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Nov 16, 2011.
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Added on 16 Nov 2011
Authors: By Anatole Manzi and Sophie G. Beauvais
The 64th World Health Assembly held by the World Health Organization in May 2011 reaffirmed the crucial contribution of the nursing and midwifery professions to strengthening health systems and recognized the need to support nurses and midwives through coordinated training and human resources programmes. (Sixty-Fourth World Health Assembly. Agenda item 13.4. WHA64.7. 24 May 2011. pdf) Implementing nurse mentoring and quality improvement initiatives is an important strategy to improve care, particularly in sub-Saharan Africa where patient care is being shifted from physicians to nurses, especially in HIV care and treatment (Kanchanachitra et al. 2011).
In 2010, Partners in Health in Rwanda/Inshuti Mu Buzima started a collaboration with the Ministry of Health in hospitals in two rural districts to create the Mentoring and Enhanced Supervision at Health Centres (MESH) program. This program aims at strengthening clinical service delivery through ongoing clinical mentoring of nurses, continuous quality improvement initiatives, and decentralized training of nurses. Led by Manzi Anatole, Director of the MESH Program, this expert panel discussion focused on clinical mentoring initiatives for nurses and touched upon issues ranging from monitoring and evaluation to integration in the health system.
- The classic definition of a mentor is someone with expertise but also who is able to bring about personal guidance beyond the technical including professional development, life skills, and other areas.
- The skills of mentoring and coaching are not usually taught in pre-service training or in lectures.
- Consistent and thorough documentation and record keeping is needed to support quality improvement initiatives.
- Mentoring contributes to nurses’ professional development by teaching skills in new areas and encouraging growth. Mentoring has the potential to sustainably contribute to high-quality clinical care (WHO 2005).
- A mentoring approach that leads to improved quality of care must focus on both individuals through side-by-side teaching and on systems through supportive supervision.
- In addition to the tailored clinical training, mentors need to receive hands-on training in supportive supervision techniques, approaches to adult learning, and implementing Continuous Quality Improvement models.
- Mentors need to be trained on how to use existing data sources/reports to inform their mentoring interventions. They can then teach their nurse mentees how to effectively utilize data to improve patient care.
- Mentors should provide regular feedback to their mentees, supervisors and stakeholders. Similarly, mentors should receive regular feedback from these parties.
- Local and national government bodies should be involved early in the process of designing and implementing a mentoring program.
- Lack of management skills has been shown to affect mentoring and training outcomes. Thus, training health center managers could sustain improvements brought about through clinical mentoring. (Rowe et al. 2010)
- Nurse attrition rates and lack of motivation have been identified as challenges to implementing mentoring programs at health centres. The WHO proposes the following measures to address this challenge: recognition schemes, performance management, training and professional development, leadership, participation mechanisms, and intra-organizational communication processes.
- In Rwanda, nurses receive basic training in secondary school and some pursue additional training in post-secondary institutions. Traditional efforts to support ongoing nurse training have included costly centralized training workshops and sporadic supervision visits, which are often consumed by data collection and reporting.
- MESH mentors, who are higher level Rwandan nurses and part of the district hospital team, make monthly visits to health centers to provide one-on-one mentoring during patient consultations, lead teaching sessions, and help to identify and address operational and facility issues with the health center staff.
- One challenge identified is the reliance on short-term visiting mentors which does not always prove very effective over time due to intermittent contact and lack of knowledge of the local context by mentors.
- Clinton Health Access Initiative: The Ministry of Health of South Africa has recently produced a manual called "Clinical Mentorship for Integrated Services" (January 2011. PDF), which lays out the national policy on clinical mentorship. It defines the qualifications of a mentor and more importantly the clinical competencies that must be met by the mentees. Mentors grade mentees on competency, and mentees grade themselves on confidence to perform a task or apply specific knowledge.
- In the U.S.A., there is little emphasis on coaching and mentoring in nursing programs.
- I-TECH (International Training and Education Center for Health) built an intensive clinical mentoring component into its advanced training provided to nurses. Some challenges were met when transitioning mentoring to local or regional sites. At I-TECH, mentors support and encourage the collection, review, utilization and integration of data that includes not only clinical information but systems challenges identified by the staff, administration and/or mentors. They work closely with staff to review the information collected and help them recognize and understand the importance of the findings and how the information directly impacts the care provided.
- Kanchanachitra, C. et al., 2011. Human resources for health in Southeast Asia: shortages, distributional challenges, and international trade in health services. Lancet, 377(9767), pp.769-81.
- Inke Mathauer and Ingo Imhoff. Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Human Resources for Health. 2006, 4:24 doi:10.1186/1478-4491-4-24 (Open Access)
- Rowe, L. a et al., 2010. Building capacity in health facility management: guiding principles for skills transfer in Liberia. Human Resources for Health 2010, 8:5 doi:10.1186/1478-4491-8-5 (Open Access)
- World Health Organization. WHO recommendations for clinical mentoring to support scale-up of HIV care , antiretroviral therapy and prevention in resource-constrained settings. 7 August 2006. ISBN 92 4 159468 3 pp.16-18.
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