Men and Women of the Corporation

Many countries in middle- and low-income countries today suffer from severe staff shortages and/or maldistribution of health personnel which has been aggravated more recently by the disintegration of health systems in low-income countries and by the global policy environment. One of the most damaging effects of severely weakened and under-resourced health systems is the difficulty they face in producing, recruiting, and retaining health professionals, particularly in remote areas. Low wages, poor working conditions, lack of supervision, lack of equipment and infrastructure as well as HIV and AIDS, all contribute to the flight of health care personnel from remote areas. In this global context of accelerating inequities health service policy makers and managers are searching for ways to improve the attraction and retention of staff in remote areas. But the development of appropriate strategies first requires an understanding of the factors which influence decisions to accept and/or stay in a remote post, particularly in the context of mid and low income countries (MLICS), and which strategies to improve attraction and retention are therefore likely to be successful. It is the aim of this review article to explore the links between attraction and retention factors and strategies, with a particular focus on the organisational diversity and location of decision-making. This is a narrative literature review which took an iterative approach to finding relevant literature. It focused on English-language material published between 1997 and 2007. The authors conducted Pubmed searches using a range of different search terms relating to attraction and retention of staff in remote areas. Furthermore, a number of relevant journals as well as unpublished literature were systematically searched. While the initial search included articles from high- middle- and low-income countries, the review focuses on middle- and low-income countries. About 600 papers were initially assessed and 55 eventually included in the review. The authors argue that, although factors are multi-facetted and complex, strategies are usually not comprehensive and often limited to addressing a single or limited number of factors. They suggest that because of the complex interaction of factors impacting on attraction and retention, there is a strong argument to be made for bundles of interventions which include attention to living environments, working conditions and environments and development opportunities. They further explore the organisational location of decision-making related to retention issues and suggest that because promising strategies often lie beyond the scope of human resource directorates or ministries of health, planning and decision-making to improve retention requires multi-sectoral collaboration within and beyond government. The paper provides a simple framework for bringing the key decision-makers together to identify factors and develop multi-facetted comprehensive strategies. There are no set answers to the problem of attraction and retention. It is only through learning about what works in terms of fit between problem analysis and strategy and effective navigation through the politics of implementation that any headway will be made against the almost universal challenge of staffing health service in remote rural areas.

https://link.springer.com/content/pdf/10.1186%2F1472-6963-8-19.pdf

Staffing remote rural areas in middle- and low-income countries: A literature review of attraction and retention

Instrument content validity is often established through qualitative expert reviews, yet quantitative analysis of reviewer agreements is also advocated in the literature. Two quantitative approaches to content validity estimations were compared and contrasted using a newly developed instrument called the Osteoporosis Risk Assessment Tool (ORAT). Data obtained from a panel of eight expert judges were analyzed. A Content Validity Index (CVI) initially determined that only one item lacked interrater proportion agreement about its relevance to the instrument as a whole (CVI = 0.57). Concern that higher proportion agreement ratings might be due to random chance stimulated further analysis using a multirater kappa coefficient of agreement. An additional seven items had low kappas, ranging from 0.29 to 0.48 and indicating poor agreement among the experts. The findings supported the elimination or revision of eight items. Pros and cons to using both proportion agreement and kappa coefficient analysis are examined.

Two Quantitative Approaches for Estimating Content Validity

Behavioral Risk Factor Surveillance System

Synopsis of Psychiatry

In many areas of the world, the discipline and profession of nursing has been strengthened through the efforts of strong and effective leaders in education, research and clinical practice. The Seventy-second World Health Assembly designated 2020 as the International Year of the Nurse and the Midwife; not only to honour the 200th anniversary of the birth of Florence Nightingale, but also to recognize the contributions of nurses and midwives to the health and well-being of the world's population. Recently, on World Health Day, the World Health Organisation (WHO) released the State of the World's Nursing 2020 report providing data on nursing globally (WHO 2020). The report also provides a compelling case for development of the global nursing workforce, investment in nursing education, jobs, and leadership. However, operationalizing these recommendations will require investment and support at all levels of government and across all health jurisdictions.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jocn.15305

Who speaks for nursing? COVID-19 highlighting gaps in leadership.

SARS‐CoV‐2, the virus that causes COVID‐19, is wreaking havoc around the world. This unprecedented pandemic has led to illness, death, and economic destruction. The pandemic has challenged health care systems globally for a range of reasons. In developed economies the focus on non‐communicable diseases rather than infectious diseases have caught us short. A period of complacency and a lack of focus on potential pandemics has meant that documented shortages of personnel, workforce and equipment has limited healthcare delivery.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/jocn.15347

Vulnerability of nurse and physicians with COVID-19: Monitoring and surveillance needed.

Development of quality of nursing care in Thailand



Background. In Thailand there is a need to establish definitions of quality of nursing care and to determine how it is measured. There is an urgent need to focus more closely on indicators of nursing quality. In Thailand there is no agreed upon definition of quality nursing care or indicators by which to measure it.



Purpose. The purpose of this research was to develop a definition of quality of nursing care and to begin the process of defining quality of care indicator measures to evaluate the care given in acute care settings.



Methods. This descriptive study was conducted in Thailand. The process included two phases. The first phase used individual interviews and focus group discussion and the second phase included consultation with quality of nursing care experts. An interview guide was used to structure the interviews and the draft definitions of quality and suggested indicators were used when consulting with the experts in the second phase of the study.



Findings. The findings are organized into two sections: (1) definition of quality of nursing care and quality of nursing indicators; and (2) consultation with Thailand quality experts to refine the definition and quality of care indicators. The indicators were categorized into three groups: structure, process, and outcome.



Limitations. This descriptive study using qualitative method relied upon the opinions of various stakeholders. Their opinions may or may not have any direct relationship to the scientific literature related to quality. Many of the indicators need to be further refined.



Conclusions. The findings generally support the initial work done in the United States of America. There is a need to further refine the various Thailand indicators. This study is the first in Thailand that has attempted to address quality of nursing care.

Development of quality of nursing care in Thailand.

Little is known about how health disparities affect the health status and general health perceptions of Hispanics living in Texas colonias. The purpose of this study was to conduct a health survey of residents (n = 216) of a colonia community on the border between El Paso, Texas and Juarez, Mexico. Instruments used in this study included a researcher developed demographic questionnaire, the Short Acculturation Scale for Hispanics (SASH), Cutting down, Annoyance by criticism, Guilty feeling and Eye-openers (CAGE) for alcohol consumption, and the Short Form version 2 (SF36v2) health survey. Study findings show the average participant was approximately 42 years old, attained an average of 9.6 years of education, earned an average annual household income of $17,575 and had an average SASH score of 25.4. SASH scores range from 12 to 60, with higher scores suggesting higher levels of American acculturation. Findings from this health survey suggest the average resident of the colonia may have health disadvantages when compared to residents from other parts of El Paso and Texas. Binge drinking was self-reported by 13.4% of all participants; with 5.6% having a CAGE score greater than 2 (indicating an increased propensity towards problems with alcohol). The self-report rates of diabetes, depression and anxiety were 15.3%, 20.4% and 16.7% respectively. The SF36v2 composite functional health status scores mirrored the national norms.

A health survey of a colonia located on the west Texas, US/Mexico border.

Objective: The goal of this study was to develop a method to scientifically create and validate a coordinated care path for use within any hospital setting. Background: In an attempt to reduce the costs associated with high-volume and high-risk diagnosis, attention was focused on reducing patients' length of stay in the hospital. A method to reduce length of stay use a coordinated care path. A path is a guideline used to manage the clinical care of selected patients. The literature is relatively silent regarding studies that have scientifically validated the use of these paths. Methods: This project used a content validity method to validate the care path. Using current research findings, best practice standards both locally and nationally, a transdisciplinary team developed practice guidelines that included sequencing, timing of interventions, and expected patient outcomes. The path was rated by local and national experts using a four-point rating scale. Using Lynn's proportion of experts table computations, the validity of the path and each of its components was determined. Results: Of 161 items on the care path, 10 were not validated. The experts validated the instrument as a whole. Of the 161 items, 151 were validated. This is an instrument validation rate of 0.94. No additional changes or modifications to the path were suggested by the experts. The transdisciplinary team addressed the nonvalidated items. This method can be used to develop other coordinated paths for other diagnostic groups.

Robert L. Anders

Papers

Who speaks for nursing? COVID-19 highlighting gaps in leadership.

Vulnerability of nurse and physicians with COVID-19: Monitoring and surveillance needed.

Development of quality of nursing care in Thailand.

A health survey of a colonia located on the west Texas, US/Mexico border.

Development of a scientifically valid coordinated care path.