A collaborative approach to training ward nurses in acute care skills in resource limited settings: the nursing intensive care skills training (nicts) project

Introduction

Early recognition and prevention of deterioration of ward patients can improve patient outcomes and reduce critical care admissions [1]. In low and middle income countries (LMICs), with often minimal access to critical care therapies, the benefit may be even greater. However training to assist ward nurses develop acute care skills remains limited in such settings. As part of the NICST portfolio of acute care training, the Sri Lankan nursing faculty sought assistance to deliver a 2 day course for ward nurses [2].

Objectives

To design a clinically relevant short course for ward nurses in a LMIC to be delivered by local nursing tutors and facilitators.

To assess whether such a clinically focused programme would increase ward nurses' knowledge and skills in identifying and managing deteriorating patients.

Methods

A multi-modal 2 day acute care course for ward nurses was co-designed and delivered by specialist overseas trainers in partnership with national tutors. The courses were sponsored by the Ministry of Health, Sri Lanka. Based upon the NICST model of collaborative course design, local faculty were up skilled in delivery and content through a pre course Train the Trainer programme [3].

Candidates were invited to undertake on-line pre course e-learning. Core clinical guidelines were delivered using mini lectures. Facilitator-led skills stations and structured scenarios were used to develop clinical skills.

Short term knowledge acquisition was tested by a pre and post course Multi-Choice Questionnaire (MCQ). Newly acquired skills and their application was assessed through a post course Objective Clinical Skills Assessment (OSCA) station.

Results

122 ward nurses were trained over 6 courses in 2 locations. Post MCQ scores were significantly higher for each course compared to pre MCQ (Wilcoxon sign rank test P < 0.0001).

Over 71% passed the OSCA (pass mark of 60). Feedback reveals high candidate satisfaction.

Conclusions

Our short course results demonstrate an increase in relevant knowledge and clinical skills of the participants. Our NICST model demonstrates the feasibility of a local nursing faculty in a LMIC co-designing and effectively delivering a setting adapted acute care training programme integrated into the local nurse training system.

Table 1 Ward course pre and post course results.

Table 2 Selected course candidate feedback.