Emergency care in Kiribati: A combined medical and nursing model for development

Tassicker, Brady; Tong, Tanebu Julia; Ribanti, Teitinana; Gittus, Angie; Griffiths, Bronwen

doi:10.1111/1742-6723.13209

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…Therefore, although emphasis for action differed in each site, it is likely that even small improvements in a single domain positively influenced overall EC delivery at each facility. Highlights of subsequent outcomes catalysed by the Needs Assessment process include the development and implementation of the Solomon Islands Triage Scale [33], multidisciplinary EC improvement activities in Kiribati [34] and ongoing program support in Timor-Leste [35].…”

Section: Discussionmentioning

confidence: 99%

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A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region

Phillips

Bowman

Sale³

et al. 2020

BMC Health Serv Res

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Background: Emergency care (EC) describes team-based, multidisciplinary clinical service provision, advocacy and health systems strengthening to address all urgent aspects of illness and injury for all people. In order to improve facility-based EC delivery, a structured framework is necessary to outline current capacity and future needs. This paper draws on examples of EC Needs Assessments performed at the national hospitals of three different Pacific Island Countries (PICs), to describe the development, implementation and validation of a structured assessment tool and methodological approach to conducting an EC Needs Assessment in the Pacific region. Methods: This is a retrospective, descriptive analysis of the development of the Pacific Emergency Care Assessment (PECA) table using patient-focused principles within an EC systems framework. Tool implementation occurred through observation, literature review and interviews using a strengths-based, action-research and ethnographic methodological approach in Timor-Leste, Kiribati and the Solomon Islands. The 2014 Solomon Islands EC Needs Assessment provides the main context to illustrate and discuss the overall conduct, feasibility, validity and reliability of the PECA tool and methodological approach. Results: In each site, the methodological implementation enabled completion of both the PECA table and comprehensive report within approximately 6 weeks of first arriving in country. Reports synthesising findings, recommendations, priority action areas and strategies were distributed widely amongst stakeholders. Examples illustrate Face and Content, Construct and Catalytic validity, including subsequent process and infrastructure improvements triggered by the EC Needs Assessment in each site. Triangulation of information and consistency of use over time enhanced reliability of the PECA tool. Compared to other EC assessment models, the Pacific approach enabled rich data on capacity and real-life function of EC facilities. The qualitative, strengths-based method engenders long-term partnerships and positive action, but takes time and requires tailoring to a specific site.

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Section: Discussionmentioning

confidence: 99%

“…• Each Needs Assessment process has performed as a trigger for locally-led developments • Each Needs Assessment report has provided a tool for subsequent reference and future local energy directed towards ED improvement [34,35]. (Tables 3 and 5) Reliability and Rigour…”

Section: Catalytic Validitymentioning

confidence: 99%

A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region

Phillips

Bowman

Sale³

et al. 2020

BMC Health Serv Res

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“…In addition to the pilot BEC programs in Zambia, Tanzania, and Uganda, additional iterations have been implemented in emergency facilities in Nigeria, Sierra Leone, Ukraine, and Kiribati and adapted for each clinical context [30][31][32][33]. In these cases, knowledge acquisition was similarly measured by comparing pre-and post-course assessments.…”

Section: Plos Onementioning

confidence: 99%

Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit

Epps

Ramachandran

et al. 2023

PLoS ONE

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Background Emergency care is vital in low- and middle-income countries (LMICs) but many frontline healthcare workers in low-resource settings have no formal training in emergency care. To address this gap, the World Health Organization (WHO) developed Basic Emergency Care (BEC): Approach to the acutely ill and injured, a multi-day, open-source course for healthcare workers in low-resource settings. Building on the BEC foundation, this study uses an implementation science (IS) lens to develop, implement, and evaluate a comprehensive emergency care curriculum in a single emergency facility in Liberia. Methods A six-month emergency care curriculum consisting of BEC content, standardized WHO clinical documentation forms, African Federation of Emergency Medicine (AFEM) didactics, and clinical mentorship by visiting emergency medicine (EM) faculty was designed and implemented using IS frameworks at Redemption Hospital, a low-resource public referral hospital in Monrovia, the capital of Liberia. Healthcare worker performance on validated knowledge-based exams during pre- and post-intervention testing, post-course surveys, and patient outcomes were used to evaluate the program. Results Nine visiting EM physicians provided 1400 hours of clinical mentorship and 560 hours of didactic training to fifty-six Redemption Hospital staff over six-months. Median test scores improved 20.0% (p<0.001) among the forty-three healthcare workers who took both the pre- and post-intervention tests. Participants reported increased confidence in caring for medical and trauma patients and comfort performing emergency care tasks on post-course surveys. Emergency unit (EU)/Isolation unit (IU) mortality decreased during the six-month implementation period, albeit non-significantly. Course satisfaction was high across multiple domains. Discussion This study builds on prior research supporting WHO efforts to improve emergency care globally. BEC implementation over a six-month timeframe using IS principles is an effective alternative strategy for facilities in resource-constrained environments wishing to strengthen emergency care delivery.

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“…These included easy replication in black and white, use of pictographs to convey information across linguistically diverse settings and an understanding of the environmental conditions underpinning clinical practice in the Pacific. This process was a practical endeavour informed by previous experience and relationships working alongside Pacific HCW 4 …”

Section: Development Of the Guidelinementioning

confidence: 99%

Development and implementation of a Pacific Island‐centred COVID‐19 Health Worker Safety Guide

Gittus

Griffiths

Salis

et al. 2021

Emerg Medicine Australasia

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Objective Healthcare workers in Pacific Island Countries face unique workload and infection control hazards because of limited resources, cultural practices and local disease burden. In the context of COVID‐19, concern around healthcare worker safety escalated in the region, triggering the need for a relevant resource. Methods We describe a collaborative, participatory action‐research approach with a diverse range of local clinicians in Pacific Island Countries to design, develop and implement a practical guideline assisting clinicians to work safely during the pandemic. Results The resulting Health Worker Safety Guide for COVID‐19 is a relevant and usable protocol developed using local knowledge and now available in several Pacific languages. Conclusion We recommend a creative approach to facilitate meaningful communication with this group of clinicians, including low resolution technology and use of social media platforms.

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Emergency care in Kiribati: A combined medical and nursing model for development

Cited by 9 publications

References 7 publications

A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region

A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region

Implementation and outcomes of a comprehensive emergency care curriculum at a low-resource referral hospital in Liberia: A novel approach to application of the WHO Basic Emergency Care toolkit

Development and implementation of a Pacific Island‐centred COVID‐19 Health Worker Safety Guide

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