Professional Cadre Research Articles

Equity in the New Workplace: The Role of Diversity, Equality, and Inclusion

As an actor, the world continues to generate an exciting dichotomy between equity and equality, as diversity and inclusion remain a mockery of unique communities. However, as the generational differences collide both in the workplace and professional cadres, diversity and inclusion have slowly shifted the debate on equality and equity. The value system is designed to create a place of respect, opportunity, and acceptance. Equity and equality are not the same; while equity is fairness, equality is more about access to resources. The counter-argument of equity can also be viewed from the affirmative action policy to and on others; is it unfair?. This paper will briefly review the role of equity in the discussion of diversity and inclusion. Results may help Human Resource Managers and organizational leaders shape the workforce and promote color in the workplace.

Return Service Agreement in the Context of the Universal Health Care Act: Using International and Local Experiences to Guide Application of the RSA

Background. Philippines is in a constant struggle to address shortage and maldistribution of health professionals, affecting equity in service delivery. The government endeavors to generate adequate supply of health workforce through scholarship and training programs which have been further expanded with the enactment of the Universal Health Care (UHC) Act. This article aimed to give a background for discussion on the application of return service agreement (RSA) provisions in the light of attaining universal health care.
 Methods. A modified systematic review of literature was conducted guided by the key issues determined by the Department of Health with focus on the extent of scholarship grants and on number of recipients.
 Results. The Philippine government enacted policy reforms through implementing RSA in response to the progressive decline of the net flow of health professionals. However, the criticisms lie in that RSA is not a long-term solution. With the RSA provisions in the UHC Law, metrics on determining the under-produced and maldistributed professional cadre must be created. These should be responsive in addressing facility-level and health system-level gaps.
 Conclusion and Recommendation. Paucity of current local literature impedes attaining a conclusive body of evidence, therefore, further research is needed. Operationalization of RSA should not be viewed as a singular means to solve the health workforce gaps, but as part of holistic assessment, taking into consideration epidemiological, geographical, political, and social determinants. Stakeholders must ingress in collaborative intersectoral policy actions to warrant bottom-up support. Activities related to mapping, monitoring, and incentivizing medical and health-related professionals must be established to support a system conducive for workforce retention.

SUBSTANCE USE AMONG HEALTHCARE WORKERS IN A NIGERIAN TERTIARY HOSPITAL

Background: Research studies abound on substance use among healthcare workers (HCWs) in the western world, but a paucity of such information is the case in developing countries. Objectives: To determine the prevalence of substance use among HCWs in a Nigerian tertiary hospital and the variety of substances commonly used. Method: A cross-sectional study was conducted among 380 HCWs selected across 4 professional cadres by stratified random sampling method. Results: About 85.5% of the respondents were past and/or current users of substances or substance-containing food items. Out of the 325 respondents who had ever used substances before, 208 (64%) were current users- these represented 54.7% of the whole. Coffee, alcohol and kolanuts were most frequently used. Diazepam was the least used. Gender was a statistically significant determinant of substance use (p<0.05). Conclusion: Substance use among HCWs carries grave implications for practitioners and patients alike. Further research towards unearthing and addressing the factors fueling this menace in developing countries will contribute immensely in resolving this challenge.

A proposal to Activate the Role of Early Intervention Programs for the Qualification of Mothers of Children with Attention Deficit Hyperactivity Disorder (ADHD) in Light of the Saudi Vision 2030

A proposal to Activate the Role of Early Intervention Programs for the Qualification of Mothers of Children with Attention Deficit Hyperactivity Disorder (ADHD) in Light of the Saudi Vision 2030 Abstract: This Study aims to present a proposal to activate the role of early intervention programs in qualifying mothers of children with attention-deficit and hyperactivity (ADHD), in light of the Saudi Vision 2030. It aims to do this by determining the reality of the role of early intervention programs in qualifying mothers of children with Attention Deficit Hyperactivity Disorder and identifying the obstacles that hinder them. The study also aims to identify solutions for overcoming obstacles, and presents a proposal to activate the role of early intervention programs in qualifying mothers of children with ADHD in the light of Saudi Vision 2030. The study utilizes the descriptive - analytical approach to achieve these goals. The author was designed using an 88-item questionnaire divided into three domains. The sample comprised (69) mothers of children with Attention Deficit Hyperactivity Disorder (ADHD). The research results, from the point of view of mothers of children with ADHD, indicated the following; educational qualification scored highest with an average of 63.12%, followed by cognitive qualification with an average of 62.55%, then social qualification with an average of 61.34%, then religious qualification with an average of 60.98%, while psychological qualification scored lowest with an average of 59.52%. The approval rate for all proposals exceeded 85%. Based on these results a proposal was presented to activate the role of early intervention programs in qualifying mothers of children with ADHD, in light of the Saudi Vision 2030. The author recommend providing various activities that enable mothers to participate in qualification for their children, rather than limiting their participation to attending meetings and events only, by providing appropriate means, devices and tools for early intervention processes and improving the availability of professional cadres specialized in early intervention. Keywords: Proposal - Early intervention - Qualification- Mothers of Children with Attention Deficit Hyperactivity Disorder - Saudi Vision 2030. تصور مقترح لتفعيل دور برامج التدخل المبکر في تأهيل أمهات الأطفال ذوى نقص الإنتباه وفرط الحرکة في ضوء رؤية المملکة 2030 الملخص: هدف البحث الحالي إلى تقديم مقترح لتفعيل دور برامج التدخل المبکر في تأهيل أمهات الأطفال ذوى نقص الإنتباه وفرط الحرکة في ضوء رؤية المملکة 2030 , من خلال التعرف على واقع دور برامج التدخل المبکر في تأهيل أمهات الأطفال ذوى إضطراب نقص الإنتباه وفرط الحرکة وتحديد المعوقات التي تحول دون تحقيق برامج التدخل المبکر لدورها في تأهيل أمهات أطفال ذوى ADHD , والتعرف على الحلول المقترحة للتغلب على المعوقات و من ثم تقديم تصور مقترح لکيفية تفعيل دور برامج التدخل المبکر في تأهيل أمهات الأطفال ذوى نقص الإنتباه وفرط الحرکة في ضوء رؤية المملکة 2030، وقد تم إستخدام المنهج الوصفي التحليلي , ولتحقيق تلک الأهداف قامت الباحثة بإعداد إستبانة إلکترونية لهذا الغرض مکونة من (88) عبارة موزعة على ثلاثة محاور وتم تطبيقها على عينة قوامها (69) من أمهات الأطفال ذوى ADHD ،وتوصل البحث إلى عدة نتائج من وجهة نظر أمهات الأطفال ذوى ADHD تشير إلى أن التأهيل التربوى جاء فى المرتبة الاولى بمتوسط 63.12% يليه التأهيل المعرفى بمتوسط %62.55، ثم التأهيل الإجتماعى بمتوسط %61.34ثم التأهيل الديني بمتوسط 60.98%، بينما يأتى التأهيل النفسي في المرتبة الأخيرة بمتوسط %59.52، وقد تجاوزت نسبة الموافقة على جميع المقترحات الـ 85%، وبناء على تلک النتائج تم تقديم مقترح لتفعيل دور برامج التدخل المبکر في تأهيل أمهات الأطفال ذوى ADHD في ضوء رؤية المملکة 2030 , وتوصي الباحثة بتوفير الأنشطة المختلفة التي تفعل مشارکة أمهات الأطفال ذوى ADHD في تأهيل أطفالهن بدلا من جعل المشارکة محصورة في حضورهن الإجتماعات والمناسبات فقط , توفير الوسائل والأجهزة والأدوات الملائمة لعمليات التدخل المبکر, توفر الکوادر المهنية المتخصصة في التدخل المبکر لتأهيل أمهات أطفال ذوى ADHD الکلمات المفتاحية: مقترح- التدخل المبکر- تأهيل- نقص الإنتباه وفرط الحرکة -أمهات الأطفال ذوى نقص الإنتباه وفرط الحرکة - رؤية المملکة 2030.

Online behaviour change technique training to support healthcare staff \u2018Make Every Contact Count\u2019

BackgroundNational Health Service (NHS) staff support service users to change health-related behaviours such as smoking, alcohol consumption, diet and physical activity. It can be challenging to discuss behaviour changes with service users hence training is needed to equip staff with up-to-date, evidence-based behaviour change skills. In order to identify how training may help to improve health professional skills in this area, this study evaluated change in professionals’ behavioural determinants following an online behaviour change skills module as part of Making Every Contact Count (MECC) training.MethodsThis evaluation comprised a within-subject design in which staff from one Northwest England NHS Trust completed a 9-item survey immediately before and after training. This prospective survey identified behavioural determinants regarding adhering to MECC recommendations to hold health conversations with service users and provided written comments about their training experiences. Individuals working within the Trust in clinical or non-clinical roles were eligible to take part and were invited to contribute to the evaluation upon uptake of their usual NHS staff online training programmes.ResultsOf participants completing the evaluation (n=206), 12 professional cadres accessed the module, most being female (91%), nurses/midwives (43%), working in children and family services (48%), aged 22 - 62 years. Eight behavioural determinants increased significantly following training, with effect sizes ranging from sizes ranging from 0.27 to 0.51; ‘identity’ did not change. Content analysis of written feedback (n=256) indicates that training enhanced staff behaviour change skills, modelled a productive and specific method of adopting a patient-led approach to behaviour change conversations, and identified that staff may require further support with embedding skills in practice.ConclusionsBehaviour change science can be translated into useful learning for NHS staff. Online training can engage staff in learning about behaviour change skills and increase their behavioural determinants to adopt these skills in practice.

Health Workers' Awareness and Knowledge of Current Recommendation of Intermittent Preventive Treatment in Pregnancy in South-Western Nigeria.

Malaria in pregnancy is of public health significance because of its associated maternal and fetal complications. This study aimed to assess health workers' awareness and knowledge of the current World Health Organisation (WHO) recommendation of intermittent preventive treatment in pregnancy with Sulfadoxine-Pyrimethamine (IPTp-SP). A cross-sectional study among 148 health workers who offer obstetrics care in selected health facilities in Ibadan, Nigeria using a self-administered questionnaire to evaluate their awareness and knowledge of the current WHO IPTp-SP. Information on their socio-demographic and professional characteristics, awareness, knowledge and practice of the current IPTp recommendation were obtained. Data analysis involved descriptive and bivariate analyses using SPSS version 20.0 with level of significance set at p<0.05. The majority, 85(57.4%), of the health workers had been providing obstetrics care for less than 5 years with most of them, 114(77.0%), practicing at tertiary health facility. More than half, 92(62.2%), of them were aware of the current WHO IPTp-SP recommendation while about two-fifth (39.1%) had its correct knowledge. Of the health workers who were knowledgeable of the current IPTp-SP recommendation almost three-quarter, 29(72.2%) of them prescribed it. The health workers' professional cadre (p<0.001) and duration of providing obstetrics care (p=0.012) were significantly associated with their awareness and correct knowledge of the current IPTp-SP recommendation. Most of the health workers are aware but not knowledgeable of the correct administration of the current IPTp-SP recommendation. Likewise, many of them do not prescribe it. This calls for regular training and update of health workers and institutional protocol so as to effectively reduce the prevalence of malaria in pregnancy and its complications.

Products of the Industry 4.0 competence centers

Branch competence centers are organization and jurisdiction forms of company activity to unite digital, smart and virtual factories of the Industry 4.0 according to its specialty. Branch competence centers are for huge infrastructure projects solution where the result is not only the item itself (high-tech product) but also professional cadres, new types of technologies, new forms of the production data representation and other. There is the Industry 4.0 products classification and also specializations of the branch competence centers which are meant to be implemented into the industry by the first hand. Actual for the Industry 4.0 competence centers in digital projection are digital production competence centers, item exploitation accompanying competence centers and standardizing and certification competence centers of products and technologies. There are schemes of the digital companies interaction and the most probable branch competence centers in the item designing industry results are defined.

Determinants of Utilization of Nursing Process Among Nurses in University College Hospital, Ibadan, Oyo State, Nigeria

Poor utilization of nursing process can lead to poor quality of nursing care, disorganizarion of the service, conflicting roles, medication error, poor diseases prognosis, readmission, dissatisfaction with the care provided and increased mortality. Therefore, this study assessed determinants of nursing process utilization in University College Hospital (UCH), Ibadan. This study adopted a descriptive research design. A multi-stage sampling technique was adopted to select 296 respondents from all the thirty-two (32) wards at UCH while the sample size was determined using Slovin’s formula. Data were collected using the self-structured questionnaire developed by the researcher for the purpose of this study. Five research questions were raised to guide this study and tested at 0.05 level of significance using of simple percentages and Multiple Regression Analysis. The findings indicated that knowledge level of nurses on nursing process was high and adequate (86.3%) while nurses' utilization of nursing process was 56.2%. This study showed that attitudinal (R =.347, R 2 = .120, Adj. R 2 = .117, f (1,277) = 37.797; P = .000), institutional (R =.285, R 2 = .081, Adj. R 2 = .078, f (1,277) = 37.797; P = .000) and nurses' knowledge of nursing process (R =.194, R 2 = .038, Adj. R 2 = .034, f (1,277) = 10.830; P = .001) are determinants of the utilization of nursing process among nurses. Also, the nurses' age, gender, professional qualifications, professional cadre, and years of working experience failed to significantly influence the utilization of nursing process. The study concluded that nurses’ knowledge, attitude and institutional factors are core issues in the proper utilization of nursing process. Therefore, Effective and efficient implementation of the nursing process directly contributes to the quality of healthcare and the patients’ health outcomes. Keywords: Determinants, nursing process, utilization DOI : 10.7176/JHMN/70-05 Publication date: January 31 st 2020

A preprogram appraisal of factors influencing research productivity among faculty at college of medicine, University of Lagos.

Background:A defining feature of any university is its dedication to scholarly activities, leading to the generation of knowledge and ideas Research productivity is a measure of achievement of a scholar. The number of research publications in peer-reviewed journals is an important criterion for assessing productivity and prestige in the academia.Aims and Objectives:This cross-sectional descriptive study assessed the level of research productivity (RP) among junior faculty at the College of Medicine, University of Lagos, and investigated factors affecting their research output prior to the implementation of a 5-year training grant funded by the National Institutes of Health.Methods:Seventy junior faculty members attended a pre-program training, and the self-reported number of peer-reviewed publications (PRPs) was used as an indicator. Intrinsic and extrinsic factors influencing RP among the attendees were assessed and ranked.Results:The majority (42/70, 60%) of the respondents had <10 PRPs. The median (interquartile range) number of PRPs was 7 (3–18). A desire for the development of their personal skills, contribution to society, and personal research interests topped the list of intrinsic factors influencing RP. Work flexibility, research autonomy, and scholarly pursuits were the bottom three. A desire for promotion, respect from peers, and increased social standing were the top three extrinsic factors, while monetary incentives, employment opportunities, and the need to attend conferences were the lowest three. The top barriers to RP were lack of resources and lack of mentoring. Perceived older age, lack of time, and motivation were the lowest three barriers. Older age and professional cadre were associated with increased RP (P < 0.05).Conclusion:Among the participants, research output appears to be motivated primarily by a desire for personal development,promotion, and respect from peers. Lack of access to resources was the main barrier to increased RP. These factors may need to be considered when developing programs designed to promote RP.

'Gender is not even a side issue…it's a non-issue': career trajectories and experiences from the perspective of male and female healthcare managers in Kenya.

Women comprise a significant proportion of the health workforce globally but remain under-represented in the higher professional categories. Concern about the under-representation of women in health leadership positions has resulted in increased research on the topic, although this research has focused primarily on high-income countries. An improved understanding of the career trajectories and experiences of healthcare leaders in low- and middle-income countries (LMICs), and the role of gender, is therefore needed. This qualitative case study was undertaken in two counties in coastal Kenya. Drawing on the life-history approach, 12 male and 13 female healthcare leaders were interviewed between August 2015 and July 2016 on their career progression and related experiences. Although gender was not spontaneously identified as a significant influence, closer exploration of responses revealed that gendered factors played an important role. Most fundamentally, women’s role as child bearers and gendered societal expectations including child nurturing and other domestic responsibilities can influence their ability to take up leadership opportunities, and their selection and appointment as leaders. Women’s selection and appointment as leaders may also be influenced by positive discrimination policies (in favour of women), and by perceptions of women and men as having different leadership styles (against women, who some described as more emotive and reactive). These gendered influences intersect in relatively invisible ways with other factors more readily identified by respondents to influence their progression and experience. These factors included: professional cadre, with doctors more likely to be selected into leadership roles; and personal and professional support systems ranging from family support and role models, through to professional mentorship and continuing education. We discuss the implications of these findings for policy, practice and research, including highlighting the need for more in-depth intersectionality analyses of leadership experience in LMICs.

Формирование креативной компетентности в процессе обучения на основе интегративного курса «Хоровой театр»

The relevance of the subject of the article is stipulated by the challenges of contemporary musical education in the preparation of professional cadres possessing creative competency. The elaboration of innovative integrational courses, which develop the given professional quality among future specialist musicians in the process of their studies at the institutions of higher education, acquires special significance. The aim of the research is to reveal the potentials of the integrative course “Choral Theater” in the formation of creative competency of the student choirmaster. Analysis of scholarly works has made it possible for the authors to define the concept of the “creative competency of the musician” as the ability to create the situation of creative success, to solve in a productive manner nonstandard professional goals, thereby achieving maximal effectivity. The article presents the results of experimental work which was carried out by the methods of narrative interviews, observation and expert evaluation, as well as the study of the attempt of realization of the integrative course “Choral Theater” in the cycle of special disciplines for conductors-choirmasters. The research demonstrates the high pedagogical potential of active interaction between students and faculty members in the work on the projects of this course. Obviously, joint activities develop skills of command work and stimulates to the utmost degree the participants’ creative activities. As an example of their project activities the authors highlight the performance of the play “Promise me Love…”. Keywords: competency, creative competency, choral theater, integrative course, professional education.

EXERCISE PRESCRIPTION: A STRUCTURAL EQUATION ANALYSIS OF THE THEORY OF PLANNED BEHAVIOR AMONG KENYAN HEALTHCARE PROFESSIONALS

Objective : To describe the physical activity prescribing behaviour of Kenyan healthcare professionals and determine if the theory of planned behaviour explains this behavior. Design: The study design was a cross-sectional analytical, that utilized quantitative methods. Setting: The study was conducted in Public health facilities in Kakamega County, located in Western Kenya. These facilities were four (4) Sub-County hospitals, two (2) County hospitals and one (1) County referral hospital. Sample: Stratified random sampling was embraced to divide the population into homogeneous subgroups as per the professional cadres then simple random in proportion to their number in the population was done. Formulae that was used for calculating the sample size was Cochran) with an attrition rate of 10%, since the sample size was less than 10,000 people, the sample size was adjusted with the finite population correction for proportions based on the populations of nurses, doctors and clinical officers ( n = 221) Analysis: Data was analyzed through Structural Equation Modelling (SEM). Alpha level for all the computations was considered significant at an α <0.05. Main outcome measures: Self-reported PA prescription behaviour, PA involvement, attitude, subjective norm, perceived behavioural control (PBC) and intention related to PA prescription behaviour were assessed. Results: The estimation of this hypothesized structural model yielded an acceptable fit to the data, χ2 =1634.6, df = 770; χ 2 /df ratio =2.123(good), CFI = .962; RMSEA = .061, with 90% C.I. = .044 - .073, SRMR = .068. Subjective norms itself was a direct predictor of intention (β = .137, p = .007), attitude was a direct predictor of intention (β = .393, p < .001), perceived control was a direct predictor of intention (β = .207, p = .023) but it was not a significant predictor of exercise prescription (β = .07, p = .318). Intention was a direct predictor of exercise prescription (β = .251, p < .001). Conclusion: The theory of planned behaviour provided useful insight into physician prescription behaviour. A replication study on healthcare professionals with different characteristics should be conducted to increase the understanding of psychosocial predictors of this behaviour. Article visualizations:

Knowledge and practice of injection safety among healthcare workers in a Nigerian secondary healthcare facility

Injection safety is important in today’s healthcare delivery particularly in settings with a high burden of blood-borne viruses. A safe injection protects the patient, the healthcare worker and the community from avoidable infections. In Nigeria, the national policy on injection safety and healthcare waste management were developed in 2007. The development of the policy was followed by series of training on safe injection and behavioural change. Despite this, high burden of unsafe injections was reported in many parts of the country. This study assessed the level of knowledge and practice of injection safety among healthcare workers in a secondary healthcare facility in north-western Nigeria. The study targeted all the healthcare workers employed in the hospital. A self-administered questionnaire was distributed to all the available healthcare workers. &#x0D; A total of 80/88 questionnaires were returned and analysed. Majority of the respondents were male in their early career who were within the age range of 31-40years. The results showed that 88.75% of the healthcare workers correctly described injection safety as defined by the WHO. However, only 18.75% and 40.0% had good knowledge of risks associated with, and diseases that can be transmitted through unsafe injections respectively. In addition, only 25.0% reported safe injection practices. Reuse of syringe was reported by 37.50% of the respondents and over 88% recap used needles. Majority of the healthcare workers reported a previous history of needlestick injury which was not associated with their professional cadre p-value = 0.146.&#x0D; Despite injection safety training, inadequate knowledge with poor injection practice was found among the surveyed healthcare workers. The reuse of syringes and needles underscores the need for adequate and safe injection commodities at all levels of healthcare delivery. &#x0D; &#x0D; Keywords: healthcare workers, injection safety, knowledge, practice

Knowledge, attitude, and practice of hand washing among healthcare workers in a tertiary health facility in northwest Nigeria

Background: Healthcare-associated infections (HAIs) affect 1.7 million patients at any time worldwide, causing important morbidity and mortality. Up to 40% of all HAIs are thought to be transmitted by the hands of healthcare workers (HCWs). Hand washing is the most effective way of preventing the spread of infectious diseases in healthcare settings. This study assessed knowledge and practice hand washing among HCWs in Ahmadu Bello University Teaching Hospital, a tertiary healthcare center in Zaria, Kaduna State, northwestern Nigeria. Methods: A cross-sectional descriptive study was carried out among 116 HCWs selected using stratified sampling technique. Data were collected using interviewer-administered semistructured questionnaire and observation checklist using Epi Info mobile version 7.2.0.1 (United States Centres for Disease Control and Prevention (CDC), February 2018). Data were analyzed using SPSS software version 23. Results: Respondents of the study were nurses (37.9%), doctors (31.9%), and laboratory (18.1%) and supportive (12.1%) staff. About three-quarter (72.4%) of the HCWs had good knowledge and 62.0% exhibited positive attitude toward hand washing technique, based on the World Health Organization recommendations. Overall, good adherence to proper hand washing was found among 55.2% of the respondents. Respondents’ professional cadre and unit of work, and their level of knowledge and attitude toward proper hand washing practices were shown to be significantly associated with their adherence to the practice (P

Prevalence and predictors of low back pain in a Southern Nigerian hospital.

Background:Low back pain (LBP) is the most common musculoskeletal disease in adults. The data on LBP from Sub-Saharan Africa are inadequate. The aim of this study was to assess the prevalence and analyze the predictors of LBP among hospital staff in a Nigerian tertiary hospital.Materials and Methods:The study participants were recruited using an opt-in approach, with the aim of including representative numbers from each professional cadre. Each participant gave formal consent. Ethical clearance was obtained.Results:Five hundred and sixty-three participants with the mean age of 36.0 ± 8.3 years and 62% female were interviewed. The point prevalence of LBP was 234 (42% [95% confidence interval [CI]: 37%–45%]). Profession was a significant predictor of LBP (P = 0.001) – nurses (53% [95% CI 43%–63%]), administrative officers (49% [95% CI 40%–59%]), engineers (50% [95% CI 24%–76%]), and health information staff (50% [95% CI 26%–75%]) had the highest prevalence. In univariate regression, female gender, increasing age, body mass index ≥25 kg/m2, and frequently adopting a bending posture, were significantly associated with LBP, while in multivariate regression, only the female gender was a significant predictor.Conclusion:The pattern of both the professions at risk, due to the well-known mechanisms of poor ergonomics, and the marked risk for the female gender, in the hospital setting, suggest underresourced work and societal environments as the underlying factors-more research is needed.

Using the behavior change wheel to identify barriers to and potential solutions for primary care clinical guideline use in four provinces in South Africa

BackgroundClinical practice guidelines risk having little impact on healthcare if not effectively implemented. Theory informed, targeted implementation may maximise their impact. Our study explored barriers to and facilitators of guideline implementation and use by South African primary care nurses and allied healthcare workers in four provinces in South Africa. We also proposed interventions to address the issues identified.MethodsWe used qualitative research methods, comprising focus group discussions using semi-structured topic guides. Seven focus group discussions were conducted (48 providers) in four South African provinces (Eastern Cape, Western Cape, Kwazulu-Natal, Limpopo). Participants included mostly nurses, dieticians, dentists, and allied health practitioners, from primary care facilities in rural and peri-urban settings. The analysis proceeded in three phases. Firstly, two analysts conducted inductive thematic content analysis to develop themes of data. This was followed by fitting emergent themes to the Theoretical Domains Framework and finally to the associated Behaviour Change Wheel to identify relevant interventions.ResultsParticipants are knowledgeable about guidelines, generally trust their credibility and are receptive and motivated to use them. Guidelines are seen by nurses to provide confidence and reassurance, as well as professional authority and independence where doctors are scarce. Barriers to guideline use include: inadequate systems for printed book distribution, insufficient and substandard photocopies, linguistic inappropriateness (e.g. complicated language, lack of summaries, unavailable in local languages), unsupportive auditing procedures, limited involvement of end-users in guideline development, and patchy training that may not filter back to all providers. Future aspirations identified include: improving the design features of guidelines, accessible places to find guidelines, making digitally-formatted versions available, more supplementary materials (e.g. posters) to support patient engagement, accessible clinical support following training, and in-facility training for all professional cadres to ensure fair access, similar levels of capability and interdisciplinary consistency.ConclusionsSouth African primary care nurses and allied health practitioners have high levels of motivation to use guidelines, but face many systemic barriers. We used the Behaviour Change Wheel to suggest relevant, implementable interventions addressing identified barriers. This theory-informed approach may improve clinical guideline implementation and impact healthcare for South Africa.

The most important social problems faced by families in caring for children with autism and ways of treatment and rehabilitation

"The most important social problems of the family in the care of Autistic children and ways of treatment and rehabilitation (Rami in a field study center for the care of autistic children and slow learners)"(Social problems, Autistic children, rehabilitation)The current research aims to identify the most important social and psychological problems experienced by families in the care of children Autistic and what are the most prominent solutions and treatments to the families of the children, especially the parents in the care of these children, and what are the most important roads in the rehabilitation and treatment provided by Rahman Institute which (Rami previously) in care autistic child and that contribute to overcome the difficulties faced by them.The most important findings of the research:1-74% of families with autistic children suffer from difficulties in social relations.2-92% of the sample in which the brothers suffer frompsychological and social burden the existence of an autistic brother.3-80% of the children's families in which the parents of Autistic problems and disorders family suffers.4-70% of households Autistic children suffer injury as a result of social epilepsy or mental disability problems.5-80% of households have resorted to international organizations to take care of the child within and outside the country.6-78% of the families of autistic children confirms the ability of the Institute on the rehabilitation of the child in its ability to rely on himself.&#x0D; 7-74% of the sample confirms the auspices of medically Institute of autistic children.&#x0D; The most important recommendations on the family:1. Child can be treated early bands to help him develop social and language skills.2. The child was given an opportunity in the completion of his duties, which help him to give confidence in himself and the evolution of his senses and make it stable.The most important recommendations for the state:&#x0D; &#x0D; Provide special food and medical basket autistic child.&#x0D; Providing material support.&#x0D; Training professional cadres in the perpetuation of how to communicate with the families of autistic children.&#x0D;

Doctors' Attitude and Willingness to Use Electronic Medical Records at the Lagos University Teaching Hospital, Lagos, Nigeria.

Background There have been few studies conducted on Electronic Medical Records (EMR) among medical doctors who practice in resource limited settings. This study aimed to assess the attitude to and willingness of medical doctors at the Lagos University Teaching Hospital to use EMR and to identify the factors that are associated with the willingness to use EMR. Methods A stratified sampling method was used to select medical doctors to participate in the study according to their experience and professional cadre. A pretested self-administered questionnaire was used to collect data which were entered and analyzed using the Epi-info version 7 software. Statistically significant associations were tested using the chi-square and fishers exact tests. Results There were 202 participants in the study. All (100%) had good attitude towards EMR. Nearly all of them (96.54%) were willing to use EMR. There was no significant association between age, gender and willingness to use EMR. However, there was a statistically significant association with work duration and IT skills (p< 0.05). Conclusion Work duration and IT skills are significant factors in determining the willingness to use EMR. There is therefore a need to include IT skills acquisition in medical training so as to increase the chance of use of EMR.

Neonatal nursing policy and practice in Kenya: Key stakeholders and their views on task-shifting as an intervention to improve care quality.

Background: Improving the quality of facility based neonatal care is central to tackling the burden of neonatal mortality in Low and Middle Income Countries (LMIC). Quality neonatal care is highly dependent on nursing care but a major challenge facing health systems in LMICs is human resource shortage. In Kenya, task-shifting among professional care cadres is being discussed as one potential strategy of addressing the human resource shortage, but little attention is being paid to the potential for task-shifting in the provision of in-patient sick newborn care. This study identified key neonatal policy-making and implementation stakeholders in Kenya and explored their perceptions of task-shifting in newborn units. Methods: The study was exploratory and descriptive, employing qualitative methods including: document review, stakeholder analysis, observation of policy review process meetings and stakeholder feedback. A framework approach was used for analysis. Results: In Kenya, guidelines for the care of sick neonates exist but there are few specialized neonatal nurses and no policy documents outlining the nurse to patient ratio required in neonatal care or other higher dependency areas. The Ministry of Health, Nursing Council of Kenya and international agencies were identified as playing key roles in policy formulation while County governments, the National Nurses Association of Kenya and frontline care providers are central to implementation. Newborns were perceived to be highly vulnerable requiring skilled care but in light of human resources challenges, most expressed some support for shifting ‘unskilled’ tasks. However, a few of the key implementers were concerned about the use of unqualified staff and all stakeholders emphasized the need for training, regulation and supervision. Conclusions: Task-shifting has the potential to help address human recourse challenge in low-income settings. However, any potential task-shifting intervention in neonatal care would require a carefully planned process involving all key stakeholders and clear regulations to steer implementation.

ДІЯЛЬНІСТЬ СТАРШИНСЬКОЇ ШКОЛИ УПА ІМЕНІ ПОЛК. Є. КОНОВАЛЬЦЯ НА КОЛОМИЙЩИНІ (ІЗ ОСОБИСТИХ ЗІЗНАННЬ ФЕДОРА СТЕФАНОВИЧА-«КРОПИВИ»)

For an unbiased interpretation of the history of the Ukrainian people’s struggle for independence it is necessary to conduct versatile studies on the activity of Ukrainian liberation movement, particularly, on its personnel structure. Cadres play the most important role in any organization. Consequently, the clarification of the peculiarities and possibilities of their preparation makes up an important scientific problem. The article provides the protocol of the interrogation of colonel Fedir Stepanovych, whose nom de guerre was «Kropyva» («the nettle») and who was the organizer and the first head of Colonel E. Konovalets’ Officer School of the UPA in the Hutsul region. It should be underlined that the aforementioned document is an important source for a complex research of Ukrainian liberation movement in general and the peculiarities of preparation of master sergeants (starshyn) and staff sergeants (pidstarsshyn) specifically. The published protocol clarifies the question of functioning of master and staff sergeants schools of the UPA in MD-4 «Hoverlia». F. Stepanovych’ own evidence describes the officer school’s disposition place, strength, the names of administrative staff, programs, productivity of work. Besides, it gives the general information on the administrative staff of the OUN and UPA in Stanislaviv land.There is no separate complex research on the functioning of centres of preparation of commanding and rank-and-file staff of the UPA’s MD-4 «Hoverlia». That is the reason why this article purposes to provide the available information on the peculiarities of functioning of master sergeants (starshyn) and staff sergeants (pidstarsshyn) schools in MD-4 «Hoverlia».In the territory of Karpatskyi Krai (the Carpathian area of OUN) the shortage of master sergeants (starshyn) and staff sergeants (pidstarsshyn) cadres was acute. This problem was solved by both enrolling of persons who served in the armies of other states and by the independent preparation of such. For that purpose separate training courses were organized in accordance with independently developed programs to prepare commanding and rank-and-file staff. On the whole, master and staff sergeants training lasted from one to four months. Their instructors were those who had previous military experience. In addition, the UPA sergeants schools which absorbed the skilled staff of instructors who began intense training differed qualitatively from the rest. After the decision to organize military preparation for a number of OUN members the OUN leadership took to carrying it out. It is found out that there functioned 14 master and staff sergeants schools in the Karpatskyi Krai territoryHence, for the Ukrainian insurgents, combating for the restoration of their own state, the provision of their structures with professional cadres was a priority task. This question was solved by organization of their own training courses, under the supervision of skilled insurgents who had earlier participated in military service in the armies of other states and received direct fighting experience. Almost ten years of the Ukrainian liberation movement’s opposition to the Soviet punitive system became a bright acknowledgement of the effective work of training structures in MD-4 «Hoverlia».