Gundo Rodwell, Mearns Gael, Dickinson Annette, Chirwa Ellen
Auckland University of Technology, Auckland, New Zealand.
University of Malawi, Kamuzu College of Nursing, Lilongwe, Malawi.
Malawi Med J. 2019 Jun;31(2):138-143. doi: 10.4314/mmj.v31i2.6.
There are no critical care nurse training programs in Malawi despite the high burden of diseases which culminate in critical illness. This paper presents contextual issues that influence preparedness of nurses for critical care nursing practice in Malawi. The qualitative findings presented are part of a larger mixed methods study which explored learning needs of critical care nurses as a way of informing the development of a training program for the critical care nurses in Malawi.
Interpretive descriptive design was used. Data were gathered through 10 key informant interviews with nurse leaders (n=8) and anaesthetists (n=2); and two focus group discussions with registered nurses and nurse midwife technicians working in intensive care and adult high dependency units at two tertiary hospitals. Transcribed data were analyzed manually and through the use of NVivo data management software utilizing Thorne's steps of analysis1.
Being unprepared to work in intensive care and high dependency units was a dominant theme. Factors that contributed to this sense of unpreparedness were lack of educational preparation, organisational factors and workforce issues. The consequences of nurses' perceptions of being unprepared were fearfulness, a change of nurses' attitudes and elevation of risk to patients. The nurses managed unpreparedness by relying on other health professionals and learning on the job.
The findings illuminated contextual issues to be considered when developing programs for upskilling nurses in hospitals within Malawi and contributes to the developing body of knowledge related to nursing education and practice development within developing countries.
尽管马拉维疾病负担沉重，最终导致危重病情况频发，但该国却没有重症护理护士培训项目。本文介绍了影响马拉维护士为重症护理实践做好准备的背景问题。所呈现的定性研究结果是一项规模更大的混合方法研究的一部分，该研究探索了重症护理护士的学习需求，以此为制定马拉维重症护理护士培训项目提供信息。
采用解释性描述设计。通过对护士领导（n = 8）和麻醉师（n = 2）进行10次关键 informant访谈收集数据；并与在两家三级医院的重症监护病房和成人高依赖病房工作的注册护士和助产士技术员进行了两次焦点小组讨论。转录的数据通过手动方式以及使用NVivo数据管理软件，按照索恩的分析步骤进行分析。
对在重症监护病房和高依赖病房工作毫无准备是一个主要主题。导致这种毫无准备感的因素包括缺乏教育准备、组织因素和劳动力问题。护士认为自己毫无准备所带来的后果是恐惧、护士态度的改变以及患者风险的增加。护士们通过依赖其他卫生专业人员和在工作中学习来应对毫无准备的情况。
这些发现揭示了在为马拉维医院护士提升技能制定项目时需要考虑的背景问题，并为发展中国家与护理教育和实践发展相关的知识体系做出了贡献。
