M.J. Oosthuizen

Proposing evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings: a summative analysis.

Objectives Many resource-limited countries have adopted and implemented healthcare reform to improve the quality of healthcare, but few have had much impact and strategies in support of these efforts remain limited. We aimed to explore and propose evidence-based strategies to strengthen implementation of healthcare reform in resource-limited settings. Design Descriptive and exploratory designs in two phases. Phase I involved assessing the effectiveness of the healthcare reform implemented in Ethiopia in the form of business process reengineering, with evidence compiled from healthcare professionals through a self-administered questionnaire; and phase II involved proposing strategies and seeking consensus from experts using Delphi method. Setting Public hospitals in central Ethiopia. Participants 406 healthcare professionals and 10 senior health policy experts. Findings The healthcare reform that we evaluated was able to restructure hospital departments into case teams, with the goal of adopting a ‘one-stop shopping’ approach. However, shortages of critical infrastructure, furniture and supplies and job dissatisfaction continued to hamper the system. The most important predictors that influenced implementation of the reform were financial resources, top management commitment and support, collaborative working environment and information technology (IT). Five strategies with 14 operational objectives and 67 potential interventions that could strengthen the reform are proposed based on their strategic priority, which are as follows: reinforce patient-centred quality of care services; foster a healthy and respectful workforce environment; efficient and accountable leadership and governance; efficient use of hospital financing and maximise innovations and the use of health technologies. Conclusions Effective implementation of healthcare reform remained a challenge for governments in resource-limited settings. Resilient operational, clinical and governance functions of health systems, as well as a motivated and committed health workforce, are important to move healthcare reform processes forward. Political commitments at this juncture might be critical though there need to be a clear demarcation between political and technical engagements.

AN EXPLORATION OF THE PROFESSIONAL SOCIALISATION OF STUDENT NURSES

Desirable levels of knowledge and skills or appropriate values and beliefs of the nursing profession are not manifested in all students who become professional nurses. The aim of the study was to explore the perceptions of professional nurses regarding their role in the professional socialisation of student nurses and the experiences of the students as members of the nursing profession. A qualitative design was applied to collect data from two purposively selected samples, professional nurses and students. Focus-group interviews (two with sample 1 and 5 with sample 2) were conducted. Findings revealed that a lack of exemplary role models, an unfavourable environment and students’ own reasons of career choice influenced the professional socialisation of students. Exemplary role modelling, supportive learning environments, the empowerment of professional nurses and the commitment to professional values of nursing are vital to develop well-socialised professional practitioners.

TEACHING AND FACILITATION STRATEGIES FOR THE PROFESSIONAL SOCIALISATION OF STUDENT NURSES

A fundamental goal of the professional socialisation of student nurses is to enhance nursing conduct and quality of care. Professional socialisation requires internalisation of characteristics typical of a profession when a student nurse learns and applies knowledge, skills, norms and values. The success of professional socialisation lies in the quality of teaching and learning. The quantitative phase of a sequential mixed methods study revealed the perceptions of nurse educators regarding their role in the teaching and facilitation of professional socialisation. The study findings informed the development of guidelines to support educators in planning and implementing teaching and facilitation strategies. Strategies should incorporate values and beliefs of the nursing profession; be student centred; take cognisance of the hidden curriculum; and utilise various teaching, facilitation and assessment methods. The role of the educator in supporting students in a positive and empowering manner becomes imperative for the professional socialisation of students.