Continuing Education Intervention Research Articles

Assessment of knowledge, attitude and practice in pharmacovigilance among clinical post graduate students in a teaching hospital, Vizianagaram, Andhra Pradesh, India

Background: Adverse drug reactions (ADR) are global problem causing morbidity and mortality. Good pharmacovigilance (PV) programme can address this problem. Under reporting of ADR is one of the obstacles for good PV. In order to achieve this, health professionals need to have enough Knowledge, attitude and practice (KAP) of ADR`s. The present study was conducted to assess KAP about PV among post graduate (PG) students.Methods: A self administered questionnaire validated by Lynn M consisting of 22 questions covering knowledge, attitude & practice about PV was distributed among PG students of clinical departments of MIMS College. Answering of the questionnaires was supervised directly. Filled questionnaires were analyzed by using Microsoft Excel spread sheet.Results: Evaluation showed an average of 52.3% correct and 47.7% incorrect knowledge about ADR`s and PV.50% students are not sure regarding occurrence of ADR.90% students are not been trained upon reporting of ADR`s. Our study found out that PG students have better attitude towards PV, but have improper knowledge & less awareness about PV. We also found lack of practice among the students.Conclusions: Imparting knowledge and awareness of PV among the PG students by means of continuous educational intervention can create better practice among PG students.

Implementation and evaluation of an innovative leadership and teacher training program for non-physician emergency medicine practitioners in Uganda.

IntroductionLeadership and teaching skills are essential, but not often emphasized, components of medical training. As emergency care develops as a specialty in Uganda, two cadres of providers are being trained: physicians and non-physician clinicians (NPCs). Building formal leadership and educator training into these curricula is essential.MethodsA week long continuing education (CE) course on leadership and teaching is described and evaluated for effectiveness using Kirkpatrick’s framework for learner-centred outcomes. The emergency care trained NPCs participated in a week-long course consisting of lectures, role-playing, and small group discussions, as well as a personality self-assessment. The evaluation process consisted of: 1) an immediate post-course survey to measure learner satisfaction, 2) a retrospective, pre/post self-assessment with a Likert-type scoring tool to measure knowledge gains, and 3) a three-month follow up survey and structured interviews to measure knowledge retention and behaviour change in practice.ResultsAll 15 NPCs participated in the evaluation process. Learner satisfaction was high with an average score of 9.3 (on a 1–10 scale) for course content, amount learned, and use of time. Participants reported gains in knowledge for each of the 24 competencies measured, with an average difference in pre- and post-course Likert scores of 1.11 (on a scale of 1–5). Lastly, all 15 participants shared detailed examples of using course content in practice three months after the course finished. The most frequently mentioned themes were “giving and receiving feedback,” “delegating and assigning tasks,” and “communication.”ConclusionThis course was a successful CE intervention in this setting as measured by Kirkpatrick’s framework. The most frequently mentioned concepts used in practice point to the NPCs ability to take on leadership roles in this setting. Further research and evaluation methods should focus on the influence of culture and personalities on leadership education and translation into practice in an EM setting.

Continuous Educational Interventions Help Emergency Medical Services Effectively Reduce the Therapeutic Time in Acute Ischemic Stroke

Continuous Educational Interventions Help Emergency Medical Services Effectively Reduce the Therapeutic Time in Acute Ischemic Stroke

Effect of educational intervention about first aid and ergonomics on improving bakery workers’ performance related to occupational hazards at Zagazig City

Background Workers in bakeries face many hazards in their work environment. Hazards have the potential for causing injury or illness. Aim The aim was to evaluate the effect of educational intervention about first aid and ergonomics on improving bakery workers’ performance related to occupational hazards at Zagazig City. Materials and methods A quasiexperimental design was used, and the period of study lasted from February to April 2018. The study was conducted at bakeries in Zagazig City. All workers in 20 bakeries, randomly chosen from 119 bakeries, were included as the study sample. Three tools were used: tool I was the interviewing questionnaire form that was designed to collect data related to demographic characteristics of the bakery workers, the hazards of job exposures inside bakeries as reported by bakers, and the health problems reported by bakers during the last six months of the study. Tool II was the interview questionnaire form that consists of two parts: knowledge of bakery workers about first aid and ergonomics before/after the intervention. Tool III was an observational checklist used to assess the bakery workers’ practices regarding first aid and practices regarding the ergonomic maneuvers and an observational checklist to evaluate work environment safety of the bakeries. Results The greatest hazard related to job exposure inside the bakery as reported by the study sample was poor position (92.1%), and the lowest hazard is syncope (16.1%). Furthermore, the major health problems reported by bakers during the last six months were musculoskeletal problems (55.1%), and the least was gastrointestinal (4.5%). The total adequate score of their knowledge about first aids increased from 9.0% before sessions to 100.0% after sessions; moreover, none of bakery workers had satisfactory first aids practices at pre-educational sessions compared with 76.4% after the intervention. Additionally, none of the bakery workers before intervention performed practices of ergonomic maneuver, whereas after intervention implementation, the percentage increased to 84.3%. Conclusion The post-test score was higher than the pretest score in both knowledge and practices about first aid and ergonomic maneuver. Recommendations Continuous educational intervention should be initiated for all workers of bakeries in Sharkia Governorate to raise their knowledge and practices about first aid and ergonomics related to occupational hazards.

Enhancing Routine HIV Testing in Primary Care With a Continuing Education Intervention.

Since 2006, the Centers for Disease Control and Prevention (CDC) has recommended routine HIV screening in primary care settings for people ages 13 to 64, regardless of individual risk factors. However, an extensive body of research has identified several barriers to primary care providers' (PCPs) adherence to the CDC recommendations. Employing a pre-postintervention design, this study provided an assessment of barriers among 11 PCPs and implemented an evidence-based continuing education program adapted to the specific individual barriers they identified. The study found that PCPs were initially providing HIV testing using risk-based criteria but that the continuing education program increased intentions to perform routine HIV testing (e.g., during annual wellness examinations and new patient visits). Results of the study inform individual quality improvement projects and legislative or policy actions to increase HIV screening in sites providing primary care. [J Contin Educ Nurs. 2018;49(12):563-574.].

Effectiveness of Peripheral Intravenous Skill Continuing Education Using Low-Fidelity Simulation Among Nurses in India.

Many nurses have limited opportunities to practice peripheral intravenous (IV) skill access until they begin their nursing career, particularly in limited resource settings. Continuing nursing education is needed for practicing nurses to build nurse capacity and skill accuracy in IV access globally. A pretest-posttest design was used to measure effectiveness of peripheral IV continuing education among 180 nurses in India. A skills checklist was used to observe for skill accuracy using low-fidelity simulation. A statistically significant improvement in knowledge regarding peripheral IV skill access and care was found (p < .001), and 95% of nurse participants successfully simulated IV access accuracy after the continuing education intervention. Findings support the need for continuing nursing education to improve peripheral IV access and care knowledge and skill among nurses, particularly in low- and middle-income countries or other settings where hands-on experience is limited during undergraduate nursing education programs. J Contin Educ Nurs. 2018;49(6):255-261.

Correction to: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

Correction to: 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

Developing and evaluating a training intervention to address fear of cancer recurrence.

13 Background: Growing numbers of cancer survivors are increasingly receiving care from primary care providers (PCPs), who often lack cancer-specific expertise. In addition to long-term effects from cancer, survivors tend to be older with multiple chronic conditions, often leaving psychosocial concerns such as fear of cancer recurrence (FCR) unaddressed. This study reports the development and testing of a continuing education intervention to train PCPs to identify and address FCR. Methods: The training was developed through key-informant interviews with 42 health care professionals, researchers, and cancer survivors. The 30-minute training was then delivered and pilot-tested with a total of 46 participants, including physicians, PAs, NPs, nurses, and social workers in six discrete primary care practices. A one group pre-test, post-test design was used to evaluate the effectiveness of the training. Participants completed self-report surveys consisting of 5 domains developed from Social Cognitive Theory and Kirkpatrick’s Evaluation of Training Programs. Data were analyzed using descriptive statistics, paired-sample t-tests, and ANOVAs. Results: ± 10.9. Participants reported high levels of confidence that the training would change their practice, although they also identified barriers to action. Results of t-tests indicated that the training significantly increased participants’ knowledge and self-efficacy. With the except of 1 knowledge domain, no significant differences were found in multivariate analyses. Conclusions: This study demonstrated that a brief, on-site interprofessional training is feasible in a range of primary care practices, well-received by participants, and achieved goals of improved knowledge, self-efficacy and confidence to implement anticipated practice behavior changes. Such training efforts are important, as quality healthcare for increasing numbers of cancer survivors can be improved through continuing education efforts for their PCPs.

Chronic Heart Failure.

Chronic heart failure (CHF) is the most common reason for hospital admissions in Germany. For the National Disease Management Guideline (NDMG) on CHF, a multidisciplinary expert panel revised the chapters on drug therapy, invasive therapy, and care coordination, following the methods of evidence-based medicine. Recommendations are based on international guideline adaptations or systematic literature search. They were developed by a multidisciplinary expert panel, approved in a formal consensus procedure, and tested in open consultation, as specified by the requirements for S3 guidelines. The pharmacological treatment is based on ACE inhibitors, beta-blockers and mineralocorticoid receptor antagonists as well as diuretics to treat fluid retention, if present. Sacubitril/Valsartan and ivabradine showed positive effects on mortality in large but methodologically limited RCT. They are recommended if established combination therapy is not sufficient for symptom control, or if drugs are not tolerated/contraindicated. The indications for pacemakers or defibrillators have been confined to patient subgroups in which clinical trials have shown a clear benefit. Moreover, the goals of treatment and the patient's expectations should be aligned with each other. Structured care programs, specialized nurses, remote, or telephone monitoring showed moderate effects on patient related outcomes in RCT. All patients with heart failure are suggested to be enrolled in a structured program (e.g., a disease management program) including coordinated multidisciplinary care and continuous educational interventions. In patients with a poor prognosis, more intensive care is recommended, e.g. specialized nurses, or telephone support.

What is the problem with nursing documentation? Perspective of Indonesian nurses

BackgroundNursing documentation reflects the quality in patient care. It promotes effective communication between caregivers. However, although its significance has been discussed in numerous articles, nursing documentation remains problematic in Indonesia. ObjectiveThis research was the first of its kind in Indonesia which aim to identify issues with nursing documentation. MethodA qualitative approach through focus group discussions (FGD) with head nurses and staff was conducted to identify problems that hinder nurses’ abilities to follow proper documentation procedure in an urban hospital in Indonesia. The nurses who have more than one year work experience were recruited through simple random technique. There were 35 participants involved. The open-ended questions regarding the nursing documentation process were administered. The group discussions were held two times on each teams and conducted separately between the head nurses and their staff. The data for this descriptive qualitative study were recognized through content analysis methods. ResultsThe results of the study were captured in three themes: (1) Inadequate supervision for nurses on nursing documentation; (2) Competency issues in documentation; (3) Lack of confidence and motivation on documentation. ConclusionEducation is amongst the top listed contributing factors for quality nursing documentation. This is confirmed with this research. The findings of the study suggest the need for continuous support and educational intervention to ensure adherence to the nursing documentation procedure.

Self-perceived provision of patient centered care by healthcare professionals: The role of emotional intelligence and general self-efficacy

ObjectiveThis study aimed to investigate whether healthcare professionals’ emotional intelligence (EI) is associated with self-perceived provision of patient-centered care (PCC), taking into account the potential mediating effect of general self-efficacy (GSE). MethodsA sample of 318 healthcare professionals, recruited in 2015 among four hospitals in Italy, completed the Provider-Patient Relationship Questionnaire, the Emotional Intelligence Scale, and the General Self-Efficacy scale. A structural equation model was tested with GSE mediating the relationship between EI and self-perceived provision of PCC. Groups of participants based on gender, profession, and work setting were also compared on the study variables. ResultsEI had direct effects on the self-perceived provision of PCC dimensions. GSE partially mediated only the relationship between EI and involving the patient in care. Healthcare professionals in rehabilitation units showed higher self-perceived provision of PCC than those in acute care or ambulatory services. ConclusionSelf-perceived provision of PCC seems to have the potential to be improved by EI and to be distinguishable from GSE. Practice implicationsSince EI can be developed, findings of this study have potential implications for improving PCC through continuing education interventions for healthcare professionals.

Changing occupational therapists’ knowledge of their role in secondary transition planning

ABSTRACTStudents with disabilities need to effectively transition to adult occupations after secondary school. Occupational therapists are uniquely qualified to support this transition to adulthood; however, school-based occupational therapists report a lack of understanding of their role in transition planning (Kardos & White, 2005; Mankey, 2011). The purpose of this mixed-method study was to explore the effectiveness of a six-module e-training intervention designed to teach school-based occupational therapists about their role in secondary transition planning. Participants completed pre/post tests and provided qualitative information via online discussion. Results suggest that online training modules are an effective continuing education intervention to improve occupational therapists’ knowledge of secondary transition.

Building and Participating in a Simulation: Exploring a Continuing Education Intervention Designed to Foster Reflective Practice Among Experienced Clinicians.

Engaging health professionals in the processes of first building and then participating in simulations has not yet been explored. This qualitative study explored the experience of building and participating in a simulation as an educational intervention with experienced clinicians. Pediatric rehabilitation clinicians, along with a patient facilitator and standardized patients, created simulations and subsequently participated in a live simulation. The educational content of the simulation was culturally sensitive communication. We collected participants' perspectives about the process from individual journal entries and focus groups. A thematic analysis of these data sources was conducted. Participants described a process of building and participating in a simulation that provided: 1) a unique opportunity for clinicians to reflect on their current practice; 2) a venue to identify different perspectives through discussion and action in a group; and 3) a safe environment for learning. The combined process of building and participating in a simulation stimulated reflection about the clinicians' own abilities in culturally sensitive communication through discussion, practice, and feedback. It provided a safe environment for participants to share their multiple perspectives and to develop new ways of communicating. This type of educational intervention may contribute to the continuing education of experienced clinicians in both academic and community settings.

Hyperglycemia grand rounds: descriptive findings of outcomes from a continuing education intervention to improve glycemic control and prevent hypoglycemia in the hospital setting

Hyperglycemia is common in the hospital in-patient setting and is associated with adverse outcomes. Healthcare professionals (HCPs) often fail to use best practices established to manage this condition or to coordinate care among team members.Objectives: The objective of the Hyperglycemia Grand Rounds (HGR) continuing education initiative was to improve knowledge levels in a team setting, leading to improved clinical competence, evidence-based behaviors, and improved patient care.Methods: To achieve that goal, a four-module seminar series was presented to HCPs on-site in a “Grand Rounds” format at healthcare institutions across the United States. Outcomes data included satisfaction, learning, impact, and intent-to-implement measures at event time and at follow-up. At the site level, detailed questionnaires assessed skill gaps and expected outcomes from administrators at the time the modules were scheduled and the impact after modules were completed. Demographic information allowed identification of HCPs receiving maximum benefits; data on barriers to implementation are reported.Results: Seventy-eight percent of participants self-reported a positive impact on competence, performance, or patient outcomes. Forty percent of learners said they intended to make specific changes in practices. Eighty-two percent of administrators confirmed expected changes in their health system. The follow-up study concurred with the initial findings.Conclusion: The HGR was an effective program in improving self-reported competence amongst attendees that could potentially lead to improved care. This descriptive report summarizes outcomes from 1 year of educational efforts to more than 2000 healthcare professionals.

A competency-based approach to nurses' continuing education for clinical reasoning and leadership through reflective practice in a care situation

Newly graduated nurses need to demonstrate high levels of competencies when they enter the workplace. A competency-based approach to their education is recommended to ensure patients' needs are met. A continuing education intervention consistent with the competency-based approach to education was designed and implemented in eight care units in two teaching hospitals. It consists of a series of 30-min reflective practice groups on clinical events that newly graduated nurses encountered in their practice. It was evaluated using a descriptive longitudinal evaluative research design, combining individual and group interviews with stakeholders, the analysis of facilitators' journal entries, and a research assistant's field notes. The results suggest that issues associated with the implementation of the continuing education intervention revolved around leadership for managers, flexibility for nursing staff, and role shifting for the facilitators. Newly graduated nurses who participated in the study noted that the reflective practice sessions contributed to the development of both clinical reasoning and leadership. Nursing managers stated the advantages of the intervention on nurses' professional development and for the quality and safety of care. Following the end of the study, participants from two units managed to pursue the activity during their work time.

Self-care needs in healthcare contexts: how to gather, read and fulfill them

In light of a continuing education intervention (entitled “On the other side”) conducted with a multi-professional group at a Northern Italian hospital, this paper offers a reflection on educational needs analysis for healthcare professionals. This process has been extensively investigated, including in the context of healthcare training, leading to the call for a multi-method approach to developing professionals’ competencies in the interest of optimizing their patients’ health and quality of life. However, when professionals’ deepest inner need is for self-care to help them cope with the perceived heavy demands of clinical practice, educators may usefully adopt the phenomenological approach, which involves bracketing, the ability to see, taking responsibility and attending to professionals’ emotional experience. The analysis of professionals’ self-care needs should be viewed as a continuous process, to be implemented on an ongoing basis throughout the entire educational intervention, and as a practice that itself requires a caring attitude.

ATTITUDES TOWARDS AND ADHERENCE TO TREATMENT: A STUDY AMONG DIABETIC SAUDI MALES, KING ABDUL AZIZ SPECIALIZED HOSPITAL, TAIF, SAUDI ARABIA

This study was conducted to identify attitudes of diab etic patients towards compliance to treatment and to measure their compliance to treatment. A cross sectional study was conducted in King Abdul Aziz Specialized Hospital; Taif; KSA during June – October 2013. Convenient method of sampling was adopted. Al l adult (> 18 years) diabetic males were recruited. Data was collected through face - to - face interview method using structure questionnaire. Data was processed using the software Statistical Package for Social Science (SPPS). A total of 378 patients was rec ruited, of them 219(57.9 %) aged 40 - 65 years. Patie nts who were living in the town were 307(81.2 %) and more than one third had either college or university education. Overall 185(48.9 %) of the patients had positive attitude s towards compliance to treatme nt, while 193(51.1 %) had negative ones. Significant associations were documented between patients’ attitude towards compliance and both patient’s marital status and employment status (* P = 0.015), (* P = 0.020) respectively. The prevalence of non adherence was found to be 80.7 % (n = 305). Out of the patients who had positive attitudes towards compliance 145(78.54 %) were non - adherent, and 40(21.6 %) were adherent. In contrast, of the patients who had negative attitudes towards compliance 160(82.9 %) were n on - adherent and 33(17.1 %) were adherent, ( P = 0.226). In conclusion in this setting non - adherence to treatment was prevalent. Continuous patient educational interventions tailored to individual patient are needed to improve both patients’ attitude s and ad herence to treatment.

Consequences of a Lack of Standardization of Continuing Education Terminology: The Case of Practice Facilitation and Educational Outreach

Systematic reviews published in the quality improvement and continuing education literature have noted that the lack of standardized terminology for categorizing and describing various interventions in published studies is a major obstacle to drawing conclusions about their effectiveness. A case in point is practice facilitation and educational outreach. Although they are 2 long-standing interventions with some common characteristics, researchers studying 1 intervention may be unfamiliar with the other given the relatively separate literatures that have developed around both sets of terms. A comparison of articles included in recent systematic reviews of practice facilitation and educational outreach revealed a small but significant overlap of articles, journals, key words, and noncorresponding authors, but no overlap of corresponding authors. Based on these findings, the authors join the call for the creation of an intervention taxonomy and its application to these and other continuing education interventions.

Assessment of Knowledge, Attitude and Perception of Pharmacovigilance and Adverse Drug Reaction (ADR) Reporting among the Pharmacy Students in South India

The Study entitled Assessment of Knowledge, Attitude and perception of Pharmacovigilance and Adverse Drug Reaction (ADR) Reporting among the Pharmacy Students in South India was designed to assess the awareness of Pharmacovigilance and ADR reporting, and to evaluate the impact of an educational intervention. A validated (pilot study) self administered (KAP) Knowledge, attitude, perception survey questionnaire was used in the study. This prospective knowledge attitude practice (KAP) questionnaire study, of 6 month duration included a total of 225(90%) participants out of 250. An interactive educational intervention was designed for all participants of pre-KAP questionnaire survey. The impact of effectiveness of educational intervention among the pharmacy students was evaluated by means of post-KAP questionnaire survey. The paired t-test and chi-square test in GraphPad InStat was used for statistical calculation. The overall response rates between pre intervention and post intervention was statistically significant (P< 0.001) shows effectiveness of educational intervention for improving awareness of pharmacovigilance and ADR reporting among the participants. The study concluded that imparting the knowledge and awareness of Pharmacovigilance among the pharmacy students by means of continuous educational intervention would bring up updated knowledge and practice in drug safety and rational use.

Handling of Diskus Dry Powder Inhaler in Chinese Chronic Obstructive Pulmonary Disease Patients

The incorrect handling of Diskus inhalers in Chinese patients with chronic obstructive pulmonary disease (COPD) is not well documented. The present study was conducted to evaluate in detail the handling errors related to the Diskus device, and to elucidate the importance of educating COPD patients on the proper use of the device. A total of 384 COPD patients from a pulmonary clinic in China over a period of 5 years were included in the study. The compliance of COPD patients to the 13 discrete steps of Diskus usage were scored and analyzed by three measures: (1) On day 0, patients were given only a package insert on Diskus, and the handling error rate was assessed. Then the patients were given instruction on the 13-step Diskus procedure until they could demonstrate the proper technique. (2) On days 1, 2, and 3, the observation group was continuously educated on a 13-step procedure, and the percentage of patients who scored 100% for each step was recorded. The control group had no such training. (3) On days 10, 20, and 30, the percentage of all subjects correctly performing the Diskus 13-step inhalation procedure was assessed. Incorrect handling techniques on Diskus usage were widely distributed among Chinese COPD patients. Step 8 ("Inhale forcefully from the beginning, slowly, deeply, and uniformly during the inspiratory phase until the lungs are full") was the most commonly mishandled step (93.8%). The total score and individual step scores of the patients from the observation group were significantly improved during 3-day continuous education. There was also a significantly higher percentage of correctly performed steps in the observation group than in the control group upon assessment on day 10 (96.24% vs. 85.63%, respectively; p<0.01), day 20 (97.31% vs. 86.09%, respectively; p<0.01), and day 30 (98.19% vs. 87.39%, respectively; p<0.01). Handling errors of the Diskus 13-step inhalation procedure were commonly observed in Chinese COPD patients. Continuous educational interventions and regular supervision by health-care providers are therefore crucial for the optimum use of the Diskus inhaler.