Evaluating the Effects of Supplementing Ward Nurses on Quality of Newborn Care in Kenyan Neonatal Units: Protocol for a Prospective Workforce Intervention Study

Abstract

Background: Data from High Income Countries have now linked low nurse staf to patient ratios to poor quality patient care. Adequately stafng hospitals is however still a challenge in resource-constrained Low-middle income countries (LMICs) and poor staf-to-patient ratios are largely taken as a norm. This in part relates to limited evidence on the relationship between stafng and quality of patient care in these settings and also an absence of research on benefts that might occur from improving hospital staf numbers in LMICs. This study will determine the efect on the quality of patient care of prospectively adding extra nursing staf to newborn units in a resource constrained LMIC setting and describe the relationship between stafng and quality of care. Methods: This prospective workforce intervention study will involve a multi-method approach. We will conduct a before and after study in newborn units of 4 intervention hospitals and a single time-point comparison in 4 non-intervention hospitals to determine if there is a change in the level of missed nursing care, a process measure of the quality of patient care. We will also determine the efect of our intervention on routinely collected quality indicators using interrupted time series analysis. Using three nurse stafng metrics (Total nursing hours, nursing hours per patient day and nursing hours per patient per shift), we will describe the relationship between stafng and the quality of patient care. Discussion: There is an urgent need for the implementation of stafng policies in resource constrained LMICs that are guided by relevant contextual data. To the best of our knowledge, this is the frst study to evaluate the prospective addition of nursing staf in resource-constrained care settings. Our fndings are likely to provide the much-needed evidence for better stafng in these settings. Trial registration: This study was retrospectively registered in the Pan African Clinical Trial Registry (https:// pactr.samrc.ac.za/Default.aspx?Logout=True) database on the 10th of June 2022 with a unique identifcation number-PACTR202206477083141.