Evaluation of an intervention to train health professionals working with Aboriginal and Torres Strait Islander people to provide smoking cessation advice

Objective : To investigate the effectiveness and cultural relevance of Quitskills training tailored for health professionals working with Aboriginal and Torres Strait Islander people who smoke. Methods : A retrospective analysis was conducted with data collected from 860 participants (54% Aboriginal and Torres Strait Islander participants) in tailored Quitskills training from 2012 to 2016. Course participants took part in a survey at pre‐training, post‐training and four‐six weeks post‐training to assess confidence in skills to address tobacco, and perceptions of the strengths, areas for improvement and cultural relevance of the training. Results : Confidence in skills and knowledge to address tobacco increased significantly from pre‐ to post‐training (all indicators of confidence in skills increased p<0.001) and remained high at follow‐up. Tailored Quitskills training was perceived as being culturally relevant by Aboriginal and Torres Strait Islander participants, and the training facilitators were the most commonly cited strength of the training. Conclusions : Quitskills is an appropriate course for increasing skills and confidence among health professionals working with Aboriginal and Torres Strait Islander people who smoke. Implications for public health : Training courses that are tailored for Aboriginal and Torres Strait Islander people can build the capacity of the health workforce in a culturally relevant manner.     

Improving management of vaccine supply chains: A multi-methods evaluation of vSTEP in Zambia

BackgroundEquipping supply chain professionals at all levels of the health care systems with essential leadership and management skills is essential to achieving global immunization targets. Numerous and diverse professional development initiatives have been established to support vaccine supply chain managers in Gavi-eligible countries. However, COVID-19 catalyzed rapid innovation in approaches to support leadership development in times of rapid change, and systematic evaluation of these approaches can inform future workforce development strategies to ensure resilient health systems. Therefore, we sought to evaluate outcomes and short-term impact of the fully virtual Strategic Training Executive Program 2.0 (vSTEP 2.0) program in Zambia on participant engagement, skill development, and application of new skills to improve supply chain performance.MethodsWe used a multi-method design to describe the outcomes and short-term impact of vSTEP 2.0 at three levels: (1) delegate response to the training experience (including participation, completion, and satisfaction); (2) delegate change in leadership skill (including achievement of learning objectives and change in competencies); and (3) application of new skills to impact supply chain performance.ResultsThe program achieved high levels of engagement and an 83% graduation rate despite the length and rigor of the program. High satisfaction was evidenced by positive feedback from delegates on the quality and relevance of the program, especially in the context of COVID response (100% would "definitely" recommend). Delegates demonstrated significant growth in all domains of leadership competencies and applied their learnings to address a complex challenge in supply chain performance in their home organization.DiscussionThese findings demonstrate a strong appetite for leadership development support among vaccine supply chain professionals, especially in times of rapid change such as during the COVID response. These results also demonstrate the feasibility and impact of a fully virtual model for leadership development, with implications well beyond the COVID-19 pandemic.     

A mixed-methods study of interprofessional learning of resuscitation skills

Objectives This study aimed to identify the effects of interprofessional resuscitation skills teaching on medical and nursing students’ attitudes, leadership, team‐working and performance skills. Methods Year 2 medical and nursing students learned resuscitation skills in uniprofessional or interprofessional settings, prior to undergoing observational ratings of video‐recorded leadership, teamwork and skills performance and subsequent focus group interviews. The Readiness for Interprofessional Learning Scale (RIPLS) was administered pre‐ and post‐intervention and again 3–4 months later. Results There was no significant difference between interprofessional and uniprofessional teams for leadership, team dynamics or resuscitation tasks performance. Gender, previous interprofessional learning experience, professional background and previous leadership experience had no significant effect. Interview analysis showed broad support for interprofessional education (IPE) matched to clinical reality with perceived benefits for teamwork, communication and improved understanding of roles and perspectives. Concerns included inappropriate role adoption, hierarchy issues, professional identity and the timing of IPE episodes. The RIPLS subscales for professional identity and team‐working increased significantly post‐intervention for interprofessional groups but returned to pre‐test levels by 3–4 months. However, interviews showed interprofessional groups retained a ‘residual positivity’ towards IPE, more so than uniprofessional groups. Conclusions An intervention based on common, relevant, shared learning outcomes set in a realistic educational context can work with students who have differing levels of previous IPE and skills training experience. Qualitatively, positive attitudes outlast quantitative changes measured using the RIPLS. Further quantitative and qualitative work is required to examine other domains of learning, the timing of interventions and impact on attitudes towards IPE.     

Mobile in situ obstetric emergency simulation and teamwork training to improve maternal-fetal safety in hospitals

BACKGROUND: Evidence from other high-risk industries has demonstrated that teamwork skills can be taught and effective teamwork may improve safety. Increasingly, health care providers, hospital administrators, and quality and safety professionals are considering simulation as a strategy to improve quality and patient safety. MOBILE OBSTETRIC SIMULATION AND TEAM TRAINING PROGRAM: A mobile obstetric emergency simulation and team training program was created to bring simulation technology and teamwork training used routinely in other high reliability fields directly to health care institutions. A mobile unit constituted a practical approach, given the expense of simulation equipment, the time required for staff to develop educational materials and simulation scenarios, and the need to have a standardized program to promote consistent evaluation across sites. Between 2007 and 2009, in situ simulation of obstetric emergencies and teamwork training was tested with more than 150 health care professionals in labor and delivery units across four rural and two community hospitals in Oregon. HOW DO ORGANIZATIONS DETERMINE WHICH TYPE OF SIMULATION IS BEST FOR THEM? Because simulation technologies are relatively costly to start and maintain, it can be challenging for hospitals and health care professionals to determine which format (send staff to a simulation center, develop in-house simulation program, develop a consortium of hospitals that run a simulation program, or use a mobile simulation program) is best for them. CONCLUSIONS: In situ simulation is an effective way to develop new skills, to maintain infrequently used clinical skills even among experienced clinical teams, and to uncover and address latent safety threats in the clinical setting.     

ARE RURAL PEOPLE GETTING HEARTSMART?

Objective: This study evaluates the impact of a cardiac rehabilitation program (HeartSmart) in a rural area on the quality of life, dietary behaviour, weight loss and physical activity participation of patients with cardiovascular disease (CVD) or at high risk of CVD. Design: The evaluation of the program consisted of a single group pre and post‐test design with follow‐up at 3, 6 and 12 months after program completion, complemented with a cross‐sectional survey of non‐participants as a pseudo comparison group. Setting: The HeartSmart program is a hospital‐based cardiac rehabilitation program in Bunbury, a regional centre of Western Australia. Subjects: A total of 203 participants and 159 non‐participants. Interventions: The program consisted of 7 weeks of education and exercise sessions. Results: The program had a high rate of completion (92%). Evaluation results suggested that HeartSmart participants demonstrated significant improvements in quality of life, compliance with medication, dietary behaviour, weight loss and physical activity participation. The largest changes were mostly observed between pre and post‐program stages, with sustained behaviour change at 6 months after the completion of the program. Further evidence of the HeartSmart benefits was provided through significantly better health‐related behaviour, confidence to diet and exercise, dietary fat intake, cardiac knowledge and quality of life scores among HeartSmart participants compared with non‐participants. Conclusions: While this program has achieved its objectives, there are a few issues that need to be considered by similar programs: the post‐program stage of patient follow‐up by general practitioners; the geographical disadvantage of those living outside regional centres to access the service; enhancing the primary prevention aspect of the program; adapting the program to the needs of Aboriginal clients; facilitating evaluations by resourcing and training program staff in computer skills.     

Sustainable eating: Opportunities for nutrition professionals

Increasing demand for food from a growing human population is leading to adverse environmental and health consequences. The emerging topical issue of sustainable eating and diets might offer new opportunities for the training of nutrition professionals. Ongoing research is uncovering synergies between how dietary patterns can meet both health and environmental goals. Yet this area is a challenge for the nutrition professions, as relevant education often involves politically driven, systems leadership‐style thinking, which is drawn from a less familiar evidence base than traditional nutritional sciences. As pressures mount to achieve sustainability agenda goals, new evidence appraisal and educational input are essential to support the potential role of nutrition professionals. This article appraises sustainable eating and diets, as well as considering the value of better education to be embedded more consistently within nutrition curricula and Continued Professional Development (CPD), to achieve sustainability literacy for nutrition professionals. The importance of stronger advocacy skills and collaborative leadership is also highlighted, as well as the need for more effective high‐level policy involvement. Recommendations for how nutrition professionals can be more effectively equipped for this emerging and dynamic area of professional practice are provided.     

Developing effective physician leaders: changing cultures and transforming organizations

In this article, the authors discuss the problematic issue of transformational change in the face of cultural conflict between the worlds of clinical care and organizational leadership, and describe a case study of organizational cultural change facilitated through a physician leadership development program. A locally developed physician leadership program can be extremely effective at both improving physicians' leadership skills and increasing understanding of the strategic goals and direction of the organization. The transformational change required for physicians to develop and appreciate business and leadership skills can be supported and encouraged in a leadership development program that includes the components of careful curriculum design, program monitoring, and opportunities to apply new skills in practice. For Columbus Children's Hospital, Columbus, Ohio, this organizational transformational change effort was successfully achieved when a new medical leadership development program helped academic and community physicians to become involved in organizational leadership. The authors describe the background and development of this program and provide results of their evaluation of the program, with discussion of future extensions to the program.     

Communication skills for behaviour change in dietetic consultations

Background: Both the UK’s National Health Service (NHS) and the National Institute of health and Clinical Excellence (NICE) have recommended increased training for health professionals in communication skills. There is evidence to suggest that communication skills are important in helping people to change health‐related behaviour, which is a key role for dietitians. This study investigated the views of UK dietitians about their training needs and experience in relation to communication skills in dietetic practice. Methods: In October 2007, a cross‐sectional survey was mailed to all British Dietetic Association members (n = 6013). The survey gathered quantitative data and free‐text comments to ascertain the level, type and effect of communication skills training received by dietitians at both the pre‐ and post‐registration level. Results: There were 1158 respondents; a response rate of 19.3%. Ninety‐eight percent (n = 1117) rated communication skills as either very or extremely important in client consultations. Post‐registration training had been undertaken by 73% (n = 904). Of these, over 90% of respondents perceived that post‐registration training had led to improvements in their relationships with patients, their confidence in client interviews and their ability to cope with challenging clients. However, 248 (21.4%) felt time keeping in interviews had worsened. Lack of time for client interviews was also the most commonly identified barrier (19%, n = 216) to implementing the skills. Conclusions: This study has explored an important and under‐researched area. Respondents strongly endorsed the importance of good communication skills and the benefits of post‐registration training in this area. Some felt that good communication was time consuming but others felt that time management had improved. Further research and training is required to support the implementation of these skills into dietetic practice.     

From rural beginnings to statewide roll‐out: Evaluation of facilitator training for a group‐based diabetes prevention program

Objective: To evaluate the approach used to train facilitators for a large‐scale group‐based diabetes prevention program developed from a rural implementation research project. Participants: Orientation day was attended by 224 health professionals; 188 submitted the self‐learning task; 175 achieved the satisfactory standard for the self‐learning task and attended the workshop; 156 completed the pre‐ and post‐training questionnaires. Main outcome measures: Two pre‐ and post‐training scales were developed to assess knowledge and confidence in group‐based diabetes prevention program facilitation. Principal component analysis found four factors for measuring training effectiveness: knowledge of diabetes prevention, knowledge of group facilitation, confidence to facilitate a group to improve health literacy and confidence in diabetes prevention program facilitation. Self‐learning task scores, training discontinuation rates and satisfaction scores were also assessed. Results: There was significant improvement in all four knowledge and confidence factors from pre‐ to post‐training (P < 0.001). The self‐learning task mean test score was 88.7/100 (SD = 7.7), and mean assignment score was 72.8/100 (SD = 16.1). Satisfaction with training scores were positive and ‘previous training’ interacted with ‘change in knowledge of diabetes prevention program facilitation’ but not with change in ‘confidence to facilitate.’ Conclusions: The training program was effective when analysed by change in facilitator knowledge and confidence and the positive mean satisfaction score. Learning task scores suggest tasks were manageable and the requirement contributed to facilitator self‐selection. Improvement in confidence scores in facilitating a group‐based diabetes prevention program, irrespective of previous training and experience, show that program‐specific skill development activities are necessary in curriculum design.     

SOCIAL WORK IN HOME DIALYSIS

This paper describes the author's 2-year experience as a social worker in a home dialysis training center. The experience is reviewed in relation to current trends in health care: greater recognition of the patient's emotional response; more patient responsibility for treatment; increased communication among various professions and between the health care team and patients; rehabilitation of chronically ill patients; and decentralized delivery of services. It is concluded that the social worker can provide leadership in responding to these trends. The basis for this leadership lies in the development of good working relationships in the interdisciplinary team and between professionals and patients. For this purpose the social worker must acquire skills in dealing with the conflicts arising from these more complex relationships.     

Specialist public health capacity in England: working in the new primary care organizations

OBJECTIVES: To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. STUDY DESIGN: Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. RESULTS: Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. CONCLUSIONS: Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.     

Interprofessional education: a review of context, learning and the research agenda

Medical Education 2012: 46: 58–70 Context Interprofessional education (IPE) is not a recent phenomenon and has been the subject of several World Health Organization reports. Its focus is on health professionals and students learning with, from and about one another to improve collaboration and the quality of patient care. The drivers for IPE include new models of health care delivery in the context of an ageing population and the increasing prevalence of long‐term chronic disease, in addition to the patient safety agenda. The delivery of complex health care requires a team‐based and collaborative approach, although teamwork and collaborative practice are not necessarily synonymous. The rationale for IPE is that learning together enhances future working together. Discussion Systematic reviews of IPE have shown some evidence that IPE fosters positive interaction among different professions and variable evidence that it improves attitudes towards other professionals. Generalisation across published papers is difficult because IPE initiatives are diverse and good evaluation methodology and data are lacking. In terms of constructive alignment from an education viewpoint, there is a need for educators to define learning outcomes and match these with learning activities to ensure that IPE demonstrates added value over uniprofessional learning. Assessment is difficult as pre‐qualification professional education focuses on the individual and professional accreditation organisations mandate only for their own professions. Conclusions Interprofessional education draws from a number of education, sociology and psychology theories, and these are briefly discussed. The most pressing research questions for the IPE community are defined and the challenges for IPE explored.     

Health literacy as an empowerment tool for low-income mothers

Health literacy commonly refers to the extent to which one can access and accurately interpret healthcare information. Statistics reveal that limited health literacy is prevalent among those of lower socioeconomic status. When working with low-income mothers, it is recommended in this article that healthcare professionals operationalize a broader conceptualization of health literacy than assessment of reading levels and translating knowledge of risk factors for illness and disease. Nutbeam's continuum of functional, interactive, and critical health literacy directs healthcare professionals to expand their health education mandate to encompass equipping low-income mothers with the necessary knowledge and skills to gain control over their lives and optimize the healthy development of their children. Tenets from social cognitive theory, principles from interdependence theory, and strategies from Freire's empowerment education model are integral to successful progression along Nutbeam's health literacy continuum.     

Fostering the healthcare workforce during the COVID-19 pandemic: Shared leadership,social capital,and contagion among health professionals

Health professionals managing patients with COVID-19 disease are at high risk of contagion. All medical personnel involved in caring for patients need coordination, knowledge and trust. Empirical work on human resources has tended to focus on the effects of human resource practices on performance, whereas leadership and social interactions have been overlooked. Based upon interviews with medical staff working in specialised medical units, this study uses the social capital theory to examine relationships among shared leadership, social capital, and contagion rates. First, shared leadership was found to positively affect COVID-19 contagion among health professionals. Second, by sharing information and a common language, and showing high levels of trust, namely social capital, medical units seem to reduce contagion rates of COVID-19. In other words, shared leadership plays a fundamental role in improving performance in healthcare by means of social capital.     

Rural professionals’ perceptions of interprofessional continuing education in mental health

We describe the impact of an interprofessional education programme in mental health for professionals in six rural Canadian communities. The 10‐session programme, offered primarily via videoconference, focussed on eight domains of mental health practice. One hundred and twenty‐five professionals, representing 15 professions, attended at least some sessions, although attendance was variable. Data were collected between September 2006 and December 2007. The programme was evaluated using a mixed methods approach. Participants reported high levels of satisfaction for all topics and all aspects of the presentations: they were most satisfied with the opportunity to interact with other professionals and least satisfied with the videoconference technology. Professionals’ confidence (n = 49) with mental health interventions, issues and populations was measured pre‐ and post‐programme. There was a significant increase in confidence for seven of the eight mental health interventions and four of the six mental health issues that had been taught in the programme. Participants reported developing a more reflective mental health practice, becoming more aware of mental health issues, integrating new knowledge and skills into their work and they expressed a desire for further mental health training. They noted that interprofessional referrals, inter‐agency linkages and collaborations had increased. Conditions that appeared to underpin the programme’s success included: scheduling the programme over an extended time period, a positive relationship between the facilitator and participants, experiential learning format and community co‐ordinators as liaisons. Participants’ dissatisfaction with the videoconference technology was mitigated by the strong connection between the facilitator and participants. One challenge was designing a curriculum that met the needs of professionals with varied expertise and work demands. The programme seemed to benefit most of those professionals who had a mental health background. This programme has the potential to be of use in rural communities where professionals often do not have access to professional development in mental health.     

Student leadership and activism for social change in the US

As the US health-care system continues on a path toward greater patient and provider dissatisfaction and decreasing access to primary health services, there is a growing need for leadership among tomorrow's health professionals. Students of today must acquire the skills to lead the United States toward solutions that will offer universal access and eliminate disparities. As examined in the US, there are two main modes for students to learn these meaningful skills; curriculum- and institution-based leadership development and organization-based leadership development. In this paper we review these two methods from an American perspective and discuss ways that educational institutions can support student leadership development. In addition, we address ways in which non-governmental organizations can provide opportunities to foster student leadership. Lastly, we offer recommendations for US policy change at institutional, local, state, and national levels to help achieve the goals stated above.     

Steps towards evidence‐based foot‐care for children: Behaviour and opinions of health professionals

Allied health professionals (AHPs) working with children need the appropriate knowledge, skills and experiences to provide high‐quality care. This includes using research to drive improvements in care and ensuring that knowledge and practices are consistent and build upon the best available evidence. The aim of this work was to understand more about the shared behaviours and opinions of health professionals supporting children's foot health care; how they find information that is both relevant to their clinical practice as well as informing the advice they share. A qualitative design using semi‐structured, one‐to‐one, telephone interviews with AHPs was adopted. Thematic analysis was used to generate meaning, identify patterns and develop themes from the data. Eight interviews were conducted with physiotherapists, podiatrists and orthotists. Five themes were identified relating to health professionals: (a) Engaging with research; (b) Power of experience; (c) Influence of children's footwear companies; (d). Dr Google – the new expert and (e) Referral pathways for children's foot care. The findings indicate that the AHPs adopted a number of strategies to develop and inform their own professional knowledge and clinical practice. There could be barriers to accessing information, particularly in areas where there is limited understanding or gaps in research. The availability of online foot health information was inconsistent and could impact on how AHPs were able to engage with parents during consultations.     

Role of Directorates in Promoting Nursing and Midwifery Across the Various States of India: Call for Leadership for Reforms

Background:While the roles and responsibilities of nursing professionals have multiplied over the years, but there are huge concerns with regard to the development of the nursing workforce and human resources (HR) issues for their career growth. The major lacuna is in not involving the nursing professionals in policy framing and decision-making. As a result, there is a leadership crisis of the nursing workforce across India.Objectives:The paper, is part of the WHO supported study, entitled “Study on Nursing and Midwifery in India: a critical review”, is developed with the objective to review the current organizational and management structure for the nursing positions at the State Directorates in India and obtain a Leadership perspective to strengthen nursing management capacities to address maternal health issues.Results:Since none of the states have neither a Nursing Cell nor the post of Director Nursing, final decision-making powers rest with state health secretaries and medical directors. The nursing management structure majorly managed by senior policy makers from the medical fraternity, and provides very little scope for nursing professionals to participate in policy decision making to bring about reforms. There is no uniformity on HR issues concerning career graphs and pay structures across the states.Conclusions:In order to strengthen nursing as a profession and for facilitating their role at the policy level, more powers and autonomy needs to be given to them and this requires HR policy guidelines for nurses. Setting up a separate nursing directorate, to be headed by a senior nursing professional, is suggested in every state along with a strong nursing division at the National level. This total paradigm shift will empower nursing professionals to take up the leadership role at the policy level to bring about necessary reforms. Across the country, nursing professionals repeatedly echoed one requirement: To reframe nursing leadership at all levels.     

Can videoconferencing affect older people's engagement and perception of their social support in long‐term conditions management: a social network analysis from the Telehealth Literacy Project

Social support is a key component in managing long‐term conditions. As people age in their homes, there is a greater risk of social isolation, which can be ameliorated by informal support networks. This study examined the relationship between changes in social support networks for older people living in a regional area following weekly videoconference groups delivered to the home. Between February and June 2014, we delivered 44 weekly group meetings via videoconference to participants in a regional town in Australia. The meetings provided participants with education and an opportunity to discuss health issues and connect with others in similar circumstances. An uncontrolled, pre‐post‐test methodology was employed. A social network tool was completed by 45 (87%) participants either pre‐ or post‐intervention, of which 24 (46%) participants completed the tool pre‐ and post‐intervention. In addition, 14 semi‐structured interviews and 4 focus groups were conducted. Following the intervention, participants identified increased membership of their social networks, although they did not identify individuals from the weekly videoconference groups. The most important social support networks remained the same pre‐ and post‐intervention namely, health professionals, close family and partners. However, post‐intervention participants identified friends and wider family as more important to managing their chronic condition compared to pre‐intervention. Participants derived social support, in particular, companionship, emotional and informational support as well as feeling more engaged with life, from the weekly videoconference meetings. Videoconference education groups delivered into the home can provide social support and enhance self‐management for older people with chronic conditions. They provide the opportunity to develop a virtual social support network containing new and diverse social connections.     

Health education leadership development: a conceptual model and competency framework

A National Public Health Education Leadership Institute was developed through collaboration among national health education professional organizations, the Centers for Disease Control and Prevention, and a school of public health. The institute provides health educators in leadership positions throughout the country access to a 15-month integrated and sequential professional leadership development program. This article presents a conceptual model and competency framework for that program. The model contains elements considered critical for design of leadership programs in public health and can be used by both professional development and academic programs to shape their design of leadership curricula.