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

护士在提供优质护理中的作用：了解劳动力短缺

• 批准号: MR/R018510/1
• 负责人: David Gathara
• 金额: $ 24.02万
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR018510%2F1
• 关键词: Role; Nurses; delivery; quality; care

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.

越来越多的人达成共识，即通过全民健康覆盖(UHC)实现关于健康生活和福祉的可持续发展目标3(SDG 3)，需要将重点放在人力资源促进健康(HRH)上。在发展中国家，卫生工作者的短缺估计超过700万人，其中非洲最贫穷国家的短缺最为严重。肯尼亚面临着严重的卫生人力危机，各县公共部门的护理密度在每千人1.2%至0.008人之间，而国际建议的最低卫生人力门槛为每千人2.5%。护士是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，应在促进和制定有效的卫生政策方面发挥关键作用。然而，我们建议护士经常被低估，她们的贡献被低估，因为她们在讨论主要的HRH问题和经常缺乏护理质量(QoC)时发出了‘声音’。文献中与政策制定过程中参与程度不高有关的一些障碍包括：缺乏对护士在政策制定中的关键利益相关者的认识，将护理人员视为只是一个辅助职业的负面形象，以及官僚程序。一个很少被研究的潜在的重要方面是，护士职业社会化如何影响他们的职业认同，如何影响护士在卫生保健系统内调动权力和权威的能力。越来越多的良好信息被用来在政策和管理辩论中提供证据和宣传，其中护理质量的衡量标准是特别关注的。在LMIC中衡量医疗质量的努力几乎完全集中在医疗方面。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质量的护理；然而，护士是临床干预措施(例如治疗、营养干预等)的守门人。以及其他护士发起的干预措施，以及主要负责整体护理，以满足更广泛的患者需求。然而，很少有人注意到护理质量的衡量标准及其可能突出护理缺陷对质量的影响。如果缺乏这样的措施，可能会进一步削弱护士影响政策和管理决策的能力。我们将以身份认同理论为视角，开始研究护士作为专业人员的身份是如何产生的，以及它对他们在管理和政策角色中发挥权力和代理作用的能力的潜在影响。我们还将探讨如何在非洲的背景下调整和实施更具体于护理的质量措施。能够更好地为旨在提供高质量医疗保健和全民健康覆盖的劳动力政策和管理决策提供信息的措施。实证研究将通过民族志、与关键利益相关者的访谈和利益相关者会议，探索护士的职业认同及其在国家、县和医院层面的实践中的影响。我们将检查现有的方法来衡量错过的护理，在开发和预测工具之前，与护理界共同设计的，可能产生护理质量的指标，为政策和实践的辩论提供参考的现有方法。这一工作方案将通过使用身份透镜来探索护理专业如何塑造和定义劳动力政策、角色和任务，从而贡献基本的新思维。此外，我们将开发工具，提供经常缺乏的护理服务质量和数量的数据。我们将着手确定护士可以积极参与研究、改善护理和为政策提供信息的途径，作为应对全球劳动力挑战的更广泛努力的一部分。

项目成果

Quantifying nursing care delivered in Kenyan newborn units: protocol for a cross-sectional direct observational study.

• DOI: 10.1136/bmjopen-2018-022020
• 发表时间: 2018-07-23
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Gathara D;Serem G;Murphy GAV;Abuya N;Kuria R;Tallam E;English M
• 通讯作者: English M

Exploring the complex realities of nursing work in Kenya and how this shapes role enactment and practice-A qualitative study.

探索肯尼亚的护理工作的复杂现实，以及这种塑造角色颁布和实践的定性研究。

• DOI: 10.1002/nop2.1812
• 发表时间: 2023-08
• 期刊: NURSING OPEN
• 影响因子: 2.3
• 作者: Mbuthia, Daniel;Brownie, Sharon;Jackson, Debra;McGivern, Gerald;English, Mike;Gathara, David;Nzinga, Jacinta
• 通讯作者: Nzinga, Jacinta

Professional identity transitions, violations and reconciliations among new nurses in low- and middle-income countries

• DOI: 10.1016/j.ssmqr.2021.100024
• 发表时间: 2021-12-01
• 期刊: SSM-QUALITATIVE RESEARCH IN HEALTH
• 作者: Mbuthia, Daniel Waweru;Mcgivern, Gerry;Nzinga, Jacinta
• 通讯作者: Nzinga, Jacinta