REINVESTING THE BENEFITS OF EDUCATION IN ADVANCED NURSING PRACTICE IN WEST AFRICA: A CASE STUDY IN BENIN Dado Marcelline OLOUKOÏ, RN, MSN, APN Nurse educator, Institut national médico-sanitaire de Cotonou, Benin Christophe DEBOUT, RN, PhD, CRNA Nurse anesthetist Programme director, IFITS, France Nurse Scientist, Health Chair, Sciences-Po Paris, France
Disclosure presenter
Outline Context Aims Methods Outcomes Conclusion and perspectives 3
Context (1/3) In sub-saharan Africa, the extent of the health crisis is widely recognized Spread of HIV/AIDS Paludism Persistence of parasitic diseases At the same time some countries as Benin are struggling to invest in healthcare professionals education Consequently the supply is struggling to meet the demand and resulting in imbalances in the nation distribution of health care. Rural areas are most affected. (WHO, 2008) 4
Context (2/3) In Benin, the health profile is characterized by high morbidity especially with regard to communicable diseases with epidemic potential; Like many African countries, Benin is subject to a critical shortage of healthcare workforce From 2005 to 2010 a process of reforms has been initiated in the education of nurses and midwives in Benin: Nursing and midwifery move from vocational to academic education University was strong enough to face the regional and international requirements 5
Context (3/3) An ambitious project Introduction of advanced practice nurses in the Beninese healthcare system 2015: creation of a Master s in Nursing and Obstetric Sciences to prepare APNs Several specializations are offered: anesthesia/critical care, mental health, pediatrics/child care gynecology/obstetrics In the preparation phase of this project, Beninese teachers were sent to France to get a master s degree in advance nursing practice 6
Aims Main objective To explore the reinvestment of advanced practice skills of a West African nurse educated in France upon her return to Benin Operational objectives Identify the contribution of this foreign educated nurse in the conception and implementation of a university-based APN program in Benin Identify barriers and facilitators encountered Address the issue of legislation and regulation of these new nursing roles in Benin 7
Methodology Qualitative case study (Baxter, 2008) exploring the transition experienced by a Beninese nurse trained in advanced practice in France after her return to Benin Retrospective analysis of the conception and implementation phases of the project Documents analysis: Cohorts of students Assessment results Post graduation follow-up Reflective practice performed by the Beninese nurse involved 8
Outcomes (1/5) The master s programme was developed in 2014: Preliminary work: exhaustive literature search Benin health indicators analysis organisation of a Workshop to identify the compentences and skills of APNs Elaboration of the first draft of curriculum with an external consultant (Prof D Morin) It was validated at the end of 2014 Its implementation began in 2015 9
Outcomes (2/5) Theoretical framework selected: the PEPPA model (Bryant-Lukosius & DiCenso, 2004) This model guided the development, implementation and evaluation of APN roles this model gave credibility to this project: it clarify how APNs could help the country to cope with the shortage of physician and specialists. 10
Outcomes (3/5) The barriers and facilitators have been identified in the conception and implementation phase of this project Weak leadership of nurse educators in this APN programme Students were frequently not friendly welcomed by physicians during theirs placements: MDs were afraid to train their future concurrent in the healthcare market Absence of legislation related to APN in Benin Effective lobby of the University at Ministry level: the programme has been approved and in the future scholarship could be given to students Initiation of a research study aimed to identified the conditions of introduction of APN title in the legislation 11
Outcomes (4/5) The first class of 12 graduate advanced practice nurses was deployed to health centers nationwide. They perform nursing and medical procedures in primary care. They provide the Beninese population with a better access to health care (88% vs. 79%); they counterbalance the chronic shortage of qualified physician in health centers in the face of a constantly increasing population. 10 students will be graduated soon 19 are joining the programme 12
Outcomes (5/5) The foreign educated APN nurse educator was comfortable to contribute to this project having gained enough knowledge during her training in France She was able to transfer this knowledge to APN students and help them to built the competency they need More precisely: contribution to the writing of the syllabus appointment as the Master s SIO pedagogical leader and as assistant of the lecturer on Advanced nursing practices involved in the course of gerontology follow-up of master s students during clinical placements. 13
Conclusion and perspectives An national achievement: APNs implementation is in its early stage in Benin but this role has started taking root. What we need to improve: Getting more PhD prepared nurse educators in order to gain leadership on this programme Through research and lobbing, making government authorities recognize the added-value of APNs and getting the legislation we need to practice 14
Acknowledgement We need people of good will to promote advanced practice by providing the nurses with short or long-term training opportunities. We would like to thank our main partner the Dutch cooperation NiFFUC / CINOP which allowed me to be at this congress 15
References Baxter, P., & Jack, S. (2008). Qualitative Case Study Methodology: Study Design and Implementation for Novice Researchers. e Qualitative Report, 13(4), 544-559 Bryant-Lukosius, D., & DiCenso, A. (2004). A framework for the introduction and evaluation of advanced practice nursing roles. Journal of advanced nursing, 48(5), 530-540. http:/dx.doi.org/10.1787/5km4hv77vw47-fr Poghosyan L, Lucero R, Rauch L, Berkwitz B. Nurse practionner workforce: a substantial supply of primary care providers. Nurs Econ.2012;30(5):268-74,294. Sheer B, Wong FKY. The development of advanced nursing practice globally. J Nurs Scholar. 2008;40 (3):204-11 Strategic plan for the development of the National Medical and Health Institute (INMES) 2018-2022 WHO (2008) Task shifting : rational redistribution of tasks among health workforce teams : global recommendations and guidelines. WHO, Human resources for health: Global strategy 2030; project; December 2015. 16
THANK YOU 17