Simulation training program for midwives to manage postpartum hemorrhage: A randomized controlled trial

PurposeTo explore the effectiveness of a simulation training program for midwives in performance and knowledge for the management of postpartum hemorrhage (PPH).MethodsThe study design was a randomized controlled trial. Midwives working at one obstetrics ward in an urban area were randomly assigned to simulation training program or no training. This “simulation program” included pre study e-learning and simulation. Inclusion criteria were midwives who: 1) had two or three years of clinical experience, 2) worked in an obstetrics ward, and 3) had experience with birth assistance. There was one exclusion criterion namely prior experience of simulation training for PPH. Change in performance was evaluated using a PPH scenario performance test at one month after the simulation training. Change in knowledge was evaluated by a 25-item multiple-choice questionnaire completed shortly before the training and one month after the training. The ethical review committee of St Luke's International University granted approval (No. 14-096).ResultsEighty-one midwives were randomly assigned to either the intervention group (n = 40) or the control group (n = 41). Performance in the simulation training group was significantly better in comparison to the no training group; mean performance score was 23.85(SD 2.71) in the training group versus 18.00(SD 3.01) in the no training group (MD 5.85 95% CI 4.85–7.12, t = 9.17, p < 0.001). Knowledge was significantly increased in the simulation training group; amount of knowledge score was 3.65(SD 3.40) in the training group versus − 0.02(SD 3.02) in the no training group (MD 3.67 95% CI 2.25–5.10, t = 5.14, p < 0.001).ConclusionBoth performance and knowledge about the management of PPH were significantly improved after simulation training. However, assessments of long-term effects on performance, and knowledge and the clinical outcomes in managing of obstetric complications are necessary to adequately evaluate the effectiveness of simulation training.     

Development and assessment of the validity and reliability of a scale for measuring the mentoring competencies of Japanese clinical midwives: An exploratory quantitative research study

BackgroundMidwives are always involved in educational activities whenever novice midwives are present. Although various scales for measuring the educational competencies of nurses have already been developed in previous studies, a scale for the educational competencies particular to midwives has yet to be developed, or even no previous studies have revealed their functions as clinical educators.ObjectivesThe purpose of this study was to develop a scale to measure the mentoring competencies of clinical midwives (MCCM Scale) and to confirm its validity and reliability.DesignAn exploratory quantitative research study.MethodsQuestionnaires were distributed to 1,645 midwives at 148 facilities who had previously instructed novice midwives. 1,004 midwives (61.0%) voluntarily returned valid responses and 296 (18.0%) voluntarily agreed to participate in the survey for test–retest reliability.ResultsExploratory factor analyses were performed over 41 items and the following seven factors were extracted with a reliability coefficient (Cronbach's α) of 0.953: (i) supporting experimental study, (ii) personal characteristics particularly in clinical educators, (iii) thoughtfulness and empathy for new midwives, (iv) self-awareness and self-reflection for finding confidence, (v) making effective use of the new midwives' own experience, (vi) commitment to educational activities, and (vii) sharing their midwifery practice. Test–retest reliability was measured based on a convenience sample of 246 (83.1%). Pearson's test–retest correlation coefficient for the entire scale was r = 0.863. The factor loadings of each item on its respective factor were 0.313–0.925. The total score of the MCCM Scale was positively correlated with that of the Quality of Nurses' Occupational Experience Scale (r = 0.641, p = 0.000) and was negatively correlated with the total score of the Japanese Burnout Scale (r = − 0.480, p = 0.000).ConclusionThe MCCM Scale is composed of 41 items and three subscales measured from a total of seven factors. The validity and reliability of the MCCM Scale was supported by the statistical analyses.     

Military personnel with self-reported ankle injuries do not demonstrate deficits in dynamic postural stability or landing kinematics

BackgroundThe odds of sustaining non-contact musculoskeletal injuries are higher in Special Operations Forces operators than in infantry soldiers. The ankle is one of the most commonly injured joints, and once injured can put individuals at risk for reinjury. The purpose of this study was to determine if any differences in postural stability and landing kinematics exist between operators with a self-reported ankle injury in the past one year and uninjured controls.MethodsA total of 55 Special Operations Forces operators were included in this analysis. Comparisons were made between operators with a self-reported ankle injury within one-year of their test date (n = 11) and healthy matched controls (n = 44). Comparisons were also made between injured and uninjured limbs within the injured group. Dynamic postural stability and landing kinematics at the ankle, knee, and hip were assessed during a single-leg jump-landing task. Comparisons were made between groups with independent t-tests and within the injured group between limbs using paired t-tests.FindingsThere were no significant differences in dynamic postural stability index or landing kinematics between the injured and uninjured groups. Anterior-posterior stability index was significantly higher on the uninjured limb compared to the injured limb within the injured group (P = 0.02).InterpretationSingle ankle injuries sustained by operators may not lead to deficits in dynamic postural stability. Dynamic postural stability index and landing kinematics within one year after injury were either not affected by the injuries reported, or injured operators were trained back to baseline measures through rehabilitation and daily activity.     

Does nurses’ role,health or symptoms influence their personal use of ingestible complementary and alternative medicines?

ObjectivesTo investigate the influence of work-related characteristics, health, health behaviours and symptoms on ingestible biologically-based Complementary and Alternative Medicine (CAM) use within the Australian nursing and midwifery workforce.BackgroundCAM use is widespread worldwide, but there is little research into nurses’ and midwives’ personal use of ingestible CAM in Australia.MethodsAn online survey in 2014–15 used validated instruments and items to examine use of ingestible biologically-based CAM (herbs, foods and vitamins, minerals, amino acids, enzymes and other supplements), and the health and work-related characteristics of 5041 nurses and midwives recruited through the New South Wales Nurses and Midwives Association and professional networks.ResultsA small proportion of nurses (6.8%) identified as personal CAM users. Most were female, older, worked in foundational roles (frontline Registered and Enrolled Nurses/Midwives) and used one CAM, most commonly a multivitamin, although Vitamin D, Fish Oil, Calcium and Glucosamine ± Chondroitin were also common. In comparison to non-users, CAM users were less likely to take sick days or indulge in risky drinking, but more likely to be symptomatic (with stiff joints, bodily/joint pain, severe tiredness, allergies, indigestion/heartburn), diagnosed with osteoarthritis and to adhere to healthy diet recommendations.ConclusionsFindings showed a credible pattern of front line workers with physically demanding workloads that impact their physical health and are linked to frequent symptoms, using CAM treatments and achieving some success in being able to continue working and avoid sickness absence. Further investigation is warranted to protect and maintain the health of the nursing and midwifery workforce.     

The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis

BackgroundThe association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis.MethodsSixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n = 18), mild pain (n = 27), or moderate/severe pain (n = 22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified.FindingsThe moderate/severe pain group demonstrated worse global pain (P < 0.01) and physical function scores (P < 0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P = 0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P = 0.009), which was associated with higher weight acceptance peak knee adduction moments (P = 0.003) and worse global pain (P = 0.003) and physical function scores (P = 0.006).InterpretationGreater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait.     

Nasal high flow oxygen therapy in the ward setting: A prospective observational study

BackgroundWhilst research demonstrates the benefits of nasal high flow oxygen in the intensive care setting, limited literature exists on its benefits in ward patients.ObjectivesThis study evaluated the use of nasal high flow oxygen in adult ward patients with respiratory failure or at risk of respiratory deterioration. Primary outcome was an improvement in pulmonary function as indicated by decreases in respiratory and heart rates and an increase in arterial oxygen saturation via pulse oximetry_.Research methodologyUsing a prospective observational research design, purposeful sampling recruited 67 adult ward patients receiving nasal high flow oxygen between May and July 2015 (inclusive). All recruited patients were included in the data analysis.ResultsThe median age was 71.0 years (q25, q75 = 58.0, 78.0) and most patients were medical specialty patients (n = 46, 68.7%). After commencing nasal high flow oxygen, respiratory rate (t = 2.79, p = <0.01) and heart rate (t = 2.23, p = 0.03) decreased and arterial oxygen saturation via pulse oximetry increased (t = 4.08, p = <0.001).ConclusionNasal high flow oxygen appears effective in a selective group of ward patients with respiratory failure, or at risk of respiratory deterioration, and may reduce demand on critical care beds; this warrants further research.     

Nurse workload and inexperienced medical staff members are associated with seasonal peaks in severe adverse events in the adult medical intensive care unit: A seven-year prospective study

ObjectiveOur purpose was to identify potential organizational factors that contributed to life-threatening adverse events in adult intensive care unit.MethodsA prospective, observational, dynamic cohort study was carried out from January 2006 to December 2013 in a 20-bed adult medical intensive care unit. All patients admitted to the intensive care unit and who experienced one or more selected life-threatening adverse events (mainly unexpected cardiac arrest, unplanned extubation, reintubation after planned extubation, and readmission within 48 h of intensive care unit discharge) were included in the analysis. Negative binomial regression was used to model how human resources, work organization, and intensive care activity influenced the monthly rate of selected severe adverse events. Data were collected from local and national databases.ResultsOverall, 638 severe adverse events involving 498 patients were recorded. Adverse events increased seasonally in May, November and December (p < .001 vs other months). The proportion of inexperienced nurses and doctors’ working hours could not explain these seasonal peaks of adverse events. Multivariate analysis identified bed-to-nurse ratio and the arrival of inexperienced residents or senior registrars as being independently associated with the rate of adverse events (incidence risk ratio = 1.36 (95% confidence interval, 1.05–1.75), and 1.07 (95% confidence interval, 1.01–1.13), respectively; p = .01 in both cases). According to this model, a one-unit increase in the day–night shifts carried out by each nurse per month tended to reduce the rate of adverse events (incidence risk ratio = 0.60 (95% confidence interval, 0.36–1.01), p = .05). Severity at intensive care unit admission did not influence the rate of adverse events (incidence risk ratio = 1.02 (95% confidence interval, 1.00–1.04), p = .12).ConclusionsResults identify nurse workload and the arrival of inexperienced residents or senior registrars as risk factors for the occurrence of life-threatening adverse events in the adult medical intensive care unit. Limiting fluctuations in bed-to-nurse ratio and providing inexperienced medical staff members with sufficient supervision may decrease severe adverse events in critically ill patients.     

Evolution of childbirth expectations in Spanish pregnant women

PurposeTo analyze the change of childbirth expectations over the course of pregnancy as well as their relation to socio-demographic and clinical variables.BackgroundThe study of expectations in pregnant women is gaining more interest from a biopsychosocial approach because of its consequences on pregnant women's wellbeing. To our knowledge there are no previous studies analyzing the evolution of childbirth expectations over the course of pregnancy.MethodsLongitudinal study (first trimester and third trimester). Women were evaluated for childbirth expectations in their first trimester (n = 285) and third trimester (n = 122) of pregnancy. They also completed questionnaires collecting socio-demographic information.ResultsChildbirth expectations appear to remain more or less stable over the course of pregnancy, although they tend to become slightly negative at the end of gestation, specifically referring to personal control and delivery circumstances. Multiparity and planned pregnancy are associated with higher positive expectations.ConclusionIt seems essential to explore and to try to adjust childbirth expectations to more realistic ones, in order for them to be fulfilled. Midwives and other maternity healthcare providers play a key role in this regard.     

Quadriceps rate of torque development and disability in individuals with anterior cruciate ligament reconstruction

BackgroundThe purpose of this study was to determine associations between self-reported function (International Knee Documentation Committee Index), isometric quadriceps strength and rate of torque development in individuals with a unilateral anterior cruciate ligament reconstruction.MethodsForty-one individuals [31% male, BMI mean 25 (SD 4) kg/m², months post anterior cruciate ligament reconstruction mean 49 (SD 40)] completed the self-reported function and isometric quadriceps function testing. Rate of torque development was assessed at 0–100 ms (early), 100–200 ms (late) ms, and peak following the onset of contraction. Associations were examined between rate of torque development, strength, and self-reported function. Linear regression was used to determine the unique amount of variance explained by the combination of rate of torque development and strength.FindingsHigher rate of torque development 100–200 ms is weakly associated with higher self-reported function in individuals with a unilateral anterior cruciate ligament reconstruction (r = 0.274, p = 0.091); however, rate of torque development 100–200 ms does not predict a significant amount of variance in self-reported function after accounting for strength (ΔR² = 0.003, P = 0.721).InterpretationQuadriceps strength has a greater influence on self-reported function compared to rate of torque development in individuals with an anterior cruciate ligament reconstruction with time from surgery.     

Nurses’ personal and ward accountability and missed nursing care: A cross-sectional study

BackgroundMissed nursing care is considered an act of omission with potentially detrimental consequences for patients, nurses, and organizations. Although the theoretical conceptualization of missed nursing care specifies nurses’ values, attitudes, and perceptions of their work environment as its core antecedents, empirical studies have mainly focused on nurses’ socio-demographic and professional attributes. Furthermore, assessment of missed nursing care has been mainly based on same-source methods.ObjectivesThis study aimed to test the joint effects of personal and ward accountability on missed nursing care, by using both focal (the nurse whose missed nursing care is examined) and incoming (the nurse responsible for the same patients at the subsequent shift) nurses’ assessments of missed nursing care.DesignA cross-sectional design, where nurses were nested in wards.ParticipantsA total of 172 focal and 123 incoming nurses from 32 nursing wards in eight hospitals.MethodsMissed nursing care was assessed with the 22-item MISSCARE survey using two sources: focal and incoming nurses. Personal and ward accountability were assessed by the focal nurse with two 19-item scales. Nurses' socio-demographics and ward and shift characteristics were also collected. Mixed linear models were used as the analysis strategy.ResultsFocal and incoming nurses reported occasional missed nursing care of the focal nurse (Mean = 1.87, SD = 0.71 and Mean = 2.09, SD = 0.84, respectively; r = 0.55, p < 0.01). Regarding the focal nurse's assessment of his/her own missed nursing care, findings showed that, above and beyond nurses’ overload and personal socio-demographic characteristics, higher personal accountability was significantly associated with decreased missed care (β = −0.29, p < 0.01), whereas ward accountability was not (β = −0.23, p > 0.05). The interaction effect was significant (β = −0.31, p < 0.05); the higher the ward accountability, the stronger the negative relationship between nurses' personal accountability and missed nursing care. Similar patterns were obtained for the incoming nurses' assessment of focal nurse's missed care.ConclusionsUse of focal and incoming nurses' missed nursing care assessments limited the common source bias and strengthened our findings. Personal and ward accountability are significant values, which are associated with lower missed nursing care, beyond scarce resources. Implementation of local and national education programs for nurses and managers, accompanied with empirical research, might increase personal and ward accountability, thereby decreasing missed nursing care. This might help to create a safety culture and reduce negative outcomes for patients, nurses, and organizations.     

Determining the effectiveness of an Elder Abuse Nurse Examiner Curriculum: A pilot study

ObjectivesTo pilot and evaluate a novel Elder Abuse Nurse Examiner Curriculum and its associated training materials for their efficacy in improving Sexual Assault Nurse Examiner (SANE)s' knowledge of elder abuse and competence in delivering care to abused older adults.MethodsPilot training was held with 18 SANEs from across Ontario, Canada. A 52-item pre- and post-training questionnaire was administered that assessed participants' self-reported knowledge and perceived skills-based competence related to elder abuse care. A curriculum training evaluation survey was also delivered following the training. Qualitative non-participant observational data were collected throughout the training.ResultsThere were statistically significant improvements in self-reported knowledge and perceived skills-based competence from pre-training to post-training for all content domains of the curriculum: older adults and abuse (p < 0.0001), documentation, legislative, and legal issues (p < 0.0001); interview with the older adult, caregiver, and other relevant contacts (p < 0.0001); assessment (p = 0.0018); medical and forensic examination (p < 0.0001); case summary, discharge plan, and follow-up care (p < 0.0001). The post-training evaluation survey demonstrated satisfaction among participants across all components of the curriculum and its delivery, particularly with reference to the comprehensiveness of the curriculum, and the clarity and appropriateness of the training materials.ConclusionsThe Elder Abuse Nurse Examiner Curriculum and associated training materials were efficacious in improving SANEs' self-reported knowledge of and perceived competence in delivering elder abuse care. Future steps will further evaluate these materials as a component of a pilot of a larger comprehensive Elder Abuse Intervention at multiple sites across Ontario.     

Estimation of critically ill patients’ complaints by the nurse,the physician and the patient’s family: A prospective comparative study

ObjectivesTo evaluate the ability of the families of critically ill patients and of the intensive care team caring for the patient to communicate and accurately identify patients’ complaints.DesignThe complaints of critically ill patients were evaluated by a psychologist using a list of 12 items. The same day as the patient interview, the psychologist collected an estimation of the patient’s complaints from the family, the nurse and the physician.Setting20-bed Intensive Care Unit in a large University Hospital.Main Outcome MeasuresPatients’ complaints.Results51 patients were included. The most frequently reported complaints were insomnia, the inability to talk and presence of a tracheal tube. Patients reported a significantly higher prevalence of “misunderstanding” than that estimated by the nurses (55% vs 33%, p = 0.045). The reported prevalence of “inability to talk” as the main complaint was significantly higher among patients than estimated by nurses and physicians (16% vs 2%, p = 0.03 and 16% vs 2%, p = 0.03 respectively). For the analysis of the individual complaints, there was a poor agreement between the patients and the other respondents.ConclusionThis study found that the estimation of critically ill patients’ complaints by their families, nurses and physicians was largely suboptimal.     

Evaluating the effectiveness of a strategy for teaching neonatal resuscitation in West Africa

AimTo evaluate the effectiveness of a strategy for teaching neonatal resuscitation on the cognitive knowledge of health professionals who attend deliveries in Ghana, West Africa.MethodsTrain-the-trainer model was used to train health professionals at 2–3 day workshops from 2003 to 2007. Obstetric Anticipatory Care and Basic Neonatal Care modules were taught as part of Neonatal Resuscitation Training package. American Neonatal Resuscitation Program was adapted to the clinical role of participants and local resources. Cognitive knowledge was evaluated by written pre- and post-training tests.ResultsThe median pre-training and post-training scores were 38% and 71% for midwives, 43% and 81% for nurses, 52% and 90% for nurse anaesthetists, and 62% and 98% for physicians. All groups of the 271 professionals (18 nurse anaesthetists, 55 nurses, 68 physicians, and 130 midwives) who completed the course showed significant improvement (p < 0.001) in median post-training test scores. Midwives at primary health care facilities were less likely to achieve passing post-test scores than midwives at secondary and tertiary facilities [35/53 vs. 24/26 vs. 45/51 (p = 0.004)] respectively.ConclusionEvidence-based neonatal resuscitation training adapted to local resources significantly improved cognitive knowledge of all groups of health professionals. Further modification of training for midwives working at primary level health facilities and incorporation of neonatal resuscitation in continuing education and professional training programs are recommended.     

Variabilidad en la tasa de episiotomías y su relación con desgarros perineales graves y morbilidad neonatal

ObjectiveTo determine the variability in the use of episiotomy among midwives and its relation to third and fourth-degree tears, and the impact on neonatal morbidity.MethodA study was conducted on historical groups from a total of 2,366 eutocic births with a single live fetus greater than or equal to 37 weeks gestation and 18 midwives over a three year period (2009, 2010 and 2011) in «Mancha-Centro» Hospital (Alcázar de San Juan).The outcomes variables for this analysis were the incidence of episiotomy, perineal lacerations, and neonatal morbidity.ResultsThe variability in the use of episiotomy ranged from 19.5% to 50.1% among the 18 midwives in the study, with an average rate of 34.9% (824). Grouped at intervals, 22.1% (524) had a rate of ≤ 25%, 26.1% (621) between 26-35%, 38% (898) between 36-44%, and 13.7% (323) a rate of ≥ 45%, with homogeneity between the groups for all the confounding factors.There was no statistical association between higher rates of episotomy and pH of umbilical artery < 7.10, Apgar score after 5 min < 7, and the level of neonatal resuscitation type iii and iv. There was also no relationship between the rate of episiotomy with perineal integrity and third and fourth-degree tears.DiscussionThe variability in the rate of episiotomy is high, and it is not related to the increased presence of third and fourth-degree tears or increased neonatal morbidity. Episiotomy rates should not be greater than 25%, in order to prevent perineal trauma or loss of fetal well-being.     

A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia, New Zealand, and the United Kingdom

ObjectiveThe aim of this study was to examine the prevalence of overweight and obesity and the association with demographic, reproductive work variables in a representative cohort of working nurses and midwives.DesignA cross sectional study of self reported survey data.SettingsAustralia, New Zealand and the United Kingdom.MethodsMeasurement outcomes included BMI categories, demographic (age, gender, marital status, ethnicity), reproductive (parity, number of births, mother's age at first birth, birth type and menopausal status) and workforce (registration council, employment type and principal specialty) variables.Participants4996 respondents to the Nurses and Midwives e-Cohort study who were currently registered and working in nursing or midwifery in Australia (n = 3144), New Zealand (n = 778) or the United Kingdom (n = 1074).ResultsAmongst the sample 61.87% were outside the healthy weight range and across all three jurisdictions the prevalence of obesity in nurses and midwives exceeded rates in the source populations by 1.73% up to 3.74%. Being overweight or obese was significantly associated with increasing age (35–44 yrs aOR 1.71, 95% CI 1.41–2.08; 45–55 yrs aOR 1.90, 95%CI 1.56–2.31; 55–64 aOR 2.22, 95% CI 1.71–2.88), and male gender (aOR 1.46, 95% CI 1.15–1.87). Primiparous nurses and midwives were more likely to be overweight or obese (aOR 1.37, 95% CI 1.06–1.76) as were those who had reached menopause (aOR 1.37, 95% CI 1.11–1.69). Nurses and midwives in part-time or casual employment had significantly reduced risk of being overweight or obese, (aOR 0.81, 95% CI 0.70–0.94 and aOR 0.75, 95% CI 0.59–0.96 respectively), whilst working in aged carried increased risk (aOR 1.37, 95% CI 1.04–1.80).ConclusionNurses and midwives in this study have higher prevalence of obesity and overweight than the general population and those who are older, male, or female primiparous and menopausal have significantly higher risk of overweight or obesity as do those working fulltime, or in aged care. The consequences of overweight and obesity in this occupational group may impact on their workforce participation, their management of overweight and obese patients in their care as well as influencing their individual health behaviours and risks of occupational injury and chronic disease.     

Work environment characteristics associated with quality of care in Dutch nursing homes: A cross-sectional study

BackgroundA lack of relationship between direct care staffing levels and quality of care, as found in prior studies, underscores the importance of considering the quality of the work environment instead of only considering staff ratios. Only a few studies, however, have combined direct care staffing with work environment characteristics when assessing the relationship with quality of care in nursing homes.ObjectivesTo examine the relationship between direct care staffing levels, work environment characteristics and perceived quality of care in Dutch nursing homes.DesignCross-sectional, observational study in cooperation with the Dutch Prevalence Measurement of Care Problems.Settings: Twenty-four somatic and 31 psychogeriatric wards from 21 nursing homes in the Netherlands.Participants: Forty-one ward managers and 274 staff members (registered nurses or certified nurse assistants) from the 55 participating wards.MethodsWard rosters were discussed with managers to obtain an insight into direct care staffing levels (i.e, total direct care staff hours per resident per day). Participating staff members completed a questionnaire on work environment characteristics (i.e., ward culture, team climate, communication and coordination, role model availability, and multidisciplinary collaboration) and they rated the quality of care in their ward.Data were analyzed using multilevel linear regression analyses (random intercept). Separate analyses were conducted for somatic and psychogeriatric wards.ResultsIn general, staff members were satisfied with the quality of care in their wards. Staff members from psychogeriatric wards scored higher on the statement ‘In the event that a family member had to be admitted to a nursing home now, I would recommend this ward’. A better team climate was related to better perceived quality of care in both ward types (p ≤ 0.020). In somatic wards, there was a positive association between multidisciplinary collaboration and agreement by staff of ward recommendation for a family member (p = 0.028). In psychogeriatric wards, a lower score on market culture (p = 0.019), better communication/coordination (p = 0.018) and a higher rating for multidisciplinary collaboration (p = 0.003) were significantly associated with a higher grade for overall quality of care. Total direct care staffing, adhocracy culture, hierarchy culture, as well as role model availability were not significantly related to quality of care.ConclusionsOur findings suggest that team climate may be an important factor to consider when trying to improve quality of care. Generating more evidence on which work environment characteristics actually lead to better quality of care is needed.     

Stove-related injuries treated in EDs in the United States, 1990-2010

BackgroundHousehold stoves are a common source of injury in the United States.PurposeTo investigate the epidemiology of stove-related injuries.MethodsThe National Electronic Injury Surveillance System database was used to analyze cases of nonfatal stove-related injuries treated in US hospital emergency departments (EDs) from 1990 through 2010.ResultsAn estimated 910 696 (95% CI, 789 279-1 032 113) individuals were treated for stove-related injuries during the 21-year study period, yielding an average of 43 366 injured persons annually or 5 injuries every hour. The number (m = ? 252.85; P = .033) and rate (m = ? 0.026; P < .001) of injured individuals significantly decreased during the study. Injuries were highest in 1991 (50 656 cases; 2.0 per 10 000) and lowest in 2005 (38 669 cases; 1.31 per 10 000), although there was an increase in 2010 (48 990 cases; 1.58 per 10 000). Patients ≤ 19 years experienced 41.3% of stove-related injuries. The primary mechanism of injury was contact with stove parts (37.5%). The body region most commonly injured was the hand (44.6%), and a thermal burn was the most common diagnosis (51.8%). The majority (94.4%) of patients were treated and released from the ED. Patients > 60 years of age were 3.85 (95% CI, 2.97-4.98) times more likely to be admitted to the hospital than younger patients.ConclusionsThis is the first comprehensive study of stove-related injuries in the United States using a nationally representative sample. Strategies to prevent stove-related injuries should address the multiple mechanisms of injury.     

Use of a facilitated discussion model for antenatal care to improve communication

BackgroundAchieving health literacy is a critical step to improving health outcomes and the health of a nation. However, there is a lack of research on health literacy in low-resource countries, where maternal health outcomes are at their worst.ObjectivesTo examine the usefulness and feasibility of providing focused antenatal care (FANC) in a group setting using picture cards to improve patient–provider communication, patient engagement, and improve health literacy.DesignAn exploratory, mixed methods design was employed to gather pilot data using the Health Literacy Skills Framework.SettingsA busy urban district hospital in the Ashanti Region of Ghana was used to gather data during 2014.ParticipantsA facility-driven convenience sample of midwives (n=6) aged 18 years or older, who could speak English or Twi, and had provided antenatal care at the participating hospital during the previous year prior to the start of the study participated in the study.MethodsData were collected using pre-test and post-test surveys, completed three months after the group FANC was implemented. A semi-structured focus group was conducted with four of the participating midwives and the registered nurse providing support and supervision for the study (n=5) at the time of the post-test. Data were analyzed concurrently to gain a broad understanding of patient communication, engagement, and group FANC.ResultsThere were no significant differences in the mean communication (t(df = 3) = 0.541, p = 0.626) and engagement (t(df = 3) = −0.775, p = 0.495) scores between the pre- and post-test. However, the focus group revealed the following themes: (a) improved communication through the use of picture cards; (b) enhanced information sharing and peer support through the facilitated group process and; and (c) an improved understanding of patient concerns.ConclusionsThe improved communication noted through the use of picture cards and the enhanced information sharing and peer support elicited through the group FANC undoubtedly provided patients with additional tools to invoke self-determination, and carry out the behaviors they thought were most important to improve pregnancy outcomes.     

Parenting and childhood atopic dermatitis: A cross-sectional study of relationships between parenting behaviour,skin care management,and disease severity in young children

BackgroundThe development of child behaviour and parenting difficulties is understood to undermine treatment outcomes for children with atopic dermatitis. Past research has reported on correlates of child behaviour difficulties. However, few research studies have sought to examine parenting confidence and practices in this clinical group.ObjectivesTo examine relationships between child, parent, and family variables, parent-reported and directly-observed child and parent behaviour, parents’ self-efficacy with managing difficult child behaviour, self-reported parenting strategies, and disease severity.DesignCross-sectional study design.ParticipantsParent-child dyads (N = 64) were recruited from the dermatology clinic of a paediatric tertiary referral hospital in Brisbane, Australia. Children had a diagnosis of atopic dermatitis of ≥3 months and no other chronic health conditions except asthma, allergic rhinitis, or allergy.MethodsParents completed self-report measures assessing child behaviour; parent depression, anxiety, and stress; parenting conflict and relationship satisfaction; self-efficacy with managing difficult child behaviour, and use of ineffective parenting strategies; and self-efficacy for managing atopic dermatitis, and performance of atopic dermatitis management tasks. The Scoring Atopic Dermatitis index was used to assess disease severity. Routine at-home treatment sessions were coded for parent and child behaviour.ResultsPearson’s and Spearman’s correlations identified relationships (p < 0.05) between self-efficacy with managing difficult child behaviour and child behaviour problems, parent depression and stress, parenting conflict and relationship satisfaction, and household income. There were also relationships between each of these variables and use of ineffective parenting strategies. Greater use of ineffective parenting strategies was associated with more severe atopic dermatitis. Using multiple linear regressions, child behaviour and household income explained unique variance in self-efficacy for managing difficult child behaviour; household income alone explained unique variance in use of ineffective parenting strategies. Self-efficacy for managing difficult child behaviour and self-efficacy for managing atopic dermatitis were positively correlated (rho = 0.48, p < 0.001), and more successful self-reported performance of atopic dermatitis management tasks correlated with less permissive (r = 0.35, p = 0.005) and less authoritarian (r = 0.41, p = 0.001) parenting. Directly observed aversive child behaviour was associated with more severe atopic dermatitis, parent stress, and parent-reported child behaviour problems.ConclusionThis study revealed relationships between parents’ self-efficacy and parenting practices across the domains of child behaviour management and atopic dermatitis management. Parents of children with more severe atopic dermatitis may have difficulty responding to child behaviour difficulties appropriately, potentially impacting on illness management. Incorporating parent and parenting support within treatment plans may improve not only child and family wellbeing, but also treatment outcomes.