Critical care nursing role in low and lower middle-income settings: a scoping review

ObjectivesA scoping review was conducted to answer the question: How is critical care nursing (CCN) performed in low-income countries and lower middle-income countries (LICs/LMICs)?DesignScoping review guided by the JBI Manual for Evidence Synthesis.Data sourcesSix electronic databases and five web-based resources were systematically searched to identify relevant literature published between 2010 and April 2021.Review methodsThe search results received two-stage screening: (1) title and abstract (2) full-text screening. For sources of evidence to progress, agreement needed to be reached by two reviewers. Data were extracted and cross-checked. Data were analysed, sorted by themes and mapped to region and country.ResultsLiterature was reported across five georegions. Nurses with a range formal and informal training were identified as providing critical care. Availability of staff was frequently reported as a problem. No reports provided a comprehensive description of CCN in LICs/LMICs. However, a variety of nursing practices and non-clinical responsibilities were highlighted. Availability of equipment to fulfil the nursing role was widely discussed. Perceptions of inadequate resourcing were common. Undergraduate and postgraduate-level preparation was poorly described but frequently reported. The delivery of short format critical care courses was more fully described. There were reports of educational evaluation, especially regarding internationally supported initiatives.ConclusionsDespite commonalities, CCN is unique to regional and socioeconomic contexts. Nurses work within a complex team, yet the structure and skill levels of such teams will vary according to patient population, resources and treatments available. Therefore, a universal definition of the CCN role in LIC/LMIC health systems is likely unhelpful. Research to elucidate current assets, capacity and needs of nurses providing critical care in specific LIC/LMIC contexts is needed. Outputs from such research would be invaluable in supporting contextually appropriate capacity development programmes.

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Mapping evidence on the distribution of paediatric cancers in sub-Saharan Africa: a scoping review protocol

Systematic Reviews ◽

10.1186/s13643-019-1184-4 ◽

2019 ◽

Vol 8 (1) ◽

Author(s):

Sehlisiwe R. Ndlovu ◽

Desmond Kuupiel ◽

Themba G. Ginindza

Keyword(s):

Scoping Review ◽

Low Income ◽

Relevant Literature ◽

Sub Saharan Africa ◽

World Health ◽

Low Income Countries ◽

Future Research ◽

International Agency ◽

Healthcare Needs ◽

Sub Saharan

Abstract Background Paediatric cancers account for a minor fraction of deaths and hence receive little attention from policymakers. In low-income countries, the absence of comprehensive national paediatric strategies results in a lack of access for a majority of children with cancer. In sub-Saharan Africa (SSA), the burden of childhood cancers is underestimated due to a lack of paediatric cancer registries, poor health care systems and competing healthcare needs. The objective of this study is to map evidence on the distribution of paediatric cancers in the SSA region. Method A scoping review will be conducted to map literature on the distribution of paediatric cancers in SSA. An electronic literature search will be conducted from the following databases: PubMed, Google Scholar, EBSCOhost (CINAHL and Health Source) and World Health Organization (WHO)/International Agency for Research in Cancer (IARC) (GLOBOCAN databases). We will also search the reference lists of included studies to source relevant literature. A pilot search was conducted to determine the feasibility of the study. Study selection will be guided by the inclusion and exclusion criteria. After charting the data, a descriptive overview of the studies will be presented in a narrative format. An account of the study characteristics will be described in this narrative. The analysis will be mainly based on mapping the country-specific outcomes emerging from the studies, and a numerical summary of these outcomes will be conducted. Tables, maps and charts will be produced and presented in the result section. Discussion This review study will identify existing research gaps for future research to influence policy implementation and to improve the availability of diagnosis and treatment of paediatric cancers in SSA.

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Patient-reported outcomes for diabetes and hypertension care in low- and middle-income countries: A scoping review

PLoS ONE ◽

10.1371/journal.pone.0245269 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245269

Author(s):

Sarah Masyuko ◽

Carrie J. Ngongo ◽

Carole Smith ◽

Rachel Nugent

Keyword(s):

Scoping Review ◽

Low Income ◽

English Language ◽

Patient Reported Outcome Measures ◽

Low Income Countries ◽

Future Research ◽

Middle Income ◽

Middle Income Countries ◽

Patient Reported ◽

Low And Middle Income

Introduction Patient-reported outcome measures (PROMs) assess patients’ perspectives on their health status, providing opportunities to improve the quality of care. While PROMs are increasingly used in high-income settings, limited data are available on PROMs use for diabetes and hypertension in low-and middle-income countries (LMICs). This scoping review aimed to determine how PROMs are employed for diabetes and hypertension care in LMICs. Methods We searched PubMed, EMBASE, and ClinicalTrials.gov for English-language studies published between August 2009 and August 2019 that measured at least one PROM related to diabetes or hypertension in LMICs. Full texts of included studies were examined to assess study characteristics, target population, outcome focus, PROMs used, and methods for data collection and reporting. Results Sixty-eight studies met the inclusion criteria and reported on PROMs for people diagnosed with hypertension and/or diabetes and receiving care in health facilities. Thirty-nine (57%) reported on upper-middle-income countries, 19 (28%) reported on lower-middle-income countries, 4 (6%) reported on low-income countries, and 6 (9%) were multi-country. Most focused on diabetes (60/68, 88%), while 4 studies focused on hypertension and 4 focused on diabetes/hypertension comorbidity. Outcomes of interest varied; most common were glycemic or blood pressure control (38), health literacy and treatment adherence (27), and acute complications (22). Collectively the studies deployed 55 unique tools to measure patient outcomes. Most common were the Morisky Medication Adherence Scale (7) and EuroQoL-5D-3L (7). Conclusion PROMs are deployed in LMICs around the world, with greatest reported use in LMICs with an upper-middle-income classification. Diabetes PROMs were more widely deployed in LMICs than hypertension PROMs, suggesting an opportunity to adapt PROMs for hypertension. Future research focusing on standardization and simplification could improve future comparability and adaptability across LMIC contexts. Incorporation into national health information systems would best establish PROMs as a means to reveal the effectiveness of person-centered diabetes and hypertension care.

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The development of critical care nursing education in Zambia

British Journal of Nursing ◽

10.12968/bjon.2020.29.9.499 ◽

2020 ◽

Vol 29 (9) ◽

pp. 499-505

Author(s):

Chris Carter ◽

Priscar Sakala Mukonka ◽

Lilian Jere Sitwala ◽

Barbara Howard-Hunt ◽

Joy Notter

Keyword(s):

Critical Care ◽

Nursing Education ◽

Healthcare Services ◽

Sub Saharan Africa ◽

Critical Care Nursing ◽

Middle Income ◽

Care Services ◽

Sub Saharan ◽

Nursing Course ◽

Care Nursing

Background: Critical care services reflect the healthcare services they support. In many low-to-middle-income countries (LMICs), balancing a sparse workforce, resources and competing demands to fund services, is a significant challenge when providing critical care. In Zambia, critical care has evolved significantly over the past 10 years. This article explores the provision of critical care services and the review and validation of a critical care nursing course. Objectives: To review the literature relating to critical care nursing in sub-Saharan Africa to support a review and validation of the current critical care nursing course and to prepare a framework for a Bachelor of Science (BSc) in critical care nursing programme in Zambia. Results: A search of the published literature identified key themes, including a paucity of evidence, limited educational opportunities, a lack of national and international opportunities, protocols and standards, and the challenges of providing technical services. The subsequent review and validation took account of these themes. Conclusion: This project has had an impact on improving critical care nurses' knowledge and skills and provided the foundations for the BSc in critical care nursing.

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Skills, competencies, and policies for advanced practice critical care nursing in Europe: a scoping review

Nurse Education in Practice ◽

10.1016/j.nepr.2021.103142 ◽

2021 ◽

pp. 103142

Author(s):

Ingrid Egerod ◽

Gudrun Kaldan ◽

Sara Nordentoft ◽

Anders Larsen ◽

Suzanne Forsyth Herling ◽

...

Keyword(s):

Critical Care ◽

Scoping Review ◽

Advanced Practice ◽

Critical Care Nursing ◽

Care Nursing

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Evidence characterising skills, competencies and policies in advanced practice critical care nursing in Europe: a scoping review protocol

BMJ Open ◽

10.1136/bmjopen-2019-031504 ◽

2019 ◽

Vol 9 (9) ◽

pp. e031504

Author(s):

Gudrun Kaldan ◽

Sara Nordentoft ◽

Suzanne Forsyth Herling ◽

Anders Larsen ◽

Thordis Thomsen ◽

...

Keyword(s):

Critical Care ◽

Intensive Care ◽

Scoping Review ◽

Nursing Practice ◽

European Countries ◽

Advanced Practice ◽

Critical Care Nursing ◽

Advanced Level ◽

Intensive Care Nursing ◽

Care Nursing

IntroductionThe management of critically ill patients is challenged by increasing population age and prevalence of comorbid diseases. High-quality intensive care nursing practice is imperative to accommodate these issues. The roles of the nurse practitioner (NP) and the acute care NP have existed for decades in the USA, Canada and Australia but are still evolving in Europe. Some European countries have introduced the advanced practice nurse (APN), but the current standard of the advanced level of nursing is variable and consensus regarding the framework, role and definition is lacking. Literature and evidence are sparse as well. Identification of skills and competencies required for the APN is warranted. Mapping skills and competencies will enable future educational harmonisation and facilitate mobility of the advanced-level intensive care nursing workforce across Europe. The aim of our scoping review is to identify literature describing skills, competencies and policies characterising advanced nursing practice in intensive care across Europe.Methods and analysisWe will apply a five-stage scoping review methodology with a comprehensive systematic literature search as outlined by Arksey and O’Malley. In collaboration with a research librarian, we will search nine interdisciplinary databases and grey literature for publications originating in European countries in 1992–2018. Using a two-stage screening process with Covidence to remove duplicates, we will first scan the title and abstract and then perform full-text review to determine the eligibility of the papers. Qualitative content analysis will be used to chart the data.Ethics and disseminationOur study is a part of the European Union-funded INACTIC project (International Nursing Advanced Competency-based Training for Intensive Care) with the overall aim of developing a common European curriculum for advanced practice critical care nursing. Results from this scoping review mapping the evidence of APNs in Europe will be presented at national and international conferences and published in a peer-reviewed journal.

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Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052439 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2439

Author(s):

Brendon Stubbs ◽

Kamran Siddiqi ◽

Helen Elsey ◽

Najma Siddiqi ◽

Ruimin Ma ◽

...

Keyword(s):

Health Survey ◽

Low Income ◽

World Health ◽

Low Income Countries ◽

Multivariable Logistic Regression Analysis ◽

World Health Survey ◽

Middle Income ◽

Middle Income Countries ◽

The World ◽

Low And Middle Income

Tuberculosis (TB) is a leading cause of mortality in low- and middle-income countries (LMICs). TB multimorbidity [TB and ≥1 non-communicable diseases (NCDs)] is common, but studies are sparse. Cross-sectional, community-based data including adults from 21 low-income countries and 27 middle-income countries were utilized from the World Health Survey. Associations between 9 NCDs and TB were assessed with multivariable logistic regression analysis. Years lived with disability (YLDs) were calculated using disability weights provided by the 2017 Global Burden of Disease Study. Eight out of 9 NCDs (all except visual impairment) were associated with TB (odds ratio (OR) ranging from 1.38–4.0). Prevalence of self-reported TB increased linearly with increasing numbers of NCDs. Compared to those with no NCDs, those who had 1, 2, 3, 4, and ≥5 NCDs had 2.61 (95% confidence interval (CI) = 2.14–3.22), 4.71 (95%CI = 3.67–6.11), 6.96 (95%CI = 4.95–9.87), 10.59 (95%CI = 7.10–15.80), and 19.89 (95%CI = 11.13–35.52) times higher odds for TB. Among those with TB, the most prevalent combinations of NCDs were angina and depression, followed by angina and arthritis. For people with TB, the YLDs were three times higher than in people without multimorbidity or TB, and a third of the YLDs were attributable to NCDs. Urgent research to understand, prevent and manage NCDs in people with TB in LMICs is needed.

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Factors associated with the disbursements of development assistance for health in low-income and middle-income countries, 2002–2017

BMJ Global Health ◽

10.1136/bmjgh-2020-004858 ◽

2021 ◽

Vol 6 (4) ◽

pp. e004858

Author(s):

Modhurima Moitra ◽

Ian Cogswell ◽

Emilie Maddison ◽

Kyle Simpson ◽

Hayley Stutzman ◽

...

Keyword(s):

Low Income ◽

Development Assistance ◽

Health Spending ◽

Recipient Country ◽

Health Systems Strengthening ◽

Low Income Countries ◽

Middle Income ◽

Development Assistance For Health ◽

Country Characteristics ◽

Health Accounts

IntroductionIn 2017, development assistance for health (DAH) comprised 5.3% of total health spending in low-income countries. Despite the key role DAH plays in global health-spending, little is known about the characteristics of assistance that may be associated with committed assistance that is actually disbursed. In this analysis, we examine associations between these characteristics and disbursement of committed assistance.MethodsWe extracted data from the Creditor Reporting System of the Organization for Economic Co-operation and Development, Institute for Health Metrics and Evaluation, and the WHO National Health Accounts database. Factors examined were off-budget assistance, administrative assistance, publicly sourced assistance and assistance to health systems strengthening. Recipient-country characteristics examined were perceived level of corruption, civil fragility and gross domestic product per capita (GDPpc). We used linear regression methods for panel of data to assess the proportion of committed aid that was disbursed for a given country-year, for each data source.ResultsFactors that were associated with a higher disbursement rates include off-budget aid (p<0.001), lower administrative expenses (p<0.01), lower perceived corruption in recipient country (p<0.001), lower fragility in recipient country (p<0.05) and higher GDPpc (p<0.05).ConclusionSubstantial gaps remain between commitments and disbursements. Characteristics of assistance (administrative, publicly sourced) and indicators of government transparency and fragility are also important drivers associated with disbursement of DAH. There remains a continued need for better aid flow reporting standards and clarity around aid types for better measurement of DAH.

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Economics of healthcare access in low-income and middle-income countries: a protocol for a scoping review of the economic impacts of seeking healthcare on slum-dwellers compared with other city residents

BMJ Open ◽

10.1136/bmjopen-2020-045441 ◽

2021 ◽

Vol 11 (7) ◽

pp. e045441

Author(s):

Noemia Teixeira de Siqueira-Filha ◽

Jinshuo Li ◽

Eliud Kibuchi ◽

Zahidul Quayyum ◽

Penelope Phillips-Howard ◽

...

Keyword(s):

Economic Impact ◽

Scoping Review ◽

Low Income ◽

Purchase Power Parity ◽

Healthcare Access ◽

Well Being ◽

Power Parity ◽

Middle Income ◽

Slum Dwellers ◽

Scoping Reviews

IntroductionPeople living in slums face several challenges to access healthcare. Scarce and low-quality public health facilities are common problems in these communities. Costs and prevalence of catastrophic health expenditures (CHE) have also been reported as high in studies conducted in slums in developing countries and those suffering from chronic conditions and the poorest households seem to be more vulnerable to financial hardship. The COVID-19 pandemic may be aggravating the economic impact on the extremely vulnerable population living in slums due to the long-term consequences of the disease. The objective of this review is to report the economic impact of seeking healthcare on slum-dwellers in terms of costs and CHE. We will compare the economic impact on slum-dwellers with other city residents.Methods and analysisThis scoping review adopts the framework suggested by Arksey and O’Malley. The review is part of the accountability and responsiveness of slum-dwellers (ARISE) research consortium, which aims to enhance accountability to improve the health and well-being of marginalised populations living in slums in India, Bangladesh, Sierra Leone and Kenya. Costs of accessing healthcare will be updated to 2020 prices using the inflation rates reported by the International Monetary Fund. Costs will be presented in International Dollars by using purchase power parity. The prevalence of CHE will also be reported.Ethics and disseminationEthical approval is not required for scoping reviews. We will disseminate our results alongside the events organised by the ARISE consortium and international conferences. The final manuscript will be submitted to an open-access international journal. Registration number at the Research Registry: reviewregistry947.

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Critical Care Nursing in the Philippines

Critical Care Nursing Clinics of North America ◽

10.1016/j.cnc.2020.11.001 ◽

2021 ◽

Vol 33 (1) ◽

pp. 75-87

Author(s):

Rudolf Cymorr Kirby P. Martinez ◽

Maria Isabelita C. Rogado ◽

Diana Jean F. Serondo ◽

Gil P. Soriano ◽

Karen Czarina S. Ilano

Keyword(s):

Critical Care ◽

The Philippines ◽

Critical Care Nursing ◽

Care Nursing

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Scoping review assessing the evidence used to support the adoption of mobile health (mHealth) technologies for the education and training of community health workers (CHWs) in low-income and middle-income countries

BMJ Open ◽

10.1136/bmjopen-2017-019827 ◽

2018 ◽

Vol 8 (7) ◽

pp. e019827 ◽

Cited By ~ 12

Author(s):

Niall Winters ◽

Laurenz Langer ◽

Anne Geniets

Keyword(s):

Systematic Reviews ◽

Scoping Review ◽

Low Income ◽

Health Workers ◽

Education And Training ◽

Evidence Base ◽

Mobile Technologies ◽

Middle Income ◽

And Training ◽

Formal Theories

ObjectivesUndertake a systematic scoping review to determine how a research evidence base, in the form of existing systematic reviews in the field of mobile health (mHealth), constitutes education and training for community health workers (CHWs) who use mobile technologies in everyday work. The review was informed by the following research questions: does educational theory inform the design of the education and training component of mHealth interventions? How is education and training with mobile technology by CHWs in low-income and middle-income countries categorised by existing systematic reviews? What is the basis for this categorisation?SettingThe review explored the literature from 2000 to 2017 to investigate how mHealth interventions have been positioned within the available evidence base in relation to their use of formal theories of learning.ResultsThe scoping review found 24 primary studies that were categorised by 16 systematic reviews as supporting CHWs’ education and training using mobile technologies. However, when formal theories of learning from educational research were used to recategorise these 24 primary studies, only four could be coded as such. This identifies a problem with how CHWs’ education and training using mobile technologies is understood and categorised within the existing evidence base. This is because there is no agreed on, theoretically informed understanding of what counts as learning.ConclusionThe claims made by mHealth researchers and practitioners regarding the learning benefits of mobile technology are not based on research results that are underpinned by formal theories of learning. mHealth suffers from a reductionist view of learning that underestimates the complexities of the relationship between pedagogy and technology. This has resulted in miscategorisations of what constitutes CHWs’ education and training within the existing evidence base. This can be overcome by informed collaboration between the health and education communities.

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