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

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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.