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The aim of this Swedish study was to develop the concept of moral sensitivity in health care practice. This process began with an overview of relevant theories and perspectives on ethics with a focus on moral sensitivity and related concepts, in order to generate a theoretical framework. The second step was to construct a questionnaire based on this framework by generating a list of items from the theoretical framework. Nine items were finally selected as most appropriate and consistent with the research team’s understanding of the concept of moral sensitivity. The items were worded as assumptions related to patient care. The questionnaire was distributed to two groups of health care personnel on two separate occasions and a total of 278 completed questionnaires were returned. A factor analysis identified three factors: sense of moral burden, moral strength and moral responsibility. These seem to be conceptually interrelated yet indicate that moral sensitivity may involve more dimensions than simply a cognitive capacity, particularly, feelings, sentiments, moral knowledge and skills.

Background. There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs. Methods. Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 hospitals in London. Interviews were conducted until thematic saturation was reached. Thematic analysis was applied to the data to identify the key determinants of antimicrobial prescribing behaviors. Results. The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior of clinical leaders or seniors influences practice of junior doctors. Senior doctors consider themselves exempt from following policy and practice within a culture of perceived autonomous decision making that relies more on personal knowledge and experience than formal policy. Prescribers identify with the clinical groups in which they work and adjust their APB according to the prevailing practice within these groups. A culture of \"noninterference' in the antimicrobial prescribing practice of peers prevents intervention into prescribing of colleagues. These sets of cultural rules demonstrate the existence of a \"prescribing etiquette,\" which dominates the APB of healthcare professionals. Prescribing etiquette creates an environment in which professional hierarchy and clinical groups act as key determinants of APB. Conclusions. To influence the antimicrobial prescribing of individual healthcare professionals, interventions need to address prescribing etiquette and use clinical leadership within existing clinical groups to influence practice.

The objective of the study is to present the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) conceptual approach to the assessment of certainty of evidence from modeling studies (i.e., certainty associated with model outputs). Expert consultations and an international multidisciplinary workshop informed development of a conceptual approach to assessing the certainty of evidence from models within the context of systematic reviews, health technology assessments, and health care decisions. The discussions also clarified selected concepts and terminology used in the GRADE approach and by the modeling community. Feedback from experts in a broad range of modeling and health care disciplines addressed the content validity of the approach. Workshop participants agreed that the domains determining the certainty of evidence previously identified in the GRADE approach (risk of bias, indirectness, inconsistency, imprecision, reporting bias, magnitude of an effect, dose–response relation, and the direction of residual confounding) also apply when assessing the certainty of evidence from models. The assessment depends on the nature of model inputs and the model itself and on whether one is evaluating evidence from a single model or multiple models. We propose a framework for selecting the best available evidence from models: 1) developing de novo, a model specific to the situation of interest, 2) identifying an existing model, the outputs of which provide the highest certainty evidence for the situation of interest, either “off-the-shelf” or after adaptation, and 3) using outputs from multiple models. We also present a summary of preferred terminology to facilitate communication among modeling and health care disciplines. This conceptual GRADE approach provides a framework for using evidence from models in health decision-making and the assessment of certainty of evidence from a model or models. The GRADE Working Group and the modeling community are currently developing the detailed methods and related guidance for assessing specific domains determining the certainty of evidence from models across health care–related disciplines (e.g., therapeutic decision-making, toxicology, environmental health, and health economics).

Summary Objectives Effective and efficient communication is crucial in healthcare. Written communication remains the most prevalent form of communication between specialised and primary care. We aimed at reviewing the literature on the quality of written communication, the impact of communication inefficiencies and recommendations to improve written communication in healthcare. Design Narrative literature review. Methods A search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (MeSH)terms ‘communication’, ‘primary health care’, ‘correspondence’, ‘patient safety’, ‘patient handoff’ and ‘continuity of patient care’. Reviewers screened 4609 records and 462 full texts were checked according following inclusion criteria: (1) publication between January 1985 and March 2014, (2) availability as full text in English, (3) categorisation as original research, reviews, meta‐analyses or letters to the editor. Results A total of 69 articles were included in this review. It was found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences. Conclusion There is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow‐up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver.

To suggest approaches for guideline developers on how to assess a methodologist's expertise with Grading of Recommendations Assessment, Development and Evaluation (GRADE) methods and tasks and to provide a set of minimum skills and experience required to perform specific tasks related to guideline development using GRADE. We used an iterative and consensus-based process involving individuals with in-depth experience with GRADE. We considered four main tasks: (1) development of key questions; (2) assessment of the certainty of effect estimates; (3) development of recommendations; and (4) teaching GRADE. There are three basic approaches to determine a methodologist's skill set. First, self-report of knowledge, skills, and experience with a standardized “GRADE curriculum vitae (CV)” focused on each of the GRADE-related tasks; second, demonstration of skills using worked examples; third, a formal evaluation using a written or oral test. We suggest that the GRADE CV is likely to be useful and feasible to implement. We also suggest minimum training including attendance at one or more full-day workshops and familiarity with the main GRADE publications and the GRADE handbook. The selection of a GRADE methodologist must be a thoughtful, reasoned decision, informed by the criteria suggested in this article and tailored to the specific project. Our suggested approaches need further pilot testing and validation.

Neither country has widespread testing available, as strongly recommended by WHO, alongside treatment and robust contact tracing.1 In neither country do health workers have adequate access to personal protective equipment; nor are there nearly enough hospital beds to accommodate the onslaught of patients. Even worse, by refusing to ease sanctions against Iran, Venezuela, and Cuba, the US has crippled the ability of other countries to respond, continuing to block medical supplies and other humanitarian aid.2 Meanwhile, Asian countries, including China, South Korea, Singapore, and Taiwan, have provided rapid, effective, and often innovative responses, thanks in part to their recent experience with outbreaks of Middle East respiratory syndrome in 2015 and the 2002–03 severe acute respiratory syndrome epidemic. The global health model is based in large part on technical assistance and capacity building by the US, the UK, and other rich countries, whose response has been sclerotic and delayed at best.

Objectives. To establish a validated, standardized set of core competencies for community health workers (CHWs) and a linked workforce framework. Methods. We conducted a review of the literature on CHW competency development (August 2015), completed a structured analysis of literature sources to develop a workforce framework, convened an expert panel to review the framework and write measurable competencies, and validated the competencies (August 2017) by using a 5-point Likert scale survey with 58 participants in person in Biloxi, Mississippi, and electronically across the United States. Results. The workforce framework delineates 3 categories of CHWs based upon training, workplace, and scope of practice. Each of the 27 competencies was validated with a mean of less than 3 (range = 1.12–2.27) and a simple majority of participants rated all competencies as “extremely important” or “very important.” Conclusions. Writing measurable competencies and linking the competencies to a workforce framework are significant advances for CHW workforce development. Public Health Implications. The standardized core competencies and workforce framework are important for addressing health disparities and maximizing CHW effectiveness.

Evaluating the professional competencies of Peruvian doctors is crucial for proposing necessary improvements. However, there is a lack of knowledge regarding the specific characteristics and competencies that are assessed in these studies. The objective of this study is to characterize published studies focusing on the assessment of professional competencies among physicians in Peru. A comprehensive scoping review was conducted, encompassing scientific journal publications that evaluated the professional competencies of physicians in Peru. The search was performed in PubMed, Google Scholar, Scopus, and SciELO, with the review period extending until 2022. The identified competencies were classified using the Accreditation Council for Graduate Medical Education (ACGME) and the Ministry of Health of Peru (MINSA) frameworks. The findings were presented using absolute and relative frequency measures. A total of forty-nine studies focused on the assessment of professional competencies among physicians were identified, indicating an upward trend over the years. The primary focus of these studies was on evaluating competencies related to medical knowledge (79.6% according to ACGME classification) and the treatment of health problems (57.1% according to MINSA classification). However, there was a noticeable lack of emphasis on assessing behavioral competencies such as ethics, professionalism, and communication. Most of the included studies (65.3%) were exclusively conducted in Lima. Among the studies that disclosed their funding sources, 61% were self-funded. Most studies primarily concentrated on evaluating knowledge-based competencies, specifically in the areas of diagnosis and treatment. There is a scarcity of studies assessing other important competencies. Additionally, centralization and limited funding appear to be areas that require improvement in the evaluation of professional competencies among Peruvian physicians.

To map the characteristics of nursing educators' competency standards for practice from the existing literature, examine the evidence and identify commonalities and differences. Many countries or regions have produced nursing educator standards, however, there is no common set of standards or competencies used globally. Mapping these nursing educator standards should identify a common set of standards that can be applied across any nursing educator practice setting. The review was conducted using the JBI methodology for scoping reviews and followed an a priori protocol. A comprehensive search of studies or guidelines (2001–2022) was undertaken to identify specific nursing educator competencies from any practice setting and in any language. Preceptorship and mentorship studies were excluded from the search terms. Databases searched for relevant records and guidelines were CINAHL, ERIC, Medline (Ovid), Pubmed, Scopus, Google and targeted websites. After screening and selection, relevant data were extracted and summarized using an extraction guide. Characteristics of the reports were identified and all three levels of competency statements were mapped against commonly occurring categories derived from the data. 1145 evidence records were screened after removal of duplicates with 14 records included in the review. The included evidence sources were from various nursing educator practice settings and educator roles. All evidence sources had at least two levels of competency statements and 16 competency categories were identified. Common categories in the first two competency levels were: leadership and management; research and scholarship; professional values and professional development; and facilitating learning. Statements related to learner evaluation were also common in the level 2 competencies. Level 3 competencies were included in seven evidence sources and most of the sources included almost all categories. Low-occurring statements at all levels were in the ‘Nursing skills’ and ‘Decision-making/strategic planning” categories. Common characteristics and categories were found between different evidence sources in this review. The most common competency review categories included leadership and management, professional development and facilitating learning. Few decision-making competencies were identified from the evidence sources. These results can inform educators and managers in developing globally-based nursing educator competencies, performance management tools and job descriptions.

OBJECTIVEThe aim of this study was to describe the role preparation and competency development of nurse managers. BACKGROUNDApproximately 70 000 nurses are retiring annually. This represents a significant loss of nursing leadership wisdom. Few systematic studies of nurse manager role preparation and competency development have been conducted. METHODSAn electronic survey was completed by a national sample of 647 nurse managers managing 964 patient care units in 54 hospitals. RESULTSFindings suggest that nurse managers rate themselves as competent for the 1st 6 years as a nurse manager. They begin to reach proficiency by year 7. Experience had the strongest association with nurse manager competence, followed by graduate leadership education. CONCLUSIONSNurse executives need to evaluate the bench strength of their nursing leadership talent pool. They need to develop policies and strategies that promote nurse manager competence.