Sharon Brownie: Nursing Research in a Global Context
Nurses are the largest part of the health care workforce an millions more will be needed in LMIC if high quality care is to be available to everyone. Research that addresses the consequences of the shortage of nurses but also helps generate ideas on solutions is important and should be conducted in partnership with the nursing profession.
First I am a registered nurse and a midwife, and I have built on that basic foundation over the years. I now lead three schools of nursing across East Africa: one in Nairobi, one in Kampala and one in Dar es Salaam, so that is Tanzania, Uganda and Kenya. We specialise in providing upgrade programmes for working nurses, from enrolled nurse to diploma, and diploma to bachelor nursing or bachelor midwifery.
Globally, the health workforce is challenged by insufficient numbers and inequitable distribution of the workforce. Currently almost a billion people do not have access to affordable health care. Most of that is due to health workforce shortage and health workforce maldistribution. That is exacerbated in East Africa, and in Kenya in particular where there is a significantly lower percentage of nurses per thousand population than what is recommended. The challenge of how that relates within health care centres and in-patient units like the neonatal units: there is simply insufficient hands able to provide the quality and level of care. Sometimes nurses are looking up to 10, 12, or 15 babies each alone; there is insufficient resource to provide the care that is needed.
This recent large-scale research project has been important and welcomed. It is important from the point of view that Kenya still has statistics that show that far too many newborns die and do not reach their first month alive, or their first five years of life. This research is important because it really helped to focus on what the issues are. What is the quality of care? What care is provided? What care is missed? What resources might be needed? The reason that this is unique is that it didn't rush to a suggested or recommended solution. First of all the research has been done to understand what the issues are and where the gaps are. That can help build solutions in the future.
The most important things for improving nursing relates to several well-known documented pillars of nursing. There needs to be right enabling legislation; there needs to be legislation that allows, under the Nurses Act, for advanced and specialty practice. Another pillar is that there needs to be sufficient resources so there is sufficient numbers of nurses. The third pillar is there needs to be access to education and the right programmes for nurses to develop specialty in advance skills in areas like neonatal nursing, midwifery and all areas of nursing practice.
Kenya, like many East African countries has limited numbers of nurses with specialist qualifications. For neonatal nursing, it is important for there to be legislation and enabling conditions for specialty in advance nursing practice, including the right education. And then there is the issue that we need sufficient nurses and resources through the health system to be able to provide and meet the level of demand and need that exists.
Further research is needed to understand and to delve more into the major causes of death. The strategies that work the best in helping mothers and families care for newborns. The amount of resource required, those combinations of factors would help ensure that the right solutions are put in place.
More generally for research priorities, it is important to look at the particular needs of the population and the health trends. Kenya, like the other East African countries has alarming rates of non-communicable disease – diabetes, cancers, cardio-vascular disease, diseases of lifestyle, diseases of urbanisation. There needs to be a lot more research in those areas. There also needs to be more research that will assist in health literacy. The levels of cancer are rising and people tend to come very late because they do not necessarily have the information to understand early signs of cancer. Research into areas of what the population does know, what kind of health education, health promotion and how to hold some of those things earlier.
This interview was recorded in December 2018