scholarly journals Development and feasibility testing of a play-based psychosocial intervention for reduced patient stress in a pediatric care setting: experiences from Pakistan

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Muneera A. Rasheed ◽  
Vardah Bharuchi ◽  
Waliyah Mughis ◽  
Ayesha Hussain
Keyword(s):  
Parental Stress ◽  
Psychosocial Intervention ◽  
Tertiary Care ◽  
Theory Of Change ◽  
Pediatric Care ◽  
Clinical Psychologist ◽  
Play Intervention ◽  
Middle Income ◽  
Psychology Trainees ◽  
Parent Interactions

Abstract Background Hospitalization can be a source of great stress for children and their families. In high-income countries, there are specialized staff to help children cope using different techniques including play. However, it is a major challenge in low and middle-income countries (LMIC) due to financial constraints and untrained human resource. The objective of study was to develop and test the feasibility and acceptance of a psychology trainee-delivered model postulated on employing play as a means of enhancing child-parent interactions leading to reduced stress during hospitalization. Methods This study was conducted in the paediatric ward of a tertiary care private hospital in Pakistan. Pre-intervention survey revealed that parental stress stemmed mainly from seeing their child irritable, distressed, or in pain. Using a theory of change model, a play-based psychosocial intervention was developed to address these factors. The intervention approach was informed by principles of Nurturing Care Framework and play therapy. Children between birth and 6 years admitted in the acute care ward were eligible. The intervention was delivered between March 2019 and December 2020 by psychology trainees who were supervised by a clinical psychologist. The play-based sessions were delivered at the bedside and ranged from 20 to 40 min. Parents receiving the intervention were later interviewed for their stress, child emotions, and feedback about the service using structured surveys administered by psychology graduates. The trainees delivering the intervention were requested to provide their feedback as a written qualitative open-ended narrative. These narratives were analyzed using an inductive approach. Results The survey was conducted with 223 families with about half of the sample having children under 2 years of age. Forty-five percent of parents reported play intervention to be one of 3 key factors in improving their experience during hospital stay. Only 5% of parents reported feeling stressed about the child illness after the intervention. Ninety to 96% parents felt respected, listened to, and understood by the therapists. Thematic analysis of the feedback by trainees indicated the internship to be a useful experience and a new avenue for professional life whereas physicians appreciated the interventions. Conclusions The authors conclude that psychology trainees can feasibly deliver a play-based intervention under supervision for reduced stress in children and their parents during hospitalization with mutual benefits.

scholarly journals Development and Feasibility Testing of a Play-Based Psychosocial Intervention for Reduced Patient Stress in a Paediatric Care Setting: Experiences from Pakistan

2020 ◽  
Author(s):  
Muneera Rasheed ◽  
Vardah Bharuchi ◽  
Waliyah Mughis ◽  
Ayesha Hussain
Keyword(s):  
Human Resource ◽  
Parental Stress ◽  
Psychosocial Intervention ◽  
Theory Of Change ◽  
Key Factors ◽  
Play Intervention ◽  
Psychology Trainees ◽  
Patient Stress ◽  
Reducing Stress ◽  
Great Stress

Abstract Background: Hospitalization can be a source of great stress for children and their families. In high-income countries there are specialized staff to help children cope using different techniques including play. However, it is a major challenge in LMIC due to lack of financial and untrained human resource. The objective of study was to develop and test the feasibility and acceptance of a psychology trainee-delivered model postulated on reducing stress of hospitalized children and their caregivers. The paper describes the development of the model and feedback from the stakeholders.Methods: This feasibility study was conducted in the Paediatrics ward of a quaternary care private hospital in Pakistan. Intervention was developed using a theory of change model after surveying parental stress in relation to their child’s illness. At baseline, most parental negative emotions were identified to stem from the fear of the child relapsing, and seeing their child irritable, distressed or in pain. The package was a play-based psychosocial intervention informed by principles of Nurturing Care Framework and play therapy delivered by psychology trainees. The trainees were supervised by clinical psychologists. Children between birth to 6 years admitted in the general ward (non-intensive unit) and their parents were eligible for the intervention. Parents receiving the intervention were interviewed for their stress and feedback about the service using surveys. The trainees delivering the intervention presented their feedback as a written qualitative open-ended narrative.Results: The findings indicated the intervention when delivered on the bedside was feasible and acceptable to both parents and trainees. 45% of parents reported play intervention to be one of 3 key factors in improving their experience during hospital stay. Only 5% of parents reported feeling stressed about the child illness after the intervention. 90-96% parents felt respected, listened to, and understood by the therapists. Thematic analysis of the feedback by trainees and physicians indicated the internship to be a useful experience and a new avenue for professional life. Conclusions: The authors conclude that psychology trainees can feasibly deliver a play-based intervention under supervision for reduced stress in children and their parents during hospitalization with mutual benefits. A trainee delivered model could be a strategy to deal with shortage of trained human resource in LMICs.

scholarly journals How to improve patient experience of compassion through nursing: Development of an on-job mentorship programme in a tertiary care hospital, Pakistan

2020 ◽  
Author(s):  
Alma Arshad ◽  
Naureen Lalani ◽  
Noureen Sultan ◽  
Aly Zubairi ◽  
Ayesha Hussain ◽  
...  
Keyword(s):  
Nursing Education ◽  
Patient Experience ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Theory Of Change ◽  
Pediatric Care ◽  
Care Hospital ◽  
Intervention Package ◽  
Middle Income ◽  
Experience Of Care

Abstract Background Evidence suggests improvement in nursing staff satisfaction, competence, and retention after implementation of evidence-based mentorship programmes. When guided by a framework of compassion, mentoring as a caring action can not only build healthy, transformative relationships and energize the workplace environments but a similar behavior is reciprocated to patients which subsequently can drive patient experience of care. However, examples of on-job mentorship programs for nurses in low- and middle-income countries (LMIC) are limited owing to human and financial constraints. Objective The current study describes the development of a feasible an on-job nursing mentorship program using a compassionate framework aimed at improving nurses’ experience and thus enhancing patient experience from a tertiary care hospital in Pakistan. Methods The intervention package was built by a team composed of service and nursing leadership, director patient experience of care and a compassion specialist using a theory of change model. The package followed a series of steps that were based on the principles of implementation science, a) identification of a framework, b) creating a working group and c) multiple meetings to frame the model followed by implementing the preconditions for roll-out of the programme. Results The intermediate outcome was to have nurses demonstrate skills of compassion with the eventual outcome of improving the patient's experience of compassion. The pre-conditions were identified as: recruitment of staff with appropriate skills for pediatric care, precision of compassionate experience definition, creation of a compassionate culture and development of competent head nurses as supervisor. In order to ensure the pre-conditions, various interventions were planned and some were implemented through the course of designing. These involved, creation of space to talk about compassionate skills with staff, provide trainings and on-job coaching, revising career ladder of supervisors, inclusion of pediatric compassion specific nursing education service orientation program, recognition of efforts and promotion of compassionate values in numerous communication platforms, arrangement of training workshops, creation of checklists and development of dashboards. Conclusion The approach helped to delineate feasible pathways for an on-job compassionate mentorship programme through strengthening routine supervision leading to improved patient experience of care in the pediatric service.

scholarly journals Development of an on-job mentorship programme to improve nursing experience for enhanced patient experience of compassionate care

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Alma Arshad Hookmani ◽  
Naureen Lalani ◽  
Noureen Sultan ◽  
Aly Zubairi ◽  
Ayesha Hussain ◽  
...  
Keyword(s):  
Patient Experience ◽  
Tertiary Care ◽  
Intervention Development ◽  
Theory Of Change ◽  
Pediatric Care ◽  
Care Hospital ◽  
Compassionate Care ◽  
Frontline Staff ◽  
Middle Income ◽  
Experience Of Care

Abstract Background Evidence suggests improvement in nursing staff satisfaction, competence, and retention after implementation of evidence-based mentorship programmes. When guided by a framework of compassion, mentoring as a caring action can not only build healthy, transformative relationships but a similar behavior is reciprocated to patients which subsequently can drive patient experience of care. However, examples of on-job mentorship programs for nurses in low- and middle-income countries (LMIC) are limited. Objective The objective of the study was to develop an on-job nursing mentorship programme using a compassionate framework aimed at improving nurses’ experience and thus enhancing patient experience in a tertiary care hospital in Pakistan. Methods Designed as an intervention development study, it was completed between January 2018–December 2019. The programme was developed by a team composed of service and nursing leadership, director patient experience of care and a compassion specialist using a theory of change model. The package followed a series of steps, a) identification of a framework, b) creation of working group c) needs assessment and d) multiple meetings to frame the model followed by implementing the preconditions for roll-out of the programme with the frontline staff. Results The eventual outcome was improving the patient’s experience of compassion while the intermediate outcome was to have nurses demonstrate compassionate care. The pre-conditions were identified as: recruitment of staff with appropriate skills for pediatric care, provision of compassionate experience to the frontline nurses by addressing their specific pain points, development of competent head nurses as supervisors and creation of a compassionate culture. To ensure the pre-conditions, various interventions were planned with some implemented through the course of the study while others are in the process of being rolled out. These involved, inclusion of pediatric compassion specific module during orientation of new hires, creation of space to talk about compassionate skills with staff, provision of trainings and mentorship to create competent head nurses, and creating a culture that promoted and recognized compassionate care values. Conclusion The approach helped to delineate feasible pathways for an on-job compassionate mentorship programme enhancing routine supervisors' role as facilitators of compassionate care.

scholarly journals A Review of the Community Health Club Literature Describing Water, Sanitation, and Hygiene Outcomes

2021 ◽  
Vol 18 (4) ◽  
pp. 1880
Author(s):  
Jason Rosenfeld ◽  
Ruth Berggren ◽  
Leah Frerichs
Keyword(s):  
Social Capital ◽  
Collective Action ◽  
Community Health ◽  
Theory Of Change ◽  
Health Promotion Program ◽  
Review Of The Literature ◽  
Middle Income ◽  
Health Club ◽  
Qualitative Evidence ◽  
Sanitation And Hygiene

The Community Health Club (CHC) model is a community-based health promotion program that utilizes water, sanitation, and hygiene (WASH) education as the first stage of a longitudinal development process. Although the CHC model has been implemented in fourteen countries over 20 years, this is the first review of the literature describing the model’s outcomes and impact. We conducted a review of the literature that provided quantitative or qualitative evidence of CHC interventions focused on WASH in low- and middle-income countries. We identified 25 articles that met our inclusion criteria. We found six major outcomes: WASH behaviors and knowledge, social capital, collective action, health, and cost or cost-effectiveness. The most consistent evidence was associated with WASH behaviors and knowledge, with significant effects on defecation practices, hand washing behaviors, and WASH knowledge. We also found qualitative evidence of impact on social capital and collective action. CHCs catalyze favorable changes in WASH behaviors and knowledge, yielding outcomes commensurate with other WASH promotion strategies. This review provides insights into the model’s theory of change, helping identify areas for further investigation. The CHC model’s holistic focus and emphasis on individual and collective change offer promising potential to address multiple health and development determinants.

scholarly journals Effective Utilization of Limited Isolation Rooms to Provide Safe Patient Care and Staff Safety in a Low- and Middle-Income Country

2020 ◽  
Vol 41 (S1) ◽  
pp. s203-s204
Author(s):  
Rozina Roshanali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Limited Resource ◽  
Multidrug Resistant ◽  
Communicable Diseases ◽  
Care Hospital ◽  
Middle Income ◽  
Safe Patient Care ◽  
Bed Management ◽  
Resource Setting

Background: My tertiary-care hospital is a 750-bed hospital with only 17 airborne infection isolation room (AIIR) and negative-pressure rooms to isolate patients who have been diagnosed or are suspected with prevalent diseases like tuberculosis, measles, and chickenpox. On the other hand, only 14 single-patient isolation rooms are available to isolate patients with multidrug-resistant organisms (MDROs) such as CRE (carbapenum-resistant Enterobacter) or colistin-resistant MDROs. Due to the limited number of isolation rooms, the average number of hours to isolate infected patients was ~20 hours, which ultimately directly placed healthcare workers (HCWs) at risk of exposure to infected patients. Methods: Plan-Do-Study-Act (PDSA) quality improvement methodology was utilized to decrease the average number of hours to isolate infected patients and to reduce the exposure of HCWs to communicable diseases. A detailed analysis were performed to identify root causes and their effects at multiple levels. A multidisciplinary team implemented several strategies: coordination with information and technology team to place isolation alerts in the charting system; screening flyers and questions at emergency department triage; close coordination with admission and bed management office; daily morning and evening rounds by infection preventionists in the emergency department; daily morning meeting with microbiology and bed management office to intervene immediately to isolate patients in a timely way; infection preventionist on-call system (24 hours per day, 7 days per week) to provide recommendations for patient placement and cohorting of infected patients wherever possible. Results: In 1 year, a significant reduction was achieved in the number of hours to isolate infected patients, from 20 hours to 4 hours. As a result, HCW exposures to communicable diseases also decreased from 6.7 to 1.5; HCW exposures to TB decreased from 6.0 to 1.9; exposures measles decreased from 4.75 to 1.5; and exposures chickenpox decreased from 7.3 to 1.0. Significant reductions in cost incurred by the organization for the employees who were exposed to these diseases for postexposure prophylaxis also decreased, from ~Rs. 290,000 (~US$3,000) to ~Rs. 59,520 (~US$600). Conclusions: This multidisciplinary approach achieved infection prevention improvements and enhanced patient and HCW safety in a limited-resource setting.Funding: NoneDisclosures: None

scholarly journals Surgical Site Infections at a Level I Trauma Center in India: Data From an Indigenously Developed, e-SSI Surveillance System

2020 ◽  
Vol 41 (S1) ◽  
pp. s397-s398
Author(s):  
Ayush Lohiya ◽  
Samarth Mittal ◽  
Vivek Trikha ◽  
Surbhi Khurana ◽  
Sonal Katyal ◽  
...  
Keyword(s):  
Surveillance System ◽  
Trauma Center ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Surgical Site Infections ◽  
Trauma Patients ◽  
Care Hospital ◽  
Middle Income ◽  
Predominant Pathogen ◽  
Level I

Background: Globally, surgical site infections (SSIs) not only complicate the surgeries but also lead to $5–10 billion excess health expenditures, along with the increased length of hospital stay. SSI rates have become a universal measure of quality in hospital-based surgical practice because they are probably the most preventable of all healthcare-associated infections. Although, many national regulatory bodies have made it mandatory to report SSI rates, the burden of SSI is still likely to be significant underestimated due to truncated SSI surveillance as well as underestimated postdischarge SSIs. A WHO survey found that in low- to middle-income countries, the incidence of SSIs ranged from 1.2 to 23.6 per 100 surgical procedures. This contrasted with rates between 1.2% and 5.2% in high-income countries. Objectives: We aimed to leverage the existing surveillance capacities at our tertiary-care hospital to estimate the incidence of SSIs in a cohort of trauma patients and to develop and validate an indigenously developed, electronic SSI surveillance system. Methods: A prospective cohort study was conducted at a 248-bed apex trauma center for 18 months. This project was a part of an ongoing multicenter study. The demographic details were recorded, and all the patients who underwent surgery (n = 770) were followed up until 90 days after discharge. The associations of occurrence of SSI and various clinico-microbiological variables were studied. Results: In total, 32 (4.2%) patients developed SSI. S. aureus (28.6%) were the predominant pathogen causing SSI, followed by E. coli (14.3%) and K. pneumoniae (14.3%). Among the patients who had SSI, higher SSI rates were associated in patients who were referred from other facilities (P = .03), had wound class-CC (P < .001), were on HBOT (P = .001), were not administered surgical antibiotics (P = .04), were not given antimicrobial coated sutures (P = .03) or advanced dressings (P = .02), had a resurgery (P < .001), had a higher duration of stay in hospital from admission to discharge (P = .002), as well as from procedure to discharge (P = .002). SSI was cured in only 16 patients (50%) by 90 days. SSI data collection, validation, and analyses are essential in developing countries like India. Thus, it is very crucial to implement a surveillance system and a system for reporting SSI rates to surgeons and conduct a robust postdischarge surveillance using trained and committed personnel to generate, apply, and report accurate SSI data.Funding: NoneDisclosures: None

scholarly journals How to Achieve the Desired Outcomes of a Complex Intervention in Nursing Homes: A Theory of Change

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 383-383
Author(s):  
Martin Dichter ◽  
Jonas Hylla ◽  
Almuth Berg ◽  
Daniela Eggers ◽  
Ralph Möhler ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Psychosocial Intervention ◽  
Sleep Disturbances ◽  
Intervention Development ◽  
Psychosocial Interventions ◽  
Causal Chain ◽  
Theory Of Change ◽  
Expert Survey ◽  
People With Dementia ◽  
Individual Knowledge

Abstract Background Recent systematic reviews suggest the effectiveness of complex psychosocial interventions to reduce sleep disturbances in people with dementia (PwD) living in nursing homes. However, it is unclear how and under which circumstances these interventions work and which components and processes are crucial determinants for effectiveness. Objectives To develop a Theory of Change (ToC) that describes a causal chain for the reduction of sleep disturbances. Design and Methods The ToC approach is a participatory method in intervention development to generate knowledge about how, why, and under which circumstances interventions are effective. We conducted two expert workshops, a subsequent expert survey (n=12), a systematic literature review, and expert interviews (day and night nurses). Results Necessary preconditions for the reduction of sleep disturbances were identified on staff, management and cultural levels of nursing homes. Intermediate goals like “individual knowledge on PwD is available”, “a specific institutional concept to promote sleep is implemented”, “person-centred care is implemented” and “sleep preferences of PwD are fulfilled” were defined. The intermediate goals, interventions, promoting and inhibiting factors as well as rationales were sorted into a causal chain. All intermediate goals were rated as relevant or highly relevant based on the expert survey. Conclusions The ToC model displays how a complex psychosocial intervention is likely to be effective in reducing sleep disturbances and meeting sleep preferences of PwD in nursing homes. The model is the basis for the development and evaluation of a planned complex psychosocial intervention to prevent and reduce sleep disturbances in PwD.

scholarly journals Case Study of Pediatric Cerebral Sinus Venous Thrombosis Center of a Low Middle-Income Country

2021 ◽  
Vol 27 ◽  
pp. 107602962110228
Author(s):  
Bushra Moiz ◽  
Ronika Devi Ukrani ◽  
Aiman Arif ◽  
Inaara Akbar ◽  
Muhammed Wahhaab Sadiq ◽  
...  
Keyword(s):  
Sinus Thrombosis ◽  
Care Center ◽  
Tertiary Care ◽  
Age Groups ◽  
Activated Protein C ◽  
Positive Association ◽  
Cerebral Venous Sinus Thrombosis ◽  
P Value ◽  
Middle Income ◽  
Duration Of Symptoms

Pediatric cerebral venous sinus thrombosis (CVST) is rare but a potentially fatal disease requiring its understanding in local setting. In this study, we observed the clinical course, management, and outcome of pediatric patients with sinus thrombosis in a tertiary care center at Pakistan. Patients between age 0 to 18 years of both genders diagnosed with sinus thrombosis during 2011 to 2020 were included. Data was collected through in-house computerized system and SPSS version 19 was used for analysis. Of 143492 pediatric admissions, 32 (21 males and 11 females) patients with a median (IQR) age of 4.5 years (0-16) had CVST. This is equivalent to 18.5 CVST events per million pediatric admissions. Adolescents were mostly affected, and the overall mortality was 7%. Primary underlying disorders were infections (59%), hematological neoplasms (12.5%), thrombotic thrombocytopenic purpura (3%) and antiphospholipid syndrome (3%). Activated protein C resistance (44%) was the most common inherited thrombophilia. Twenty-one (66%) patients were anemic with a mean (±SD) hemoglobin of 9.0 g/dL (±2.3). Regression analysis showed a positive association of anemia with multiple sinus involvement ( P-value 0.009) but not with duration of symptoms ( P-value 0.344), hospital stay ( P-value 0.466), age ( P-value 0.863) or gender ( P-value 0.542) of the patients. SARS-COV2 was negative in patients during 2020. Adolescents were primarily affected by sinus thrombosis and infections was the predominant risk factor for all age groups, with a low all-cause mortality. A high index of clinical suspicion is required for prompt diagnosis and intervention.

scholarly journals Much research, but little learned to date: A scoping review on mental health of health workers in low- and lower-middle income countries and roadmap for future research

2021 ◽  
Author(s):  
Julia Lohmann ◽  
Denny John ◽  
Aso Dzay
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Health Workers ◽  
Tertiary Care ◽  
Psychological Wellbeing ◽  
Future Research ◽  
Measurement Tool ◽  
High Quality ◽  
Middle Income ◽  
Middle Income Countries

Abstract BackgroundSARS-CoV-2 has resulted in unprecedented research efforts on health workers’ work realities and their potential mental health impacts. To understand the latter, high-quality evidence on the baseline situation is paramount. With the aim of providing a comprehensive overview of existing evidence and to inform future research, we undertook a scoping review of the quantitative literature on mental health and psychological wellbeing of clinical skilled healthcare personnel working in all settings of care in low- and lower-middle income countries (LLMIC).MethodsWe performed a systematic search of the literature up to the end of 2019, in English or French language, in MEDLINE, EMBASE, PsychINFO, Global Health, and CAIRN. We included both studies estimating levels of mental health and studies investigating associations with other factors. We extracted data on study characteristics and methodology, and assessed the methodological quality of the included studies along nine criteria.ResultsWe found 143 relevant studies, 135 including data on mental health levels and 126 including data on associations with other factors. The studies covered 26 of the world’s 78 LLMICs, with most studies conducted in India, Nigeria, Pakistan, or Egypt, in urban secondary- and tertiary-care settings. 67% of studies assessed burnout, 25% general psychological wellbeing, and 20% other mental health outcomes. Only 19% of studies were of high quality due to shortcomings particularly in regards to sample representativeness, context-specific measurement tool validity, and reporting of methodological detail. We found much heterogeneity in investigated associated factors. Studies focused almost exclusively on potential determinants of mental health, while none linked mental health to objectively measured performance outcomes.ConclusionWe conclude that despite its impressive size, we can learn comparatively little from the current body of literature. Based on our findings, we outline areas for expansion, methodological improvement, and standardization of reporting in future research on mental health of health workers.Systematic review registrationPROSPERO no. CRD42019140036

Sign in / Sign up

Export Citation Format

Share Document