Improving Care of Critically Unwell Patients through Development of a Simulation Programme in a Malawian Hospital

Abstract

Introduction: Malawi is one of the world's poorest countries with very limited healthcare spending and a lack of post-graduate training for healthcare workers, including in critical illness management. Critical illness simulation courses have been shown to be an effective training tool and form a key part of training for healthcare professionals in the developed world. However, these courses can be difficult and costly to set. We therefore developed an affordable and simple to run programme for use in a regional hospital in Malawi.Methods: We delivered a series of lectures alongside a simulation course based around critical illness management, including cardio-pulmonary-resuscitation. The course was taught by a visiting physician who trained a local clinical officer to continue running the course in the future. Feedback on candidate confidence in managing acutely unwell patients was collected before and after the course.Results: All staff in the unit attended the course. Median candidate confidence across all seven assessed areas increased significantly.Conclusions: Despite the basic equipment used in our course, we received very positive feedback and feel that this highlights that significant improvements in staff skillset, and therefore patient outcomes, can be achieved using a relatively simple and low cost intervention that can also easily be continued by local members of staff, ensuring sustainability. Introduction of similar courses in other resource poor settings may help improve patient outcomes without the significant financial outlay and lack of future-proofing seen with many healthcare initiatives that are deployed, and are often unsuccessful, in the developing world.

Effect of an educational programme on critical care nurses’ competence at two tertiary hospitals in Malawi

“…The participants considered the training relevant and expressed satisfaction with the content and approach. The significant increase in the participants' overall competence and scores on three domains of competence; knowledge, skill and experience after the training is consistent with the outcome of similar training programmes in critical care settings in Malawi and other developing countries 16,19,[28][29][30] .…”

“…Similarly, the study by Barnes and Paterson-Brown 16 which was conducted in Malawi reported significant improvement in the nurses' confidence in the management of critical illness after a training intervention. However, there was minimal increase in the scores on attitude and value domain of ICCN-CS-1 in the present study.…”

“…We support calls for ongoing education of the critical care nurses to facilitate the transfer of knowledge into practice 37 . The involvement of local facilitators as was done in the present study could also help to minimise challenges, and ensure acceptability and sustainability of the educational programmes 16,38 . Further research is required to establish the nurses' learning needs that are specific to the management of critically ill COVID-19 patients.…”

Contextual issues that influence preparedness of nurses for critical care nursing practice in Malawi

“…There are no training programs specific for critical care nurses in Malawi. This is in contrast to middle and high-income countries where post-registration critical care nursing programs are prevalent7. At the time of data collection, there were less than 10 nurses who had been formally trained in critical care nursing outside the country.…”

“…The lack of competent staff including nurses is considered one of the biggest challenges6. The lack of competent staff could possibly be attributed to the lack of training programs specific for critical care nurses in developing countries like Malawi7.…”