Care Skills Research Articles

Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study.

In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients. This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults. This qualitative study used semistructured interviews to explore caregivers' perspectives on telehomecare for homebound or bedridden older adults. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines. Participants were selected using convenience sampling from caregivers of homebound or bedridden older adults with experience in both in-person home visits and telehomecare services provided by the Department of Family Medicine at Chiang Mai University, in an urban area of Chiang Mai Province in Northern Thailand. Semistructured interviews were conducted. The interviews were audio recorded with participant consent and transcribed verbatim. The framework method was used, involving multiple readings of transcripts to facilitate familiarization and accuracy checking. The study used the technology acceptance model and comprehensive geriatric assessment as the analytical framework. The study included 20 caregivers of older adult patients. The patients were predominantly female (15/20, 75%), with an average age of 86.2 years. Of these patients, 40% (n=8) of patients were bedridden, and 60% (n=12) of patients were homebound. Caregivers expressed generally positive attitudes toward telehomecare. They considered it valuable for overall health assessment, despite recognizing certain limitations, particularly in physical assessments. Psychological assessments were perceived as equally effective. While in-person visits offered more extensive environmental assessments, caregivers found ways to make telehomecare effective. Telehomecare facilitated multidisciplinary care, enabling communication with specialists. Caregivers play a key role in care planning and adherence. Challenges included communication issues due to low volume, patient inattention, and faulty devices and internet signals. Some caregivers helped overcome these barriers. The loss of information was mitigated by modifying signaling equipment. Technology use was a challenge for some older adult caregivers. Despite these challenges, telehomecare offered advantages in remote communication and resolving scheduling conflicts. Caregivers varied in their preferences. Some preferred in-person visits for a broader view, while others favored telehomecare for its convenience. Some had no strong preference, appreciating both methods, while others considered the situation and patient conditions when choosing between them. Increased experience with telehomecare led to more confidence in its use. Caregivers have positive attitudes and high expectations for telehomecare services. Although there may be barriers to receiving care through this mode, caregivers have demonstrated the ability to overcome these challenges, which has strengthened their confidence in telehomecare. However, it is important to enhance the skills of caregivers and health care teams to overcome barriers and optimize the use of telehomecare.

Implementation of a high fidelity simulation based training program for physicians of children requiring long term invasive home ventilation: a study by ISPAT team.

The number of children requiring long-term invasive home ventilation (LTIHV) has increased worldwide in recent decades. The training of physicians caring for these children is crucial since they are at high risk for complications and adverse events. This study aimed to assess the efficacy of a comprehensive high-fidelity simulation-based training program for physicians caring for children on LTIHV. A multimodal training program for tracheostomy and ventilator management was prepared by ISPAT (IStanbul PAediatric Tracheostomy) team. Participants were subjected to theoretical and practical pre-tests which evaluated their knowledge levels and skills for care, follow-up, and treatment of children on LTIHV. Following the theoretical education and hands-on training session with a simulation model, theoretical and practical post-tests were performed. Forty-three physicians from 7 tertiary pediatric clinics in Istanbul were enrolled in the training program. Seventy percent of them had never received standardized training programs about patients on home ventilation previously. The total number of correct answers from the participants significantly improved after the theoretical training (p < 0.001). The number of participants who performed the steps correctly also significantly increased following the hands-on training session (p < 0.001). All of the 43 participants who responded rated the course overall as good or excellent. The knowledge and skills of clinicians caring for children on LTIHV can be enhanced through a comprehensive training program consisting of theoretical training combined with hands-on training in a simulation laboratory.

CLINICIAN-LEADERS IN CARDIAC REHABILITATION: CLINICAL EXERCISE PHYSIOLOGISTS

https://youtu.be/5aocJv-Xyk0 BACKGROUND Clinical exercise physiologists (CEP) are members of the multidisciplinary team in cardiac rehabilitation (CR). CEPs undertake multiple roles, including individualizing patient care to help restore or improve daily functioning in patients with heart disease. CEPs are equipped with a wide range of knowledge and skills for successful patient care and also have the skillset to propel career development to serve in leadership roles. The Million Hearts Cardiac Rehabilitation Collaborative (CRC) is working to achieve the goal of increasing enrollment to 70% CR participation in eligible patients. However, given the critical healthcare staffing shortage, the workforce poses a unique challenge to adequately staff clinics to improve access to CR, especially in historically marginalized rural and urban communities. PURPOSE: Describe the prevalence of CR programs that are solely staffed by CEPs and the job tasks they perform in the United States. METHODS CR program managers in the United States were sent an email invitation to participate in an electronic survey from the American Association of Cardiovascular and Pulmonary Rehabilitation. Depending on the participant’s responses, the final survey could be as few as 11 and up to 44 required multiple choice questions. RESULTS Among 297 CR programs that responded to the survey, 86% (n= 256) stated they staff a CEP and 12% (n= 30) stated their program is run entirely by CEPs. Among the programs run entirely by CEPs, the minimum degree for CEP staff was a bachelor’s in 93% (n= 28) and a master’s in 7% (n= 2). The ACSM clinical exercise physiology credential was preferred or required in 73% (n= 22) of programs. Job tasks performed by CEPs in these CR programs were provided patient education (100%), monitored ECG during exercise (100%), assessed patient symptoms (100%), screened patients entering CR (100%), measured blood pressure via auscultation (97%), measured blood glucose (97%), and administered supplemental oxygen (93%). CEPs can hold a leadership position in 83% (n= 25) of these institutions. CONCLUSIONS Leveraging the CEP practice patterns to serve as CR clinical leaders permits other health care professionals, such as nurses, to be used in other areas of health care. Although no formal framework exists on the educational preparation for a CEP career ladder, findings suggest that CEPs are competent to run and oversee CR programs. Innovative strategies to improve referral, enrollment, and retention of patients with heart disease into CR will require increases in CR capacity which can be filled by CEPs.

Psychologists as Pivotal Members of the Pediatric Palliative Care Team

ContextPediatric psychologists possess unique expertise to positively impact the care provided to children with serious illness and their families. Despite increasing recognition regarding the value of psychology in palliative care, psychologists are not yet routinely integrated into pediatric palliative care (PPC) teams. ObjectivesThis special paper seeks to demonstrate distinctive contributions psychologists can offer to PPC teams, patients, and families, as well as highlight how psychologists enhance the work of their interdisciplinary PPC colleagues. MethodsExisting literature, consensus and policy statements, and recently developed competencies inform and provide evidence for the value of incorporating psychologists into PPC. ResultsAs children with serious illness are at risk for mental and physical health symptoms, psychologists’ specialized training in evidence-based assessment and intervention allows them to assess areas of concern, create treatment plans, and implement nonpharmacological therapies targeting symptom management and promotion of quality of life. By improving patient and family outcomes, psychology involvement saves money. In addition to clinical care, psychologists are skilled researchers, which can help to advance PPC interdisciplinary research. Lastly, psychologists can play a valuable role in contributing to PPC team education, dynamics, and well-being. ConclusionsWith strong skills in research, clinical care, education, and advocacy, pediatric psychologists are exceptionally equipped to provide care to children with serious illness and their families. Given their unique contributions, it is critical future efforts are directed towards advocating for the inclusion of psychologists into PPC, with the ultimate goal of improving care for children with serious illness and their families.

Training, skills, and leadership experience: The need to expand clinical psychology training as illustrated by psychology leadership stories.

Training for clinical psychologists is grounded in training models emphasizing clinical work, scholarship, and research. Rigorous competencies, varying by clinical specialty area, guide the specifics of training within domains of knowledge, skills, and aptitudes-with the goal of ensuring well-trained clinical psychologists. Research further illuminates the skills, characteristics, and experiences needed to maximize the effectiveness of clinical care provided by trained clinical psychologists. In addition, data indicate that clinical psychologists spend an average of 20% of their work time in management and leadership activities beyond clinical duties of direct care, requiring expanded and additional skills beyond those formally conceptualized and broadly included in graduate training. We utilize descriptions of three clinical psychologists' leadership journeys to illustrate the gap in training filled by these bootstrapping autodidacts when successes led to promotion to higher levels of responsibility and leadership. Our proposed solution is a call to action. We call for consideration of an expansion of clinical psychology training by (a) overtly translating currently taught clinical skills into needed leadership skills to consistently fill the gap rather than relying on individuals to acquire enough experience to adequately perform the translation themselves, and (b) adding both pragmatic and theoretical leadership skills into an expanded training curriculum. We strongly urge this rethinking and expansion of training to adequately support and foster future clinical psychologists in administrative and other leadership roles. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

AIGC-Assisted Instructional Design for the Self-Regulated Learning Course on "Implementing 2D Animation for the Ziyun Temple Stories"

The instructional design effectively utilizes generative AI to assist in the self-regulated learning course "2D Animation Implementation of Chiayi Temple Stories". It adopts 2D animation and the PPVIO teaching model, leveraging generative AI to create 2D animation scripts and 2D animations. This enhances and sharpens students' storytelling, 2D animation production, and the ability to use generative AI. It also promotes social care, communication, collaboration, and practical application skills. Within the domain of animation graphics, tools like Midjourney and other image-generating AIs are used, with animations completed using the Cartoon Animator 5 software. In this teaching design, teachers play a guiding and mentoring role, leading students to ask more precise prompts to make good use of ChatGPT, and guiding students to overcome the setbacks of self-regulated learning. With the assistance of AI generation tools, students can not only achieve cross-disciplinary learning objectives but, more importantly, reduce the time needed to learn drawing tools. This allows students, even those not specializing in IT, to enhance their digital capabilities in a shorter period. Two suggestions are put forth. Firstly, in the creative section, although the use of AI generation tools is convenient, once technical barriers are removed, the educational content should elevate the level of students' professional creation, such as emphasizing artistic styles. Secondly, regarding self-regulated learning, self-regulated learning should not be pursued for its own sake, nor should learning be for the mere act of learning. It's crucial to stress self-monitoring, self-regulation, and self-discipline to truly grasp the essence of self-regulated learning.

COVID-19 Pivoted Virtual Skills Teaching Model: Project ECHO Ontario Skin and Wound Care Boot Camp.

To describe a virtual, competency-based skin and wound care (SWC) skills training model. The ECHO (Extension for Community Healthcare Outcomes) Ontario SWC pivoted from an in-person boot camp to a virtual format because of the COVID-19 pandemic. An outcome-based program evaluation was conducted. Participants first watched guided commentary and videos of experts performing in nine SWC multiskills videos, then practiced and video-recorded themselves performing those skills; these recordings were assessed by facilitators. Data were collected using pre-post surveys and rubric-based assessments. Descriptive statistics and thematic analysis were applied to data analysis. Fifty-five healthcare professionals participated in the virtual boot camp, measured by the submission of at least one video. A total of 216 videos were submitted and 215 assessment rubrics were completed. Twenty-nine participants completed the pre-boot camp survey (53% response rate) and 26 responded to the post-boot camp survey (47% response rate). The strengths of the boot camp included the applicability of virtual learning to clinical settings, boot camp supplies, tool kits, and teaching strategies. The analysis of survey responses indicated that average proficiency scores were greater than 80% for three videos, 50% to 70% for three of the videos, and less than 50% for three of the videos. Participants received lower scores in local wound care and hand washing points of contact. The barriers of the boot camp included technical issues, time, level of knowledge required at times, and lack of equipment and access to interprofessional teams. This virtual ECHO SWC model expanded access to practical skills acquisition. The professional development model presented here is generalizable to other healthcare domains.

Smartphones' impact on nursing performances: a cross-sectional multicenter study.

In recent years, the technology world has significantly shaped society. This study aims to survey the views of registered nurses with hospital working experience regarding the personal communication devices use impact in hospital units. The secondary outcome of this study was to identify differences in mobile device use based on demographic and organizational factors. Cross-sectional study by survey. The questionnaire comprises 22 items divided into four sections. Overall 778 questionnaires were included in the study, 329 questionnaires were collected on pen-and-paper, whereas 449 by an online survey. Findings showed that smartphones have a different impact on performance, utilization and impact scale according to gender, age and educational attainment. Generally males using more frequently personal communication devices for non-work-related activities affected negatively their working performance by respect to females. Moreover, younger nurses report being more distracted by using smartphones for non-work-related activities than older nurses. At the same time, younger nurses believe that smartphones may lead to an improvement in patient care skills. Nurses with fewer years of service (1 month - 10 years) report being more distracted by non-work-related activities on their smartphones than nurses with more years of service (>20 years). The smartphone is a potential distraction source. The most exposed groups are the younger nurses' and those with little work experience, and both groups (young age, less experience) can be considered factors for potential distraction.

The Perceived Impact of Substance Use Education on Social Work Students' Knowledge, Attitudes, and Skills.

In 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) published a report revealing that over 46 million individuals in the United States had a substance use disorder (SUD). In the same year, a record number of drug-related overdose deaths were reported. Social workers play an important role in connecting with people who use substances and providing adequate care and treatment; yet, negative attitudes and lack of holistic knowledge about individuals who use substances create challenges in providing effective care. Social work curricula that integrates substance use content has been identified as one way to address this. A 14-week course was introduced in one institution's Master of Social Work curriculum with the goal of providing students with a comprehensive education on SUDs. Foundational knowledge and practical skill development were covered. Seventeen trained instructors taught a total of 1204 students between May 2020 and January 2022. Quantitative and qualitative data were collected to explore changes in student's self-perceived knowledge, attitudes, and skills related to substance use. Among those who completed the survey (N = 553), the majority felt that the course would have a positive impact on their future work and professional development. Specifically, 96.4% reported being satisfied or very satisfied with the course overall. Among those who completed a 30-day follow-up survey (n = 69), data revealed an increase in students' self-perceived knowledge, accompanied by a shift in attitudes and positive changes in self-perceived client-centered care skills. Findings from this article support the development, implementation, and evaluation of evidence-based substance use content within social work curricula. This has implications for improving knowledge, attitudes, and skills among social workers who work with people who use substances.

Experimenting with care and cod: On document-practices, versions of care and fish as the new experimental animal.

A key ambition in care studies has been to study care in practice and as practice. By turning towards practices, care studies has rendered visible and acknowledged important work that is not captured through looking at formal procedures or official and written materials, such as policy documents and medical protocols. In this literature, document materials and the written have often been seen as unable to demonstrate and address the 'specificities of care' (Mol et al., 2010, p. 9). We challenge this view by showing how pragmatically-oriented approaches can be extended to the procedural and formalized aspects of care practices. We draw upon fieldwork in the life sciences-comparative immunology-investigated through experiments on Atlantic cod (Gadus Morhua). How to care for fish is a contested domain; many uncertainties exist around how to care for fish so that legal requirements are met. We ask: How are existing legal and ethical principles and procedures put to work in cod immunology and animal research? By what document-practices and document-tools is care for cod in research negotiated and settled? How does the cod stand out as an object of care in the life sciences? Our article answers these questions by empirically teasing out how scientists navigate the terrain and arguing for the importance of bringing the document-based realities of animal research into analysis. We do this by delineating three different versions of care: procedural care, skilled care, and dispassionate care.

Place of care in the last three years of life for Medicare beneficiaries

BackgroundMost older adults prefer aging in place; however, patients with advanced illness often need institutional care. Understanding place of care trajectory patterns may inform patient-centered care planning and health policy decisions. The purpose of this study was to characterize place of care trajectories during the last three years of life.MethodsLinked administrative, claims, and assessment data were analyzed for a 10% random sample cohort of US Medicare beneficiaries who died in 2018, aged fifty or older, and continuously enrolled in Medicare during their last five years of life. A group-based trajectory modeling approach was used to classify beneficiaries based on the proportion of days of institutional care (hospital inpatient or skilled nursing facility) and skilled home care (home health care and home hospice) used in each quarter of the last three years of life. Associations between group membership and sociodemographic and clinical predictors were evaluated.ResultsThe analytic cohort included 199,828 Medicare beneficiaries. Nine place of care trajectory groups were identified, which were categorized into three clusters: home, skilled home care, and institutional care. Over half (59%) of the beneficiaries were in the home cluster, spending their last three years mostly at home, with skilled home care and institutional care use concentrated in the final quarter of life. One-quarter (27%) of beneficiaries were in the skilled home care cluster, with heavy use of skilled home health care and home hospice; the remaining 14% were in the institutional cluster, with heavy use of nursing home and inpatient care. Factors associated with both the skilled home care and institutional care clusters were female sex, Black race, a diagnosis of dementia, and Medicaid insurance. Extended use of skilled home care was more prevalent in southern states, and extended institutional care was more prevalent in midwestern states.ConclusionsThis study identified distinct patterns of place of care trajectories that varied in the timing and duration of institutional and skilled home care use during the last three years of life. Clinical, socioregional, and health policy factors influenced where patients received care. Our findings can help to inform personal and societal care planning.

A virtual simulation-based clinical skills course.

Advancements in technology continue to transform the landscape of medical education. Virtual reality (VR) and remote simulation represent unique approaches to teaching students clinical skills through experiential learning. We developed, implemented and evaluated a virtual simulation-based course modelled on Kolb's Learning Cycle. A 5-day, 15-h virtual clerkship clinical skills curriculum designed to help students recognise a patient requiring urgent or emergent care was piloted in May 2020. VR and remote simulations facilitated concrete experiences, reflective observation, concept formation, and active experimentation. Curricular evaluation included analysis of usage, performance, self-assessment, and perceptions of educational value. One hundred and fifty-six students completed 436 VR sessions (median 3 per student). Students repeated virtual cases, on average, 75% of the time, demonstrating improvement in average performance scores from 59% (attempt 1) to 72% (attempt 2). Post-course evaluations, completed by 109 (69.9%) students, demonstrated significant improvements in mean scores in all domains of a self-assessment based on emergent care skills. We developed and implemented a virtual clinical skills course that allowed students to progress through all four stages of Kolb's Learning Cycle. VR and remote simulations represent an opportunity for educators to reimagine and expand opportunities for experiential learning. The number of students accommodated, total virtual simulations completed, and positive student feedback suggests that this may be a feasible, acceptable, and scalable method for increasing opportunities for progression through Kolb's Learning Cycle. Further investigation into impact on educational outcomes is needed.

RESILIENSI CAREGIVER PADA LANSIA DENGAN SKIZOFRENIA

Abstract: This study aims to determine the sources of family caregiver resilience in the elderly with schizophrenia. Elderly is the longest span of life that individuals go through, being a caregiver for the elderly with schizophrenia has a special burden for the family. The role of caregivers is important in seeking healing and stability in the lives of elderly patients in society. The research subjects were family members who had cared for people with schizophrenia in the past year. The research was conducted using qualitative methods, and subject interview data were analyzed using a phenomenological approach. Five key themes were found related to the resilience of family caregivers in the elderly with schizophrenia, namely caregivers understanding patient disorders, caregiver commitment to healing, caregivers learning coping skills, interpreting positive parenting experiences, and forming a sense of mutual support among family members. Caregiver resilience can be increased by early intervention in the family to find out the health status and possible care that can be carried out by the family, support the knowledge and skills of care, and improve the caregiver support network.

Revolutionizing Critical Care Training with Simulation-Based Education

One key principle in healthcare education involves creating teaching and assessment methods that enable instructors to evaluate a trainee’s performance in scenarios mirroring real clinical practice. Standardized patients (SPs) have frequently been employed to evaluate the history-taking and physical examination skills of medical students and practicing physicians.1 Unfortunately, in critical care settings, training and skill development involving real-time patients and situations come with inherent risks and may give rise to numerous ethical concerns. Particularly in the realm of critical care, where rapid decision-making and precise skills are often the difference between life and death, the demand for effective training methods has grown exponentially. While traditional approaches have their merits, there’s a paradigm shift taking place in healthcare education, with simulation-based training emerging as a powerful tool for nurturing the next generation of critical care specialists.2 Simulation-based training in critical care represents a profound leap forward in the way we prepare healthcare professionals for real-world challenges. It’s not just a trend; it’s a revolution, one that’s enhancing the knowledge and skill set of medical personnel and, most importantly, improving patient outcomes. This editorial aims to shed light on the transformative potential of simulation-based training in critical care and its many advantages.

1911 Recommendations for a deprescribing approach that can be implemented in care homes: STOPPING study findings and lessons

Abstract Introduction Care home residents often have multiple long-term conditions and experience polypharmacy. Deprescribing is the reduction or stopping of prescription medicines that may no longer be providing benefit. Previous research has found that deprescribing is generally safe but it is unknown how to make it work well in practice, like care homes. Method Using the findings from the NIHR-funded STOPPING project, which aimed to support the development of better deprescribing practice approaches within care homes, considering different views and environments, recommendations for designing a deprescribing approach for care homes were developed. The STOPPING project included interviews with residents and their family members/friends, care home staff, and healthcare professionals about their experiences and beliefs about what influences deprescribing in 15 different care homes, and in-depth interviews with care home staff assessing current deprescribing tools/approaches about their acceptability, feasibility, and suitability for use in care homes. Results The developed approach included four implementation aspects: (1) plan and coordinate, (2) communicate and collaborate, (3) access and share information, and (4) monitor and evaluate. Proposed actions to encourage deprescribing in care homes were identified for each aspect (e.g., communication with residents and families about medication changes addressing concerns and offering clear instructions about observations). Conclusion Deprescribing within care homes is a complex and collaborative process, which involves many individuals with unique clinical and care skills, knowledge, and beliefs. To ensure it is successful, these different people need to be involved and contribute their specific knowledge and views. Communication and collaboration between care homes and healthcare professionals (such as GPs, nurses, and pharmacists) are essential to ensure deprescribing is done well. Information sharing and integrated working may support better communication and collaboration. Further work is needed to develop tools and approaches, and this work must include input from care home staff and residents.

APN nurses' core competencies for general clinical health assessment in primary health care. A scoping review.

The field of Advanced Practice Nursing (APN) has developed over the past six decades. However, the definition of roles and responsibilities of APN nurses seem to be contested due to both a lack of a clear definition of the concept and to institutional and cultural barriers that restrict the nurses' opportunities to practise to the full extent of their competencies. The objective of this scoping review was to identify, examine and conceptually map the available literature on APN nurses' core competencies for general health assessment in primary health care. We performed a scoping review, following the methodological guidance for reporting as it is described by the Joanna Briggs Institute (JBI). Furthermore, the PRISMA-ScR statement and checklist for reporting scoping reviews were followed. Guiding the initial process for the search, we used the Population, Concept and Context mnemonic (PCC) to clarify the focus and context of the review. We found three areas of core competencies on which APN nurse draw in performing general health assessments in primary health care: (1) 'Collaborative, leadership and management skills' (2) 'Person-centred nursing care skills' and (3) 'Academic and educational skills'. Furthermore, we found that the three areas are interrelated, because it is crucial that APN nurses draw on collaborative competencies related to leadership and management to meet the service users' needs and deliver high-quality and person-centred care. There is a need for a more specific investigation into how APN nurses' core competencies play a role during general health assessments of patients in primary care. We suggest an evaluation of what works for whom in what circumstances looking into the interrelation between competencies, skills and knowledge when an APN nurse performs a general health assessment in a primary healthcare setting.

What matters to migrant women during labor and birth: Chinese mothers’ experiences in Switzerland

BackgroundIn Switzerland, foreigners account for 25.3% of the permanent resident population, and the fertility rate of migrant women is higher than that of Swiss women. However, migrant women from non-European countries are more likely to report having negative childbirth experiences than Swiss women. For example, during pregnancy, Chinese migrant mothers often felt dissatisfied with the follow-up pregnancy complications and lacked information on medical procedures and prenatal courses. In this paper, we explored their childbirth experiences in Swiss hospitals and how Swiss healthcare providers supported them.MethodA qualitative study employing in-depth, semi-structured interviews was conducted with 14 Chinese mothers and 13 family members. All interviews were audio-recorded, transcribed, and translated into English for data analysis. Thematic analysis was employed to generate a detailed description.ResultsThree main themes were extracted from the transcripts: (1) Sense of security, (2) Intrapartum care, and (3) Postpartum needs.ConclusionsOur study shows Chinese migrant mothers prioritized giving birth in a physically and psychologically safe environment, with pain control and practical and emotional support from their intimate partners. They desired a physiological labor and birth with minimal obstetric interventions. Our research also reveals their postpartum needs, emphasizing the importance of postpartum support and obtaining culturally sensitive care during their postpartum hospital stay. The study adds new knowledge of specific migrant studies in Switzerland, as called for by the Swiss Federal Office of Public Health. The results call for the transcultural care skills training of Swiss healthcare providers to enable migrant women to have a more positive childbirth experience.

The effects of hospice care education on first-year undergraduate nursing students in mainland China: A mixed-methods study

BackgroundWith the rising number of people with end-stage chronic diseases, the demand for hospice care has increased dramatically. As the future health professionals for the implementation of hospice care, undergraduate nursing students in mainland China still lack knowledge and skills of hospice care, thus hospice care education plays a vital role in its development. ObjectivesTo understand the effects of hospice care education on nursing students' death attitudes, end-of-life attitudes, humanistic care qualities, and their learning experiences. DesignThis study used a mixed-methods design. SettingA University of Chinese Medicine in mainland China. ParticipantsThe first-year undergraduate nursing students (n = 65). MethodsA mixed-methods study was conducted to evaluate the impact of a hospice care course from March to June 2021. The quantitative part included a quasi-experimental study designed with pre- and post-intervention measurements and the qualitative part included a descriptive qualitative study with semi-structured individual interviews. ResultsThe quantitative data revealed that after the course, nursing students experienced improvements in their death attitudes, end-of-life attitudes, and humanistic care qualities. Two categories were identified from the qualitative data. The category of “Gain from learning” included 4 themes (Confronting death and thinking about life; Understanding and agreeing with the idea of hospice care; Perceiving the humanistic spirit of medicine; Enhancing of the nursing discipline cognition and professional identity) and the category of “Course feedback” included 2 themes (Expressing recognition for the course arrangement; Making suggestions on the course optimization). ConclusionsHospice care education had a positive influence on nursing students. Students expressed satisfaction with the course arrangement. However, future hospice care courses should further optimize the curriculum designs by increasing the discussion of death-related topics, sharing more real clinical cases, recruiting students from different majors, and providing clinical practice, to provide high-quality nursing education for the development of hospice care.

ANALISA PERSEPSI TERHADAP SELF CARE SKILLS PADA PASIEN DM TIPE II PADA MASYARAKAT PERKOTAAN

Assessment of the impacts of urban change at the neighborhood level provides a unique opportunity to generate insights into the extent and nature of positive and negative impacts on health-related outcomes. Several specific components and mechanisms that cause urban change can influence behavior, perception and self-care, thereby impacting health. The high prevalence of non-communicable diseases, one of which is Type 2 Diabetes Mellitus. Type 2 Diabetes Mellitus occurs when the body stops producing sufficient amounts of insulin, or when the body does not use insulin properly (something known as insulin resistance). in 2021 in the Jember urban area it will reach 1,700, one of which is due to lifestyle factors in the urban environment. One strategy for dealing with type 2 diabetes mellitus is to optimize the prevention of type 2 diabetes and associated comorbidities with a therapeutic approach, one of which is optimizing self-care which can reduce complications, reduce cardiovascular and kidney risks, and improve health outcomes. The aim of this research was to determine the relationship between disease perception and the self-care skills of type II diabetes mellitus patients. This research used a cross sectional method with a total of 100 respondents, data collection used a disease perception questionnaire and a quality of life questionnaire which were given to respondents directly. The results of the chi square test research obtained a value of p = 0.030 or &lt; (0.05), so Ha was accepted, meaning that there was a relationship between disease perception and the quality of life of type II diabetes mellitus patients. The conclusion obtained from this research is that there is a relationship between perception of illness and self-care skills. The increase in good self-care skills is due to good perception.. Keywords: Perception, Self Care Skills, Urban Society, Diabetes Mellitus

A retrospective observational study of vCare: a virtual emergency clinical advisory and transfer service in rural and remote Australia

BackgroundProvision of critical care in rural areas is challenging due to geographic distance, smaller facilities, generalist skill mix and population characteristics. Internationally, the amalgamation telemedicine and retrieval medicine services are developing to overcome these challenges. Virtual emergency clinical advisory and transfer service (vCare) is one of these novel services based in New South Wales, Australia. We aim to describe patient encounters with vCare from call initiation at the referring site to definitive care at the accepting site.MethodsThis retrospective observational study reviewed all patients using vCare in rural and remote Australia for clinical advice and/or inter-hospital transfer for higher level of care between February and March 2021. Data were extracted from electronic medical records and included remoteness of sites, presenting complaint, triage category, camera use, patient characteristics, transfer information, escalation of therapeutic intervention and outcomes. Data were summarised using cross tabulation.Results1,678 critical care patients were supported by vCare, with children (12.5%), adults (50.6%) and older people (36.9%) evenly split between sexes. Clinicians mainly referred to vCare for trauma (15.1%), cardiac (16.1%) and gastroenterological (14.8%) presentations. A referral to vCare led to an escalation of invasive intervention, skill, and resources for patient care. vCare cameras were used in 19.8% of cases. Overall, 70.5% (n = 1,139) of patients required transfer. Of those, 95.1% were transferred to major regional hospitals and 11.7% required secondary transfer to higher acuity hospitals. Of high-urgency referrals, 42.6% did not receive high priority transport. Imaging most requested included CT and MRI scans (37.2%). Admissions were for physician (33.1%) and surgical care (23.3%). The survival rate was 98.6%.ConclusionvCare was used by staff in rural and remote facilities to support decision making and care of patients in a critical condition. Issues were identified including low utilisation of equipment, heavy reliance on regional sites and high rates of secondary transfer. However, these models are addressing a key gap in the health workforce and supporting rural and remote communities to receive care.