From disease- to people-centred pandemic management: organized communities, community-oriented primary care and health information systems.

BACKGROUND: The COVID-19 pandemic exposed the health equity gap between and within countries. Western countries were the first to receive vaccines and mortality was higher among socially deprived, minority and indigenous populations. Surprisingly, many sub-Saharan countries reported low excess mortalities. These countries share experiences with community organization and participation in health. The aim of this article was to analyse if and how this central role of people can promote a successful pandemic response. METHODS: This analysis was partly based on local and national experiences shared during an international and Latin American conference on person-and people-centred care in 2021. Additionally, excess mortality data and pandemic control-relevant data, as well as literature on the pandemic response of countries with an unexpected low excess mortality were consulted. RESULTS: Togo, Mongolia, Thailand and Kenya had a seven times lower mean excess mortality for 2020 and 2021 than the United States of America. More successful pandemic responses were observed in settings with experience in managing epidemics like Ebola and HIV, well-established community networks, a national philosophy of mutual aid, financial government assistance, more human resources for primary care and paid community health workers. DISCUSSION: Since trust in authorities and health needs vary greatly, local strategies are needed to complement national and international pandemic responses. Three key levers were identified to promote locally-tailored pandemic management: well-organized communities, community-oriented primary care, and health information systems. An organized community structure stems from a shared ethical understanding of humanity as being interconnected with each other and the environment. This structure facilitates mutual aid and participation in decision making. Community-oriented primary care includes attention for collective community health and ways to improve health from its roots. A health information system supports collective health and health equity analysis by presenting health needs stratified for social deprivation, ethnicity, and community circumstances. CONCLUSIONS: The difference in excess mortality between countries during the COVID-19 pandemic and various country experiences demonstrate the potential of the levers in promoting a more just and effective health emergency response. These same levers and strategies can promote more inclusive and socially just health systems.

RESUMEN: ANTECEDENTES: La pandemia de COVID-19 expuso la brecha de equidad en salud dentro y entre países. Los países occidentales fueron los primeros en recibir vacunas y la mortalidad fue mayor entre las poblaciones indígenas, minoritarias y socialmente desfavorecidas dentro de los países. Sorprendentemente, muchos países subsaharianos reportaron un exceso de mortalidad bajo. Estos países comparten experiencias de organización y participación comunitaria en salud. El objetivo es analizar si y cómo este papel central de las personas puede promover una respuesta exitosa a la pandemia. MéTODOS: Este análisis se basa en parte en las experiencias locales y nacionales compartidas durante una conferencia internacional y latinoamericana sobre la atención centrada en las personas y comunidades en 2021. Además, se consultó los datos de exceso de mortalidad y los datos relevantes para el control de la pandemia, así como la literatura sobre la respuesta a la pandemia de países con un exceso de mortalidad inesperadamente bajo. RESULTADOS: Togo, Mongolia, Tailandia y Kenia tuvieron un exceso de mortalidad promedio por 2020 y 2021 siete veces menor que los Estados Unidos de América. Se observaron respuestas pandémicas más exitosas en entornos con experiencia en el manejo de epidemias como el ébola y el VIH, redes comunitarias bien establecidas, una filosofía nacional de ayuda mutua, asistencia financiera del gobierno, más recursos humanos para atención primaria y trabajadores de salud comunitarios remunerados. DISCUSIóN: Dado que la confianza en autoridades y las necesidades en salud varían mucho, se necesitan estrategias locales para complementar las respuestas nacionales e internacionales a la pandemia. Se identificaron tres palancas clave para promover la gestión de pandemias adaptada localmente: comunidades bien organizadas, atención primaria orientada a la comunidad y sistemas de información de salud. Una estructura comunitaria organizada surge de una comprensión ética compartida que concibe a la humanidad interconectada entre sí y con el medio ambiente. Esta estructura facilita la ayuda mutua y la participación en la toma de decisiones. La atención primaria orientada a la comunidad incluye la atención a la salud comunitaria colectiva y las formas de mejorar la salud desde sus raíces. Un sistema de información de salud puede apoyar el análisis de la salud colectiva y la equidad en salud al presentar las necesidades de salud estratificadas por privación social, etnicidad y circunstancias de la comunidad. CONCLUSIONES: La diferencia en el exceso de mortalidad entre países durante la pandemia de COVID-19 y las experiencias de varios países, demuestran el potencial de las palancas para promover una respuesta de emergencia sanitaria más justa y eficaz. Estas mismas palancas y estrategias pueden promover sistemas de salud más inclusivos y socialmente justos.

The influence of learning styles preference of undergraduate nursing students on educational outcomes in substance use education.

This paper reports a study identifying the learning styles preference of undergraduate nursing students and examining its influence on educational outcomes. There are limited recent studies in the UK on the learning styles preference of undergraduate and its influence on educational outcomes. A purposive sample of 110 undergraduate nursing students completed a demographic questionnaire and the Honey and Mumford's learning styles inventory. A pre-post-test design was used to evaluate the educational outcomes. Reflector learning styles preference was the dominant learning styles among the majority of undergraduate nursing students. An interesting phenomenon about the distribution of the learning styles preference is the additional "dual" learning style category. The hypothesis that learning styles preference will determine knowledge acquisition, changes in attitude and intervention confidence skills was rejected. However, as this is a multi-layered hypothesis the findings showed that only the dual learning styles preference group was found to have a significant influence in intervention confidence skills. Further research is warranted to replicate this study using the same methodology but with several different population samples specialising in different branch of nursing. As there are limited literature on the dual learning styles preferences, this dual preference phenomenon needs further investigation to establish its acceptability in nursing education.

Predictors of educational outcomes of undergraduate nursing students in alcohol and drug education.

This paper reports a study which aimed to evaluate the impact of an educational programme on alcohol and drug on knowledge acquisition, changes in attitude and intervention confidence skills of undergraduate nursing students and identify the influence of selected demographic variables on educational outcomes. Despite the high levels of morbidity and mortality resulting from substance misuse, few nurses have been adequately prepared to respond effectively. There remains a dearth of evidence on the educational interventions in alcohol and drug with undergraduate nursing students and this study intends to add a body of knowledge to this field. A quasi-experimental, pre-post-test design was used using with a purposive sample of four cohorts of undergraduate nursing students (n=110) in England. Pre-tests and post-tests after the educational intervention on alcohol and drug were administered to measure the educational outcomes. The data was collected between March 2002 and September 2003. The results showed the educational intervention on alcohol and drug had a significant impact on educational outcomes. There were significant differences between the pre-test and post-test knowledge mean score (t=-.4.61, d.f.=109, p=0.000), attitude (t=-2.36, d.f.=109, p=0.02) and intervention confidence skills (t=-9.75, d.f.=109, p=0.000). Within the multi-layered hypothesis, the results indicate that only ethnicity was found to have a significant influence on both knowledge acquisition (F(2,106)=6.59, p=0.002) and intervention confidence skills (F(2,106)=15.0, p=0.000). The study provides some evidence that a short intensive educational programme on alcohol and drug can be effective in improving educational outcomes. Further research should be undertaken with undergraduate nurses specialising in different branch of nursing.

Educational intervention of undergraduate nursing students' confidence skills with alcohol and drug misusers.

There is a paucity literature on the educational interventions and evaluation programmes in alcohol and drug with undergraduate nursing students in the United Kingdom and this study intends to add a body of knowledge to this area. The aim of the study was to assess the intervention confidence skills of undergraduate nursing students before and after an educational intervention on alcohol and drug misuse. The research study is a quasi-experimental, pre- and post-test design. The sample was made of four cohorts of undergraduate nursing students (n=110) enrolled at a course leading to a diploma or BSc in nursing from three educational institutions. A visual analogue scale was used to measure intervention confidence skills before and after the educational programme in alcohol and drug. The findings showed an improvement in the level of intervention confidence skills of undergraduate nursing students. Further research is needed to examine effectiveness of educational interventions in working with substance misusers and whether substance misuse education is the key predictor of changing in changing intervention confidence skills.

Learning style preferences of undergraduate nursing students.

AIM: To determine the predominant learning style preferences of undergraduate nursing students. METHOD: A demographic questionnaire and Honey and Mumford's (2000a) learning styles questionnaire were administered to a purposive sample of 136 students. RESULTS: A response rate of 81% (110) was obtained. The results are congruent with U.K. studies, which show that the reflector is the preferred learning style of undergraduate nursing students. A 'dual' learning style category was also identified. CONCLUSION: A mismatch between teaching style and the learning styles of students has been found to have serious consequences. A variety of modes of teaching and learning should be used to meet the learning needs of students.