A middle-range model for improving quality of nursing education in Malawi

Factors Associated With Junior Nurses Ability to Recognise and Respond to Clinical Deterioration: A Cross-Sectional Study in Tertiary Hospitals in Malawi

RATIONALE

Recognising and responding swiftly to patient deterioration is critical for preventing adverse events. Junior nurses play a vital role in identifying the signs of clinical deterioration and initiating interventions. No prior studies have assessed junior nurses' abilities to manage clinical deterioration in Malawi.

OBJECTIVES

This study aimed to assess junior nurses' ability to recognise and respond to clinical deterioration in Malawian tertiary hospitals and identify associated factors.

METHODS

The institutional based cross-section study design was used which included 322 junior nurses across all departments of four tertiary hospitals in Malawi (November-December 2023). Data collection utilised a questionnaire for clinical deterioration recognition and response ability in junior nurses. Chi-square, Fisher's exact, and logistic regression tests were used for data analysis.

FINDINGS

Junior nurses achieved a median score of 71 with an interquartile range of 68-75 on the clinical deterioration questionnaire. According to the study, nurses with more work experience, those who worked in intensive care units, and those who participated in discussions about clinical deterioration had better scores. In contrast, nurses with less than 1 year of experience were 5.5 times more likely to struggle with recognising and responding to clinical deterioration than those with 5 years of experience (OR: 5.506, p = 007). Additionally, working in the paediatric department decreased junior nurses' ability to recognise and respond to clinical deterioration six times compared to working in the intensive care unit (OR: 6.068, p = 0.018). Furthermore, junior nurses who had never engaged in discussions related to clinical deterioration had a seven times higher likelihood of poor ability to recognise and respond to clinical deterioration (OR = 6.954, p = 0.005).

CONCLUSION

This study highlights the need for specialised training programmes related to clinical deterioration that incorporate active learning, such as clinical scenarios and practical applications, along with mentorship initiatives to enhance junior nurses' skills and confidence in recognising and responding to clinical deterioration.

Identifying the factors influencing the quality of education from the perspective of nursing students: A qualitative study

BACKGROUND

Nursing education in Iran suffers from challenges such as inadequate training time, non-scientific methods, lack of facilities, and so on. Nursing students can better discuss these issues and identify variables affecting their education. Thus, this study sought to uncover factors affecting education quality from nursing students' perspectives.

MATERIALS AND METHODS

This is a qualitative study that was conducted on nursing students in 2022. Purposive sampling chose 20 undergraduate nursing students from Abadan University of Medical Sciences, Abadan, Iran. The data was acquired using a semi-structured interview. Content analysis was performed using MAXQDA-10 software to extract relevant themes.

RESULTS

The factors derived from content analysis were classified into two internal and external main themes and six sub-themes, including professors, students, the university/education department, hospitals, and the educational system.

CONCLUSIONS

Analyzing the strengths and weaknesses of trainers and professors in practical programs and teaching new practical teaching methods can effectively enhance the quality of nursing education. Also, giving training and welfare equipment and necessities in educational hospitals and changing the headlines and contents of some nursing courses will improve education quality.

The need for and acceptability of a cancer training course for medical and nursing students in Tanzania: a convergent mixed methods study

BACKGROUND

The cancer burden in Africa is on the rise. A Cancer Training Course on screening, prevention, care, and community education is crucial for addressing a wide range of cancer health issues. When appropriately educated healthcare providers on cancer provide care, patient care improves, and healthcare costs decrease. However, in Tanzania, doctors and nurses receive little or no training in primary cancer care in their bachelor's program.

AIM

This study assessed the need and acceptability of a cancer training course for nursing and medical doctor students at the Muhimbili University of Health and Allied Sciences (MUHAS) in Dar es Salaam, Tanzania.

METHODS

This study was a cross-sectional parallel mixed method study during the 3-month follow-up within the larger study on sexual health training for health professionals. The study was a randomized controlled (RCT), single-blind, parallel trial of sexual health training versus a waitlist control among health students at MUHAS in Tanzania. Descriptive analysis was performed to analyze the participants' demographic information, need, and acceptability of the cancer training courseto determine the frequencies and percentages of their distribution between disciplines. In addition, inductive thematic analysis was performed for the qualitative data. The RCT study was registered at Clinical Trial.gov (NCT03923582; 01/05/2021).

RESULTS

Data were collected from 408 students (272 medical doctors and 136 nursing students). The median age of the participants was 23 years. Most (86.0%) medical and 78.1% of nursing students reported receiving little to no cancer training. On the other hand, most (92.3%) medical and nursing (92.0%) students were interested in receiving cancer training. Furthermore, 94.1% of medical and 92.0% of nursing students needed a cancer training course in their undergraduate program. In addition, participants said a cancer training course would be important because it would help them improve the quality of cancer care and enhance the quality of life for patients by ensuring early diagnosis and treatment.

CONCLUSION

A cancer training course is both highly needed and acceptable to medical and nursing students. Implementation of this cancer training course will improve students' knowledge and skills and eventually improve the quality of cancer care and patients' quality of life by ensuring early diagnosis and management.

Design, delivery and effectiveness of health practitioner regulation systems: an integrative review

BACKGROUND

Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions.

METHODS

We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework.

FINDINGS

This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners.

CONCLUSION

We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.

Pre-service midwifery education in sub-Saharan Africa: A scoping review

BACKGROUND

In response to a global call for more midwives, maternal health stakeholders have called for increased investment in midwifery pre-service education. Given the already long list of challenges and the increasing burden on health care systems due to the COVID-19 pandemic, the need to prioritize investment is acute, particularly in sub-Saharan Africa. An important first step is to examine the current evidence.

METHODS

We conducted a scoping review of the peer-reviewed literature about pre-service midwifery education in sub-Saharan Africa. A search of studies published between 2015 and 2021 in French or English was conducted using six databases (PubMed, CINAHL, Embase, Scopus, Web of Science and African Index Medicus).

RESULTS

The search yielded 3061 citations, of which 72 were included. Most were a mix of qualitative and quantitative cross-sectional, country-specific studies. Organized by pre-service educational domain, the literature reflected a misalignment between international standards for midwifery education and what schools and clinical sites and the larger administrative systems where they operate, reliably provide. Inadequate infrastructure, teaching capacity in school and clinical settings and clinical site environment were factors that commonly impede learning. Literature related to faculty development and deployment were limited.

CONCLUSION

Schools, faculty and clinical sites are overwhelmed yet recommendations by key stakeholders for change are substantive and complex. Efforts are needed to help schools map their current status by pre-service education domain and prioritize where scarce resources should be directed. These results can inform research and investments in pre-service midwifery education in sub-Saharan Africa.

The future of cancer nursing in Europe: Addressing professional issues in education, research, policy and practice

Cancer nursing has evolved to meet the demands of rising cancer incidence, newer and more complex treatment options, and the emergence of specialist roles supporting patients from pre-diagnosis, through treatment, survivorship and end of life care. Nurses are involved in direct and in-direct care of people at risk of, and living with and after cancer in diverse contexts. As a result, nurses are positioned to have a significant influence on the processes and outcomes of cancer care, through education, research, policy, practice and leadership. However, nursing and cancer care face challenges, arising from workforce shortages, under-investment in services and under-representation in decision-making. This paper discusses the evolution of cancer nursing across education, policy, research, profession and practice, and sets an agenda for innovation and disruption across these domains to ensure sustainability of cancer care services and care for people living with and after cancer. We argue for the continued advancement of cancer nursing with critical focus on identifying and addressing inequities in role recognition and access to specialist cancer nursing education throughout Europe. Partnership, exchange of learning, and co-design will be central to progressing education, evidence and policy to support future growth in the cancer nursing workforce and embed cancer nurses in research and policy setting at local, national and international levels.

Nurses' and nurse educators' experiences of a Pediatric Nursing Continuing Professional Development program in Rwanda

OBJECTIVES

In 2016, a Pediatric Nursing Continuing Professional Development (PNCPD) program was created and implemented in Kigali, Rwanda, through the Training, Support, and Access Model (TSAM) for Maternal, Newborn, and Child Health (MNCH). This partnership project between Canada and Rwanda provided pediatric nursing education to forty-one Rwandan nurses and nurse educators in 2018 and 2019. The objective of this research study was to explore the experiences of nurses and nurse educators applying pediatric knowledge and skills to academic and clinical settings after participating in the PNCPD program.

METHODS

This study was situated within an interpretive descriptive perspective to explore the ways in which knowledge gained during the PNCPD program in Rwanda was applied by nurses and nurse educators in their nursing practice, both academically and clinically. Data was collected through individual interviews. Inductive content analysis was used for data analysis.

RESULTS

The analysis of the interviews resulted in the emergence of five themes: Transformations in Pediatric Nursing Practice, Knowledge Sharing, Relationship-Based Nursing, Barriers and Facilitators to Knowledge Implementation, and Scaling-up PNCPD within the Health System.

CONCLUSIONS

The results of this study have the potential to inform positive changes to child health care in Rwanda, including scaling up pediatric nursing education to other areas of the healthcare system.

Nursing students' conceptions of competence and the learning processes that support the development of competence: a phenomenographic study

The development of competence among student nurses is important to nurse educators, nursing regulatory bodies, employers and patients. Several teaching and learning strategies support the development of competence among student nurses, but the level of competence at the point of graduation remains below expected standards. Therefore, more research is needed to find strategies that can enhance the development of competence among students. The study explored students' conceptions of competence and the learning processes that support the development of competence in nursing practice. Gaining an understanding of learning and competence from the student's perspective can improve our current understanding of the development of competence. Utilising a phenomenographic approach, in-depth interviews and focus group discussions were conducted among purposively sampled groups of nursing students. The analysis of data was managed through ATLAS. ti 8.1 and followed the process of familiarisation, condensation, comparison, grouping, articulating labelling and contrasting of excerpts to generate the students' conceptions of learning. Five categories of description emerged and showed that the development of competence involves students increasing their understanding of what competence is, hence changing their learning strategies to meet the level of competence, as they understood it. In order of hierarchy from the lowest, the categories of description were: competence is understood as task completion; competence is understood as passing assessments /satisfying facilitators; competence is understood as applying theory to practice; competence is understood as performance of nursing according to clinical standards/guidelines; and competence is understood as performance that yields positive health outcomes.

Quality improvement training for burn care in low-and middle-income countries: A pilot course for nurses

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We can empower practitioners to lead quality improvement projects in LMICs.

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Nurses can play a significant role in the improvement of burns services.

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Interactive blended-learning courses can support nurses to lead on quality improvement.

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The training and development must be designed to be context specific.

Background

There is an urgent need to empower practitioners to undertake quality improvement (QI) projects in burn services in low-middle income countries (LMICs). We piloted a course aimed to equip nurses working in these environments with the knowledge and skills to undertake such projects.

Methods

Eight nurses from five burns services across Malawi and Ethiopia took part in this pilot course, which was evaluated using a range of methods, including interviews and focus group discussions.

Results

Course evaluations reported that interactive activities were successful in supporting participants to devise QI projects. Appropriate online platforms were integral to creating a community of practice and maintaining engagement. Facilitators to a successful QI project were active individuals, supportive leadership, collaboration, effective knowledge sharing and demonstrable advantages of any proposed change. Barriers included: staff attitudes, poor leadership, negative culture towards training, resource limitations, staff rotation and poor access to information to guide practice.

Conclusions

The course demonstrated that by bringing nurses together, through interactive teaching and online forums, a supportive community of practice can be created. Future work will include investigating ways to scale up access to the course so staff can be supported to initiate and lead quality improvement in LMIC burn services.

Strengthening of oncology nursing education and training in Africa in the year of the nurse and midwife: addressing the challenges to improve cancer control in Africa

The Cancer burden in Africa is increasing. Nurses play a pivotal role in health care systems and find themselves in a key position to engage with patients, communities and other health professionals to address disparities in cancer care and work towards achieving cancer control in Africa. The rapidly evolving nature of cancer care requires a highly skilled and specialised oncology nurse to either provide clinical care and/or conduct research to improve evidence-based practice. Although Africa has been slow to respond to the need for trained oncology nurses, much has been done over the past few years. This article aims to provide an update of Oncology nursing education and training in Africa with specific focus on South Africa, Ghana, Nigeria, Kenya, Zambia and Egypt. Mapping oncology nursing education and training in Africa in 2020, the International Year of the Nurse and the Midwife, provides an opportunity to leverage on the essential roles of the oncology nurse and commit to an agenda that will drive and sustain progress to 2030 and beyond.

Developing a specialist children's nursing workforce in sub-Saharan Africa: a descriptive programme evaluation

BACKGROUND

Achieving Universal Health Coverage in low and lower-middle income countries requires an estimated additional five and a quarter million nurses. Despite an increasing focus on specialist nursing workforce development, the specialist children's workforce in most African countries falls well below recommended densities. The Child Nursing Practice Development Initiative was established with the aim of building the children's nursing workforce in Southern and Eastern Africa, and Ghana. The purpose of this evaluation was to enable scrutiny of programme activities conducted between 2008 and 2018 to inform programme review and where possible to identify wider lessons of potential interest in relation to specialist nursing workforce strengthening initiatives.

METHODS

The study took the form of a descriptive programme evaluation. Data analysed included quantitative programme data and contextual information from documentary sources. Anonymised programme data covering student enrolments between January 2008 and December 2018 were analysed. Findings were member-checked for accuracy.

RESULTS

The programme recorded 348 enrolments in 11 years, with 75% of students coming from South Africa and 25% from other sub-Saharan African countries. With a course completion rate of 94, 99% of known alumni were still working in Africa at the end of 2018. Most graduates were located at top-tier (specialist) public hospital facilities. Nine percent of known alumni were found to be working in education, with 54% of graduates at centres that offer or plan to offer children's nursing education.

CONCLUSION

The programme has made a quantifiable, positive and sustained contribution to the capacity of the specialist clinical and educational children's nursing workforce in nine African countries. Data suggest there may be promising approaches within programme design and delivery in relation to very high course completion rates and the retention of graduates in service which merit further consideration. Outputs from this single programme are however modest when compared to the scale of need. Greater clarity around the vision and role of specialist children's nurses and costed plans for workforce development are needed for investment in specialist children's nursing education to realise its potential in relation to achievement of Universal Health Coverage.

Continuing Professional Development status in the World Health Organisation, Afro-region member states

There is evidence of underperformance of the Global Health Indicators, particularly in the WHO Afro-region. Yet, quality, effective healthcare delivery, and access to information about best practice remains a challenge to nurses and midwives in the WHO Afro-region. For nurses and midwives to have the capacity to practice safely and competently they need to engage in mandatory Continuing Professional Development (CPD). However a composite picture is not available for future project planners, researchers, and policy developers. Published literature from the past five years and professional body webpages were searched. The results of shining a light on the WHO Afro-region member states’ CPD status revealed strengths, weaknesses, opportunities, and threats. The strengths lay in the beginnings of mandatory CPD and annual licensure renewal, while the weaknesses revealed inequity of CPD distribution across the region. The opportunities showed international academic partnership with possibilities for further engagement, and the threats were evident in the health context of the Afro-region, the shortage of nurses and the lesser participation of nurses in CPD programs. The illumination of the CPD status in the Afro-region suggests that a revised CPD landscape is necessary to strengthen the relevance and response capacity of nurses and midwives, as key contributors towards the Global Health Indicators.