scholarly journals Evidence-based implementation of normal childbirth: what are the obstacles? (qualitative study)

2020 ◽  
Vol 3 (2) ◽  
pp. 115-126
Author(s):  
Rizki Amalia ◽  
Moch. Hakimi ◽  
Herlin Fitriani
Keyword(s):  
Clinical Care ◽  
Sampling Technique ◽  
Obstetric Care ◽  
Evidence Based ◽  
Independent Practice ◽  
Structured Interviews ◽  
Delivery Assistance ◽  
Quality Of Obstetric Care ◽  
The Impact

Evidence-based is a very effective strategy to improve the quality of midwifery services. One of the most frequently problems faced is the gap between midwifery practices that are in accordance with the procedures (based on evidence-based) with clinical care practices that occur in the clinic. The purpose of this study was to explore in-depth the obstacles to the implementation of evidence-based normal childbirth, which are the position of delivery, monitoring and documenting delivery by using partographs in the Independent Practice of Midwives of Gunungkidul District, Yogyakarta.This research was a qualitative research with a phenomenological descriptive approach. The participants of this study were midwives who had the Independent Midwife Practice (PMB) consisting of 7 informants. Participant selection in this study used a purposive sampling technique with convenience sampling and identification of obstacles used was the Consolidated Framework for Implementation Research (CFIR). Data collection used was semi-structured interviews and observations. Data analysis used was a thematic analysis.The interview and observation of delivery assistance is done at the Independent Midwife Practice Center (PMB). The position of delivery that was often used by patients was lithotomy and left slant, and the application of evidence-based monitoring and documentation using partograph was still not optimal. This was because there were several obstacles in its application, which were obstacles from patients, families, midwives, and obstacles from the organization. The impact of these obstacles was that it can reduce the quality of obstetric care in patients according to evidence-based. The evaluation of clinical practice based on evidence-based by the organization and the existence of feedback from patients to midwives are expected to improve the quality of service to patients.    

scholarly journals ASSISTANCE TO PLANNED HOME CHILDBIRTH: PROFESSIONAL TRAJECTORY AND SPECIFICITIES OF THE OBSTETRIC NURSE CARE

2020 ◽  
Vol 29 ◽  
Author(s):  
Thalita Rocha Oliveira ◽  
Alessandra Franco Barbosa ◽  
Valdecyr Herdy Alves ◽  
Diego Pereira Rodrigues ◽  
Paolla Amorim Malheiros Dulfe ◽  
...  
Keyword(s):  
Professional Training ◽  
Sampling Technique ◽  
Obstetric Care ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Autonomous Action ◽  
Home Childbirth ◽  
Obstetric Nurses ◽  
Quality Of Obstetric Care

ABSTRACT Objective: to analyze the professional trajectory of obstetric nurses, who work in planned home childbirth. Method: a descriptive and exploratory study with a qualitative approach, conducted with 12 obstetric nurses who work in planned home childbirth. The participants were recruited using the non-probabilistic Snowball Sampling technique. In this perspective, semi-structured interviews were used, applied during the months of August to November 2018, in private places in the city of Rio de Janeiro. The collected data were submitted to content analysis in the thematic modality. Results: the research pointed out the value of experience and professional training - important milestones - in the setting of planned home childbirth, and motivators for the work of the professionals, as they enable autonomy. It is also emphasized the need for the obstetric nurse to acquire different skills for home childbirth, not covered during the training process. Conclusion: the results consolidate that obstetric nurses, who work in planned home childbirth and have a professional trajectory focused on the constant theoretical improvement associated with an approximation with “experts” in the area, provide experience, safety and quality of obstetric care, as well as autonomous action, in this care-related setting.

scholarly journals An exploration of the experiences of GP registrar supervisors in small rural communities: a qualitative study

2019 ◽  
Author(s):  
Danielle Couch ◽  
Belinda O’Sullivan ◽  
Deborah Russell ◽  
Matthew McGrail ◽  
Glen Wallace ◽  
...  
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Clinical Care ◽  
Rural Practice ◽  
Structured Interviews ◽  
Training Systems ◽  
Potential Factor ◽  
Access To Primary Care ◽  
The Impact

Abstract Background: In Australia registrar training to become a general practitioner (GP) involves three to four years of supervised learning with at least 50% of GP registrars training wholly in rural areas. These rural placements are important for developing the broad skills needed for effective rural practice. Having enough rural GP supervisors is essential to enable rural GP training to occur. We aimed to explore what makes GPs’ participate in supervising or not, their experiences of supervising, and the impact of their practice context. Methods: Semi-structured interviews were undertaken with 25 GPs based in rural Tasmania, all in towns of <25,000 population, to explore the GPs’ professional backgrounds, their experiences of supervising GP registrars, their practice context and their decisions about supervising GP registrars or not. Thematic analysis was undertaken; key ideas, concepts and experiences were identified and then reviewed and further refined to core themes. Results: Supervising was perceived to positively impact on quality of clinical care, reduce busy-ness and improve patient access to primary care. It was energising for GPs working in rural contexts. Rural GPs noted business factors as impacting both the decision to participate in supervision and the experience of participating: including uncertainty of registrar supply, discontinuity of registrar supply within rotational training systems, registrar competence and business income generation. Conclusions: Supervising is strongly positive for rural GPs and a potential factor related to their work satisfaction but increasing supervision capacity in rural areas may depend on supervision policies and systems which promote more viable supervision models tailored to the business needs of rural GPs and their practice context.

A COMPARATIVE STUDY OF EVIDENCE BASED PRACTICES BEFORE AND AFTER INTERNATIONAL ACCREDITATION AND PERCEPTION OF EMPLOYEES

2021 ◽  
pp. 66-68
Author(s):  
Binu Thomas ◽  
Ankur Joshi
Keyword(s):  
Sampling Technique ◽  
Positive Association ◽  
Health Centers ◽  
Evidence Based ◽  
Cross Sectional ◽  
Evidence Based Practices ◽  
Validated Questionnaire ◽  
Before And After ◽  
The Impact

Purpose: To compare the availability of evidence based practices before and after joint commission international accreditation as well as to assess employee perception about the impact of accreditation. Method: Conducted a cross sectional study in 11 health centers belong to Dubai health authority. Prepared a checklist and questionnaire to assess the processes improvements as well as the perception of employees respectively. Studied perception by recruiting physician (n=106) and nurses (n=194) using convenience sampling technique. Done content validity of the tools with clinical quality experts. Conducted pilot study for the questionnaire and checked the reliability using Cronbach alpha (0.924). After obtaining ethical clearance and consent from subjects, the researcher personally visited the health centers and administered validated questionnaire to the participants. To study processes improvements , the researcher audited documents for availability of evidence based practices before and after accreditation using the validated checklist with 17 processes reecting various domains of quality in healthcare . Results: Observed tremendous improvement in the availability of evidence-based practices. The proportion of practices before and after the accreditation was statistically signicantly different (p <.001). Majority (96.3%) of doctors and nurses perceived improvements in practices after accreditation. Statistical signicance was noted between qualication and perception of employees about the impact of accreditation (p <.001). Similarly there was also positive association between length of service and perception (p <.001) Discussion: Observed processes improvements ensuring quality of health care after accreditation. Likewise, majority of employees perceived that the accreditation has improved quality of patient care

scholarly journals Behavior of Patients with Chronic Kidney Disease

2020 ◽  
Vol 11 (2) ◽  
Author(s):  
Yuni Kurniawaty ◽  
Nihayatuz Nyoman Wahyu Lestarina ◽  
Baswara Yua Kristama
Keyword(s):  
Health Workers ◽  
Sampling Technique ◽  
Self Management ◽  
Structured Interviews ◽  
Treatment Management ◽  
Physical Conditions ◽  
Holistic Interpretation ◽  
Management Method ◽  
The Impact

Background: CKD patients increase with increasing age prevalence of 15.8%. Changes in behavior in people with CKD focus on diet, physical activity, quality of life, fatigue, knowledge, self-efficacy and self-management. Method: This research is qualitative with phenomenological methods. The subjects were 12 informants with CKD using purposive sampling technique. Data collection was carried out using in-depth and semi-structured interviews in June - August 2019 at William Booth Hospital in Surabaya. Data analysis using Giorgi's phenomenological analysis and thematic analysis then inductively and triangulating data. Results: This study found 4 themes, namely: holistic interpretation of needs, suggestions for healing, understanding of bodily functions and diet disobedience. Conclusion: CKD patients strive to meet their needs holistically with all the limitations of physical conditions by trying to carry out routine the treatment process recommended by health workers, even though barriers come from an understanding of bodily functions that are able to balance in CKD conditions and from the environment such as climate that makes disobedient to a fluid and nutritional diet. Seeing the importance of the impact of compliance with CKD patients in the implementation of CKD treatment management health workers need to make a systematic approach to CKD patients in treatment management

Impact and Challenges of Centres for Education and Community Action in Cameroon’s North West Region

2018 ◽  
Vol 8 (2) ◽  
pp. 51-74
Author(s):  
Fonteh Athanasius Amungwa
Keyword(s):  
Rural Development ◽  
Economic Crisis ◽  
Formal Education ◽  
Community Education ◽  
Sampling Technique ◽  
Community Action ◽  
Structured Interviews ◽  
North West ◽  
West Region ◽  
The Impact

This paper examines the impact of community education and challenges facing Centres for Education and Community Action as a rural development strategy in Cameroon. The study was conducted in the North-West Region of Cameroon, employing field observations, semi-structured interviews with key informants using a convenient sampling technique and through elaborate review of documents. These research instruments were blended into what is termed triangulation and the data collected was analysed descriptively. The main focus of qualitative analysis is to understand the ways in which people act and the accounts that people give for their actions. This paper posits that extreme dependence on the provision of Western formal education cannot solve the problems of a rapidly changing society like Cameroon, which is facing a long-term economic crisis and persistent unemployment issues of graduates. Consequently, education should be redefined in the context of the prevailing economic crisis to make it responsive to the aspirations of rural communities. Findings showed that community education had contributed towards rural development immensely but has suffered many challenges due to neglect of the field in the policy agenda. This paper recommends the integration of community education with formal education to facilitate group and community betterment in particular and rural transformation in general.

scholarly journals When and why do people act on flawed science? Effects of anecdotes and prior beliefs on evidence-based decision-making

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Audrey L. Michal ◽  
Yiwen Zhong ◽  
Priti Shah
Keyword(s):  
Educational Interventions ◽  
Evidence Based ◽  
Prior Beliefs ◽  
Learning Experiment ◽  
Apply Research ◽  
Evidence Quality ◽  
The Media ◽  
The Impact ◽  
Learning Interventions

AbstractToday’s citizens are expected to use evidence, frequently presented in the media, to inform decisions about health, behavior, and public policy. However, science misinformation is ubiquitous in the media, making it difficult to apply research appropriately. Across two experiments, we addressed how anecdotes and prior beliefs impact readers’ ability to both identify flawed science and make appropriate decisions based on flawed science in media articles. Each article described the results of flawed research on one of four educational interventions to improve learning (Experiment 1 included articles about having a tidy classroom and exercising while learning; Experiment 2 included articles about using virtual/augmented reality and napping at school). Experiment 1 tested the impact of a single anecdote and found no significant effect on either participants’ evidence evaluations or decisions to implement the learning interventions. However, participants were more likely to adopt the more plausible intervention (tidy classroom) despite identifying that it was unsupported by the evidence, suggesting effects of prior beliefs. In Experiment 2, we tested whether this intervention effect was driven by differences in beliefs about intervention plausibility and included two additional interventions (virtual reality = high plausible, napping = low plausible). We again found that participants were more likely to implement high plausible than low plausible interventions, and that evidence quality was underweighed as a factor in these decisions. Together, these studies suggest that evidence-based decisions are more strongly determined by prior beliefs than beliefs about the quality of evidence itself.

scholarly journals OP0277-PARE METABERN, THE EUROPEAN REFERENCE NETWORK FOR RARE HEREDITARY DISEASES: STRUCTURE, OBJECTIVES, METABOLIC RMDS AND THE ROLES OF EUROPEAN PATIENT ADVOCACY GROUPS (EPAGS)

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 168.2-168
Author(s):  
L. Wagner ◽  
S. Sestini ◽  
C. Brown ◽  
A. Finglas ◽  
R. Francisco ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Social Science ◽  
Metabolic Pathways ◽  
Metabolic Disorders ◽  
Clinical Care ◽  
Single Point ◽  
Link Type ◽  
The Impact

Background:Inborn metabolic disorders (IMDs) currently encompass more than 1,500 diseases with new ones still to be identified1. Each of them is characterised by a genetic defect affecting a metabolic pathway. Only few of them have curative treatments, that target the respective metabolic pathway. Commonly, treatment examples include diet, substrate reduction therapies, enzyme replacement therapies, gene therapy and biologicals, enabling IMD-patient now to survive to adulthood. About 30 % of all IMDs involve the musculoskeletal system and are here referred to as rare metabolic RMDs. Generally, IMDs are very heterogenous with respect to symptoms and severity, often being systemic and affecting more children than adults. Thus, challenges include certified advanced training of adult metabolic experts, standardised transition plans, social support and development of therapies for diseases that do not have any cure yet.Objectives:Introduction of MetabERN, its structure and objectives, highlighting on the unique features and challenges of metabolic RMDs and describing the involvement of patient representation in MetabERN.Methods:MetabERN is stratified in 7 subnetworks (SNW) according to the respective metabolic pathways and 9 work packages (WP), including administration, dissemination, guidelines, virtual counselling framework, research/clinical trials, continuity of care, education and patient involvement. The patient board involves a steering committee and single point of contacts for each subnetwork and work package, respectively2. Projects include identifying the need of implementing social science to assess the psycho-socio-economic burden of IMDs, webinars on IMDs and their transition as well as surveys on the impact of COVID-193 on IMD-patients and health care providers (HCPs), social assistance for IMD-patients and analysing the transition landscape within Europe.Results:The MetabERN structure enables bundling of expertise, capacity building and knowledge transfer for faster diagnosis and better health care. Rare metabolic RMDs are present in all SNWs that require unique treatments according to their metabolic pathways. Implementation of social science to assess the psycho-socio-economic burden of IMDs is still underused. Involvement of patient representatives is essential for a holistic healthcare not only focusing on clinical care, but also on the quality of life for IMD-patients. Surveys identified unmet needs of patient care, patients having little information on national support systems and structural deficits of healthcare systems to ensure HCP can provide adequate clinical care during transition phases. These results are collected by MetabERN and forwarded to the Directorate-General for Health and Food Safety (DG SANTE) of the European Commission (EC) to be addressed further.Conclusion:MetabERN offers an infrastructure of virtual healthcare for patients with IMDs. Thus, in collaboration with ERN ReCONNET, MetabERN can assist in identifying rare metabolic disorders of RMDs to shorten the odyssey of diagnosis and advise on their respective therapies. On the other hand, MetabERN can benefit from EULAR’s longstanding experience regarding issues affecting the quality of life, all RMD patients are facing, such as pain, stiffness, fatigue, rehabilitation, maintaining work and disability claims.References:[1]IEMbase - Inborn Errors of Metabolism Knowledgebase http://www.iembase.org/ (accessed Jan 29, 2021).[2]MetabERN: European Refence Network for Hereditary Metabolic Disorders https://metab.ern-net.eu/ (accessed Jan 29, 2021).[3]Lampe, C.; Dionisi-Vici, C.; Bellettato, C. M.; Paneghetti, L.; van Lingen, C.; Bond, S.; Brown, C.; Finglas, A.; Francisco, R.; Sestini, S.; Heard, J. M.; Scarpa, M.; MetabERN collaboration group. The Impact of COVID-19 on Rare Metabolic Patients and Healthcare Providers: Results from Two MetabERN Surveys. Orphanet J. Rare Dis.2020, 15 (1), 341. https://doi.org/10.1186/s13023-020-01619-x.Acknowledgements:The authors thank the MetabERN collaboration group, the single point of contacts (SPOC) of the MetabERN patient board and the Transition Project Working Group (TPWG)Disclosure of Interests:None declared

scholarly journals Improving the experience of facility-based delivery for vulnerable women through obstetric care navigation: a qualitative evaluation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kirsten Austad ◽  
Michel Juarez ◽  
Hannah Shryer ◽  
Patricia L. Hibberd ◽  
Mari-Lynn Drainoni ◽  
...  
Keyword(s):  
Health Workers ◽  
Positive Impact ◽  
Qualitative Evaluation ◽  
Obstetric Care ◽  
Hospital Staff ◽  
Public Hospitals ◽  
Future Research ◽  
Care Seeking ◽  
Structured Interviews ◽  
The Impact

Abstract Background Global disparities in maternal mortality could be reduced by universal facility delivery. Yet, deficiencies in the quality of care prevent some mothers from seeking facility-based obstetric care. Obstetric care navigators (OCNs) are a new form of lay health workers that combine elements of continuous labor support and care navigation to promote obstetric referrals. Here we report qualitative results from the pilot OCN project implemented in Indigenous villages in the Guatemalan central highlands. Methods We conducted semi-structured interviews with 17 mothers who received OCN accompaniment and 13 staff—namely physicians, nurses, and social workers—of the main public hospital in the pilot’s catchment area (Chimaltenango). Interviews queried OCN’s impact on patient and hospital staff experience and understanding of intended OCN roles. Audiorecorded interviews were transcribed, coded, and underwent content analysis. Results Maternal fear of surgical intervention, disrespectful and abusive treatment, and linguistic barriers were principal deterrents of care seeking. Physicians and nurses reported cultural barriers, opposition from family, and inadequate hospital resources as challenges to providing care to Indigenous mothers. Patient and hospital staff identified four valuable services offered by OCNs: emotional support, patient advocacy, facilitation of patient-provider communication, and care coordination. While patients and most physicians felt that OCNs had an overwhelmingly positive impact, nurses felt their effort would be better directed toward traditional nursing tasks. Conclusions Many barriers to maternity care exist for Indigenous mothers in Guatemala. OCNs can improve mothers’ experiences in public hospitals and reduce limitations faced by providers. However, broader buy-in from hospital staff—especially nurses—appears critical to program success. Future research should focus on measuring the impact of obstetric care navigation on key clinical outcomes (cesarean delivery) and mothers’ future care seeking behavior.

scholarly journals COVD-07. THE IMPACT OF COVID-19 ON PATIENTS AND CAREGIVERS AFFECTED BY BRAIN TUMORS: THE PATIENT NAVIGATOR PERSPECTIVE

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii22-ii22
Author(s):  
Kyle Walsh
Keyword(s):  
Clinical Trials ◽  
Brain Tumor ◽  
Clinical Care ◽  
Structured Interview ◽  
Patient Navigator ◽  
Structured Interviews ◽  
Social Distancing ◽  
Tumor Patient ◽  
Patient Navigators ◽  
The Impact

Abstract BACKGROUND Preliminary evidence indicates that glioma patients are at higher risk for COVID-19 complications due to systemic immunosuppression. Interruptions in cancer care may exacerbate patient and caregiver anxiety, but surveying patients/caregivers about their COVID-19 experiences is often limited by attainable sample sizes and over-reliance upon single-institution experiences. METHODS To explore how COVID-19 is impacting brain tumor patients/caregivers across the U.S., we performed semi-structured interviews with brain tumor patient navigators employed by two different 501(c)3 nonprofit organizations. A semi-structured interview guide was used, utilizing prompts and open-ended questions to facilitate dialogue. A core set of COVID-19 topics were covered, including: financial issues, coping strategies, geographic variability, variability by tumor grade/histology, disruptions in care continuity, accessing clinical trials, psychosocial issues, and end-of-life care. Interviews were audio-recorded, transcribed, and organized by discussion topic to identify emerging themes. Inductive sub-coding was completed using the constant comparison method, within and between transcripts. RESULTS/CONCLUSIONS Ten patient navigators were interviewed between April 15th and May 8th, with interviews lasting approximately one hour (range 38-77minutes). Navigators reported having contact with 183 unique brain tumor families during the pandemic (range 7–38 families per navigator). High concordance emerged across narratives, revealing important considerations for the neuro-oncology workforce. The most prominent theme was increased caregiver burden, attributed to maintaining social distancing by reducing visits from home-health aides and friends/family. A related theme that applied to both patients and caregivers was increased social isolation due to social distancing, suspension of in-person support groups, and church/temple closures. Accessing clinical trials was a recurrent issue, exacerbated by patients’ increasing unwillingness to travel. Glioblastoma patients, especially those with recurrent tumors, expressed greater reluctance to travel. Access to standard-of-care treatment was rarely interrupted, but reduced access to supportive services – especially physical and occupational therapy – was identified as an emerging COVID-related deficiency in clinical care.

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