Supportive supervision from a roving nurse mentor in a community health worker programme: a process evaluation in South Africa.
Supportive supervision from a roving nurse mentor in a community health worker programme: a process evaluation in South Africa.
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DOI：
10.1186/s12913-022-07635-w
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发表时间：
2022-03-10
影响因子：
2.8
通讯作者：
Goudge J
中科院分区：
文献类型：
--
作者：
Malatji H;Griffiths F;Goudge J
许多低收入和中等收入国家正在重新定位社区卫生工作者方案，以提供更全面的促进和预防服务以及转诊至正规卫生服务。然而，监督不足、方案分散以及社区妇女的识字率低往往导致方案的绩效不佳。我们评估了与CHW团队一起工作的巡回护士导师在南非半农村地区证明支持性监督的影响。我们在干预前、干预中和干预后6个 月进行了纵向过程评估，使用深入访谈、焦点小组和观察来评估干预效果是如何产生和持续的。我们的参与者是社区卫生工作者、他们的主管、客户和设施工作人员以及社区代表。护士导师的工作环境是资源短缺、社区卫生服务机构和设施工作人员之间的冲突，以及社区卫生服务工会的活跃。在15个月的 期间，导师能够(1)支持和培训卫生福利院及其主管学习和实践新技能，(2)解决他们对失败的恐惧，(3)建立运作系统来解决卫生福利院活动效率低下的问题，从而改善服务提供。在干预接近尾声时，卫生部直接雇用了卫生工作人员，并增加了他们的津贴，这增加了他们的积极性和融入当地初级保健诊所队伍的积极性。然而，鉴于社区的重点是获得政府住房，而不是更好的医疗保健，以及社区的不稳定性质，护士导师无法与当地机构建立合作。在一个地区医疗保健系统中，由一名巡回护士导师监督几个社区卫生服务团队是一个可行的选择，特别是在缺乏合格的主管来支持社区卫生服务活动的情况下。一名流动护士导师可促进社区卫生服务中心的知识和技能发展，并提升初级主管的能力。然而，干预效果的长期可持续性取决于卫生署对社区卫生工作者的正式雇用。网上版载有补充材料，可在10.1186/s12913-022-07635-w查阅。
Many low and middle- income countries (LMICs) are repositioning community health worker (CHW) programmes to provide a more comprehensive range of promotive and preventive services and referrals to the formal health service. However, insufficient supervision, fragmented programmes, and the low literacy levels of CHWs often result in the under-performance of the programmes. We evaluate the impact of a roving nurse mentor working with CHW teams proving supportive supervision in a semi-rural area of South Africa. We conducted a longitudinal process evaluation, using in-depth interviews, focus groups and observations prior to the intervention, during the intervention, and 6 months post-intervention to assess how the effects of the intervention were generated and sustained. Our participants were CHWs, their supervisors, clients and facility staff members and community representatives. The nurse mentor operated in an environment of resource shortages, conflicts between CHWs and facility staff, and an active CHW labour union. Over 15 months, the mentor was able to (1) support and train CHWs and their supervisors to gain and practice new skills, (2) address their fears of failing and (3) establish operational systems to address inefficiencies in the CHWs’ activities, resulting in improved service provision. Towards the end of the intervention the direct employment of the CHWs by the Department of Health and an increase in their stipend added to their motivation and integration into the local primary care clinic team. However, given the communities’ focus on accessing government housing, rather than better healthcare, and volatile nature of the communities, the nurse mentor was not able to establish a collaboration with local structures. A roving nurse mentor overseeing several CHW teams within a district healthcare system is a feasible option, particularly in a context where there is a shortage of qualified supervisors to support CHWs activities. A roving nurse mentor can contribute to the knowledge and skills development of the CHWs and enhance the capacity of junior supervisors. However, the long-term sustainability of the effects of intervention is dependent on CHWs’ formal employment by the Department of Health. The online version contains supplementary material available at 10.1186/s12913-022-07635-w.
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影响因子：
2.1
作者：
Doherty, TM;Coetzee, M
通讯作者：
Coetzee, M
DOI：
10.1136/bmj.h1258
发表时间：
2015-03-19
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moore GF;Audrey S;Barker M;Bond L;Bonell C;Hardeman W;Moore L;O'Cathain A;Tinati T;Wight D;Baird J
通讯作者：
Baird J
影响因子：
3.3
作者：
Kok, Maryse C.;Ormel, Hermen;Dieleman, Marjolein
通讯作者：
Dieleman, Marjolein
影响因子：
8.1
作者：
Ballard, Madeleine;Bancroft, Emily;Palazuelos, Daniel
通讯作者：
Palazuelos, Daniel
影响因子：
8.1
作者：
Munshi, Shehnaz;Christofides, Nicola J.;Eyles, John
通讯作者：
Eyles, John