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

尽管指导方针旨在帮助结构复杂的质量改进干预措施，仍然有有限的了解关键工作人员的作用，他们如何执行和任何影响的权力和社会地位，他们在医疗保健环境。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进行分类，报告实施过程并描述干预措施的背景。然而，知识和住宿的基本社会动力，其中包括地区医院作为一个机构的基本结构（包括权力和影响力的轨迹和执行）和关键角色，如高级护士缺乏深度，随后缺乏理论发展。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元和其中的个人，包括纽带、资本和权力，特别关注高级护士的角色，2）从社交网络和社会运动的角度建立导致低质量新生儿护理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。这个项目将使用现实主义的方法来构建科学探究。社交网络和社会运动理论将被用作理论框架。方法将包括一个系统的审查，社交网络分析，并与个人的网络位置的兴趣，特别是重点对高级护士作为潜在的关键实现新生儿护理单位（病房）的变化定性访谈。丰富的理论的发展将被用来产生有关的地方和功能的社交网络干预措施，以提高新生儿护理质量在地区医院设置，包括如何操纵的背景下可能会支持基层行动/集体行动，以改善新生儿患者的护理建议。调查结果将提供上下文敏感和实用的指导，未来的干预方案的领导人。

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.