[TimorLesteStudies] New article: Application of standard treatment guidelines in rural community health centres, Timor-Leste

[Bu Wilson]

Michiyo Higuchi, Junko Okumura, Atsuko Aoyama, Sri Suryawati, and John Porter, 2011
Application of standard treatment guidelines in rural community health centres, Timor-Leste
Health Policy and  Planning. 


                  Abstract
                  
                  
Objective To analyse nurses’ and midwives’ knowledge of and attitudes towards standard treatment guidelines (STGs), which were developed
                     to help their practices at rural community health centres (CHCs) in Timor-Leste.
                  

                  
                  
Methods Fifty-five nurses and midwives were individually interviewed. Data were analysed qualitatively using the Framework approach.
                  

                  
                  
Results Overall, the 
standard treatments for acute respiratory tract infections, malaria and 
diarrhoea were well known by the respondents.
                     Clinical nurses showed precise and detailed 
knowledge, especially for antibiotic use. The respondents were willing 
to use
                     STGs and believed that they ‘should’ follow them. 
This feeling arose due to their self-awareness as frontline health 
workers
                     and, at the same time, as peripheral civil 
servants. The changes brought about by the introduction of STGs were 
positively
                     perceived. Three components of the change were 
observed: the concept, daily practice and perceived patient 
satisfaction. The
                     respondents had previously felt a lack of 
confidence and hoped to improve their capacity as health care workers; 
they became
                     confident in their practices by using STGs. 
Self-confidence was identified more clearly in the clinical nurse 
interviews.
                     Few difficulties in using STGs were indicated, and 
the respondents suggested ways to deal with these difficulties.
                  

                  
                  
Discussion By using the 
STGs, the nurses/midwives gained knowledge and self-confidence. The 
positive perception of the changes promoted
                     further use of the STGs. Clinical nurse training 
positively influenced the knowledge of and attitudes towards the STGs. 
Few
                     difficulties in applying STGs in daily practice 
were identified, which is contrary to previous studies that targeted 
physicians
                     in the Western world. Development of STGs within a 
health policy framework was considered a key factor. The STGs exist 
across
                     related policies and various programmes, which are 
interconnected. The Timor-Leste experience indicates the value of STGs
                     for non-physician health care providers at the 
primary health care level.
                  

               


doi:
                                    
                                    10.1093/heapol/czr051
                                    
                                 
                              
                              
                              
                                 
                                 First published online:
                                 
                                 July 11, 2011
                                 
--
Dr Bu V.E. Wilson
T: Australia +61  0  407 087 086
T: Timor-Leste + 670 744 0011
E: buvewilson at gmail.com

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