BackgroundPaediatric Early Warning Systems (PEWSs) improve identification of deterioration, however, their sustainability has not been studied. Sustainability is critical to maximise impact of ...interventions like PEWS, particularly in low-resource settings. This study establishes the reliability and validity of a Spanish-language Clinical Sustainability Assessment Tool (CSAT) to assess clinical capacity to sustain interventions in resource-limited hospitals.MethodsParticipants included PEWS implementation leadership teams of 29 paediatric cancer centres in Latin America involved in a collaborative to implement PEWS. The CSAT, a sustainability assessment tool validated in high-resource settings, was translated into Spanish and distributed to participants as an anonymous electronic survey. Psychometric, confirmatory factor analysis (CFA), and multivariate analyses were preformed to assess reliability, structure and initial validity. Focus groups were conducted after participants reviewed CSAT reports to assess their interpretation and utility.ResultsThe CSAT survey achieved an 80% response rate (n=169) with a mean score of 4.4 (of 5; 3.8–4.8 among centres). The CSAT had good reliability with an average internal consistency of 0.77 (95% CI 0.71 to 0.81); and CFAs supported the seven-domain structure. CSAT results were associated with respondents’ perceptions of the evidence for PEWS, its implementation and use in their centre, and their assessment of the hospital culture and implementation climate. The mean CSAT score was higher among respondents at centres with longer time using PEWS (p<0.001). Focus group participants noted the CSAT report helped assess their centre’s clinical capacity to sustain PEWS and provided constructive feedback for improvement.ConclusionsWe present information supporting the reliability and validity of the CSAT tool, the first Spanish-language instrument to assess clinical capacity to sustain evidence-based interventions in hospitals of variable resource levels. This assessment demonstrates a high capacity to sustain PEWS in these resource-limited centres with improvement over time from PEWS implementation.
When the pandemic struck and the businesses temporarily halted, the temperature of uncertainty held every citizen of this country. Business, public service, and education providers, among others, ...weren't spared from this situation. As the health crisis prolonged, crucial adjustments had to take place, including shifts from the in-school teaching settings to home-based online learning. This prompted key amendments in structures, policies, practices and norms of conduct among learning institutions. Because order is key to a stable operation, tertiary schools are called upon to sustain the interest of their students in every way possible, particularly in the aspects of control and formation which are primarily dictated by clear-cut standards. While it is an acknowledged fact that those who work hard are rewarded and those who are otherwise may be given what is due them, it cannot be a position to trek in terms of placing rigidity in the rules, such as class participation but more so, in attendance. The mandate of this research is to take a closer look at the impact of truancy committed by students during online classes and its implications to student learning. The same shall be linked with existing parameters, rulings, policies and legislations that prevent the desirable student achievement levels given the global pandemic. Moving forward, the study proposes to lodge critical recommendations to school leaders and planners, policy makers and legislators in the formulation, implementation and evaluation of realistic guideposts that may direct the higher education sector in adapting to the stirrings of the new learning paradigm.
