Being passionate about nursing, and especially nursing for MSF, I couldn’t quite believe my luck when I was able to become involved in carrying out nursing research!
Though later, I found myself sitting in my London flat trying to figure out how I was going to convince nurses to use smartphones to monitor how often they carried out almost every task and how long it took over six weeks.
The word “overwhelmed” didn’t quite seem to cut it. Especially as I’m a bit of a technophobe.
I’m part of an innovative new project run by MSF. Instead of relying on “safe staffing guidelines” designed for high-resource, stable settings (i.e. economically developed countries), we’re aiming to understand what nursing involves in humanitarian projects – where there are often higher numbers of patients and their conditions are often more severe.
Making the list
To get started, we needed to go through the nursing tasks we wanted to monitor.
First, we picked the most well-known: vital signs, medication, washing patients and performing invasive procedures such as inserting an intravenous cannula or a urinary catheter.
Then, we picked the less well-known tasks. This included indirect patient care, which covers things like checking biomedical equipment, documenting the consumption of medication and materials, and ward rounds.
Finally, we added surveillance, which is when a nurse is at the nursing station, not fulfilling a specific task but still observing the patients and ready to be called upon or to take action if they see anything – such as a child vomiting or a mosquito net not tucked in.
In my first attempt to list tasks, I had 24 in total.
To understand what nurses are doing, the study also wants to understand what nurses aren’t doing.
My list also included shift demographics and an end-of-shift survey.
The shift demographics task is to outline the shift and ward nurses are working on, including the number of patients and their severity. This will be filled out every shift to show how the demands on nursing care are continuously changing.
To understand what nurses are doing, the study also wants to understand what nurses aren’t doing. This is where the end-of-shift survey outlines any possible “missed care”. Missed nursing care “refers to any aspect of required patient care that is omitted (either in part or in whole) or delayed” (Kalisch, 2009, p1510).
It’s not the fact that a nurse purposefully missed it, but that due to an increase in severe patients, poor communication or a lack of equipment, tasks were delayed, left incomplete or not started at all.
Overall, the hardest task was deciding how much information we wanted to collect.
How much detail do we want to go into? Do we want to know exactly which vital signs are being taken or the amount of medication each patient requires? How do we collect this information without disrupting the nursing task itself?
From the “What?” to the “How?”
Vicky (our nursing advisor), Cesc (the study leader) and I had countless conversations about what data we were looking to collect and why. The “how” came a little later when it was suggested that we use a platform for developing healthcare data collection tools called CommCare.
Overall, the hardest task was deciding how much information we wanted to collect and how do we collect this information without disrupting the nursing task itself?
I’d not used CommCare before, so the reading up and watching of YouTube videos began. As it turned out, the platform is actually really user-friendly and the available tutorials were excellent. So, I set aside my technophobia and started developing apps!
Building an app
After outlining an initial framework of what the app could look like on CommCare and adding some images – which looked great – Cesc and I then took on the tasks of taking that framework, adding the details and testing it.
It was great to test, as you could see what was and wasn’t working. The more I played with the app the more I got the feel of how the nurses would be using it and then adapted it to make it better. Recording a task was surprisingly quick, which was reassuring.
I then went on to develop an environment survey and an observation of care delivery survey in CommCare.
So, with the data collection tools developed, we called in the steering committee to discuss and were given the green light!
Next step: piloting the app in the field.
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