Neonatal nasogastric tube feeding in a low-resource African setting – using ergonomics methods to explore quality and safety issues in task sharing

Abstract

BackgroundSharing tasks with lower cadre workers may help ease the burden of work on the constrained nursing workforce in low- and middle-income countries but the quality and safety issues associated with shifting tasks are rarely critically evaluated. This research explored this gap using a Human Factors and Ergonomics (HFE) method as a novel approach to address this gap and inform task sharing policies in neonatal care settings in Kenya.MethodsWe used Hierarchical Task Analysis (HTA) and the Systematic Human Error Reduction and Prediction Approach (SHERPA) to analyse and identify the nature and significance of potential errors of nasogastric tube (NGT) feeding in a neonatal setting and to gain a preliminary understanding of informal task sharing.ResultsA total of 47 end tasks were identified from the HTA. Sharing, supervision and risk levels of these tasks reported by subject matter experts (SMEs) varied broadly. More than half of the tasks (58.3%) were shared with mothers, of these, 31.7% (13/41) and 68.3% were assigned a medium and low level of risk by the majority (≥4) of SMEs respectively. Few tasks were reported as ‘often missed’ by the majority of SMEs. SHERPA analysis suggested omission was the commonest type of error, however, due to the low risk nature, omission would potentially result in minor consequences. Training and provision of checklists for NGT feeding were the key approaches for remedying most errors. By extension these strategies could support safer task shifting.ConclusionInclusion of mothers and casual workers in care provided to sick infants is reported by SMEs in the Kenyan neonatal settings. Ergonomics methods proved useful in working with Kenyan SMEs to identify possible errors and the training and supervision needs for safer task-sharing.Electronic supplementary materialThe online version of this article (10.1186/s12912-018-0314-y) contains supplementary material, which is available to authorized users.

It’s Complicated: Patient and Informal Caregiver Performance of Outpatient Parenteral Antimicrobial Therapy-Related Tasks

“…5,[9][10][11][12] Patient self-management task analysis has focused on tasks such as management of oral medications at the hospital-to-home transition, 5 on performance of activities of daily living while managing a chronic condition, 10,11 or on shared caregiver-nurse tasks. 13 OPAT, on the other hand, requires patients and caregivers to accomplish tasks that highly-skilled health care workers (eg, nurses) perform in hospitals. Task analysis has not been used to understand patient-performed tasks that require as high a level of competency as those required for OPAT.…”

Informal task‐sharing practices in inpatient newborn settings in a low‐income setting—A task analysis approach

“…The range of tasks reported to be delegated to mothers includes: feeding (NGT feeding or cup and spoon feeding), weighing of babies, routine application of chlorhexidine and other forms of cord care, feeding chart documentation, oral drug administration and collecting urine and stool samples among other tasks. Expert mothers in particular supported tasks such as expressing breast milk and kangaroo mother care (KMC) (Omondi et al, ). The involvement of mothers in these ways might be thought of as helping achieve a family‐centred approach to care which may have considerable benefits.…”

“…At the moment in Kenya, there is no legal provision guiding their role in inpatient nursing care and they do not have any recognizable training in public health facilities (Republic of Kenya, ). However, implementation of a new cadre must not add to the already high workload of the few, already somewhat beleaguered nurses in such contexts (Omondi et al, ). Thus, these scope of practice, training and regulation should be carefully considered and outlined in the appropriate policy provisions.…”

Application of NASA-TLX and SHERPA in Setting Up Fused Filament Fabrication Equipment

“…Even there is no research of HTA-NASA TLX-SHERPA in FFF, there are some publications that address this methodology in the analysis of set up equipment (Ghasemi, Nasleseraji, Hoseinabadi, & Zare, 2013;Murphy et al, 2018), being critical for the productivity that is generated from setting up as in this case. The results here reported should serve as a warning in regards to working conditions for the users of FFF equipment in the future.…”