Frontline Healthcare Professionals Research Articles

Online Health Information Seeking and eHealth Literacy Among Patients Attending a Primary Care Clinic in Hong Kong: A Cross-Sectional Survey.

BackgroundPrevious studies have suggested that patients’ online health information seeking affects their medical consultations and patient-doctor relationships. An up-to-date picture of patients’ online health information-seeking behaviors can inform and prepare frontline health care professionals to collaborate, facilitate, or empower their patients to access and manage health information found online.ObjectiveThis study explores the prevalence, patterns, and predictors of online health information-seeking behaviors among primary care patients in Hong Kong, and the relations between online health information seeking and electronic health (eHealth) literacy.MethodsPatients attending a university primary care clinic in Hong Kong were asked to complete a questionnaire survey on their demographic backgrounds; health status; frequency and pattern of online health information seeking; contents, sources, and reasons for online health information seeking; and their eHealth literacy. eHealth literacy was measured by the validated eHealth Literacy Scale (eHEALS). Regression analyses explored various demographic and behavioral predictors to online health information seeking, and predictors to eHealth literacy.ResultsIn all, 97.32% (1162/1194) respondents used the internet, of which 87.44% (1016/1162) had used the internet to find health information. Most respondents (65.97%, 665/1008) searched once monthly or more. Few (26.88%, 271/1008) asked their doctor about health information found online, but most doctors (56.1%, 152/271) showed little or no interest at all. The most sought topic was symptom (81.59%, 829/1016), the top reason was noticing new symptoms or change in health (70.08%, 712/1016), the most popular source was online encyclopedia (69.98%, 711/1016), and the top reason for choosing a source was convenience (55.41%, 563/1016). Poisson regression analysis identified high eHEALS score, fair or poor self-rated health, having a chronic medical condition, and using the internet several times a day as significant predictors of online health information seeking. Multiple regression analysis identified lower age, better self-rated health, more frequent internet use, more frequent online health information seeking, and more types of health information sought as significant predictors to higher eHealth literacy.ConclusionsOnline health information seeking is prevalent among primary care patients in Hong Kong, but only a minority shared the information with doctors. Websites were chosen more for convenience than for accuracy or authoritativeness. Doctors should recognize patients’ online health information-seeking behavior, and facilitate and empower them to search for high-quality online health information.

A WISH TO DIE AND THE OLDER ADULT: THE IMPACT OF BESPOKING ON VIRTUAL CONTINUING EDUCATION

Introduction Older adults with depression or chronic illness may express a wish to die. Front-line healthcare professionals may be clinically tasked with the challenging scenario of distinguishing whether a patient is depressed, suicidal and/or requesting a medically assisted death (MAID), a procedure recently legalized in Canada. Baycrest, a large academic geriatric health centre in Toronto, offers virtual interactive learning through modules and webinars, which have been shared nationally with healthcare professionals interested in geriatric mental health. Our mandate is to create continuing education that engages learners and optimizes learning outcomes. In our most recent module, “A Wish to Die: MAID, Depression and the Older Adult”, we introduced the process of customization or bespoking and examined the impact on learning of this novel educational methodology. Methods 1) Bespoking A free learning event, “Depression, MAID and the Older Adult” was advertised through national memberships and databases of Canadian healthcare professionals working in the area of seniors' mental health. Through SurveyMonkey, participants were asked to choose the nature of the case (acute care vs. community vs. long-term care) and other components that could be individualized and customized. A small group of registrants was not bespoked and comprised the comparison group. 2) Virtual Blended Learning An interactive online module was made available for 2 weeks and was followed 1 week later by a live, facilitated webinar to consolidate learning. 3) Evaluation Knowledge and comfort in working with older adults who express a wish to die were assessed pre-module and post-webinar. Impact and change in practice (e.g., use of a new tool) were assessed at 6 weeks post-webinar. The data were summarized using descriptive statistics, including Fisher's exact tests to compare groups, and longitudinal logistic regression with random intercepts. All analyses were done using SAS version 9.4. Results The proportion of participants with an approach to working with older adults who express a wish to die significantly increased from 22% (pre, N=27) to 63% (post, N=27, p=0.003) and non-significantly increased from post to 86% at follow up (N=22, p=0.08) for the Bespoke group (Figure 1). The non-Bespoke group significantly increased from 28% (pre, N=36) to 72% (post, N=36, p=0.0003) but then non-significantly decreased from post to 58% at follow up (N=19, p=0.32). There was no significant group difference in the change in proportions from pre to post (p=0.85) but the change in proportions from post to follow up was significantly greater for the Bespoke group compared to the non-Bespoke group (p=0.05). At follow up, the Bespoke group had a larger proportion with an approach to working with an older adult who expresses a wish to die, but it was not significant (86% versus 58%, p=0.08). At 6 weeks post-webinar, ∼89% (N=45, all participants) reported participation in the learning activity had a positive impact on their practice. ∼72% indicated that participation had helped with client/patient care (N=43). 93% (N=27, Bespoke group) wanted more bespoke education opportunities. Conclusions A large majority of study participants responded that the learning activity had a positive impact on their practice and helped with patient care. Interest in further bespoke learning opportunities was high. Learning outcomes were similar between groups with a positive trend for bespoked participants to identify having an approach to an expressed wish to die after the intervention. Bespoking is easy to implement, appears to contribute to engagement and through virtual technology, can target the needs of multiple learners simultaneously. Incorporating customization into the development of an online learning module was an effective means for transmitting knowledge about a clinical approach to an older adult who expresses a wish to die. The utility and feasibility of using bespoke methodology in continuing education merits study in other subject areas, both within geriatric psychiatry and more broadly, with larger sample sizes. This research was funded by This project was funded by the Ontario Ministry of Health and Long-term Care Academic Health Sciences Centres Alternate Funding Plan Innovation Fund.

Barriers to adopt the Health Promoting Hospitals (HPH) initiative in Iran: The Q method derived perspectives of front line practitioners

ObjectiveThis study aimed to investigate prospects of a sample of Iranian front line health care professionals about their perceived barriers to implement the HPH initiative. MethodsThe six stages Q methodology was applied to systematically envisage divergent perspectives of the 33 health professionals (7 physicians, 2 managerial and 24 nurses) working in the 10 educational hospitals in Iran. ResultsAnalysis of the study participants’ viewpoints (the Q-sorts) resulted in a five factor solution (accounted for 48% of the total variance) to endorse main barriers of the HPH implementation in the typical Iranian hospitals. The health professionals’ dominant biomedical approach and their deficit commitment to health promotion programs, inappropriate decision-making mechanisms and insufficiency of the organizational infrastructure in the Iranian national health system (INHS) were among the important emanated factors to sustainably maintain the HPH program. ConclusionThe identified barriers reflect the spheres that need to be focused in interventions to facilitate the successful implementation of the HPH initiative in Iran and other developing countries. Practice implicationsDespite the existent consensus about overall merits of the HPH to fulfill best interests of hospitalized patients, major challenges deems to exist for operability of this beneficial undertaking in Iran.

Divergent approaches in the vaccination of recently arrived migrants to Europe: a survey of national experts from 32 countries, 2017.

BackgroundMigrants within the European Union and European Economic Area (EU/EEA) may be underimmunised and lack documentation on previous vaccinations. We investigated approaches to vaccination in recently arrived adult and child migrants, and guideline availability and implementation. Methods: Between March and May 2017, a national vaccination expert from every EU/EEA country and Switzerland completed an electronic questionnaire. We used descriptive analyses to calculate percentages, and framework analysis to synthesise free-text responses. Results: We approached 32 countries (response rate 100%). Although 28 experts reported vaccination guidance at national level, specific guidelines for recently arrived migrants were only available in six countries and not consistently implemented. Twenty-three countries administered vaccinations during on-arrival health checks. Most experts recommended multiple vaccination opportunities be made available: at point of entry (n = 13) or at holding level (reception centres, migrant camps, detention centres) (n = 21). In 30 countries, child migrants without evidence of previous vaccination were re-vaccinated according to the national schedule. Diphtheria-pertussis-tetanus and polio vaccinations were given to migrant children in all countries, measles-mumps-rubella (MMR) in 31 countries, hepatitis B vaccination in 25. Low levels of catch-up vaccination were reported in adult migrants, with only 13 countries offering MMR and 10 countries charging fees. Conclusion: Existing guidance is often not migrant-specific and may not be applied in practice; clarification is needed on which vaccines should be given. Strategies are needed specifically for catch-up vaccination in adult migrants. Vaccinations should be offered in multiple settings, free of charge, with sufficient guidance and training provided to front-line healthcare professionals.

Perceptions of Do Not Attempt Resuscitation (DNAR) amongst nurses in an Asian modern ageing society

Objectives: Do Not Attempt Resuscitation (DNAR) orders have been used in hospitals worldwide for the past 30 years, but are still considered to be a challenging and difficult area of practice. Nurses being the frontline healthcare professionals should be involved during the decision-making process and are required to have good understanding of the DNAR order, in order to provide effective and efficient care. Our aim was to investigate: nurses’ involvement during decision-making process, level of understanding of issues surrounding DNAR orders; and how they perceive care for patients with DNAR orders. Methods: A descriptive crossed sectional study design using electronic questionnaires was adopted for the study. The study was conducted among 400 nurses at a tertiary hospital in Singapore. Results: This study showed that 44.5% of nurses reported physicians did not involve them in decisions for DNAR orders; only 8% felt that they should be involved in the decision-making process. Even if they did not agree with the order, 63.2% would still comply whilst 21% of them were willing to discuss this further with the treatment teams. Most agreed that antibiotics, intravenous fluids, oxygen therapy and artificial feeding were appropriate for patients with DNAR orders. Majority (57.1%) expressed uneasiness in discussing end of life issues with patients even in specialty areas. Conclusion: Nurses should be encouraged to advocate for their patient and take part in the decision-making process. Communication between the medical team and nurses can be improved and there is an obvious need for further improvement in education and collaboration in this area.

Better tracheostomy care through targeted education using social media

The National Tracheostomy Safety Project (NTSP) has published strategies to manage and prevent airway emergencies in patients with tracheostomies and laryngectomies.1,2 However, front-line healthcare professionals most likely to benefit from guidance may not have access to or are unlikely to read publications in traditional medical literature. To improve dissemination of such guidelines, The Health Foundation launched Evidence into Practice in 2017. The NTSP’s aim for this project was to produce assessable, digestible resources, and target and influence relevant front-line staff via social media platforms. The NTSP engaged a social media marketing and production company (FeedFirst Ltd.) to produce short (<2 min) videos around key tracheostomy themes, coupled with a branding exercise. The themes were the following: (i) problems can be prevented by basic care, done well; (ii) emergencies can be managed by following NTSP algorithms; and (iii) vocalisation should be a routine goal of daily care. A marketing campaign was devised to target key staff groups (ICU nurses, ENT nurses, paramedics, physiotherapists, speech therapists, doctors, and hospital managers) identified via social media profiles on Facebook, LinkedIn, Twitter, and YouTube. Strategies included themed events, paid advertising, and encouraging peer-to-peer sharing of resources. Engagement metrics were captured using social media listening tools from January 1, 2018 to March 31, 2018. A total of 629 270 social media impressions of new NTSP video and infographic resources were captured, including over 267 000 Twitter impressions, 275 430 Facebook impressions, 82 880 YouTube video views (over 80 000 min watched; Fig. 7), and 3960 LinkedIn impressions. Only 85 000 (31.8%) of the Twitter impressions resulted from paid advertising, demonstrating significant social mobilisation around the content, and peer-to-peer sharing. By developing high-quality, professional content to convey key safety messages and targeting front-line staff via native and promoted social media activity, we have demonstrated an effective reach of our resources to target staff. In comparison, the NTSP paper underpinning this project had been cited only 89 times since publication in 2012. We recommend considering a similar social media marketing strategy to target key staff for similar educational projects in the future. The authors would like to thank Health Foundation, an independent UK charity for better health and health care. 1.McGrath BA, Bates L, Atkinson D, et al. Anaesthesia 2012; 67: 1025–412.McGrath BA, Lynch J, Bonvento B. BMJ Qual Improv Rep 2017; 6 (1). bmjqir.u220636.w7996

Simulated medication errors: A means of evaluating healthcare professionals' knowledge and understanding of medication safety.

To determine multi-disciplinary perceptions of the clinical significance of medication errors (MEs), the responsible health professional(s), the contributing factors and potential preventive strategies. The five simulated ME cases represented errors from five wards at a children's hospital in Australia. Pre-determined answers for each case were developed through consensus among the researchers. The root cause analysis (RCA) was undertaken via a questionnaire disseminated to physicians, nurses and pharmacists at the study hospital to seek their opinions on the ME cases. Agreement model between the participants and pre-determined responses regarding the contributing factors was conducted using general estimating equation (GEE) analysis. Of the 111 RCA questionnaires distributed, 25 were returned. The majority (93%) of respondents rated the significance of the MEs as either 'moderate' or 'life-threatening'. Furthermore, they correctly identified two contributing factors relevant to all cases: dismissal of policies/procedures or guidelines (90%) and human resources issues (87%). GEE analysis revealed varied agreement patterns across the contributing factors. Suggested prevention strategies focused on policy and procedures, staffing and supervision, and communication. Simulated case studies had potential use to seek front-line healthcare professionals' understanding of the clinical significance and contributing factors to MEs, along with preventive measures.

Effect of a financial incentive on the acceptance of a smoking cessation programme with service charge: a cluster-controlled trial.

Frontline health care professionals in Hong Kong may encounter high refusal rates for the Hospital Authority's Smoking Counselling and Cessation Programme (SCCP) when smokers know it is subject to a service charge. We compared SCCP booking and attendance rates among smokers with or without a financial incentive. In this multicentre non-randomised cluster-controlled trial, adult smokers who attended one of six general out-patient clinics between November 2015 and April 2016 were invited to join an SCCP. Attendees in the three intervention-group centres but not the three control-group centres received a supermarket coupon to offset the service charge. A total of 173 smokers aged 18 years or older (92 in the intervention group and 81 in the control group) were recruited into the study. In the intervention group, 47 smokers (51%) agreed via a questionnaire that they would join the SCCP, compared with only 23 smokers in the control group (28%). The booking rates were 83% (n=39) in the intervention group and 83% (n=19) in the control group. Among those who had booked a place, 19 (49%) intervention-group participants and 11 (58%) control-group participants attended an SCCP session. Multivariable logistic regression revealed that offering a coupon was associated with agreeing to join an SCCP (odds ratio=4.963, 95% confidence interval=2.173-11.334; P<0.001) and booking an SCCP place (odds ratio=4.244, 95% confidence interval=1.838-9.799; P<0.001). Provision of a financial incentive was positively associated with agreement to join an SCCP and booking an SCCP place. Budget holders should consider providing the SCCP free of charge to increase smokers' access to the service.

Zigmond T and Brindle N, A Clinician’s Brief Guide to the Mental Health ActHuline-Dickens S, A Clinician’s Brief Guide to Children’s Mental Health LawThe Law Society, Deprivation of Liberty: Collected Guidance

Mental health and capacity law can often feel complex and bewildering. They are governed by a range of different legal frameworks, including (but not limited to) the Mental Health Act 1983 (MHA), the Mental Capacity Act 2005 (MCA), and the Human Rights Act 1998 (HRA). Each legal framework comes with its own unique set of legal principles and ideological baggage, and is also subject to the constant ebb and flow of case law. Last year alone saw major judgments handed down on, for example, the interface between the MHA and MCA,1 the zone of parental responsibility in relation to 16 and 17 year olds,2 and deprivation of liberty in intensive care settings.3 The legal frameworks are also subject to frequent legislative reform; most recently the Police and Crime Act 2017, which reformed police powers under sections 135 and 136 of the MHA and the duties of coroners to investigate the deaths of people who were subject to the Deprivation of Liberty Safeguards (DoLS). Even the judiciary and specialist legal practitioners struggle to keep abreast of the changes. However, mental health and mental capacity law is not ‘lawyers’ law’, in the sense that it is not primarily played out in the courtroom. It is written overwhelmingly for front-line health and social care professionals (and in the case of the MCA, family and other unpaid carers), most of whom will have had no formal legal training. The question, therefore arises, how can busy professionals become and remain fully conversant with these complex and fluctuating legal frameworks?

Achieving Consensus on Continuing Professional Development Priorities for Registered Nurses in Rural and Remote India through Nominal Group Technique

Background: Nurses can often be key frontline healthcare professionals working in remote and rural settings due to resource constraints including an acute shortage of medical practitioners. The provision of regular and appropriate Continuing Professional Development (CPD) to support nurses to be able to provide effective health care therefore becomes even more significant in these settings. Engagement and “buy in” from relevant stakeholders at an organisational level is a critical step to ensure CPD provision for nurses. Objectives: The overall aim was to achieve consensus on CPD for registered nurses working in remote and rural settings among key stakeholders using the Nominal Group Technique (NGT). The objectives were to identify stakeholders’ perspectives on the priorities for CPD training for registered nurses; the preferred modes of delivery for CPD and perceived barriers and facilitators for CPD access. Methods: NGT was used as a qualitative method with key organisational stakeholders in several iterative stages in the form of a workshop. Results: 22 senior healthcare professionals involved in medical and nursing education representing north, northeast, central India and the state of Karnataka in South India participated in the workshop. Three key findings emerged from this study: priorities of CPD; preferred modes of CPD delivery; barriers and facilitators to CPD access. Conclusion: Engagement with key stakeholders to identify CPD priorities can help facilitate strategic planning and provision of relevant and accessible CPD programmes for nurses working within remote and rural health care contexts in India.

Recommendations for successful sensory screening in older adults with dementia in long-term care: a qualitative environmental scan of Canadian specialists

ObjectivesThis study aimed to identify screening tools, technologies and strategies that vision and hearing care specialists recommend to front-line healthcare professionals for the screening of older adults in long-term care...

Domains associated with successful quality improvement in healthcare \u2013 a nationwide case study

BackgroundThere is a distinct difference between what we know and what we do in healthcare: a gap that is impairing the quality of the care and increasing the costs. Quality improvement efforts have been made worldwide by learning collaboratives, based on recognized continual improvement theory with limited scientific evidence. The present study of 132 quality improvement projects in Norway explores the conditions for improvement from the perspectives of the frontline healthcare professionals, and evaluates the effectiveness of the continual improvement method.MethodsAn instrument with 25 questions was developed on prior focus group interviews with improvement project members who identified features that may promote or inhibit improvement. The questionnaire was sent to 189 improvement projects initiated by the Norwegian Medical Association, and responded by 70% (132) of the improvement teams. A sub study of their final reports by a validated instrument, made us able to identify the successful projects and compare their assessments with the assessments of the other projects. A factor analysis with Varimax rotation of the 25 questions identified five domains. A multivariate regression analysis was used to evaluate the association with successful quality improvements.ResultsTwo of the five domains were associated with success: Measurement and Guidance (p = 0.011), and Professional environment (p = 0.015). The organizational leadership domain was not associated with successful quality improvements (p = 0.26).ConclusionOur findings suggest that quality improvement projects with good guidance and focus on measurement for improvement have increased likelihood of success. The variables in these two domains are aligned with improvement theory and confirm the effectiveness of the continual improvement method provided by the learning collaborative. High performing professional environments successfully engaged in patient-centered quality improvement if they had access to: (a) knowledge of best practice provided by professional subject matter experts, (b) knowledge of current practice provided by simple measurement methods, assisted by (c) improvement knowledge experts who provided useful guidance on measurement, and made the team able to organize the improvement efforts well in spite of the difficult resource situation (time and personnel). Our findings may be used by healthcare organizations to develop effective infrastructure to support improvement and to create the conditions for making quality and safety improvement a part of everyone’s job.

Antibiotic Overconsumption in Pregnant Women With Urinary Tract Symptoms in Uganda.

Urinary tract infections (UTIs) are one of the most common bacterial infections in women. During pregnancy physiological changes, like frequency, mimic UTI symptoms, and therefore bacteriological cultures are needed to confirm the diagnosis. However, in developing countries antibiotic therapy is commonly initiated without culture confirmation. We investigated the prevalence of bacteriuria among pregnant women with and without UTI symptoms in Uganda. In total 2 562 urine samples were evaluated with nitrite and leukocyte esterase tests, using urine culture and/or dipslide with species identification as reference. The prevalence of culture-proven UTI among pregnant women with UTI symptoms was 4%. Since treatment is initiated based only on the presence of symptoms, 96% were erroneously given antibiotics. Further, there is a high prevalence of resistance to commonly used antibiotics, with 18 % ESBL and 36 % multidrug resistant Escherichia coli strains. Nitrite, leukocyte esterase tests, and urine microscopy alone were of poor diagnostic value. Using dipslide, gynecologists and nurses, not trained in microbiology, were mostly able to identify E. coli and negative cultures. Mixed Gram-negative flora, suggesting fecal contamination was, however, in the majority of cases interpreted as a single pathogenic bacterium and would have resulted in antibiotic treatment. To prevent excessive use of antibiotics, dipslide possibly supported by a combination of nitrite and leukocyte esterase tests can be used. Trained frontline health care professionals correctly diagnosed E. coli UTI and negative urine cultures, which would help preventing antibiotic misuse. In addition, regular screening for antibiotic resistance would improve correct treatment.

Why an Open Disclosure Procedure Is and Is not Followed After an Avoidable Adverse Event.

The aim of the study was to analyze the relationships between factors that contribute to healthcare professionals informing and apologizing to a patient after an avoidable adverse event (AAE). A secondary study based on the analysis of data collected in a cross-sectional study conducted in 2014 in Spain was performed. Health professionals from hospitals and primary care completed an online survey. The responses from 1087 front-line healthcare professionals were analyzed. The willingness of the professionals to fully disclose an AAE was greater among those who were backed by their institution (odds ratio [OR] = 72.6, 95% confidence interval [CI] = 37.5-140.3) and who had experience with that type of communication (OR = 2.4, 95% CI = 1.3-4.5). An apology for the patient was more likely when there was institutional support (OR = 31.3, 95% CI = 14.4-68.2), the professional was not aware of lawsuits (OR = 2.7, 95% CI = 1.2-6.1), and attributed most AAE to human error (OR = 2.2, 95% CI = 1.1-4.2). The fear of lawsuits was determined by the lack of support from the center in disclosing AAE (OR = 5.5, 95% CI = 2.8-10.6) and the belief that being open would result in negative consequences (OR = 2.0, 95% CI = 1.1-3.6). The culture of safety, the experience of blame, and the expectations about the outcome from communicating an AAE to patients affect the frequency of open disclosure. Nurses are more willing than physicians to participate in open disclosure. Health care organizations must act to establish a framework of legal certainty for professionals.

The Second Victim Phenomenon After a Clinical Error: The Design and Evaluation of a Website to Reduce Caregivers' Emotional Responses After a Clinical Error.

BackgroundAdverse events (incidents that harm a patient) can also produce emotional hardship for the professionals involved (second victims). Although a few international pioneering programs exist that aim to facilitate the recovery of the second victim, there are no known initiatives that aim to raise awareness in the professional community about this issue and prevent the situation from worsening.ObjectiveThe aim of this study was to design and evaluate an online program directed at frontline hospital and primary care health professionals that raises awareness and provides information about the second victim phenomenon.MethodsThe design of the Mitigating Impact in Second Victims (MISE) online program was based on a literature review, and its contents were selected by a group of 15 experts on patient safety with experience in both clinical and academic settings. The website hosting MISE was subjected to an accreditation process by an external quality agency that specializes in evaluating health websites. The MISE structure and content were evaluated by 26 patient safety managers at hospitals and within primary care in addition to 266 frontline health care professionals who followed the program, taking into account its comprehension, usefulness of the information, and general adequacy. Finally, the amount of knowledge gained from the program was assessed with three objective measures (pre- and posttest design).ResultsThe website earned Advanced Accreditation for health websites after fulfilling required standards. The comprehension and practical value of the MISE content were positively assessed by 88% (23/26) and 92% (24/26) of patient safety managers, respectively. MISE was positively evaluated by health care professionals, who awarded it 8.8 points out of a maximum 10. Users who finished MISE improved their knowledge on patient safety terminology, prevalence and impact of adverse events and clinical errors, second victim support models, and recommended actions following a severe adverse event (P<.001).ConclusionsThe MISE program differs from existing intervention initiatives by its preventive nature in relation to the second victim phenomenon. Its online nature makes it an easily accessible tool for the professional community. This program has shown to increase user’s knowledge on this issue and it helps them correct their approach. Furthermore, it is one of the first initiatives to attempt to bring the second victim phenomenon closer to primary care.

Implementation and Evaluation of a Blended Learning Course on Tuberculosis for Front-Line Health Care Professionals.

To implement and evaluate the effectiveness of a 10-module blended learning course on tuberculosis diagnosis for Ethiopian health care professionals. This implementation science research was conducted within the routine in-service training for health care professionals in Ethiopia. A combined web-based and face-to-face acid-fast bacilli microscopy course was designed and its applicability studied after 6 weeks of enrollment of 108 medical laboratory professionals. A survey was conducted to capture participants' feedback on the course. Of 108 participants enrolled, 81 attended and 73 (90%) completed the course; 72 (94%) had no experience taking online courses. Mean percentages of quizzes, assignments/exercises, and hands-on scores were 88%, 70%, and 95%, respectively. No significant differences were found in scores between participants from public, private, and nongovernmental health facilities ( P = .386) or between higher and lower level facilities ( P = .533). Participants' overall satisfaction with the course was 88%. Blended learning was an effective pedagogic approach for this category of professionals because of the crucial need for hands-on training for practicing and translating knowledge into skills. This approach also had the advantages of keeping the costs of the entire course low and reaching a greater number of participants, all without significant disruption of work schedules.

Evidence-Based Review and Discussion Points.

Evidence-Based Review and Discussion Points.

Ebola outbreak preparedness planning: a qualitative study of clinicians' experiences

ObjectivesThe 2014–15 Ebola outbreak in West Africa highlighted the challenges many hospitals face when preparing for the potential emergence of highly contagious diseases. This study examined the experiences of frontline health care professionals in an Australian hospital during the outbreak, with a focus on participant views on information, training and preparedness, to inform future outbreak preparedness planning. Study designSemi-structured interviews were conducted with 21 healthcare professionals involved in Ebola preparedness planning, at a hospital in Australia. MethodsThe data were systematically coded to discover key themes in participants' accounts of Ebola preparedness. ResultsThree key themes identified were: 1) the impact of high volumes of—often inconsistent—information, which shaped participants' trust in authority; 2) barriers to engagement in training, including the perceived relative risk Ebola presented; and finally, 3) practical and environmental impediments to preparedness. ConclusionsThese clinicians' accounts of Ebola preparedness reveal a range of important factors which may influence the relative success of outbreak preparedness and provide guidance for future responses. In particular, they illustrate the critical importance of clear communication and guidelines for staff engagement with, and implementation of training. An important outcome of this study was how individual assessments of risk and trust are produced via, and overlap with, the dynamics of communication, training and environmental logistics. Consideration of the dynamic ways in which these issues intersect is crucial for fostering an environment that is suitable for managing an infectious threat such as Ebola.

Cardiauvergne is a remote monitoring and care coordination service for patients with severe heart failure

Since 2011, thanks to the cooperation of frontline healthcare professionals, it has provided care to more than 1200patients across the Auvergne health region. The organisation, blending telemedicine and human contact, has made this initiative a successful example of how the boundaries between community and hospital healthcare can be removed.

Delayed discharges within community hospitals

Purpose The purpose of this paper is to understand the perspectives of frontline health and social care professionals in relation to delays in discharge from community hospitals. Design/methodology/approach A qualitative approach was taken, using semi-structured interviews and non-participant observation, within three community hospitals in NHS Scotland. In total, 12 frontline health and social care professionals were interviewed and observation of the multi-disciplinary team meeting was completed. Thematic content analysis was used to analyse the data produced. Findings The key findings were delayed discharge as an issue, lack of resources and capacity, difficulties in the relationship between acute and community health staff, silo working between health and social care, conflicting pressures on staff, and influence over services and external factors. There were perceived different ways of working within acute health, community health and social work, which were suggested to reduce efficiency, cause tension and ultimately result in delays. All professionals perceived an inability to influence any of the factors causing delays in discharge. Practical implications The internal issues regarding inter-professional working could potentially damage integration, indicating a need to teach collaborative team skills as well as quality improvement training to support staff to challenge and change current ways of working. Originality/value The paper contributes to the evidence base of community hospitals. There are implications for both health and social care policy.