Factors influencing implementation of simulation in nursing and midwifery training in Malawi.

Background: The study explored factors influencing implementation of simulation-based education (SBE) in nursing and midwifery education in Malawi. Aim: This study aimed to identify factors influencing nursing and midwifery educators in selected training institutions and clinical sites. Setting: The study covered one district and four central hospitals, five professional training institutions, Ministry of Health and Nurses and Midwives Council of Malawi officials. Methods: Using mixed-methods approach, quantitative data were gathered from 293 participants, including 149 final-year nursing and midwifery students, and 144 clinical instructors. Qualitative data were obtained from 24 faculty members, 11 clinical instructors and two key informants. Researchers conducted 37 in-depth interviews, 10 focus group discussions and eight desk reviews. Descriptive statistics were used to analyse the quantitative data, while content analysis was used for qualitative findings. Results: Five themes emerged from qualitative data: absence of simulation in regulatory body syllabi, insufficient formal training, demand for knowledgeable clinical instructors, inadequate human and material resources, and resistance to change. Survey results indicated that 83% of the participants had theoretical SBE knowledge but lacked practical skills, with only 13% considering SBE as a current teaching method. Educators emphasised lack of infrastructure, skills laboratories, teaching hospitals, equipment, and a deficit in formal training as critical barriers to SBE implementation. Conclusion: The study concluded that skilled educators, appropriate infrastructure and resources could facilitate SBE implementation in Malawi. Contribution: Recommendations included regulatory body support, formal training for educators, utilisation of low-fidelity simulators, and establishment of SBE centres and corners in health facilities.

Patient's experiences of diabetes care at a tertiary health facility in Lilongwe, Malawi.

BACKGROUND: Little is known about experiences of rural people with diabetes care at a tertiary health facility in low-income settings. Understanding their experiences is essential for developing effective diabetes care interventions. METHODS: The study employed a qualitative narrative inquiry. Participants were identified at a diabetes clinic at a tertiary-level healthcare facility. Ten participants from the rural areas attending the diabetes clinic were purposively selected. Data were collected through in-depth interviews in the privacy of the homes of the study participants and analysis was done using the Riessman approach to thematic narrative analysis. RESULTS: In this study, the following four themes emerged: (1) the long pathway to a diagnosis of diabetes; (2) Poverty-related hardships and diabetic clinic attendance; (3) The impact of health worker attitudes and behavior on diabetes care; and (4) Low resources and their impact on self-management. CONCLUSIONS: Rural-based patients living with diabetes encounter enormous challenges as they access diabetes care. One of the challenges is delayed diagnosis of diabetes. There is a need to introduce point-of-care (POC) testing to improve diabetes diagnosis. In addition, there is a need to strengthen awareness campaigns among the population so that people are well informed about the signs and symptoms of diabetes to promote early diagnosis. Diabetes care must be decentralized from tertiary hospitals to primary health centers. This will improve access to diabetes care and reduce the burden associated with traveling a long distance to access diabetes care in Malawi.

Predictors of Students' Performance in Nursing and Midwifery Technician Licensure Examination in Southern Malawi.

Introduction: Success in the nursing and midwifery licensure examination is the only legal prerequisite to practice as a nurse and midwife in Malawi. However, the past decade has registered poor performance of students in Nursing and Midwifery Technician (NMT) licensure examinations for candidates who failed on the first attempt. The study sought to unravel whether students' socio-demographic and academic characteristics could predict NMT licensure examination performance on the first attempt. Methods: We conducted a quantitative ex post facto using stratified random sampling. We reviewed 280 former NMT licensure exam candidate records from 2013 to 2017 with a study population of 2,668 NMTs. We reported descriptive statistics and used Chi-square / Fisher's exact test and logistic regression to determine the significance of associations and predictors respectively. Results: We found that the NMT licensure examination could be predicted by students' academic characteristics, especially entry Malawi School Certificate of Education (MSCE) point scores [p < 0.001, OR 0.830, 95% CI (0.771-0.892)], and exit college final scores [p < 0.001, OR 1.214, 95% CI (1.131-1.303)]. We established that students' socio-demographic characteristics like age [χ2 (2, N =280) =13.143, p < 0.001], and marital status [χ2 (1, N = 280) = 5.645, p = 0.018] were significantly associated with NMT licensure examination performance but were not predictors of NMT licensure examination outcome. Furthermore, we did not find any association between NMT licensure examination performance and the sex of the students [χ2 (1, N = 280) = 0.523, p = 0.470]. Conclusion: NMT licensure examinations performance predictors are academic variables like entry MSCE and exit college final scores. Consequently, teaching institutions should frame relevant admission criteria, and timely support the students at risk of failure in licensure exams.

Exploring perceived barriers to effective utilization of learner-centred teaching methods by tutors at Holy Family College of Nursing and Midwifery, Phalombe, Malawi.

Introduction: Learner-centred teaching implies a paradigmatic shift in roles of a teacher from being a source of knowledge to that of a facilitator in the process of knowledge construction. Literature shows that perceptions which teachers hold about barriers to utilisation of learner-centred teaching methods influence how the teachers teach. Anecdotal records as well as observation of classroom teaching demonstrate that tutors at Holy Family College of Nursing and Midwifery dominantly use traditional teacher-centred teaching methods. Research Design and Methods: This was a qualitative study based on the philosophical principle of constructivism. Study population and sample: All tutors at Holy Family College of Nursing and Midwifery were the study population. Purposive sampling technique was used to select participants. In-depth interviews with 12 tutors were held using a semi-structured interview guide. Data analysis: Data were analysed using the 6-step thematic method. Findings: The participants suggested that effective utilization of learner-centred teaching methods is negatively affected by teacher-related as well as technical barriers. Conclusion: Teachers clinging to power and need for more resources negatively affect utilisation of learner-centred teaching methods.

'This disease would suit better those who have money': Insulin-Treated Diabetes Illness Experience in rural Malawi.

Background: Understanding the illness experience among rural-based insulin-treated diabetic patients has implications for practice and policy. However, there is a lack of in-depth knowledge about insulin-treated diabetic patients' illness experiences in rural Malawi. We explored the experiences of people living with insulin-treated diabetes in rural Malawi. Research Designs and Methods: The study used a qualitative narrative inquiry. Participants were identified at Kamuzu Central Hospital Diabetes Clinic. The hospital is a tertiary level health care facility. We purposively selected 10 participants from rural areas attending the clinic. Data were collected through in-depth interviews in the privacy of the homes of the study participants and analysis was done using Riessman approach of thematic narrative analysis. Results: The following five themes emerged: (1) diabetes perceived as the illness for the rich; (2) 'everything is on a standstill'; (3) dietary challenges of the diabetes illness experience; (4) drug-related challenges associated with the diabetes illness experience and (5) experiencing physical effects of the diabetes illness. Conclusion: Rural-based insulin-treated diabetic patients struggled to live with the illness in the context of low resources. There is a need for multi-factorial approaches at both the community and system levels so as to support people living with diabetes in the rural areas in order to improve their experiences.

Effect of a formative assessment intervention on nursing skills laboratory learning in a resource-constrained country.

BACKGROUND: Following a global trend, nursing education institutions in Malawi adopted the skills laboratory approach for the teaching and learning of essential nursing skills in the bachelor degree in nursing. Students and faculty expressed concern about the lack of regular and planned formative assessments that build the competencies required in the middle and senior years of study. PURPOSE: The aim was to investigate the effect of a Formative Assessment Framework (FAF) on students learning in skills laboratories. METHODS: A sequential, mixed methods design was chosen, starting with qualitative approach followed by a quantitative approach using a quasi-experimental design. Formative Assessment Framework (FAF) was developed after phase 1, validated and tested on the teaching of eight nursing procedures in phase 2. Quantitative data were collected from students (n = 160) for 6 weeks. Data were analysed using STATA software packages. RESULTS: Significant mean differences occurred between the pretest and posttest mean scores for seven procedures with a p-value of <0.05. CONCLUSION: The use of a Formative Assessment Framework had a significant effect on clinical teaching and learning. The findings indicate that the FAF has the capacity to improve the students' clinical preparation for competencies in the OSCE, which takes place in the skills laboratories.