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医疗服务提供者参与一项临床指导干预措施以改善坦桑尼亚姆万扎地区生殖、孕产妇和新生儿护理的经历。

Healthcare Providers' Experiences With a Clinical Mentorship Intervention to Improve Reproductive, Maternal and Newborn Care in Mwanza, Tanzania.

作者信息

Isangula Kahabi, Mbekenga Columba, Mwansisya Tumbwene, Mwasha Loveluck, Kisaka Lucy, Selestine Edna, Siso David, Rutachunzibwa Thomas, Mrema Secilia, Pallangyo Eunice

机构信息

School of Nursing and Midwifery, Aga Khan University, Dar es Salaam, Tanzania.

Aga Khan Health Services, Mwanza, Tanzania.

出版信息

Front Health Serv. 2022 May 6;2:792909. doi: 10.3389/frhs.2022.792909. eCollection 2022.

Abstract

INTRODUCTION

There is increasing evidence suggesting that clinical mentorship (CM) involving on-the-job training is one of the critical resources-friendly entry points for strengthening the knowledge and skills of healthcare providers (HCPs), which in turn facilitate the delivery of effective reproductive, maternal, and newborn health (RMNH) care. The article explores the experiences of HCPs following participation in the CM program for RMNH in eight districts of Mwanza Region in Tanzania.

MATERIALS AND METHODS

A qualitative descriptive design employing data from midterm project review meetings and Key Informant Interviews (KIIs) with purposefully selected HCPs (mentors and mentees) and District Medical Officers (DMOs) during endline evaluation were employed. Interview data were managed using Nvivo Software and analyzed thematically.

RESULTS

A total of 42 clinical mentors and master mentors responded to a questionnaire during the midterm review meeting. Then, a total of 17 KIIs were conducted with Mentees (8), Mentors (5), and DMOs (4) during endline evaluation. Five key themes emerged from participants' accounts: (i) the topics covered during CM visits; (ii) the benefits of CM; (iii) the challenges of CM; (iv) the drivers of CM sustainability; and (iv) suggestions for CM improvement. The topics of CM covered during visits included antenatal care, neonatal resuscitation, pregnancy monitoring, management of delivery complications, and infection control and prevention. The benefits of CM included increased knowledge, skills, confidence, and change in HCP's attitude and increased client service uptake, quality, and efficiency. The challenges of CM included inadequate equipment for learning and practice, the limited financial incentive to mentees, shortage of staff and time constraints, and weaker support from management. The drivers of CM sustainability included the willingness of mentees to continue with clinical practice, ongoing peer-to-peer mentorship, and integration of the mentorship program into district health plans. Finally, the suggestions for CM improvement included refresher training for mentors, engagement of more senior mentors, and extending mentorship beyond IMPACT catchment facilities.

CONCLUSION

CM program appears to be a promising entry point to improving competence among HCPs and the quality and efficiency of RMNH services potentially contributing to the reduction of maternal and neonatal deaths. Addressing the challenges cited by participants, particularly the equipment for peer learning and practice, may increase the success of the CM program.

摘要

引言

越来越多的证据表明,涉及在职培训的临床指导(CM)是增强医疗服务提供者(HCPs)知识和技能的关键资源友好型切入点之一,这反过来又有助于提供有效的生殖、孕产妇和新生儿健康(RMNH)护理。本文探讨了坦桑尼亚姆万扎地区八个区的HCPs参与RMNH临床指导项目后的经历。

材料与方法

采用定性描述性设计,利用中期项目审查会议的数据以及在终期评估期间与有目的地挑选的HCPs(指导者和被指导者)及地区医务主任(DMOs)进行的关键信息提供者访谈(KIIs)的数据。访谈数据使用Nvivo软件进行管理并进行主题分析。

结果

在中期审查会议期间,共有42名临床指导者和高级指导者回复了问卷。然后,在终期评估期间,共对8名被指导者、5名指导者和4名DMOs进行了17次KIIs。参与者的叙述中出现了五个关键主题:(i)临床指导访问期间涵盖的主题;(ii)临床指导的益处;(iii)临床指导的挑战;(iv)临床指导可持续性的驱动因素;(v)临床指导改进的建议。访问期间临床指导涵盖的主题包括产前护理、新生儿复苏、孕期监测、分娩并发症管理以及感染控制与预防。临床指导的益处包括知识增加、技能提升、信心增强、HCPs态度转变以及客户服务接受度、质量和效率提高。临床指导的挑战包括学习和实践设备不足、对被指导者的经济激励有限、人员短缺和时间限制以及管理层支持较弱。临床指导可持续性的驱动因素包括被指导者继续临床实践的意愿、持续的 peer-to-peer 指导以及将指导项目纳入地区卫生计划。最后,临床指导改进的建议包括为指导者提供进修培训、聘请更多资深指导者以及将指导范围扩大到IMPACT服务区域设施之外。

结论

临床指导项目似乎是提高HCPs能力以及RMNH服务质量和效率的一个有前景的切入点,可能有助于降低孕产妇和新生儿死亡率。解决参与者提到的挑战,特别是同伴学习和实践的设备问题,可能会提高临床指导项目的成功率。

需注意,原文中“peer-to-peer mentorship”直译为“同伴对同伴指导”,在医学领域可能有更专业贴切的中文术语,但因未明确要求意译,所以保留原文表述。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4d20/10012706/572edff00bbd/frhs-02-792909-g0001.jpg

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