Poor Staff Research Articles

Attitude toward Safety among Staffs in the Iranian Maternity Care Units of Public Hospitals with High Maternal Death Rate, 2015-2016

Background: Although extensive Mother-friendly Hospital initiatives have been improved the quality of maternity care in Iran, recent national reports have been indicated that obstetrics errors are still common. The current study aimed to assess safety attitude in the maternity care units of public hospitals in a region with high rate of maternal death in Iran. Materials and Methods: Data was collected from 314 midwives, specialist and also managers working in all public hospitals in 2016. The Cronbach’s alpha coefficient was used to analyze psychometric features of the Safety Attitudes Questionnaire (SAQ). Results: 86.2% of the participants (n = 314) completed the questionnaire. Results showed that lower scores in teamwork, safety climate and also job satisfaction subcomponents. The working conditions and stress recognition had the highest negative scores. There was a significant relationship between the following subcomponents and work load: teamwork (r = ﹣0.416, P-value = 0.05), stress recognition (r = 0.40, P-value = 0.05) and also working conditions (r = 0.421; P-value = 0.02). The score of midwives was significantly lower than specialists regarding job satisfaction (P-value = 0.014), working conditions (P-value = 0.02) and also the overall safety attitude score (P-value = 0.001). About 63% of respondents reported no error during the last year. The mean of error reporting during the last year significantly increased among specialists compared to midwives (P-value = 0.001). Conclusion: Maternity care units in the region with high maternal death have been faced with many intangible barriers related to safety attitude such as poor teamwork climate, working condition and also poor stress recognition. It is now needed to promote supportive environment for midwives and also strengthening staff cohesion through guiding the strategic direction of current maternity risk management system in creating open and just culture, improving leadership behaviors among senior managers and also addressing poor staffing levels.

Predictors of Utilization of Skilled Birth Attendants Among Women of Reproductive Age in Mandera East Sub County, Mandera County, Kenya

The single most critical intervention in the reduction of maternal mortality is to ensure that a health worker with appropriate skills is present during pregnancy, delivery and time after delivery. The main objective of the study was to determine predictors of the utilization of skilled birth attendants among women of reproductive age in Mandera East Sub County, Kenya. The cross-sectional descriptive study consisted of use of both the qualitative and quantitative approaches for data collection. Quantitative data were collected using interviewer administered questionnaire, among 365 randomly selected consenting women who delivered a baby a year prior to the conduct of the research. Qualitative data were collected through in-depth interviews of nine women including three who utilized skilled birth attendants and six who did not. Quantitative data were analyzed using SPSS software while qualitative data from in depth interview were analyzed thematically and corroborated with results from questionnaire. Data were analyzed using Chi-square test and logistical regression to identify independent predictors of utilization of skilled birth attendants. A p-value of <0.05 was considered significant. The ages of the respondents ranged from 15-49 years with a mean of 27 ±1.391 years. The results showed antenatal attendance of 84.4% while the proportion of birth attended by Skilled Birth Attendant was low (37.8%) among women of reproductive age in Mandera East. The main predictors of utilization of skilled birth attendants were: education level of the mother, type of occupation of the mother, household income, transport to the facility, parity, reliability of transport at odd hours, occupation of husbands and decision making. Barriers to utilization of SBAs included: Availability and convenience of TBAs, poor staff attitude, limited number of SBAs, poor and unreliable transport especially at night, poor referral system, cultural beliefs and misconceptions. Despite the attendance of ANC clinics being high, the level of utilization of skilled birth attendants among the study population was still low with high number of deliveries still conducted by unskilled persons at home. This study recommends that the county government should come up with strategies of ensuring that women have access to education such as Adult Education Programme; economic empowerment of women through Business enterprises; provide attraction and retention package for healthcare staffs especially SBAs; Provision of incentives to TBAs for referral of pregnant women to the facility; Strengthen referral system especially in hard to reach areas.

Succession Management and Organizational Survival in Selected Transportation Companies in Ontisha, Nigeria

Inefficiency in succession management; lack of planning, poor staff mentoring and incompetent employees are major problems faced by transportation companies in Onitsha. The broad objective examined the relationship between succession management and organizational survival in some selected transportations companies in Onitsha. One research question and one hypothesis in line with the specific objective were employed. It employed descriptive research design, primary and secondary source of data are the major instrument used for the study. Descriptive statistical tool was used to analyze the data. Pearson Product Moment Correlation Coefficient was computed to test the hypothesis. The findings revealed that mentoring has positive relationship with business continuity. Based on the finding, it is paramount for mentoring to be encouraged in the organization because it gives opportunities to develop competent, capable and productive employees who will enhance organizations growth even after the incapacitation or demise of the key stakeholder.

Implication of Economic Recession on the Health Care Delivery System in Nigeria

The economic recession in Nigeria has affected various sectors of the economy including the health sector leading to low productivity, poor service delivery and poor health outcome. The Nigerian health sector is still striving to provide basic health care services with the collaborative efforts of the three tiers of government but efforts to achieve this seem unfeasible due to the current state of the Nigerian economy. Nigeria operates a dual system of health care delivery which includes; the orthodox and traditional health care delivery systems. The orthodox health care system is managed and controlled by the three levels of government while the traditional health care delivery system is managed by the traditional health institutions. Some of the challenges confronting the Nigerian health care delivery system include; lack of adequate health infrastructures, poor health funding, lack of political will, shortage of manpower and corruption. The impact of economic recession on the Nigerian health care delivery system may include; high cost of drugs, poor financing of the health sector, high cost of treatment, high disease morbidity and mortality, poor staff motivation, emergence of counterfeit drugs and increase in out-of-pocket expenditure on health care. Approaches to tackling the problems facing the health sector as a result of economic recession include; deliberate health policy reforms, full government support in terms of financing the health sector and strengthening the provision of health enablers, institutionalizing comprehensive health care services and establishing an efficient monitoring and evaluation system. Hence, to strengthen the Nigerian economy, the health care system should be given due attention by adequately tackling its problems and improving its performance so as to suppress the cycle of ill-health, poverty and under-development.

Bibliografia zalecająca w Polsce

Teza/cel artykułu – celem artykułu jest przedstawienie rozwoju bibliografii zalecającej w Polsce w okresie powojennym, jej założeń teoretyczno-metodologicznych i realizacji praktycznej oraz przyczyn jej zaniku. Metody – zagadnienie przedstawiono na podstawie analizy piśmiennictwa, przykładów bibliografii zalecającej oraz tematyki poradników bibliograficznych, wydawanych w Bibliotece Narodowej. Wyniki/wnioski – Bibliografia zalecająca w Polsce opracowywana w okresie powojennym, a zwłaszcza w latach 40. i 50. wzorowana była na bibliografii zalecającej radzieckiej, w kolejnych dekadach pełniła rolę raczej bibliografii wyborowej, głównie jako pomoc w bibliotekach publicznych i szkolnych. Na zanik bibliografii zalecającej w Polsce w latach 90. XX w. złożył się splot różnych okoliczności, takich jak: niski poziom zainteresowania społecznego tym typem bibliografii i niewielkie jej wykorzystanie, pracochłonność, zwłaszcza przy znaczącym wzroście produkcji wydawniczej, dostęp do bibliograficznych baz danych, a także rezygnacja Biblioteki Narodowej z jej opracowywania.

LEGISLATIVE CONTROLS ON DIRECTOR AND EXECUTIVE TERMINATION PAYMENTS IN THE UK AND AUSTRALIA – LESSONS FOR SOUTH AFRICA

The awarding of termination payments to departing company directors and senior executives has attracted a lot of controversy in many jurisdictions in light of the excessive nature and size of termination packages, as well as the corporate governance flaws in the process by which these payments are determined. Termination payments are frequently perceived to be rewards for failure in view of the large packages that have been paid to company executives on termination of their service contracts, often following poor financial performance and staff retrenchments. This article examines the legislative controls on termination payments in the UK under the Companies Act 2006, and in Australia under the Corporations Act 2001. It then evaluates the position in South Africa under the Companies Act 71 of 2008 in light of the approaches followed by the UK and Australia. The article concludes that the provisions of the Companies Act 71 of 2008, relating to directors’ and executives’ termination payments are inadequate to promote transparency, accountability and certainty. It further makes proposals for more robust regulation of directors’-and executive-termination payments under the Companies Act 71 of 2008.

Barriers to spousal contribution to childbirth pain relief in Nigeria.

The aim of this study was to investigate the barriers inhibiting the use of spousal presence for childbirth pain relief in health facilities and recommendations from three perspectives: the midwife, the woman, and the spouse. Spousal presence is a non-invasive, participatory and inexpensive technique used in pain management during childbirth. Although it contributes to a large extent in relieving childbirth pain, it is underutilized in Nigerian hospitals. Overcoming the challenges impeding spousal presence and participation during childbirth will improve maternal outcome, satisfaction and midwifery care practices. A cross-sectional survey conducted in four hospitals in Nigeria involving midwives (n=100), women (n=142) and their spouses (n=142) from June to December 2014 using pretested questionnaires. Five themes were identified: poor infrastructural facility, lack of adequate pain management policy, lack of midwife pain management practices, midwives' attitudes towards spousal presence during childbirth and feelings about spousal presence during childbirth pain relief. Infrastructural defects in the health facilities resulting in the lack of privacy in maternity units for both spouses and partners negatively influence the presence of a spouse during childbirth and pain relief. Adopting effective strategies such as good infrastructural facilities, staff training and spouse-friendly hospital policies will encourage spouses to fully participate in and contribute to childbirth pain relief. This study identified poor staff attitudes towards pain relief and spousal presence during childbirth as barriers. Providing adequate policies on pain management, continuous staff education and orientation on spousal relationship will improve active spousal participation and maternal satisfaction during childbirth.

Divergent Paths: The Academy and the Judiciary

In Divergent Paths: The Academy and the Judiciary, Judge Richard Posner proposes a partnership between the federal judiciary and law schools.1 He provides a sweeping critique of the federal judiciary and suggests ways in which law schools can address these failings. His critiques fall under the headings of structural deformations (e.g., method of appointment, lifetime tenure), process deficiencies, (e.g., legal formalism in judicial opinion writing, lack of curiosity), and management deficiencies (e.g., poor staff management, lack of collegiality). The corresponding solutions include law schools providing continuing education for federal judges and changing their curricula to include new knowledge and skills. It is an ambitious and comprehensive volume on improving the federal judiciary.

Survey on the perception of urology as a specialty by medical students.

Upon inquiring with medical students and urologists across Canada, it is evident that urology is perceived as a male-dominant specialty, among other stereotypes. These misperceptions may hamper the recruitment of the best and brightest trainees. With that in mind, we surveyed medical students at our institution to obtain an objective assessment of their perception of urology and to determine the cause for misperceptions. A 25-factor, validated, anonymous, cross-sectional, self-reported, electronic survey was sent to all medical students at McMaster University to assess their perception of urology. The survey was piloted among students and educational leaders to optimize face and content validity, and minimize measurement bias. Six variables (years in training, role model, a family member or friend in urology, gender, and exposure) were selected a priori and entered into a logistic regression model to determine factors associated with a positive impression of the specialty. The overall response rate was 70%. Of the respondents, 66% had no exposure to urology and 61% found the amount of exposure to be inadequate. Urology staff and resident involvement in education was considered to be poor by over 30% of medical students. Over 70% perceived urology to be a specialty with a great gender imbalance. On multivariate analysis, exposure to urology was the most important factor (p<0.001) associated with students' positive perception of the specialty, in addition to male gender, earlier years in training, and positive role models. Concerns regarding inadequate urology exposure and poor staff and resident involvement in undergraduate education were seen as potential causes for misperceptions of the specialty. Increasing exposure to urology, encouraging female students, constant effort to approach senior students, and providing mentorship are found to be important factors in establishing a positive perception of urology.

Influences on uptake of cancer screening in mental health service users: a qualitative study.

BackgroundCancers are a leading cause of death worldwide. People with mental illness are 30 % more likely to die from cancer than the general population. One reason for this may be low uptake of nationally offered cancer screening tests by people with mental illness. We aimed to identify barriers and facilitators for breast, cervical and bowel cancer screening uptake by people with mental illness in order to inform interventions to promote equal access.MethodsThe interview study was conducted in both urban and rural settings. The study was informed by the Theoretical Domains Framework, using framework analysis and triangulation across participant groups. Participants included 45 mental health service users (service users) eligible for cancer screening, 29 mental health professionals and 11 professionals involved in cancer screening.ResultsThemes emerging from the data that affected uptake included knowledge of screening programmes by both service users and healthcare providers; knowledge of, and attitudes towards, mental illness; health service-delivery factors; service users’ beliefs and concerns about cancer screening, and practical issues. These are relevant to different stages of the screening process. Service users do not receive invitations to screening or cancer testing kits if they are admitted to hospital. They are not routinely invited for screening if they are not registered with a general practitioner (GP). Lack of integrated care means that mental health staff do not know if someone is overdue for a test and cancer screening is often not considered during health promotion. Barriers including information processing problems, the extent to which the screening process aggravates symptoms, poor staff client relationships and travel difficulties vary between individuals. Screening professionals are motivated to help, but may lack time or training to manage mental health needs. Reactive measures are available, but service users must request help which they may find difficult.ConclusionsThere are specific barriers to cancer screening uptake for mental health service users that prevent equality of care. Interventions that can be personalised are needed at individual, policy and service-delivery levels. Primary and secondary care staff and policy-makers should work together to develop an integrated approach to cancer screening in this population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1505-4) contains supplementary material, which is available to authorized users.

The delivery of injury prevention exercise programmes in professional youth soccer: Comparison to the FIFA 11+

Injury prevention exercise programmes for amateur soccer have gained considerable attention, but little is known about their relevance and adaptability to professional soccer settings. The first aim of this study was to evaluate the delivery and content of injury prevention exercise programmes used by professional youth soccer teams, compared to the industry standard injury prevention exercise programme for soccer, the Fédération Internationale de Football Association's FIFA 11+. The second aim was to document specific challenges to implementing injury prevention exercise programmes in this context. Prospective observational study. The participants were soccer coaches, fitness coaches and physiotherapists (n=18) from four teams in a professional youth soccer academy. Each team's chosen injury prevention exercise programmes were observed weekly across an entire soccer season (160 sessions). The delivery and content of the programmes were documented on a standardised worksheet and compared to the FIFA 11+. Specific implementation challenges were recorded. Fitness coaches were the primary deliverers of injury prevention exercise programmes, with support from physiotherapists. Multiple delivery formats and locations were employed, along with the extensive use of equipment. Across all injury prevention exercise programme sessions, a median of one FIFA 11+ exercise was performed in its original form and a further four in a modified form. Implementation challenges included poor staff communication, competing training priorities and heavy game schedules. Although the basic components of the FIFA 11+ hold relevance for professional youth male teams, the delivery and content of injury prevention exercise programmes require considerable tailoring for this context. Recognising this will inform the development of improved, context-specific injury prevention exercise programmes, along with corresponding strategies to enhance their implementation.

Expectant Mother’s Preferences for Services in Public Hospitals of Tamil Nadu, India

Substantial programmatic efforts have been undertaken to improve the access to maternal care services in the public health system of India, yet the service users are often regarded as passive recipients. Limited research is available on the preferences of service users on what they regard the greatest issues in service delivery. A hospital-based discrete choice experiment (DCE) has been conducted in the public health facilities of Tamil Nadu, a southern state of India. This study uses a sample of 261 women who came for antenatal check-ups across six different public hospitals in Tamil Nadu. The DCE technique, which is rooted in random utility theory (RUT), and conditional logit model have been used to analyze the relative importance of health service attributes. The result showed that regular ward visits by specialist doctors like obstetricians and gynaecologists (O&amp;G) and paediatricians were the most preferred attribute of the maternal care service. Expectant mothers are willing to wait the maximum and are prepared to tolerate health service characteristics in public hospitals, such as poor patient amenities, poor staff attitude and lack of privacy maintained during physical examination, provided specialist doctors are available in the hospitals.

Infection Prevention and Control Life Saving Skills: Practice among Midwives in University of Port Harcourt Teaching Hospital Rivers State

The burden of increased maternal mortality is a global health concern. The burden is greater in developing countries such as Nigeria. This descriptive survey of midwives knowledge and utilization of infection prevention and control life saving skill in managing pregnant women was carried out in University of Port Harcourt Teaching Hospital, to determine the knowledge and utilization of nurse-midwives on the concept. A sample population of 83 respondents selected through convenience sampling technique had a self structured questionnaire was administered to them to collect data for the study. Three objectives, three research questions and one hypothesis guided the study. Data collected were analyzed using descriptive statistics of frequencies and percentages while chi square inferential statistics was used to test the research hypothesis at 0.05 level of significance. Results showed that majority of the respondents 41(49.4%) had good knowledge on the skill under study, but only 15(18.1%) always utilized it for managing pregnant women. As regards factors affecting the utilization of the concept, majority, 79(95.2%) linked it with poor staffing. Opinion on other factors affecting utilization of infection prevention and control live saving skill among midwives was also high: 74(89.2%) identified non-availability of relevant equipment and 66(79.5%) attributed it to emergency situations. Though, majority of nurse-midwives showed good knowledge of infection prevention and control skill, the utilization of the skill was not encouraging as it reflected non-compliance. The hypothesis testing showed that the calculated chi-square value is less than the critical chi-square value (x2cal=11.7, x2tab=12.592, df=6,p>0.05), based on this result we therefore accept the null hypothesis which states that there is no significant relationship between midwives’ knowledge and utilization of infection prevention and control life saving skill in managing pregnant women. Based on the findings it was recommended among others, that formulation of operational policies and legislation making utilization of infection prevention and control skill mandatory for all health care professionals providing care for pregnant women be put in place.

Quitline Activity in Rajasthan, India.

Quitline activity in Rajasthan, India is a voluntary activity of Rajasthan Cancer Foundation (RCF) since April 2013. To kick-off, it took the benefit of the State Government- PIRAMAL SWASTHYA (PS)1 collaborative 104 Health Information Helpline that existed already in public-private partnership. It is a reactive quitline that helps callers through the counselors and nursing staff trained specifically through the weekly sessions held by the first author, the RCF resource on quitline. Besides structuring of the scripts for primary intervention and follow-ups after 1 week, 1 month, 6 months and a year, he also monitors calls, advices and coordinates with the supervisors to manage and analyze the data base, and reports to the PS lead at the Jaipur Center on overall performance and to plan strategic communication with the State Government on its outcomes. The quitline has limitations of its informal existence through a voluntary effort of RCF, no specific resource allocation, suboptimal data management, minimal awareness in the masses due to poor IEC (Information, Education and Communication; except its efforts made by RCF in last 1 year through the government-run State TV and City Radio) and staff shortage and its attrition due to lack of plan for career advancement. Despite these challenges in the year 2013, the quit line has registered a quit rate (for complete abstinence) of 19.93% amongst 1525 callers. The quit rate were 58.01% (304/ 524) among the responders at the 3rd follow-up at 18 months (in September 2014)2. In view of an increase in quit rate by 5- 9 times over the prevailing quit rate in the former ever daily users [both smokers and the users of smokeless tobacco (SLT)], efforts are being made by RCF in concurrence with PS to have this cost-effective model established formally with optimal resource allocation in collaboration with willing agencies (the State and Central Governments and the International Quitline Agencies) and its replication in 4 more states where PS is collaborating with the respective state governments similarly (Assam, Chhattisgarh, Jharkhand and Karnataka).

The daily relationships between staffing, safety perceptions and personality in hospital nursing: A longitudinal on-line diary study

BackgroundThe association between poor staffing conditions and negative patient safety consequences is well established within hospital nursing. However, many studies have been limited to nurse population level associations, and have used routine data to examine relationships. As a result, it is less clear how these relationships might be manifested at the individual nurse level on a day-to-day basis. Furthermore, personality may have direct and moderating roles in terms of work environment and patient safety associations, but limited research has explored personality in this context. ObjectiveTo further our understanding of these associations, this paper takes a within-person approach to examine nurses’ daily perceptions of staffing and patient safety. In addition, we explore the potential role of personality factors as moderators of daily level associations. MethodWe recruited eighty-three hospital nurses from three acute NHS Trusts in the UK between March and July 2013. Nurses completed online end-of-shift diaries over three–five shifts which collected information on perceptions of staffing, patient–nurse ratio and patient safety (perceptions of patient safety, ability to act as a safe practitioner, and workplace cognitive failure). Personality was also assessed within a baseline questionnaire. Data were analysed using hierarchical linear modelling, and moderation effects of personality factors were examined using simple slopes analyses, which decomposed relationships at high and low levels of the moderator. ResultsOn days when lower patient–nurse ratios were indicated, nurses reported being more able to act as a safe practitioner (p=.011) and more favourable perceptions of patient safety (p=<.001). Additionally, when staffing was perceived more favourably, nurses reported being more able to act as a safe practitioner (p=<.001), more favourable perceptions of patient safety (p=<.001) and experienced less workplace cognitive failure (p=<.001). Conscientiousness and emotional stability emerged as key moderators of daily level associations between staffing and patient safety variables, with many relationships differing at high and low levels of these personality factors. ConclusionThe findings elucidate the potential mechanisms by which patient safety risks arise within hospital nursing, and suggest that nurses may not respond to staffing conditions in the same way, dependent upon personality. Further understanding of these relationships will enable staff to be supported in terms of work environment conditions on an individual basis.

Anaesthesia consent in public hospital population - An ethical dilemma.

Sir, I read with interest the article published by Kumar et al.[1] in your esteemed journal. I would like to commend the authors for summarising an issue that is extremely important considering the increasing incidence of medico-legal litigations under consumer protection act. Anaesthesia and anaesthesiologists are usually blamed, when surgical deaths are under litigations. I am writing to bring to the notice of the readers and authors, another closely related issue – Awareness about Anaesthesia. Although some of us work in private hospitals with well-informed patients, there is a section of our patients who are not so privileged. These patients do not have the resources to sue or question why they were not properly informed, but for the most part, trust in our judgement and decisions. Multiple studies[2,3,4,5] have been done in Indian public hospital population to find out the quantum of basic information about anaesthesia that the people had in public hospitals of India who were undergoing surgery. Attempts have been made to analyse whether patients were aware about anaesthesia and relevant issues such as type, who administers anaesthesia, anaesthesia as a speciality and importance of consent. Although a full discussion of the results is beyond the scope of this letter, it was disheartening to discover that only about 10–30% of uneducated public hospital population knew about anaesthesia as a physician speciality.[2,3] All these studies uniformly confirmed that education was significantly related to awareness about anaesthesia. Singh et al. highlighted another interesting finding in rural population: About 83.6% patients were not aware of contents of pre-operative consent they had signed.[5] In view of the above-mentioned findings, I would like to stress on the point Kumar et al. underlined – ‘Consent should be informed’. Consent paper work in local language may be beneficial in educating our patients, though this will need to be a state-based system change to avoid potential legal complications. Another consideration is the poor healthcare staff–patient ratio and overworked resident physicians in majority of the public hospitals. This might be a road block in our attempt to improve the awareness about our speciality in public hospital population. Despite the evolution of anaesthesia as a speciality in the last few decades, by leaps and bounds, people have misconceptions and at times are totally ignorant about this speciality. Therefore, it is imperative that we not only inform people about the details and risks of anaesthesia that they will be undergoing, but also educate them about our speciality which is not therapeutic, but plays a vital role in the surgical outcome. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Health care worker’s perception about the quality of health care at the outpatient department in Mwananyamala Hospital in Dar es Salaam, Tanzania

Background: Quality of care is a complex issue influenced by many factors. It is fundamental in assessing health care delivery in health facilities in developing countries. Health care workers’ perceptions help policy makers and planners to identify bottlenecks in the system to improve utilisation and sustainability of health care services in the population. The objective of this study was to explore health care workers’ perception about the quality of health care delivered at the outpatient department in Mwananyamala Hospital in Dar es Salaam, Tanzania. Methods: A cross-sectional qualitative study was conducted from April to May 2013. Results: Health care workers’ mentioned extrinsic as well as intrinsic factors, which may influence the quality of health care services. Extrinsic factors included poor physical infrastructure, unavailability of medical equipment and/or essential drugs and poor staffing levels. Intrinsic factors mentioned were motivation for health care workers and workplace training opportunities.Conclusion: Multiple factors influencing perceived quality of health care Mwananyamala hospital have been identified to include physical infrastructure, availability of medical equipment and essential medicines, staffing levels, remuneration and promotion.

Pragmatic cluster randomised controlled trial of facilitated family case conferencing compared with usual care for improving end of life care and outcomes in nursing home residents with advanced dementia and their families: the IDEAL study protocol.

BackgroundCare for people with advanced dementia requires a palliative approach targeted to the illness trajectory and tailored to individual needs. However, care in nursing homes is often compromised by poor communication and limited staff expertise. This paper reports the protocol for the IDEAL Project, which aims to: 1) compare the efficacy of a facilitated approach to family case conferencing with usual care; 2) provide insights into nursing home- and staff-related processes influencing the implementation and sustainability of case conferencing; and 3) evaluate cost-effectiveness.Design/MethodsA pragmatic parallel cluster randomised controlled trial design will be used. Twenty Australian nursing homes will be randomised to receive either facilitated family case conferencing or usual care.In the intervention arm, we will train registered nurses at each nursing home to work as Palliative Care Planning Coordinators (PCPCs) 16 h per week over 18 months. The PCPCs’ role will be to: 1) use evidence-based ‘triggers’ to identify optimal time-points for case conferencing; 2) organise, facilitate and document case conferences with optimal involvement from family, multi-disciplinary nursing home staff and community health professionals; 3) develop and oversee implementation of palliative care plans; and 4) train other staff in person-centred palliative care.The primary endpoint will be symptom management, comfort and satisfaction with care at the end of life as rated by bereaved family members on the End of Life in Dementia (EOLD) Scales. Secondary outcomes will include resident quality of life (Quality of Life in Late-stage Dementia [QUALID]), whether a palliative approach is taken (e.g. hospitalisations, non-palliative medical treatments), staff attitudes and knowledge (Palliative Care for Advanced Dementia [qPAD]), and cost effectiveness. Processes and factors influencing implementation, outcomes and sustainability will be explored statistically via analysis of intervention ‘dose’ and qualitatively via semi-structured interviews. The pragmatic design and complex nature of the intervention will limit blinding and internal validity but support external validity.DiscussionThe IDEAL Project will make an important contribution to the evidence base for dementia-specific case conferencing in nursing homes by considering processes and contextual factors as well as overall efficacy. Its strengths and weaknesses will both lie in its pragmatic design.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12612001164886. Registered 02/11/2012.

How ready are our health systems to implement prevention of mother to child transmission Option B+?

In January 2015, the South African National Department of Health released new consolidated guidelines for the prevention of mother to child transmission (PMTCT) of HIV, in line with the World Health Organization's (WHO) PMTCT Option B+. Implementing these guidelines should make it possible to eliminate mother to child transmission (MTCT) of HIV and improve long-term maternal and infant outcomes. The present article summarises the key recommendations of the 2015 guidelines and highlights current gaps that hinder optimal implementation; these include late antenatal booking (as a result of poor staff attitudes towards ‘early bookers’ and foreigners, unsuitable clinic hours, lack of transport to facilities, quota systems being applied to antenatal clients and clinic staff shortages); poor compliance with rapid HIV testing protocols; weak referral systems with inadequate follow-up; inadequate numbers of laboratory staff to handle HIV-related monitoring procedures and return of results to the correct facility; and inadequate supply chain management, leading to interrupted supplies of antiretroviral drugs. Additionally, recommendations are proposed on how to address these gaps. There is a need to evaluate the implementation of the 2015 guidelines and proactively communicate with ground-level implementers to identify operational bottlenecks, test solutions to these bottlenecks, and develop realistic implementation plans.

Nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting.

The aim of this study was to determine nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting. Pain is highly prevalent among older people, yet is often under-recognised and undertreated in people with dementia. People with dementia can lose the ability to report pain and it is the role of the nurse to identify and appropriately assess pain, to provide effective treatment. This requires nurses to have sufficient knowledge and training in the assessment and management of pain in residents with dementia; however, research suggests deficits in this area. A cross-sectional survey design was used to determine nurses' knowledge and attitudes to pain assessment in dementia. A questionnaire comprising three sections was distributed to 96 registered nurses across 17 nursing homes in a health-care trust in a UK region. A total of 32 responses were obtained (response rate 33%). The majority of nurses had a good knowledge in relation to the assessment and management of pain in residents with dementia. There was, however, some uncertainty among nurses over analgesic choice, the safety of opioid use in dementia, and the use of dementia-specific pain assessment tools for residents with no cognitive impairment. The main barriers to effective pain assessment for older people with dementia were workload pressures, poor staffing and lack of medical support. This study highlights the need to develop pain education programmes and clear guidance specifically designed for nurses caring for older people with dementia. It also emphasises the need for better communication and co-ordination of pain treatment for nursing home residents with dementia.