Najjuma Josephine Nambi, Bajunirwe Francis, Mbalinda Scovia Nalugo, Ssedyabane Frank, Mwebembezi Gerald, Moore Shirley, Kaddumukasa Mark, Atukunda Esther C
Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
College of Health Sciences, Makerere University, Kampala, Uganda.
Adv Med Educ Pract. 2025 Aug 4;16:1317-1329. doi: 10.2147/AMEP.S535086. eCollection 2025.
Simulation-based education (SBE) improves skills and knowledge among health professionals. Stroke nursing necessitates swift decision-making, elevated levels of clinical competence, and interdisciplinary collaboration. SBE improves these competencies but encounters implementation challenges. The objective of this study was to explore the barriers and facilitators of SBE implementation for stroke care for nurses at a referral hospital in Uganda.
From March to July 2024, a descriptive qualitative study was carried out at Mbarara Regional Referral Hospital and Mbarara University of Science and Technology using focus group discussions (FGDs), and key-informant interviews (KIIs). The FGDs were carried out with nursing students. The KIIs participants included purposively selected nurses, nurse educators, and other health care providers involved in stroke care and bedside teaching. The study was guided by the Consolidated Framework for Implementation Research (CFIR) and used deductive thematic analysis to identify barriers and facilitators for simulation-based stroke education (SBSE).
We conducted 4 FGDs, and 12 KIIs. The FGDs participants' mean age was 24 years and 36 years for other participants in KIIs. The barriers to SBSE included anticipated high cost for simulation methods, the anticipated high costs to translate lessons learned to real hospital setting, resistance to change from established routines. The high patient-to-nurse ratios and lack of stroke-specific structured training are also barriers. The facilitators included strong institutional administrative support for simulation methodology, availability of training facilities at the simulation center, and prior exposure to simulation methodologies.
Strong administrative support exists for SBSE. However, for successful implementation, there is a need to address the resource limitations, address anticipated resistance to change, and foster a culture of continuous learning and improvement within healthcare institutions. Future interventions should strategically address identified barriers while leveraging facilitators can enhance the success of SBSE stroke nursing care in resource-limited settings.
基于模拟的教育（SBE）可提高卫生专业人员的技能和知识水平。中风护理需要迅速做出决策、具备较高的临床能力水平以及跨学科协作。SBE可提升这些能力，但在实施过程中面临挑战。本研究的目的是探讨乌干达一家转诊医院中护士实施中风护理SBE的障碍和促进因素。
2024年3月至7月，在姆巴拉拉地区转诊医院和姆巴拉拉科学技术大学开展了一项描述性定性研究，采用焦点小组讨论（FGD）和关键信息提供者访谈（KII）。FGD是与护理专业学生进行的。KII的参与者包括经过有目的挑选的护士、护士教育工作者以及参与中风护理和床边教学的其他医疗保健提供者。该研究以实施研究综合框架（CFIR）为指导，并采用演绎主题分析来确定基于模拟的中风教育（SBSE）的障碍和促进因素。
我们进行了4次FGD和12次KII。FGD参与者的平均年龄为24岁，KII的其他参与者平均年龄为36岁。SBSE的障碍包括模拟方法预计成本高昂、将所学经验应用于实际医院环境的预计成本高昂、对既定常规的变革抵触。高患者与护士比例以及缺乏中风特定的结构化培训也是障碍。促进因素包括机构对模拟方法的强有力行政支持、模拟中心培训设施的可用性以及先前接触过模拟方法。
对SBSE存在强有力的行政支持。然而，为了成功实施，需要解决资源限制问题、应对预计的变革抵触，并在医疗机构内培育持续学习和改进的文化。未来的干预措施应从战略上解决已确定的障碍，同时利用促进因素，以提高资源有限环境中SBSE中风护理的成功率。
