Facilitating the quality of care in a specialist Pacific ophthalmic nursing workforce

Topical review: Task shifting and the recruitment and retention of eye health workers in underserved areas

Many populations experience difficulty accessing eye care, especially in rural areas. Implementing workforce recruitment and retention strategies, as well as task shifting through widening scope of practice, can improve eye care accessibility. This article provides novel evidence on the compatibility of these strategies aimed at enhancing ophthalmic workforce recruitment, retention, and efficacy.

PURPOSE

The global burden of blindness is unequally distributed, affects rural areas more, and is frequently associated with limited access to eye care. The World Health Organization has specified both task shifting and increasing human resources for eye health as instruments to improve access to eye care in underserved areas. However, it is uncertain whether these two instruments are sufficiently compatible to provide positive synergic effects. To address this uncertainty, we conducted a structured literature review and synthesized relevant evidence relating to task shifting, workforce recruitment, retention, and eye care. Twenty-three studies from across the globe were analyzed and grouped into three categories: studies exploring recruitment and retention in human resources for eye health in general, studies discussing the relationship between task shifting and recruitment or retention of health workers in general, and studies specifically discussing task shifting and recruitment or retention in eye care workers.

FINDINGS

Our findings demonstrate that incentives are effective for initiating task shifting and improving recruitment and retention in rural areas with a stronger effect noted in midlevel eye care professionals and trainees. Incentives can take various forms, e.g., financial and nonfinancial. The consideration of context-specific motivational factors is essential when designing strategies to facilitate task shifting and to improve recruitment and retention.

Contextual factors affecting integration of eye health into school health programme in Zanzibar: a qualitative health system research

BACKGROUND

Short-term school eye health programmes supported by external funders have sustainability issues. This study aimed to understand the contextual factors affecting integrating eye health into the school health programme.

METHODS

We elicited responses from 83 respondents, purposefully selected from the Ministry of Health (n = 7), Ministry of Education and Vocational Training (n = 7), hospitals/eye centres (n = 5), master trainers (4) and schools (n = 60) who participated in in-depth interviews. Their responses were analysed and grouped into contextual factors according to the WHO Consolidated Framework for Implementation Research: stakeholders/political, institutional, physical, cultural, delivery system and others. Themes were then generated, and quotations were presented to illustrate the findings.

RESULTS

The six contextual factors affecting the integration of eye health into the school eye health programme were i) Stakeholders/political (Good ministry coordination, defined departmental roles and resource mobilisation from multiple stakeholders; Good stakeholder synergies and address current gaps); ii) Institutional (Institutional coordination and adequate clinic space; Securing human and financial resources; Strategic advocacy for institutional resources); iii) Physical (Long travel distance to service points); vi) Cultural (low eye health awareness among parents, teachers and children); iv) Delivery system (Practical approach to increase screening coverage using teachers as screeners; Balance teachers' workload, increase screening sensitivity and follow up and; v) Others (Comprehensive training material and effective training delivery; Improved curriculum, teacher selection and supervision and incentives).

CONCLUSION

Integrated school eye health delivery is generally well-received by stakeholders in Zanzibar, with the caveat that investment is required to address the six contextual factors identified in the study.

Identification of the educational needs and feasible educational modalities for specialist nurses working with ophthalmic patients in a tertiary eye centre in Singapore

Aims:

We aim to identify the educational needs and feasible educational modalities for specialist nurses working with ophthalmic patients in a tertiary eye centre in Singapore.

Design:

This was a mixed-method study utilising paper-based surveys and focus groups with nurses working at a tertiary eye centre in Singapore.

Participants:

One hundred nurses were invited to respond to the survey, with a response rate of 91%. Two focus groups with a total of 19 nurses were facilitated.

Methods:

Participants completed a modified Hennessy–Hicks survey. Among these participants 19 were invited to participate in a focus group. Descriptive statistical analysis was performed on the survey results. Focus groups were analysed using the inductive thematic analysis procedure described by Braun and Clarke.

Findings:

The participants in this study reported a need for ophthalmic-specific education programmes, more training in patient education and a need to broaden clinical exposure and experience.

Conclusion:

For ophthalmic nursing, where the workforce and patient population are considered relatively small, and postgraduate programmes are limited, the need to develop local education strategies to meet workforce needs has emerged.

Professional practice models for nurses in low-income countries: an integrative review

BACKGROUND

Attention is turning to nurses, who form the greatest proportion of health personnel worldwide, to play a greater role in delivering health services amidst a severe human resources for health crisis and overwhelming disease burden in low-income countries. Nurse leaders in low-income countries must consider essential context for nurses to fulfill their professional obligation to deliver safe and reliable health services. Professional practice models (PPMs) have been proposed as a framework for strategically positioning nurses to impact health outcomes. PPMs comprise 5 elements: professional values, patient care delivery systems, professional relationships, management approach and remuneration. In this paper, we synthesize the existing literature on PPMs for nurses in low-income countries.

METHODS

An integrative review of CINAHL-EBSCO, PubMed and Scopus databases for English language journal articles published after 1990. Search terms included nurses, professionalism, professional practice models, low-income countries, developing countries and relevant Medical Subject Heading Terms (MeSH).

RESULTS

Sixty nine articles published between 1993 and 2014 were included in the review. Twenty seven articles examined patient care delivery models, 17 professional relationships, 12 professional values, 11 remuneration and 1 management approach. One article looked at comprehensive PPMs.

CONCLUSIONS

Adopting comprehensive PPMs or their components can be a strategy to exploit the capacity of nurses and provide a framework for determining the full expression of the nursing role.

Implementation of evidence-based nursing practice for diabetic patients: an Iranian experience

Evidence-based nursing is recognized as an indicator of quality in nursing practice, a basis for accountability and the gold standard of professional nursing care. The aim of this study was to explore nurses' experiences and perceptions about evidence-based nursing practice in giving care to patients with diabetic foot ulcers. A qualitative research design was adopted, and content analysis was used to analyse data. Semistructured interviews were held with 19 bachelor-degree nurses working in a teaching hospital in an urban area of Iran. During data analysis, two main themes developed: 'structural backgrounds of the organization' and 'empowerment'. Accordingly, it was concluded that successful implementation of evidence-based nursing requires the reconfiguration of the administrative structure in the hospital. In addition, it requires the support of nurse leaders to facilitate the implementation of evidence-based nursing in the practice.

Evidence for integrating eye health into primary health care in Africa: a health systems strengthening approach

Background

The impact of unmet eye care needs in sub-Saharan Africa is compounded by barriers to accessing eye care, limited engagement with communities, a shortage of appropriately skilled health personnel, and inadequate support from health systems. The renewed focus on primary health care has led to support for greater integration of eye health into national health systems. The aim of this paper is to demonstrate available evidence of integration of eye health into primary health care in sub-Saharan Africa from a health systems strengthening perspective.

Methods

A scoping review method was used to gather and assess information from published literature, reviews, WHO policy documents and examples of eye and health care interventions in sub-Saharan Africa. Findings were compiled using a health systems strengthening framework.

Results

Limited information is available about eye health from a health systems strengthening approach. Particular components of the health systems framework lacking evidence are service delivery, equipment and supplies, financing, leadership and governance. There is some information to support interventions to strengthen human resources at all levels, partnerships and community participation; but little evidence showing their successful application to improve quality of care and access to comprehensive eye health services at the primary health level, and referral to other levels for specialist eye care.

Conclusion

Evidence of integration of eye health into primary health care is currently weak, particularly when applying a health systems framework. A realignment of eye health in the primary health care agenda will require context specific planning and a holistic approach, with careful attention to each of the health system components and to the public health system as a whole. Documentation and evaluation of existing projects are required, as are pilot projects of systematic approaches to interventions and application of best practices. Multi-national research may provide guidance about how to scale up eye health interventions that are integrated into primary health systems.