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Taking the transformative potential of education as its starting point, this thesis analyses Belgian attempts to use schools policy to strengthen the hegemony of the colonial state in the Congo during the interwar years. Through an empirical treatment of the development of the colonial school system, based largely on archival research, the study pursues two main contentions. The first is that the Belgian colonial authorities played a far more direct role in formulating and implementing education policy than is often believed. The second is that the state authorities’ interest in education was defined both by the economic imperative of colonial exploitation, which compelled them to train skilled workers, and the fear that access to education would fuel potential sedition. Six thematic chapters demonstrate that this paradox of necessity and fear shaped Belgian education policy in the Congo, looking at the reasons behind the fear of potential unrest, and at its ramifications. This thesis argues that these pressures caused the Belgian colonial authorities to try to mould Congolese society using education as a tool, by using specific streams of instruction to inculcate certain groups of Congolese, such as auxiliaries, healthcare workers, and women, with the principles of colonial rule. The thesis also considers how these policies were put into practice, focusing on relations between the colonial authorities and the Catholic and Protestant mission societies, and evaluates their efficacy. Moreover, this thesis attempts to establish, where possible, the reactions of colonized Congolese to European educational provision. Having analysed these issues, this thesis concludes that the colonial education system in the Congo during the interwar years failed to fulfil its main purpose and perpetuate Belgian colonial rule.

Low hand hygiene compliance among health staff is a problem globally in health care settings. Improving hand hygiene could prevent many of the health care associated infections that affects hundreds of millions of patients every year around the globe. The aim of this literature study was to describe obstacles to maintain proper hand hygiene in hospitals, seen from a global perspective. Eight articles from seven countries, all based on qualitative research have been analysed according to Friberg's five-step method that contributes to evidence-based nursing. The challenges to sustain hand hygiene found in the results were split into two main categories: Organizational factors and Individual factors. Organizational factors included five subcategories: Work environment, Inadequate education, Infrastructure, Insufficient management and Power structures. The results showed that when these factors were negatively affected so was compliance regarding proper hand hygiene. These were often issuesthat the health staff felt powerless to change and affect. Individual factors included two subcategories: Attitudes and social factors. Example of this could be healthcare workers neglected hygiene guidelines out of personal reasons or healthcare workers giving care to patients that didn’t accept how it was carried out because of social and cultural differences. The complex issues revolving these matters need to be addressed on an overall perspective. Cooperation between management and health staff is fundamental to obtain changes within healthcare organizations. Both parties need to work together to be able to improve hand hygiene compliance and to reduce healthcare associated infections.

Introdução: A tuberculose é uma doença de repercussão mundial que desafia os serviços de saúde (SS). Estima-se que um terço da população mundial apresenta a forma latente da doença. Os profissionais da saúde (PAS) inseridos na assistência direta podem ter maior probabilidade de contágio; entretanto, os índices de ocorrência da doença nesta população não foram, até o momento, reconhecidos de forma sistemática. Objetivo: Estimar a prevalência e a incidência de tuberculose ocupacional nos serviços de saúde. Método: Trata-se de uma revisão sistemática de literatura segundo protocolo do Joanna Briggs Institute, que buscou responder quais os índices de tuberculose ocupacional nos SS. Foram considerados estudos primários que incluíssem dados de incidência e prevalência de tuberculose ocupacional ou de viragem tuberculínica em PAS. Foram definidos como PAS indivíduos em formação ou formados em cursos na área da saúde e que atuam na assistência direta. Quanto a SS, foram consideradas instituições de atendimento em qualquer um dos níveis assistenciais e que realizam atendimento direto a pacientes suspeitos ou portadores de tuberculose em suas fases transmissíveis, de forma a manter a homogeneidade da investigação. Foram excluídos os relatos de surtos e as ações dirigidas a populações em geral. Resultados: Foram identificadas 2.081 citações potencialmente relevantes em dez bases de dados, sem limites de tempo e idioma, a seleção final levou a 17 estudos. Em todos os artigos selecionados o desfecho estudado foi tuberculose latente. Não foram identificados estudos com dados com relação à tuberculose doença. O teste tuberculínico foi utilizado em 88,2% dos estudos. A prevalência de tuberculose latente (TL) variou entre 0,1% e 59,7% e a taxa de incidência anual variou de 3,3% a 26%. Um estudo identificou a densidade de incidência de 547/100.000 pessoas/ano. Conclusão: As evidências demonstram que a tuberculose é um importante agravo entre os PAS nos Serviços de Saúde, com importantes variações de acordo com o contexto. Os resultados indicam que a despeito da relevância do fenômeno, ainda há lacunas de informação sobre a incidência e a prevalência da tuberculose doença em PAS. / Introduction: Tuberculosis is a disease of worldwide repercussion that defies health care services (HS). It is estimated that one-third of the world population has a latent form of the disease. Healthcare workers (HCW) dealing with direct patient assistance may have higher contagion probability. However, the rates of the disease occurrence in this population have not been established in a systematic way yet. Objective: To estimate the global prevalence and incidence of occupational tuberculosis in HS by means of the literature review. Method: This is a systematic literature review according to the Joanna Briggs Institute, which sought to identify the rates of occupational tuberculosis in HCW. Primary studies were considered to include data on the incidence and prevalence of occupational tuberculosis or tuberculin skin test reaction in HCW. Reports of outbreaks and actions addressed to the community in general were excluded. Results: Out of ten cross-referenced databases, 2,081 potentially relevant studies were identified, without time and language limits, and the final selection was 17 studies. In all the articles selected, the outcome was latent tuberculosis. No studies with data regarding the tuberculosis disease were identified. The tuberculin skin test was used in 88.2% of the studies. The prevalence of latent tuberculosis ranged from 0.1 % to 59.7%. The annual incidence rate varied from 3.3% to 26%. As the risk and occupational exposure the absence of vaccination prior, the duration of care and performance in tuberculosis specific services were shown as relevant factors. One study identified the density of incidence of 547/100,000 people per year. Conclusion: Evidence indicates that tuberculosis is a relevant disease with the HCW and has important rates variations according to the context. The results demonstrate that despite the relevance of the phenomenon, there are still gaps in information on the incidence and prevalence of the tuberculosis disease in HCW.

This thesis attempted to examine stressors associated with the psychiatric technician profession and levels of burnout amongst them. This was accomplished through the use of a survey which included demographic data, the Maslach Burnout Inventory Human Services Survey (MBI‑HSS), an adaptation of the Nursing Stress Scale (NSS) and a self‑care assessment tool. A total of three research questions were examined statistically including levels of burnout on subcategories (personal accomplishment, emotional exhaustion and depersonalization), most common stressors identified by psychiatric technicians and percentage of participants who utilized therapy to cope with work related stress. The survey was made available via survey monkey and posted on the website for the California Association of Psychiatric Technicians website and via links posted on Union Chapter social media pages. A total of 123 Psychiatric Technicians participated in the study. Results indicated high levels of emotional exhaustion, depersonalization and personal accomplishment among psychiatric technicians. Results indicate that extended work hours and staffing minimums were significant issues impacting union members. Also significant among participants, was high level of difficulty attending work due to work related stress during the last three months. For future research, it is recommended that similar studies of psychiatric technicians be conducted to provide further insight into burnout, how it happens and how to avoid it.

Vårdpersonalens låga följsamhet av riktlinjer för handhygien är ett globalt problem och en av orsakerna till vårdrelaterade infektioner (VRI). Att förmedla säker vård och arbeta förebyggande så att vårdskador undviks är en av vårdpersonalens kärnkompetenser. Syftet var att belysa vad som kan påverka vårdpersonalens följsamhet till riktlinjer för handhygien inom hälso- och sjukvården. Examensarbetet utfördes som en allmän litteraturstudie där 18 vetenskapliga artiklar fördes till resultatet, vilket visade att följsamheten påverkas av både arbetsmiljö och mänskliga faktorer. Arbetsmiljö innefattade Fysisk miljö; Organisatorisk och Social arbetsmiljö; Teknik. I de mänskliga faktorerna ingick Individ; Vårdteam; Kunskap och Utbildning. Två huvudresultat lyftes till diskussion. I den organisatoriska och sociala arbetsmiljön sågs tidsbrist och ett tydligt ledarskap ha en påverkan på vårdpersonalens följsamhet till riktlinjer för handhygien. I vårdteamet kunde patientinvolvering och fler medarbetare i personalens närhet, samt positiva eller negativa förebilder påverka vårdpersonalens följsamhet till riktlinjer för handhygien. Vidare forskning behövs om vad som kan leda till ökad och mer bestående följsamhet av riktlinjer för handhygien. Ny teknik kan komma att skapa nya förutsättningar för vårdpersonalen att öka följsamheten till riktlinjer för handhygien. / Healthcare workers´ (HCW) low adherence to guidelines on hand hygiene is a global challenge and one of the causes of healthcare associated infections (HCAI). HCW are to provide safe care and take precautions as not to harm the patient. Safe care is one of the core competences for HCW. The aim was to illustrate factors that can have an impact on HCW adherence to guidelines on hand hygiene in a healthcare setting. The thesis was carried out as a general literature study, where 18 articles were included in the result. The result showed that both the work environment and human factors have an impact on HCW adherence to guidelines on hand hygiene. Work environmental factors included the Physical environment; the Organizational and Social work environment; Technical equipment. Human factors included the Individual; the Nursing team; Knowledge and Education. Two main findings were lifted for discussion from the result; in regards of the organizational work environment, lack of time and a clear leadership was found to have an effect on HCW adherence to guidelines on hand hygiene. In regards of the nursing team; involvement of the patient reminding about hand hygiene, more coworkers in near proximity and positive or negative role models, affected adherence to guidelines on hand hygiene. Further research is required as to what can lead to increased and sustained adherence to guidelines on hand hygiene. New technical equipment may become important in the future and create new ways for HCW to follow the guidelines on hand hygiene.

A study on skills among healthcare workers investigates how healthcare workers use skills in difficult caring contexts, aiming to describe how practical knowledge is employed in decision making in occuring situations. The dialogue seminar method, with it’s elements of reading and writing to explore practical knowledge, was used to gather information. Contributing healthcare workers represent a multiplicity of experiences and perspectives. Their narratives on caring dilemmas are presented and used as framework for the study. The author creates an analogy between caring dilemmas and performing knowledge in professional art work. The narratives of the healthcare workers has been arranged in a documentary composition and on several occasion presented to a wider audience in order to make a reality-check on the study’s conclusions. The study shows how terms from professional art work such as presence, interpretation and reflexive techniques are useful in understanding skills of healthcare workers. The investigation also points out problems related to the inability of healthcare organizations to comprehend and acknowledge the practical dimension of healthcare workers skills. The study has been carried out within the KTH Advanced Programme for Reflective Practice presented at www.dialoger.se. / QC 20100823

Background: Intimate partner violence (IPV) against women is public health and human rights concern. The studies forming this thesis seek to understand healthcare worker and community attitudes and perceptions about IPV; their role in support, care and prevention of IPV, and the feasibility of introducing routine screening for IPV among women attending healthcare. Methods: Four interrelated studies were conducted in Temeke District, Dar es Salaam, Tanzania: 1) a content analysis of 16 in-depth interviews with healthcare workers about their experiences of meeting IPV clients, 2) a grounded theory analysis of seven focus group discussions that explore community perceptions, 3) a cross sectional study of 657 healthcare workers and students to understand their attitudes and perceptions about IPV and future roles in care and support, and 4) evaluation of a pilot intervention that introduces routine screening in an outpatient department. The pilot intervention included screening of 102 women, ten observations of healthcare worker interactions with women clients, three focus group discussions, and five narratives written by healthcare workers about their experiences with the screening tools. Results: Gender inequalities, attitudes, and poverty intersect in the explanation of IPV. Healthcare workers view low economic status among women, rigid gender norms, and stigma that influences women to stay in violent relationships. Alcohol abuse, multiple sexual partners and low levels of income among men were cited as triggers for IPV episodes. Between 20-67% of healthcare workers and students report meeting IPV clients at work. More than 9o% observed clients with unexplained feelings of sadness and/or loss of confidence. Resource and training limitations, heavy workloads and low salaries constrain services. A strong desire to make a difference in the care and support of IPV clients was present, but violence as a hidden agenda with a client resistance to disclosure was a challenge. The community study shows a transition in gender norms is making violence against women less acceptable. Conclusions and suggestions: Healthcare workers and the community strongly wish and are committed to support IPV prevention. Both groups understood the meaning, provocative factors and some IPV effects. This awareness contributes to their desire to be part of a change. At the central level, prevention of IPV should be on the governments’ policy agenda and should be prioritised. Education about gender-based violence must be incorporated into the curricula of healthcare workers. At community level, advocacy is necessary for changing harmful gender norms and measures to combat women’s poverty. Men should be engaged at all levels. Provision of information on the human rights perspectives of IPV should be strengthened and related to other types of violence.

Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCWs) remains essential for maintaining the health and availability of HCWs, as well as influenza prevention in healthcare environments. Yet, annual vaccination coverage among HCWs continues to be below recommended standards during pandemic (pH1N1) and non-pandemic (sINFLU) influenza seasons. The primary aim of this research is to inform the design and implementation of effective HCW targeted influenza vaccination campaigns via a 1) systematic review of the existing literature on HCW pH1N1 vaccination, 2) qualitative content analysis of motivators and barriers to HCW pH1N1 and sINFLU vaccination, as well as 3) quantitative regression analysis of modifiable factors predicting pH1N1 and sINFLU vaccination. The qualitative and quantitative analysis processes were applied to data collected from a large-scale multi-professional sample of HCWs. Findings from all analysis sections were found to be consistent. Most attitudes, beliefs, motivators, and barriers influencing HCW influenza vaccination were similar for pH1N1 and sINFLU vaccinations. Yet, a number of notable differences were also identified. HCWs were likely to accept vaccination if they perceived, 1) vaccination to be safe, 2) vaccination to be protective against influenza for self, loved ones, patients or communities, and 3) influenza to be a serious and severe infection to self and others. Additionally, encouragement from supervisors and colleagues, physicians, and loves ones also enhanced vaccine uptake. Most HCWs avoided vaccination because of 1) limited knowledge or misinformation about vaccination, 2) concern for vaccine induced side-effects and 3) assuming vaccination was not a requirement for healthy adults. With respect to pH1N1 vaccination, mass media communications, perceptions of novel vaccinations, and rapid vaccine development processes especially deterred HCW pH1N1 vaccination. Future vaccination programs targeting HCWs should look towards influencing HCWs’ vaccination attitudes and promoting pro-vaccination cultures in healthcare workplaces.

The 2014 West Africa Ebola outbreak saw a substantial number of healthcare workers (HCWs) being infected, despite the use of personal protective equipment (PPE). PPE is intended to protect HCWs when caring for patients with Ebola virus disease (EVD), but PPE may play a role in the spread of Ebola in healthcare environments. Before the removal of PPE, chemical disinfection may prevent the transfer of pathogens to HCWs, but the efficacy of common disinfectants against enveloped viruses, such as Ebola, on PPE surfaces is relatively unknown. The purpose of this study is to assess the efficacy of two common disinfectants, chlorine bleach (Clorox® bleach) and quaternary ammonium (Micro-Chem Plus®), used in healthcare settings for inactivation of enveloped viruses on PPE. The virucidal activity of the two disinfectants were tested against bacteriophage Φ6, an enveloped, non-pathogenic surrogate for enveloped viruses, on Tyvek suit surfaces. Virus was dried onto Tyvek suit surface, exposed to the disinfectants at use-dilution for a contact time of one minute, and the surviving virus was quantified using a double agar layer (DAL) assay. The Clorox® bleach and Micro-Chem Plus® produced a >3.21 log10 reduction and >4.33 log10 reduction, respectively, in Φ6 infectivity. The results of this study suggest that chlorine bleach and quaternary ammonium are effective in the inactivation of enveloped viruses on Tyvek suit surfaces. Chemical disinfection of PPE should be considered as a viable method to reduce the spread of pathogenic, enveloped viruses to HCWs, patients, and other environmental surfaces in healthcare settings.