Critical care nursing role in low and lower middle-income settings: a scoping review

Abstract

ObjectivesA scoping review was conducted to answer the question: How is critical care nursing (CCN) performed in low-income countries and lower middle-income countries (LICs/LMICs)?DesignScoping review guided by the JBI Manual for Evidence Synthesis.Data sourcesSix electronic databases and five web-based resources were systematically searched to identify relevant literature published between 2010 and April 2021.Review methodsThe search results received two-stage screening: (1) title and abstract (2) full-text screening. For sources of evidence to progress, agreement needed to be reached by two reviewers. Data were extracted and cross-checked. Data were analysed, sorted by themes and mapped to region and country.ResultsLiterature was reported across five georegions. Nurses with a range formal and informal training were identified as providing critical care. Availability of staff was frequently reported as a problem. No reports provided a comprehensive description of CCN in LICs/LMICs. However, a variety of nursing practices and non-clinical responsibilities were highlighted. Availability of equipment to fulfil the nursing role was widely discussed. Perceptions of inadequate resourcing were common. Undergraduate and postgraduate-level preparation was poorly described but frequently reported. The delivery of short format critical care courses was more fully described. There were reports of educational evaluation, especially regarding internationally supported initiatives.ConclusionsDespite commonalities, CCN is unique to regional and socioeconomic contexts. Nurses work within a complex team, yet the structure and skill levels of such teams will vary according to patient population, resources and treatments available. Therefore, a universal definition of the CCN role in LIC/LMIC health systems is likely unhelpful. Research to elucidate current assets, capacity and needs of nurses providing critical care in specific LIC/LMIC contexts is needed. Outputs from such research would be invaluable in supporting contextually appropriate capacity development programmes.

Knowledge and awareness of infection control practices among nursing professionals: A cross-sectional survey from South Asia and the Middle East

“…A recent review found that the structure and the skills of the ICU nurses vary according to the patient population, and availability of the resources, and treatments[ 20 ]. The current study found a strong association between the economic status of the countries (either UMIC or HIC vs LMIC) and better knowledge among the nurses.…”

Critical Care Nursing in a Resource-Constrained Setting: A Qualitative Study of Critical Care Nurses’ Experiences Caring for Patients on Mechanical Ventilation

“…Available equipment was often too old and not functioning properly, and there was a general shortage of medication, which was also the case in the current study. Brotherton et al (2021) and Macey et al (2022) found that low- and middle-income countries experienced equipment shortages as a major problem in providing critical care services. In high-income countries, healthcare systems are well-funded, and have structural support and needed resources (Papanicolas et al, 2018).…”

“…The provision of critical care is an intricate duty unique to regional, political, educational, socioeconomic, and cultural contexts (Losonczy et al, 2021; Macey et al, 2022). This is because personnel and physical resources vary based on socioeconomic status.…”

“…This is because personnel and physical resources vary based on socioeconomic status. Low- and middle-income countries reportedly have inadequate resources to meet healthcare system needs (Macey et al, 2022), affecting the provision of critical care nursing and nurses’ experiences of caring for patients on mechanical ventilation. This qualitative study explored critical care nurses’ experiences caring for patients on mechanical ventilators at an intermediate hospital in northeastern Namibia.…”

Home ventilation in low resource settings: Learning to do more, with less

“…The availability and access to pediatric critical care facilities and expertise is usually a prerequisite for implementing and supporting a home LTV program, especially for invasive LTV. In two recent scoping reviews, the severe shortage of pediatric critical care resources and lack of adequately trained heath care professionals, including nurses, has highlighted the significant need worldwide for more pediatric critical care in LMIC where the burden of disease of severe illness is significantly greater 15,16 The highly variable rate of invasive home LTV reported in LMIC (8%-100% of LTV cohorts) is likely to be strongly determined by availability of supporting pediatric critical care facilities in the same settings (Table 1).…”