Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in Myanmar.Methods:A total of 30 CHNs from t...Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in Myanmar.Methods:A total of 30 CHNs from township health centers in the northeastern,southern,and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews.Quantitative data were processed using Microsoft Excel software,and qualitative data were analyzed using thematic analysis.This study is registered with researchregistry6201.Results:Around the country,30 CHNs uncovered their hardships in implementing primary health care to achieve UHC.Over 90%of the participants agreed to the problem of inadequate health infrastructure,while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion.Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services.Complications are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidencebased practices.Insecure work and living conditions,unsupportive community relationships,and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC.Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs.Conclusion:Myanmar’s CHNs face many challenges in achieving UHC.These challenges are not confined to the health sector.Some situations,such as geographical barriers and transportation problems,remain persistent challenges for healthcare providers.This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure.Meanwhile,public empowerment plays a critical role in promoting health development.展开更多
Objectives:From the view of everyday practices and the socio-technical coordination lens,this study aimed to analyz the gap between creators’intention and the users’implementation(mainly nursing staff and social wor...Objectives:From the view of everyday practices and the socio-technical coordination lens,this study aimed to analyz the gap between creators’intention and the users’implementation(mainly nursing staff and social workers)of an alert system in assisted living communities.Methods:Qualitative methods were employed by way of five user interviews and focus groups with six system developers.Modeling instruments were applied for data collection to analyze the different clinical workflows versus the expectations of the system development team.Results:Results indicate that the clinical workflow changed over time,which led to a mismatch of nurse care coordination,social practices,and technology use.The results show different mental models of the socio-technical practice.Applying the coordination theory,the following recommendations could be developed to overcome the mismatch.First,it is recommended that nursing staff set goals together.Second,a communication rhythmwith the nursing staff and developer teams should be established,with guided questions to facilitate the conversation,to shed light on the different workflows and the difference in social practices when using sensor technologies or alert systems.Third,a checklist for new employees should be created so they know how and on which devices to use the alert system.Fourth,the user experience with the alert system should be improved(e.g.,an improved user interface).Conclusions:This work indicates recommendations to close the mental model gap to overcome the mismatch between optimal use of the alert system and how the nursing staff is actually using it.展开更多
Environmental management of military activities is of growing global concern by defence forces. As one of the largest landholders in Australia, the Australian Defence Force (ADF) is increasingly concerned with susta...Environmental management of military activities is of growing global concern by defence forces. As one of the largest landholders in Australia, the Australian Defence Force (ADF) is increasingly concerned with sustainable environmental management. This paper focuses on how the ADF is maintaining effective environmental management, especially in environmentally sensitive marine protected areas. It uses Shoalwater Bay Training Area (SWBTA) as a research example to examine environmental management strategies conducted by the ADF. SWBTA is one of the most significant Defence training areas in Australia, with a large number of single, joint and combined military exercises conducted in the area. With its maritime component contained in the Great Barrier Reef Marine Park (GBRMP), the Great Barrier Reef World Heritage Area (GBRWHA), and abutting Queensland's State Marine Parks, it has high protection values. It is therefore vital for the ADF to adopt environmentally responsible management while they are conducting military activities. As to various tools employed to manage environmental performance, the ISO 14001 Environmental Management System (EMS) is widely used by the ADE This paper exanlines military activities and marine environmental management within SWBTA, using the Talisman Saber (TS) exercise series as an example. These are extensive joint exercises conducted by the ADF and the United States defence forces. The paper outlines relevant legislative framework and environmental policies, analyses how the EMS operates in environmental management of military activities, and how military activities comply with these regulations. It discusses the implementation of the ADF EMS, including risk reduction measures, environmental awareness training, consultation and communication with stakeholders. A number of environmental management actions used in the TS exercises are presented to demonstrate the EMS application. Our investigations to this point indicate that the ADF is complying with all relevant legislation and policies. Further research is required to confirm compliance and conclude that military activities have good accord with environmental management objectives.展开更多
基金This work was supported by the Ministry of Health and Sports,Republic of the Union of Myanmar(MOHS IR Grant 2019,Research ID No.501).
文摘Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in Myanmar.Methods:A total of 30 CHNs from township health centers in the northeastern,southern,and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews.Quantitative data were processed using Microsoft Excel software,and qualitative data were analyzed using thematic analysis.This study is registered with researchregistry6201.Results:Around the country,30 CHNs uncovered their hardships in implementing primary health care to achieve UHC.Over 90%of the participants agreed to the problem of inadequate health infrastructure,while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion.Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services.Complications are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidencebased practices.Insecure work and living conditions,unsupportive community relationships,and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC.Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs.Conclusion:Myanmar’s CHNs face many challenges in achieving UHC.These challenges are not confined to the health sector.Some situations,such as geographical barriers and transportation problems,remain persistent challenges for healthcare providers.This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure.Meanwhile,public empowerment plays a critical role in promoting health development.
基金This work was supported by the National Library of Medicine grant #1R01LM01222.
文摘Objectives:From the view of everyday practices and the socio-technical coordination lens,this study aimed to analyz the gap between creators’intention and the users’implementation(mainly nursing staff and social workers)of an alert system in assisted living communities.Methods:Qualitative methods were employed by way of five user interviews and focus groups with six system developers.Modeling instruments were applied for data collection to analyze the different clinical workflows versus the expectations of the system development team.Results:Results indicate that the clinical workflow changed over time,which led to a mismatch of nurse care coordination,social practices,and technology use.The results show different mental models of the socio-technical practice.Applying the coordination theory,the following recommendations could be developed to overcome the mismatch.First,it is recommended that nursing staff set goals together.Second,a communication rhythmwith the nursing staff and developer teams should be established,with guided questions to facilitate the conversation,to shed light on the different workflows and the difference in social practices when using sensor technologies or alert systems.Third,a checklist for new employees should be created so they know how and on which devices to use the alert system.Fourth,the user experience with the alert system should be improved(e.g.,an improved user interface).Conclusions:This work indicates recommendations to close the mental model gap to overcome the mismatch between optimal use of the alert system and how the nursing staff is actually using it.
文摘Environmental management of military activities is of growing global concern by defence forces. As one of the largest landholders in Australia, the Australian Defence Force (ADF) is increasingly concerned with sustainable environmental management. This paper focuses on how the ADF is maintaining effective environmental management, especially in environmentally sensitive marine protected areas. It uses Shoalwater Bay Training Area (SWBTA) as a research example to examine environmental management strategies conducted by the ADF. SWBTA is one of the most significant Defence training areas in Australia, with a large number of single, joint and combined military exercises conducted in the area. With its maritime component contained in the Great Barrier Reef Marine Park (GBRMP), the Great Barrier Reef World Heritage Area (GBRWHA), and abutting Queensland's State Marine Parks, it has high protection values. It is therefore vital for the ADF to adopt environmentally responsible management while they are conducting military activities. As to various tools employed to manage environmental performance, the ISO 14001 Environmental Management System (EMS) is widely used by the ADE This paper exanlines military activities and marine environmental management within SWBTA, using the Talisman Saber (TS) exercise series as an example. These are extensive joint exercises conducted by the ADF and the United States defence forces. The paper outlines relevant legislative framework and environmental policies, analyses how the EMS operates in environmental management of military activities, and how military activities comply with these regulations. It discusses the implementation of the ADF EMS, including risk reduction measures, environmental awareness training, consultation and communication with stakeholders. A number of environmental management actions used in the TS exercises are presented to demonstrate the EMS application. Our investigations to this point indicate that the ADF is complying with all relevant legislation and policies. Further research is required to confirm compliance and conclude that military activities have good accord with environmental management objectives.