Community Health Centers Research Articles

Prevalence of non-communicable disease risk factors among nursing staff in a low and middle-income country: A cross-sectional digital survey-based study.

To assess the prevalence of non-communicable disease risk factors among the nursing staff and educate them on prevention. Nursing staff is integral to the Indian community healthcare systems. Recent studies report a high prevalence of non-communicable diseases in Indian nursing staff. Therefore, data on the prevalence of non-communicable disease risk factors among nursing staff are crucial for education on prevention. A cross-sectional digital survey-based study. We invited 4435 nursing staff to attend our online survey. We used a customized questionnaire for data collection, including a digitized version of the Community-Based Assessment Checklist form. A score of >4 was considered high risk and warranted screening. Among 682 nursing staff who attended, 70% had never undergone screening for non-communicable diseases. The prevalence of non-communicable disease risk factors was significantly higher in male nursing staff. In addition, logistic regression analysis showed that age, tobacco and alcohol use, increased waist circumference, physical inactivity and family history of non-communicable diseases were significant risk factors among nursing staff. The study findings suggest that the nursing staff have suboptimal self-health concerns on non-communicable diseases. This situation warrants continued medical education, awareness campaigns on adopting a healthy lifestyle and health promotion.

Optimizing pediatric periprocedural pain management part I-Evolving ethics and topical anesthetics.

Pediatric procedure-related pain management is often incompletely understood, inadequately addressed, and critical in influencing a child's lifelong relationship with the larger health care community. We highlight the evolution of ethics and expectations around optimizing periprocedural pain management as a fundamental human right. We investigate the state-of-the-art of topical anesthetics, reviewing their mechanisms of action and providing comparisons of their relative safety and efficacy data to help guide clinical selection. In total, this two-part review offers a combination of conventional approaches and innovative techniques that should be used multimodally-in series and in parallel-to help optimize pain management and provide alternatives to sedation medication and general anesthesia.

Using a customer discovery process to enhance the potential dissemination and scalability of a family healthy weight program for rural communities and small towns

AimCustomer discovery, an entrepreneurial and iterative process to understand the context and needs of potential adoption agencies, may be an innovative strategy to improve broader dissemination of evidence-based interventions. This paper describes the customer discovery process for the Building Healthy Families (BHF) Online Training Resources and Program Package (BHF Resource Package) to support rural community adoption of an evidence-based, family healthy weight program.MethodsThe customer discovery process was completed as part of a SPeeding Research-tested INTerventions (SPRINT) training supported by the U.S. Centers for Disease Control and Prevention. Customer discovery interviews (n=47) were conducted with people that could be potential resource users, economic buyers, and BHF adoption influencers to capture multiple contextual and needs-based factors related to adopting new evidence-based interventions. Qualitative analyses were completed in an iterative fashion as each interview was completed.ResultsThe BHF Resource Package was designed to be accessible to a variety of implementation organizations. However, due to different resources being available in different rural communities, customer discovery interviews suggested that focusing on rural health departments may be a consistent setting for intervention adoption. We found that local health departments prioritize childhood obesity but lacked the training and resources necessary to implement effective programming. Several intervention funding approaches were also identified including (1) program grants from local and national foundations, (2) healthcare community benefit initiatives, and (3) regional employer groups. Payment plans recommended in the customer discovery interviews included a mix of licensing and technical support fees for BHF delivery organizations, potential insurance reimbursement, and family fees based on ability to pay. Marketing a range of BHF non-weight related outcomes was also recommended during the customer discovery process to increase the likelihood of BHF scale-up and sustainability.ConclusionsEngaging in customer discovery provided practical directions for the potential adoption, implementation, and sustainability of the BHF Resource Package. However, the inconsistent finding that health departments are both the ideal implementation organization, but also see childhood obesity treatment as a clinical service, is concerning.

Training on Determining Beyond Use Date (BUD) on Pharmacy Practice at Surabaya Health Vocational School

All drugs must be injected immediately after being prepared because the life of the drug can be shorter and it no longer refers to the Expiration Date (ED). If the medicine is not injected immediately, then to maintain the quality of the medicine before the BUD limit is to give the medicine vial a mark of the date and time the medicine was prepared and it must be stored according to storage requirements. The method used theoretical presentation, question/answer, discussion and practice offline in one of Surabaya Health Vocational School classrooms. The results are the community service activities through training on determining the Beyond Use Date (BUD) in Pharmacy practice at the Surabaya Health Vocational School received a positive response and the participants were very enthusiastic. It is hoped that there will be special standards established by the Surabaya Health Vocational School to help provide understanding regarding determining the Beyond Use Date (BUD) in the pharmaceutical practice and further collaboration with the Health Service, Community Health Center or Hospital on an ongoing basis.

Care, connection, and social distancing: The challenges of baby loss during the COVID-19 pandemic in Aotearoa New Zealand

ProblemThe COVID-19 pandemic hindered access to routine healthcare globally, prompting concerns about possible increases in pregnancy loss and perinatal death. BackgroundPUDDLES is an international collaboration exploring the impact of the COVID-19 pandemic on parents who experience pregnancy loss and perinatal death in seven countries, including Aotearoa New Zealand. AimTo explore parents’ experiences of access to healthcare services and support following baby loss during the COVID-19 pandemic in Aotearoa New Zealand. MethodsWe conducted in-depth, semi-structured interviews with 26 bereaved parents, including 20 birthing mothers, and six non-birthing parents (one mother and five fathers). Types of loss included 15 stillbirths, four late miscarriages, and one neonatal death. Participant ethnicities were broadly representative of Aotearoa New Zealand’s multi-ethnic society. Data were analysed using Template Analysis. FindingsAnalysis revealed five themes relating to pandemic impact on bereaved parent’s experiences. These were: ‘Distanced and Impersonal care’; ‘Navigating Hospital Rules’; Exclusion of Non-birthing Parents; ‘Hindered Access to Social Support’; and ‘Continuity of Relational Care’. DiscussionThe COVID-19 pandemic exacerbated isolation of bereaved parents through perceived impersonal care by healthcare professionals and restrictions on movement hindered access to social and cultural support. Compassionate bending of the rules by healthcare professionals and community postnatal visits by continuity of care midwives following the bereavement appeared to be mitigating factors. ConclusionSocial isolation is an added challenge for parents experiencing baby loss during a pandemic, which may be mitigated by flexible and compassionate care from healthcare professionals, especially continuity of care midwives.

Exploring Awareness and Understanding of Breast Cancer Risk Factors, Screening, and Treatment among Females in Pakistan

Purpose: Breast cancer is a pressing concern in Pakistan, ranking as the second leading cause of death among women. Despite its increasing incidence, it often lacks adequate attention from policymakers and healthcare professionals. This oversight could have severe consequences. To effectively tackle this health crisis, a thorough understanding of breast cancer's prevalence, risk factors, diagnosis, treatment, and outcomes in Pakistan is crucial. Methodology: To assess the level of awareness and understanding of breast cancer among women, this study was conducted. A cross-sectional survey was conducted in the outpatient department of Fauji Foundation Hospital, Rawalpindi, involving 350 female patients. Data were collected using a pre-structured questionnaire and analyzed using SPSS Version 16.0. Findings: Descriptive statistics were used, and the results were expressed as percentages and presented graphically. The study found that 70% of women were aware of breast cancer. Furthermore, 74% of the patients were married, and 87% had children. Knowledge about signs, symptoms, diagnosis, and treatment of breast cancer was relatively high among the women surveyed. However, only 23% of women had knowledge about performing breast self-examinations, and 18% had heard about mammography. This study provides valuable insights into breast cancer awareness and prevention behaviors among women in Pakistan, with significant implications for theory, policy, and practice. The findings highlight gaps in knowledge and awareness, particularly regarding breast self-examinations and mammography screenings. Unique Contribution to Theory, Policy and Practice: Policy implications stemming from the study results include the need for targeted awareness campaigns, educational programs, and screening initiatives to improve breast cancer awareness and preventive behaviors among women in Pakistan. Policymakers should allocate resources towards these efforts and integrate breast cancer education into existing healthcare services and community outreach programs to ensure widespread dissemination of information and access to screening services.

Online palliative care education and mentorship in Nepal: Project ECHO - a novel approach to improving knowledge and self-efficacy among interprofessional health-care providers.

Palliative care access in Nepal is severely limited, with few health-care providers having training and skills to pain management and other key aspects of palliative care. Online education suggests an innovation to increase access to training and mentoring, which addresses common learning barriers in low- and middle-income countries. Project ECHO (Extensions for Community Health Care Outcomes) is a model of online education which supports communities of practices (COPs) and mentoring through online teaching and case discussions. The use of online education and Project ECHO in Nepal has not been described or evaluated. An online course, consisting of 14 synchronous weekly palliative care training sessions was designed and delivered, using the Project ECHO format. Course participants included health-care professionals from a variety of disciplines and practice settings in Nepal. The goal of this study was to evaluate the impact of a virtual palliative care training program in Nepal on knowledge and attitudes of participants. Pre- and post-course surveys assessed participants' knowledge, comfort, and attitudes toward palliative care and evaluated program acceptability and barriers to learning. Forty-two clinicians, including nurses (52%) and physicians (48%), participated in program surveys. Participants reported significant improvements in their knowledge and attitudes toward core palliative care domains. Most participants identified the program as a supportive COP, where they were able to share and learn from faculty and other participants. Project ECHO is a model of online education which can successfully be implemented in Nepal, enhancing local palliative care capacity. Bringing together palliative care local and international clinical experts and teachers supports learning for participants through COP. Encouraging active participation from participants and ensuring that teaching addresses availability and practicality of treatments in the local health-care context addresses key barriers of online education. This study describes a model of structured virtual learning program, which can be implemented in settings with limited access to palliative care to increase knowledge and attitudes toward palliative care. The program equips health-care providers to better address serious health-related suffering, improving the quality of life for patients and their caregivers. The program demonstrates a model of training which can be replicated to support health-care providers in rural and remote settings.

Using Project ECHO to deliver a tele-mentoring and teaching program on palliative care in South Asia: Interpretive description of participants' experiences with a community of practice for learning.

To explore the learning experiences of participants (learners and teachers), in a yearlong tele-teaching and mentoring program on pediatric palliative care, which was conducted using the Project ECHO (Extension for Community Healthcare Outcomes) model and consisted of 27 teaching and clinical case discussion sessions for palliative medicine residents in India and Bangladesh. The goal of the study is to explore how participation and learning is motivated and sustained for both residents and teachers, including the motivators and challenges to participation and learning in a novel online format. Qualitative interviews with ECHO participants, including learners and teachers were conducted. Interviews were recorded and transcribed. Thematic analysis of interview data was conducted within an interpretive description approach. Eleven physicians (6 residents, 5 teachers) participated in interviews. Key elements of the ECHO program which participants identified as supporting learning and participation include small group discussions, a flipped classroom, and asynchronous interactions through social media. Individual learner characteristics including effective self-reflection and personal circumstances impact learning. Providing opportunities for a diverse group of learners and teachers, to interact in communities of practice (COP) enhances learning. Three major themes and 6 subthemes describing learning processes were identified. Themes included (1) ECHO program structure, (2) learner characteristics, and (3) COP. Subthemes included flipped classroom, breakout rooms, learning resources, personal circumstances, self-awareness of learning needs, and community interactions. Project ECHO suggests a novel model to train health providers, which is effective in low- and middle-income countries. Online learning programs can lead to learning through community of practice when learners and teachers are able to interact and engage in peer support and reflective practice. Educators should consider incorporating small group discussions, a flipped classroom design, and opportunities for asynchronous interactions to enhance learning for participants in online learning programs.

Barriers to equitable healthcare services for under-five children in Ethiopia: a qualitative exploratory study

BackgroundDisparities in child healthcare service utilization are unacceptably high in Ethiopia. Nevertheless, little is known about underlying barriers to accessing child health services, especially among low socioeconomic subgroups and in remote areas. This study aims to identify barriers to equity in the use of child healthcare services in Ethiopia.MethodsData were obtained from 20 key- informant interviews (KII) and 6 focus group discussions (FGD) with mothers and care givers. This study was conducted in Oromia Region, Arsi Zone, Zuway Dugda District from June 1–30, 2023. The study participants for this research were selected purposively. The information was collected based on the principle of saturation after sixteen consecutives interview were conducted. Both KII and FGD were audio-recorded and complementary notes were taken to record observations about the participants’ comments and their interactions. Each interview and FGD data were transcribed word-for-word in the local Afaan Oromo and Amaharic languages and then translated to English language. Finally, the data were analyzed thematically using NVivo 14 software and narrated in the linked pattern of child health service utilization.ResultsThis study identified six major themes which emerged as barriers to healthcare utilization equity for caregivers and their -under-five children. Barriers related to equity in low level of awareness regarding need, low socioeconomic status, geographical inaccessibility, barriers related to deficient healthcare system, community perception and cultural restrictions, and barriers of equity related to political instability and conflict. The most commonly recognized barriers of equity at the community level were political instability, conflict, and a tremendous distance to a health facility. Transportation challenges, poor functional services, closure of the health facility in working hours, and lack of proper planning to address the marginalized populations were identified barriers of equity at organizational or policy level.ConclusionThis study showed that inequity in child healthcare utilization is an important challenge confronting Ethiopia. To achieve equity, policy makers and planners need to change health policy and structure to be pro-poor. It is also necessary to improve the healthcare system to increase service utilization and access for impoverished women, individuals with lower levels of education, and residents of isolated rural areas. Furthermore, context specific information pertaining to cultural barriers and political ecology are required.

Precision healthcare: A deep dive into machine learning algorithms and feature selection strategies for accurate heart disease prediction

This paper presents a comprehensive exploration of machine learning algorithms (MLAs) and feature selection techniques for accurate heart disease prediction (HDP) in modern healthcare. By focusing on diverse datasets encompassing various challenges, the research sheds light on optimal strategies for early detection. MLAs such as Decision Trees (DT), Random Forests (RF), Support Vector Machines (SVM), Gaussian Naive Bayes (NB), and others were studied, with precision and recall metrics emphasized for robust predictions. Our study addresses challenges in real-world data through data cleaning and one-hot encoding, enhancing the integrity of our predictive models. Feature extraction techniques—Recursive Feature Extraction (RFE), Principal Component Analysis (PCA), and univariate feature selection—play a crucial role in identifying relevant features and reducing data dimensionality. Our findings showcase the impact of these techniques on improving prediction accuracy. Optimized models for each dataset have been achieved through grid search hyperparameter tuning, with configurations meticulously outlined. Notably, a remarkable 99.12 % accuracy was achieved on the first Kaggle dataset, showcasing the potential for accurate HDP. Model robustness across diverse datasets was highlighted, with caution against overfitting. The study emphasizes the need for validation of unseen data and encourages ongoing research for generalizability. Serving as a practical guide, this research aids researchers and practitioners in HDP model development, influencing clinical decisions and healthcare resource allocation. By providing insights into effective algorithms and techniques, the paper contributes to reducing heart disease-related morbidity and mortality, supporting the healthcare community's ongoing efforts.

Prevalence of Chronic Kidney Disease and its Association with Pesticide Exposure in Bargarh District, Odisha, India

Background: Bargarh, a district in Odisha, is known for intense agricultural activities because of uninterrupted irrigation from the Hirakud reservoir. The number of chronic kidney disease (CKD) cases in the district is increasing rapidly. The present study assesses the prevalence of CKD and CKDu (of unknown etiology) in the district and its association with pesticide application. Materials and Methods: A door-to-door survey was conducted to find out the CKD hotspots in the different blocks of the district with the help of primary and community health centers. The prevalence of CKD in the identified hotspot villages was assessed using a random clustered sampling method along with the collection of data related to age, sex, occupation and source of drinking water. Soil and water samples collected from identified hotspot and nonhotspot villages were analyzed to assess the presence of nephrotoxic pesticide residues. Results: A total of 16 villages were identified with high CKD prevalence rates and designated as hotspot villages. Data indicate that about 21% of males under ≥ 40 years age group were found to be suffering from CKD. Cases of CKDu (85%) were more prominent in these hotspot villages. Analysis of soil and water samples demonstrated the presence of seven different nephrotoxic pesticides above the maximum residues levels (MRLs) in hotspot villages compared to nonhotspot villages. Conclusion: The presence of nephrotoxic pesticides above MRLs in the hotspot villages indicates their possible association with the onset and progression of CKD among the exposed population. Further research is needed to establish their causative association with CKDu in the study region.

Facilitators of and barriers to County Behavioral Health System Transformation and Innovation: an interview study

BackgroundInadequate and inequitable access to quality behavioral health services and high costs within the mental health systems are long-standing problems. System-level (e.g., fee-for-service payment model, lack of a universal payor) and individual factors (e.g., lack of knowledge of existing resources) contribute to difficulties in accessing resources and services. Patients are underserved in County behavioral health systems in the United States. Orange County’s (California) Behavioral Health System Transformation project sought to improve access by addressing two parts of their system: developing a template for value-based contracts that promote payor-agnostic care (Part 1); developing a digital platform to support resource navigation (Part 2). Our aim was to evaluate facilitators of and barriers to each of these system changes.MethodsWe collected interview data from County or health care agency leaders, contracted partners, and community stakeholders. Themes were informed by the Consolidated Framework for Implementation Research.ResultsFive themes were identified related to behavioral health system transformation, including 1) aligning goals and values, 2) addressing fit, 3) fostering engagement and partnership, 4) being aware of implementation contexts, and 5) promoting communication. A lack of fit into incentive structures and changing state guidelines and priorities were barriers to contract development. Involving diverse communities to inform design and content facilitated the process of developing digital tools.ConclusionsThe study highlights the multifaceted factors that help facilitate or hinder behavioral health system transformation, such as the need for addressing systematic and process behaviors, leveraging the knowledge of leadership and community stakeholders, fostering collaboration, and adapting to implementation contexts.

Training the Next Generation of Local Public Health Leaders: A Case Study of Community Health Organizers in Pennsylvania.

Few short-term training programs exist for persons with limited experience or training in public health to support public health initiatives. We describe a public health training designed by the Pennsylvania (PA) Training Center for Health Equity for the PA Community Health Organizer (CHO) program. The CHO program was created to address the immediate needs of underserved communities and promote lasting health equity during the pandemic. CHOs are professionals who promote community action and align efforts with local organizations to build sustainable public health infrastructure and apply evidence-based practices to program policy, planning, and development. The training content, delivered by Project Extension for Community Healthcare Outcomes (ECHO) in 12 monthly sessions, focused upon foundational public health concepts in a novel community case study approach. The ECHO All Teach, All Learn training model was successful in providing relevant public health information to this new workforce, and the pre-/post-training evaluation demonstrated a positive increase in knowledge across all domains.

Managing the quality of primary health care in urban China: the impact of organizational and physician features.

Global health care quality improvement efforts have focussed on management practices. However, knowledge in primary care settings, especially in developing countries, such as China, is lacking. To examine the organizational and physician features associated with health care quality in China's community health centres (CHCs). We conducted a cross-sectional survey of 224 primary care physicians (PCPs) in 38 CHCs in Jinan, Tianjin, Shenzhen, and Shanghai. Clinical and prevention care quality with a 5-level scale (1 = never, 5 = always) reported by the PCPs were used to measure the quality of care. Two-level hierarchical linear models were estimated to examine the organization and physician-level variables associated with primary care quality. The average clinical care quality score was 4.08 and 3.59 for preventative care out of 5. At the organizational level, organizational culture and organizational support were the strongest predictors of physician-reported quality of care. At the physician level, professional fulfilment, psychological safety, and organizational citizenship behaviour were positively associated with care quality. Chinese CHCs clinical quality ranked high by PCPs, but the quality of preventative care provision required improvement. To improve primary care quality, managers of CHCs should implement optimal organizational structures, supportive organizational cultures, and strong organizational support at the organization level and cultivate high professional fulfilment, safe, and trustful relationships with colleagues at the physician level.

Ocular disorders in a tertiary Hospital in South East Nigeria

The object of this study was to determine the pattern of ocular disease patients that presented to the Enugu State University of Science and Technology Teaching Hospital, Park Lane, Enugu, Nigeria. A retrospective study was conducted, where the medical case notes of patients who had ocular examinations, other clinical examinations, and investigations from April 2022 through December 2022 were retrieved. There were a total of 1145 patients, with a male population of 476 (41.6%), while females were 669 (58.4%). The mean age of the study population was 40.8 years, with a Standard Deviation (SD) of 22.4. A total of 924 (80.7%) participants were adults while children (aged 16 years and below) were 221 in number and constituted 19.3% of the study population. The most common eye disease was refractive error, which occurred in 266 (23.2%) of the participants; it was followed by allergic eye diseases, 201 (17.6%), cataract, 170 (14.9%), glaucoma, 111 (9.7%), and trauma to the eye, 94 (8.2%). Among the children, the most common eye disease seen were allergic eye diseases, 78 (35.3%), followed by refractive error, 70 (31.7%), trauma, 21 (9.5%), cataract, 11 (5.0%), while infections of the eye were 10 (4.5%). The most common eye disease among the adult participants was refractive error, 196 (21.1%), and then cataract, 159 (17.2%), allergic eye diseases, 123 (13.3%), glaucoma, 105 (11.4%), and retinal pathologies, 82 (8.9%). The most common causes of eye diseases in this study were refractive error, allergic eye diseases, cataracts, glaucoma, and trauma. Health education at community and primary health care level could help to reduce the number of people with avoidable causes of visual impairment.

Service Quality and Related Factors in Primary Health Care Services: A Cross-Sectional Study

Primary health care services aim to prevent diseases and improve health efficiently and effectively. This study measures perceived service quality in a primary healthcare organization and examines the effect of personality traits on service quality. The cross-sectional study population comprised individuals over the age of 18 who applied to the Bingöl Central Community Health Centre. A total of 460 participants were included in the study between November 2018 and March 2019. The participants completed a face-to-face questionnaire that included socio-demographic characteristics, the SERVQUAL Scale, and an abbreviated form of the revised Eysenck Personality Questionnaire. This study is based on doctoral research in public health. The study found median values for personality trait sub-dimensions as follows: neuroticism: 2, psychoticism: 2.65, extraversion: 4, and lying: 5. The SERVQUAL Score was −0.02. The study revealed that the quality of primary health care services did not meet the participants’ expectations. The study findings also indicated that age, educational attainment, and extraverted and psychotic personality traits were significantly associated with the satisfaction of service quality expectations (p < 0.05). It is recommended to provide primary health care services in facilities with good physical characteristics, with sufficient and competent health personnel, and in a timely and accurate manner to improve service quality.

Risk Factors and Outcomes of Patients Colonized with KPC and NDM Carbapenemase-Producing Enterobacterales

Carbapenemase-producing enterobacterales (CPE) poses an increasing threat in hospitals worldwide. Recently, the prevalence of different carbapenemases conferring carbapenem resistance in enterobacterales changed in our country, including an increase in New Delhi Metallo-beta-lactamase (NDM)-CPE. We conducted a comparative historical study of adult patients colonized with Klebsiella pneumoniae carbapenemase (KPC)-CPE (July 2016 to June 2018, a historical cohort) vs. NDM-CPE (July 2016 to January 2023). We identified patients retrospectively through the microbiology laboratory and reviewed their files, extracting demographics, underlying diseases, Charlson Comorbidity Index (CCI) scores, treatments, and outcomes. This study included 228 consecutive patients from whom a CPE rectal swab screening was obtained: 136 NDM-CPE positive and 92 KPC-CPE positive. NDM-CPE-colonized patients had a shorter hospitalization length and a significantly lower 30-day post-discharge mortality rate (p = 0.002) than KPC-CPE-colonized patients. Based on multivariate regression, independent risk factors predicting CPE-NDM colonization included admission from home and CCI < 4 (p < 0.001, p = 0.037, respectively). The increase in NDM-CPE prevalence necessitates a modified CPE screening strategy upon hospital admission tailored to the changing local CPE epidemiology. In our region, the screening of younger patients residing at home with fewer comorbidities should be considered, regardless of a prior community healthcare contact or hospital admission.

Implementation of SI-KEPPO Innovation to Increase Return Visits of Hypertension Patients at Public Health Center of Sobo, Banyuwangi

The key to managing hypertension is regular control visits to the community health center or other health facilities. These visits are critical in monitoring response to treatment, adjusting therapy if necessary, and providing education and support to the patient. Low compliance of hypertension patients with re-visits or regular control can hinder the success of hypertension management and increase the risk of complications. The SI-KEPPO (Automatic Reminder Message Group System) innovation aims to provide an effective solution in managing and arranging re-visits or reminding individuals or groups of contact time automatically via text messages or other messages. This activity is a community service aimed at doctors, nurses, administration staff and counter staff. A direct training is carried out on computers owned by the Community Health Center so that deficiencies and advantages are detected in the existing facilities at the Community Health Center. The material presented is an introduction to the program or innovation by explaining the use of the innovation, the preparations made and the procedures for implementing it. There were 1 doctor, 4 nurses, 1 medical center administration staff, 1 operator staff, and 1 counter staff who participate in community service activities. All participants were very enthusiastic about this training and it could increase the number of repeat visits for hypertensive patients.

Crisis leadership behaviors in healthcare: survey validation and influence on staff outcomes in primary care clinics during the COVID-19 pandemic

Background The COVID-19 pandemic triggered an unprecedented transition from in-person to virtual delivery of primary health care services. Leaders were at the helm of the rapid changes required to make this happen, yet outcomes of leaders’ behaviours were largely unexplored. This study (1) develops and validates the Crisis Leadership and Staff Outcomes (CLSO) Survey and (2) investigates the leadership behaviours exhibited during the transition to virtual care and their influence on select staff outcomes in primary care.MethodsWe tested the CLSO Survey amongst leaders and staff from four Community Health Centres in Ontario, Canada. The CLSO Survey measures a range of crisis leadership behaviors, such as showing empathy and promoting learning and psychological safety, as well as perceived staff outcomes in four areas: innovation, teamwork, feedback, and commitment to change. We conducted an exploratory factor analysis to investigate factor structure and construct validity. We report on the scale’s internal consistency through Cronbach’s alpha, and associations between leadership scales and staff outcomes through odds ratios.ResultsThere were 78 staff and 21 middle and senior leaders who completed the survey. A 4-factor model emerged, comprised of the leadership behaviors of (1) “task-oriented leadership” and (2) “person-oriented leadership”, and select staff outcomes of (3) “commitment to sustaining change” and (4) “performance self-evaluation”. Scales exhibited strong construct and internal validity. Task- and person-oriented leadership behaviours positively related to the two staff outcomes.ConclusionThe CLSO Survey is a reliable measure of leadership behaviours and select staff outcomes. Our results suggest that crisis leadership is multifaceted and both person-oriented and task-oriented leadership behaviours are critical during a crisis to improve perceived staff performance and commitment to change.

Application of family nursing documentation in Tarakan City, Indonesia

Documentation of nursing care is authentic proof of nursing service activities, serving as the basis for fulfilling nurses' responsibilities and accountabilities. Family nursing documentation holds distinct characteristics compared to other nursing practice settings. The Indonesian nursing professional organization has established three standards for nursing care: diagnosis, intervention, and outcome. This research aimed to understand how the implementation of family nursing care documentation is conducted by community nurses in Tarakan City. The research was a correlational study with a cross-sectional approach. The study population consisted of all the nurses working in Community Health Centers in Tarakan City, totaling 80 individuals. The sample was selected using total sampling. The research variables included demographic factors, nurses' knowledge about the documentation concept, and the application of family nursing documentation; these were measured using a modified researcher-made questionnaire and declared valid and reliable. The analysis of research data used descriptive analysis and the Spearman Rank correlation test. This research identified that the majority of community nurses in Tarakan City did not implement family nursing documentation, and the level of knowledge regarding nursing documentation concepts was low. The Spearman's rank correlation test yielded a p-value of 0.874, indicating no significant correlation between the level of knowledge and the implementation of family nursing documentation. The inhibiting factors for the implementation of family nursing care documentation primarily included a high workload, a limited number of health center nurses, motivation, and the lack of clear and uniform documentation guidelines.