Journal articles on the topic 'Nursing – Study and teaching (Continuing education) – Swaziland'

Background: This study develops a school nurse competency framework for continuing education based on focus group interviews and a literature review. Methods: This study uses a qualitative content analysis with 12 school nurses. Six school nurses verify the content validity for the competency framework for continuing education using the content validity index. Results: School nurse competencies are defined as the knowledge, skills, and attitudes required of school nurses to provide safe school nursing. Six core competencies are identified. These include the ability to (1) provide patient-centered care; (2) communicate and collaborate with students, teaching staff, and community resources; (3) think critically for evidence-based practice; (4) implement school health services and programs; (5) integrate legal and ethical nursing practice, and (6) conduct health education. Conclusion: It is necessary to develop and implement continuing education programs for school nurses based on the training needs and competency indicators identified in this study.

The nursing faculty shortage is being filled by adjunct clinical faculty with no classroom teaching experience. These novice faculty members must undergo a socialization and orientation process (onboarding), when transitioning into the academic environment. To support orientation, the Live Continuing Education Program for Adjunct Clinical Nursing Faculty (LCEP-ACNF), a competency-based 4.0-hour continuing education unit program for novice clinical faculty was used. In this study, the LCEP-ACNF was tested in a statewide sample of clinical faculty. For this mixed-methods study a convenience sample of faculty members (N = 312) from all nursing programs in one northeast state was recruited. All 312 participants completed pretest competency-based evaluation and a demographics sheet. Participants’ (N = 312; n = 162) posttest scores were significantly higher than their pretest scores (Z = 11.10, p < .01). Eight interviews were conducted and the themes emerged were, communication with other faculty members on clinical teaching, orientation strategies, student evaluation and feedback strategies, and mentorship issues for novice clinical faculty. Evaluation results for the LCEP-ACNF were overall positive, including the need for more continuing education offerings, mentorship, and teaching strategies. The results suggest an increased need for clinical faculty development and orientation, a need for developing the clinical coordinator role and mentorship for all novice clinical faculty. Lastly, the LCEP-ACNF should be offered twice a year, regionally and nationally.

Postpartum depression (PPD) occurs in 13% of new mothers internationally, but many do not receive treatment. In the Western world, hospital-based perinatal nurses have extended contact with new mothers and are in a unique position to teach them to recognize symptoms of and seek treatment for PPD. In this replication study framed by self-efficacy theory, teaching new mothers about PPD was predicted by a nurse’s self-efficacy related to PPD teaching, expectations for teaching from supervisor, PPD continuing education, teaching experience on other topics, and experience with observing other nurses teaching patients about PPD. The results of the study demonstrate the importance of the climate created by the nursing supervisor in which teaching about PPD is expected and facilitators of effective patient teaching are available.

AbstractPsychiatric nursing, in various parts of the world, including regions of Canada, is recognized as a distinct nursing profession. In psychiatric mental health nursing practice, reflection is considered a foundational skill given the relational nature of nurses’ therapeutic work. Communicating the significance of reflection for practice to students and teaching this intangible skill is challenging for educators. The purpose of this qualitative study was to explore with psychiatric mental health nurse educators their views on how they develop reflective practitioners. Participants’ perspectives and experiences in teaching reflective practice were captured in four themes: building the use of self as an agent of change, building skills of reflection/building the habit of reflection, building a bridge between theory and practice, and building a continuing reflective practice – from student to practitioner. Recommendations include a systematic incorporation of reflection into a curriculum and creating supportive learning environments that facilitate the development of reflective practitioners.

Background: This paper reports the qualitative findings from stage 5 of an action research project which involved the redesign of continuing professional education (CPE) courses in one organisation. Aim: The aim of this study was to explore key stakeholders perceptions of the teaching, learning and outcomes of a new curriculum design for CPE involving e-learning. Method: This project used participatory action research, involving stakeholders as participants in a process of inquiry about the change. The study took place in an academic teaching hospital and consisted of three focus group interviews with a total of 20 nurses. Participants included stakeholders who had developed curricula and managers from clinical areas where CPE courses had been undertaken. Findings: Four main themes emerged, revealing staff perceptions on the process of change and their own ‘lightbulb moments’ experienced during this process. Results also indicate that the change has resulted in learner-focused CPE, with a range of opportunities for continued educational development in future. Conclusion: Key stakeholders' experience is seldom reported in studies related to CPE. This study provides an insight into the experiences of key stakeholders in relation to the development and delivery of CPE courses. Stakeholders indicated that they were able to see the benefits of implementing new CPE curricula they had contributed to. They also commented that clinical-pertinent and competence-based courses were more learner focused as a result of combining online content with supported workshops.

Background Clinical nursing education provides opportunities for students to learn in multiple patient care settings, receive appropriate guidance, and foster the development of clinical competence and professionalism. Nurse preceptors guide students to integrate theory into practice, teach clinical skills, assess clinical competencies, and enhance problem-solving and critical thinking skills. Previous research has indicated that the teaching competencies of nurse preceptors can be transferred to students’ clinical learning to enhance their clinical competencies. Objective This study aimed to develop a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors and to examine the effectiveness of the CTBL program on nurse preceptors’ clinical teaching competencies, self-efficacies, attitudes toward web-based learning, and blended learning outcomes. Methods A quasi-experimental single-group pretest and posttest design was adopted. A total of 150 nurse preceptors participated in the CTBL program, which was conducted from September 2019 to December 2019. A set of questionnaires, including the clinical teaching competence inventory, preceptor self-efficacy questionnaire, attitudes toward web-based continuing learning survey, and e-learning experience questionnaire, was used to assess the outcomes before and after the CTBL program. Results Compared with the baseline, the participants had significantly higher total mean scores and subdomain scores for clinical teaching competence (mean 129.95, SD 16.38; P<.001), self-efficacy (mean 70.40, SD 9.35; P<.001), attitudes toward web-based continuing learning (mean 84.68, SD 14.76; P<.001), and blended learning outcomes (mean 122.13, SD 14.86; P<.001) after the CTBL program. Conclusions The CTBL program provides a comprehensive coverage of clinical teaching pedagogy and assessment strategies. The combination of the WCP and case-based approach provides a variety of learning modes to fit into the diverse learning needs of the preceptors. The CTBL program allows the preceptors to receive direct feedback from the facilitators during face-to-face sessions. Preceptors also gave feedback that the web-based workload is manageable. This study provides evidence that the CTBL program increases the clinical teaching competencies and self-efficacies of the preceptors and promotes positive attitudes toward web-based learning and better blended learning outcomes. The health care organization can consider the integration of flexible learning and intellect platforms for preceptorship education.

Purpose: Nurses working on the frontlines of the COVID-19 pandemic have experienced a combination of physical, psychological, logistical, professional, and personal challenges. Those nurses enrolled in baccalaureate and graduate nursing degree programs were affected significantly in their ability to remain focused on meeting course expectations while contending with pandemic-induced challenges. Nursing faculty in a public state-based university school of nursing in upstate New York responded by developing initiatives to support students and foster their success.Results: Supported by unsolicited anecdotal reports, this article describes the experiences and perspectives of nurses in clinical roles working in a pandemic epicenter, while simultaneously completing nursing degree programs. Students were confronted by professional and personal stressors that challenged their ability to manage multiple responsibilities. Faculty supported students with intensive caring and communication, and by selective strategic policy and pedagogical adaptations, while adhering to and preserving program integrity and standards. These four distinct efforts supported student retention and success, and created opportunities for faculty dialogue, assessment, and reflection upon the nature of the changes and plans for future implementation. Self-care was identified as an important coping strategy for both students and faculty.Conclusions: Faculty believe the four-pronged approach enabled students to succeed in their programs of study and feel supported as individuals and professionals. Despite the continuing global health crisis, there have been numerous positive outcomes and lessons learned by both students and faculty while learning and teaching during the pandemic, with implications for future curricular and pedagogical approaches.

This study examines the pedagogical training process of medical professors at a Brazilian university, the meanings attributed to it, and the positive and negative aspects identified in it. This is a descriptive-exploratory study, using a qualitative approach with a questionnaire utilizing open-ended and closed questions and a semi-structured interview. The majority of queried individuals had no formal teacher training and learned to be teachers through a process of socialization that was in part intuitive or by modeling those considered to be good teachers; they received pedagogical training mainly in post-graduate courses. Positives aspects of this training were the possibility of refresher courses in pedagogical methods and increased knowledge in their educational area. Negative factors were a lack of practical activities and a dichotomy between theoretical content and practical teaching. The skills acquired through professional experience formed the basis for teaching competence and pointed to the need for continuing education projects at the institutional level, including these skills themselves as a source of professional knowledge.

Introduction Death and the dying experience are common phenomena in all clinical settings. Death and the dying presents physical and emotional strain on the dying patient, his relations and professional caregivers. Objective The study therefore assessed the sociodemographic determinants of nurses’ attitudes towards death and caring for dying patient. Method A cross–sectional design was used to study 213 randomly selected nurses, working in one of the tier one teaching hospital in Nigeria. Attitude towards death and the dying was collected with Frommelt Attitude Care of the Dying and Death Attitude Profit–Revised questionnaire. The data collected was analysed with SPSS version 20 and inferential analyses were considered statistically significant at p < 0.05. Results The study revealed that most of the nurses had negative attitudes toward the concept of death (76.5%) and caring for dying patient (68%). Furthermore, a chi-square test revealed significant associations between the nurses’ years of working experience (χ2 = 24.57, p <.00) and current unit of practice (χ2 = 21.464; p = .002) and their attitude towards caring for the dying patient. Also, nurses’ age (χ2 = 13.77, p = .032), professional qualifications (χ2 = 13.774, p = .008), and current ward of practice (χ2 = 16.505, p = .011) were significantly associated with their attitudes to death. Furthermore, the study observed a significant association between nurses’ attitudes to death and caring for the dying patient (χ2 = 11.26, p < 0.01). Conclusion This study concluded that nurses had negative attitudes towards death and dying and therefore prescribes, as part of continuing professional development strategy, the need for requisite positive value – laden, ethnoreligious specific education regarding end of life care.

Background E-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses’ continuing education within a life-long learning perspective. A systematic review of systematic reviews on e-learning for nursing and health professional students in an academic context has been published previously; however, no such review exists regarding e-learning for registered nurses in a continuing education context. Objective We aimed to systematically summarize the qualitative and quantitative evidence regarding the effects of e-learning on nursing care among nurses in a continuing education context. Methods We conducted a systematic review of systematic qualitative, quantitative, and mixed-studies reviews, searching within four bibliographic databases. The eligibility criteria were formulated using the population, interventions, comparisons, outcomes, and study design (PICOS) format. The included population was registered nurses. E-learning interventions were included and compared with face-to-face and any other e-learning interventions, as well as blended learning. The outcomes of interest were derived from two models: nursing-sensitive indicators from the Nursing Care Performance Framework (eg, teaching and collaboration) and the levels of evaluation from the Kirkpatrick model (ie, reaction, learning, behavior, and results). Results We identified a total of 12,906 records. We retrieved 222 full-text papers for detailed evaluation, from which 22 systematic reviews published between 2008 and 2018 met the eligibility criteria. The effects of e-learning on nursing care were grouped under Kirkpatrick’s levels of evaluation: (1) nurse reactions to e-learning, (2) nurse learning, (3) behavior, and (4) results. Level 2, nurse learning, was divided into three subthemes: knowledge, skills, attitude and self-efficacy. Level 4, results, was divided into patient outcomes and costs. Most of the outcomes were reported in a positive way. For instance, nurses were satisfied with the use of e-learning and they improved their knowledge. The most common topics covered by the e-learning interventions were medication calculation, preparation, and administration. Conclusions The effects of e-learning are mainly reported in terms of nurse reactions, knowledge, and skills (ie, the first two levels of the Kirkpatrick model). The effectiveness of e-learning interventions for nurses in a continuing education context remains unknown regarding how the learning can be transferred to change practice and affect patient outcomes. Further scientific, methodological, theoretical, and practice-based breakthroughs are needed in the fast-growing field of e-learning in nursing education, especially in a life-learning perspective. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050714; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=50714

ABSTRACT Objective: to identify the methods of teaching used in education with the nursing staff at the Center for Intensive Therapy for prevention of nosocomial infection. Methods: the study was conducted during 2007 in library collections and electronic databases, which were twenty works relevant to the topic, published in the last five years. Results: This study emphasized the continuing education as a skill to be developed for performance improvement and training of all nursing staff with regard to prevention of nosocomial infection. Conclusion: the specific programs for the prevention of nosocomial infection in intensive care unit should be prepared to contribute to the awakening of the team, in order to involve personal and collective, which leads to behavior change and cooperation for the formation of habits of professional. It is a clear need for training of staff in order to develop skills for effective educational practices, underpinned by theoretical concepts, and that fosters the growth of professionals through continuing education, this factor considered crucial in determining the quality of care. Descriptors: methodologies; continuing education in nursing; hospital infection. RESUMO Objetivo: identificar as metodologias de ensino utilizadas na educação permanente com a equipe de enfermagem no Centro de Terapia Intensiva para prevenção da infecção hospitalar. Métodos: a pesquisa foi realizada durante o ano de 2007 em acervos bibliográficos e bases de dados eletrônicas, nas quais foram encontradas vinte obras, publicadas nos últimos cinco anos. Resultados: esta pesquisa enfatizou a educação permanente como uma habilidade a ser desenvolvida para o desempenho e aprimoramento profissional de toda equipe de enfermagem no que tange a prevenção da infecção hospitalar. Conclusão: os programas específicos para a prevenção da infecção hospitalar no Centro de Tratamento Intensivo devem ser elaborados de forma a contribuir para o despertar da equipe, quanto ao envolvimento pessoal e coletivo, o que leva a mudança de comportamento e cooperação para a formação de hábitos dos profissionais. É evidente a necessidade de capacitação da equipe no intuito de desenvolver competências para efetivação das praticas educacionais, sustentadas em concepções teóricas, e que propicie o crescimento dos profissionais, através da formação continuada, fator este considerado como fundamental na determinação da qualidade do cuidado. Descritores: metodologias; educação continuada em enfermagem; infecção hospitalar. RESUMEN Objetivo: Identificar los métodos de enseñanza utilizados en la educación con el personal de enfermería en el Centro de Terapia Intensiva para la prevención de la infección nosocomial. Métodos: El estudio se realizó durante 2007 en las colecciones de bibliotecas y bases de datos electrónicas, que fueron veinte las obras pertinentes para el tema, publicado en los últimos cinco años. Resultados: En este estudio se hizo hincapié en la educación continua como una habilidad a desarrollar para la mejora del desempeño y la formación de todo el personal de enfermería con respecto a la prevención de la infección nosocomial. Conclusión: Los programas específicos para la prevención de la infección nosocomial en la unidad de cuidados intensivos deben estar dispuestos a contribuir en el despertar del equipo, a fin de involucrar a personal y colectiva, lo que conduce a un cambio de comportamiento y la cooperación para la formación de hábitos de los profesionales. Es evidente la necesidad de formación del personal con el fin de desarrollar habilidades para la eficacia de las prácticas educativas, sustentada por conceptos teóricos, y que fomenta el crecimiento de los profesionales mediante la formación continua, este factor se considera crucial en la determinación de la calidad de la atención. Descriptores: metodologías; educación continua en enfermería; infección hospitalaria.

Objective: The purpose of this phenomenological study was to explore nursing faculty attitudes towards students with disabilities enrolled in baccalaureate nursing programs. Additionally, we aimed to describe the types of accommodations provided to students with disabilities in the clinical setting.Methods: In two institutions of higher education in the southeastern United States, purposive and snowball sampling was used to recruit 14 nursing faculty with experience teaching in clinical courses. One-on-one interviews were conducted using a semi-structured interview guide. Data were transcribed and analyzed using Colaizzi’s process for phenomenological data analysis. The social model of disability served as the conceptual framework for the study.Results: Six themes emerged from the data analysis: ‘Math is a basic required skill,’ ‘You can’t just skip clinical,’ ‘It’s my job to help them learn,’ ‘I’m not prepared for this,’ ‘What type of job will they get,’ and ‘overcoming obstacles.’ Nursing faculty reported positive attitudes towards students with disabilities, but also voiced concerns about patient safety and the ability for a student with a disability to find success. Several barriers including disclosure, lack of accessibility in hospitals, nursing culture, and faculty workload were identified.Conclusions: A lack of clear policies and guidelines leaves nursing faculty unsure of what accommodations are appropriate for students with disabilities and how to implement accommodations in clinical courses. The study demonstrates a need for continuing education regarding teaching methodologies that are effective and meaningful for students with attention deficit hyperactivity disorder, diagnosed anxiety, and specific learning disabilities. Further research is warranted to identify appropriate accommodations for students with disabilities in the clinical setting.

AbstractObjective: To assess the preparedness of psychiatric nurses to care for patients with Acquired Immune Deficiency Syndrome (AIDS). Method: Voluntary anonymous questionnaires were sent to psychiatric and general nurses in a district general teaching hospital. The behaviour, knowledge and attitudes towards AIDS of both groups were then compared with those of three experts specialising in the care of AIDS patients. Results: No inter group differences were found but a majority of nurses differed from the experts on two statements. Contrary to expert opinion nurses believed AIDS could be spread by needle stick injury and if given a choice they stated they would not volunteer to work on an AIDS ward. On controversial issues such as testing and where best to treat psychiatrically disturbed AIDS patients there was wide variation. Conclusion: While this study shows an improvement in health professionals knowledge, behaviour and attitudes towards AIDS, there remain underlying anxieties that need to be addressed with continuing education and training.

Background: E-learning as a new paradigm in modern education, is an alternative learning model than just face to- face. As simply, e-learning is defined as learning to use the electronic media, which aims to increase knowledge and performance. Studying by using e-learning is important to build the education sector in Indonesia, particularly as an effort to improve equity and access in education, particularly in health domain. Implementing of e-learning in health education are very relevant to the concept of continuing medical /health education that leads to continuous professional education. However, the higher education in Indonesia is still slightly to implement learning-based electronic systems. Several studies have shown the enthusiasm of higher education in using e-learning. The benefits and differences of using e-learning need to be carefully evaluated, especially for health education. This study analyzed the use of e-learning for teaching and learning in health education. In addition, identifying the barriers of e-learning for students.Method: The study was conducted in Poltekkes Kemenkes Palembang involving second-year Nursing students. A quasi-experimental approach was used for two groups of students, 1) e-learning users (treatment) and 2) non e- learning users (control), who were taking the Health Promotion subject. The data were collected using a pre-post tests and questionnaires. Data was analysed quantitatively and qualitatively.Results: Pre-post test results showed a significant difference to the increasing of students’s knowledge who is participating in e-learning compared with conventional learning (p <0,05). There is a positive perception of the discussion, assignments, quizzes / exams, and the availability of teaching materials amongst the students who are participating in e-learning.Conclusion: Blended learning method provide a positive impact on teaching and learning in nursing students. This method should be considered as a complement to conventional learning.

Purpose Cambodia has one of the highest death rates for children under five years of age in Southeast Asia. The high mortality rate of children under five years of age, especially the neonate is 35 per 1,000 for the period zero to four years. There are no neonatal nursing standards of practice to guide nurses providing neonatal nursing care. Some general guidelines are currently being implemented for both doctors and nurses. The Minister for Health officially launched the Cambodian Council of Nurses’ Guideline for the Standard of Nursing Care in December 2015. In the absence of specific neonatal nursing standards of practice, the purpose of this paper is to develop the Neonatal Nursing Standard of Practice for Cambodia. Design/methodology/approach The Delphi technique was selected as being appropriate for this study. The snowball with purposive sampling was used. The identified experts were located across Cambodia so the e-Delphi approach was considered appropriate and applicable according to the study context. Four experts preferred to be interviewed face-to-face, while 16 experts were confident to use e-mail to respond to the questionnaire in Round 1. In total, 19 experts provided responses via e-mail to the Rounds 2 and 3 questionnaires. Findings A Standard for Neonatal Nursing Practice for Cambodia which consists of ten standards was found as a result of this study: assessment, nursing diagnosis, planning, implementation, evaluation, ethics, evidence-based practice and research, health teaching and health promotion, continuing education, and communication. Originality/value All items and sub-items achieved consensus as either being at the most significant level and therefore, could be key indicators for neonatal nursing standards of practice. The results of this study can be incorporated into a focused discussion led by the Nursing and Midwifery Bureau of the Ministry of Health to develop national standards of practice for neonatal nurses in Cambodia.

Technology is an integrated presence between science and machines. Information technology in nursing includes knowledge, attitudes and skills. These three things are needed by a health care profession in their daily work. The ability of nurses to use nursing technology is a form of caring. Nurse caring behavior is very important in fulfilling patient satisfaction, therefore students' understanding of technology as a form of caring in nursing needs to be instilled since the period of education. The purpose of this study was to identify the relationship between the technological skill competency in nursing and caring of nursing profession students. The research method used in this study is correlation analytic with cross sectional approach. Questionnaire was utilized to gather the needed data and information. The subjects of this study were 90 nursing students, total sampling was applied to gained participants. Respondents met the inclusion criteria, namely studying at STIKes in the Surabaya region, being willing to be respondents, and graduating a bachelor's degree in nursing, a maximum of one year before continuing to Ners profession student. The results showed that there was a significant relationship between the ability to use technology (medical devices) and caring of Ners professional students (p = 0.000; r = 0.630. There was a significant relationship between the ability to use technology (Information and Communication Technology) and caring (p = 0.000; r = 0.469). The ability to use technology makes nurses understand the patient as a whole or holistic human. If the nurse understands the patient completely then he will understand all aspects of the patient as a unique person, this will help patients to develop and accelerate the healing process. The ability of nurses to use technology is an expression of caring in nursing, where caring and technology are an integral part. Technology plays an important role in health care, technology is used to improve patient safety, save lives patient and support nurses in their job. Teaching caring from the time of education is very important because this is the first stage for nursing students to learn the value and meaning of the nursing profession.

Objective: describe the profile of occupational accidents among doctors and nurses. Methodology: exploratory, descriptive and quantitative study, conducted at a public teaching hospital in the city of Teresina, Piauí, with 67 health professionals. Data were obtained in the months from February to May 2011, through a form, and analyzed the program "Statistical Package for the Social Sciences", version 20.0. Results: It was found that 28 professionals reported injuries, being the most prevalent category of nursing technician. As to age, the most affected were between 41 and 50 years. Regarding frequency, 11 had suffered two accidents, only one 10 and 2 with three accidents, with a total of 34 accidents. Peripheral venous puncture was practicing more involved in accidents, being mentioned by 16 of the 28 victims. 47 participants cited the Internal Commission for Accident Prevention as a place you should report the accident. Conclusion: verifies the need for continuing education courses on the use of containment barriers and accident prevention to minimize risk and ensure the safety of workers. Keywords: Occupational diseases. Occupational risks. Health personnel.

Introduction: Nurses should be committed to undertake continuing professional development (CPD) courses to advance nursing practice and guarantee lifelong learning. Online CPD programs may allow nurses to fulfil the demand for specialty competency. Aim: This study focuses on utilising online (CPD) activities to develop cardiac nurses’ ability to perform advanced clinical skills. Method: The study was conducted in one of the largest accredited teaching hospitals in South Australia. The department is staffed by a specialised multi-professional team, some of whom have completed specialised cardiac post-graduation diploma courses in order to meet the complex needs of cardiac patients. To keep the team abreast of the latest developments in practice, the in-service education department at local study setting runs several CPD programs for the cardiology department via varied learning modes, such as online CPD programs, classroom learning and bedside-based learning. The nursing team maintains advanced clinical skills through online CPD, orientation programs, and in-service classroom-based courses. Regarding online CPD courses, electrocardiography interpretation and underwater sealing draining management courses are mandatory courses which all registered nurses must complete while working in medical or surgical cardiac wards. Results: The interview process was conducted in five stages: 1. Determining the type of the interview where in such types of qualitative studies the researcher should focus on the fundamental question of the phenomenological inquiry throughout the unstructured, in-depth interview process. 2. Making initial contact where the researcher established a rapport with the participant and prepared them mentally by giving them the participant information sheet. 3. Context of the interview where interviews be conducted in a quiet room in the School of Nursing in order to maintain participant privacy and anonymity, participants requested to conduct the interviews in their work setting. Nonetheless, the researcher ensured that participant privacy and anonymity was upheld. 4. Selecting the lived experience where Each participant was interviewed once. Interview duration was 15 to 30 minutes. The interviews started with a grand tour question. Grand tour questions are very broad questions asked by the interviewer at the early stage of an interview to obtain a description of the event or experience. 5. All interviews were concluded by thanking the participant and offering them the choice to have a copy of their interview transcript to verify what they had said. The researcher wrote an interview summary after listening to the interviews on the same day. The summary was prepared to help the researcher evaluate the amount of data gathered and identify whether the point of data saturation was reached. In addition, writing the summary helped the researcher reflect on the interview and gain an understanding of the participant experience Conclusion This study explained the process of data collection, describing the setting, nature of participants and process of data collection using phenomenological interview. As the human experience is complex, gathering in-depth data should be systematic to ensure that the researcher has obtained the most sufficient data to explore the essence of the experience.

Este trabalho é resultado de um estudo sobre a educação permanente. Tem como objetivo refletir sobre a educação permanente como base para o trabalho do enfermeiro. Para construção desse artigo utilizamos como metodologia a Revisão Integrativa, que foi realizada nas seguintes bases de dados Biblioteca Virtual de Saúde (BVS), SciELO, LILACS, REDIB e BDENF. A educação permanente trabalha com instrumentos que refletem sobre a pratica dos serviços de saúde, que é um processo de trabalho educativo que visa mudanças nas relações de trabalho unindo o conhecimento cientifico e a pratica, onde o aprender e o ensinar se incorporam ao dia a dia das organizações e ao processo de trabalho. Vimos a importância da educação na enfermagem e principalmente como esses conceitos se complementam e interagem entre si. Portanto, Todo processo educativo não tem um fim em si mesmo. Ele é um processo inacabado, sendo necessário retroalimentá-lo continuamente pela dinâmica do setor saúde, a educação permanente e continuada são ferramentas para essa construção. Espera-se que esse estudo possa ampliar reflexões acerca da educação permanente em saúde, subsidiando novas pesquisas e contribuindo para a melhoria da qualidade da assistência.Descritores: Enfermagem, Educação permanente, Assistência. The challeng of continuing education in nursing workAbstract: This work is the result of a study on lifelong education. It aims to reflect on lifelong education as the basis for nurses' work. For the construction of this article we used as a methodology the Integrative Revision, which was performed in the following databases Virtual Health Library (VHL), SciELO, LILACS, REDIB and BDENF. Continuing education works with instruments that reflect on the practice of health services, which is an educational work process that aims at changes in labor relations, uniting scientific knowledge and practice, where learning and teaching are incorporated into everyday life Organizations and the work process. We have seen the importance of education in nursing and especially how these concepts complement and interact with one another. Therefore, every educational process has no end in itself. It is an unfinished process, and it is necessary to continuously feed it through the dynamics of the health sector, permanent and continuous education are tools for this construction. It is hoped that this study could broaden reflections about the permanent education in health, subsidizing new researches and contributing to the improvement of the quality of care.Descriptors: Nursing, Continuing Education, Assistance. El desafío de la educación permanente en el trabajo de enfermeríaResumen: Este trabajo es el resultado de un estudio sobre el aprendizaje permanente. Su objetivo es reflexionar sobre la educación continua como base para el trabajo de las enfermeras. La construcción de este artículo se utiliza como metodología de la revisión integradora, que se realizó en las siguientes bases de datos de la Biblioteca Virtual en Salud (BVS), SciELO, LILACS, REDIB y BDENF. La educación permanente trabaja con herramientas que se reflejan en la práctica de los servicios de salud, que es un proceso de trabajo educativo dirigido a los cambios en las relaciones laborales que une conocimiento y la práctica científica, donde el aprendizaje y la enseñanza se incorporan en el diario organizaciones y el proceso de trabajo. Vimos la importancia de la educación en enfermería y sobre todo cómo estos conceptos se complementan mutuamente y recíprocamente. Por lo tanto, todo el proceso educativo no es un fin en sí mismo. Es un proceso inacabado, lo que requiere que se retroalimenta continuamente por la dinámica del sector de la salud, la educación permanente y continua son herramientas para esta construcción. Se espera que este estudio se expandirá reflexiones sobre la educación permanente en salud, el apoyo a nuevas investigaciones y contribuir a la mejora de la calidad de la atención.Descriptores: Enfermería, Educación Continua, Asistencia.

Este trabalho é resultado de um estudo sobre a educação permanente. Tem como objetivo refletir sobre a educação permanente como base para o trabalho do enfermeiro. Para construção desse artigo utilizamos como metodologia a Revisão Integrativa, que foi realizada nas seguintes bases de dados Biblioteca Virtual de Saúde (BVS), SciELO, LILACS, REDIB e BDENF. A educação permanente trabalha com instrumentos que refletem sobre a pratica dos serviços de saúde, que é um processo de trabalho educativo que visa mudanças nas relações de trabalho unindo o conhecimento cientifico e a pratica, onde o aprender e o ensinar se incorporam ao dia a dia das organizações e ao processo de trabalho. Vimos a importância da educação na enfermagem e principalmente como esses conceitos se complementam e interagem entre si. Portanto, Todo processo educativo não tem um fim em si mesmo. Ele é um processo inacabado, sendo necessário retroalimentá-lo continuamente pela dinâmica do setor saúde, a educação permanente e continuada são ferramentas para essa construção. Espera-se que esse estudo possa ampliar reflexões acerca da educação permanente em saúde, subsidiando novas pesquisas e contribuindo para a melhoria da qualidade da assistência.Descritores: Enfermagem, Educação permanente, Assistência. The challeng of continuing education in nursing workAbstract: This work is the result of a study on lifelong education. It aims to reflect on lifelong education as the basis for nurses' work. For the construction of this article we used as a methodology the Integrative Revision, which was performed in the following databases Virtual Health Library (VHL), SciELO, LILACS, REDIB and BDENF. Continuing education works with instruments that reflect on the practice of health services, which is an educational work process that aims at changes in labor relations, uniting scientific knowledge and practice, where learning and teaching are incorporated into everyday life Organizations and the work process. We have seen the importance of education in nursing and especially how these concepts complement and interact with one another. Therefore, every educational process has no end in itself. It is an unfinished process, and it is necessary to continuously feed it through the dynamics of the health sector, permanent and continuous education are tools for this construction. It is hoped that this study could broaden reflections about the permanent education in health, subsidizing new researches and contributing to the improvement of the quality of care.Descriptors: Nursing, Continuing Education, Assistance. El desafío de la educación permanente en el trabajo de enfermeríaResumen: Este trabajo es el resultado de un estudio sobre el aprendizaje permanente. Su objetivo es reflexionar sobre la educación continua como base para el trabajo de las enfermeras. La construcción de este artículo se utiliza como metodología de la revisión integradora, que se realizó en las siguientes bases de datos de la Biblioteca Virtual en Salud (BVS), SciELO, LILACS, REDIB y BDENF. La educación permanente trabaja con herramientas que se reflejan en la práctica de los servicios de salud, que es un proceso de trabajo educativo dirigido a los cambios en las relaciones laborales que une conocimiento y la práctica científica, donde el aprendizaje y la enseñanza se incorporan en el diario organizaciones y el proceso de trabajo. Vimos la importancia de la educación en enfermería y sobre todo cómo estos conceptos se complementan mutuamente y recíprocamente. Por lo tanto, todo el proceso educativo no es un fin en sí mismo. Es un proceso inacabado, lo que requiere que se retroalimenta continuamente por la dinámica del sector de la salud, la educación permanente y continua son herramientas para esta construcción. Se espera que este estudio se expandirá reflexiones sobre la educación permanente en salud, el apoyo a nuevas investigaciones y contribuir a la mejora de la calidad de la atención.Descriptores: Enfermería, Educación Continua, Asistencia.

Background Control of blood pressure remains suboptimal worldwide. High rates of undiagnosed and untreated hypertensive patients raise the need of searching for the basis of this situation among prescribing physicians. Aim To evaluate the awareness of medical residents and practicing physicians in Jordan about the treatment of high blood pressure according to the seventh report of the Joint National Committee (JNC VII). Method A written questionnaire was distributed to 200 physicians from different areas of Jordan during the period from November 2005 till February 2006. Recruitment of physicians in this study was in general, military, private hospitals and in clinics. A rigorously developed questionnaire on changes seen in JNC VII, target blood pressure goals, and the treatment of high blood pressure options was administered by trained medical personnel. Results One hundred and forty five physicians (72.5%) consented to complete the questionnaire. The practices of recent graduates from medical school were not better than those of older graduates. As a general rule, physicians in Jordan under treat high blood pressure. Conclusion Our findings highlight the need for the revision of the teaching curricula in medical schools with regard to the management of hypertension, as well as the initiation of a widespread and intensive continuing medical education for all physicians involved in the management of patients with hypertension. Particular efforts are needed to encourage the use of low-cost thiazides and the use of angiotension converting enzyme inhibitors in heart failure patients and other compelling indications.

Abstract: Rapid changes in today’s healthcare industry are reshaping nurses’ role. The emergence of new healthcare system, the shift from service to business orientations, and extensive redesign of workplace affects the where and how nursing care is delivered as well as those who delivered the care. In the Philippines, healthcare system is in the midst of dramatic evolvement- the devolution of hospitals to LGUs, free healthcare for senior citizens and no balance billing policy yielding to increased client-nurse ratio. These impacts change the roles of nurse managers and their practice. The study aimed to understand the experience and phenomena of nurse managers, their roles in the dynamics of healthcare practice, and seek ways to enhance the development of these roles. The study used descriptive phenomenology-qualitative design, and utilized Colaizzi method during data analyses. Through researcher-made guide questions, the study employed purposively nurse managers as key informants from tertiary hospitals that experienced devolution using the inclusion and exclusion criteria. The researchers conducted interviews with audio- tapes that then later transcribed. The study revealed that nurse managers encountered challenges in the workplace like deprivation of responsibility, less administrative support that challenged their responsibili- ties. The nurse managers identified new roles that they have developed over time like Carative-managerial role, responsibility to educate and the responsibility to the nursing profession. They are believers that the enhancement of such roles is realized through rest and recreation among staffs to avoid burnout and exhaustion, acquiring continuing professional education, clinical teaching and mentoring skills strategies to understand better human behavior. The researchers recommends consumption of such study findings as basis for improving hospital facilities for the provision of patient safety, revisiting and strengthening the hiring and screening policies for new nurses, administrative support for staff development and as basis to conduct further studies on the emerging roles to other settings. Keywords: changing roles, nurses roles, nurse managers, emerging roles, health care practice, role devel- opment

Introduction: Adolescent pregnancy is a global public health problem, for which healthcare providers (HCPs) play a critical role to prevent unintended pregnancy. This study investigated the knowledge, attitude and practice (KAP) of HCPs towards the use of contraceptives in adolescents.Results: Of the 101 eligible for the study, 79.2% HCPs from the selected clinics and hospital responded. The majority (91.2%) of respondents felt confident to explain to adolescents how to use old contraceptive methods such as oral contraceptives or IUCD, less than half of the respondents (41.3%) were confident to explain how to use new contraceptive methods such as transdermal contraceptive patches or vaginal rings. Medical doctors felt more confident to prescribe new contraceptive methods compared with nurses, both vaginal rings (p-value = 0.0006) and transdermal contraceptive patches (p-value = 0.0003). More than two-thirds of the respondents disagreed that beliefs influenced their ability to offer contraceptive services to adolescents, half of the respondents strongly disagreed that it was morally wrong for adolescents to use contraceptives. Although three-quarters of respondents strongly agreed (median = 5, [IQR 5–6]) that they were comfortable with prescribing contraceptives to adolescents, only 23% of the respondents very much prescribed or always prescribed contraceptives to adolescents.Conclusion: Most of the HCPs prescribed contraceptives irregularly, and had limited knowledge about newer methods. To change HCPs’ KAP, in addition to continuing medical education (CME), the establishment of family planning clinics for adolescents and more undergraduate contraceptive teaching for medical and nursing students could result in the increased utilisation of contraceptive services by adolescents.

Introducción: El desempeño de la enfermería obstétrica en el escenario del parto y el parto, ha ido ganando protagonismo por ser una profesional considerada una figura indispensable para el logro de un parto humanizado, con el objetivo de rescatar la autonomía de las mujeres. Materiales y métodos: Este es un estudio cuasi experimental, antes y después, que desarrolló una intervención educativa, realizada a través de un curso de capacitación aplicado al personal de enfermería. Celebrada del 01 al 03 de agosto de 2018 en la sala de partos de un hospital de maternidad en Teresina-PI. Se solicitó la autorización del comité de enseñanza e investigación de la institución, con una opinión favorable para llevar a cabo. Resultados: Treinta y dos profesionales participaron en la intervención, con la mayoría del personal de enfermería del centro obstétrico, con 87.50% de técnicos de enfermería y 85.71% de enfermeras obstétricas. Se puede observar que en la prueba previa hubo un mayor número de errores en las preguntas, 5 con 46.87% de error y 10 con 32.50% de error en el tema de cuidados de enfermería en trabajo de parto y parto, con mejoría después de la aplicación de la intervención con 18.75 y 9.25 errores respectivamente en el examen posterior. Discusión: Frente a varias opciones de estrategias de instrucción, la educación continua tiene un lugar destacado en enfermería, porque a partir de los resultados, podemos ver la mejora del conocimiento de profesionales después de aplicar la intervención educativa. Conclusión: La intervención permitió a los profesionales ampliar sus conocimientos y proporcionar al binomio madre-RN una atención humanizada respaldada por evidencia científica. Introduction: The performance of obstetric nursing in the scenario of labor and childbirth has gained prominence because nursing professionals are considered indispensable actors for the achievement of humanized birth, to rescue the autonomy of women. Materials and methods: This is a quasi-experimental study of the before and after type, in which an educational intervention was developed, conducted through a training course applied to the nursing staff. The study was accomplished from August 01 to 03, 2018, in the childbirth room of a maternity hospital in Teresina-PI. Authorization from the teaching and research committee of the institution was requested, with a favorable Opinion for its realization. Results: Thirty-two professionals participated in the intervention. The majority was from the obstetric center; 87.50% were nursing technicians and 85.71% obstetric nurses. There was a greater number of errors in questions 5 (46.87% of error) and 10 (32.50% of error) in the pre-test, in the theme nursing care in labor and childbirth, and an improvement of to 18.75 and 9.25 of error, respectively, in the post-test. Discussion: Among the several options of instructional strategies, continuing education has a prominent place in nursing, as the results of this study showed an improvement in the knowledge of professionals after application of the educational intervention. Conclusion: The intervention allowed the professionals to broaden their knowledge and provide the mother-newborn binomial with a humanized care supported by scientific evidence.

ABSTRACT The evaluation of the General Competencies in undergraduate courses in the healthcare area remains challenging. Objectives To develop an instrument for supporting teaching staff in evaluating the General Competencies of undergraduate students in the healthcare area; to test the reliability of the instrument with teachers and students of the same working field; validate the instrument of General Competencies, directed to teachers and students from the health area. Methods the present was a Methodological study, approved by REC N. 826.770. The validation of the construct, criterion and content based on the National Curricular Guidelines (NCG), and the search for a theoretical framework were performed, as well as statistical tests such as alpha Cronbach, t Test, p-value, Factorial Analysis, Pearson’s Correlation Coefficient and Akaike Information Criterion, which also ensured the reliability. The study was performed in a Higher Education Institution in Curitiba/PR, in the courses of Nursing, Biomedical Sciences, Pharmacy, Psychology and Medicine. The study population consisted of 50 evaluations of students and 50 of teachers, covering all the periods and courses during the second half of 2014. Results it was possible to create one model with three versions of instruments that evaluated the general competencies for the healthcare area courses. One of these was directed towards the general competencies of 10 courses in the healthcare area, subdivided in Health Care, Decision-making, Communication, Leadership, Administration and Management and Continuing Education, with one instrument directed at the student and another ‘mirror’ at the professor. The second and third versions had three dimensions: Health Care, Management in Healthcare and Education in Health, directed towards the general competencies of the new structure of the NCG of the medical course. The three versions also had an instrument for teachers and a mirror one for students. Conclusion To validate the instrument on General Competencies, directed to teachers and undergraduate students of health area courses, the theoretical search, the NCG and the experts’ evaluation were used for Content Validity; the t Test, Chi-square Test and Pearson’s correlation coefficient were used for Criterion Validation; statistical tests of exploratory and confirmatory factorial analysis and the AIC were used for Construct Validity; and Cronbach’s alpha and the AIC were used for Content validity, using the same steps described for the first goal, to ensure the reliability of the instruments. After this process three versions of the instrument were developed, the first two to be used with teachers and with teachers and students together; and the third version is adequate to be used with students or teachers; and also, for teachers and students together. However, it can be used by all health courses studied.

ABSTRACT The evaluation of the General Competencies in undergraduate courses in the healthcare area remains challenging. Objectives To develop an instrument for supporting teaching staff in evaluating the General Competencies of undergraduate students in the healthcare area; to test the reliability of the instrument with teachers and students of the same working field; validate the instrument of General Competencies, directed to teachers and students from the health area. Methods the present was a Methodological study, approved by REC N. 826.770. The validation of the construct, criterion and content based on the National Curricular Guidelines (NCG), and the search for a theoretical framework were performed, as well as statistical tests such as alpha Cronbach, t Test, p-value, Factorial Analysis, Pearson’s Correlation Coefficient and Akaike Information Criterion, which also ensured the reliability. The study was performed in a Higher Education Institution in Curitiba/PR, in the courses of Nursing, Biomedical Sciences, Pharmacy, Psychology and Medicine. The study population consisted of 50 evaluations of students and 50 of teachers, covering all the periods and courses during the second half of 2014. Results it was possible to create one model with three versions of instruments that evaluated the general competencies for the healthcare area courses. One of these was directed towards the general competencies of 10 courses in the healthcare area, subdivided in Health Care, Decision-making, Communication, Leadership, Administration and Management and Continuing Education, with one instrument directed at the student and another ‘mirror’ at the professor. The second and third versions had three dimensions: Health Care, Management in Healthcare and Education in Health, directed towards the general competencies of the new structure of the NCG of the medical course. The three versions also had an instrument for teachers and a mirror one for students. Conclusion To validate the instrument on General Competencies, directed to teachers and undergraduate students of health area courses, the theoretical search, the NCG and the experts’ evaluation were used for Content Validity; the t Test, Chi-square Test and Pearson’s correlation coefficient were used for Criterion Validation; statistical tests of exploratory and confirmatory factorial analysis and the AIC were used for Construct Validity; and Cronbach’s alpha and the AIC were used for Content validity, using the same steps described for the first goal, to ensure the reliability of the instruments. After this process three versions of the instrument were developed, the first two to be used with teachers and with teachers and students together; and the third version is adequate to be used with students or teachers; and also, for teachers and students together. However, it can be used by all health courses studied.

As ações realizadas pelo enfermeiro assistencialista podem ser determinantes para o bom resultado de uma cirurgia ou procedimento, pois a manipulação correta dos materiais esterilizados e o conhecimento quanto aos indicadores do processo, tornam o profissional capaz de identificar se o processo de esterilização foi eficaz para inibir o crescimento de bactérias e vírus, bem como das toxinas. Portanto, a atualização deve ser de forma permanente, pois há diferentes métodos de esterilização que podem melhor integrar a Central de Materiais Especiais. O objetivo desta pesquisa foi identificar o conhecimento dos enfermeiros assistencialistas inerentes à central de materiais especiais e seus processos de órteses e próteses, em um hospital do nordeste do Rio Grande do Sul. Realizou-se um estudo exploratório-descritivo, de abordagem quantitativa, cujo questionário foi aplicado com 32 enfermeiros assistenciais de um hospital de médio porte. Os resultados mostraram que mesmo que os enfermeiros assistenciais que recebido informações sobre a central de materiais, órteses, próteses e materiais especiais, esse conhecimento foi limitado, pois houve discrepância nas respostas, gerando dúvidas sobre a real ciência da equipe. Portanto, agrega informações na área acadêmica, mostrando pontos fracos que precisam ser trabalhados no ensino, quanto a gerência assistencial da instituição, ficou evidenciado a participação dos profissionais nos treinamentos e a flexibilidade de horários como facilitador para tal. Também elucida a importância da educação permanente, pois quando o conhecimento não é absorvido de forma apropriada no ensino superior, seja pela não abordagem ou falta de discussão, o mesmo pode ser adquirido durante o exercício profissional. Palavras-chave: Conhecimento. Enfermagem. Esterilização. Educação Continuada. Abstract The actions performed by the assisting nurse can be decisive for the good result of a surgery or procedure, as the correct handling of sterilized materials and the knowledge of the process indicators, make the professional able to identify whether the sterilization process was effective to inhibit the growth of bacteria and viruses, as well as toxins. Therefore, the update must be permanent, as there are different sterilization methods that can better integrate the Central of Special Materials. The objective of this research was to identify the knowledge of the assisting nurses inherent to the special materials center and their orthosis and prosthesis processes, in a hospital in the northeast of Rio Grande do Sul. An exploratory-descriptive study was carried out, with a quantitative approach, whose a questionnaire was applied to 32 assisting nurses from a medium-sized hospital. The results showed that even though the respondents received information about the materials center, orthoses, prostheses and special materials, this knowledge was limited, as there was a discrepancy in the answers, generating doubts about the real science of the team. Therefore, it aggregates information in the academic area, showing weaknesses that need to be worked on in teaching, regarding the institution's assistance management, it was evident the participation of professionals in training and the flexibility of schedules as a facilitator for this. It also elucidates the importance of continuing education, because when knowledge is not absorbed properly in higher education, whether due to lack of approach or lack of discussion, it can be acquired during professional practice. Keywords: Knowledge. Nursing. Sterilization. Continuing Education.

ABSTRACT Objective: describing educative actions with community health agents (CHA). Methodology: the study is about an experience report. The populations is nine CHA. The development procedure of educational actions was reasoned on Problem Methodology. The reflection of this experience emerged from the theoretical references that were important to the theme. The scenery was a small town in the countryside of Rio Grande do Sul on July 2009. Results: activity was initiated from observation of reality to recognize the CHA’s social and work context. From observation emerged the key points related with diseases prevalent in the region to theorization. Mediated by readings, dialogued-expositive lectures, tapes, photos and figures; among other techniques as dynamics and workshops. In the following strategies were building in order to supply necessities from reality. In the last, we return to reality with application of knowledge (re)formulated based in orientations and operational groups. Conclusion: this type of activities provided for student being near of the different sceneries of the community and the health practices. The problematizing approach promoted interaction between CHA and student, and valorization of each participant’s personal knowledge. Descriptors: nursing; education, continuing; public health; teaching; health promotion.RESUMO Objetivo: descrever ações educativas junto aos Agentes Comunitários de Saúde (ACS). Metodologia: o estudo é um relato de experiência. A população é de nove ACS. O procedimento para desenvolvimento das ações educativas foi fundamentado na Metodologia da Problematização. A reflexão desta experiência se deu à luz do referencial teórico pertinente ao tema. O cenário foi um município de pequeno porte no interior do estado do Rio Grande Sul em julho de 2009. Resultados: a atividade teve início partindo da observação da realidade, com o intuito de conhecer o contexto social e laboral dos ACS. Da observação, emergiram os pontos-chave relacionados a patologias prevalentes na comunidade para posterior teorização. Mediada por leituras, aulas expositivas dialogadas, vídeos, fotos e figuras; entre outras técnicas como dinâmicas e oficinas. Sequencialmente constituíram-se estratégias para suprir necessidades oriundas da realidade concreta. Por último, houve o retorno à realidade, com a aplicação dos conhecimentos (re)formulados em orientações e grupos operativos. Conclusão: atividades como esta proporcionam ao estudante aproximação com diferentes realidades da comunidade e das práticas de saúde. A problematização promoveu interação entre ACS e estudantes, e valorização do conhecimento pessoal de cada participante. Descritores: enfermagem; educação continuada; saúde pública; ensino; promoção da saúde.RESUMENObjetivo: describir las acciones educativas junto a los Agentes Comunitarios de Salud (ACS). Metodología: el estudio es un informe de la experiencia. La población es de nueve ACS. El procedimiento para el desarrollo de la metodología problematizadora se basa en el plan de estudios. La reflexión de esta experiencia fue dado a la luz de la teoría relevante para el tema. El escenario fue una ciudad pequeña en el estado de Rio Grande do Sul en julio de 2009. Resultados: la actividad tuvo inicio a partir de la observación de la realidad, con objetivo de conocer el contexto social y laboral de los ACS. De la observación, emergieron los puntos clave relacionados a las patologías prevalentes en la comunidad para posterior teorización, mediada por lecturas, clases expositivas, dialogadas, videos, fotos y figuras; entre otras técnicas como dinámicas y talleres. Secuencialmente, se constituyeron estrategias para suplir necesidades oriundas de la realidad concreta. Por último, hubo el retorno a la realidad, con la aplicación de los conocimientos (re)formulados en orientaciones y grupos operativos. Conclusión: actividades como esta proporcionan al estudiante acercamiento con diferentes realidades de la comunidad y de las prácticas de salud. La problematización promovió interacción entre ACS y estudiante, y valoración del conocimiento personal da cada participante. Descriptores: enfermería; educación continua; salud pública; enseñanza; promoción de salud.

Background. Standardization of clinical practices is an essential part of continuing education of newly registered nurses in the intensive care unit (ICU). The development of educational standards based on evidence can help improve the quality of educational programs and ultimately clinical skills and practices. Objectives. The objectives of the study were to develop a standardized learning curve of arterial blood gas (ABG) sampling competency, to design a checklist for the assessment of competency, to assess the relative importance of predictors and learning patterns of competency, and to determine how many times it is essential to reach a specific level of ABG sampling competency according to the learning curve. Design. A quasi-experimental, nonrandomized, single-group trial with time series design. Participants. All newly registered nurses in the ICU of a teaching hospital of Tehran University of Medical Sciences were selected from July 2016 to April 2018. Altogether, 65 nurses participated in the study; however, at the end, only nine nurses had dropped out due to shift displacement. Methods. At first, the primary checklist was prepared to assess the nurses’ ABG sampling practices and it was finalized after three sessions of the expert panel. The checklist had three domains, including presampling, during sampling, and postsampling of ABG competency. Then, 56 nurses practiced ABG sampling step by step under the supervision of three observers who controlled the processes and they filled the checklists. The endpoint was considered reaching a 95 score on the learning curve. The Poisson regression model was used in order to verify the effective factors of ABG sampling competency. The importance of variables in the prediction of practice scores had been calculated in a linear regression of R software by using the relaimpo package. Results. According to the results, in order to reach a skill level of 55, 65, 75, 85, and 95, nurses, respectively, would need average ABG practice times of 6, 6, 7, 7, and 7. In the linear regression model, demographic variables predict 47.65 percent of changes related to scores in practices but the extent of prediction of these variables totally decreased till 7 practice times, and in each practice, nurses who had the higher primary skill levels gained 1 to 2 skill scores more than those with low primary skills. Conclusions. Utilization of the learning curve could be helpful in the standardization of clinical practices in nursing training and optimization of the frequency of skills training, thus improving the training quality in this field. This trial is registered with NCT02830971.

RESUMOObjetivo: relatar a experiência vivenciada por discentes do curso de mestrado sobre a realização de uma oficina de práticas integrativas e complementares em saúde, com enfoque na Terapia Comunitária Integrativa (TCI). Método: trata-se de um estudo descritivo, tipo relato de experiência. Deu-se o estudo a partir da disciplina Processo Ensino-Aprendizagem cuja proposta de avaliação consistia na realização de uma oficina desenvolvida na semana de Enfermagem com 13 pessoas. Apresentaram-se os resultados em forma de relato. Resultados: percebeu-se, mediante a experiência da execução da oficina, que os participantes, embora inseridos na área da saúde, seja enquanto formação acadêmica ou atuação profissional, detinham um conhecimento vago acerca da temática das Práticas Integrativas e Complementares. Conclusão: tornou-se tal prática gratificante e exitosa na medida em que redimensiona e possibilita a ressignificação de fundamentos diante da produção do conhecimento na área da saúde, ao considerá-lo enquanto um processo dinâmico e não estático. Descritores: Terapias Complementares; Saúde; Educação Superior; Saúde Pública; Capacitação Profissional; Educação Continuada. ABSTRACTObjective: to report the experience of students of the master's degree course on the realization of a workshop on integrative and complementary practices in health, focusing on Integrative Community Therapy (ICT). Method: it is a descriptive study, type of experience report. The study was based on the discipline Teaching-Learning Process whose evaluation proposal consisted of a workshop developed in Nursing week with 13 people. The results were presented in the form of a report. Results: it was perceived, through the experience of the execution of the workshop, that the participants, although inserted in the health area, either as an academic or professional activity, had a vague knowledge about the theme of Integrative and Complementary Practices. Conclusion: it has become such a rewarding and successful practice insofar as it resizes and enables the re-signification of foundations in the production of knowledge in the health area, considering it as a dynamic and non-static process. Descriptors: Complementary Therapies; Health; College education; Public health; Professional Training; Continuing Education.RESUMEN Objetivo: relatar la experiencia vivenciada por discentes del curso de maestría sobre la realización de un taller de prácticas integrativas y complementarias en salud, con enfoque en la Terapia Comunitaria Integrativa (TCI). Método: se trata de un estudio descriptivo, tipo relato de experiencia. Se dio el estudio a partir de la asignatura Proceso Enseñanza-Aprendizaje cuya propuesta de evaluación consistía en la realización de un taller desarrollado en la semana de Enfermería con 13 personas. Se presentaron los resultados en forma de relato. Resultados: se percibió, mediante la experiencia de la ejecución del taller, que los participantes, aunque insertos en el área de la salud, sea como formación académica o actuación profesional, tenían un conocimiento vago acerca de la temática de las Prácticas Integrativas y Complementarias. Conclusión: se ha convertido en tal práctica gratificante y exitosa en la medida en que redimensiona y posibilita la resignificación de fundamentos ante la producción del conocimiento en el área de la salud, al considerarlo como un proceso dinámico y no estático. Descritores: Terapias Complementarias; Salud; Educación Superior Salud Pública; Capacitación Profesional; Educación Continua.

Objective: The study sought to determine if librarians are collaborating with nurses and professional nursing organizations to teach evidence-based practice (EBP) continuing education courses, workshop, classes, or other training activities.Methods: A 15-question survey was sent to 1,845 members of the Medical Library Association through email.Results: The survey was completed by 201 consenting respondents. Some respondents (37) reported having experience teaching continuing education in collaboration with professional health care organizations and 8 respondents, more specifically, reported having experience teaching EBP continuing education courses, workshops, classes, or other training activities in collaboration with professional nursing organizations.Conclusions: The survey results suggest that librarians do not have a systematic approach as a community of practitioners to seek out collaboration opportunities with professional nursing organizations to teach EBP continuing education courses, workshops, classes, or other training activities.

Nipissing University in North Bay, Ontario, is currently the only post- secondary institution in that province to offer a part-time Baccalaureate of Science in Nursing (BScN) program for Registered Practical Nurses (RPNs) through a blended learning model. This program represents a “bridge” from the nurse’s college diploma and offers a curriculum that enables students to continue to practice nursing as they study. Since the program’s inception in 2010, over 500 students have been admitted, attesting to its need. Flexibility, access, partnership, and excellence in teaching and learning comprise the heart of this complex, innovative, and student-centred program. As a blended learning program, it uses synchronous and asynchronous online technologies to deliver theoretical content; these experiences are balanced with face-to-face learning in the clinical setting. Clinical learning is facilitated through partnership agreements with the students’ employers.This paper describes how this RPN to BScN blended learning program has brought Nipissing to a leading edge in continuing education for RPNs. It also demonstrates Nipissing University’s commitment to drive change in the world of professional and adult education.

ABSTRACT Objective: to analyze the perception of nurses regarding an educational intervention with innovative pedagogical methods on acute management of burns. Method: a qualitative and exploratory study based on Paulo Freire's sociocultural pedagogical approach. The educational intervention was carried out with 18 nurses who worked in the areas of urgency and emergency. The intervention was centered on active teaching-learning methodologies, in which the main teaching methods were case-based learning, conceptual maps, simulation training, and digital portfolio. Data was collected in November 2017 and October 2018, in the setting of a state public university, by means of a sociodemographic questionnaire, records produced from focus groups, field diaries and portfolios, which were analyzed based on data triangulation, using Bardin's content analysis technique. Results: four categories were identified: collaborative construction of knowledge based on autonomy and dialog between the students; learning with dynamism and joy; from problematizing reality to critical thinking; and education that leads to professional empowerment and confidence. Conclusion: the nurses perceived the educational intervention as positive, since the innovative and participatory teaching methods adopted contributed to the development of competences and skills, ensuring more critical thinking, autonomy and empowerment for these professionals. The study represents an advance in the scope of Nursing education and in the orientation of continuing education actions.

Abstract Background Nurses with degree qualifications offer better nursing care compared to nurses prepared at lower levels. University based nursing degrees have been sanctioned as entry into professional nursing and several low-resource states have introduced university based nursing degrees. The clinical teaching of students enrolled in such degrees is challenged, as most nurses in practice do not have university degrees and may not have the necessary skills to facilitate clinical learning as expected at degree level. A university in Uganda established a bachelor’s degree in Nursing program and was expecting to use nurses in practice at a teaching hospital for the clinical teaching of university-degree nursing students. This study reports on the perceptions of the nurses in practice regarding their readiness for the clinical teaching of undergraduate nursing students. Methods A qualitative descriptive research study was conducted among 33 conveniently sampled nurses from Arua Regional Referral Hospital (ARRH) who had been supervising Diploma and/or Certificate in Nursing students. Five focus group discussions and three informant interviews were used to generate the data. Data were transcribed verbatim and analysed using an inductive approach through thematic analysis. Results The nurses in practice perceived themselves as ready for clinical teaching of undergraduate nursing students. Three themes emerged namely; “Willingness to teach undergraduate students” “Perceived attributes of undergraduate students”, and “The clinical practice environment”. Conclusion The nurses in practice need support in the execution of the clinical teaching role of university-degree nursing students. The nature of supports would include, continuing professional development specific to clinical teaching, engaging the educators in the clinical environment, positively engaging power gradients and address insecurities among the nurses and the students. Students in these programmes should be exposed to the clinical environment earlier within the programme, and be exposed to interprofessional and trans-professional education.

If trust is critical in relationships between teachers and distance education students, then how do teachers facilitate trust? This particularly challenging question arose from our experience teaching distance education nursing students who were continuing their education through the medium of audio-teleconferencing. Although audio-teleconferencing has the advantage of allowing students to stay in their own communities while accessing educational opportunities, we believed that it complicates the development of trusting relationships between teachers and students. In a qualitative study, students were asked to provide their perspectives on factors that facilitate trust within this distance education learning environment. Their responses indicate that, within the context of the learning milieu, trusting is construed as a developmental process, and through this process, trust in the learning, in the curriculum, and in one's co-learners occurs.

Abstract Background Job satisfaction among nursing faculty is critical to improving quality of nursing education, producing future nurses who will contribute directly to the health of patients at a local and national level. This study explores factors associated with job satisfaction among graduate nursing faculties in different universities of Nepal. Methods A cross-sectional study was conducted among nursing faculty with at least one year of teaching in their respective institutions. A 36-items job satisfaction questionnaire with 6-point Likert type responses was administered online. The questionnaire was pre-tested with 30 faculties pooled from multiple institutions. Link to the final survey was sent via e-mail to 327 nursing faculties working in 39 nursing colleges. Respondents were contacted by phone as a follow up to the email to politely remind them about the survey. Data analysis was carried out with SAS University Edition software. Chi-Square test and t-test were used for simple descriptive analysis. A multivariate binary logistic regression model was used to identify the significant factors associated with nursing faculties’ job satisfaction. Adjusted odds ratio was calculated and significance was considered at p ≤ 0.05 with 95% confidence interval. Results The response rate was 54.4%. After retrospective cleaning of data, usable response rate was 52.3% (n = 171). The average age of the nursing faculties was 36.8 ± 7.0 years. Based on the overall job satisfaction score, 36.8% nursing faculties were satisfied with their current job. The coefficient for Cronbach’s alpha was 0.895 suggesting very good reliability of the overall measure. The significant factors associated with job satisfaction were the involvement of the faculties in decision making process related to the department (OR = 4.83) and adequate access to reference materials (OR = 2.90). Conclusions This study suggests that nursing faculties have positive attitude towards their job but are dissatisfied with the benefits offered to them and the operating condition of their institutions. Expanding the teaching learning resources, such as reference books, subscription to journals, and continuing education opportunities for nursing faculties through participation in professional meetings would be helpful in improving the quality of nursing education in Nepal.

Abstract Background The need for effective continuing education is especially high in in-hospital geriatric care, as older patients have a higher risk of complications, such as falls. It is important that nurses are able to prevent them. However, it remains unknown which interventions change the behavior of nurses. Therefore, the aim of this study is to identify intervention options to change the behavior of hospital nurses regarding fall prevention among older hospitalized patients. Methods This study used a mixed method design. The Behavior Change Wheel (BCW) was used to identify intervention functions and policy categories to change the behavior of nurses regarding fall prevention. This study followed the eight steps of the BCW and two methods of data collection were used: five focus groups and three Delphi rounds. The focus groups were held with hospital nurses (n = 26). Geriatric experts (n = 11), managers (n = 13) and educators (n = 13) were included in the Delphi rounds. All data were collected within ten tertiary teaching hospitals in the Netherlands. All participants were included based on predefined in- and exclusion criteria and availability. Results In Geriatric experts’ opinions interventions targeting behavior change of nurses regarding fall prevention should aim at ‘after-care’, ‘estimating fall risk’ and ‘providing information’. However, in nurses’ opinions it should target; ‘providing information’, ‘fall prevention’ and ‘multifactorial fall risk assessment’. Nurses experience a diversity of limitations relating to capability, opportunity and motivation to prevent fall incidents among older patients. Based on these limitations educational experts identified three intervention functions: Incentivisation, modelling and enablement. Managers selected the following policy categories; communication/marketing, regulation and environmental/social planning. Conclusions The results of this study show there is a discrepancy in opinions of nurses, geriatric experts, managers and educators. Further insight in the role and collaboration of managers, educators and nurses is necessary for the development of education programs strengthening change at the workplace that enable excellence in nursing practice.

Abstract Objectives: To investigate students' conceptions of technical courses on pediatric patient safety; to investigate situations that favour the insecure care in pediatric units and to elaborate a booklet, in order to contribute to the teaching of the safety in the nursing care to the hospitalized child and to the health education to the workers of pediatric units. Method: Qualitative study based on symbolic interactionism. The data were collected in 2015, through a questionnaire to students from technical schools, complemented by systematic observation in two hospital units, located in the northwest of Rio Grande do Sul and treated by the thematic analysis. Results: Failures were reported in drug administration and hand hygiene, among others. To improve safety was suggested adequate organization of the work and higher workload of clinical practice. Conclusion and implications for the practice: Continuing education and more practical classes can help in the construction of knowledge to safe attendance.

BackgroundIn response to COVID-19, the UK government ordered strict social distancing measures. The UK Armed Forces followed these to protect the force and ensure readiness to respond to various tasking requests. Clinical training has adapted to ensure geographically dispersed medical personnel are trained while social distancing is maintained. This study aimed to evaluate remote training for Combat Medical Technicians, Medical Assistants and Royal Air Force Medics (CMTs/MAs/RAFMs) during the COVID-19 pandemic and the views of trainers on how this should be delivered now and in the future.MethodsA mixed quantitative and qualitative survey study was conducted to determine the experiences of a sample of Defence Medical Services personnel with remote training during the COVID-19 pandemic. Medical and nursing officers involved in teaching CMTs/MAs/RAFMs were eligible to participate.ResultsThere were 52 survey respondents. 78% delivered remote training to CMTs/MAs/RAFMs, predominantly using teleconferencing and small-group webinars. 70% of respondents report CMTs/MAs/RAFMs received more training during the COVID-19 pandemic than before. 94% of respondents felt webinar-based remote training should continue after COVID-19. The perceived benefits of webinar-based training included reduced travel time, more training continuity and greater clinical development of learners.ConclusionsThe challenge of continuing education of medical personnel while maintaining readiness for deployment and adhering to the Government’s social distancing measures was perceived to have been met within our study sample. This suggests that such an approach, along with clear training objectives and teleconferencing, may enable personnel to deliver high-quality training in an innovative and secure way.

Objetivo: analisar na literatura científica como tem sido desenvolvida a educação permanente da equipe de enfermagem no Centro de Tratamento Intensivo. Método: trata-se de um estudo bibliográfico, descritivo, tipo revisão integrativa em que se buscou por artigos entre 2007 a 2017 no idioma português, nas bases de dados, LILACS, MEDLINE, BDENF e na Biblioteca Virtual de Saúde. Realizou-se a análise descritiva dos resultados a partir dos dados existentes na figura síntese dos artigos, com respaldo na literatura científica. Resultados: encontraram-se 583 artigos e cinco compuseram a amostra final. Considera-se, de modo geral, que os resultados decorrentes das capacitações realizadas foram satisfatórios, o que mostra a importância de um programa permanente de capacitação da equipe de enfermagem na Terapia Intensiva. Conclusão: pode-se dizer que, apesar de existirem ações de educação permanente no Centro de Terapia Intensiva, essa é uma política que ainda precisa se fortalecer e se consolidar nos hospitais brasileiros, visto que, neste estudo, encontrou-se um número reduzido de artigos relacionados ao tema, o que responde, em parte, aos pressupostos das autoras relativos a esta revisão integrativa. Descritores: Ensino; Educação Continuada; Enfermagem; Terapia Intensiva; Metodologia; Hospitais.AbstractObjective: to analyze in the scientific literature how the continuing education of the nursing team at the Intensive Care Unit has been developed. Method: this is a bibliographic, descriptive, integrative review type study that searched for articles between 2007 and 2017 in Portuguese, in the databases, LILACS, MEDLINE, BDENF and in the Virtual Health Library. A descriptive analysis of the results was carried out based on the existing data in the synthesis figure of the articles, supported by the scientific literature. Results: 583 articles were found and five made up the final sample. It is considered, in general, that the results resulting from the training carried out were satisfactory, which shows the importance of a permanent training program for the nursing team in Intensive Care. Conclusion: it can be said that, although there are permanent education actions in the Intensive Care Unit, this is a policy that still needs to be strengthened and consolidated in Brazilian hospitals, since, in this study, a small number of articles related to the theme, which responds, in part, to the assumptions of the authors regarding this integrative review. Descriptors: Teaching; Continuing Education, Nursing; Intensive Care; Methodology; Hospitals.ResumenObjetivo: analizar la literatura científica tal como se ha desarrollado la educación permanente del equipo de enfermería en el Centro de Cuidados Intensivos. Método: se trata de un estudio de tipo de revisión bibliográfica, descriptiva e integradora que buscó artículos entre 2007 y 2017 en portugués, en las bases de datos, LILACS, MEDLINE, BDENF y en la Biblioteca Virtual en Salud. Se realizó un análisis descriptivo de los resultados con base en los datos existentes en la figura de síntesis de los artículos, respaldados por la literatura científica. Resultados: se encontraron 583 artículos y cinco constituyeron la muestra final. Se considera, en general, que los resultados resultantes de la capacitación realizada fueron satisfactorios, lo que demuestra la importancia de un programa de capacitación permanente para el equipo de enfermería en Cuidados Intensivos. Conclusión: se puede decir que, aunque existen acciones de educación permanente en el Centro de Cuidados Intensivos, esta es una política que aún debe fortalecerse y consolidarse en los hospitales brasileños, ya que, en este estudio, se encontró un pequeño número de artículos relacionados con el tema, que responde, en parte, a los supuestos de los autores con respecto a esta revisión integradora. Descriptores: Enseñanza; Educación continuada; Enfermería; Terapia intensiva; Metodología; Hospitales.

Objetivo: analisar a produção científica acerca das intervenções de enfermagem da CIPE® para pacientes com lesão por pressão. Método: trata-se de um estudo bibliográfico, tipo revisão integrativa em artigos publicados entre 2014 a 2018, realizado nas bases da Biblioteca Virtual de Saúde e portal de periódicos CAPES. Analisaram-se os dados de forma descritiva pelos resultados apresentados em figuras. Resultados: selecionaram-se 31 artigos, que evidenciaram diversas intervenções de enfermagem, como a supervisão periódica da pele, mudança de decúbito, uso de coberturas e escalas, ensino do autocuidado, educação continuada da equipe e desenvolvimento de protocolos. Conclusão: espera-se o desenvolvimento de novos estudos envolvendo a temática, considerando a complexidade do cuidar de lesões, evidenciando a necessidade de mais pesquisas com intervenções direcionadas a sistematizar o cuidado, minimizar o sofrimento e alcançar a cicatrização da lesão. Descritores: Enfermagem; Lesão por Pressão; Processo de Enfermagem; Ferimentos e Lesões; Cuidados de Enfermagem; Terminologia Padronizada em Enfermagem.ABSTRACTObjective: to analyze the scientific production about ICNP® nursing interventions for patients with pressure injury. Method: this is a bibliographic study, integrative review type in articles published from 2014 to 2018, conducted in the bases of the Virtual Health Library and CAPES journal portal. Data were analyzed descriptively by the results presented in figures. Results: 31 articles were selected, which showed various nursing interventions, such as periodic supervision of the skin, change of position, use of covers and scales, self-care teaching, continuing education of the team and development of protocols. Conclusion: it is expected the development of new studies involving the theme, considering the complexity of caring for injuries, highlighting the need for further research with interventions aimed at systematizing care, minimizing suffering and achieving wound healing. Descriptors: Nursing; Pressure Injury; Nursing Process; Wounds and Injuries; Nursing Care; Standardized Nursing Terminology.RESUMEN Objetivo: analizar la producción científica sobre las intervenciones de enfermería ICNP® para pacientes con lesión por presión. Método: este es un estudio bibliográfico, tipo revisión integradora en artículos publicados de 2014 a 2018, realizado en las bases de la Biblioteca Virtual en Salud y el portal de la revista CAPES. Los datos fueron analizados descriptivamente por los resultados presentados en las figuras. Resultados: se seleccionaron 31 artículos que mostraban diversas intervenciones de enfermería, tales como supervisión periódica de la piel, cambio de posición, uso de cubiertas y escalas, enseñanza de autocuidado, educación contínua del equipo y desarrollo de protocolos. Conclusión: se espera el desarrollo de nuevos estudios que involucren el tema, considerando la complejidad del cuidado de las lesiones, destacando la necesidad de una mayor investigación con intervenciones destinadas a sistematizar la atención, minimizar el sufrimiento y lograr la curación de la herida. Descriptores: Enfermería; Lesión por Presión; Proceso de Enfermería; Heridas y Lesiones; Atención de Enfermería; Terminología Normalizada de Enfermería.

Indigenous cross-cultural training has been around since the 1980s. It is often seen as a way to increase the skills and competency of staff engaged in providing service to Indigenous clients and customers, teaching Indigenous students within universities and schools, or working with Indigenous communities (Fredericks and Bargallie, “Indigenous”; “Which Way”). In this article we demonstrate how such training often exposes power, whiteness, and concepts of an Indigenous “other”. We highlight how cross-cultural training programs can potentially provide a setting in which non-Indigenous participants can develop a deeper realisation of how their understandings of the “other” are formed and enacted within a “white” social setting. Revealing whiteness as a racial construct enables people to see race, and “know what racism is, what it is not and what it does” (Bargallie, 262). Training participants can use such revelations to develop their racial literacy and anti-racist praxis (Bargallie), which when implemented have the capacity to transform inequitable power differentials in their work with Indigenous peoples and organisations.What Does the Literature Say about Cross-Cultural Training? An array of names are used for Indigenous cross-cultural training, including cultural awareness, cultural competency, cultural responsiveness, cultural safety, cultural sensitivity, cultural humility, and cultural capability. Each model takes on a different approach and goal depending on the discipline or profession to which the training is applied (Hollinsworth). Throughout this article we refer to Indigenous cross-cultural training as “cultural competence” or “cultural awareness” and discuss these in relation to their application within higher education institutions. While literature on health and human services programs in Australia, Canada, New Zealand, and other nation states provide clear definitions of terms such as “cultural safety”, cultural competence or cultural awareness is often lacking a concise and consistent definition.Often delivered as a half day or a one to two-day training course, it is unrealistic to think that Indigenous cultural competence can be achieved through one’s mere attendance and participation. Moreover, when courses centre on “cultural differences” and enable revelations about those differences they are in danger of presenting idealised notions of Indigeneity. Cultural competence becomes a process through which an Indigenous “other” is objectified, while very little is offered by way of translating knowledge and skills into practice when working with Indigenous peoples.What this type of learning has the capacity to do is oversimplify and reinforce racism and racist stereotypes of Indigenous peoples and Indigenous cultures. What is generally believed is that if non-Indigenous peoples know more about Indigenous peoples and cultures, relationships between Indigenous and non-Indigenous peoples will somehow improve. The work of Goenpul scholar Aileen Moreton-Robinson is vital to draw on here, when she asks, has the intellectual investment in defining our cultural differences resulted in the valuing of our knowledges? Has the academy become a more enlightened place in which to work, and, more important, in what ways have our communities benefited? (xvii)What is revealed in a range of studies – whether centring on racism and discrimination or the ongoing disparities across health, education, incarceration, employment, and more – is that despite forty plus years of training focused on understanding cultural differences, very little has changed. Indigenous knowledges continue to be devalued and overlooked. Everyday and structural racisms shape everyday experiences for Indigenous employees in Australian workplaces such as the Australian Public Service (Bargallie) and the Australian higher education sector (Fredericks and White).As the literature demonstrates, the racial division of labour in such institutions often leaves Indigenous employees languishing on the lower rungs of the employment ladder (Bargallie). The findings of an Australian university case study, discussed below, highlights how power, whiteness, and concepts of “otherness” are exposed and play out in cultural competency training. Through their exposure, we argue that better understandings about Indigenous Australians, which are not based on culture difference but personal reflexivity, may be gained. Revealing What Was Needed in the Course’s Foundation and ImplementationThis case study is centred within a regional Australian university across numerous campuses. In 2012, the university council approved an Aboriginal and Torres Strait Islander strategy, which included a range of initiatives, including the provision of cross-cultural training for staff. In developing the training, a team explored the evidence as it related to university settings (Anning; Asmar; Butler and Young; Fredericks; Fredericks and Thompson; Kinnane, Wilks, Wilson, Hughes and Thomas; McLaughlin and Whatman). This investigation included what had been undertaken in other Australian universities (Anderson; University of Sydney) and drew on the recommendations from earlier research (Behrendt, Larkin, Griew and Kelly; Bradley, Noonan, Nugent and Scales; Universities Australia). Additional consultation took place with a broad range of internal and external stakeholders.While some literature on cross-cultural training centred on the need to understand cultural differences, others exposed the problems of focusing entirely on difference (Brach and Fraser; Campinha-Bacote; Fredericks; Spencer and Archer; Young). The courses that challenged the centrality of cultural difference explained why race needed to be at the core of its training, highlighting its role in enabling discussions of racism, bias, discrimination and how these may be used as means to facilitate potential individual and organisational change. This approach also addressed stereotypes and Eurocentric understandings of what and who is an Indigenous Australian (Carlson; Gorringe, Ross and Forde; Hollinsworth; Moreton-Robinson). It is from this basis that we worked and grew our own training program. Working on this foundational premise, we began to separate content that showcased the fluidity and diversity of Indigenous peoples and refrained from situating us within romantic notions of culture or presenting us as an exotic “other”. In other words, we embraced work that responded to non-Indigenous people’s objectified understandings and expectations of us. For example, the expectation that Indigenous peoples will offer a Welcome to Country, performance, share a story, sing, dance, or disseminate Indigenous knowledges. While we recognise that some of these cultural elements may offer enjoyment and insight to non-Indigenous people, they do not challenge behaviours or the nature of the relationships that non-Indigenous people have with Aboriginal and Torres Strait Islander peoples (Bargallie; Fredericks; Hollinsworth; Westwood and Westwood; Young).The other content which needed separating were the methods that enabled participants to understand and own their standpoints. This included the use of critical Indigenous studies as a form of analysis (Moreton-Robinson). Critical race theory (Delgado and Stefancic) was also used as a means for participants to interrogate their own cultural positionings and understand the pervasive nature of race and racism in Australian society and institutions (McLaughlin and Whatman). This offered all participants, both non-Indigenous and Indigenous, the opportunity to learn how institutional racism operates, and maintains discrimination, neglect, abuse, denial, and violence, inclusive of the continued subjugation that exists within higher education settings and broader society.We knew that the course needed to be available online as well as face-to-face. This would increase accessibility to staff across the university community. We sought to embed critical thinking as we began to map out the course, including the theory in the sections that covered colonisation and the history of Indigenous dispossession, trauma and pain, along with the ongoing effects of federal and state policies and legislations that locates racism at the core of Australian politics. In addition to documenting the ongoing effects of racism, we sought to ensure that Indigenous resistance, agency, and activism was highlighted, showing how this continues, thus linking the past to the contemporary experiences of Indigenous peoples.Drawing on the work of Bargallie we wanted to demonstrate how Aboriginal and Torres Strait Islander peoples experience racism through systems and structures in their everyday work with colleagues in large organisations, such as universities. Participants were asked to self-reflect on how race impacts their day-to-day lives (McIntosh). The final session of the training focused on the university’s commitment to “Closing the Gap” and its Reconciliation Action Plan (RAP). The associated activity involved participants working individually and in small groups to discuss and consider what they could contribute to the RAP activities and enact within their work environments. Throughout the training, participants were asked to reflect on their personal positioning, and in the final session they were asked to draw from these reflections and discuss how they would discuss race, racism and reconciliation activities with the governance of their university (Westwood and Westwood; Young).Revelations in the Facilitators, Observers, and Participants’ Discussions? This section draws on data collected from the first course offered within the university’s pilot program. During the delivery of the in-person training sessions, two observers wrote notes while the facilitators also noted their feelings and thoughts. After the training, the facilitators and observers debriefed and discussed the delivery of the course along with the feedback received during the sessions.What was noticed by the team was the defensive body language of participants and the types of questions they asked. Team members observed how there were clear differences between the interest non-Indigenous participants displayed when talking about Aboriginal and Torres Strait Islander peoples and a clear discomfort when they were asked to reflect on their own position in relation to Indigenous people. We noted that during these occasions some participants crossed their arms, two wrote notes to each other across the table, and many participants showed discomfort. When the lead facilitator raised this to participants during the sessions, some expressed their dislike and discomfort at having to talk about themselves. A couple were clearly unhappy and upset. We found this interesting as we were asking participants to reflect and talk about how they interpret and understand themselves in relation to Indigenous people and race, privilege, and power.This supports the work of DiAngelo who explains that facilitators can spend a lot of time trying to manage the behaviour of participants. Similarly, Castagno identifies that sometimes facilitators of training might overly focus on keeping participants happy, and in doing so, derail the hard conversations needed. We did not do either. Instead, we worked to manage the behaviours expressed and draw out what was happening to break the attempts to silence racial discussions. We reiterated and worked hard to reassure participants that we were in a “safe space” and that while such discussions may be difficult, they were worth working through on an individual and collective level.During the workshop, numerous emotions surfaced, people laughed at Indigenous humour and cried at what they witnessed as losses. They also expressed anger, defensiveness, and denial. Some participants revelled in hearing answers to questions that they had long wondered about; some openly discussed how they thought they had discovered a distant Aboriginal relative. Many questions surfaced, such as why hadn’t they ever been told this version of Australian history? Why were we focusing on them and not Aboriginal people? How could they be racist when they had an Aboriginal friend or an Aboriginal relative?Some said they felt “guilty” about what had happened in the past. Others said they were not personally responsible or responsible for the actions of their ancestors, questioning why they needed to go over such history in the first place? Inter-woven within participants’ revelations were issues of racism, power, whiteness, and white privilege. Many participants took a defensive stance to protect their white privilege (DiAngelo). As we worked through these issues, several participants started to see their own positionality and shared this with the group. Clearly, the revelation of whiteness as a racial construct was a turning point for some. The language in the group also changed for some participants as revelations emerged through the interrogation and unpacking of stories of racism. Bargallie’s work exploring racism in the workplace, explains that “racism”, as both a word and theme, is primarily absent in conversations amongst non-Indigenous colleagues. Despite its entrenchment in the dialogue, it is rarely, if ever addressed. In fact, for many non-Indigenous people, the fear of being accused of racism is worse than the act of racism itself (Ahmed; Bargallie). We have seen this play out within the media, sport, news bulletins, and more. Lentin describes the act of denying racism despite its existence in full sight as “not racism”, arguing that its very denial is “a form of racist violence” (406).Through enhancing racial literacy, Bargallie asserts that people gain a better understanding of “what racism is, what racism is not and how race works” (258). Such revelations can work towards dismantling racism in workplaces. Individual and structural racism go hand-in-glove and must be examined and addressed together. This is what we wanted to work towards within the cultural competency course. Through the use of critical Indigenous studies and critical race theory we situated race, and not cultural difference, as central, providing participants with a racial literacy that could be used as a tool to challenge and dismantle racism in the workplace.Revelations in the Participant Evaluations?The evaluations revealed that our intention to disrupt the status quo in cultural competency training was achieved. Some of the discussions were difficult and this was reflected in the feedback. It was valuable to learn that numerous participants wanted to do more through group work, conversations, and problem resolution, along with having extra reading materials. This prompted our decision to include extra links to resource learning materials through the course’s online site. We also opted to provide all participants with a copy of the book Indigenous Australia for Dummies (Behrendt). The cost of the book was built into the course and future participants were thankful for this combination of resources.One unexpected concern raised by participants was that the course should not be “that hard”, and that we should “dumb down” the course. We were astounded considering that many participants were academics and we were confident that facilitators of other mandatory workplace training, for example, staff Equal Employment Opportunity (EEO), Fire Safety, Risk Management, Occupational Health and Safety, Discrimination and more, weren’t asked to “dumb down” their content. We explained to the participants what content we had been asked to deliver and knew their responses demonstrated white fragility. We were not prepared to adjust the course and dumb it down for white understandings and comfortabilities (Leonardo and Porter).Comments that were expected included that the facilitators were “passionate”, “articulate”, demonstrated “knowledge” and effectively “dealt with issues”. A couple of the participants wrote that the facilitators were “aggressive” or “angry”. This however is not new for us, or new to other Aboriginal women. We know Aboriginal women are often seen as “aggressive” and “angry”, when non-Indigenous women might be described as “passionate” or “assertive” for saying exactly the same thing. The work of Aileen Moreton-Robinson in Australia, and the works of numerous other Aboriginal women provide evidence of this form of racism (Fredericks and White; Bargallie; Bond). Internationally, other Indigenous women and women of colour document the same experiences (Lorde). Participants’ assessment of the facilitators is consistent with the racism expressed through racial microaggression outside of the university, and in other organisations. This is despite working in the higher education sector, which is normally perceived as a more knowledgeable and informed environment. Needless to say, we did not take on these comments.The evaluations did offer us the opportunity to adjust the course and make it stronger before it was offered across the university where we received further evaluation of its success. Despite this, the university decided to withdraw and reallocate the money to the development of a diversity training course that would cover all equity groups. This meant that Aboriginal and Torres Strait Islander peoples would be covered along with sexual diversity, gender, disability, and people from non-English speaking backgrounds. The content focused on Aboriginal and Torres Strait Islander peoples was reduced to one hour of the total course. Including Aboriginal and Torres Strait Islander peoples in this way is not based on evidence and works to minimise Indigenous Australians and their inherent rights and sovereignty to just another “equity group”. Conclusion We set out to develop and deliver a cross-cultural course that was based on evidence and a foundation of 40 plus years’ experience in delivering such training. In addition, we sought a program that would align with the university’s Reconciliation Action Plan and the directions being undertaken in the sector and by Universities Australia. Through engaging participants in a process of critical thinking centring on race, we developed a training program that successfully fostered self-reflection and brought about revelations of whiteness.Focusing on cultural differences has proven ineffective to the work needed to improve the lives of Indigenous Australian peoples. Recognising this, our discussions with participants directly challenged racist and negative stereotypes, individual and structural racism, prejudices, and white privilege. By centring race over cultural difference in cultural competency training, we worked to foster self-revelation within participants to transform inequitable power differentials in their work with Indigenous peoples and organisations. The institution’s disbandment and defunding of the program however is a telling revelation in and of itself, highlighting the continuing struggle and importance of placing additional pressure on persons, institutions, and organisations to implement meaningful structural change. ReferencesAhmed, Sara. On Being Included: Racism and Diversity in Institutional Life. Duke University Press, 2012.Anderson, Ian. “Advancing Indigenous Health through Medical Education”. 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