Improving Nursing Education and Regulation through Task Analysis in Eastern and Southern Africa

Maleshoane Monethi-Seeiso, Peter Johnson, Phelelo Marole, Marion Subah, Leah Hart and Khumo Modisaeman Tuesday, May 21, 2013 Room 207

Definition
A systematic method of collecting data regarding the responsibilities, knowledge, and skills associated with acceptable performance within the profession.(Althouse 2000) A study method that regulators can use to determine what tasks nurses perform on a dayto-day basis according to setting, level of experience, and education/training.
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Purpose
Results of a task analysis study can be used to: Develop relevant national standards, competencies and scopes of practice Identify gaps in nursing education and practice Update nursing pre-service and in-service curricula Create or strengthen the content of a nurse licensure exam Direct national training priorities
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Summary of Jhpiegos experiences with Task Analysis

Country Liberia Cadre Nursing Purpose Pre-service curriculum Methods Survey Method Respondents 165 Timeline Tasks 2007-2009 264

Mozambique

Nursing and Midwifery Medical licentiate Nursing

Professional re-organization

Self-Administered Survey Method Structured interview Task Analysis Card Game

395

2010-2012 300+

Zambia Botswana

Core competencies Nurse licensure examination

80 223

2010 2011current

400 89

Lesotho

Nursing

New graduate mentorship program

Task Analysis Card Game

160

2012current

102

Lesotho

Social work

Scope and standards of practice

Task Analysis Card Game

<100

2013current

70

Process
Gather relevant documents (standards, curriculum, essential health service package, strategic plans) Create a draft task list Validate the task list (expert panel review) Collect data Analyze results Apply to priority areas for strengthening of nursing/midwifery education, regulation and practice

Four Variables
1. Frequency How often does the nurse or midwife perform each task?
Daily, weekly, monthly, rarely, never

2. Criticality How critical is the performance of the task in terms of patient or public health outcomes?
High, moderate, low

Four Variables
3. Performance How comfortable does the nurse or midwife feel performing the task?
Proficient, competent, not comfortable performing

4. Location Where was the nurse or midwife trained to perform the task?
Pre-service, in-service, on the job, not trained

Methods of Data Collection

- Paper-based, self-administered survey - Data collector administered survey - Direct observation of health care worker Possible Limitations: Responder fatigue from lengthy surveys Resource intensive Incomplete/invalid data
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The Task Analysis Card Game

Card Game
Video of card game from Botswana expert panel

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Lesotho Data Collection

10 Districts 13 Workshops

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Data analysis pending

Low criticality + high frequency tasks
Consider removing them from curriculum/training For example, bed making

Low level of comfort (performance) + high criticality

Prioritize for in-service training

Low level of comfort (performance) in a certain geographical region or health facility level
May influence deployment decisions

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Mozambique: Nurses
Findings Results of Implementation

Two education pathways to Professional rebecome a nurse 2 year organization curriculum vs 3 years One path to become a The tasks performed by nurse both types of providers were exactly the same! Some tasks which were performed for which the nurses were not trained

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Zambia: Medical Licentiates

Findings SOP poorly defined Several essential tasks that were performed for which they were not trained (provided most of the primary care in DHs) Poorly compensated compared to physicians Results of Implementation Educational requirement strengthened Direct Entry Program WHO collaborated to create core competencies Job title changed from: nonphysician clinicians to: Associate Clinicians
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Liberia
Findings Overlapping responsibilities between RNs, CMs and physicians Gaps in curriculum, especially for MNCH care competencies Results of Implementation Updated entry-level job description for RNs and CMs Updated core competencies required to meet national Curricular strengthening

Udaya, et. al., International Journal of Nursing and Midwifery, 2011.

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Building Regulator Capacity

Operationalize Regulatory Processes

Build Capacity (regulatory training, board orientation, site visits)

Continue to Mentor and Support

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Conclusion
Provides a valuable source of evidence to guide nursing and health care systems strengthening. Builds capacity of key stakeholders and regulators throughout the process. Has been well received by governments, councils, and donors. Is easily adaptable to low-resource settings.

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Expert Nurse Panel in Lesotho

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Acknowledgements
Peter Johnson, PhD, CNM Leah Hart, RN, MSN/MPH, Technical Development Officer Laura Skolnik, Country Director Jhpiego-Lesotho Jhpiego Research Collaborators Lesotho Ministry of Health, Director of Nursing Services, HR Lesotho nurse participants

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Thank you for your attention!

Panelist discussion

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