ROLE OF NURSING RESEARCH IN IMPROVING QUALITY OF CARE

Introduction

A portfolio of multi-disciplinary nursing research work spanning 7 years

Nurses form the largest component of the health professional workforce and are recognized as essential to the delivery of safe and effective care. However, nurses’ 'voice' in discussion on major human resource issues and on quality of care (QoC) has been shown to be often lacking. In Kenya we don’t have a good understanding of what nursing care is currently being provided, what tasks are nurses actually engaged in and what is the quality of the care provided. Other questions within the Kenyan context include: How the role of nurses is influencing decision making processes, how are nurses trained and socialized and how does this influence their professional image. Finally, how does the nursing identity shape and influence nurses’ authority in governing service provision. We believe that in actively engaging nurses in evidence-based research we can improve routine provision of care and informing policy as part of broader efforts to tackle the global workforce challenge.

What have we done in the past?

1. Gap in provision, access and quality2. Care left undone/missed care3. Nursing: Work done by nurses -What should be done – nursing standards -What is being done - task analysis -How it can be done – experts & stakeholders4.The impossible job of being a neonatal nurse -Task sharing in practice -Nurses’ perception of QoC across sectors5. Acceptability & implications

The context: Ethnography1. Senior stakeholders views on nursing2. Nurses -How nurses manage the pressures and stresses working in newborn unit -What influences a nurses ability to provide quality care

Nurses have many competing priorities

• There are also a number of non-nursing activities that are time consuming

-Completing charge sheets -Going to the stores -Getting blood samples -Dis-infection of cups• Nightshifts: one nurse; cover reduced; 12hrs; napping

(mothers and nurses); nutritionists, students, cleaners absent; handover pointless

• If we don’t fix primary issues, we won’t fix second-ary issues: materials; pay; working conditions; other responsibilities; career; layout all barriers

- A Nairobi NBU nurse’s job is essentially impossible. Ratios; materials; pay; material conditions; other responsibilities; career etc.- A host of other factors impact on care: management; culture of not ‘seeing’ infants; training issues; devolution; infants ‘difficult’ and emotional- …The model of nursing care is not based on any particular medical rationale, but has instead grown organically around nurses’ needs and the local expectations of their role. It is long-standing and robust.

Patterns and factors contributing to missed nursing care in Kenya hospitals

Not all care that is planned is delivered with shortage of human resources as the main reason reported for this.Variation in care done (left undone) by:• Staffing• SectorMore care is left undone in the public sector and where there are high nurse patient ratiosTask sharing is already being practiced although informally Improving neonatal care requires an expansion of appropriate human resources for health and re-thinking of the tasks done by nursesMore nursing research is required to quantify the work done by nurses and the implications for the nurse workforce deficits on patient outcomes.

Summary

Role of nurses in the delivery of quality care: understanding the workforce deficit and its effectsCurrent work

What should we do?

Increasing the nursing workforce is a pre-requisite to improving newborn care

There is need to re-focus the nursing practice to allow nurses to concentrate on technical nursing roles

Review and generate local evidence on how to enhance and support the nursing workforce

Package and present evidence to policy makers (finance) and partner organisations to invest in human resource St

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Participants drawn from: Ministry of Health, Nairobi City County, UNICEF-Kenya, the Nursing Council of Kenya, the Midwives Association of Kenya, Aga Khan University, University of Nairobi, Kenyatta University, Kenyatta National Hospital and others

Improving Inpatient Neonatal Care ServicesStakeholder workshop

Collaborators

This brief has been produced by KEMRI Wellcome Trusthttp://kemri-wellcome.org/