Sue Anne Bell

A case series study on the effect of Ebola on facility-based deliveries in rural Liberia

BackgroundAs communities’ fears of Ebola virus disease (EVD) in West Africa exacerbate and their trust in healthcare providers diminishes, EVD has the potential to reverse the recent progress made in promoting facility-based delivery. Using retrospective data from a study focused on maternal and newborn health, this analysis examined the influence of EVD on the use of facility-based maternity care in Bong Country, Liberia, which shares a boarder with Sierra Leone - near the epicenter of the outbreak.MethodsUsing a case series design, retrospective data from logbooks were collected at 12 study sites in one county. These data were then analyzed to determine women’s use of facility-based maternity care between January 2012 and October 2014. The primary outcome was the number of facility-based deliveries over time. The first suspected case of EVD in Bong County was reported on June 30, 2014. Heat maps were generated and the number of deliveries was normalized to the average number of deliveries during the full 12 months before the EVD outbreak (March 2013 – February 2014).ResultsPrior to the EVD outbreak, facility-based deliveries steadily increased in Bong County reaching an all-time high of over 500 per month at study sites in the first half of 2014 – indicating Liberia was making inroads in normalizing institutional maternal healthcare. However, as reports of EVD escalated, facility-based deliveries decreased to a low of 113 in August 2014.ConclusionEbola virus disease has negatively impacted the use of facility-based maternity services, placing childbearing women at increased risk for morbidity and death.

Skills and educational needs of accident and emergency nurses in Ghana: An initial needs analysis

Background The specialty of emergency medicine is highly reliant on a well-trained team of providers. Ghana has recently begun a specialist training program for physicians and the need to train specialist emergency nurses has been recognized. The first step to developing this training is to conduct a needs assessment. This study was conducted to elucidate current nursing functioning and gain knowledge of the educational desires and needs for nurses in the Accident and Emergency Center (A&E) at Komfo Anokye Teaching Hospital (KATH). Methods Three nurses from the University of Michigan (UM) worked collaboratively with the nursing leadership at KATH to conduct a needs assessment of currently practising nurses in the A&E. The UM nurses observed nursing practice in the department and KATH nurses participated in a multiple choice exam, a self-assessment questionnaire of educational desires, answered written open-ended questions and participated in focus groups. Results KATH nurses scored relatively low on a general knowledge multiple choice exam, and indicated through the self-assessment that they would like to learn more about many topics. Open-ended questions gave further insight into areas of knowledge gaps. Several themes including Cohesion, Carrying out Orders/Decision Making and Overwhelming Volume, emerged from observations in the emergency department. Discussion Current nurse knowledge and function as well as areas to focus on for future specialty training in emergency nursing have been identified by this needs assessment. The emergency department nurses shared an overwhelming interest in increasing their skill level, learning new methods of patient care and implementing new technologies into their clinical practice.

The implementation of the South African Triage Score (SATS) in an urban teaching hospital, Ghana

INTRODUCTION Triage is the process of sorting patients based on the level of acuity to ensure the most severely injured and ill patients receive timely care before their condition worsens. The South African Triage Scale (SATS) was developed out of a need for an accurate and objective measure of urgency based on physiological parameters and clinical discriminators that is easily implemented in low resource settings. SATS was introduced in the emergency center (EC) of Komfo Anokye Teaching Hospital (KATH) in January 2010. This study seeks to evaluate the accurate use of the SATS by nurses at KATH. METHODS This cross-sectional study was conducted in the EC at KATH in Kumasi, Ghana. Patients 12 years and over with complete triage information were included in this study. Each component of SATS was calculated (i.e. for heart rate of 41-50, a score of 1 was given) and summed. This score was compared to the original triage score. When scores did not equate, the entire triage record was reviewed by an emergency physician and an advanced practice emergency nurse separately to determine if the triage was appropriate. These reviews were compared and consensus reached. RESULTS 52 of 903 adult patients (5.8%) were judged to have been mis-triaged by expert review; 49 under-triaged (sent to a zone that corresponded to a lower acuity level than they should have been, based on their vital signs) and 3 over-triaged. Of the 49 patients who were under-triaged, 34 were under-triaged by one category and 7 by two categories. CONCLUSION Under-triage is a concern to patient care and safety, and while the under-triage rate of 5.7% in this sample falls within the 5-10% range considered unavoidable by the American College of Surgeons Committee on Trauma, concentrated efforts to regularly train triage nurses to ensure no patients are under-triaged have been undertaken. Overall though, SATS has been implemented successfully in the EC at KATH by triage nurses.

The Development of Sustainable Emergency Care in Ghana: Physician, Nursing and Prehospital Care Training Initiatives

BACKGROUND Ghanas first Emergency Medicine residency and nursing training programs were initiated in 2009 and 2010, respectively, at Komfo Anokye Teaching Hospital in the city of Kumasi in association with Kwame Nkrumah University of Science and Technology and the Universities of Michigan and Utah. In addition, the National Ambulance Service was commissioned initially in 2004 and has developed to include both prehospital transport services in all regions of the country and Emergency Medical Technician training. Over a decade of domestic and international partnership has focused on making improvements in emergency care at a variety of institutional levels, culminating in the establishment of comprehensive emergency care training programs. OBJECTIVE We describe the history and status of novel postgraduate emergency physician, nurse, and prehospital provider training programs as well as the prospect of creating a board certification process and formal continuing education program for practicing emergency physicians. DISCUSSION Significant strides have been made in the development of emergency care and training in Ghana over the last decade, resulting in the first group of Specialist-level emergency physicians as of late 2012, as well as development of accredited emergency nursing curricula and continued expansion of a national Emergency Medical Service. CONCLUSION This work represents a significant move toward in-country development of sustainable, interdisciplinary, team-based emergency provider training programs designed to retain skilled health care workers in Ghana and may serve as a model for similar developing nations.

Analysis of nursing education in Ghana: Priorities for scaling-up the nursing workforce

In this cross-sectional study, the strengths, challenges and current status of baccalaureate nursing education in Ghana were described using a descriptive design. The World Health Organization Global Standards for the Initial Education of Nurses and Midwives were used as the organizing framework, with baseline data on the status of nursing education from two state-funded universities in Ghana presented. A serious shortage of qualified faculty was identified, along with the need for significant upgrading to the existing infrastructure. Additionally, the number of qualified applicants far exceeds the available training slots. Faculty and infrastructure shortages are common issues in nursing education and workforce expansion; however, in low-resource countries, such as Ghana, these issues are compounded by high rates of preventable disease and injury. An understanding of the strengths and challenges of nursing education in Ghana can inform the development of strategies for nursing workforce expansion for other low-resource countries.

Development of an emergency nursing training curriculum in Ghana

The formal provision of emergency health care is a developing specialty in many sub-Saharan African countries, including Ghana. While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses. The results of a unique collaboration are described between a university in the United States, a Ghanaian university and a Ghanaian teaching hospital that has developed an emergency nursing diploma program. The expected outcomes of this training program include: (a) an innovative, interdisciplinary, team-based clinical training model, (b) a unique and low-resource emergency nursing curriculum and (c) a comprehensive and sustainable training program to increase in-country retention of nurses.

The role of short-term volunteers in a global health capacity building effort: the Project HOPE-GEMC experience

BackgroundIncreasingly, medical students and practicing clinicians are showing interest in traveling to low-income settings to conduct research and engage in clinical rotations. While global health activities have the potential to benefit both the individual and the host, there can be challenges. We describe one way to harmonize the desire of volunteers to have a meaningful impact on the health care delivery system in a developing country with the needs of that country.MethodsThe Project Health Opportunities for People Everywhere (HOPE)-Ghana Emergency Medicine Collaborative (GEMC) Partnership has successfully integrated short-term volunteer physicians and nurses to facilitate the training of emergency medicine (EM) residents and specialist nurses in Kumasi, Ghana.ResultsSince the launching of this partnership in 2011, eight physicians and 10 nurses have rotated at Komfo Anokye Teaching Hospital (KATH). The impact of these volunteers goes beyond the clinical service and supervision they provide while on the ground. They act as mentors to the trainees and assist the program leadership with teaching and assessments.ConclusionsAlthough generally smooth, there have been challenges, all of which have been met and are being resolved. This partnership is an example of how collaborations can harness the expertise and energy of short-term volunteers to achieve the goals of capacity building and self-sustainability.

All-Cause Hospital Admissions Among Older Adults After a Natural Disaster

Study objective: We characterize hospital admissions among older adults for any cause in the 30 days after a significant natural disaster in the United States. The main outcome was all‐cause hospital admissions in the 30 days after natural disaster. Separate analyses were conducted to examine all‐cause hospital admissions excluding the 72 hours after the disaster, ICU admissions, all‐cause inhospital mortality, and admissions by state. Methods: A self‐controlled case series analysis using the 2011 Medicare Provider and Analysis Review was conducted to examine exposure to natural disaster by elderly adults located in zip codes affected by tornadoes during the 2011 southeastern superstorm. Spatial data of tornado events were obtained from the National Oceanic and Atmospheric Administration’s Severe Report database, and zip code data were obtained from the US Census Bureau. Results: All‐cause hospital admissions increased by 4% for older adults in the 30 days after the April 27, 2011, tornadoes (incidence rate ratio 1.04; 95% confidence interval 1.01 to 1.07). When the first 3 days after the disaster that may have been attributed to immediate injuries were excluded, hospitalizations for any cause also remained higher than when compared with the other 11 months of the year (incidence rate ratio 1.04; 95% confidence interval 1.01 to 1.07). There was no increase in ICU admissions or inhospital mortality associated with the natural disaster. When data were examined by individual states, Alabama, which had the highest number of persons affected, had a 9% increase in both hospitalizations and ICU admissions. Conclusion: When all time‐invariant characteristics were controlled for, this natural disaster was associated with a significant increase in all‐cause hospitalizations. This analysis quantifies acute care use after disasters through examining all‐cause hospitalizations and represents an important contribution to building models of resilience—the ability to recover from a disaster—and hospital surge capacity.

Women's mental health and intimate partner violence following natural disaster: a scoping review

Introduction Survivors of natural disasters in the United States experience significant health ramifications. Women particularly are vulnerable to both post-disaster posttraumatic stress disorder (PTSD) and depression, and research has documented that these psychopathological sequelae often are correlated with increased incidence of intimate partner violence (IPV). Understanding the link between these health concerns is crucial to informing adequate disaster response and relief efforts for victims of natural disaster. Purpose The purpose of this review was to report the results of a scoping review on the specific mental health effects that commonly impact women following natural disasters, and to develop a conceptual framework with which to guide future research. METHODS A scoping review of mental and physical health effects experienced by women following natural disasters in the United States was conducted. Articles from 2000-2015 were included. Databases examined were PubMed, PsycInfo, Cochrane, JSTOR, Web of Science, and databases available through ProQuest, including ProQuest Research Library. RESULTS A total of 58 articles were selected for inclusion, out of an original 149 that were selected for full-text review. Forty-eight articles, or 82.8%, focused on mental health outcomes. Ten articles, or 17.2%, focused on IPV. Discussion Certain mental health outcomes, including PTSD, depression, and other significant mental health concerns, were recurrent issues for women post-disaster. Despite the strong correlation between experience of mental health consequences after disaster and increased risk of domestic violence, studies on the risk and mediating factors are rare. The specific challenges faced by women and the interrelation between negative mental health outcomes and heightened exposure to IPV following disasters require a solid evidence base in order to facilitate the development of effective interventions. Additional research informed by theory on probable health impacts is necessary to improve development/implementation of emergency relief policy. Bell SA , Folkerth LA . Womens mental health and intimate partner violence following natural disaster: a scoping review. Prehosp Disaster Med. 2016;31(6):648-657.

Psychometric Validation and Comparison of the Self-Reporting Questionnaire-20 and Self-Reporting Questionnaire-Suicidal Ideation and Behavior Among Congolese Refugee Women.

Background: The Self-Reporting Questionnaire (SRQ) has long been used among refugee populations to detect common mental health disorders. Purpose: Our purpose was to compare findings from psychometric validation of the 20-item SRQ with a modified version, the SRQ-SIB (suicidal ideation and behavior). Methods: Factor analysis of both scales was performed in a sample of Congolese refugee women as well as predictive validity, contrast validity, and internal consistency. Results: Both scales exhibited a reliability of .911. The SRQ-SIB exhibited a three-factor solution; somatic, psychological, and SIB. The SIB was highly predictive for having experienced sexual violence. Analyses validate the use of both, but the SIB is useful for differentiating more severe cases of common mental disorder (CMD). Conclusions: The SRQ-SIB may be an important tool for the nursing assessment of suicide among refugee women.