“My hands are tied”: Nurses’ perception of organizational culture in Kenyan private hospitals

It is estimated that by 2030 the global shortage of nurses and midwives will be 7.6 million, with African countries among the most adversely affected. Within this context, it is important to understand the specific organizational factors that contribute to registered nurses (RNs)’ decisions to remain or leave their workplaces in East Africa. The aim of this study was to commence exploration of these factors by exploring nurses’ perceptions of organizational culture of selected private hospitals in Kenya. A small-scale exploratory qualitative approach was employed, with eight nurses undertaking semi-structured interviews. There were five female and three male nurses. All participants were RNs; two held a bachelor’s degree in nursing and the rest held diplomas in nursing. The thematic analysis revealed four major themes and nine sub-themes. The major themes included: restrictive work environment, top-down leadership, normalizing the abnormal in team dynamics and professionalism, and ethical concerns. These findings suggest an urgent need for Kenyan private hospital administrators to create a hospital work environment that provides more autonomy for nurses. There is a need for inclusive leadership styles that target hospital organizational structures and processes in order to address nursing workforce team dynamics. A merit-based salary and progressive reward systems are recommended to empower nurses to remain in the workforc

A Pilot Study Exploring Nursing Knowledge of Depression and Suicidal Ideation in Kenya

Nurses play key roles in recognizing, diagnosing, managing, and referring persons with mental disorders. This cross-sectional study assessed mental health literacy (depression and suicidal ideation) among nurses in a private urban referral hospital in Kenya. Nurses read a vignette and answered questions regarding diagnosis, treatment/interventions, and related attitudes and beliefs. Thirty-seven nurses (12 males) completed the questionnaire. Three correctly identified the diagnosis and 23 identified depression only. Although 75% noted the symptoms were extremely distressing, fear, and stigma were common reactions. This highlights challenges in mental health promotion/prevention in Kenya, and suggests continuous nursing education and curriculum enhancement is needed

Introduction of an Advanced Practice Nurse Program in Kenya: A New Era in Nursing Education

Purpose: The purpose of this presentation is to share the intra and interprofessional collaborative process of developing an Advanced Practice Nursing (APN) program to be offered in 2020 in Kenya, a low middle-income country. Methods: Engagement with stakeholders (students, clinicians, regulators and educators) affirmed the need for an APN program. Faculty from Schools of Nursing and Midwifery in three East African countries developed an APN curriculum with input from local and international agencies such as the Nursing Council of Kenya with linkages to the ICN, the Nursing Now Team and partner universities in the UK and USA. The curriculum was reviewed for relevance and cultural sensitivity. Christmals and Crous (2019) noted the importance of contextualizing the APN role to the specific country and healthcare systems. The development of collaborative frameworks between nursing and midwifery, and higher educational councils is important (Muraraneza, Mtshali, and Mukamana, 2017), therefore, feedback from the Council for Higher Education was sought and incorporated. The final document will be sent to external reviewers from partner universities prior to implementation in 2020. Limited resources and opposition from the medical profession have been reported as challenges to APN programs in Sub Saharan Africa (Christmals and Armstrong, 2019). To address these problems, the Liverpool John Moore University, UK, will host a six weeks’ capacity building program for East African faculty who will teach in this program. The program will be also offered in partnership with Family Medicine physicians and pharmacists and this will enhance interprofessional competencies (Monahan, Sparbel, Heinschel, Rugen, and Rosenberger, 2018). A workshop will be held in 2020 to share a common understanding of the program with all collaborative partners. The APN role is evolving globally and there is no consensus on the core competencies and its definition (Heale and Buckley, 2016). Kenya has no scope of practice for APN (East, Arudo, Loefler and Evans, 2014) and one will be developed. Results: An APN curriculum has been developed and is in the final stages of review prior to implementation in 2020. Anticipated challenges have been identified such as lack of resources among others, and strategies have been put in place to mitigate them. Conclusion: An APN program is pivotal to the realization of the Universal Health Coverage (UHC) as graduates of this program will be deployed in primary health care settings. The intra and interprofessional collaboration will strengthen both the program and partnerships (local and global) with mutual benefits for all involved

Reorienting Nurturing Care for Early Childhood Development during the COVID-19 Pandemic in Kenya: A Review

In Kenya, millions of children have limited access to nurturing care. With the Coronavirus disease 2019 (COVID-19) pandemic, it is anticipated that vulnerable children will bear the biggest brunt of the direct and indirect impacts of the pandemic. This review aimed to deepen understanding of the effects of COVID-19 on nurturing care from conception to four years of age, a period where the care of children is often delivered through caregivers or other informal platforms. The review has drawn upon the empirical evidence from previous pandemics and epidemics, and anecdotal and emerging evidence from the ongoing COVID-19 crisis. Multifactorial impacts fall into five key domains: direct health; health and nutrition systems; economic protection; social and child protection; and child development and early learning. The review proposes program and policy strategies to guide the reorientation of nurturing care, prevent the detrimental effects associated with deteriorating nurturing care environments, and support the optimal development of the youngest and most vulnerable children. These include the provision of cash transfers and essential supplies for vulnerable households and strengthening of community-based platforms for nurturing care. Further research on COVID-19 and the ability of children’s ecology to provide nurturing care is needed, as is further testing of new ideas

Guidelines for enhanced student support to part-time Bachelor of Science in nursing students in Kenya

There is evidence that a higher percentage of registered nurses’ workforce with a bachelor’s degree has been associated with better patient outcomes including lower hospital mortality. In this regard, the World Health Organization (WHO), in 2009 passed a resolution urging its member states to scale up nursing education to a bachelor’s level. In 2010, the Institute for Medicine recommended that 80% of the registered nurse workforce should be trained at the bachelor’s degree level by 2020. Registered nurses upgrading their qualifications enter university as mature and part-time students. Studies have shown that mature and part-time students in universities have higher attrition than their full-time peers. They are less likely to access extra support and personal development opportunities available at university, have a history of campus isolation and have fewer opportunities to engage on campus. The purpose of this study was to explore and describe the support needs of part-time Bachelor of Science students in Kenya to develop guidelines for enhanced student support. An exploratory descriptive qualitative design was used. In phase I, the researcher utilised focus group discussions to explore needs and perceived support with 100 part-time BScN students in the four Kenyan universities. In phase II, part-time Bachelor of Science in Nursing (BScN) support needs, and enablers and barriers to the provision of support to part-time BScN students, were explored through individual interviews of ten educators of part-time BScN students. Data were analysed using Tesch’s protocol of qualitative data analysis. Data were coded by two researchers who agreed on the final codes. Four themes emerged from phase I data: resource needs, psychological needs, curriculum redesign needs, and policy needs. Four themes emerged from phase II data: learning needs, resources need, adult students’ needs and psychosocial needs. The findings of the two phases were integrated to form five themes: support as resources provision, support for learning needs, support through curriculum review, support through policy formulation and need for psychosocial support. The findings of phases I and II informed the development of guidelines and their associated recommendations for implementation were developed and validated by experts. The guidelines propose evidence-based recommendations for universities offering part-time BScN programmes, nurse educators teaching part-time BScN students, university education regulators, and regulators of nursing education and practice.Health StudiesPh. D. (Nursing Science

Surviving Covid-19 Diagnosis Among Registered Nurses: Reactions, Consequences, and Coping Mechanisms

Background: To mitigate the spread of Covid-19, nurses infected with the virus were required to isolate themselves from their families and community. Isolated patients were reported to have experienced mental distress, posttraumatic stress disorder symptoms, and suicide. Though studies have reported the psychological impact of the Covid-19 pandemic, less is known about the lived experiences of nurses who survived Covid-19 infection in sub-Saharan Africa. Methods: A descriptive phenomenological approach was used to study the lived experiences of registered nurses who survived Covid-19 disease. In-depth interviews were conducted among nurses diagnosed with Covid-19 from two hospitals in Kenya between March and May, 2021. Purposive and snowball sampling were used to recruit registered nurses. Data were analyzed using Giorgi's steps of analysis. Results: The study included ten nurses between 29 and 45 years of age. Nurses' experiences encompassed three themes: diagnosis reaction, consequences, and coping. Reactions to the diagnosis included fear, anxiety, and sadness. The consequence of the diagnosis and isolation was stigma, isolation, and loneliness. Nurses coping mechanisms included acceptance, creating routines, support, and spirituality. Conclusion: Our findings aid in understanding how nurses experienced Covid-19 infection as patients and will provide evidence-based content for supporting nurses in future pandemics. Moreover, as we acknowledge the heroic contribution of frontline healthcare workers during the Covid-19 pandemic, it is prudent to recognize the considerable occupational risk as they balance their duty to care, and the risk of infection to themselves and their families