搜索结果：The Journal of nursing education

•The National Academy of Medicine report, The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity calls for a series of policy reforms to unleash the potential of nurses to play greater roles in advancing health equity.•The report recommends that the systems that educate, pay and employ nurses: 1) permanently remove barriers to care; 2) value their contributions; 3) prepare nurses to tackle health equity; and 4) diversify the workforce. The need to fully support nurses is interwoven throughout the report.•All nurses should work in partnership with others to advance the nine major report recommendations. The National Academy of Medicine's long-anticipated report, The Future of Nursing 2020–2030: Charting a Path to Achieve Health Equity, offers an aspirational vision: the achievement of health equity in the United States built on strengthened nursing capacity, diversity, and expertise (Wakefield, 2021Wakefield M. Federally qualified health centers and related primary care workforce issues.Jama. 2021; 325: 1145-1146Crossref PubMed Scopus (10) Google Scholar). Released in May 2021, the report arrives at a critical moment for the profession. Many nurses are burned out, exhausted, and have experienced moral injury from caring for an unrelenting stream of patients with COVID-19. The pandemic has laid bare and further exacerbated long-existing health inequities. School closings during the pandemic similarly exacerbated educational disparities, and poor treatment of Black, Indigenous, and other people of color by police spotlighted inequities in law enforcement. Collectively, these inequities have resulted in renewed calls to dismantle structural, cultural, and interpersonal racism, including within nursing. This new report provides a roadmap for how the nursing profession can contribute its expertise to create a fairer, more just and healthier world. The report is the second collaboration between the Robert Wood Johnson Foundation (RWJF) and the National Academy of Medicine (NAM) on the future of nursing. The first report, released in 2010, re-conceptualized the role of nurses in transforming the healthcare system (Shalala et al., 2011Shalala D. Bolton L.B. Bleich M.R. Brennan T. Campbell R. Devlin L. The future of nursing: Leading change, advancing health. 10. The National Academy Press, Washington DC2011: 12956https://www.nap.edu/catalog/12956/the-future-of-nursing-leading-change-advancing-healthGoogle Scholar). RWJF and AARP formed The Future of Nursing: Campaign for Action, a nationwide initiative to advance the report recommendations. Over the past decade, the nursing field strengthened nursing education, advanced practice, promoted leadership, and increased workforce diversity. In doing so, the nursing field has built – and is continuing to build – its capacity to provide high-quality care to more Americans. As nursing built its capacity and as the evidence increasingly linked inequities to poorer health status, it became clear that nurses could do more to build healthier communities and advance equity. Nurses are the most trusted profession and the first point of contact for most people seeking health care. They are bridge builders and collaborators who engage and connect with people, communities, and organizations to promote health and well-being (Pittman, 2019Pittman, P. (2019,. March 12). Activating nursing to address the unmet needs of the 21st century: Background paper for the NAM Committee on Nursing 2030.Robert Wood Johnson Foundation. Available at: https://publichealth.gwu.edu/sites/default/files/downloads/HPM/Activating%20Nursing %20To%20Address%20Unmet%20Needs%20In%20The %2021st%20Century.pdfGoogle Scholar). Their expertise could be better used to combat the many shortcomings of the U.S. health system. The United States spends $3.5 trillion each year on health care (CMS, 2020) more than any other country in the world but ranks last compared with other high-income countries on equity, access to care, health care outcomes, and administrative efficiency (Schneider et al., 2021Schneider, E. et al.,(2021, August)) Mirror, Mirror 2021 — Reflecting Poorly: Health Care in the U.S. compared to other high-income countries (Commonwealth Fund). https://doi.org/10.26099/01dv-h208.Google Scholar). Life expectancy, infant mortality and maternal mortality are worse in the United States compared with other high-income nations. Disparities in health care access and outcomes related to race, income, geography and other social and environmental factors are also common. RWJF has long believed that nurses have enormous potential for tackling the shortcomings of health and health care in the United States and in 2019 asked the NAM to form a committee tasked with charting a path for the nursing profession to create a culture of health, reduce health disparities, and improve the health and well-being of the nation. As the committee was well into the process of reviewing evidence and preparing to write the report, the pandemic took hold across the country and shined a light on the nation's rampant health inequities. The committee delayed the report to incorporate the major lessons from the pandemic: its disproportionate and devastating toll on poor and marginalized populations that could largely be attributed to persistent health disparities; the need to fully support nurses; and better prepare the workforce for future disasters. Released in May 2021, the report called for a series of policy reforms to unleash the potential of nurses to play greater roles in advancing health equity. The report recommends that the systems that educate, pay, and employ nurses: (1) permanently remove barriers to care; (2) value their contributions; (3) prepare nurses to tackle health equity; and (4) diversify the workforce. The report underscores that prioritizing nurse well-being is paramount to advancing the recommendations. In addition, the report calls on national nursing organizations to develop a shared agenda for addressing the social determinants of health and achieving health equity. Finally, the committee prioritized research needs to build the evidence base to support nurses in advancing health equity. Each of these areas is discussed below. Far too often in the United States, people do not see a health care provider when they need one. Nearly 30 million people are uninsured in the United States, and roughly 40 million have health plans that leave them potentially underinsured (Collins et al., August 2020Collins, Sara R., Gunja, Munira Z., & Aboulafia, Gabriella N. (2020). U.S. Health insurance coverage in 2020: A looming crisis in affordability — findings from the Commonwealth Fund Biennial Health Insurance Survey, 2020.Commonwealth Fund. https://doi.org/10.26099/6aj3-n655.Google Scholar). In addition, timely access to health care is undermined due to the inability to pay; geographic inaccessibility to services and providers, particularly in rural and underserved urban areas; lack of health literacy; and fundamental mistrust of the health care system and providers. Research demonstrates that delays in obtaining care can lead people to experience worse symptoms and disease progression (Man et al., 2018Man R.X.G. Lack D.A. Wyatt C.E. Murray V. The effect of natural disasters on cancer care: A systematic review.The Lancet Oncology. 2018; 19: e482-e499https://doi.org/10.1016/S1470-2045(18)30412-1Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar). Nurses can help to explicitly address these gaps in access to care. For example, about 70% to 80% of advanced-practice nurses work in primary care, including in pediatrics, adult practice, gerontology, and nurse midwifery. While the primary care nurse practitioner field has grown, the number of physicians entering primary care has stagnated or declined (Barnes et al., 2018Barnes H. Richards M.R. McHugh M.D. Martsolf G. Rural and nonrural primary care physician practices increasingly rely on nurse practitioners.Health Affairs. 2018; 37: 908-914https://doi.org/10.1377/hlthaff.2017.1158Crossref PubMed Scopus (127) Google Scholar; Barnes et al., 2018Xue Y. Ye Y. Brewer C. Spetz J. Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.Nursing outlook. 2016; 64: 71-85https://doi.org/10.1377/hlthaff.2017.1158Crossref PubMed Scopus (117) Google Scholar). Care provided by nurse practitioners has been found to be comparable to the care provided by physicians, according to numerous studies (Perloff et al., 2019Perloff J. Clarke S. DesRoches C.M. O'Reilly-Jacob M. Buerhaus P. Association of state-level restrictions in nurse practitioner scope of practice with the quality of primary care provided to Medicare beneficiaries.Medical Care Research and Review. 2019; 76: 597-626Crossref PubMed Scopus (24) Google Scholar; Yang et al., 2020Yang B.K. Johantgen M.E. Trinkoff A.M. Idzik S.R. Wince J. Tomlinson C. State Nurse Practitioner practice regulations and US health care delivery outcomes: A systematic review.Medical Care Research and Review. 2021; 78: 183-196https://doi.org/10.1177/1077558719901216Crossref PubMed Scopus (32) Google Scholar). They are less expensive to employ than physicians and are more likely to care for vulnerable populations, including those in rural areas (Perloff et al., 2016Perloff J. DesRoches C.M. Buerhaus P. Comparing the cost of care provided to Medicare beneficiaries assigned to primary care nurse practitioners and physicians.Health Services Research. 2016; 51: 1407-1423Crossref PubMed Scopus (83) Google Scholar). However, the ability of nurses to expand access to care is limited by state and federal laws, institutional barriers, and restrictive health systems policies that prohibit them from working to the full extent of their education and training (Wakefield et al., 2021Wakefield M.K. Williams D.R. Le Menestrel S. Flaubert J.L. 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While the advent of Covid-19 has required nurse faculty be innovative, flexible, nimble and agile, there have been challenges. For example, faculty have had to move in-person classes online, conceptualise and offer alternative clinical experiences, and re-define how student performance is evaluated and graded. When we look back on this experience, what will faculty have learned from these experiences, and what are possible changes arising from these learnings? The move to online education has required faculty make changes to examination procedures and grading practices while implementing strategies to foster student engagement (Jackson et al., 2020). Many institutions have moved to a pass/fail rather than a letter grading system. Some institutions have offered students limited choices of how they wish to be graded. For example, at the University of California—Berkeley, decided the default for all class will be pass/fail. However, students have the option to select a letter grade instead (A's for all? Universities debate how to grade during a pandemic, 2020). Moreover, in many parts of the world, the move to providing education in an online format has highlighted several issues associated with online learning. First, faculty must be clear about the difference between what many are doing—offering education in an emergency distance learning format—and robust online education. While many academic institutions, and nursing programs, may have embraced online education and have well developed plans about how to offer robust online programs, COVID-19 has propelled many faculty to offer online education in the absence of “well-considered, durable learning plans” (Gardner, 2020, p. 21). Emergency remote teaching is “a temporary shift of instructional delivery to an alternate delivery mode due to crisis circumstances” (Hodges, Moore, Lockee, Trust, & Bond, 2020, np). More thoughtful, systematic approaches will be needed to make the transition to online teaching and learning successful and permanent. Second, online education has made very visible disparity issues that affect students’ ability to learn and be successful. For example, students restricted to home may not have access to the Internet or Wi-Fi; students in rural areas may not have access to the broadband width necessary to access more sophisticated learning materials such as videos or voice-over PowerPoint© presentations; irrespective of geographic location, students may not have access to laptops and computers at home. Such limitations call for increased faculty sensitivity as they implement online education. Rethinking presentation of online information in a low-fidelity format is one solution to address some of these issues. But doing so requires thought and intentional planning. However, both these activities require time—a privilege not accorded during the pandemic. The challenge to provide relevant clinical experiences has resulted in an increased use of simulation, telehealth and virtual reality while being sensitive to regulatory requirements stipulated by state or country boards of nursing. Although these resources are available, nurse faculty have been challenged by availability of resources—not all academic institutions have needed technology—and be regulatory requirements. Fortunately, some regulatory bodies have altered the percentage of direct patient care student contact hours consequent to COVID-19. For example, the California State Board of Nursing decreased the direct patient care clinical hour requirement for students in obstetrics, paediatrics and mental health/psychiatric course from 75% to 50% and increased the accepted percent of clinical practice from 25% to 50% (State of California, Department of Consumer Affairs, 2020) https://www.dca.ca.gov/licensees/clinical_hours_guidance.pdf. Such flexibility makes possible timely student graduation. In addition, organisations such as the Society for Simulation in Healthcare (https://www.ssih.org/) have been offering numerous strategies including how to use high-fidelity manikins to provide meaningful clinical learning experiences. Planning meaningful clinical learning experiences has been challenging, and in some instances, fraught with ethical dilemmas. While some clinical agencies have supported continuing to have students in their agencies, others have not. Moreover, faculty and educational administrators have questioned how nursing students could be sent to a facility that may not be able to provide them with adequate personal protective equipment (PPE), or how faculty whose average was 59, many of whom had underlying health issues, could be asked to supervise these students, all this despite please from healthcare facilities for help. A typical first response to the COVID-19 experience may be to add or reinforce content about infectious diseases to the curriculum. In fact, this is what the American Association of Colleges of Nursing (2020) has suggested: Minimally, topics such as surveillance and detection, isolation, quarantine, and containment, and proper handwashing, cough and respiratory etiquette should be addressed (https://www.aacnnursing.org/Portals/42/AcademicNursing/pdf/Considerations-for-COVID19-Nursing-Schools.pdf). However, adding content to an already overloaded curriculum will not be the solution to preparing nurses for a future in which events such as Covid-19 become more common, given the number of new and lethal viruses that have surfaced since the beginning of the 21st century. Rather nurse faculty need to be deliberate in determining what content is taught—an undertaking that has challenged faculty for years. There is no better time to re-envision what constitutes core content for entry-level (prelicensure) students and what strategies best help them learn than the present. To paraphrase the WHO State of the World's Nursing (2020), focus of nurse preparation should be on delivering primary care, “ensuring quality of care and patient safety, preventing and controlling infections, and combating antimicrobial resistance” (p. 12). Curricula need to be explicit about the nurse's role in “health promotion, health literacy and management of noncommunicable diseases” (p. 13). Preparing nurses for their critical role managing epidemics should be an integral part of the curriculum, irrespective of educational level (undergraduate or graduate). Emphasis on population health should be strengthened. Given implementation of student engagement activities such as the flipped classroom has had limited success, the need for future healthcare workers to be well prepared to care for an increasing aging population and those with mental health issues, and advances in the neuroscience of learning, the possibility exists that current curricula, and teaching and learning practices are not adequate. Perhaps the time is now to reconsider what constitutes critical information and competencies for entry-level nurses. It is possible, given societal healthcare needs, that content considered critical decades ago is no longer relevant OR cannot be learned in the current time frame. These possibilities lead to two responses: decrease or change the focus of content included in the education of nurses OR increase the time to completion. The former seems more appealing than the latter. That said what information could be removed? What information could be expanded? For example, although care of mothers, infants and children is considered essential undergraduate knowledge in most countries, one could argue that this information is more specialised and warrants being offered at the postgraduate level. Doing so would provide room for inclusion of more comprehensive information about critical care nursing, noncommunicable diseases, social determinants of health, infectious diseases and the nurse's role in planetary health in the curriculum. Perhaps this is the time to revisit what constitutes a generalist nurse prepared at the undergraduate level. It is time to move from a focus on content to a focus on competency-based education (Barton, Murray, & Spurlock, 2020). Competencies “provide the structure and process for performance and assessment ‘…’the intended outcome” (Giddens, 2020, p. 124). A focus on competency-based education could accelerate the production of nurses, provide increased flexibility in terms of content taught and help address current criticisms by many clinical practice colleagues about new graduate nurses’ inability to think critically. The International Confederation of Midwives’, 2019 Essential Competencies for Midwifery Practice is an example of how integrated statements convey expectations, including necessary knowledge, skills and behaviours to produce an educated midwife. In many parts of the world, it takes three to four years to educate a nurse. Often content relevant to the discipline is offered in the final two years of the curriculum (Very common in the United States). However, given evidence from neuroscience of teaching and learning (Ambrose, Bridges, DiPiertro, Lovett, & Norman, 2010), distributing disciplinary content overall years of the curriculum may provide students the opportunity and time to process and practice what they are learning. Such a practice is not common in many parts of the world. The structure of the academic semester may need to change (McMurtrie, 2020). For example, as is common in many online nursing programs, courses are offered in 7-week segments. Perhaps there is rationale for offering select courses in even less time. Although this option may be appealing, the challenge in any practice discipline is to assure students have the opportunity to practice what they have learned in class in the clinical setting. While regulatory bodies have stipulated hours of clinical practice, for example the Nursing and Midwifery Board of Ireland (NMBI) has stipulated the minimum number of theoretical (1,533) and clinical hours (2,300) required in order to register to practice in the country and the North Carolina State Board of Nursing has stipulated 120 hr of focused client care experience in the final year of registered nurse curricula, there is no evidence to date to support the range of stipulated clinical hours (Bowling, Cooper, Kellish, Kubin, & Smith, 2018). Adopting competencies and examining alternative evaluation methods such as objective structured clinical examinations (Kolivand, Esfandyari, & Heydarpor, 2020; Walsh, Bailey, & Koren, 2009) may be one approach to providing evidence to determine the number of clinical hours necessary for registration or licensure. Irrespective of changes are made or not made, it is imperative that nurse faculty systematically research student outcomes based on modifications made during the pandemic. Such information will help faculty be ready for the next pandemic. However, of utmost importance is that research efforts be rigorous and ethically developed (Barton et al., 2020). Lastly, those of us who are responsible for educating future nurses must continue to reinforce the essential contribution nurses make to the health of society. Given the life-threatening experiences demonstrated by caring for COVID-19 patients, students who may have considered nursing as a career may no longer entertain the possibility. Nurse faculty must assure students they will be provided an education that prepares them to be knowledgeable caregivers. To do less would be a travesty and would threaten the future supply of nurses—a supply that will continue to be sorely needed.

BackgroundAlthough perceived distance is a key factor in deciding and reaching healthcare, its impact on antenatal care (ANC) utilisation remains underexplored.ObjectiveThis study aims to examine the effect of perceived distance on ANC uptake, stratified by key maternal characteristics.DesignCross-sectional analysis based on demographic and health survey data (DHS).MethodsThis study analysed the demographic and health survey data of 26 sub-Saharan African countries, comprising 186,873 women who had given birth within the five years preceding the surveys. The exposure variable was perceived distance to a healthcare facility, categorised as "a big problem" or "not a big problem." Whereas the outcome variable was the number of ANC contacts, classified as no, one to three, four to seven and eight or more contacts. A Generalised Structural Equation Model (GSEM) with a multinomial logit link was employed to examine the association. Analyses were further stratified by socio-demographic characteristics.ResultsThe analysis revealed that women who perceived the distance as a major problem had 15% higher odds of receiving only 1-3 contacts (aOR = 1.15, 95% CI: 1.05, 1.25, p = 0.002), and 51% higher odds of receiving no ANC (aOR = 1.51, 95% CI: 1.35, 1.66, p < 0.001), compared to those receiving eight or more contacts. These associations were particularly pronounced among women with lower educational status (aOR=1.48, 95%CI: 1.29, 1.64), rural residents (aOR=1.55, 95%CI: 1.37, 1.74), low household income (aOR=1.47, 95%CI: 1.27,1.68), and younger age (aOR=1.55, 95%CI: 1.31, 1.80).ConclusionPerceived distance remains a significant barrier to the utilisation of antenatal care services in resource-limited settings. Strengthening health system responsiveness and addressing structural barriers, such as transportation infrastructures, through innovations like mobile antenatal care is vital to improving maternal health outcomes and advancing global health equity. Ensuring access to high-quality antenatal care (ANC) is essential for improving maternal and newborn health outcomes. However, evidence on the effect of geographical distance on ANC use in sub-Saharan Africa remains limited and inconclusive. This study examined the relationship between perceived distance to a health facility and ANC utilisation across 26 sub-Saharan African countries. We analysed the Demographic and Health Survey (DHS) data from 186,873 women who had given birth in the five years preceding the survey. Women who reported that distance to a health facility was a major problem had 15% higher odds of attending only 1-3 ANC contacts and 51% higher odds of receiving no ANC, compared with women who attended at least eight contacts. These associations were stronger among women with lower levels of education, those living in rural areas, women from low-income households, and younger women. These findings underscore the importance of addressing perceived distance-related barriers to improve uptake of the WHO-recommended number of ANC contacts and to promote equitable access to maternal health services in sub-Saharan Africa.

The development and integration of geriatric medicine into national health care systems vary widely across countries. While a robust care workforce requires providers from several disciplines, including nursing, social sector, rehabilitation, psychiatry, neurology, and others, a strong core of highly qualified geriatricians is essential to delivering older person-centred and integrated care. The number and professional profile of geriatricians, along with the status of the specialty, are important to informing efforts to reshape health care systems in response to the global ageing scenario. WHO developed and distributed a structured questionnaire to representatives of national geriatrics and gerontology societies beginning in March 2025. The survey collected data on the status of the geriatric medicine specialty, including its formal recognition at the country level, the estimated number of practising geriatricians, and information on training curricula, professional environments, and systemic challenges. A total of 48 national societies completed the survey. Recognition of geriatric medicine ranged widely, from full specialty status in some countries to subspecialty or non-recognition in others. The number of practicing geriatricians per 100,000 persons aged 60 years and older ranged from <0.1 to >30 across countries, illustrating marked workforce disparities and some severe shortages. Where the geriatric medicine specialty is formally available, pre-service training durations ranged from 24 to 96 months. Geriatricians worked in diverse settings, though integration into primary care and public health was limited. Training in and exposure to geriatric medicine principles during undergraduate and postgraduate medical training were minimal in many countries. Key challenges included workforce shortages, fragmentation of care, and undervaluation of the speciality's role in informing health care for older people. Strategic priorities reported by respondents included investment in training, policy development, and institutional support. The survey highlights disparities in geriatric medicine across countries and identifies several challenges and priorities. Strengthening education, policy, and workforce development is essential to meet the needs of ageing populations and support healthy ageing worldwide. At the same time, countries should also think of innovative approaches and building capacity of existing other health occupations to improve geriatric care. Future updates of this survey will provide longitudinal insights into workforce evolution. These findings provide a global evidence base to guide workforce planning and policy under the United Nations Decade of Healthy Ageing (2021-2030).

Access to safe, high quality, acceptable and sustainable general practice (GP) and primary care services is essential to improved health outcomes and quality of life for people living in residential aged care homes (RACH). There are, however, critically low levels of service availability and a decline in GPs providing RACH services globally, suggesting there is an urgent need for safe and effective models of care. Telehealth, delivered as part of a holistic model of care, offers a solution to address this gap but comprehensive, person-centred research is needed to directly assess its effect on safety and quality of care in RACH settings. This collaborative 4-year project (General practice and Residential Aged CarE: GRACE video-telehealth) will (1) scope current telehealth models of care and their acceptability and person-centredness, including identifying the barriers and enablers experienced by RACH residents, carers, staff, GPs and practice managers; (2) co-design a best-practice model of care with an accompanying suite of digital resources and education materials to improve the uptake of video-telehealth; and (3) implement and evaluate this best-practice model of care. This is a mixed-methods study of residents, carers, RACH staff, GPs and their practice teams that will be conducted across New South Wales, Australia. This protocol describes a staged approach across three phases. In Phase 1, we will collect baseline measures of the frequency of telehealth use in GP practices and RACHs, clinical outcomes (eg, hospitalisations), questionnaires to measure person-centred care, satisfaction and usability of telehealth and qualitative observations and semi-structured interviews. In Phase 2, we will conduct workshops to co-design an intervention that will include developing a model of care to support person-centred video-telehealth, with an accompanying online hub of resources and educational materials to facilitate and support its utilisation. In Phase 3, we will implement and evaluate the intervention. Data will be analysed statistically and thematically and synthesised. Ethics approval has been obtained from the University of Sydney Human Research Ethics Committee (2025/000340) (human.ethics@sydney.edu.au). Prior informed written consent will be obtained from all research participants. Findings from each phase of the study will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales and Australia.

Comprehensive pain management in children requires a specialized skillset, with a limited number of clinicians possessing the level of expertise required to successfully navigate the complexities of holistic care. The emergence of pediatric anesthesia fellowship programs in sub-Saharan Africa presents an opportunity to embed a pediatric pain curriculum for trainees, improving the availability of specialist skill and knowledge in the field. Existing pain curricula fall short in addressing the sociocultural aspects of pediatric pain identified through research as being unique to the African context, and do not include elements of leadership and advocacy training required to navigate the complexities of resource-constrained healthcare settings. A Delphi survey including literature review, iterative rounds of surveys and expert consensus was used to establish a pediatric pain curriculum for pediatric anesthesia fellows undertaking advanced training in sub-Saharan Africa. The 22-member expert panel included anesthetists, nurses, surgeons, pharmacists, pediatricians, a physiotherapist and a patient-caregiver dyad with a lived experience of pain. After completing three rounds of surveys, a steering committee of five members was assembled to resolve outstanding items to achieve the final curriculum. The process yielded a curriculum containing 20 knowledge items and 23 skills items. Attitudes are a key component of the curriculum and were grouped into six themes. A further aspect of the process was the identification of foundational knowledge with which trainees should enter a fellowship training program. This was termed the foundational curriculum. Using a Delphi method, consensus has been achieved on a pediatric pain curriculum for pediatric anesthesia fellows in sub-Saharan Africa with potential to meet the identified need for transformative pain care in this patient population.

Effective coverage (EC) has emerged as a better measure of service coverage, in the past decades, compared to the simple crude coverage measures. It represents the proportion of a population in need of a service that successfully receives it with sufficient quality to achieve the intended health benefits. Nevertheless, EC in maternal and newborn health (MNH) services are significantly variable across and within countries. Therefore, this study aimed to identify the societal and health system factors that can explain why some countries are having higher EC of MNH services than others in Sub-Saharan Africa (SSA). A mixed-method case study design was employed with inclusion of document review. Effective coverage rates were estimated using countries demographic and health survey (DHS) datasets. Two countries were then selected for each MNH service domain from each performance category, high, medium, and low, for further analysis of explanatory factors. Data sources included DHS and health facility survey summary reports, the Global Health Expenditure Database, and TheGlobalEconomy.com. We found huge variation in EC of MNH services across countries in SSA. The scores range from 7% in Ethiopia to 64% in Liberia for 4+ ANC visits, 9% in Ethiopia and Nigeria to 81% in Rwanda for institutional delivery, 3% in Ethiopia to 77% in Gambia for PNC mothers, and 1% in Ethiopia to 68% in South Africa for PNC newborns. These discrepancies are highly likely influenced by multilevel health system and societal factors. High-performing countries in EC of MNH services have higher service availability and readiness scores than medium- and low-performing ones. For instance, Ghana and Liberia scored 83% and 84%, respectively, for tracer indicators of ANC service availability, compared to 43% in Ethiopia and 64% in Malawi. Similar pattern is observed between the selected countries EC estimates of MNH services and their health service specific readiness index scores. In addition, they also have favourable societal factors including high proportion of women attending primary and/or more school levels, better mass media and internet access, and relatively lower political instability indexes. Low-performing countries like Ethiopia and Nigeria had complex futures including having low health service availability and readiness scores and unfavourable societal factors including in women's education, and internet and mass media access. Furthermore, the two countries had weakest average political stability index that hinders the utilization and delivery of MNH services. The findings revealed that better health service availability and readiness, strong healthcare financing, favourable societal factors and having a relatively stable political index are critical in determining countries performance in EC of MNH services. Therefore, countries, particularly low performers in EC of MNH services need to learn from positive outliers in improving EC of MNH services. Strengthening existing health facilities with better staffing, training, and resources is crucial beyond merely expanding new ones.

Polypharmacy is a growing health care concern that is ameliorated through deprescribing, the process of safely removing inappropriate medications. Despite the proven benefits of deprescribing, formal deprescribing education in the health professions in the United States, including interprofessional deprescribing activities, is limited. A deprescribing interprofessional educational (IPE) simulation activity was conducted with 52 third- and fourth-year health professions students to improve their understanding of deprescribing and communication among the interprofessional health care team. The virtual simulation featured prebriefing, an unfolding case study, and debriefing. In total, 21 MD students, 20 PharmD (Doctor of Pharmacy) students, and 11 DNP (Doctor of Nursing Practice) and FNP (Family Nurse Practitioner) students participated in the IPE simulation activity. A retrospective pre/post survey was administered, with 49 students (94%) responding. Participants provided positive feedback about the simulation, indicating that they rated the activity highly, valued the unfolding case study used, and were able to consolidate their learning on deprescribing. IPE activities are a promising avenue for deprescribing education.

Group antenatal care (G-ANC), integrating medical care with education, has demonstrated positive effects on maternal and newborn health. Individual studies have shown promising evidence in sub-Saharan Africa, but systematically synthesising the existing research would facilitate implementation and identify gaps for further research. This systematic review aimed, therefore, to review the existing evidence on feasibility, acceptability and effectiveness of G-ANC in resource-limited settings to guide policy and support implementing G-ANC to reduce maternal and perinatal mortality. A systematic and comprehensive literature search was conducted in the PubMed/MEDLINE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase) and Google Scholar electronic databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses of healthcare interventions were followed. Data were extracted using a prespecified protocol and quality was assessed using the Joanna Briggs Institute appraisal tool. Random-effects meta-analyses were used to pool estimates. The review is registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024565501). Of the 576 articles identified, 34 articles with 42&#x2009;234 participants were included. G-ANC increased the likelihood of attending four or more ANC visits (pooled risk ratio (RR)=1.45; 95%&#x2009;CI 1.22 to 2.82), was associated with the likelihood of attending postnatal care visits (RR=1.23; 95%&#x2009;CI 1.03 to 1.47), increased uptake of postpartum family planning methods (RR=1.85; 95%&#x2009;CI 1.26 to 2.73) and was associated with improved birth weight (RR=1.53; 95%&#x2009;CI 1.09 to 2.14). It was also associated with improved quality of care, health literacy, psychosocial gains, empowerment and facilitating culturally sensitive discussions. There was, however, no significant difference found between groups regarding likelihood of giving birth at health facilities compared with the traditional ANC. Also, no cost-effectiveness studies of G-ANC were identified in sub-Saharan Africa, highlighting a key evidence gap for guiding future implementation and scale-up. Exposure to G-ANC enhances utilisation of maternal healthcare such as ANC attendance, postnatal care, family planning uptake and improves birth weight. It also improves maternal engagement, health literacy and empowerment through a highly participatory learning approach and peer support. Nevertheless, no notable difference was observed between the groups in terms of likelihood of giving birth in health facilities. CRD42024565501.

Undergraduate nursing students are expected to demonstrate primary palliative care competencies upon graduation. The growing aging population and rising prevalence of complex chronic illnesses highlight an urgent need to prepare nurses who can deliver high-quality palliative care. Despite the 2021 AACN Essentials outlining revised primary palliative care competencies, new graduates continue to report insufficient preparation in these competencies. A quasi-nonexperimental design with a purposeful sample of prelicensure nursing students was utilized. An interprofessional multimodal teaching approach was implemented to deliver the course content. UNPCKS-2.0 scores increased from preintervention (M = 17.60 [SD = 4.52]) to postintervention (M = 18.60 [SD = 1.34]). CARES PC 2.0 results showed improved interprofessional communication, with "strongly agree" responses increasing from 27% preintervention to 71% postintervention. Survey data and student reflections demonstrated improved understanding of goals of care and quality-of-life support. Findings support integrating palliative care competencies throughout undergraduate nursing curricula.

Nursing organizations have called for competencies that entry-level nurses must demonstrate for transition to practice, including demonstrating clinical judgment and use of informatics tools like the electronic health record (EHR). More information is needed to understand how the EHR supports clinical judgment in nursing students. This study employed a qualitative descriptive design. Semistructured interviews were conducted among prelicensure nursing students (N = 18) about EHR use. Content analysis was used to code statements in alignment with the domains of Tanner's clinical judgment model and the dimensions of the Lasater clinical judgment rubric. Students utilized the EHR to engage in clinical judgments associated with safe medication administration. Students described utilizing the EHR to inform all domains of clinical judgment, yet they engaged in the reflection domain least. There were barriers to student EHR use. The EHR is an important contributor to nursing clinical judgment and should be thoroughly integrated within prelicensure curriculum.

This study examined the effect of intramuscular (IM) injection training delivered using the Pecha Kucha (PK) method on nursing students' knowledge, skill, and satisfaction levels. A single-blind, randomized controlled trial was conducted with 76 first-year nursing students. The intervention group received training through the PK method, while the control group was trained using a traditional PowerPoint presentation. Data were collected using a descriptive information form, the Knowledge Test for Intramuscular Injection in the Ventrogluteal Region, the Skill Test for Intramuscular Injection in the Ventrogluteal Region, and the Visual Analog Satisfaction Scale. Although the PK group had higher scores, there were no statistically significant differences between the PK and traditional PowerPoint groups in terms of mean IM knowledge, skill, and satisfaction scores (p > .05). The PK approach should be implemented in diverse samples and various nursing skill training sessions to broaden applicability.

High-risk fertility behavior is a leading contributor to adverse maternal and child health outcomes. This study assessed the prevalence and determinants of high-risk fertility behavior among reproductive-age women in sub-Saharan Africa. We conducted a secondary analysis of Demographic and Health Survey data from eight sub-Saharan African countries with extremely high or very high maternal mortality. A weighted sample of 78,353 reproductive-age women who had given birth in the five years preceding the survey was included. A multilevel mixed-effects binary logistic regression model was used to identify individual- and community-level factors associated with high-risk fertility behavior, accounting for the hierarchical nature of the data. Statistical significance was determined using AOR with a 95% CI and a P-value &#x2264;0.05. The overall prevalence of high-risk fertility behavior was 71.46% (95% CI: 71.14%, 71.77%), with the highest prevalence observed in Chad (87.75%) and the lowest in Lesotho (40.49%). Key individual-level determinants included women's and husbands' education, religion, wealth status, child sex, marital status, mobile phone and Internet use, antenatal care attendance, history of pregnancy termination, and contraceptive use. At the community level, low poverty was associated with a reduced likelihood of high-risk fertility behavior. The prevalence of high-risk fertility behavior remains high in countries with extremely high and very high maternal mortality rates, highlighting a need to address it through urgent and concerted interventions. Policymakers and planners should prioritize interventions targeting the key determinants of high-risk fertility behavior to curb its occurrence and improve maternal and child health outcomes. High-risk fertility behavior (HRFB) is defined as having children at very young or older ages, having many births, or spacing pregnancies too closely, which can lead to serious health problems for mothers and children. This study aimed to determine the magnitude of high-risk fertility behaviors and the factors that affect the behavior among women in eight sub-Saharan African countries with very high maternal mortalities. Using data from over 78,000 women, we analyzed both individual- and community-level characteristics linked to HRFB. This study found that about 71% of women had HRFB. The highest rates were in Chad, and the lowest were in Lesotho. Factors such as low education, poverty, limited use of antenatal care, lack of contraception, and reduced access to mobile phones or the Internet increased the likelihood of HRFB. Communities with lower poverty showed lower rates. These findings underscore the need for targeted policies and programs to reduce HRFB and improve maternal and child health.

Although critical thinking remains foundational to clinical judgment, it is often treated as a capability students have rather than a cognitive process to be intentionally developed. As competency frameworks and assessment models emphasize observable performance, the thinking processes that support learning and judgment development may receive less attention in nursing curricula. The purpose of this article is to revisit and clarify the role of critical thinking in the development of clinical judgment within nursing education. The distinctions among critical thinking, clinical reasoning, clinical decision-making, and clinical judgment are reviewed within the framework of educational strategies that may position critical thinking as implicit, despite its pivotal role in clinical judgment. Literature suggests that critical thinking underlies clinical reasoning and clinical judgment, but may receive inadequate attention when educational frameworks prioritize observable performance outcomes and competency demonstration. Clinical judgment cannot be developed or assessed without deliberate attention to the thinking processes that support it. Strengthening critical thinking requires intentional strategies that make thinking visible and integral to the application of learning in practice.

Human trafficking (HT) is a global, national, and local public health concern, yet victims often go unidentified due to limited provider education and a lack of screening protocols. This quality improvement project implemented an asynchronous online HT education module for senior nursing students to enhance knowledge and confidence in identifying victims through recognition of red flags and use of screening questions. The module addressed HT indicators, screening tools, screening questions, and available resources. Pre- and posttests using the PROTECT instrument assessed perceived knowledge, actual knowledge, and confidence. Postintervention scores showed statistically significant improvement (p < .001) in knowledge and confidence. Only 10.67% of participants had prior HT training, and 52% preferred online, asynchronous learning. HT education significantly improved nursing students' knowledge and confidence, supporting the integration of HT training into undergraduate nursing curricula.

Snakebite envenomation remains a critical health challenge across the culturally and ecologically diverse sub-Saharan Africa (SSA). This study examined healthcare providers' (HCPs') knowledge, attitudes, and practices (KAP), and their determinants towards snakebite envenomation. A cross-sectional study was conducted across nine SSA countries using the validated Knowledge, Attitudes, and Practices of Snake Envenomation - Healthcare Providers Questionnaire (KAPSE-HCPQ). The fractional logistic regression was conducted to identify the factors associated with KAP. A total of 3,544 HCPs were enrolled through professional and digital networks. General practitioners represented approximately half of the participants (50.1%), whereas toxicologists were 3.2%. Considerable variations were reported across sub-Saharan countries. Uganda and Sierra Leone attained perfect median knowledge scores (100%, range: 93-100, 73-100, respectively) yet both demonstrated marked deficiencies in practice (range: 0-25% and 0-75%, respectively). Attitude scores ranged from the lowest in Ethiopia (79%, range: 75-85%) to the highest in Uganda (91%, range: 87-95%). Higher knowledge was significantly associated with advanced training, antivenom availability, curricular inclusion of toxicology, and self-study. Positive attitudes were significantly associated with prior clinical exposure, faculty-based education, informal information sources, and participants' countries. HCPs demonstrated incorrect practices, such as applying a tourniquet above the bite site, attempting to suck out the venom, incising the bite wound, and asking to run to the nearest health facility, which may accelerate the systemic venom spread. In contrast, pharmacists and HCPs unaware of management guidelines demonstrated poorer practices. The study identifies a substantial gap between theoretical knowledge and clinical practice among HCPs across SSA, with variations by country, profession, training, and resource availability. Urgent interventions training, protocol standardization, and reliable antivenom supply are required to improve snakebite outcomes. Although healthcare providers across sub-Saharan Africa generally have good knowledge and favorable attitudes towards snakebite management, their actual practices remain persistently inadequate, irrespective of their country&#x2019;s income level.Systemic barriers - limited formal training, absent institutional protocols, unreliable antivenom supply, and weak referral systems- are highly associated with inadequate clinical practice.Urgent standardization of training protocols and reliable antivenom supply are needed to improve snakebite outcomes across the SSA region.

Malnutrition remains a major public health challenge in low- and middle-income countries and disproportionately affecting children under five. Eggs, given their high nutrient density and relative physical or economic accessibility, have been tested for their effect on improving nutritional outcomes in children under five. However, findings from scientific exercises to test the impact of egg-based trials on child growth have not been systhematically pooled and synthesised. Therefore, this meta-analysis aimed to synthesise evidence on the impact of egg-based interventions on the nutritional status of children underfive as determined by weight-for-height Z-score (WHZ), weight-for-age z-score (WAZ), and height-for-age z-score (HAZ). Research articles of randomised controlled trials published between 2013 and 2023 were identified through a comprehensive search of PubMed/MEDLINE, Web of Science, CINAHL, Embase, Science Direct, Google Scholar, and African Index Medicus data bases. Articles evaluated the effect of egg-based interventions against alternative diets, behaviour-change education, or no alternative intervention were included. Primary outcomes are WHZ, WAZ, and HAZ. Random-effects models were used to pool effect sizes (mean difference), and subgroup analyses and meta-regression explored sources of heterogeneity. Publication bias was assessed using funnel plots and Egger's test. Seven studies involving 3673 children met the inclusion criteria. Egg-based intervention significantly improved WAZ (MD: 0.33; 95% CI: 0.11-0.55) and WHZ (MD: 0.30; 95% CI: 0.12-0.48). However, no significant effect was observed on HAZ (MD: 0.05; 95% CI: -0.05-0.14). It is figuredout that egg-based interventions can improve weight-related nutritional outcomes (WHZ and HAZ) among children underfive in sub-Saharan Africa,&#xa0;but not linear growth (HAZ).

Introduction: The Corona virus (COVID-19) pandemic caused, among others, the need for colleges and universities managers around the world to reinvent new ways of providing education preserving its good quality at the same time. With the new ordinances of the Ministry of Education and Health, all courses can use remote methodologies for the continuity on the current school year. With new challenges and paradigms emerging from this methodological proposal: provide for the user the feeling of immersion, of being in the class room, from the navigation and interaction in this virtual environment, at the same time that the educator, respecting the educational principles and the pedagogical approach that he believes, does not transform this moment into a simple distance education. Objective: to describe the state of the art on nursing education and the challenges of using remote technologies in the time of Corona virus pandemic. Methods: this is a reflective study based on secondary sources of literature relevant to the theme, considering articles from national and international journals and recent productions on education, health training, remote technologies, COVId-19 and public health. Results: it is evident that experiencing the effects of the corona virus pandemic (COVID-19) in the health educational sector, especially in the field of nursing, goes beyond a structural reorganization of courses. It implies change attitude of managers, teachers and students to reformulate educational practices (sometimes with traditional tools), with innovative practices preserving a methodology that provides to the student criticality reflection, dialogue, bonding and interaction; elements that are part of a training aimed at transformation, empowerment and not just the transmission of knowledge. In this context, the COVID-19 pandemic caused paradigm shifts perhaps not yet overcome by health science institutions , because when they perceived themselves within a reality that generated changes in the political, economic, cultural and social aspects at a global level, they had to reinvent and insert new ways of teaching in their work process; they had to discuss different educational approaches and, given the needs to readjust health teaching methods, they inserted remote technologies as essential tools to meet the real need for continuity of classes in non-face-to-face model. For many, it is a challenge, as it currently permeates a reflection on the attention of distance learning in the field of nursing and other courses in the health area. However, as it opened up to discussions about new ways of teaching mediated by innovation, it can be said that this will be one of the greatest impact of the pandemic in benefit the education: the contribution of new information and communication technologies in the teaching-learning process for training in health, as well as the reflection on distance education and its concepts, differentiating it from the concepts of remote methodology and the use of technologies. Conclusion: In nursing education, the discussion related to the use of remote technologies in the classroom has always been a point of debate. However, with the need to include these tools for the continuity of classes in the non-face-to-face model resulting from the social isolation strategy motivated by the pandemic of COVID-19, it can provide an opportunity to have a new look on the subject and perhaps there is an opportunity to expand the debate on the use of remote methodologies in health education, seeking a reflection on their interaction with the other teaching methods already implemented.

Nursing students often have limited opportunities to engage with pediatric populations affected by socioeconomic disadvantage in outpatient or community settings. Partnerships with community-based programs can address this gap while fostering essential professional competencies. This qualitative descriptive study explored senior nursing students' perceptions of a clinical experience involving an after-school academic enrichment program (SHINE) serving youth from economically under-served communities. Postexperience questionnaires were completed by 21 baccalaureate nursing students following participation in the SHINE program. Data were analyzed thematically. Four primary themes emerged: (1) communication skills; (2) cultural competence; (3) advocacy; and (4) leadership and teamwork. Students described enhanced confidence when interacting with children from diverse backgrounds, increased awareness of social determinants of health, and recognition of the nurse's role in advocacy and collaboration. Embedding nursing students in community-based programs provides meaningful learning experiences that strengthen communication, cultural awareness, and leadership skills. These findings support continued integration of population-based clinical experiences in undergraduate nursing curricula.