Role of Nurses in the delivery of quality care: understanding the workforce deficit

越来越多的人认为，通过全民健康覆盖（UHC）实现关于健康生活和福祉的可持续发展目标3（SDG 3）需要重点关注卫生人力资源（HRH）。在发展中国家，保健工作人员的短缺估计超过700万，非洲最贫穷国家的短缺情况最为严重。肯尼亚面临着严重的卫生人力危机，公共部门的护理密度在各县每1 000人1.2至0.008人之间，而国际建议的最低卫生人力门槛为每1 000人2.5人。护士构成卫生专业人员队伍的最大组成部分，被认为是提供安全和有效护理的关键，应成为促进和制定有效卫生政策的关键角色。然而，我们建议护士往往被低估，他们的贡献被低估，他们的“声音”在讨论中的主要HRH问题和护理质量（QoC）往往缺乏。与穷人参与政策制定的文献中的一些障碍包括：缺乏认识的护士作为政策制定的关键利益相关者，护理的负面形象，“只有一个辅助专业”，和官僚程序。一个潜在的重要方面，很少被审查是如何护理专业社会化影响他们的专业身份可能会影响护士的能力，调动权力和权威的卫生保健system. Ingreasingly可用性良好的信息被用来提供证据和宣传的政策和管理辩论的措施，护理质量是一个特别的重点。衡量LMIC护理质量的努力几乎完全集中在护理的医疗方面。在初级保健一级，大部分护理实际上是由护士提供的。在较大的设施中，质量评估也侧重于医疗护理质量;但护士是临床干预措施（例如治疗，营养干预等）的守门人。和其他护士发起的干预措施，以及在很大程度上负责整体护理，以满足更广泛的病人需求。然而，很少有人注意到护理质量的措施和他们的潜力，突出的护理赤字对质量的影响。缺乏这些措施可能会进一步削弱护士的能力，影响政策和管理decisions.We将开始工作使用身份理论作为一个透镜，以研究如何创建护士作为专业人员的身份，其潜在的影响力，他们的能力，发挥权力和机构在管理和政策的作用。我们还将探讨如何更具体的护理质量的措施可能会适应和实施在非洲的背景下。能够更好地为旨在提供优质护理和全民医保的劳动力政策和管理决策提供信息的措施。实证研究将探讨护士的专业身份和他们的影响力，在实践中，在国家，县和医院各级通过民族志，采访主要利益相关者和利益相关者会议。我们将研究现有的方法来衡量错过护理文献审查之前，开发和预测试工具，共同设计的护理community，这可能会产生护理质量的指标，告知辩论的政策和practices.This工作计划将有助于通过使用身份透镜，探索护理专业如何塑造和定义劳动力政策，角色和任务的新思维。此外，我们还将开发工具，提供经常缺乏的护理质量和数量的数据。我们将着手确定护士可以积极参与研究的途径，改善护理和告知政策，作为应对全球劳动力挑战的更广泛努力的一部分。

There is growing consensus that achieving Sustainable Development Goal 3(SDG 3) on healthy lives and well-being through universal health coverage (UHC) requires a critical focus on human resources for health (HRH). In developing countries the shortage of health workers is estimated to be over 7 million, with the worst shortages experienced in the poorest countries in Africa. Kenya faces a severe health workforce crisis with nursing densities in the public sector ranging between 1.2 to 0.008 per 1000 population across counties, compared to an internationally suggested minimum health workforce threshold of 2.5/1000 population. Nurses form the largest component of the health professional workforce and are recognized as essential to the delivery of safe and effective care and should be key players in promoting and shaping effective health policy. However, we suggest nurses are often undervalued and their contribution underestimated with their 'voice' in discussion on major HRH issues and on quality of care (QoC) often lacking. Some of the barriers associated with poor involvement in policy development in the literature include: lack of recognition of nurses as key stakeholders in policy development, a negative image of nursing as 'only an assisting profession', and bureaucratic processes. A potentially important aspect that has rarely been examined is how nursing professional socialization influencing their professional identity may influence the ability of nurses to mobilize power and authority within the health care system.Increasingly availability of good information is used to provide evidence and advocacy in policy and management debates with measures of quality of care being of a particular focus. Efforts to measure quality of care in LMIC have focused almost exclusively on medical aspects of care. At primary care level most of this care is actually delivered by nurses. In larger facilities too, quality assessment focuses on medical quality of care; yet nurses are gate keepers of the delivery of clinical interventions (e.g. treatments, nutrition interventions etc.) and other nurse initiated interventions as well as being largely responsible for holistic care to address wider patient needs. However, little attention has been paid to measures of nursing quality and their potential to highlight the impact of the nursing deficit on quality. The absence of such measures may further undermine the ability of nurses to affect policy and management decisions.We will begin work using an identity theory as a lens to examine how the identity of nurses as professionals is created and its potential influence on their ability to exert power and agency in management and policy roles. We will also explore how measures of quality that are more specific to nursing care might be adapted and implemented in an African context. Measures that can better inform workforce policy and management decisions aimed at providing quality care and universal health coverage. Empirical research will explore nurses' professional identity and their influence in practice at national, county and hospital levels through ethnography, interviews with key stakeholders and stakeholder meetings. We will examine existing approaches to measuring missed nursing care by reviewing literature before developing and pretest tools, co-designed with the nursing community, that may produce metrics of nursing quality to inform debate on policy and practice.This programme of work will contribute essential new thinking by using an identity lens to explore how the nursing profession shapes and defines workforce policy, roles and tasks. In addition, we will develop tools that provide the often lacking data on quality and quantity of nursing care delivered. We will embark on work to identify avenues through which nurses can be actively engaged in research, improving care and informing policy as part of broader efforts to tackle the global workforce challenge.