Training Program For Healthcare Professionals Research Articles

Measuring empathy in pediatrics: validation of the Visual CARE measure

BackgroundEmpathy is a key element of “Patient and Family Centered Care”, a clinical approach recommended by the American Academy of Pediatrics. However, there is a lack of validated tools to evaluate paediatrician empathy. This study aimed to validate the Visual CARE Measure, a patient rated questionnaire measuring physician empathy, in the setting of a Pediatric Emergency Department (ED).MethodsThe empathy of physicians working in the Pediatric ED of the University Hospital of Udine, Italy, was assessed using an Italian translation of the Visual Care Measure. This test has three versions suited to different age groups: the 5Q questionnaire was administered to children aged 7–11, the 10Q version to those older than 11, and the 10Q–Parent questionnaire to parents of children younger than 7.The internal reliability, homogeneity and construct validity of the 5Q and 10Q/10Q–Parent versions of the Visual Care Measure, were separately assessed. The influence of family background on the rating of physician empathy and satisfaction with the clinical encounter was also evaluated.ResultsSeven physicians and 416 children and their parents were included in the study. Internal consistency measured by Cronbach’s alpha was 0.95 for the 10Q/10Q–Parent versions and 0.88 for the 5Q version. The item-total correlation was > 0.75 for each item. An exploratory factor analysis showed that all the items load onto the first factor.Physicians’ empathy scores correlated with patients’ satisfaction for both the 10Q and 10Q–Parent questionnaires (Spearman’s rho = 0.7189; p < 0.001) and for the 5Q questionnaire (Spearman’s rho = 0.5968; p < 0,001). Trust in the consulting physician was lower among immigrant parents (OR 0.43. 95% CI 0.20–0.93).ConclusionsThe Visual Care Measure is a reliable second-person test of physician empathy in the setting of a Pediatric Emergency Room. More studies are needed to evaluate the reliability of this instrument in other pediatric settings distinct from the Emergency Room and to further evaluate its utility in measuring the impact of communication and empathy training programmes for healthcare professionals working in pediatrics.

Building a Maternal and Newborn Care Training Programme for Health-Care Professionals in Guinea-Bissau.

The Integrated Programme of Maternal and Child Health aims to reduce maternal and child mortality in Guinea-Bissau.The purpose of this article is to share our experience in building a training programme on maternal and newborn care for health-careprofessionals in Guinea-Bissau. Regional directors of the four target areas chose a group of staff who provide prenatal and childbirth careto attend the course (12 to 15 trainees per region). In each region, 15 highly interactive and practical sessions were scheduled overeight weeks. The trainees' summative and reactive assessment was obtained using a multiple choice questionnaire (final test) and ananonymous survey, respectively. Attendees included 25 nurses, 17 midwives and 14 doctors. About two thirds had five years' practice or less. Test medianscores were higher among trainees with two to nine years of practice (54.4% to 60.9%), as compared to those with a year or less(47.8%) or 10 or more years (45.7%). Pedagogical variables were rated as 'good' or 'very good' by 91% to 95% of the attendees. Use of an interactive and practical pedagogical methodology produced positive results and was crucial to tailoring thetraining to local needs. However, adapting the syllabus according to professional categories and experiences should be considered. Our results warrant further development and evaluation of training programmes on maternal and neonatal care inGuinea-Bissau.

Developing a National Undergraduate Curriculum for Health Professionals in Ireland on health behaviour change (Making Every Contact Count)

Introduction: (comprising context and the problem statement) The Integrated care Programme in Ireland aims to integrate prevention and management of chronic disease into clinical practice. It will require changes in service delivery to make every clinical consultation count to: Routinely assess patients for their lifestyle risk factors for chronic disease Support patients in changing their lifestyle related health behavior Encourage self-management for patients with existing chronic disease. Changing this culture and practice to Make Every Contact Count will require upskilling of our existing healthcare staff and teaching the skills and knowledge required in undergraduate training programmes for all health professionals as outlined in the National Implementation plan for Healthy Ireland in the Health Services (2015-2017). Short description of practice change implemented: All new staff in the Irish health service will “Make Every Contact Count” by routinely assessing patients risk factors for chronic disease and carrying out a lifestyle behavior change intervention as part of all clinical interactions. Aim and theory of change: In 2015, the Health and Wellbeing Division, HSE established a collaborative between the Higher Education Institutions in Ireland to develop a competency based national standard undergraduate curriculum for medical, nursing and allied health professionals to support the integration of chronic disease prevention into clinical practice by Making Every Contact Count through brief interventions. Targeted population and stakeholders: Targeted population: All undergraduate students on health professional degree programmes. Key stakeholders are: HSE, HEI’s, all service users including those at risk of chronic disease and who have chronic diseases. Timeline: The curriculum will be delivered in relevant courses in HEI’s in Ireland from September 2017. Highlights: (Innovation, Impact and outcomes) This is the first time that a collaborative standard competency based national curriculum for healthcare professionals has been developed in Ireland. Collaborative health service and education initiative Shifts the emphasis towards chronic disease prevention in training healthcare professionals Evidence informed curriculum: The curriculum includes lifestyle choices and personal wellness, communicating with patients for chronic disease prevention and health behaviour change interventions to Make Every Contact Count. Comments on sustainability: Supports sustainable change in the routine delivery of lifestyle behaviour change interventions as part of all clinical consultations. Comments on transferability: Internationally transferable into other undergraduate training programmes for healthcare professionals. Conclusions: (comprising main findings) A nationally directed, collaborative approach was useful in: Creating leadership and commitment to the curriculum across all HEI’s Providing a multidisciplinary approach to its development Supporting the collective exchange of knowledge and resources. Supporting the implementation across all HEI’s in Ireland. Discussions: New staff recruited in the HSE will have the skills and knowledge to carry out brief interventions as a routine part of all their clinical consultations. Lessons learned: The importance of champions within positions of influence in each HEI was crucial to support the curriculum development and implementation. Progress to date: Curriculum has been developed and plans for implementation in each HEI are being developed.

Palliative care education in Latin America: A systematic review of training programs for healthcare professionals.

The integration of palliative care (PC) education into medical and nursing curricula has been identified as an international priority. PC education has undergone significant development in Latin America, but gaps in the integration of PC courses into undergraduate and postgraduate curricula remain. The aim of our review was to systematically examine the delivery of PC education in Latin America in order to explore the content and method of delivery of current PC programs, identify gaps in the availability of education opportunities, and document common barriers encountered in the course of their implementation. We carried out a systematic review of peer-reviewed academic articles and grey literature. Peer-reviewed articles were obtained from the following databases: CINAHL Plus, Embase, the Web of Science, and Medline. Grey literature was obtained from the following directories: the International Association for Hospice and Palliative Care's Global Directory of Education in Palliative Care, the Worldwide Hospice Palliative Care Alliance's lists of palliative care resources, the Latin American Association for Palliative Care's training resources, and the Latin American Atlas of Palliative Care. The inclusion criteria were that the work: (1) focused on describing PC courses; (2) was aimed at healthcare professionals; and (3) was implemented in Latin America. The PRISMA checklist was employed to guide the reporting of methods and findings. We found 36 programs that were delivered in 8 countries. Most of the programs were composed of interdisciplinary teams, taught at a postgraduate level, focused on pain and symptom management, and utilized classroom-based methods. The tools for evaluating the courses were rarely reported. The main barriers during implementation included: a lack of recognition of the importance of PC education, a lack of funding, and the unavailability of trained teaching staff. Considerable work needs to be done to improve the delivery of PC education programs in Latin American countries. Practice-based methods and exposure to clinical settings should be integrated into ongoing courses to facilitate learning. A regional platform needs to be created to share experiences of successful training programs and foster the development of PC education throughout Latin America.

Assessing the adaptation and implementation fidelity of an Online Tobacco Cessation Training Program for Healthcare Professionals in three Spanish-speaking Latin American countries: The Fruitful Study

Assessing the adaptation and implementation fidelity of an Online Tobacco Cessation Training Program for Healthcare Professionals in three Spanish-speaking Latin American countries: The Fruitful Study

The long way of implementing patient-centered care and shared decision making in Germany

The main focus of the paper is on the description of the development and current state of research and implementation of patient-centered care (PCC) and shared decision making (SDM) after fifteen years of substantial advances in health policy and health services research.What is the current state of SDM in health policy?The “Patients’ Rights Act” from 2013 standardizes all rights and responsibilities within the framework of medical treatment for German citizens and legal residents. This comprises the right to informed decisions, comprehensive and comprehensible information for patients, and decisions based on a clinician-patient-partnership.What is the current state of SDM interventions and patient decision support tools?SDM training programs for healthcare professionals have been developed. Their implementation in medical schools has been successful. Several decision support tools – primarily with support from health insurance funds and other public agencies – are to be implemented in routine care, specifically for national cancer screening programs.What is the current state of research and routine implementation?The German government and other public institutions are constantly funding research programs in which patient-centered care and shared decision-making are important topics. The development and implementation of decision tools for patients and professionals as well as the implementation of CME trainings for healthcare professionals require future efforts.What does the future look like?With the support of health policy and scientific evidence, transfer of PCC and SDM to practice is regarded as meaningful. Research can help to assess barriers, facilitators, and needs, and subsequently to develop and evaluate corresponding strategies to successfully implement PCC and SDM in routine care, which remains challenging.

Perceptions of telecare training needs in home healthcare services: a focus group study

BackgroundThe implementation and use of telecare requires significant changes to healthcare service organisation and delivery, including new ways of working for staff. Competency development and training for healthcare professionals is therefore required to enable necessary adaptation of clinical practice and ensure competent provision of telecare services. It is however unclear what skills healthcare staff need when providing care at a distance and there is little empirical evidence on effective training strategies for telecare practice. Training should however emphasise the experiences and preferences of prospective trainees to ensure its relevance to their educational needs. The aim of this study was to explore healthcare professionals’ perceptions of training related to the general use of telecare, and to identify specific training needs associated with the use of virtual visits in the home healthcare services.MethodsSix focus group interviews were held with a total of 26 participants working in the home healthcare services in Norway, including registered nurses, enrolled nurses, physiotherapists, occupational therapists, social workers, health workers, and healthcare assistants. The data material was analysed by way of systematic text condensation.ResultsThe analysis resulted in five categories relevant to telecare training for healthcare professionals: Purposeful training creates confidence and changes attitudes; Training needs depend on ability to cope with telecare; The timing of training; Training must facilitate practical insight into the patients’ perspective; and Training content must focus on the telecare process. Findings are discussed in light of implications for the form and content of a training program for healthcare professionals on how to undertake virtual home healthcare visits.ConclusionAppropriate preparation and training for telecare use is important for healthcare professionals and must be taken seriously by healthcare organisations. To facilitate the knowledge, skills and attitudes required for new ways of working and enable quality and safety in telecare practice, staff should be provided with training as part of telecare implementation processes. Telecare training should be hands-on and encourage an overall patient-centred approach to care to ensure good patient-professional relationships at a distance.

Palliative Care in the Elderly Injured Patient

The purpose of this review is to provide up-to-date insight into the current practices of palliative care in elderly trauma patients. The use and need of palliative care programs have grown substantially throughout the USA in both public and not-for-profit hospitals. The geriatric trauma outcome score has been proposed as a tool to help better explain to patients and their stakeholders the likelihood of mortality in injured geriatric trauma patients. The study of frailty and the differences between patients of similar age has become a focus of many surgical societies. Recent studies also address how to improve end-of-life communication through training programs for health-care professionals. Palliative care in trauma and other populations is evolving. Adequately trained staff are needed for facilitating care in this vulnerable patient population, while also providing education on best practices for appropriate discussion of palliation and end-of-life care in the trauma population.

Effect of a spiritual care training program for staff on patient outcomes.

Physicians and nurses do not assess spirituality routinely, even though spiritual care is a vital part of palliative care for patients with an advanced serious illness. The aim of our study was to determine whether a training program for healthcare professionals on spirituality and the taking of a spiritual history would result in improved patient quality of life (QoL) and spiritual well-being. This was a cluster-controlled trial of a spiritual care training program for palliative care doctors and nurses. Three of seven clinical teams (clusters) received the intervention, while the other four served as controls. Included patients were newly referred to the palliative care service, had an estimated survival of more than one month, and were aware of their diagnosis and prognosis. The primary outcome measure was the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp) patient-reported questionnaire, which patients completed at two timepoints. Total FACIT-Sp score includes the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire, which measures overall quality of life, as well as a spiritual well-being score. Some 144 patients completed the FACIT-Sp at both timepoints-74 in the control group and 70 in the intervention group. The change in overall quality of life, measured by change in FACT-G scores, was 3.89 points (95% confidence interval [CI 95%] = -0.42 to 8.19, p = 0.076) higher in the intervention group than in the control group. The difference between the intervention and control groups in terms of change in spiritual well-being was 0.32 (CI 95% = -2.23 to 2.88, p = 0.804). A brief spiritual care training program can possibly help bring about enhanced improvement of global patient QoL, but the effect on patients' spiritual well-being was not as evident in our participants. Further study with larger sample sizes is needed to allow for more definite conclusions to be drawn.

Leadership Training Program for Medical Staff in Belgium

Today healthcare is facing many challenges in a volatile, uncertain, complex and ambiguous environment. There is a need to develop strong leaders who can cope with these challenges. This article describes the process of a leadership training program for healthcare professionals in Belgium (named ‘Clinical Leadership Program’ or ‘CLeP’) in order to develop the future generation of strong healthcare leaders. The process over the past 3 years, refining time frame, content and format &amp; faculty will be discussed. At the start of 2013 a literature study and round up of existing programs were made. Furthermore, a preliminary program was constructed and adapted by different stakeholders. Their feedback taken into account, CLeP was launched 6 months later. From there, 9 different hospitals and 10 groups fulfilled the program. In total 179 healthcare professionals are educated (100 physicians, 37 nurses and 42other healthcare staff). After the completion of the program, in depth interviews served as an evaluation and suggestion for further development of our program. The ‘Clinical Leadership Program’ consists of 2 modules spread over 5 days of training, each covering a different theme. These themes incorporate ‘Me’, ‘Team’, ‘Organization’, ‘Institution’ and ‘Societal impact’ respectively. The first module covers the first two days, while the second module covers day 3-5. After applying, groups of 20 participants follow the 4 months program under the guidance of a senior mentor. They can choose to follow either only the first or both of the modules and whether or not to perform an assignment within their program. In order to develop the future generation of strong healthcare leaders, CLeP was worked out. This article describes the experiences and learnings of our program over the past 3 years. In the future, similar programs will be needed even more.

The Influence of Skill Development Training Program for Spiritual Care of Elderly Individual on Elderly Care Technician Students' Perception of Spiritual Support.

Spiritual care means helping an individual protect, maintain and gain all the dimensions of his/her existence. Elderly care technicians face numerous cases or crisis situations in which elderly individuals from different backgrounds question the meaning and value of life. Elderly care technicians must acknowledge that the spirituality is an important element in the way an elderly individual receives healthcare and they must be equipped for this matter. This study was conducted in order to examine the influence of "Skill Development Training Program for Spiritual Care of Elderly Individual," which was carried out with students from elderly care program, on the perception of spirituality support in a pretest-posttest quasi-experimental study design with control group. As the data collection form, "Spiritual Support Perception" (SSP) scale was used. The mean scores of the intervention group after the training and after one month are 50.39±5.34 and 51.13±4.98, respectively, and those of the control group are 43.16±4.83 and 42.72±4.48. A statistically significant difference was found between the mean scores of the intervention group from the pretest and the posttests immediately after the training and one month after the training (f=94.247, p=0.001). In the control group, however, there was no significant change in the SSP mean scores (f=0.269, p=0.77). As a result, this study pointed out the necessity of such training programs for healthcare professionals to make a distinction between their professional duties and their own personalities in order to offer spiritual care to the elderly individual.

Effect of Standardized Smoking Cessation Training Program for Healthcare Professionals on Their Knowledge

Effect of Standardized Smoking Cessation Training Program for Healthcare Professionals on Their Knowledge

Systematic development of a theory-informed multifaceted behavioural intervention to increase physical activity of adults with type 2 diabetes in routine primary care: Movement as Medicine for Type 2 Diabetes.

BackgroundDespite substantial evidence for physical activity (PA) as a management option for type 2 diabetes, there remains a lack of PA behavioural interventions suitable for delivery in primary care. This paper describes the systematic development of an evidence-informed PA behavioural intervention for use during routine primary care consultations.MethodsIn accordance with the Medical Research Council Framework for the Development and Evaluation of Complex Interventions, a four-stage systematic development process was undertaken: (1) exploratory work involving interviews and workshop discussions identified training needs of healthcare professionals and support needs of adults with type 2 diabetes; (2) a systematic review with meta- and moderator analyses identified behaviour change techniques and optimal intervention intensity and duration; (3) usability testing identified strategies to increase implementation of the intervention in primary care and (4) an open pilot study in two primary care practices facilitated intervention optimisation.ResultsHealthcare professional training needs included knowledge about type, intensity and duration of PA sufficient to improve glycaemic control and acquisition of skills to promote PA behaviour change. Patients lacked knowledge about type 2 diabetes and skills to enable them to make sustainable changes to their level of PA. An accredited online training programme for healthcare professionals and a professional-delivered behavioural intervention for adults with type 2 diabetes were subsequently developed. This multifaceted intervention was informed by the theory of planned behaviour and social cognitive theory and consisted of 15 behaviour change techniques. Intervention intensity and duration were informed by a systematic review. Usability testing resolved technical problems with the online training intervention that facilitated use on practice IT systems. An open pilot study of the intervention with fidelity of delivery assessment informed optimisation and identified mechanisms to enhance implementation of the intervention during routine diabetes consultations.ConclusionsMovement as Medicine for Type 2 diabetes represents an evidence-informed multifaceted behavioural intervention targeting PA for management of type 2 diabetes developed for delivery in primary care. The structured development process undertaken enhances transparency of intervention content, replicability and scalability. Movement as Medicine for Type 2 diabetes is currently undergoing evaluation in a pilot RCT.Trial registration ISRCTN67997502 Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-016-0459-6) contains supplementary material, which is available to authorized users.

Rational use of medicines – Indian perspective!

India, the largest democracy in the world, is with a federal structure of 29 states and 7 union territories. With a population of more than 1.2 billion, resource is always a constraint and so is in the health system too. In the federal structure, providing healthcare is largely the responsibility of state governments. Medicines are important component of health care delivery system and quality care is dependent on the availability and proper use of quality medicines. In spite of being known as pharmacy of the third world, poor access to medicines in the country is always a serious concern. Realizing the need of quality use of medicines, several initiatives have been initiated. As early as 1994, seeds of rational use of medicines were sown in the country with two initiatives: establishment of a civil society, Delhi Society for Promoting Rational Use of Drugs (DSPURD) and establishment of government agency in Tamil Nadu, a southern state, called Tamil Medical Services Corporation Limited (TNMSCL). DSPUD was in official association with World Health Organization Country Office for implementing essential medicine programme in the country for two biennia. In addition to organizing sensitising and training programme for healthcare professionals throughout the country, it looked after the procurement and appropriate use of medicines in Delhi government health facilities. TNMSCL has made innovations in medicine management including procurement directly from manufacturers as a part of pooled procurement, establishing warehouses with modern storage facilities and Information Technology enabled management of whole process. TNMSCL Model is now replicated in almost the entire country and even in some small other countries as it is successful in improving access to medicines.The National Government and the State Governments have developed strategies to promote rational use of medicines as a part of improving access and quality care in public health facilities. National Government developed policies and regulations for combating antimicrobial resistance, controlling the prices of medicines, establishing generic medicines stores and advocating for the need for improvement of medicine logistics at state level and prescription auditing system. There is wide variation in medicine procurement and management system among the states. Spending on medicines ranges from as small as 2% of health budget to as high as 17%. The procurement system varies from individual facilities to partial pooled procurement to complete centralised system.There are attempts of developing essential medicine lists, standard treatment guidelines and costing of treatment of common illnesses. Except for the few states, essential medicine list remains an ornamental showpiece. However, with apex court's intervention, the prices are now controlled for all 348 medicines listed in national list. The pharmaceutical companies continue to violate price regulations either through making the medicines at different strengths or new fixed dose combinations (FDCs). Perhaps the largest number of FDCs and many of them with no valid justification are available in the country. Decisions on compulsory licensing have made the new anticancer medicines affordable. Other countries have also benefited from this decision. While some progress has been made for appropriate use of medicines in public health facilities, there are little efforts in private sectors and at community levels. Availability of prescription medicines without much control and free drug advertising are other concerns. Like all other countries irrational use of medicines continues to be of concern in India despite of several attempts of improving use of medicines both in the health system as well as in community. But efforts continue to be made for improving the use of medicines!

The effect of training in mindfulness and affect consciousness on the therapeutic environment for patients with psychoses: an explorative intervention study

The ward atmosphere and the relationships between patients and staff contribute to the improvement in symptoms and psychiatric patient functioning and satisfaction. The quality of the therapeutic relationship is connected to the degree of self-reflection and self-awareness by the staff. To examine the effect of two different training programmes for healthcare professionals on the ward atmosphere in wards for psychotic patients. Exploratory intervention study with two eight-week interventions of mindfulness training and affect-consciousness training. The outcome was measured on mindfulness and on relevant subscales of the Ward Atmosphere Scale. Data were collected by means of questionnaires and analysed using paired samples t-tests and repeated measures anova. Two groups professionals (n = 27 & n = 23) participated in the study. Improvements indicated that both interventions had a positive impact on the ward atmosphere. The exploratory design and the small samples size make definitive conclusions difficult. Patient assessment on the ward atmosphere scale would have strengthened the validity of the results. The ward atmosphere in two different wards for psychotic patients improved after staff training in mindfulness or affect consciousness. There were differences in change profiles for the groups in accordance with the differences in the two interventions. We recommend awareness on the quality of the ward atmosphere in wards for psychotic patients. Both training in mindfulness and affect consciousness can support healthcare professionals in their awareness.

Interprofessional approaches to integrating SBIRT into students' clinical experiences

Background Most healthcare professional training programs lack sufficient curricula on substance use[1-3], and even fewer provide students the opportunity to practice screening and brief intervention (BI) in a clinical setting. The University of Missouri-Kansas City Screening, Brief Intervention and Referral to Treatment (UMKC-SBIRT) training project educates baccalaureate nursing (BSN), doctorate of nursing practice (DNP), and master of social work (MSW) students through didactics, role plays with classmates, standardized patient practice, and clinical experience to help students achieve competency.

Development of an existential support training program for healthcare professionals.

Our aim was to describe the developmental process of a training program for nurses to communicate existential issues with severely ill patients. The Medical Research Council (MRC) framework for the development and evaluation of complex interventions was used to develop a training program for nurses to communicate about existential issues with their patients. The steps in the framework were employed to describe the development of the training intervention, and the development, feasibility and piloting, evaluation, and implementation phases. The development and feasibility phases are described in the Methods section. The evaluation and implementation phases are described in the Results section. In the evaluation phase, the effectiveness of the intervention was shown as nurses' confidence in communication increased after training. The understanding of the change process was considered to be that the nurses could describe their way of communicating in terms of prerequisites, process, and content. Some efforts have been made to implement the training intervention, but these require further elaboration. Existential and spiritual issues are very important to severely ill patients, and healthcare professionals need to be attentive to such questions. It is important that professionals be properly prepared when patients need this communication. An evidence-based training intervention could provide such preparation. Healthcare staff were able to identify situations where existential issues were apparent, and they reported that their confidence in communication about existential issues increased after attending a short-term training program that included reflection. In order to design a program that should be permanently implemented, more knowledge is needed of patients' perceptions of the quality of the healthcare staff's existential support.

Competency-based SBIRT training for health-care professionals: nursing and social work students

Background Most health-care professional training programs lack educational curricula on substance use disorders and strategies for early intervention or referral to treatment. The University of Missouri-Kansas City Screening, Brief Intervention and Referral to Treatment (UMKC-SBIRT) training project educates baccalaureate nursing, advanced practice nursing, and master’s of social work students through didactics threaded throughout coursework; roleplays with classmates and faculty; standardizes patient practice; and offers clinical experience to help students achieve competency. Methods

Strategies that assist children with communicative disability during hospital stay: Parents' perceptions and ideas.

There is a lack of research on the use of augmentative and alternative communication (AAC) in paediatric care, despite the fact that most children in need of AAC frequently need to visit hospitals and sometimes have to stay for long periods. The aim of this study was to investigate parents' experiences of the hospital visits with their children with communicative disabilities and to collect their ideas about how to optimize communication in this situation. Ten parents who had children with communicative disability took part in three focus group interviews. The analysis had a retrospective qualitative content theory. In the qualitative content analysis of the focus group interviews, 4 categories and 17 subcategories were identified. Overall, the results highlighted the importance of enabling direct communication between the child and the staff during the hospital stay. Parents of children with communication difficulties highlighted the importance of listening to their children and understanding their needs during hospital care and that hospital staff are in need of more knowledge in communicative disability and AAC to accomplish this. Training programmes for health-care professionals should be established to facilitate these requirements and connect to the United Nations conventions. Hospitals should provide and use AAC/communicative support.

Does delivery of a training program for healthcare professionals increase access to pulmonary rehabilitation and improve outcomes for people with chronic lung disease in rural and remote Australia?

Access to pulmonary rehabilitation (PR), an effective management strategy for people with chronic respiratory disease, is often limited particularly in rural and remote regions. Difficulties with establishment and maintenance of PR have been reported. Reasons may include a lack of adequately trained staff. There have been no published reports evaluating the impact of training programs on PR provision. The aim of this project was to evaluate the impact of an interactive training and support program for healthcare professionals (the Breathe Easy, Walk Easy (BEWE) program) on the delivery of PR in rural and remote regions. The study was a quasi-experimental before-after design. Data were collected regarding the provision of PR services before and after delivery of the BEWE program and patient outcomes before and after PR. The BEWE program was delivered in one rural and one remote region. Neither region had active PR before the BEWE program delivery. At 12-month follow-up, three locally-run PR programs had been established. Audit and patient outcomes indicated that the PR programs established broadly met Australian practice recommendations and were being delivered effectively. In both regions PR was established with strong healthcare organisational support but without significant external funding, relying instead on the diversion of internal funding and/or in-kind support. The BEWE program enabled the successful establishment of PR and improved patient outcomes in rural and remote regions. However, given the funding models used, the sustainability of these programs in the long term is unknown. Further research into the factors contributing to the ability of rural and remote sites to provide ongoing delivery of PR is required.