Collective strategies to cope with work related stress among nurses in resource constrained settings: An ethnography of neonatal nursing in Kenya

McKnight, Jacob; Nzinga, Jacinta; Jepkosgei, Joyline; English, Mike

doi:10.1016/j.socscimed.2019.112698

Cited by 42 publications

(62 citation statements)

References 49 publications

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“…It is important to remember, however, that these organisational routines and local practical norms are a response to very difficult working conditions. They enable nurses to maintain some sense of achievement by completing critical tasks; this preserves their identity as capable professionals in the face of considerable adversity 33…”

Section: Understanding Nurses Workmentioning

confidence: 99%

“…These collective strategies help preserve nurses’ dignity so they can cope in severely under-resourced environments, while the health system maintains a functioning veneer. All the while, work everyone agrees represents basic minimum standards such as regular vital signs observations, monitoring intravenous fluid intakes and support for mothers and families is commonly missed 30 32 33…”

Section: Understanding Nurses Workmentioning

confidence: 99%

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Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

et al. 2020

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There are global calls for research to support health system strengthening in low-income and middle-income countries (LMICs). To examine the nature and magnitude of gaps in access and quality of inpatient neonatal care provided to a largely poor urban population, we combined multiple epidemiological and health services methodologies. Conducting this work and generating findings was made possible through extensive formal and informal stakeholder engagement linked to flexibility in the research approach while keeping overall goals in mind. We learnt that 45% of sick newborns requiring hospital care in Nairobi probably do not access a suitable facility and that public hospitals provide 70% of care accessed with private sector care either poor quality or very expensive. Direct observations of care and ethnographic work show that critical nursing workforce shortages prevent delivery of high-quality care in high volume, low-cost facilities and likely threaten patient safety and nurses’ well-being. In these challenging settings, routines and norms have evolved as collective coping strategies so health professionals maintain some sense of achievement in the face of impossible demands. Thus, the health system sustains a functional veneer that belies the stresses undermining quality, compassionate care. No one intervention will dramatically reduce neonatal mortality in this urban setting. In the short term, a substantial increase in the number of health workers, especially nurses, is required. This must be combined with longer term investment to address coverage gaps through redesign of services around functional tiers with improved information systems that support effective governance of public, private and not-for-profit sectors.

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Section: Understanding Nurses Workmentioning

confidence: 99%

Section: Understanding Nurses Workmentioning

confidence: 99%

Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

et al. 2020

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“…With an overwhelming workload, nurses adopted collective coping mechanisms and a degree of rationed care [5]. Throughout a substantial body of research, it was observed that nurses coped by working to routines, categorising patients and by covering for each other and themselves in their record keeping.…”

Section: Nurses' Coping Mechanismsmentioning

confidence: 99%

“…Throughout a substantial body of research, it was observed that nurses coped by working to routines, categorising patients and by covering for each other and themselves in their record keeping. Nurses used documentation as a way of stepping back from the 'impossibility of it all' and to mentally 'escape' [5]. Collectively, they were very flexible with colleagues over tardiness and absences (sometimes ignoring or 'looking past' the fact that colleagues might be working as locums or training unofficially).…”

Section: Nurses' Coping Mechanismsmentioning

confidence: 99%

“…Currently, there is no legal or recognised regulatory provision for HCA in Kenya. We use data from recent studies of nursing practice undertaken in neo-natal wards [2][3][4][5] to illustrate the severe pressures in Kenyan county hospitals (typically 80-400 bed general hospitals) where nurses carry extreme workloads. A direct result is their delegation of tasks to largely unqualified 'helpers' .…”

Section: Introductionmentioning

confidence: 99%

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Are health care assistants part of the long-term solution to the nursing workforce deficit in Kenya?

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This commentary article addresses a critical issue facing Kenya and other Low- and Middle-Income Countries (LMIC): how to remedy deficits in hospitals’ nursing workforce. Would employing health care assistants (HCAs) provide a partial solution? This article first gives a brief introduction to the Kenyan context and then explores the development of workforce roles to support nurses in Europe to highlight the diversity of these roles. Our introduction pinpoints that pressures to maintain or restrict costs have led to a wide variety of formal and informal task shifting from nurses to some form of HCA in the EU with differences noted in issues of appropriate skill mix, training, accountability, and regulation of HCA. Next, we draw from a suite of recent studies in hospitals in Kenya which illustrate nursing practices in a highly pressurized context. The studies took place in neo-natal wards in Kenyan hospitals between 2015 and 2018 and in a system with no legal or regulatory basis for task shifting to HCAs. We proffer data on why and how nurses informally delegate tasks to others in the public sector and the decision-making processes of nurses and frame this evidence in the specific contextual conditions. In the conclusion, the paper aims to deepen the debates on developing human resources for health. We argue that despite the urgent pressures to address glaring workforce deficits in Kenya and other LMIC, caution needs to be exercised in implementing changes to nursing practices through the introduction of HCAs. The evidence from EU suggests that the rapid growth in the employment of HCA has created crucial issues which need addressing. These include clearly defining the scope of practice and developing the appropriate skill mix between nurses and HCAs to match the specific health system context. Moreover, we suggest efforts to develop and implement such roles should be carefully designed and rigorously evaluated to inform continuing policy development.

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Exploring the complex realities of nursing work in Kenya and how this shapes role enactment and practice—A qualitative study

et al. 2023

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There is a growing attention towards nursing roles in the contemporary healthcare setting, with debates about nursing roles and why nurses struggle to meet their professional standards (Harvey et al., 2020;Mantovan et al., 2020). The dilemmas and struggles nurses face in meeting individual patient care needs and consequent failure to meet their professional expectations of care are well documented (Gathara et al., 2020;Mbuthia et al., 2021). Nursing in resource-constrained settings is typified by daunting working

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Collective strategies to cope with work related stress among nurses in resource constrained settings: An ethnography of neonatal nursing in Kenya

Cited by 42 publications

References 49 publications

Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

Lessons from a Health Policy and Systems Research programme exploring the quality and coverage of newborn care in Kenya

Are health care assistants part of the long-term solution to the nursing workforce deficit in Kenya?

Exploring the complex realities of nursing work in Kenya and how this shapes role enactment and practice—A qualitative study

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