Advanced Practice Nursing

Cummings, Greta G.; McLennan, Marianne

doi:10.1097/00005110-200502000-00003

Cited by 20 publications

(2 citation statements)

References 4 publications

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“…As Daire et al [ 63 ] pointed out, there is an abundance of training that focuses on the cognitive aspects of leadership rather than on the action component. If nurses in LMICs are to play a more substantial role in reorienting HIV care strategies and workplace conditions to be more evidence-informed, this requires action-based leadership: nurses’ engagement in and capacity to lead, implement and sustain HIV care improvements [ 69 – 71 ]. This study focused on strengthening the leadership and policy engagement capacity of nurses to address gaps in HIV care and workplace policies in all health facilities in their health districts.…”

Section: Introductionmentioning

confidence: 99%

The impact of leadership hubs on the uptake of evidence-informed nursing practices and workplace policies for HIV care: a quasi-experimental study in Jamaica, Kenya, Uganda and South Africa

et al. 2015

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BackgroundThe enormous impact of HIV on communities and health services in Sub-Saharan Africa and the Caribbean has especially affected nurses, who comprise the largest proportion of the health workforce in low- and middle-income countries (LMICs). Strengthening action-based leadership for and by nurses is a means to improve the uptake of evidence-informed practices for HIV care.MethodsA prospective quasi-experimental study in Jamaica, Kenya, Uganda and South Africa examined the impact of establishing multi-stakeholder leadership hubs on evidence-informed HIV care practices. Hub members were engaged through a participatory action research (PAR) approach. Three intervention districts were purposefully selected in each country, and three control districts were chosen in Jamaica, Kenya and Uganda. WHO level 3, 4 and 5 health care institutions and their employed nurses were randomly sampled. Self-administered, validated instruments measured clinical practices (reports of self and peers), quality assurance, work place policies and stigma at baseline and follow-up. Standardised average scores ranging from 0 to 1 were computed for clinical practices, quality assurance and work place policies. Stigma scores were summarised as 0 (no reports) versus 1 (one or more reports). Pre-post differences in outcomes between intervention and control groups were compared using the Mantel Haenszel chi-square for dichotomised stigma scores, and independent t tests for other measures. For South Africa, which had no control group, pre-post differences were compared using a Pearson chi-square and independent t test. Multivariate analysis was completed for Jamaica and Kenya. Hub members in all countries self-assessed changes in their capacity at follow-up; these were examined using a paired t test.ResultsResponse rates among health care institutions were 90.2 and 80.4 % at baseline and follow-up, respectively. Results were mixed. There were small but statistically significant pre-post, intervention versus control district improvements in workplace policies and quality assurance in Jamaica, but these were primarily due to a decline in scores in the control group. There were modest improvements in clinical practices, workplace policies and quality assurance in South Africa (pre-post) (clinical practices of self—pre 0.67 (95 % CI, 0.62, 0.72) versus post 0.78 (95 % CI, 0.73–0.82), p = 0.002; workplace policies—pre 0.82 (95 % CI, 0.70, 0.85) versus post 0.87 (95 % CI, 0.84, 0.90), p = 0.001; quality assurance—pre 0.72 (95 % CI, 0.67, 0.77) versus post 0.84 (95 % CI, 0.80, 0.88)). There were statistically significant improvements in scores for nurses stigmatising patients (Jamaica reports of not stigmatising—pre-post intervention 33.9 versus 62.4 %, pre-post control 54.7 versus 64.4 %, p = 0.002—and Kenya pre-post intervention 35 versus 51.6 %, pre-post control 34.2 versus 47.8 %, p = 0.006) and for nurses being stigmatised (Kenya reports of no stigmatisation—pre-post intervention 23 versus 37.3 %, pre-post control 15.4 versus 27 %, p = 0.004). ...

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Section: Introductionmentioning

confidence: 99%

The impact of leadership hubs on the uptake of evidence-informed nursing practices and workplace policies for HIV care: a quasi-experimental study in Jamaica, Kenya, Uganda and South Africa

et al. 2015

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show abstract

“…The challenge for nurse leaders is to build inspiring organizations and to take the responsibility for creating a caring culture seriously (Bunkers 2009). Key aspects of nursing leadership are the ability to adapt to a changing environment, facilitate organizational change in the workplace and awareness of the obligation to constantly improve quality of care despite financial restraints (Cummings & McLennan 2005). This implies demands, especially on nurse leaders, who must continuously contend with the changes necessary for organizational survival, while simultaneously dealing with the strain and struggle involved in any organizational change (Crow 2006, Rudolfsson et al.…”

Section: Introductionmentioning

confidence: 99%