A Mixed-Methods Cohort Study Evaluating the Impact of a One-Day Well-Being Course for Anesthesia Providers Working in Low-Resource Settings.

BACKGROUND: Burnout, depression, and anxiety are increasingly recognized as common among health care providers. Risks for these conditions are exacerbated in low-resource settings by excessive workload, high disease burden, resource shortage, and stigma against mental health issues. Based on discussions and requests to learn more about burnout during the Vital Anaesthesia Simulation Training (VAST), our team developed VAST Wellbeing, a 1-day course for health care providers in low-resource settings to recognize and mitigate burnout and to promote personal and professional well-being. METHODS: This mixed-methods study used quantitative pre- and postcourse surveys using validated mental health measures and qualitative semistructured interviews to explore participants' experience of VAST Wellbeing during and after the course. Quantitative outcomes included burnout and professional fulfillment as measured by the Professional Fulfillment Index and general well-being as measured by the Warwick-Edinburgh Mental Wellbeing Scale. RESULTS: Twenty-six participants from 9 countries completed the study. In the immediate postcourse survey, study participants rated the course overall as "very good" (60.7%) and "excellent" (28.6%). Quantitative analysis showed no statistical differences in levels of work exhaustion, interpersonal disengagement, burnout, professional fulfillment, or general mental well-being 2 months after the course. Five themes on the impact of VAST Wellbeing were identified during qualitative analysis: (1) raising awareness, breaking taboos; (2) not feeling alone; (3) permission and capacity for personal well-being; (4) workplace empowerment; and (5) VAST Wellbeing was relevant, authentic, and needed. CONCLUSIONS: Causes of burnout are complex and multidimensional. VAST Wellbeing did not change measures of burnout and fulfillment 2 months postcourse but did have a meaningful impact by raising awareness, reducing stigma, fostering connection, providing skills to prioritize personal well-being, and empowering people to seek workplace change.

Building Global Partnerships: A Qualitative Exploration of In-Person Training for HealthCare Simulation Educators Working in Low-Resource Settings.

INTRODUCTION: Effective educational initiatives can elevate the quality of patient care globally. Simulation-based education is widely used in high-resource settings, but barriers exist to its widespread use in low-resource settings. Vital Anesthesia Simulation Training (VAST) overcomes these barriers by offering immersive, low-cost portable simulation along with simulation facilitator training. During the COVID-19 pandemic, in-person courses were stopped for more than 2 years. Postpandemic, a 3-day VAST SIMposium was hosted in Rwanda to unite 42 VAST facilitators from 12 widespread countries to introduce new and revised course materials and to rejuvenate dormant skills. The purpose of this study was to explore how the VAST SIMposium influenced perceived development of skills, confidence, and engagement in a community of practice for simulation educators working in low-resource settings. METHODS: This qualitative study involved in-depth interviews with a purposive sample of 16 VAST SIMposium attendees. Transcripts of audio recordings were analyzed using inductive thematic analysis. RESULTS: Six themes were identified during data analysis: 1) Diversity with shared passion for medical education; 2) Supportive in-person learning environment; 3) Simulation-based education relevant to low-resource settings; 4) Camaraderie; 5) Building knowledge, skills, and confidence; and 6) Being part of a community of practice. CONCLUSION: The SIMposium rejuvenated passion, knowledge, skills, and, most importantly, strengthened global connections and partnerships. These collaborations will benefit areas that are underrepresented in simulation and will ultimately improve patient outcomes. A SIMposium of this format is an efficient and effective way to foster sustainable global dissemination of simulation-based global health education.

Skill Translation Following the Vital Anesthesia Simulation Training Facilitator Course: A Qualitative Study.

BACKGROUND: Simulation-based education (SBE) is common in resource-rich locations, but barriers exist to widespread implementation in low-resource settings (LRSs). Vital Anesthesia Simulation Training (VAST) was developed to offer low-cost, immersive simulation to teach core clinical practices and nontechnical skills to perioperative health care teams. To promote sustainability, courses in new locations are preceded by the VAST Facilitator Course (VAST FC) to train local faculty. The purpose of this study was to explore the experiences of VAST FC graduates in translating postcourse knowledge and skills into their workplaces. METHODS: This qualitative study used focus group interviews with 24 VAST FC graduates (from 12 low- and middle-income and 12 high-income countries) to explore how they had applied new learning in the workplace. Focus groups were conducted by videoconferencing with data transcribed verbatim. Data were analyzed using inductive thematic analysis. RESULTS: Enabler themes for knowledge and skill translation following facilitator training were (1) the structured debriefing framework, (2) the ability to create a supportive learning environment, and (3) being able to meaningfully discuss nontechnical skills. Two subthemes within the debriefing framework were (1.1) knowledge of conversational techniques and (1.2) having relevance to clinical debriefing. Barrier themes limiting skill application were (1) added time and effort required for comprehensive debriefing, (2) unsupportive workplaces, and (3) lack of opportunities for mentorship and practice postcourse. CONCLUSIONS: Participants found parallels between SBE debriefing conversations, clinical event debriefing, and feedback conversations and were able to apply knowledge and skills in a variety of settings post course. This study supports the relevance of simulation facilitator training for SBE in LRSs.

Preparing Students for Post-COVID Nursing Careers: The Value of International Clinical Placements.

BACKGROUND: Prior to the coronavirus disease 2019 (COVID-19) pandemic, international clinical placements (ICPs) for nursing students were used to build cultural humility and global awareness. This study explored the influence of ICPs on nursing students' career planning and views of the nursing role; the findings were considered against the evolving pandemic context. METHOD: A qualitative, descriptive longitudinal study was conducted with 25 preregistration nursing students who participated in an international placement. Semistructured individual interview data were examined using thematic analysis. RESULTS: Participants were interested in patient equity and empowerment, high acuity and variety, health policy, and primary care. Participants developed resilience and nursing confidence. They saw the effects of poor health equity and health policy decisions on population health. CONCLUSION: ICPs expanded participants' understanding of global interconnectedness and also identified new career possibilities. Postpandemic, nursing education should continue to maintain a global focus on health. [J Nurs Educ. 2023;62(4):207-214.].

Peer Mentoring Programs for Culturally and Linguistically Diverse Refugee and Migrant Women: An Integrative Review.

Refugee and migrant women experience personal, cultural and structural challenges as they adapt to new lives in host countries. Peer mentoring programs are used to facilitate resettlement, build empowerment and improve job-readiness for refugee and migrant women; however, the effectiveness of these programs is not well understood. A systematic search of five databases, plus grey literature from January 2005 to December 2020, was undertaken, resulting in 12 articles. A narrative synthesis using thematic analysis identified the key components and outcomes of effective programs. Most mentoring programs were co-designed with community-based service providers, using participatory approaches to ensure cultural acceptability. Communication and sharing were facilitated using workshops and individual in-person or telephone mentoring. The training and support of mentors was critical. However, differences in expectations between mentors and mentees at times resulted in attrition. Qualitative evaluation revealed enhanced social support, greater empowerment and confidence for the women. There was improved access to the social determinants of health such as education, but limited success in obtaining employment. Mentoring programs can enhance refugee and migrant women's wellbeing and social connectedness in resettlement contexts. However, it is unclear whether these benefits can be sustained over the longer term. Future programs should be rigorously evaluated through qualitative and quantitative analyses to generate conclusive evidence for best practice.

"You Have to Go Gently": Mentors' Perspectives of a Peer Mentoring Empowerment Program to Reduce Marginalization in Refugee and Migrant Women.

The Empowerment and Peer Mentoring of Migrant and Refugee Women pilot program (EMPOWER) provides a mechanism for migrant women who have established lives in Australia to mentor newly arrived women to build the ability, confidence, and knowledge to overcome barriers to the social determinants of health such as employment. Female migrant mentors (n = 21) met with their mentees (n = 32) on a regular basis over a period of 3 to 12 months between September 2019 and November 2021. The individual mentoring was augmented by group workshops facilitated by content experts and the research team. The unique perspectives of the mentors were explored through individual interviews (n = 15) and analysis of journal entries (n = 58) submitted regularly by mentors throughout the program. Thematic analysis revealed that mentors were intrinsically motivated to build strong and trusting connections with their mentees, which were pivotal to reducing inequalities for mentees and their families. Mentors had high expectations of themselves and demonstrated commitment and flexibility to accommodate mentees' needs. However, they sometimes struggled when supporting mentees who were overwhelmed by the systemic and other stressors associated with resettlement and pre-migration trauma. Regular networking and moral support for mentors would enhance future programs.

Impact of a Pilot Peer-Mentoring Empowerment Program on Personal Well-Being for Migrant and Refugee Women in Western Australia.

The Empowerment and Peer Mentoring of Migrant and Refugee Women study (EMPOWER) examined the effectiveness of a participatory, peer mentoring program specifically tailored for migrant and refugee women to build ability, confidence, and knowledge to seek employment, a known contributor to mental health and wellbeing. Female migrant mentors (n = 21) supported five cohorts of mentees (n = 32), predominantly from Middle Eastern and Asian backgrounds, over a period of 3-12 months each between September 2019 and November 2021. The program consisted of both individual mentoring and group workshops facilitated by content experts and the research team. The mental health and wellbeing outcomes for the mentees were explored through individual interviews with both mentors and mentees. Results indicate the program helped participants develop social connections, self-esteem, self-efficacy, and personal health and safety skills. There are ongoing mental health needs in this cohort related to competing priorities and trauma. The development of trusting, respectful relationships with mentors who are committed and flexible is essential for positive wellbeing outcomes. Peer mentoring programs for migrant and refugee women can enhance mental health and wellbeing outcomes and facilitate independence. Mentors need resources to provide appropriate mental and physical health support for some groups.

One Year On: Cultural Competence of Australian Nursing Students Following International Service-Learning.

BACKGROUND: The effective delivery of health care to the growing multicultural population within Australia is a challenge for the nursing profession. A breakdown in cross-cultural communication and understanding, which stems from the tendency of nurses to project their own culturally specific values and behaviors onto patients and colleagues from other countries, can contribute significantly to non-compliance in migrant populations and conflict in collegial relationships. METHOD: The Inventory for Assessing the Process of Cultural Competence-Revised was administered to Australian undergraduate nursing students immediately before, immediately after, and 12 months after returning from international clinical placement. Data were analyzed using descriptive and inferential functions of SPSS. RESULTS: Overall cultural competence increased immediately following the placement and was sustained over time. However, there were significant differences among the five constructs measured. CONCLUSION: International clinical placements enhance cultural competence but targeted activities need to be undertaken pre-placement to develop specific aspects, in particular cultural desire. [J Nurs Educ. 2019;58(1):17-26.].

Something has shifted: Nursing students' global perspective following international clinical placements.

AIMS: To examine understandings of global health issues among nursing students following participation in an international clinical placement during their pre-registration university education. BACKGROUND: Universities use international clinical placements, especially in developing countries, to develop cultural awareness in students; however, little is known about the longer term influences on students' understandings of global nursing. DESIGN: A retrospective cross-sectional design was used, using an exploratory, descriptive qualitative approach. METHODS: Individual semi-structured interviews were conducted in 2014 with a purposive sample of 25 pre-registration nursing students from four Western Australian universities who undertook clinical placements across five countries. Data were analysed using inductive thematic analysis. RESULTS: Findings highlight that students developed new understandings around health systems including fragility of resource access, differences in clinical practice and variances in nursing roles between settings. Students also experienced challenges but were able to appreciate alternative world viewpoints. CONCLUSION: International clinical placements can develop greater awareness and help students form realistic strategies for using their nursing skills globally. Pre-placement training in cultural awareness and health system realities, along with strong supervisory support, is critical to success.

Perceptions of Nursing and Physical Therapy Students Toward Peer-Led Interprofessional Education in Manual Handling.

Perceptions of first-semester BSN students (N = 220) who received education on patient moving and handling skills from either fourth-year physical therapy/physiotherapy student peer teachers (n = 8) or regular nurse educators were obtained via validated scales and focus groups. There was a significant increase in the mean scores of items concerning communication skills in both groups, with increased scores for all items in the peer-led group. The teaching skills of physical therapy/physiotherapy student peers were evaluated highly by the nursing students.

Motivations and Expectations of Undergraduate Nursing Students Undertaking International Clinical Placements.

BACKGROUND: International clinical placements are common in preregistration nursing programs in Australian universities to enhance awareness of cultural needs and global health issues. Yet, little is known about the motivations and expectations of nursing students who choose to participate. METHOD: Using a qualitative exploratory design, individual semistructured interviews were undertaken with 52 preregistration final-year nursing students from four Western Australian universities 2 weeks prior to departure to the developing countries of Tanzania, Thailand, the Philippines, Cambodia, and India. Data were analyzed using thematic analysis. RESULTS: The interviews revealed that students were motivated by cultural inquisitiveness and a desire to help. They expected to gain cultural learning, to be challenged, to be fulfilled, to experience professional growth, and to feel gratitude. Developing an understanding of culture was a crucial outcome. CONCLUSION: By understanding the impetus and personal motivations of students, educators can guide students toward a more transformative experience whereby a more multicultural perspective on health care can be developed. [J Nurs Educ. 2016;55(9):487-494.].

Australian nursing and midwifery educators delivering evidence-based education in Tanzania: A qualitative study.

Since 2011, Western Australian nursing and midwifery educators have been providing evidence-based continuing education to Tanzanian health professionals. Despite thorough preparation before departure, differences in local resource levels and available facilities have necessitated impromptu adaptation of curriculum content and delivery methods to ensure an effective program was delivered. This study explored the personal, cultural and teaching strategies utilised by Western Australian nursing and midwifery educators in Tanzania and examined if the transferability of education packages was influenced by the educators' cultural competence. Using a qualitative exploratory approach, data was collected from 15 Western Australian nursing and midwifery educators using a demographic survey and in-depth individual semi-structured interviews. The core themes identified from the analysis were Determination to learn, Assessing needs, Communication skills and Greater understanding. These findings are described using the conceptual framework of Campinha-Bacote's The Process of Cultural Competence in the Delivery of Healthcare Services. With appropriate levels of cultural competence, international health professionals can be effective at providing ongoing professional development to colleagues in developing country contexts, which may help address difficulties with retention and motivation of staff. It is essential that prior to departure cultural competence training is provided to educators to enhance their teaching capacity and effectiveness in international settings.

Engagement and Creation of Professional Identity in Undergraduate Nursing Students: A Convention-Style Orientation Event.

BACKGROUND: In an innovative event that challenged traditional orientation programs, the Curtin University School of Nursing and Midwifery brought together nursing students, academic and student support staff, and health industry representatives. This unique whole-of-school convention consisted of sessions tailored to each student year group and aimed to promote nursing identity, highlight leadership opportunities, and showcase employer pathways. METHOD: To evaluate the event, a survey approach was used to collect quantitative data via questionnaire and qualitative data via open-ended questions from first-year students (n = 113), staff (n = 24), and industry representatives (n = 14). RESULTS: Students, staff, and industry evaluations indicated a successful event that achieved its goals, including student engagement and motivation and community building. CONCLUSION: This orientation model could be used as a basis for institution-wide engagement activities.

Evaluation of practice change in Tanzanian health professionals 12 months after participation in an Infection Prevention and Management Course.

BACKGROUND: Hospital-acquired infection (HAI) is a problem confronting developing countries. Education programmes have been shown to be effective in increasing awareness and changing practice in health professionals. METHODS: Practice change in health professionals who completed an Infection Prevention and Management Course in Tanzania was explored via focus group 12 months after completion of the course. FINDINGS: Positive changes in infection control practice were found, along with barriers to more widespread change. CONCLUSIONS: Providing tailored and continuing education programs to hospital staff, including managers, is recommended.

The wellbeing of infants exposed to buprenorphine via breast milk at 4 weeks of age.

BACKGROUND: Buprenorphine has been available in Australia since 2000 as an alternative pharmacotherapy to methadone for the treatment of opioid dependence. However, there is little information in the literature regarding the effect of buprenorphine on the wellbeing of infants exposed to buprenorphine via breast milk, following discharge from hospital. OBJECTIVE: The aim of the present study was to examine the wellbeing of infants exposed to buprenorphine via breast milk up to 4 weeks postnatally. METHODS: Approximately 4 weeks after birth, information on the feeding and sleeping patterns, skin color, infant elimination patterns and hydration, and Neonatal Abstinence Scores of infants (n = 7) exposed to buprenorphine via breast milk was collected via both observation and documentation. RESULTS: Infants were progressing well, with normal sleep patterns and skin color, and 2 mothers had minor concerns regarding infant elimination patterns. Four infants were exclusively breastfed and 3 were receiving a supplement, with a range of 260 to 700 mL of formula over 24 hours. The sleep patterns following feeding ranged from 1.55 to 3.33 hours, with a median of 2.12 hours. CONCLUSION: No adverse effects were detected in infants exposed to buprenorphine via breast milk up to 4 weeks postnatally. Further research using larger samples to assess possible developmental effects over longer periods of time is required.

Educational innovation for infection control in Tanzania: bridging the policy to practice gap.

The incidence of hospital acquired infection in developing countries is between two to 20 times higher than in developed countries and is attributable to multiple causes. Evidence-based international policies and guidelines developed to improve infection prevention and control are often not used in practice in these countries. To combat this challenge, this article presents an innovative educational framework used to bridge the gap between policy written by global health agencies and the realities of practice in Tanzania.

Attributes for effective nurse management within the health services of Western Australia, Singapore and Tanzania.

OBJECTIVE: To identify the perceptions of nurse managers in Western Australia, Singapore and Tanzania regarding desirable attributes for effective management of their health services, and to identify and discuss the implications for health-management education provided by Australian universities. METHODS: Nurse managers completed a questionnaire covering four key dimensions: personality characteristics, knowledge and learning, skills, and beliefs and values. Each of 75 items were rated as to their effect on management effectiveness, according to a 5-point Likert scale. RESULTS: Skills were considered the most important for management effectiveness by each group. Tanzanian respondents rated knowledge and learning almost as highly, and significantly higher than Western Australian respondents. They also rated personality characteristics and beliefs and values significantly higher than Western Australian respondents. No significant differences were found between Singapore and Western Australia. CONCLUSIONS: Participants desired a different relative mix of attributes in their nurse managers, with Western Australian respondents most likely to indicate that transformational leadership contributed most to managerial effectiveness. Tanzanian nurse managers were most likely to advocate transactional leadership, whereas Singaporean nurse managers' views were located somewhere between. Given that these perceptions are valid, the content and curricula of management-development courses need to be cognisant of the cultural backgrounds of participants. WHAT IS KNOWN ABOUT THE TOPIC? Views differ as to the extent to which the criteria for management effectiveness are broadly universal or contingent on culture. This applies to the area of nurse management as it does to healthcare management in general. WHAT DOES THIS PAPER ADD? It is demonstrated that each of the three quite different countries or states considered identified a distinctive combination of attributes as desirable, with the nurse managers of Western Australia most likely to favour a transformational style of leadership, those from Tanzania a transactional leadership style and those from Singapore somewhere in between. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Given the country- or state-specific desire for a different relative mix of attributes in their nurse managers, management educators in Australia need to ensure that the content and curricula of their courses are cognisant of the cultural backgrounds of their students. There are also important lessons to be taken on board regarding recruitment of nurses into management positions in terms of each of the four dimensions considered, particularly in terms of desirable personality characteristics and beliefs and values.

Estimated dose exposure of the neonate to buprenorphine and its metabolite norbuprenorphine via breastmilk during maternal buprenorphine substitution treatment.

OBJECTIVE: The aim of the present study was to estimate the dose of buprenorphine and its primary metabolite norbuprenorphine that a breastfed infant would receive during maternal maintenance treatment with buprenorphine. STUDY DESIGN: Seven pregnant opioid-dependent women taking buprenorphine (median, 7 mg/day; range, 2.4-24 mg) and who intended to breastfeed were recruited. After lactation was established, several milk samples were collected from each subject over a 24-hour dose interval, and buprenorphine and norbuprenorphine concentrations were measured by liquid chromatography-tandem mass spectrometry. The average concentration (C(avg)) across the dose interval was estimated as for both buprenorphine and norbuprenorphine (as buprenorphine equivalents). Absolute infant dose (AID), defined as C(avg) × daily milk intake, and relative infant dose (RID), defined as 100×AID/weight-adjusted maternal daily dose, via milk were calculated, assuming a milk intake of 0.15 L/kg/day. The infant's health and progress were assessed directly and by questionnaire on the study day. RESULTS: Mean (95% confidence interval) norbuprenorphine concentration in milk and AID values (1.94 [0.79-3.08] µg/L and 0.29 [0.12-0.46] µg/kg/day, respectively) were approximately half those for buprenorphine (3.65[1.61-5.7] µg/L and 0.55 [0.24-0.85] µg/kg/day, respectively). Similarly, the mean RID values were 0.18% (0.11-0.25%) for norbuprenorphine and 0.38% (0.23-0.53%) for buprenorphine. The breastfed infants showed no adverse effects, were all in good health, and were progressing as expected. CONCLUSION: Thus the dose of buprenorphine and norbuprenorphine received via milk is unlikely to cause any acute adverse effects in the breastfed infant.