Changing professional practice in tuberculosis care: an educational intervention
Changing professional practice in tuberculosis care: an educational intervention
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DOI：
10.1111/j.1365-2648.2004.03226.x
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发表时间：
2004-12-01
影响因子：
3.8
通讯作者：
van der Walt, H
中科院分区：
文献类型：
--
作者：
Dick, J;Lewin, S;van der Walt, H
的目标。本文描述了一项体验式、参与式在职教育计划的发展和实施，该计划的重点是为南非结核病患者提供护理的初级提供者以患者为中心、解决问题和批判性反思。结核病是造成发展中国家疾病负担的一个主要因素。在南非，大约90%的结核病患者在初级阶段由护士管理。尽管努力提高对这些患者的护理质量，但许多人未能按照规定完成治疗。卫生保健提供者和结核病患者之间关系不融洽是不坚持治疗的一个主要原因。因此，提高医疗服务质量和卫生保健提供者与结核病患者之间沟通的方法是一个优先事项。本文概述了制定和实施教育方案的各个阶段，并对这一过程进行了反思。数据来自对干预措施的实施和影响的深入定性评估。这一做法为保健提供者所接受，并能适应具体诊所的需要。与会者积极评价了教育干预，指出它促进了对其工作的批判性反思；鼓励解决问题;并提高了他们与患者和同事沟通的意识。然而，我们发现了阻碍实践变革的重要结构性障碍，包括服务条件、与同事的关系以及管理层的支持。体验式、参与式在职教育可以在初级保健环境中大规模实施。然而，这一过程是资源密集型的，这种教育的影响可能受到卫生系统其他层面障碍的限制。
Aim. This paper describes the development and implementation of an experiential, participatory in-service education programme focusing on patient-centeredness, problem-solving and critical reflection for primary providers delivering care to tuberculosis patients in South Africa.Background. Tuberculosis is a major contributor to the disease burden in developing countries. In South Africa, approximately 90% of tuberculosis patients are managed by nurses at the primary level. Despite efforts to improve quality of care for these patients, many fail to complete their treatment as prescribed. Poor rapport between health care providers and patients with tuberculosis is a major reason for non-adherence to treatment. Methods of improving the quality of care delivery and communication between health care providers and patients with tuberculosis is therefore a priority.Discussion. The paper outlines the stages of developing and implementing the education programme and reflects on this process. Data is drawn from an in-depth qualitative evaluation of the delivery and impacts of the intervention. The approach was acceptable to health care providers and adaptable to the needs of specific clinics. Participants evaluated the educational intervention positively, noting that it facilitated critical reflection on their work; encouraged problem-solving; and heightened their awareness of communication with patients and with colleagues. However, important structural barriers to practice change were identified, including conditions of service, relations with colleagues and support from management.Conclusions. Experiential, participatory in-service education can be implemented on a large scale in primary care settings. However, the process is resource intensive and the impacts of such education may be limited by barriers at other levels of the health system.