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Background: Levels of maternal and neonatal mortality remain high in sub-Saharan Africa, with an estimated 66% of global maternal deaths occurring in this region. Many deaths are linked to poor quality of care, which in turn has been linked to gaps in pre-service training programmes for midwifery care providers. In-service training packages have been developed and implemented across sub-Saharan Africa in an attempt to overcome the shortfalls in pre-service training. This scoping review has aimed to summarize in-service training materials used in sub-Saharan Africa for midwifery care providers between 2000 and 2020 and mapped their content to the International Confederation of Midwives (ICM) Essential Competencies for Midwifery Practice., Methods: Searches were conducted for the years 2000-2020 in Cumulative Index of Nursing and Allied Health Literature, PubMed/MEDLINE, Social Science Citation Index, African Index Medicus and Google Scholar. A manual search of reference lists from identified studies and a search of grey literature from international organizations was also performed. Identified in-service training materials that were accessible freely on-line were mapped to the ICM Essential Competencies for midwifery practice., Results: The database searches identified 1884 articles after removing duplicates. After applying exclusion criteria, 87 articles were identified for data extraction. During data extraction, a further 66 articles were excluded, leaving 21 articles to be included in the review. From these 21 articles, six different training materials were identified. The grey literature yielded 35 training materials, bringing the total number of in-service training materials that were reviewed to 41. Identified in-service training materials mainly focused on emergency obstetric care in a limited number of sub-Saharan Africa countries. Results also indicate that a significant number of in-service training materials are not readily and/or freely accessible. However, the content of in-service training materials largely met the ICM Essential Competencies, with gaps noted in the aspect of woman-centred care and shared decision making., Conclusion: To reduce maternal and newborn morbidity and mortality midwifery care providers should have access to evidence-based in-service training materials that include antenatal care and routine intrapartum care, and places women at the centre of their care as shared decision makers., (© 2022. The Author(s).)

Cannulation is essential for haemodialysis with arteriovenous access, but also damages the arteriovenous access making it prone to failure, is associated with complications and affects patients' experiences of haemodialysis. Managing Access by Generating Improvements in Cannulation is a national UK quality improvement project, designed to improve cannulation practice in the United Kingdom, ensuring it reflects current needling recommendations. It uses a simple quality improvement method, the Model for Improvement, to structure improvement to cannulation practice. It assists units in the practical implementation of the British Renal Society and Vascular Access Society of Britain and Ireland needling recommendations, ensuring actual cannulation practice reflects what is defined as best practice in cannulation. An eLearning package and awareness materials have been developed, to assist units in changing their cannulation practice. The Kidney Quality Improvement Partnership provides a structure for Managing Access by Generating Improvements in Cannulation that promotes development and dissemination. It is hoped that Managing Access by Generating Improvements in Cannulation will raise an understanding about the cannulation of arteriovenous access and change behaviours and beliefs around correct cannulation practice, to ensure longevity of this lifeline.

New graduates' adjustment to high-acuity specialty areas was evaluated using qualitative methods in a hospital system that uses the Versant New Graduate Residency Program. Subjects were interviewed at baseline in person, answered interview questions at 6 months via computer, and were interviewed at 12 months in person. Twelve themes emerged from the interviews, reflecting intrinsic and extrinsic factors affecting new graduate nurse adjustment. Study results were used to evaluate the program and improve the program implementation., Competing Interests: The authors declare no conflicts of interests., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Quality improvement and patient safety (QIPS) are core components of graduate medical education (GME). Training programs and affiliated medical centers must partner to create an environment in which trainees can learn while meaningfully contributing to QIPS efforts, to further the shared goal of improving patient care. Numerous challenges have been identified in the literature, including lack of resources, lack of faculty expertise, and siloed QIPS programs. In this article, the authors describe a framework for integrated QIPS training for residents in the University of Washington Internal Medicine Residency Program, beginning in 2014 with the creation of a dedicated QIPS chief resident position and assistant program director for health systems position, the building of a formal curriculum, and integration with medical center QIPS efforts. The postgraduate year (PGY) 1 curriculum focused on the culture of patient safety and entering traditional patient safety event (PSE) reports. The PGY-2 curriculum highlighted QIPS methodology and how to conduct mentored PSE reviews of cases that were of educational value to trainees and a clinical priority to the medical center. Additional PGY-2/PGY-3 training focused on the active report, presentation, and evaluation of cases during morbidity and mortality conferences while on clinical services, as well as how to lead longitudinal QIPS work. Select residents led mentored QI projects as part of an additional elective. The hallmark feature of this framework was the depth of integration with medical center priorities, which maximized educational and operational value. Evaluation of the program demonstrated improved attitudes, knowledge, and behavior changes in trainees, and significant contributions to medical center QIPS work. This specialty-agnostic framework allowed for training program and medical center integration, as well as horizontal integration across GME specialties, and can be a model for other institutions., (Copyright © 2020 by the Association of American Medical Colleges.)

Competing Interests: The authors have no conflicts of interests to disclose.

Registered nurses (RNs) are leaving the bedside to become advanced practice registered nurses (APRNs). Failure to successfully transition APRNs into clinical practice represents a substantial financial burden to healthcare organizations. Organizations can use the standards of the Magnet Recognition Program to help support, develop, and transition APRNs into their advanced practice role.

A formalized orientation program for experienced nurses was modeled after a program for new graduate nurses. Within a year, experienced nurses rotated through teaching stations, including simulations of shock and respiratory failure. Participants completed pre- and postsurveys and scored self-confidence on a Likert scale. Surveys showed a significant increase in participants' confidence related to elements in their new role. Future plans include a retention rate comparison of participants in this program versus nonparticipants.

A wealth of research demonstrates that work unit supervisors serve a critical function in protecting the safety and health of workers. A systematic review examined the effectiveness of workplace safety training interventions intended for various supervisor populations published from 2000 to 2019. A search of seven electronic databases was supplemented with hand searches from the reference lists of identified publications, relevant scientific journals, and the gray literature. This review included an assessment of the methodological quality using a modified version of the Quality Assessment Tool for Quantitative Studies. A total of 22 peer-reviewed studies met a set of inclusion criteria and were subsequently assessed for methodological quality. Training interventions were grouped into five topical domains: ergonomics, leadership, supervisor-worker interaction, injury, and disability management, and general safety education. Consistent evidence was found for the effectiveness of supervisory training interventions across several outcome measures. To our knowledge, this is the first study to synthesize the literature on supervisory training interventions in the area of occupational safety. While the results are encouraging, they must be viewed with caution due to the fact that the methodological rigor of the reviewed studies was low., (© 2020 Wiley Periodicals LLC.)

Background: An effective orientation ensures that new nurses are prepared to deliver competent care to patients. In organizations with several critical care units, opportunities exist to achieve standardization of core content applicable to all critical care areas., Purpose: This quality improvement project, conducted in a large children's hospital with multiple critical care units, was designed to centralize critical care orientation and standardize its content, as well as to measure learning outcomes of the revised program., Methods: Before initiation of this project, a 2-day critical care orientation class was held regularly for newly hired critical care nurses. Nurses attended this class at different time points in their orientation. Critical care units also held unit-based orientation classes. Nursing professional development specialists and representatives from each critical care unit collaborated to redesign the 2-day critical care orientation class in order to standardize content taught across the organization, increase attendance at the class, and reduce redundancy of topics covered in unit-based classes., Interventions: The redesigned program included online modules followed by 4-hour sessions that built on the knowledge gained in the modules. The sessions used multiple learner engagement strategies. Learning outcomes were evaluated using pretests and posttests., Results: Between June 2017 and March 2018, a total of 150 nurses completed the redesigned program. Median posttest scores increased significantly from median pretest scores for each critical care orientation session., Conclusion: The program achieved the goal of standardizing education and increasing critical care nurses' knowledge., (©2020 American Association of Critical-Care Nurses.)

Efficient, cost-effective, and safe orientations with clear expectations are necessary for new graduates in their transition from student to practicing nurse. In the current nursing shortage, healthcare needs to invest more in retaining new graduates. Orientation can be a factor in decisions to leave. This scoping review revealed that strong evidence is lacking regarding best practices during orientation for evaluating new graduate nurses' readiness to practice on their own. More resources, research, and tools are needed.

Sexual and gender minorities experience disparities throughout the life course. These are especially detrimental at the end-of-life and can include disenfranchised grief, homophobia and transphobia from medical staff, and forced outing. The best healthcare training approach to ameliorate health disparities is debated. Cultural competency trainings for clinicians have been commonly proposed by major medical institutions and certifying bodies to ameliorate lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) health disparities. However, cultural competency trainings have limitations, including (1) false competence, (2) measurement issues, and (3) ecological fallacy (i.e., assuming individuals conform to the norms of their cultural group). The purpose of this commentary is to describe the limitations of cultural competency training and argue for healthcare systems to implement cultural humility trainings as a way to reduce LGBTQ health disparities at the end-of-life. The strengths of cultural humility training include focus on (1) individuals instead of their cultural groups, (2) self-reflection, and (3) active listening. While there are challenges to implementing cultural humility trainings in the health-care system, we assert that these trainings align with the aims of healthcare systems and can be an essential tool in reducing LGBTQ health disparities. We suggest practical components of successful cultural humility trainings including leadership buy-in, appropriate outcome measurements, multiple training sessions, and fostering a safe reflection space.

Background: Extensive efforts have been made to train mental health providers in evidence-based psychotherapies (EBPs); there is increasing attention focused on the methods through which providers are trained to deliver EBPs. Evaluating EBP training methods is an important step in determining which methods are most effective in increasing provider skill and improving client outcomes., Methods: We searched MEDLINE (Ovid) and PsycINFO for randomized controlled trials published from 1990 through June 2019 that evaluated EBP training methods to determine the effectiveness of EBP training modalities on implementation (provider and cost) and client outcomes. Eligible studies (N = 28) were evaluated for risk of bias, and the overall strength of evidence was assessed for each outcome. Data was extracted by a single investigator and confirmed by a second; risk of bias and strength of evidence were independently rated by two investigators and determined by consensus., Results: Overall, EBP training improved short-term provider satisfaction, EBP knowledge, and adherence compared to no training or self-study of training materials (low to moderate strength of evidence). Training in an EBP did not increase treatment adoption compared to no training or self-study. No specific active EBP training modality was found to consistently increase provider EBP knowledge, skill acquisition/adherence, competence, adoption, or satisfaction compared to another active training modality. Findings were mixed regarding the additive benefit of post-training consultation on these outcomes. No studies evaluated changes in provider outcomes with regards to training costs and few studies reported on client outcomes., Limitations: The majority of included studies had a moderate risk of bias and strength of evidence for the outcomes of interest was generally low or insufficient. Few studies reported effect sizes. The ability to identify the most effective EBP training methods was limited by low strength of evidence for the outcomes of interest and substantial heterogeneity among studies., Conclusions: EBP training may have increased short-term provider satisfaction, EBP knowledge, and adherence though not adoption. Evidence was insufficient on training costs and client outcomes. Future research is needed on EBP training methods, implementation, sustainability, client outcomes, and costs to ensure efforts to train providers in EBPs are effective, efficient, and durable., Trial Registration: The protocol for this review is registered in PROSPERO (CRD42018093381).

Adequately preparing new graduate nurses for contemporary practice remains a challenge. This innovative mixed-method study explored the impact of a dedicated education unit on new graduate nurses' transition to practice. Results indicated that new graduate nurses with dedicated education unit experience were better prepared for contemporary practice compared to their peers with traditional clinical experiences. This study highlights the positive impact collaborative clinical teaching models can have on preparing new graduate nurses for practice.

Aim: To assess the effectiveness of psychoeducational interventions with respect to burden, anxiety and depression in family caregivers of People With Dementia living at home., Background: In dementia, the family assumes the role of main caregiver, maintaining the patient in a good state of health. Nevertheless, burden, anxiety and depression may have negative repercussions in caregivers. Therefore, professional supports through psychoeducational programmes are recommended as interventions for improving caregivers' health., Design: A quantitative systematic review., Data Sources: Electronic searches were performed in CINAHL/AMED/CENTRAL/Web of Science/LILACS/PUBMED from January 2005-August 2018., Review Methods: The review was conducted using the JADAD scale to assess bias risk and the quality of the randomized controlled trials (RCTs) and the CONSORT instrument to assess study quality report. The extracted data were reviewed by independent reviewer pairs. The review was reported using PRISMA., Results: A total of 18 RCTs met inclusion criteria. Seven were classified as Technology-based Interventions and 11 as Group-based Interventions., Conclusion: Psychoeducational interventions for caregivers allow them to increase their knowledge of the illness, develop problem-solving skills and facilitate social support. Technology-based Interventions significantly affect burden while Group-based Interventions affect anxiety, depression, insomnia and burden and quality of life and self-efficacy., Impact: Research findings can be used to classify caregivers in future interventions according to illness stage to obtain more precise results., (© 2019 John Wiley & Sons Ltd.)

As novice nurses enter the workforce, they are supported by their organizations in multiple ways. During the transition period, they are developing efficiencies that are important as they become advanced beginner nurses and then competent nurses. It is important for nurses to receive support in their journey to competency to gain efficiency while providing quality patient outcomes. This article explores opportunities to develop efficiencies as nurses enter practice. There are opportunities in personal support and with system support. Nurse leaders support novice nurses by facilitating proper professional experiences and proper system support., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2019 Elsevier Inc. All rights reserved.)

To streamline competency assessment documentation during orientation, we developed a comprehensive, three-phase plan, consisting of a tiered skills acquisition model, entrustable professional activities, and the full incorporation of Donna Wright's recommendations for initial competency development, allowing for the transition away from the traditional skills checklist (Wright, 2005). We were able to reduce orientation time and preceptor confusion while increasing orientation process satisfaction by the end of our revisions.

Objective: To explore midwives' roles and education requirements in newborn bloodspot screening (NBS) for genetic conditions, as programs and supporting education evolve over time., Background: NBS processes are evolving and will continue to evolve with new genetic and genomic technologies. Midwives have a critical role in facilitating NBS, as they are the primary healthcare professional to interact with parents at the time of collecting the bloodspot. As new consent processes and genomic technologies are incorporated into NBS, midwives need to stay up-to-date with these changes, so that parents can make an informed decision about having the test and future use of the DNA sample., Research Design/setting: We used a cross-sectional approach to analyse midwives' knowledge and behaviour in 2005/6 and 2016, with changes in NBS processes and education introduced in 2011., Findings: We found midwives' NBS knowledge improved in 8/18 areas after a 10-year period, mostly related to process changes, but there was also an increase in misconceptions regarding which conditions are screened. Areas of significant improvement were not consistently explained by participation in continuing professional development (CPD). We found midwives used official brochures and NBS collection cards to guide discussions with families. Changes to the NBS collection cards, together with the content of CPD materials, aligned with the significant improvements and deficits we observed. When considering potential changes to future maternity care that incorporates emerging genomic technologies, midwives indicated the main barrier was their lack of knowledge; the majority (60.3%) reported supervision support to attend genomics CPD., Key Conclusions: Changes in NBS practice should be implemented through multifaceted programs that include education sessions and procedural prompts. The NBS collection card should be seen not just as a legal consent document but also as an educational tool., Implications for Practice: As NBS programs evolve through the addition of conditions screened for or changes to technology or consent processes, multiple strategies should be applied to upskill midwives to ensure they can best support parents to make informed choices., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Background: The Thrombolysis ImPlementation in Stroke (TIPS) trial tested the effect of a multicomponent, multidisciplinary, collaborative intervention designed to increase the rates of intravenous thrombolysis via a cluster randomized controlled trial at 20 Australian hospitals (ten intervention, ten control). This sub-study investigated changes in self-reported perceptions and practices of physicians and nurses working in acute stroke care at the participating hospitals., Methods: A survey with 74 statements was administered during the pre- and post-intervention periods to staff at 19 of the 20 hospitals. An exploratory factor analysis identified the structure of the survey items and linear mixed modeling was applied to the final survey domain scores to explore the differences between groups over time., Result: The response rate was 45% for both the pre- (503 out of 1127 eligible staff from 19 hospitals) and post-intervention (414 out of 919 eligible staff from 18 hospitals) period. Four survey domains were identified: (1) hospital performance indicators, feedback, and training; (2) personal perceptions about thrombolysis evidence and implementation; (3) personal stroke skills and hospital stroke care policies; and (4) emergency and ambulance procedures. There was a significant pre- to post-intervention mean increase (0.21 95% CI 0.09; 0.34; p < 0.01) in scores relating to hospital performance indicators, feedback, and training; for the intervention hospitals compared to control hospitals. There was a corresponding increase in mean scores regarding perceptions about the thrombolysis evidence and implementation (0.21, 95% CI 0.06; 0.36; p < 0.05). Sub-group analysis indicated that the improvements were restricted to nurses' responses., Conclusion: TIPS resulted in changes in some aspects of nurses' perceptions relating to the evidence for intravenous thrombolysis and its implementation and hospital performance indicators, feedback, and training. However, there is a need to explore further strategies for influencing the views of physicians given limited statistical power in the physician sample., Trial Registration: ACTRN12613000939796, UTN: U1111-1145-6762.

Background and Purpose: Patients admitted to intensive care units (ICUs) are critically ill and suffer from life-threatening sickness of injury. To work in ICU, registered nurses require additional knowledge and skills. While practices regarding the hire of new graduate nurses (NGNs) into settings such as the ICU vary, it is common that NGNs are being hired. However, NGNs in general, are at a higher risk for turnover within the profession as compared to their more experienced colleagues. NGNs in ICU settings may be at higher risk of turnover due to the complexity of the care context. It is of particular importance that the experiences of NGNs in ICU be explored with the intent of identifying what these nurses experience but also to consider how they can be best supported during a period of transition. This manuscript reports the findings from a mixed design study that sought to understand the transition of a cohort of NGNs over a period of 2 years., Methods: This study used both a purposive and convenience sample of NGNs. The qualitative component incorporated Thorne's (2016) interpretive description. Face-to-faceinterviews were completed., Results: Five themes were identified: an emotional transition, a social transition, a transitioning mindset, transitioning through firsts, and transitioning with confidence. Within each theme, there is a distinct difference and elements of transition were evident. Findings demonstrate that the NGNs appeared to be more confident in their skills and in their nursing practice over time. Findings from this study provide important insight into the experiences of NGNs in ICUs., (© Copyright 2019 Springer Publishing Company, LLC.)

Charge nurses often act as the eyes and ears of the unit. They are leaders, clinical experts, educators, policy enforcers, and patient advocates. They ensure patients and caregivers receive high-quality, safe, and evidence-based care. With the shift in health care from the in-patient to outpatient setting, patients are becoming more acute and complex for staff nurses. Charge nurses are pivotal in the successful care and management of these patients. Unfortunately, charge nurses often receive minimal training and are placed in this role with inadequate preparation and support. This can lead to feelings of anxiety, stress, and dissatisfaction with their job. Providing nurses with structured education about this role can create a safer and more positive work environment. This article discusses the development, implementation, and evaluation of a charge nurse orientation program in the outpatient infusion setting. [J Contin Educ Nurs. 2019;50(11):517-521.]., (Copyright 2019, SLACK Incorporated.)

Cancer is a leading cause of death in Australia and is also the leading cause of disease burden as survivorship continues to improve. Given the prevalence of oncology patients in the community, it is likely to be a condition encountered by every junior doctor. Despite this oncology and in conjunction with that, palliative care has not been a core component of medical curriculum until recently. This means that the junior doctor experience is often complicated by lack of knowledge, poor understanding of the disease process, treatment options and complications and therefore makes managing these patients complicated and often an uncessarily stressful process. This reflective article explores current issues in cancer education, a reflection and comparison between pre- and post-internship experience and offers some potential solutions to these issues.

This modified Delphi study determined consensus on core nurse competency program components that apply across the continuum of transition to initial practice, to new specialty practice, to a new role, or within general nursing orientation. The literature review found no published agreement on support and systems for universal transition programs. This broad-based study addressed this gap by identifying core elements within a competency or transition program and then ranking their importance within program structure.

The purpose of this descriptive correlational study was to determine if implementing gamification teaching methodologies in nondigital format into nursing orientation has a positive effect on orientees' motivation and knowledge retention. The study included a convenience sample of 152 registered nurses who attended the nursing orientation class at a Midwestern acute care facility. This study found that gamification had a positive effect on the orientees' motivation and knowledge retention.

The paper's central focus is on the usefulness or not of taking established and well-tried and tested models of training into cultures with different social, political and clinical attitudes. Beginning with the author's description of necessary changes introduced to ensure the revival of her own institute, the Society of Analytical Psychology, the author goes on to explore issues relevant to different aspects of training in countries where the IAAP runs its own training, known as the 'Router Programmes'. Here, analysts, teachers and supervisors visiting other cultures to offer their expertise may experience clashes in their views about the nature of the analytic attitude, not only with those they train but also amongst themselves., (© 2019, The Society of Analytical Psychology.)

Modern health care demands knowledge, swift action, and critical thinking from nurses. New and experienced registered nurses are better able to provide excellent care when they are supported by documents that drive consistent nursing action. The process of developing these documents is critically important. Technical writers can improve the adoption of carefully designed forms that help newly licensed registered nurses develop a foundation in critical thinking as they move through orientation.

Background: Oncology nurse navigation opportunities are rapidly expanding as the value of the role is recognized. However, there is a lack of training opportunities focusing on the unique needs of the oncology nurse navigator (ONN). Most navigator training programs provide only general oncology navigation content., Objectives: The purpose of this article is to evaluate the current state of training for the novice ONN and begin to identify core elements to inform development of a standardized training program., Methods: Navigator training programs and literature related to the role and development needs of the novice ONN were reviewed., Findings: Training of the novice ONN varies widely, with little evaluation of the most effective way to prepare for the role. It is clear that the learning needs of the ONN are different than those of other types of navigators and oncology nurses.

Aim: This study examines how a surgical care practitioner can contribute to the learning needs of junior scrub staff learning to scrub for urological robotics cases. Key themes include education, technical training, non-technical skills, patient safety and the specialist practitioner as educator., Methods: Data collection was via an online survey, distributed by a gatekeeper to 13 participants. These were junior scrub practitioners who had completed their robotic rotation., Results: A 62% response rate was achieved. The majority of respondents indicated that there was a difference in interactions when a surgical care practitioner was assisting compared to a surgical trainee. Half of the respondents felt more confident when the surgical care practitioner was assisting., Conclusions: A range of approaches were proposed for how the surgical care practitioner could enhance learning. Structured input is likely to be more appropriate to avoid the surgical care practitioner being distracted from their own duties whilst assisting. There is scope for further research.

Background: New graduate nurses undertaking transition to practice encounter enormous challenges in their first year, and this is expounded in rural and remote locations. In rural and remote settings where geographical isolation and inadequate resources impact health care delivery, there is a perceived shortage of support systems to assist new graduate nurses to transition smoothly, with reported negative effects for all staff and on recruitment and retention., Objectives: To investigate what transition support was reported for new graduate nurses to function effectively in rural and remote settings., Design: A study protocol was developed using principles for scoping reviews that have been developed over the past fifteen years., Data Sources: CINAHL, Medline, Proquest, Embase, Informit, PubMed, and Science Direct were systematically searched according to a predetermined search strategy., Review Methods: Search terms included New Graduate AND Rural OR Remote AND Education. Studies were selected according to an inclusion and exclusion criteria. Three reviewers were involved in independent screening of articles. The degree of agreement for an article to be included was based on a Kappa score calculation for inter-rater reliability., Results: Of the 662 articles searched, 13 met the inclusion criteria and their findings synthesised to form this review. Three overarching themes (and a number of subthemes) were identified within the context of rural and remote nursing workforce development, and included: new graduates' support needs, multifaceted support strategies and recruitment and retention strategies., Conclusions: Challenges faced by new graduate nurses when transitioning to practice are exacerbated in most rural and remote settings due to resourcing, lack of structured support programs, lack of training for support staff to mentor and give feedback and this impacts on recruitment and retention as well. Structured, well supported transition programs that provide flexible support are urgently required in these settings., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

As one of the training methodologies employed in the health care context, 'Learning by Doing' prioritizes the transference of competence, control, and workplace motivation. However, there are few published works that consider the opinions of health care professionals in relation to the effects of this kind of training on their workplace competence. The goal of this research was to evaluate the level of satisfaction and impact on quality of care, as perceived by the health care professionals that participated in this training program (Formative Focus). The evaluation utilized an online questionnaire that assessed professional satisfaction through five dimensions: The training methodology; the training program; its economic impact; perceived improvement in professional competence; and, perceived improvement in quality of care. A total of 364 health professionals took part in the training course and were asked to complete an online questionnaire. The variables that contemplated satisfaction were related to quality of care and preferences regarding the training methodology. Participants preferred interactive methods for learning with emphasis on practical contents. In terms of application of learning to their jobs, health care professionals found Learning by Doing skills more useful to transfer to their workplace. This experience of Learning by Doing training indicates an interesting potential for impact on improvement: Quality of health care, health care competence of professionals, and organizational development.

Objective: To identify the perceived barriers to the implementation of the Australian national guidelines on influenza outbreak management with Sydney Local Health District (SLHD) residential aged care facility (RACF) staff., Methods: All SLHD RACFs were invited to participate in a telephone interview. The questionnaire collected information about demographic characteristics and participants' level of agreement with statements regarding perceived barriers to implementing the national guidelines for influenza outbreak management., Results: Twenty-eight of 61 RACFs (46%) participated in the study. The three most common barriers identified were as follows: scepticism towards staff influenza vaccination (n = 13, 46%); the effort required to read the national guidelines (n = 11, 39%); and lack of infrastructure to physically separate residents during an outbreak (n = 10, 36%)., Conclusions: We recommend implementing and evaluating programmes which address misconceptions about influenza vaccination amongst RACF staff. Further, all RACF staff, including care staff, should receive targeted education on the role of infection control in influenza outbreak management., (© 2018 Sydney Local Health District. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc.)

The study of disparities in minority recruitment to cancer clinical trials has focused primarily on inquiries among minority patient populations. However, clinical trial recruitment is complex and requires a broader appreciation of the multiple factors that influence minority participation. One area that has received little attention is minority recruitment training for professionals who assume various roles in the clinical trial recruitment process. Therefore, we assessed the perspectives of cancer center clinical and research personnel on their training and education needs toward minority recruitment for cancer clinical trials. Ninety-one qualitative interviews were conducted at five U.S. cancer centers among four stakeholder groups: cancer center leaders, principal investigators, referring clinicians, and research staff. Interviews were recorded and transcribed. Qualitative analyses focused on response data related to training for minority recruitment for cancer clinical trials. Four prominent themes were identified: (1) Research personnel are not currently being trained to focus on recruitment and retention of minority populations; (2) Training for minority recruitment and retention provides for a specific focus on factors influencing minority research participation; (3) Training on cultural awareness may help to bridge cultural gaps between potential minority participants and research professionals; (4) Views differ regarding the importance of research personnel training designed to focus on recruitment of minority populations. There is a lack of systematic training for minority recruitment. Many stakeholders acknowledged the benefits of minority recruitment training and welcomed training that focuses on increasing cultural awareness to increase the participation of minorities in cancer clinical trials.

Training program implementers through online methods represents a way of facilitating the widespread implementation of community-based interventions that is more financially and logistically feasible than traditional in-person training methods. However, there are few evidence-informed protocols or models that can guide the development of online training content in a way that is consistent with instructional best practices. This paper presents an evidence-informed protocol for developing a training website, or online training platform, to support the implementation of community-based interventions at scale, which was informed by a critical analysis of the instructional design literature and our experiences developing an online training platform for the HealtheStepsTM Lifestyle Prescription Program. The protocol is an operationalization of the ADDIE model of instructional design, and details the analysis, design, development, implementation, and evaluation stages of the process. Examples from the HealtheStepsTM program are used to illustrate the use of the protocol in practice. The protocol emphasizes the need for rigorous analysis of the target audience and a multidisciplinary literature base drawing from instructional design and implementation science. It can be used by researchers to guide the development of online training platforms to support the widespread implementation of evidence-based health interventions, thus increasing their public health impact., (Copyright © 2018. Published by Elsevier Ltd.)

Objective: Total quality management, which basically involves pre-analytical, analytical, and postanalytical phases, is relatively more difficult in cytopathology due to descriptive reports and subjective variability. The pre-analytical phase of total quality management constitutes a major burden of errors in the laboratory and it has not been widely studied in cytopathology except in cervical Pap smears. The present study was therefore conducted to study the pre-analytical phase over 5 years from April 2013 until May 2018 at an ISO 15189: 2012-certified cytopathology laboratory, in a resource-limited setting. It was also intended to study the level of satisfaction of the patients and the training of the professionals provided in the cytology lab so as to improve and maintain high quality standards., Methods: The study included all the documents relating to the quality program used in the last 5 years in a medical institute situated in the north sub-Himalayan region of India. All the data were recorded and analysed for pre-analytical analysis of the total quality management system., Results: In total, 20,130 samples were received for cytological investigation. The total number of errors which were detected in the cytopathology lab were 1,430, constituting 7.1% of the total investigations done. The pre-analytical phase errors comprised 57% of the total errors (815/1,430), analytical errors constituted 11% (157/1,430), while postanalytical errors represented 32% (458/1,430). Incompletely filled requisition forms constituted the most common pre-analytical error (38%). There was a gradual decrease in the errors with time, but with a sudden increase between January to June 2015 due to new technicians joining during that period., Conclusion: Pre-analytical quality management is an essential component for maintaining the quality and reducing the errors in the cytopathology lab. Documentation, continuous training, and maintenance of internal and external quality control with quality charts are the key for successful quality management. The identification of non-conformance with root-cause analysis and provision of scope for continuous improvement is vital for quality improvement in the lab. Patient satisfaction is an important aspect of quality in the lab, which should be combined with the satisfaction of the personnel working in the lab., (© 2018 S. Karger AG, Basel.)

Background: Informal caregivers of people with dementia in Beijing are increasingly called upon to provide home-based care for their patients due to the increasing number of dementia patients and the shortage of standardized institutional solutions of care for patients in China. This study aimed to clarify the needs of informal caregivers and barriers of primary care workers toward dementia management in primary care in Beijing to provide references that may help to improve the care and services provided to individuals with dementia and their family caregivers residing in urban China., Methods: A mixed-methods approach was used in this study. We performed individual in-depth interviews with 10 informal caregivers. Moreover, we carried out focus group interviews with 29 primary care workers. Content analysis was used to separately identify themes and codes. Discrepancies were discussed until final agreement was achieved., Results: Three themes representing the core attitudes of informal caregivers and primary care workers were identified: care knowledge and skills, psychological counseling, and collaborative management. Most primary care workers believed that the management of dementia patients in primary care was necessary. However, due to the heavy work load and different medical specialties involved, these workers were unable to manage it., Conclusions: Professional training focused on dementia for primary care workers should be strengthened. At the same time, the establishment of a community-based dementia team management model that includes specialists, community health service centers (CHSCs), and community committees should be explored.

Objectives: To compare the performance of critical care providers with that of electroencephalography experts in identifying seizures using quantitative electroencephalography display tools., Design: Diagnostic accuracy comparison among healthcare provider groups., Setting: Multispecialty quaternary children's hospital in Canada., Subjects: ICU fellows, ICU nurses, neurophysiologists, and electroencephalography technologists., Intervention: Two-hour standardized one-on-one training, followed by a supervised individual review of 27 continuous electroencephalography recordings with the task of identifying individual seizures on eight-channel amplitude-integrated electroencephalography and color density spectral array displays., Measurements and Main Results: Each participant reviewed 27 continuous electroencephalograms comprising 487 hours of recording containing a total of 553 seizures. Performance for seizure identification was compared among groups using a nested model analysis with adjustment for interparticipant variability within groups and collinearity among recordings. Using amplitude-integrated electroencephalography, sensitivity for seizure identification was comparable among ICU fellows (83.8%), ICU nurses (73.1%), and neurophysiologists (81.5%) but lower among electroencephalographic technologists (66.7%) (p = 0.003). Using color density spectral array, sensitivity was comparable among ICU fellows (82.4%), ICU nurses (88.2%), neurophysiologists (83.3%), and electroencephalographic technologists (73.3%) (p = 0.09). Daily false-positive rates were also comparable among ICU fellows (2.8 for amplitude-integrated electroencephalography, 7.7 for color density spectral array), ICU nurses (4.2, 7.1), neurophysiologists (1.2, 1.5), and electroencephalographic technologists (0, 0) (p = 0.41 for amplitude-integrated electroencephalography; p = 0.13 for color density spectral array). However, performance varied greatly across individual electroencephalogram recordings. Professional background generally played a greater role in determining performance than individual skill or electroencephalogram recording characteristics., Conclusions: Following standardized training, critical care providers and electroencephalography experts displayed similar performance for identifying individual seizures using both amplitude-integrated electroencephalography and color density spectral array displays. Although these quantitative electroencephalographic trends show promise as a tool for bedside seizure screening by critical care providers, these findings require confirmation in a real-world ICU environment and in daily clinical use.

Purpose: The purpose of this quality improvement project was to create a Tracheostomy Subject Matter Expert (Trach SME) Committee to standardize tracheostomy care, education, and the discharge process across Boston Children's Hospital., Design and Methods: Boston Children's Hospital (BCH) is a free-standing urban tertiary pediatric hospital with 15 inpatient units. The newly formed Trach SME Committee evaluated the discharge process across the enterprise including hospital satellites and intra-hospital practice. Education materials were centralized, and policies were reviewed, revised and standardized to reflect current best practice. The Trach SME provided education to Trach Champions from each area that became resources for their respective units. The Trach SME also developed measurement outcomes to assess the effectiveness of the education process., Results: In the implementation year of 2104, our 7-day unplanned readmission rate for tracheostomy patients was 18.18%. This rate decreased to 6.67% in 2015 and to 0% in 2016. In 2015, we began to monitor 30-day unplanned readmissions and the rate was 6.67% in 2015 and decreased to 0% in 2016., Conclusions and Practice Implications: Standardization of policies, procedures and caregiver educational materials for the management of patients with a tracheostomy tube improved tracheostomy care across the enterprise and reduced tracheostomy readmission rates., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To examine if a brief midwifery education and training session incorporated into annual mandatory training improves the knowledge and confidence of midwives to support healthy weight gain and management in pregnancy., Design: An implementation evaluation using a pre-post study design was used. Midwives completed a self- administered questionnaire prior to and following completion of the training session. Objective knowledge, perceived knowledge and confidence in relation to nutrition, physical activity and healthy weight gain and management, and process measures related to the training were assessed., Participants and Setting: All midwives from a tertiary birthing hospital in Brisbane Australia who attended the annual mandatory training day in 2015 were invited to participate., Measurement and Findings: Of the 270 midwives who attended the training 154 pre and 114 post training questionnaires were returned. An increase in perceived knowledge across topic areas was reported by 70-97% of respondents, while perceived confidence increased for 83-91% of respondents across each topic area. Objective knowledge score increased from 11 pre-training to 15 post training (maximum score 17) (p < 0.001). Ninety six percent of respondents agreed the training provided practical communication strategies and 100% would recommend the training to others., Key Conclusions: This brief education session integrated into an existing mandatory training program, improved the knowledge and confidence of midwives in delivering advice and support for healthy pregnancy weight gain., Implications for Practice: This improvement is the first step in changing practice to prevent excess weight gain during the antenatal period. This program offers an innovative model to support midwives implement change across other health services. A low cost intervention that was well received by midwives can address identified barriers to the provision of best practice care that supports a healthy pregnancy weight gain in a sustainable forum., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Differences in earnings measured using either survey or administrative data raise the question of which is preferred for program impact evaluations. This is especially true when the population of interest has varying propensities to be represented in either source., Objectives: We aim to study differences in impacts on earnings from a job training voucher experiment in order to demonstrate which source is most appropriate to interpret findings., Research Design: Using study participants with survey-reported earnings, we decompose mean earnings differences across sources into those resulting from (1) differences in reported employment and (2) differences in reported earnings for those who are employed in both sources. We study factors related to these two sources of differences and demonstrate how impact estimates change when adjusting for them., Results: We find that differences in mean earnings are driven by differences in reported employment, but that differences in impacts are driven by differences in reported earnings for those employed in both data sources. Employment and worker characteristics explain much of the research group differences in earnings among the employed. Out-of-state employment, self-employment, and employment in low unemployment insurance (UI) coverage occupations contribute importantly to research group differences in survey- and UI-based employment levels. Employment in more than one job contributes to treatment group differences in earnings among the employed. All of these factors contribute substantially to the difference between survey- and UI-based earnings impact estimates., Conclusion: Findings underscore the relevance of UI coverage to estimated earnings impacts and suggest assessing employment impacts using both UI- and survey-based measures.

Background/purpose: Inappropriate prescribing of antibiotics is a major health-care problem in intensive care units (ICUs). This study evaluates the impact of a direct hospital-wide computerized antimicrobial approval system (HCAAS) and on-the-spot education for practitioners in a neurosurgical ICU in Taiwan., Methods: We retrospectively analyzed the medical records monthly of patients who were admitted to the neurosurgical ICU during a period of 7 years and 7 months. A pretest-post-test time series analysis, comparing the three periods: period I (no infectious disease (ID) physician), period II (part-time ID physicians), and period III (full-time ID physician). Antimicrobial consumption and expenditure, incidence of hospital-associated infections, prevalence of healthcare-associated bacterial isolates, in-hospital mortality rates, and indication of antibiotics usage were analyzed., Results: Full-time ID physician can increase the consumption of narrow-spectrum antimicrobials (cefazolin, and cefuroxime), and decrease the consumptions of broad-spectrum antimicrobials (ceftazidime, cefepime, and vancomycin) compared to part-time ID physicians. From period I to period III, the expenditure of antimicrobials, incidence of hospital-associated pneumonia, and the in-hospital mortality rates (crude, sepsis-related, and overall infection-related mortality) decreased statistically. The prevalence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae, and Carbapenems-resistant Pseudomonas aeruginosa remained at low level after HCAAS implementation. From 2007 to 2009, the rational antibiotics usage continued to increase, resulting from to more prophylaxis and appropriate microbiologic proof, but less empiric antimicrobial therapy., Conclusion: Implementation of HCAAS and long-term on-the-spot education by full-time ID physician can reduce antimicrobial consumption, cost, and improve inappropriate antibiotic usage whilst not compromising healthcare quality., (Copyright © 2017. Published by Elsevier B.V.)

Introduction: Diagnostic capacity and time to diagnosis are frequently identified as a barrier to improving cancer patient outcomes. Maximising the contribution of the medical imaging workforce, including reporting radiographers, is one way to improve service delivery., Methods: An efficient and effective centralised model of workplace training support was designed for a cohort of trainee chest X-ray (CXR) reporting radiographers. A comprehensive schedule of tutorials was planned and aligned with the curriculum of a post-graduate certificate in CXR reporting. Trainees were supported via a hub and spoke model (centralised training model), with the majority of education provided by a core group of experienced CXR reporting radiographers. Trainee and departmental feedback on the model was obtained using an online survey., Results: Fourteen trainees were recruited from eight National Health Service Trusts across London. Significant efficiencies of scale were possible with centralised support (48 h) compared to traditional workplace support (348 h). Trainee and manager feedback overall was positive. Trainees and managers both reported good trainee support, translation of learning to practice and increased confidence. Logistics, including trainee travel and release, were identified as areas for improvement., Conclusion: Centralised workplace training support is an effective and efficient method to create sustainable diagnostic capacity and support improvements in the lung cancer pathway., (© 2018 The Authors. Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)

Background: The use of inappropriate elective Percutaneous Coronary Intervention (PCI) has decreased over time, but hospital-level variation in the use of inappropriate PCI persists. Understanding the barriers and facilitators to the implementation of Appropriate Use Criteria (AUC) guidelines may inform efforts to improve elective PCI appropriateness., Methods: All hospitals performing PCI in Washington State were categorized by their use of inappropriate elective PCI in 2010 to 2013. Semi-structured, qualitative telephone interviews were then conducted with 17 individual interviews at 13 sites in Washington State to identify barriers and facilitators to the implementation of the AUC guidelines. An inductive and deductive, team-based analytical approach, drawing primarily on Matrix analysis was performed to identify factors affecting implementation of the AUC., Results: Specific facilitators were identified that supported successful implementation of the AUC. These included collaborative catheterization laboratory environments that allow all staff to participate with questions and opinions; ongoing AUC education with catheterization laboratory teams and referring providers; internal AUC peer review processes; interventional cardiologist be directly involved with the pre-procedural review process; checklist-based algorithms for pre-procedural documentation; systems redesign to include insurance companies; and AUC educational information with patients. Barriers to implementation of the AUC included external pressures, such as competition for patients, and the lack of shared medical records with sites that referred patients for coronary angiography., Conclusions: The identified facilitators enabled sites to successfully implement the AUC. Catheterization laboratories struggling to successfully implement the AUC may consider utilizing these strategies to improve their processes to improve patient selection for elective PCI.