Understanding the role of senior nurses in the neonatal care delivery in Kenyan Hospitals

尽管制定了旨在帮助制定复杂的质量改进干预措施的准则，但人们对关键工作人员的作用、他们的表现以及他们在卫生保健环境中所拥有的权力和社会地位的影响的了解仍然有限。通常，帮助理解干预措施以改善护理的努力更多地侧重于使用一些框架对干预措施组成部分进行分类，报告实施过程并描述干预环境。然而，对构成地区医院作为一个机构的基本结构的基本社会动态的认识和适应（包括权力和影响力的所在地和行使）以及高级护士等关键行为者的重要作用缺乏深度，因此缺乏理论发展。哲学博士项目的目标是：1)在地区医院的社会网络中定位新生儿单位和个人，包括关系、资本和权力，特别关注高级护士的作用；2)从社会网络和社会运动的角度建立导致新生儿护理质量差的机制的现实主义理论；3)利用“社会网络干预”的经验来阐明隐藏的社会现实，并为未来的干预提出建议；即确定如何操纵上下文可能支持基层行动主义/集体行动，以改善新生儿患者护理。这个项目将使用现实主义的方法来组织科学探究。将使用社会网络和社会运动理论作为理论框架。方法将包括系统回顾，社会网络分析，以及对网络职位感兴趣的个人进行定性访谈，特别关注高级护士，因为他们可能是实现新生儿护理单位（病房）变革的关键。丰富理论的发展将用于产生关于社会网络干预的位置和功能的建议，以提高地区医院的新生儿护理质量，包括如何操纵背景可能支持基层行动主义/集体行动，以改善新生儿患者护理。研究结果将为今后干预方案的领导人提供切合实际的指导。

Despite guidelines intended to help to structure complex quality improvement interventions, there remains limited understanding of the role of key staff and how they perform and any influence of the power and social position they hold in the health care setting. Often efforts to aid understanding of interventions to improve care focus more on classifying intervention components using a number of frameworks, report on implementation processes and describe intervention contexts. However, knowledge and accommodation of the fundamental social dynamics which comprise the essential fabric of the district-hospital as an institution (including locus and performing of power and influence) and the important role of key actors such as senior nurses lack depth and subsequently lack theoretical development. The DPhil project will aim to: 1) locate the neonatal unit and individuals therein within the social network of the district hospital, including ties, capital and power with a particular focus on the roles of senior nurses, 2) build realist theory of the mechanisms leading to poor quality neonatal care, from a social networks and social movements perspective, 3) use experiences of 'social network interventions' to illuminate hidden social realities, and generate recommendations for future interventions, i.e. identify ways in which manipulation of context might support grass-roots activism/collective action to improve neonatal patient care. This project will use a realist approach to structure scientific enquiry. Social networks and social movement theory will be used as theoretical frameworks. Methods will include a systematic review, social networks analysis, and qualitative interviews with individuals in network positions of interest with a particular focus on senior nurses as potentially pivotal to achieving change on newborn care units (wards). Development of rich theory will be used to generate recommendations about the place and function of social networks interventions to improve quality of neonatal care at the district hospital setting, including how manipulation of context might support grass-roots activism/collective action to improve neonatal patient care. Findings will provide context-sensitive and practical guidance to leaders of future intervention programmes.