The Process of Compliance with Self-Care among Patients with Hypertension: A Grounded Theory Study

Introduction: Controlling hypertension across world continues to be challenging. Managing hypertension is not only concerned with lowering blood pressure by using antihypertensive medications;it also aims to minimize its consequences through adopting self-care practices. Compliance with self-care practices among patients with hypertension is considered a multidimensional phenomenon. The phenomenon of hypertension has been studied quantitatively, however;little qualitative studies were conducted to understand the compliance with self-care among patients with hypertension. Aim: To understand the process that patients with hypertension go through to comply with self-care practices. Methods: This study used a qualitative design that followed constructivist grounded theory approach;purposive sampling was used to recruit participants from cardiac clinics;semi structured, in-depth and face-to-face interview was used as a major method for data collection. Findings: Four participants with hypertension participated in this study;the phenomena of self-care was identified as the central phenomena;the start of the disease was identified as a casual condition;beliefs toward hypertension disease, beliefs toward self-care practices, knowledge and awareness regarding hypertension disease and self-care practices were identified as strategies;experiencing self-care practices was identified as consequence and being patients with hypertension in a social context. Conclusions: The process of compliance with self-care has a path of actions and interactions. The process started from the moment of diagnosis where the patients start to think about self-care. The absence of health care context leads to varying level of compliance with self-care among patients with hypertension. This indicated the need for more effective patient and health care provider relationship, education and awareness campaign.

The Effect of Reflective Learning on Childbirth Care Competence of Midwifery Students

Background: The skills of midwives in childbirth care competence are still inadequate. This problem is influenced by limitation experience of midwifery students of childbirth care in the field of practice area. That condition related to the proportion of midwifery students and case of childbirth woman was an imbalance. Midwifery students must prepare this competence in an education with childbirth care experience from practice in the laboratory and in the field of practice. Reflective learning is an appropriate learning method that uses experience as the basis of learning to improve childbirth care competence of midwifery students. Objective: This study is to analyze the effect of reflective learning implementation in childbirth care practice to improve students’ competence. Method: This research uses quasi-experimental design with non-equivalent control group design. The respondents were midwifery students in the fourth semester who had experienced the theory of childbirth care. There were totally 64 samples, 34 samples for treatment group and 30 samples for control group. Data were analyzed by using unpaired t test, Mann Whitney U and linear regression. Results: The respondents were homogeny in motivation and grade point of average (GPA). The improvement of childbirth care competency is influenced by treatment of 19.064 with R2 = 57.7%. Conclusion: The implementation of reflective learning in childbirth care practice affected the improvement of students’ competence.

Midwives’views and experiences of providing midwifery care in the task shifting context:a meta-ethnography approach

Objective:This study aimed to explore the existing knowledge about midwives’views and experiences of providing care for women in the context of task shifting.Methods:We conducted a qualitative systematic review using meta-ethnography to describe the views and experiences of midwives on providing care in the context of task shifting.Comparative textual analysis of published qualitative studies involved translation of first-order key concepts and meanings from included studies to generate second-and third-order concepts.A grid was made to identify core findings and compare them reciprocally.Results:Thirty-six qualitative studies met the inclusion criteria.The literature comprised of 32 first key concepts.Eight second-order constructs emerged,and three third-order interpretations were generated.The three overarching themes were:(1)midwives perceived themselves as providing culturally competent and high quality women-centered care;(2)they valued their profession but saw it as complex and challenging;(3)as health professionals,they reported a variety of organizational,cultural,and professional barriers to providing women-centered care.Conclusions:While performing a specific task in the task shifting context,midwives perceived their crucial roles and responsibilities,along with achieved value and reward.However,due to a range of existing barriers,the caring task posed great challenges in completely implementing women-centered care.It is essential for systems to identify and eliminate these barriers early,to consider midwives’emotional well-being,and to develop overall strategies to better support the midwifery workforce.Policy makers and administrators should establish a supportive environment to facilitate midwives to perform women-centered caring tasks in more effective and efficient ways.

On Computing the Suitability of Non-Human Resources for Business Process Analysis

Business process improvement is a systematic approach used by several organizations to continuously improve their quality of service.Integral to that is analyzing the current performance of each task of the process and assigning the most appropriate resources to each task.In continuation of our previous work,we categorize resources into human and non-human resources.For instance,in the healthcare domain,human resources include doctors,nurses,and other associated staff responsible for the execution of healthcare activities;whereas the non-human resources include surgical and other equipment needed for execution.In this study,we contend that the two types of resources(human and non-human)have a different impact on the process performance,so their suitability should be measured differently.However,no work has been done to evaluate the suitability of non-human resources for the tasks of a process.Consequently,it becomes difficult to identify and subsequently overcome the inefficiencies caused by the non-human resources to the task.To address this problem,we present a three-step method to compute a suitability score of non-human resources for the task.As an evaluation of the proposed method,a healthcare case study is used to illustrate the applicability of the proposed method.Furthermore,we performed a controlled experiment to evaluate the usability of the proposed method.The encouraging response shows the usefulness of the proposed method.

How can collective leadership influence the implementation of change in health care?

Aim: This study focuses on how a collective leadership style could influence the implementation of change in health care.Methods: Kotter's 8-step process and leadership can guide the implementation of change. Collective leadership can highlight all levels of staff engagement, establish an organizational culture of learning and trust, and create continuous improvement. At the same time, it can formulate a well-designed plan;develop efficient strategies; communicate and empower the staff; assess the performance; and integrate the improvement.Results: Collective leadership can establish vision and trust, highlight all levels of staff engagement,establish an organizational culture of learning and trust, create continuous improvement, communicate and empower the staff and integrate the improvement.Conclusions: Collective leadership can be a powerful way to overcome the barrier and create an effective environment of adaptation of changes by analyzing Kotter's eight stage process.

Factors Militating against the Delivery of Compassionate Care: A Malawian Perspective

Background/Objectives: Malawi is one of the countries in the world with the worst maternal mortality rate. In view of this, women are encouraged to deliver at a health facility assisted by a skilled birth attendant. However, this initiative can only be effective when health care workers manifest a professional demeanor which conveys care and compassion to patients/clients. The objective of the study was to foster the development of compassionate care among nurses/midwives working in selected maternal and child health care clinical settings. Methods: The study employed an action research (AR) approach. Focus group discussions (FGDs) were conducted with nurse/midwives from the selected health facilities. Purposive sampling was utilized to obtain the sample of participants to the eight FGDs and thematic analysis was used to analyze the data. Results: The data collected from nurses/midwives clearly indicate that it is not possible to effectively render compassionate care under the present work conditions. The study reveals the following factors which hinder the delivery of compassionate care: severe nursing shortages, gross lack of essential supplies and equipment, negative attitudes of nurses/midwives and unsupportive leadership which demotivates nurses/midwives. Conclusion: The study reveals problems which hinder the delivery of compassionate care, and there is need to address these problems. This will enhance the effectiveness of hospital delivery by a skilled birth attendant as a safe motherhood initiative aimed at lowering the high maternal mortality rate.

Midwifery Students’ Confidence in New-Born Care at Completion of Training in Selected Midwifery Schools in Zambia. A Multicentric Study: A Case of Zambia

Background: Quality education is one of the important factors in empowering midwives to provide quality health care services to mothers and newborns irrespective of their practice settings. Due to lack of standardization of the duration, content, and structure of midwifery education and different pathways to midwifery across the world, midwives may lack the confidence to deliver quality health care services in the main domain of the ICM competences. Aim: To assess the confidence of final year midwifery students in the domain of new-born care based on the ICM midwifery competencies. Methods: The first phase consisted of a quick situation analysis of midwifery education and regulation in Zambia, followed by a cross-sectional survey through a self-administered questionnaire to assess the confidence of final year midwifery students. Results: Most (51.9%) of the respondents were aged between 18 and 28 years, and majority of them were placed in Levels 1, 2 and 3 Hospitals and also clinics for their clinical practice, with between one hundred to ten thousand annual births, followed by 16.9% who were placed in Level 3 hospitals only. Most students (38.3%) reported receiving classroom instruction by both Lecture and Demonstration. Few students (22.7%) responded that they were not satisfied with their clinical supervision, while 77.3% were satisfied. There was significant association between confidence to perform skills independently and having enough time to practice on models in the labs (p value = 0.024), confidence when practiced for the first time on mothers (p value = 0.007) and satisfaction with supervision during clinical practice (p value = 0.000). Binary logistic regression of characteristics associated with confidence to perform new-born skills independently revealed significant association between satisfaction with clinical supervision and confidence to perform skills independently, 95% CI [1.83, 15.37]. Conclusion: Midwifery students need quality training both theoretically and practically in order for them to gain confidence in newborn care upon completion of their training. They need adequate time to practice on models in the skills laboratory, and need adequate clinical supervision for them to gain confidence in performing new born skills independently.

Implementation and Evaluation of a Postpartum Care Program for Mothers Raising Infants: A Pilot Study

Background: The aims of this pilot study were to implement and evaluate a postpartum care program for mothers raising children younger than one year to provide physical relaxation, and to reduce mothers’ parenting problems. Methods: A day-service and group-type postpartum care program was implemented with the aim of interacting with peers, promoting local communication, and relaxing mothers. Results: Forty-five pairs of mothers and infants participated in the study. Most of the mothers experienced relaxation, communicated with each other, resolved physical problems, reduced childcare concerns, and developed parenting friends. Conclusions: In addition, feasibility was assured as they were very satisfied with the content of programs such as baby massage and aroma treatment.

Assessment of quality of postnatal care services offered to mothers in Dedza district, Malawi

This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become stand-alone priority sites to improve the quality of the postnatal care services rendered.

Automated Extraction and Analysis of CBC Test from Scanned Images

Health care is an important part of human life and is a right for everyone. One of the most basic human rights is to receive health care whenever they need it. However, this is simply not an option for everyone due to the social conditions in which some communities live and not everyone has access to it. This paper aims to serve as a reference point and guide for users who are interested in monitoring their health, particularly their blood analysis to be aware of their health condition in an easy way. This study introduces an algorithmic approach for extracting and analyzing Complete Blood Count (CBC) parameters from scanned images. The algorithm employs Optical Character Recognition (OCR) technology to process images containing tabular data, specifically targeting CBC parameter tables. Upon image processing, the algorithm extracts data and identifies CBC parameters and their corresponding values. It evaluates the status (High, Low, or Normal) of each parameter and subsequently presents evaluations, and any potential diagnoses. The primary objective is to automate the extraction and evaluation of CBC parameters, aiding healthcare professionals in swiftly assessing blood analysis results. The algorithmic framework aims to streamline the interpretation of CBC tests, potentially improving efficiency and accuracy in clinical diagnostics.

Effect of Emergency Care Process Optimization on Rescue Efficiency of Emergency Patients

Objective: This paper discusses the impact of emergency care process optimization on the rescue efficiency of emergency patients. Methods: 102 cases of emergency patients received from January 2017 to February 2018 in our hospital were selected as research objects. According to the order of treatment, they were divided into control group and observation group. The routine nursing process was given to the control group, and the observation group was given an optimized nursing process to compare the rescue efficiency and nursing satisfaction of the two groups. Results: According to the results of the study, the nursing satisfaction of the two groups was compared. Among them, the total satisfaction of the observation group was 49, accounting for 96.07%;the control group was very satisfied with the nursing work, accounting for 82.35%. There was a significant difference in nursing satisfaction between the two groups, which was statistically significant (P<0.05). Comparing the rescue efficiency of the two groups of patients, the observation time, rescue time, infusion time and disease remission time were significantly lower than the control group, the rescue success rate was 94.11%, and the rescue success rate of the control group was 78.43%. The results have statistical significance (P < 0.05). Conclusion: The optimization of emergency nursing process can greatly improve the rescue efficiency of emergency patients, reduce the disability rate and mortality, improve the quality of nursing, and enhance the satisfaction of nursing. It is worthy of clinical promotion practice.

Evidence of Linkages between Patient Safety and Person-Centred Care in the Maternity and Obstetric Context—An Integrative Review

The aim was to evaluate the current state of knowledge pertaining to patient safety and its link to person-centred care. The international relevance of patient safety has expanded, as have the models of person-centred care. Inspired by this new trend, we collated and summarized the literature for evidence of the two topics. The study was guided by Russell, Whittemore and Knafl’s integrative review framework. An electronic database search was conducted for relevant articles from 2005 to 2016. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The structure and process of the evaluation of the evidence are described and the findings interpreted by means of a thematic synthesis. One theme emerged: trustful, safe communication in the relationship between the patient, family members and healthcare professionals and two domains;safety culture and multidisciplinary capacity building. The dominant dimension in the safety culture domain is respectful communication, which implies sharing experiences that lead to a sense of control during labour and birth and is related to the women’s feeling of personal capacity. The dominant dimensions in the multidisciplinary capacity building domain are collaborative teamwork, coordination and risk management, knowledge sharing and patient-centred communication. In conclusion, to enhance patient safety, it is necessary to develop patient-focused, evidence-based skills and guidelines as well as a supportive organization. Due to their interaction with patients, midwives’ communication competence on the part of midwives is essential for supporting the birth and fulfilling the women’s needs and expectations.

Application Effect of Midwifery Nursing in the Prevention of Neonatal Asphyxia

Objective:To explore the role of midwifery care in the prevention of neonatal asphyxia.Method:The 100 cases of parturient received in our hospital from January 2018 to January 2021 were divided into two groups,respectively,the control group and the experimental group with 50 cases in each group.The control group received routine care,and the experimental group received midwifery care.The psychological status of the mothers and the occurrence of neonatal asphyxia were compared between the two groups.Results:Before nursing,there was no significant difference in the mental state of the two groups of parturient(P>0.05).After the nursing,the mental state of the parturient in the experimental group was significantly better than that of the control group(P<0.05);After different ways of nursing,the incidence of asphyxia in neonates in the control group was significantly higher than that in the experimental group(P<0.05),and the comparison between the groups was statistically significant.Conclusion:The timely delivery of midwifery care for parturient can improve the mental state of the parturient and help reduce the incidence of neonatal asphyxia.It is worthy of clinical attention and promotion.

Women's awareness of the role of midwifes and their preference for health professionals for maternity care: a systematic review

Objective:Several studies have shown that women are more satisfied with midwife-led care.However,their awareness regarding the midwives’roles was inadequate.The effect of the women’s awareness on their preferences for maternity care from health professionals has not been understood.To identify research findings presenting women’s awareness of midwives’roles and preferences for receiving maternity care from health professionals.Methods:The systematic literature review used various electronic search engines,including SCOPUS,PubMed,ScienceDirect,and Cochrane Library.Also,other grey literature sources,including Google Scholar,were utilized to identify articles.The search included only English language articles published between 2017-2021.Results:This search provided 20 studies that fulfil the inclusion criteria and are relevant to the Population,Intervention,Comparison,and Outcomes question.The knowledge of midwives’role among the public is well studied in the literature,and few papers(4 studies)focused on women’s perceptions.The review of existing literature indicated the midwifery workforce in Arab countries like Saudi Arabia,the impact of midwives’role on maternal and child health outcomes,women’s experiences regarding midwife-led care,women’s knowledge and perception regarding the role of the midwife in maternal care,and the womens’preference for midwifes’role within the range of maternal care professionals.Conclusion:The review found a lack of awareness and knowledge among the public about the midwife’s role,particularly among women.According to evidence,women’s preferences for choosing health professionals for maternity care primarily depend on being informed about their care,being given care options,and the health professionals’comprehension of their particular care needs.

Design of Pharmaceutical Care Process for Retail Pharmacies Based on Pareto Analysis

Objective To study the problems of pharmaceutical care in retail pharmacies and provide reference for the standardized development of pharmaceutical care in China.Methods Based on the literature of CNKI database,Pareto analysis was used to study the present situation of pharmaceutical care in retail pharmacies.Then the following problems in pharmaceutical care were found such as low personnel professional quality,inadequate attention,imperfect laws and regulations,and lack of standard service process.As to the first three problems,there were more research references.But there was less literature on the standard care process.Results and Conclusion Focusing on the customer demand,taking drug sales process as the basic framework of pharmaceutical care standardized process,and combining with the collaboration,the service process including prescription drugs review and OTC drugs purchase consultation is established.This process elaborates the division of staff services as well as the service standards in pre-sale,on-sale,and after-sale stages.Besides,it also puts forward some advice for the previous three problems,which will ensure the smooth implementation of pharmaceutical care in drugstores.

Empirical Verification of Swanson’s Caring Processes Found in Nursing Actions: Systematic Review

Caring has long been recognized as central to nursing and is increasingly posited as a core concept although developing a theoretical description of caring which is adequate in the 21st. century continues to be a difficult task for nursing scholars. Consequently, verifying existing theoretical structures of caring remains an ongoing challenge. The aim of this article is to provide empirical verification of the caring processes of “knowing,” “being with,” “doing for,” “enabling” and “maintaining belief” from Swanson’s Middle Range Caring Theory based on the categorization of nursing actions from a systematic literature review on care. Methods: A systematic literature review was conducted in the fields of nursing sciences, medicine and psychology. Purposeful sampling was carried out covering a period from 2003-2013. The final sample included 25 articles. Results: Major themes of nursing actions included “knowing” which consisted of centering, nurturing, informed understanding, assessment skills, communication and respect for individual differences. “Being with” was characterized by intimate relationship, connecting, presencing, emotional adaptability awareness of self/other and decentering. “Doing for” included competence, knowledge, professional/technical skills, helping actions, anticipatory, multidisciplinary and preserving dignity. “Enabling” was characterized by self care, commitment, complexity of care, appropriate communication, information/education, sharing power, enabling choice and ongoing validation. Finally, “maintaining belief” was characterized by spiritual being, humanistic view, harmonious balance, hope, love, and compassion, meaning, and religious and spiritual orientation. Conclusion: Empirical verification was shown for the caring processes described in Swanson’s Caring Theory grounded in concrete nursing actions.

Caring Science in Nursing.coming of Age in:Theory-Practice-Research

Jean Watson(华生)博士通过探究护理的哲学与科学根基,比较自然科学之医学典范与人文科学之护理典范的差异,以"Caring"为护理核心本质,发展了关怀科学(Caring Science)。本论著中Watson博士概述了关怀科学的理论根基——整体论(Unitary Ontology),及其伦理归属(Ethic of Belonging);介绍了人文关怀的10大要素(Caritas Processes);阐述了人际间关怀时刻(Transpersonal Caring Moment)的内涵以及护理人员实现人性关怀的方法学(CaritasHeart TM Methodology)。最后,Watson博士提出了关怀科学在护理实践应用的指导方针。希望此论著对我国护理工作者认识和实践人文关怀有所裨益!

Automatic quality improvement reports in the intensive care unit: One step closer toward meaningful use

AIM: To examine the feasibility and validity of electronic generation of quality metrics in the intensive care unit(ICU).METHODS: This minimal risk observational study was performed at an academic tertiary hospital. The Critical Care Independent Multidisciplinary Program at Mayo Clinic identified and defined 11 key quality metrics. These metrics were automatically calculated using ICU Data Mart, a near-real time copy of all ICU electronic medical record(EMR) data. The automatic report was compared with data from a comprehensive EMR review by a trained investigator. Data was collected for 93 randomly selected patients admitted to the ICU during April 2012(10% of admitted adult population). This study was approved by the Mayo Clinic Institution Review Board.RESULTS: All types of variables needed for metric calculations were found to be available for manual and electronic abstraction, except information for availability of free beds for patient-specific time-frames. There was 100% agreement between electronic and manual data abstraction for ICU admission source, admission service, and discharge disposition. The agreement between electronic and manual data abstraction of the time of ICU admission and discharge were 99% and 89%. The time of hospital admission and discharge were similar for both the electronically and manually abstracted datasets. The specificity of the electronically-generated report was 93% and 94% for invasive and non-invasive ventilation use in the ICU. One false-positive result for each type of ventilation was present. The specificity for ICU and in-hospital mortality was 100%. Sensitivity was 100% for all metrics.CONCLUSION: Our study demonstrates excellent accuracy of electronically-generated key ICU quality metrics. This validates the feasibility of automatic metric generation.

The BP-M* Methodology for Process Analysis in the Health Sector

In this paper we present the main phases of the BP-M* methodology and its application to a care pathway for patients in the Oncology Division of a large hospital, to evaluate pros and cons of different drug administration modalities and the impact of these modalities to the organizational process. BP-M* has been developed for the manufacturing sector but the relevance of business modeling, analysis and reorganization is not restricted to a specific sector. The aim of this work is to show its application to a real life study of a complex process in the health sector.

Factors Influencing Practice of Patient Education among Nurses at the University College Hospital, Ibadan

Patient education is the process of influencing patient behaviour and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health. Health education may be general preventive, health promotion or diseases specific education. With an education system in place, patients will be satisfied with care, patients will be healthier, and will seek medical services less frequently. There is little or no documentation on the practice of patient education at the University College Hospital, Ibadan. The aim of this descriptive study was to explore factors influencing the practice of patient education among nurses at the University College Hospital, Ibadan. Stratified and simple random sampling techniques were used in selecting 200 nurses at the University College Hospital Ibadan. A self-designed questionnaire was used to collect data. Statistical package for social sciences version 15 (SPSS 15) was used in analysing data. The study revealed that the knowledge and practice of patient education among the nurses in University College Hospital was high and the knowledge was found to be significantly associated with its practice (X2 = 7.89, p = 0.017). The working experience of nurses does not determine whether they practice patient education or not. Almost all the respondents (70% - 90%) in this study affirmed that the nurses’ experiences, cultural barriers, work place culture, lack of time, heavy workload, insufficient staffing, and the complexity of patients’ condition were important factors that influenced the practice of patient education. In conclusion, nurses at the University College Hospital have good knowledge and positive attitude towards patient education but could not practice effectively. A more critical approach in addressing heavy workload, insufficient staffing, among others is needed to improve patient education. Further studies should be carried out on developing nurses’ roles as patient educators.