What to consider when implementing a tool for timely recognition of palliative care needs in heart failure: a context-based qualitative study

Background Needs assessment tools can facilitate healthcare professionals in timely recognition of palliative care needs. Despite the increased attention for implementation of such tools, most studies provide little or no attention to the context of implementation. The aim of this study was to explore factors that contribute positively and negatively to timely screening of palliative care needs in advanced chronic heart failure. Methods Qualitative study using individual interviews and focus groups with healthcare professionals. The data were analysed using a deductive approach. The Consolidated Framework for Implementation Research was used to conceptualise the contextual factors. Results Twenty nine healthcare professionals with different backgrounds and working in heart failure care in the Southern and Eastern parts of the Netherlands participated. Several factors were perceived to play a role, such as perception and knowledge about palliative care, awareness of palliative care needs in advanced chronic heart failure, perceived difficulty when and how to start palliative care, limited acceptance to treatment boundaries in cardiology, limited communication and collaboration between healthcare professionals, and need for education and increased attention for palliative care in advanced chronic heart failure guidelines. Conclusions This study clarified critical factors targeting patients, healthcare professionals, organisations to implement a needs assessment tool for timely recognition of palliative care needs in the context of advanced chronic heart failure. A multifaceted implementation strategy is needed which has attention for education, patient empowerment, interdisciplinary collaboration, identification of local champions, chronic heart failure specific guidelines and culture.

Training needs assessment for practicing pediatric critical care nurses in Malawi to inform the development of a specialized master’s education pathway: a cohort study

Background Significant improvements in under-five mortality in Malawi have been demonstrated over the past thirty years; however, Malawian healthcare remains with gaps in availability and access to quality pediatric critical care nursing training and education. To improve expertise of pediatric critical care nurses in Malawi, Kamuzu University of Health Sciences (KUHeS), Queen Elizabeth Central Hospital (QECH), and Mercy James Center (MJC) entered a partnership with Seed Global Health, a US non-governmental organization. A needs assessment was conducted to understand the training needs of nurses currently working in pediatric critical care and in preparation for the development of a specialized Master’s in Child Health pathway in Pediatric Critical Care (PCC) Nursing at KUHeS. Methods The needs assessment was completed using a survey questionnaire formatted using an ABCDE (Airway, Breathing, Circulation, Disability, and Exposure) framework. The questionnaire had Likert scale and yes/no questions. Data was manually entered into excel and was analyzed using descriptive statistics. Results One hundred and fifty-three nurses at QECH and MJC responded to the survey. Most nurses were between the ages of 25 and 35 years (N = 98, 64%), female (N = 105, 69%), and held either a Bachelors (N = 72, 47%) or diploma (N = 70, 46%) in nursing. Nurses had high rates of confidence in certain skills: airway management (N = 120, 99%), breathing assessment & management (N = 153, 100%). However, nurses demonstrated little to no confidence in areas such as: mechanical ventilation (N = 68, 44%), ECG evaluation (N = 74, 48%), and arterial blood gas collection & interpretation (N = 49, 32%). Conclusion It is important to identify priority areas for training and skills development to address in the PCC master’s within the child health pathway at KUHeS. Ideally this partnership will produce practice-ready PCC nurses and will establish a recognized PCC nursing workforce in Malawi.

The challenges confronting the training needs assessment in Saudi Arabian higher education

This research examines the problems encountered by the Training Needs Assessment (TNA) system from the perspective of faculty members and Human Resources (HR) managers in emerging public universities in the Saudi Arabian Higher Education sector. It aims to understand how problems with this will affect the success rate of Training and Development (T&D) curriculums. The research comprises an analytical study using a case study method of analysis. Qualitative data collection was carried out using semi-structured interviews with 75 senior managers and faculty members of four selected universities, selected using purposive non-random sampling. The data was analysed using Thematic Analysis (TA). The results highlight the insufficiency of the TNA techniques applied to ascertain training requirements. The primary obstacles to successful TNA were inadequate HR processes, insufficiently experienced HR directors, poor engagement, and favouritism concerning the selection of candidates for T&D. These issues affect the enthusiasm of those in the department. Additionally, resources required for T&D, particularly time and money, are misused, which could influence the growth potential of the universities against the country’s Vision 2030 plan. The findings indicate procedural differences in selecting and approving staff requests for Human Resource Development (HRD) support, managerial discretion in selecting participants for HRD programmes, and selective or restricted access to HRD programmes for foreign-born employees, which raises significant questions about equality policies. This study is unique as a contribution to the literature in exploring the challenges faced by the TNA process in Saudi Arabian Higher Education, therefore broadening understanding in the field as a whole, especially concerning the developing countries and Gulf Cooperation Council of Nations. The study concludes that there is currently unsatisfactory commitment in determining the staff training needs by the HR departments of Saudi Arabian public universities, which damages morale and leads to a lack of faith between HR directors and departmental staff. Finally, this study contributes to the area of policy decision-making by reporting the present situation surrounding the issues related to the application of TNA in T&D.

“Necessidades de saúde”: reflexões acerca da (in)definição de um conceito

Resumo Definir um conceito de necessidades em saúde é fundamental para estabelecer limites às intervenções médico-sanitárias, sejam individuais ou coletivas. Como muitas expressões de uso técnico corrente, há uma variação considerável dos sentidos atribuídos à expressão “necessidades de saúde”. A hipótese que guiou este trabalho é de que a literatura especializada apresenta uma falta de rigor na definição e utilização do termo, o que constitui em si um problema ético e político, visto que pode reverberar em questões como alocação de recursos, na definição de estratégias e ações de um projeto terapêutico. Foi realizada uma análise temática em artigos publicados nas bases BVS e Pubmed em português, espanhol e inglês, com os respectivos descritores: determinação de necessidades de cuidados de saúde, evaluacíon de necessidades e needs assessment. Constatou-se que “necessidades de saúde” é um objeto pouco explorado numa perspectiva que envolva sua reflexão. Há uma ausência de definição conceitual nos trabalhos em que aparece, denotando uma falta de uniformidade no entendimento teórico acerca dessa expressão. A falta de um conceito strictu sensu e a complexidade dos fatores envolvendo o descritor resulta em um uso difuso, com problematização incipiente e, por vezes, conveniente ao contexto empregado.