Nurse mentorship to improve the quality of health care delivery in rural Rwanda

Manzi, Anatole; Magge, Hema; Redditt, Vanessa; Karamaga, Adolphe; Niyonzima, Saleh; Drobac, Peter; Mukherjee, Joia S.; Ntaganira, Joseph; Nyirazinyoye, Laetitia; Hirschhorn, Lisa R.

doi:10.1016/j.outlook.2012.10.003

Cited by 87 publications

(126 citation statements)

References 13 publications

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“…The referral process also improved by focusing on the principle and routine practice of pre-referral treatment. A similar study in Rwanda reported that mentorship yields very good results in sustaining high-quality service provision when used in ANC by nurse mentors [11]. In our discussion, we provide a deeper reflection on the cascade model of mentorship used and how this could have influenced the positive changes that we have observed.…”

Section: Discussionmentioning

confidence: 77%

“…The model we used is centered on existing health-system structures and policies, which make it easier to integrate into district health systems [20]. In contrast, the Rwandan model recruited and trained mentors earlier by decentralising pre-service training, which they were able to influence and tailor to meet the mentorship requirements [11]. Using locally available staff, however, yields restricted teams, since health expertise in MNH is limited in the rural areas and may compromise the quality of mentorship [21, 22].…”

Section: Discussionmentioning

confidence: 99%

“…Different models have been used for clinical mentorship, ranging from field-based teams of mainly non-physician health workers, to highly skilled mentors (specialists in obstetrics/gynecology and pediatrics) and nurse mentors in India and Rwanda [4,11–13]. The basic principles are similar and include interaction between clinicians with knowledge and experience of working within the country’s health system and a lower-level cadre with limited supervision.…”

Section: Introductionmentioning

confidence: 99%

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A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Ajeani

Ayiasi

Tetui

et al. 2017

Global Health Action

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Background: There is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more results-oriented. Mentorship is one such approach that could bridge the clinical knowledge gap among health workers. Objectives: This paper describes the experiences of an attempt to improve health-worker performance in maternal and newborn health in three rural districts through a mentoring process using the cascade model. The paper further highlights achievements and lessons learnt during implementation of the cascade model. Methods: The cascade model started with initial training of health workers from three districts of Pallisa, Kibuku and Kamuli from where potential local mentors were selected for further training and mentorship by central mentors. These local mentors then went on to conduct mentorship visits supported by the external mentors. The mentorship process concentrated on partograph use, newborn resuscitation, prevention and management of Post-Partum Haemorrhage (PPH), including active management of third stage of labour, preeclampsia management and management of the sick newborn. Data for this paper was obtained from key informant interviews with district-level managers and local mentors. Results: Mentorship improved several aspects of health-care delivery, ranging from improved competencies and responsiveness to emergencies and health-worker professionalism. In addition, due to better district leadership for Maternal and Newborn Health (MNH), there were improved supplies/medicine availability, team work and innovative local problem-solving approaches. Health workers were ultimately empowered to perform better. Conclusions: The study demonstrated that it is possible to improve the competencies of frontline health workers through performance enhancement for MNH services using locally built capacity in clinical mentorship for Emergency Obstetric and Newborn Care (EmONC). The cascade mentoring process needed strong external mentorship support at the start to ensure improved capacity among local mentors to provide mentorship among local district staff.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Ajeani

Ayiasi

Tetui

et al. 2017

Global Health Action

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“…First, the MLNC requires supportive implementation and leadership by respected mentors to facilitate the acceptance of the checklist and lead to improved team work. In our districts, we were fortunate that in addition to engaged hospital staff and regular support by a pediatrician and registered dietitian, hospitals are supported by routine QI mentorship through previously described MESH mentors [21–23] who provide enhanced supervision of staff on clinical and systems improvement initiatives. Second, the MLNC is ideally initiated in the emergency room setting requiring coordination between pediatric and emergency room staff.…”

Section: Discussionmentioning

confidence: 99%

Experience: developing an inpatient malnutrition checklist for children 6 to 59 months to improve WHO protocol adherence and facilitate quality improvement in a low-resource setting

Beck¹,

Mukantaganda

Bayitondere

et al. 2018

Global Health Action

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In low-resource settings, inpatient case fatality for severe acute malnutrition (SAM) remains high despite evidenced-based protocols and resources to treat SAM. Key reasons include a combination of insufficiently trained staff, poor teamwork and inadequate compliance to WHO treatment guidelines which are proven to reduce mortality. Checklists have been used in surgery and obstetrics to ameliorate similarly complicated yet repetitive work processes and may be a key strategy to improving inpatient SAM protocol adherence and reducing unnecessary death. Here, we share our experience developing and piloting an inpatient malnutrition checklist (MLNC) for children 6 to 59 months and associated scoring system to coordinate care delivery, improve team documentation, strengthen WHO malnutrition protocol adherence and facilitate quality improvement in a district hospital in rural Rwanda. MLNC was developed after careful review of the 2009 Rwandan National Nutrition Protocol and 2013 WHO malnutrition guidelines. Critical steps were harmonized, extracted and designed into an initial MLNC with input from pediatric ward nurses, doctors, a locally based pediatrician and a registered dietitian. A scoring system was developed to facilitate quality improvement. Using the standard Plan-Do-Study-Act cycle, MLNC was modified and progress assessed on a monthly to bimonthly basis. Significant modifications occurred in the first 6 months of piloting including incorporation of treatment reminders and formatting improvements, as well as initiation of the MLNC from the emergency department. The MLNC is the first checklist to be developed that unifies WHO 10 steps of treatment of inpatient SAM with local standards. Anecdotally, MLNC was observed to identify gaps in key malnutrition care, promote protocol adherence and facilitate quality improvement. Data gathering on the MLNC local facility impact is underway. Collaborative international efforts are needed to create an inpatient malnutrition checklist for wider use to improve quality and reduce unnecessary, facility-based child mortality.

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“…As East African Countries look to collaborate and potentially unify nursing and midwifery education, practice, and legislation across nations, it is vital that nurses understand the impact of their leadership and mentorship in improving quality care throughout Rwanda (Leshabari, Nabirye, Mukamana, & Mill, 2015;Anatole et al, 2012). Based on the literature mentioned above, the nurse manager must take accountability for creating transformational environments of leadership that promote relationship-building, caring, innovation, and a holistic approach to patient care.…”

Section: The African Contextmentioning

confidence: 99%

The holistic leadership model and the nurse unit manager: assessing requisite leadership competencies in the Rwandan context

Tuyishime¹,

Rosa²

2017

RWJour

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Effective leadership is arguably one of the most relevant indicators of a profession's advancement or lack thereof. The purpose of this article is to share the authors' personal views on the leadership competencies necessary for the nurse unit manager transitioning into the role for the first time. To identify these leadership requisites, the literature was searched to identify key competencies and characteristics of effective nurse leaders across disciplines and specialties, both globally and unique to the African and Rwandan contexts. In the ever-changing healthcare scenario in Rwanda, the efforts and accomplishments of the Human Resources for Health (HRH) Program are described as just one catalyst for the increased numbers of new nurse unit managers. Through analysis of the literature in conjunction with personal experience, the authors recommend the Holistic Leadership Model rooted in an ethic of caring as a tool for new nurse unit managers to become effective leaders and agents of meaningful change.

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Nurse mentorship to improve the quality of health care delivery in rural Rwanda

Cited by 87 publications

References 13 publications

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Experience: developing an inpatient malnutrition checklist for children 6 to 59 months to improve WHO protocol adherence and facilitate quality improvement in a low-resource setting

The holistic leadership model and the nurse unit manager: assessing requisite leadership competencies in the Rwandan context

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