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.

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.

Assessing the impact of a partnership-based work/study nursing upgrade programme in a low- and middle-income setting.

AIMS AND OBJECTIVES: To evaluate the 15-year impact of the work/study nursing upgrading programme in East Africa. BACKGROUND: Working nurses in Africa are often primary family income earners, with limited ability to leave jobs and upgrade qualifications. In 2001, the university established a work/study upgrade programme for enrolled- and diploma-level nurses, allowing them to upgrade their qualifications while continuing to work and support families. Donor partnerships provided scholarships to further increase programme access. DESIGN: A mixed-method design was used involving an online alumni survey and 24 interviews and 23 focus groups with 172 purposively selected representatives of nursing graduates, employers, regulatory bodies, professional associations and senior nursing officials. METHOD: Quantitative data were analysed using frequencies and percentages. Inductive thematic analysis was used for qualitative data. Equator guidelines informed reporting of both qualitative and quantitative results. RESULTS: Of the 549 graduates who completed the survey, 81.2% (n = 446) were female, 93.1% were currently employed and 98% worked within East Africa. They reported improved professional competence (69.4%), nursing practice (25.9%) and patient outcomes (4.6%) on graduation. Extracted themes included the following: flexible/accessible programme; friendly learning environment; effective teaching and learning strategies; acquisition of nursing knowledge, skills and competencies; stakeholders' role in the programme; career/professional advancement; and strengthened health systems. CONCLUSION: The work/study programme was an effective nursing workforce capacity development strategy. Programme access was strengthened via the supporting donor partnership. Positive outcomes were achieved with respect to the university's values of quality, access, relevance and impact. RELEVANCE TO CLINICAL PRACTICE: Long-term sustainable development of nurses and midwives is fundamental to achieving sustainable development goals. Work/study programmes and private-public partnerships are effective mechanisms to strengthen the development of nursing and the overall healthcare workforce in low-resource settings.