Performance and self-perceived competencies of enrolled nurse/midwives: a mixed methods study from rural Tanzania.

BACKGROUND: Tanzania is experiencing a severe shortage of human resources for health, which poses a serious threat to the quality of health care services particularly in rural areas. Task shifting has been considered a way to address this problem. However, since a large percentage of health care providers in rural setting is comprised of Enrolled Nurse/Midwives (ENMs), most of the health care tasks are shifted to them. This article analyzes the performance and self-perceived competencies of ENMs at the dispensary level; the lowest health facility in Tanzania. Performance refers to routine duties performed by ENMs, and self-perceived competence means self-perceived proficiency in performing nursing/midwifery and medical duties. METHODS: This was a mixed methods study conducted in rural Tanzania. A purposeful sample of twelve (12) informants (six ENMs; two Community Leaders [CLs] and four Dispensary In-charges [DIs]) was recruited for semi-structured interviews. The interviews were supplemented with quantitative data from 59 ENMs. Both thematic and descriptive analysis approaches were used. RESULTS: Three themes emerged: (1) 'Approval of the performances of ENMs in meeting community health needs' underscores important services the community members got from ENMs at dispensaries. (2) 'Experienced difficulties of meeting community health needs' indicate the problems ENMs encountered while providing services to the community. In striving to serve a large number of demanding clients without adequate medical equipment and supplies, sometimes the ENMs ended up with prescription errors (3) 'Appreciating the performances and competencies of ENMs' shows the acknowledgement of community members towards ENMs' performance and competencies within and beyond their scope of practice. The community members as well as ENMs and their supervisors knew that ENMs must sometimes provide care that is outside their scope of training and competency. Overall, the performance among ENMs above 38 years of age (P < 0.05) and participants of professional development courses (P < 0.01) was high. CONCLUSIONS: The results highlight performance and self-perceived competencies of ENMs in struggling to meet community health needs. Additionally, these results highlight the health care system shortfalls in supporting and developing an adequate number of qualified health care professionals so that health care needs of all citizens, including those in rural areas, are met.

ENsCOPE: Scoping the Practice of Enrolled Nurses in an Australian Community Health Setting.

INTRODUCTION: A continuing shift of healthcare delivery from hospital to the community has increased the acuity and complexity of care provided in the home. Global financial crises and nursing shortages have prompted policies supporting two tiers of nursing and expansion of the licensed practical nurse, second level or enrolled nurse role and evoked debate surrounding roles traditionally undertaken by registered nurses. Community nursing offers unique challenges for enrolled nurses wanting to enact their full scope of practice. AIM: To compare and describe registered and enrolled nurse opinions of their current and potential enrolled nurse scope of practice in the community health setting. METHODS: A cross-sectional survey of 136 nurses (115 registered and 21 enrolled nurses) was undertaken within a large community nursing team in Australia. Participants reported their opinions of enrolled nurse scope of practice based on 27 core community nursing skills. RESULTS: Although substantial agreement was evident, there were statistically significant differences between registered nurse and enrolled nurse opinions in core skill areas; 'Patient Education' and 'Clinical Observation'. Registered nurses identified some specialized skills-catheter and gastrostomy care-that could be undertaken by enrolled nurses with further education. CONCLUSION: We confirm that registered nurses do agree with extending the skills of enrolled nurses. Education approaches that build shared confidence in enrolled nurse advanced skills are recommended. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The future supply of nurses is at risk. There are limited resources and increasing demand for quality health care where people live and work. While there may be opportunities internationally to improve productivity through advanced nursing roles, these policies should prioritize efficiency by firstly promoting the full enactment of nursing skills in these settings.

Exploring the transition experiences of students entering into preregistration nursing degree programs with previous professional nursing qualifications: an integrative review.

AIMS AND OBJECTIVES: This paper aims to investigate the transition experiences of students with previous nursing qualifications (nondegree qualifications) entering a nursing degree program. BACKGROUND: Nurses with professional nursing qualifications (nondegree) are an important pool of professionals to draw on to help address nursing shortages through providing alternative pathways to becoming registered nurses. However, research suggests this cohort need higher levels of support and intervention to be successful. DESIGN: An integrative review was conducted, guided by Whittemore and Knafl's framework. A comprehensive search was conducted and 14 studies were included in the review. METHODS: A five-stage approach was used to conduct the review: problem identification, literature search, data evaluation, data analysis and presentation of results. Constant comparative analysis was used to identify commonalities, differences and themes in the relevant literature. RESULTS: Themes emerged that suggested students struggled with academic and institutional challenges, becoming learners, managing conflicting demands of outside life, developing a student identity and experienced threat to their sense of professional identity. Additionally, the cohort did not view themselves as 'the same' as traditional students. Holland's framework provides a useful framework from which to conceptualise these students' experiences. CONCLUSION: There are challenges for this cohort of students as they transition into degree level study. Supportive activities that extend and further develop students' personality orientations may be a useful starting point in addressing some of the challenges and providing a more positive transition to university. RELEVANCE TO CLINICAL PRACTICE: The demand for health care is growing and there remains a shortfall of registered nurses. Nurses with professional qualifications (nondegree) are an important pool of professionals from which to increase registered nurse numbers and address workforce sustainability issues.

Nurses' and personal care assistants' role in improving the relocation of older people into nursing homes.

AIMS AND OBJECTIVES: This article presents findings from a study that explored nurses' and personal care assistants' role in improving the relocation of older people into a nursing home. BACKGROUND: Suggestions for improving the relocation process for older people moving into a nursing home have been the outcomes of studies that have interviewed residents and their families. However, the views of nurses and personal care assistants working in nursing homes have not been previously explored. DESIGN: An exploratory, descriptive qualitative research design. METHODS: Individual interviews were conducted with 20 care staff (seven registered nurses, five enrolled nurses and eight personal care assistants) employed at four nursing homes. FINDINGS: Using thematic analysis, two key themes were identified: 'What it's like for them' - highlighted staffs' awareness of the advantages, disadvantages and meaning of relocation, and focused on staffing and nursing care; other services provided and the environment. The second theme - 'We can make it better', revealed suggestions for improving the relocation process, and included spending time with new residents and the importance of a person-centred approach to care. CONCLUSION: Care staff have an important role in improving the relocation process of older people into a nursing home, as well as contributing to the discussion on this important clinical topic. RELEVANCE TO CLINICAL PRACTICE: Challenging care staff to acknowledge the importance of their role in helping older people settle into a nursing home is a key requirement of nursing practice in aged care. Nursing practice guidelines, with a focus on person-centred care, on how to manage the relocation process for an older person and their family are required for this aspect of nursing home care. Education of staff on relocation policies and procedures is essential to ensure that residents and their families are supported through this process.

Working effectively with consumers: Perspectives from students, teachers, nurses, and consumers.

Preparing enrolled nurses (ENs) to effectively work with mental health consumers is crucial to meeting Australia's healthcare demands. This qualitative study aimed to explore various stakeholders' perceptions regarding the mental health knowledge, skills, and attributes (KSAs) required by ENs to engage with individuals experiencing mental health issues, thus guiding future training priorities. The sample comprised 44 participants including 18 students, 3 graduate ENs, 5 experienced ENs, 5 registered nurses (RNs), 4 nurse unit managers (NUMs), 5 teachers, and 5 consumers of mental health services. Focus groups were used to collect data from the students, whilst individual interviews were conducted with all other participants. A thematic analysis revealed communication was the most vital skill for effectively working with mental health consumers. Skills such as critical thinking and clinical reasoning were also deemed crucial, given the volatile nature of the mental health inpatient environment, necessitating effective responses to acute escalations to prevent adverse outcomes for both staff and consumers. Essential knowledge components included understanding mental health disorders, symptoms, and treatments, particularly medications used for mental health issues. Participants also emphasised the importance of attributes like confidence and empathy in supporting and caring for consumers, who often experienced trauma and vulnerability. These findings provide valuable insights into the content that should be incorporated into the diploma of nursing (DN) training to produce competent graduate ENs.

Front line nurses' experiences with deteriorating ward patients: a qualitative study.

BACKGROUND: Nurses in the general ward are faced with patients who are at high risk of clinical deterioration. Having the key role in performing routine vital signs monitoring, non-registered nurses such as enrolled nurses are the front line nurses who play a pivotal role in detecting and responding to the deteriorating ward patient. AIMS: (1) To explore the experience of enrolled nurses with deteriorating patients in pre-cardiac arrest situations and (2) to identify strategies to enhance their role in caring for deteriorating ward patients. METHOD: A qualitative study using critical incident technique was conducted. Fifteen enrolled nurses who had encountered deteriorating ward patients were interviewed. Data were analysed using content analysis. FINDINGS: Three themes emerged describing enrolled nurse's experience with deteriorating patients: recognizing deterioration, responding to deterioration and taking responsibility. Two themes, including educational development and modifying clinical processes, were strategies identified to enhance the ability of enrolled nurses in recognizing and managing deteriorating patients. CONCLUSION: The study highlighted a need to enhance the ability of front line nurses in recognizing and responding to patient deterioration through nursing education and modifications of clinical processes. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing education could focus on increasing the awareness of the importance of performing complete vital signs monitoring and undertaking accurate interpretation of vital signs. Strategies to improve clinical processes could include the need for registered nurses to provide supervision of enrolled nurses in the interpretation of vital signs readings and share the responsibility of performing vital signs monitoring.

The Development and Implementation of a Model to Facilitate Self-Awareness of Professionalism for Enrolled Nurses.

Within the South African context, the nursing profession comprises different nursing cadres. The enrolled nurse is considered a sub-category of nursing and therefore does not carry the title of 'professional' as in a professional nurse. The purpose of the study was to develop, describe, implement, and evaluate a model for the facilitation of self-awareness for the professionalism of enrolled nurses at a specific nursing agency in Gauteng. A theory generating, qualitative, exploratory, descriptive and contextual design was used and was conducted following Chinn and Kramer's four stages of model development. The model can benefit nursing education because it relates to an essential aspect of growth and maturity in one's career. Ultimately, the facilitation of self-awareness for professionalism can advance one's career, or the lack of self-awareness may impede one's career. Developing, describing, implementing and evaluating this model to facilitate self-awareness for the professionalism of enrolled nurses at a specific nursing agency in Gauteng provides an original contribution to the theory in nursing professionalism and ethos. This model can be utilised as a tool to facilitate self-awareness for the professionalism of enrolled nurses at a nursing agency.

Factors affecting the provision of health service delivery in schools in Engela district, Ohangwena region, Namibia.

Background: While health services have been offered at various schools in Namibia since independence in 1990, coverage has been limited and there has been a notable decline in recent years. This reduction of services is of great concern, with questions being raised regarding what factors are affecting the provision of these services. Aim: To explore the factors affecting the provision of health services to schools in Engela district, Ohangwena region, Namibia. Settings: Semistructured interviews were conducted at a public health care facility situated in the northern part of Namibia. Methods: A qualitative, explorative, descriptive and contextual research design was utilised. Data were collected through semistructured interviews with 15 nurses from a health centre, of whom five were enrolled nurses and 10 were registered nurses. The data were then analysed thematically. Results: The study revealed three themes: participants' understanding of school health services; factors affecting the delivery of school health services; and corrective measures for improving the delivery of school health services. Conclusion: The notable decline in health service provision to various schools within the district suggests that there might be factors affecting the provision of school health services, posing a serious challenge to the active implementation of the School Health Programme. Contribution: These findings could be used to make adjustments to the provision of school health services and will also serve as an information baseline to elicit suggestions for future research related to school health services.

Adaptation and pretesting of the College Persistence Questionnaire V3 (Short Form) for measuring intention to persist among Aboriginal Diploma of Nursing students.

BACKGROUND: Culturally appropriate health care delivery is essential to improve health outcomes for Aboriginal peoples. There is a shortage of Aboriginal and Torres Strait Islander nurses partly due to disproportionately high non-completion rates among tertiary sector students. The College Persistence Questionnaire V3 (Short Form) provides scales for gauging major predictors of retention. OBJECTIVE: To adapt an instrument for measuring intention to persist among Aboriginal Diploma of Nursing students. DESIGN: Instrument adaptation and pretesting. PARTICIPANTS: A convenience sample of Aboriginal Diploma of Nursing students (N=21) at a registered training organisation in Australia. METHODS: The instrument was mapped against the domain of interest and modified. Ten experts reviewed its content validity; its reading ease and educational grade reading level were assessed. RESULTS: The expert panel endorsed individual items as valid (item-level Content Validity Index 0.90-1.00) and scale-level validation was acceptable (average scale-level Content Validity Index=0.98). The minimally-adapted instrument was 'fairly easy' to read and suitable for general adult audiences (Flesch Reading Ease score 71.3) and was below the United States 8th grade reading level (Flesch-Kincaid Grade Level 6.7). Students took <30min to complete the questionnaire. All understood its purpose, found instructions clear, and questions easy to answer. Most rated its length 'Just right'. CONCLUSION: The College Persistence Questionnaire - Registered Training Organisation Version appears suitable for assessing factors influencing retention/attrition among Aboriginal Diploma of Nursing students. Piloting and psychometric evaluation is recommended.

The relationship between resilience and empowering leader behaviour of nurse managers in the mining healthcare sector.

BACKGROUND:  The South African mining healthcare sector faces injuries, illnesses including HIV and AIDS and high staff turnover rates. In this sector, nurse managers should create an optimal environment for providing nursing care by motivating, influencing and empowering nurses. OBJECTIVES:  This study aimed to investigate the relationship between nurse managers' resilience and empowering leader behaviour in this sector. METHOD:  The study employed a quantitative, descriptive and correlational design. The research population comprised 31 nurse managers, 101 professional nurses, 79 enrolled nurses and 79 enrolled nursing auxiliaries who participated in the study. Two questionnaires were used as data collection methods, namely Wagnild and Young's Resilience Scale Questionnaire to investigate the resilience of nurse managers and the Empowering Leadership Questionnaire to measure empowering leader behaviour of the nurses supervised by a particular nurse manager. RESULTS:  Out of 31 nurse managers, 8 had a low level, 19 had a moderate level and 4 had a high level of resilience. According to Hoteling's t-test the nurse managers in the low resilience group displayed lower empowering leader behaviour as perceived by their team members than those in the high resilience group in terms of the five factors included in the Empowerment Leadership Questionnaire. CONCLUSION:  Respondents with high resilience scores tended to have higher leader empowering behaviour.Recommendations include the strengthening of nurse managers' resilience through workshops and reflection practices, debriefing and performance feedback sessions.