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

Psychometric evaluation of PHQ–9 and GAD–7 among community health volunteers and nurses/midwives in Kenya following a nation-wide telephonic survey

Background: Nurses/midwives and Community Health Volunteers (CHVs) are exposed to chronic stressors putting them at risk of developing mental health problems. This has been exacerbated by the COVID-19 pandemic. There is limited empirical evidence of the burden of mental health problems among health care workers partly due to the lack of adequately standardized and validated measures for use among health care workers in Sub-Saharan Africa. This study aimed to perform the psychometric evaluation of the PHQ-9 and GAD-7 administered to nurses/midwives and CHVs across 47 counties in Kenya. Methods: Between June and November 2021, a national survey on mental well-being and resilience among nurses/midwives and CHVs was conducted via telephone interviews. The survey had a total sample size of 1907 nurses/midwives and 2027 CHVs. Cronbach’s alpha and MacDonalds’ omega were used to evaluate the scale’s internal consistency. Confirmatory Factor Analysis (CFA) was used to test the one-factor structure of the scales. Multi-group CFA was applied to evaluate the generalizability of the scales across the Swahili and English versions, and among male and female health workers. The Spearman correlation was used to assess the tools’ divergent and convergent validity. Results: The internal consistency of PHQ-9 and GAD-7 was good, with alpha and omega values above 0.7 across study samples. CFA results indicated a one-factor structure of the PHQ-9 and GAD-7 for both nurses/midwives and CHVs. Multi-group CFA showed that both scales were unidimensional across both language and sex. The PHQ-9 and GAD-7 were positively correlated with perceived stress, burnout, and post-traumatic stress disorder, indicating convergent validity. The PHQ-9 and GAD-7 were also significantly positively correlated with resilience and work engagement, supporting divergent validity. Conclusion: The PHQ-9 and GAD-7 are unidimensional, reliable, and valid tools for screening depression and anxiety among nurses/midwives and CHVs. The tools can be administered in a similar population or study setting using either Swahili or English

Scopes of practice for advanced practice nursing and advanced practice midwifery in Kenya: A gap analysis

Background: There is increasing global evidence on the impact of advanced nursing andmidwifery practitioners, and Kenya’s healthcare system has an excellent opportunity todevelop scopes of practice and other regulatory frameworks for the integration of theseroles. Objective: The primary purpose of this gap analysis was to explore the existing evidenceon opportunities and threats toward the integration of the advanced practice nursing(APN) and advanced practice midwifery (APM) roles in Kenya’s healthcare system. Methods: The study team conducted a structured electronic database search of PubMed,CINAHL, Scopus, EBSCOhost Academic Search Complete, and PsycINFO to retrievearticles and credible websites for reports highlighting the opportunities and threatstoward the integration of the APN and APM roles in Kenya’s healthcare systems. Theretrieved articles were screened for relevance and synthesized for reporting using thetraditional literature review approach. Results: The Kenya Health Policy Framework 2014–2030, growing population needs,and implementation of universal health coverage provide an opportunity to harness andleverage advanced practice roles in nursing and midwifery. There is also momentum todevelop advanced practice because of strategic alliances and global evidence showing thecontributions and quality of services offered by advanced practice nurses and advancedpractice midwives. However, lack of financial support, structural challenges, and lack ofnational policies, regulations, and legislation continue to obstruct progress. Conclusion and implications: for nursing policy:Developing scopes of practice forAPN and APM in Kenya will benefit the professions, the country’s healthcare deliverysystem, and the population. Achieving universal health coverage depends on a healthworkforce trained and practicing at optimal levels in tandem with education and trainingto deliver quality car

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

Scopes of practice for advanced practice nursing and advanced practice midwifery in Kenya:A gap analysis

BACKGROUND: There is increasing global evidence on the impact of advanced nursing and midwifery practitioners, and Kenya's healthcare system has an excellent opportunity to develop scopes of practice and other regulatory frameworks for the integration of these roles.OBJECTIVE: The primary purpose of this gap analysis was to explore the existing evidence on opportunities and threats toward the integration of the advanced practice nursing (APN) and advanced practice midwifery (APM) roles in Kenya's healthcare system.METHODS: The study team conducted a structured electronic database search of PubMed, CINAHL, Scopus, EBSCOhost Academic Search Complete, and PsycINFO to retrieve articles and credible websites for reports highlighting the opportunities and threats toward the integration of the APN and APM roles in Kenya's healthcare systems. The retrieved articles were screened for relevance and synthesized for reporting using the traditional literature review approach.RESULTS: The Kenya Health Policy Framework 2014-2030, growing population needs, and implementation of universal health coverage provide an opportunity to harness and leverage advanced practice roles in nursing and midwifery. There is also momentum to develop advanced practice because of strategic alliances and global evidence showing the contributions and quality of services offered by advanced practice nurses and advanced practice midwives. However, lack of financial support, structural challenges, and lack of national policies, regulations, and legislation continue to obstruct progress.CONCLUSION AND IMPLICATIONS FOR NURSING POLICY: Developing scopes of practice for APN and APM in Kenya will benefit the professions, the country's healthcare delivery system, and the population. Achieving universal health coverage depends on a health workforce trained and practicing at optimal levels in tandem with education and training to deliver quality care.</p

Women's economic empowerment and health related decision-making in rural Sierra Leone.

Maternal mortality rates during childbirth in Sierra Leone are amongst the highest globally, with 1360 maternal deaths per 100,000 live births. Furthermore, the country's neonatal mortality rate is estimated at 39 deaths per 1000 live births. There is growing recognition of the health consequences of gender inequality, but challenges in addressing it. Gendered power dynamics within households affect health outcomes, with men often controlling decisions about their family's health, including their family's use of health services. The Government's Free Health Care Initiative, which abolished user fees for pregnant women, lactating mothers and children under five is promising, however this reform alone is insufficient to meet health goals. Using in-depth interviews and focus group discussions with men and women, this study explores women's economic empowerment and health decision-making in rural Sierra Leone. Findings show the concept of power related to women's income generation, financial independence and being listened to in social relationships. Whilst women's economic empowerment was reported to ease marital tensions, men remained household authority figures, including regarding health decision-making. Economic interventions play an important role in supporting women's economic empowerment and in influencing gender norms, but men's roles and women's social empowerment, alongside economic empowerment, needs consideration

Nurse practitioner role in Kenya

Changes in demographics and epidemiology of diseases have increased the demand for quality health services in Kenya. Prevalent communicable diseases and a rapid increase in non-communicable diseases and injuries strain an already burdened health system. There is also a disproportionate and unequal distribution of healthcare workers. For instance, most clinical services are available in major cities while most of the population living in rural areas continues to have unequal access to care. Like most African countries, nurses have been practicing at advanced levels regardless of their defined role, formal graduate education, or license due to a lack of other qualified clinicians. To understand the development and current status of the nurse practitioner role in Kenya, this chapter reviews the historical context and influential drivers for the development of advanced practice nursing (APN), from the initiation of the master’s level, advanced practice nursing program to the launching of the Scope of Practice for Advanced Practice Nurse–Nurse Practitioner in 2022. This chapter highlights how advanced practice has steadily evolved in Kenya. Several influential factors have facilitated the development of the nurse practitioner role, including the need to meet the universal health coverage goal by 2030. Given the progress made, including implementing an international standard curriculum and formulating the scope of practice for nurse practitioners, the future of APNs in Kenya is promising. However, more needs to be done to institutionalize the role, including formalizing prescription authority and evaluating nurse practitioner educational programs and the effectiveness of the role in improving health outcomes

The role of transformational leadership on millennials’ dedication in level five private hospitals in Kenya

The primary intent of this study is to establish the role of transformational governance on millennials’ dedication to level - 5 private hospitals in Kenya. A mixed methods study was applied using a cross-sectional exploratory survey design with quantitative and qualitative approaches. The sample comprised millennials and their leaders working in level - 5 private hospitals. The sample size was 415 respondents. Five-level multi-stage cluster sampling and purposeful sampling were used. The study findings indicated that individualized consideration and intellectual stimulation influenced millennial dedication. This study has provided actionable insights into leading millennials to safeguard millennial engagement in Kenyan healthcare. Furthermore, to be dedicated, millennials require close monitoring and support. The millennials’ values differ from those of other generations, and they prefer challenges when they get bored with routine work. However, there are two categories of millennials; the older millennials are more responsible and resilient than the younger millennials, who are not dedicated

Duty versus distributive justice during the COVID-19 pandemic

The COVID-19 pandemic exposed vulnerabilities in inadequately prioritized healthcare systems in low- and middle-income countries such as Kenya. In this prolonged pandemic, nurses and midwives working at the frontline face multiple ethical problems, including their obligation to care for their patients and the risk for infection with severe acute respiratory syndrome coronavirus 2. Despite the frequency of emergencies in Africa, there is a paucity of literature on ethical issues during epidemics. Furthermore, nursing regulatory bodies in African countries such as Kenya have primarily adopted a Western code of ethics that may not reflect the realities of the healthcare systems and cultural context in which nurses and midwives care for patients. In this article, we discuss the tension between nurses’ and midwives’ duty of care and resource allocation in the context of the COVID-19 pandemic. There is an urgent need to clarify nurses’ and midwives’ rights and responsibilities, especially in the current political setting, limited resources, and ambiguous professional codes of ethics that guide their practice

Traditional Birth Attendant reorientation and Motherpacks incentive’s effect on health facility delivery uptake in Narok County, Kenya: An impact analysis

Abstract Background A community health programme in Narok County in Kenya aimed to improve skilled birth assistance during childbirth through two demand side interventions. First, traditional birth attendants (TBAs) were co-opted into using their influence to promote use of skilled birth attendants (SBAs) at health facilities during delivery, and to accompany pregnant women to health facilities in return for a Ksh500 (Approximately USD5 as of August 2016) cash incentive for each pregnant mother they accompanied. Secondly, a free Motherpack consisting of a range of baby care items was given to each mother after delivering at a health facility. This paper estimates the impact of these two interventions on trends of facility deliveries over a 36-month period here. Methods Dependency or inferred causality was estimated between reorientation of TBAs and provision of Motherpacks with changes in facility delivery numbers. The outcome variable consists of monthly facility delivery data from 28 health facilities starting from January 2013 to December 2015 obtained from the District Health Information Systems 2 (DHIS2). Data were collected on the 13th, 14th or 15th of each month, resulting in a total of 35 collections, over 35 months. The intervention data consisted of the starting month for each of the two interventions at each of the 28 facilities. A negative binomial generalized linear model framework is applied to model the relationship as all variables were measured as count data and were overdispersed. All analyses were conducted using R software. Findings During the 35 months considered, a total of 9095 health facility deliveries took place, a total of 408 TBAs were reached, and 2181 Motherpacks were distributed. The reorientation of TBAs was significant (p = 0.009), as was the provision of Motherpacks (p = .0001). The number of months that passed since the start of the intervention was also found to be significant (p = 0.033). The introduction of Motherpacks had the greatest effect on the outcome (0.2), followed by TBA intervention (0.15). Months since study start had a much lower effect (0.05). Conclusion Collaborating with TBAs and offering basic commodities important to mothers and babies (Motherpacks) immediately after delivery at health facilities, can improve the uptake of health facility delivery services in poor rural communities that maintain a strong bias for TBA assisted home delivery