Cargando…

Exploring the space for task shifting to support nursing on neonatal wards in Kenyan public hospitals

BACKGROUND: Nursing practice is a key driver of quality care and can influence newborn health outcomes where nurses are the primary care givers to this highly dependent group. However, in sub-Saharan Africa, nursing work environments are characterized by heavy workloads, insufficient staffing and re...

Descripción completa

Detalles Bibliográficos
Autores principales: Nzinga, Jacinta, McKnight, Jacob, Jepkosgei, Joyline, English, Mike
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404312/
https://www.ncbi.nlm.nih.gov/pubmed/30841900
http://dx.doi.org/10.1186/s12960-019-0352-x
_version_ 1783400851284426752
author Nzinga, Jacinta
McKnight, Jacob
Jepkosgei, Joyline
English, Mike
author_facet Nzinga, Jacinta
McKnight, Jacob
Jepkosgei, Joyline
English, Mike
author_sort Nzinga, Jacinta
collection PubMed
description BACKGROUND: Nursing practice is a key driver of quality care and can influence newborn health outcomes where nurses are the primary care givers to this highly dependent group. However, in sub-Saharan Africa, nursing work environments are characterized by heavy workloads, insufficient staffing and regular medical emergencies, which compromise the ability of nurses to provide quality care. Task shifting has been promoted as one strategy for making efficient use of human resources and addressing these issues. AIMS AND OBJECTIVES: We aimed to understand the nature and practice of neonatal nursing in public hospitals in Nairobi so as to determine what prospect there might be for relieving pressure by shifting nurses’ work to others. METHODS: This paper is based on an 18-month qualitative study of three newborn units of three public hospitals—all located in Nairobi county—using an ethnographic approach. We draw upon a mix of 32 interviews, over 250 h’ observations, field notes and informal conversations. Data were collected from senior nursing experts in newborn nursing, neonatal nurse in-charges, neonatal nurses, nursing students and support staff. RESULTS: To cope with difficult work conditions characterized by resource challenges and competing priorities, nurses have developed a ritualized schedule and a form of ‘subconscious triage’. Informal, organic task shifting was already taking place whereby particular nursing tasks were delegated to students, mothers and support staff, often without any structured supervision. Despite this practice, nurses were agnostic about formal institutionalization of task shifting due to concerns around professional boundaries and the practicality of integrating a new cadre into an already stressed health system. CONCLUSION: Our findings revealed a routine template of neonatal nursing work which nurses used to control unpredictability. We found that this model of nursing encouraged delegation of less technical tasks to subordinates, parents and other staff through the process of ‘subconscious triage’. The rich insights we gained from this organic form of task shifting can inform more formal task-shifting projects as they seek to identify tasks most easily delegated, and how best to support and work with busy nurses. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12960-019-0352-x) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-6404312
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-64043122019-03-18 Exploring the space for task shifting to support nursing on neonatal wards in Kenyan public hospitals Nzinga, Jacinta McKnight, Jacob Jepkosgei, Joyline English, Mike Hum Resour Health Research BACKGROUND: Nursing practice is a key driver of quality care and can influence newborn health outcomes where nurses are the primary care givers to this highly dependent group. However, in sub-Saharan Africa, nursing work environments are characterized by heavy workloads, insufficient staffing and regular medical emergencies, which compromise the ability of nurses to provide quality care. Task shifting has been promoted as one strategy for making efficient use of human resources and addressing these issues. AIMS AND OBJECTIVES: We aimed to understand the nature and practice of neonatal nursing in public hospitals in Nairobi so as to determine what prospect there might be for relieving pressure by shifting nurses’ work to others. METHODS: This paper is based on an 18-month qualitative study of three newborn units of three public hospitals—all located in Nairobi county—using an ethnographic approach. We draw upon a mix of 32 interviews, over 250 h’ observations, field notes and informal conversations. Data were collected from senior nursing experts in newborn nursing, neonatal nurse in-charges, neonatal nurses, nursing students and support staff. RESULTS: To cope with difficult work conditions characterized by resource challenges and competing priorities, nurses have developed a ritualized schedule and a form of ‘subconscious triage’. Informal, organic task shifting was already taking place whereby particular nursing tasks were delegated to students, mothers and support staff, often without any structured supervision. Despite this practice, nurses were agnostic about formal institutionalization of task shifting due to concerns around professional boundaries and the practicality of integrating a new cadre into an already stressed health system. CONCLUSION: Our findings revealed a routine template of neonatal nursing work which nurses used to control unpredictability. We found that this model of nursing encouraged delegation of less technical tasks to subordinates, parents and other staff through the process of ‘subconscious triage’. The rich insights we gained from this organic form of task shifting can inform more formal task-shifting projects as they seek to identify tasks most easily delegated, and how best to support and work with busy nurses. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12960-019-0352-x) contains supplementary material, which is available to authorized users. BioMed Central 2019-03-06 /pmc/articles/PMC6404312/ /pubmed/30841900 http://dx.doi.org/10.1186/s12960-019-0352-x Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Nzinga, Jacinta
McKnight, Jacob
Jepkosgei, Joyline
English, Mike
Exploring the space for task shifting to support nursing on neonatal wards in Kenyan public hospitals
title Exploring the space for task shifting to support nursing on neonatal wards in Kenyan public hospitals
title_full Exploring the space for task shifting to support nursing on neonatal wards in Kenyan public hospitals
title_fullStr Exploring the space for task shifting to support nursing on neonatal wards in Kenyan public hospitals
title_full_unstemmed Exploring the space for task shifting to support nursing on neonatal wards in Kenyan public hospitals
title_short Exploring the space for task shifting to support nursing on neonatal wards in Kenyan public hospitals
title_sort exploring the space for task shifting to support nursing on neonatal wards in kenyan public hospitals
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404312/
https://www.ncbi.nlm.nih.gov/pubmed/30841900
http://dx.doi.org/10.1186/s12960-019-0352-x
work_keys_str_mv AT nzingajacinta exploringthespacefortaskshiftingtosupportnursingonneonatalwardsinkenyanpublichospitals
AT mcknightjacob exploringthespacefortaskshiftingtosupportnursingonneonatalwardsinkenyanpublichospitals
AT jepkosgeijoyline exploringthespacefortaskshiftingtosupportnursingonneonatalwardsinkenyanpublichospitals
AT englishmike exploringthespacefortaskshiftingtosupportnursingonneonatalwardsinkenyanpublichospitals