High maternal and newborn mortality rates remain a global health issue. Ninety-nine percent of maternal deaths occur in low and middle income countries and many could be prevented by having more qualified health providers. In 2013, 62% of maternal deaths took place in Sub-Saharan Africa. The Advanced Life Support in Obstetrics (ALSO R ) Educational Program is an internationally recognized continuous professional development course aimed at increasing the knowledge, skills, competence, and confidence of health professionals to manage obstetric emergencies. The purpose of this qualitative descriptive study was to explore midwives' experiences of translating the knowledge and skills acquired from participating in the ALSO R program into their professional practice in Rwanda. A purposive sample of nine midwives participated in one-to-one interviews directed at understanding their experience of implementing their new knowledge and skills into practice. All interviews were audio-recorded and transcribed verbatim. Content analysis was used to illuminate five themes: 1) Improved midwifery practice, 2) Availability of resources, 3) Inter-professional collaboration, 4) Job (dis)satisfaction, and 5) Autonomy for midwifery practice. The findings revealed that although midwives reported increased knowledge, skills and confidence in management of obstetric emergencies, their ability to change practice was often hampered by non-conducive work environments, a shortage of health care providers, and insufficient equipment and materials. These findings can serve to inform ALSO R course module development, midwifery education development, and health human resources policy that can address obstetrical and newborn education needs and health service delivery in Rwanda.
Clinical supervision is described as a formal process of professional learning support in the clinical practice. The goal of clinical practice is to prepare nursing students develop and apply the necessary theoretical and empirical knowledge and skills in order for them to practice as safely and effectively as professional nurses. Accordingly, the clinical environment is vital to the nursing education for the achievement of clinical learning outcomes, including enhancement of the students' competence. It is conceded that professionalism even among student nurses can increase the clients' acceptance and trust and thus provides more opportunities for students to practice such activities as history taking, physical examination, nursing procedures, and communication with the clients. This paper describes the views of the authors who have served as student nurse supervisors, as pertains to clinical supervisory challenges and possible models for enhancement of support for student nurses in Rwanda.
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