Policies and resources for strengthening of emergency and critical care services in the context of the global COVID-19 pandemic in Kenya

Needs assessment for master of nursing program among Kenyan nurses

BACKGROUND

Nurses comprise the dominant cadre of healthcare workers yet there remains an acute shortage of nurses globally with Africa most affected. However, access to higher nursing education in sub-Saharan Africa remains limited. We aimed to i) Assess the need for a Master of Nursing (MScN) program among graduate nurses in Kenya ii) Identify preferred MScN program options among graduate nurses intending to enrol for MScN in Kenya iii) Identify skills mismatch among graduate nurses in Kenya iv) Assess the relationship between intention to enrol in MScN program and job satisfaction among graduate nurses in Kenya.

METHODS

A cross-sectional design employing an online survey was used. Consenting nurses with a first degree in nursing were included. Socio-demographic indicators, job satisfaction and skills mismatch were assessed. The need for an MScN program was assessed by determining the proportion of participants who expressed the desire to pursue an MScN program. Preferred MScN program options were determined as frequencies and proportions. Skills mismatch was computed as frequencies and proportions. The relationship between the need for MScN and job satisfaction was assessed using the point biserial-correlation.

RESULTS

Of the 355 volunteers enrolled, (n = 337, 94.9% [95% CI: 92.1-96.9]) expressed the desire to pursue MScN training with the critical care/renal specialty (n = 84, 24.9% [95% CI: 20.3-29.9]) being the most preferred. A majority of the volunteers (n = 319, 89.9%) felt their skills were inferior to their responsibilities (under skilled). We found no significant correlation between the need for MScN and job satisfaction (r = 0.058; p = 0.269).

CONCLUSION

Our findings suggest a strong desire by graduate nurses in Kenya to pursue MScN with a preference for critical care specialization. There is a need to establish more MScN programs in Kenya coupled with the deployment of nurses as per the scope of practice.

The effectiveness of the Sierra Leone health sector's response to COVID-19: a quantitative analysis

BACKGROUND

The COVID-19 pandemic posed significant challenges to health systems globally, particularly in low-resource settings like Sierra Leone. Understanding the effectiveness of leadership, health workforce performance, community engagement, and service delivery during the pandemic is critical for strengthening future pandemic, preparedness and response.

METHODS

A cross-sectional study was conducted with 303 respondents, including stakeholders from the Ministry of Health, district health management teams, and community health workers. Data were collected using structured questionnaires and analyzed to assess perceptions of leadership, workforce performance, community participation, and disruptions to health services.

RESULTS

Leadership and governance were rated as "effective" or "very effective" by 58% of respondents, with key challenges including inadequate communication, delays in resource mobilization, and limited transparency. The health workforce demonstrated strong commitment (62%), but gaps in infection prevention and control training (48%) and shortages of personal protective equipment (39%) were significant barriers. Community engagement was moderately effective, with 54% rating it as "effective" or "very effective." However, low trust in the health sector and misinformation hindered compliance with preventive measures. Maternal and child health services were the most disrupted, but innovative approaches such as telemedicine and mobile health units were adopted to mitigate service interruptions.

CONCLUSION

Sierra Leone's COVID-19 response highlighted both achievements and challenges. While leadership structures, workforce dedication, and community health worker contributions were notable strengths, gaps in communication, resource availability, and community trust limited the overall effectiveness of the response. Strengthening communication channels, investing in workforce training and resources, and enhancing community engagement strategies are critical for improving preparedness and response in future health emergencies.

General ward nurses detection and response to clinical deterioration in three hospitals at the Kenyan coast: a convergent parallel mixed methods study

BACKGROUND

In low and middle-income countries like Kenya, critical care facilities are limited, meaning acutely ill patients are managed in the general wards. Nurses in these wards are expected to detect and respond to patient deterioration to prevent cardiac arrest or death. This study examined nurses' vital signs documentation practices during clinical deterioration and explored factors influencing their ability to detect and respond to deterioration.

METHODS

This convergent parallel mixed methods study was conducted in the general medical and surgical wards of three hospitals in Kenya's coastal region. Quantitative data on the extent to which the nurses monitored and documented the vital signs 24 h before a cardiac arrest (death) occurred was retrieved from patients' medical records. In-depth, semi-structured interviews were conducted with twenty-four purposefully drawn registered nurses working in the three hospitals' adult medical and surgical wards.

RESULTS

This study reviewed 405 patient records and found most of the documentation of the vital signs was done in the nursing notes and not the vital signs observation chart. During the 24 h prior to death, respiratory rate was documented the least in only 1.2% of the records. Only a very small percentage of patients had any vital event documented for all six-time points, i.e. four hourly. Thematic analysis of the interview data identified five broad themes related to detecting and responding promptly to deterioration. These were insufficient monitoring of vital signs linked to limited availability of equipment and supplies, staffing conditions and workload, lack of training and guidelines, and communication and teamwork constraints among healthcare workers.

CONCLUSION

The study showed that nurses did not consistently monitor and record vital signs in the general wards. They also worked in suboptimal ward environments that do not support their ability to promptly detect and respond to clinical deterioration. The findings illustrate the importance of implementation of standardised systems for patient assessment and alert mechanisms for deterioration response. Furthermore, creating a supportive work environment is imperative in empowering nurses to identify and respond to patient deterioration. Addressing these issues is not only beneficial for the nurses but, more importantly, for the well-being of the patients they serve.

Development and delivery of a higher diploma in emergency medicine and critical care for clinical officers in Kenya

The provision of emergency medicine and critical care in a cost-efficient manner has the potential to address many preventable deaths in low- and middle-income countries. Here, utilising Kern's framework for curriculum development, we describe the origins, development and implementation of the Emergency Medicine and Critical Care Clinical Officer training program; Kenya's first training programme for clinical officers in emergency medicine and critical care. Graduates are scattered across the country in diverse settings, ranging from national referral hospitals in the capital, Nairobi, to rural hospitals in northern Kenya. In these locations, they provide clinical care, leadership, and teaching. Similar programmes could be replicated in other locations to help plug the gap in critical care provision in Sub-Saharan Africa.

Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic

Care for the critically ill patients is often considered synonymous with a hospital having an intensive care unit. However, a focus on Essential Emergency and Critical Care (EECC) may obviate the need for much intensive care. Severe COVID-19 presented a specific critical care challenge while also being an exemplar of critical illness in general. Our multidisciplinary team conducted research in Kenya and Tanzania on hospitals' ability to provide EECC as the COVID-19 pandemic unfolded. Important basic inputs were often lacking, especially sufficient numbers of skilled health workers. However, we learnt that higher scores on resource readiness scales were often misleading, as resources were often insufficient or not functional in all the clinical areas they are needed. By following patient journeys, through interviews and group discussions, we revealed gaps in timeliness, continuity and delivery of care. Generic challenges in transitions between departments were identified in the receipt of critically ill patients, the ability to sustain monitoring and treatment and preparation for any subsequent transition. While the global response to COVID-19 focused initially on providing technologies and training, first ventilators and later oxygen, organisational and procedural challenges seemed largely ignored. Yet, they may even be exacerbated by new technologies. Efforts to improve care for the critically ill patients, which is a complex process, must include a whole system and whole facility view spanning all areas of patients' care and their transitions and not be focused on a single location providing 'critical care'. We propose a five-part strategy to support the system changes needed.