their meaning. A multidimensional approach is needed to overcome barriers to and implement evidence-based practice.
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Humains , Soins infirmiers factuels , Pratique factuelle , InternetRésumé
General Practitioners (GPs) play an important role in early detection and initiation of the diagnostic process of dementia. A consideration of barriers and enablers of this process can aid the diagnostic process. Early referral for Specialist evaluation is an important step. The GP can also provide additional advice and support to the patient and caregiver during diagnosis.