Shakpeh John K, Tiah Mary W, Kpangbala-Flomo Cecelia C, Matte Rita Florence, Lake Sodey C, Altman Susan D, Tringali Tanya, Stalonas Kerry, Goldsamt Lloyd, Zogbaum Lily, Klar Robin Toft
Redemption Hospital, Ministry of Health, Republic of Liberia, LR.
Liberian Board for Nursing and Midwifery, LR.
Ann Glob Health. 2021 Oct 8;87(1):99. doi: 10.5334/aogh.3247. eCollection 2021.
The Republic of Liberia has experienced many barriers to maintaining the quality of its healthcare workforce. The Resilient and Responsive Health Systems (RRHS) Initiative supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) has responded to Liberian identified health priorities. Liberia's maternal morbidity and mortality rates continue to rank among the highest in the world. Recent country regulations have put forth required continuing professional development (CPD) for all licensed healthcare workers for re-licensure.
The Model for Improvement was the guiding framework for this CPD to improve midwifery and nursing competencies in assisting birthing women. Two novel activities were used in the CPD. We tested the formal CPD application and approval process as this is a recent regulatory body policy. We also included the use of simulation and its processes as a pedagogical method. Over a two-year period, we developed a two-day CPD module, using didactic training and clinical simulation, for Liberian midwives. We then piloted the module in Liberia, training a group of 21 participants, including midwives and nurses, including pre- and post-test surveys as well as observational evaluation of participant skills.
There were no significant changes in knowledge acquisition noted in the post-test. Small tests of change were implemented during the program, supporting the stages of the Model of Improvement. Observation of skill acquisition was done; however, using a formal observation checklist, such as an Observed Structured Clinical Evaluation (OSCE), would add more robust findings. The CPD and follow-up activity highlighted the need for human and financial support to maintain the simulation kits and to create sustainability for future trainings. Videotaping the didactic and simulation two-day continuing professional development train-the-trainer workshop expands the sustainability beyond newly prepared trainers. Simultaneous with this CPD, the Liberian Board for Nursing and Midwifery (LBNM) worked with a partner to create a CPD portal. The CPD partners created modules from the videos and have uploaded these modules to the LBNM's new CPD portal.
Using a quality improvement model as a framework for developing and implementing CPDs provides a clear structure and supports the dynamic interactions in learning and clinical care. It is too soon to determine measurable health outcomes resulting from this project. Anecdotal feedback from clinicians and leaders was not directly related to the content of the CPD; however, it does demonstrate an increased awareness of examining changes in practice to support expanded health outcomes. Further research to examine methods and processes to determine the quality and safety outcomes of CPD trainings is necessary.
利比里亚共和国在维持其医疗保健人员素质方面面临诸多障碍。由美国总统艾滋病紧急救援计划（PEPFAR）支持的弹性和响应式卫生系统（RRHS）倡议回应了利比里亚确定的卫生优先事项。利比里亚的孕产妇发病率和死亡率仍位居世界前列。该国近期的法规规定，所有持牌医疗保健人员必须进行持续专业发展（CPD）以重新获得执照。
改进模型是此次CPD的指导框架，旨在提高助产士和护士协助分娩妇女的能力。CPD中采用了两项新活动。我们测试了正式的CPD申请和审批流程，因为这是监管机构最近的一项政策。我们还将模拟及其流程作为一种教学方法。在两年时间里，我们为利比里亚助产士开发了一个为期两天的CPD模块，采用了讲授式培训和临床模拟。然后我们在利比里亚对该模块进行了试点，培训了包括助产士和护士在内的21名参与者，包括进行前后测试以及对参与者技能的观察评估。
测试后知识获取方面没有显著变化。在项目期间进行了小范围的变革测试，以支持改进模型的各个阶段。对技能获取进行了观察；然而，使用正式的观察清单，如观察性结构化临床评估（OSCE），会得出更有力的结果。CPD及后续活动凸显了在维护模拟工具包以及为未来培训创造可持续性方面对人力和资金支持的需求。对为期两天的讲授式和模拟式持续专业发展培训师培训工作坊进行录像，可将可持续性扩展到新培训的培训师之外。与此同时，利比里亚护理和助产委员会（LBNM）与一个合作伙伴合作创建了一个CPD门户网站。CPD合作伙伴根据视频创建了模块，并将这些模块上传到了LBNM的新CPD门户网站。
使用质量改进模型作为开发和实施CPD的框架提供了清晰的结构，并支持学习和临床护理中的动态互动。现在确定该项目产生的可衡量的健康结果还为时过早。临床医生和领导者的轶事反馈与CPD的内容没有直接关系；然而，这确实表明人们对检查实践中的变化以支持扩大健康结果的认识有所提高。有必要进行进一步研究，以检查确定CPD培训质量和安全结果的方法和流程。
