A Training-of-Trainers Program for Nurses in Tanzania: ICU Standards of Care, Documentation, and Communication

Grace Kistner, Shannon Macfarlan
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Abstract

We present one method of a Training-of-Trainers (ToT) program supported by a partnership between a low-middle income country (LMIC) hospital and a high income country (HIC) organization through lectures, group discussions, assessments, and bedside coaching over a period of two weeks. The goal was to build capacity in ICU nurses by teaching standards of care and documentation, improving interdisciplinary communication, and scaling up participants’ knowledge and comfort levels in providing quality care. Nurse educators from the Alliance for Global Clinical Training (Alliance) designed the program and conducted the critical care nursing curriculum. Topics were selected by Muhimbili National Hospital (MNH) nursing peers who also provided facility information. Understanding what resources and infrastructure are routinely available is essential to applying concepts to practice. The MNH administrative team and nursing education liaison sought out the best suited participants. Identifying talent in participants for ToT programs is crucial to their success. Nurse participants were chosen as effective representatives of their individual units to be future agents of change. Participants described what they most wanted from the program, including: increased knowledge in documentation, communication, and overall critical care specialized training. Pre- and post-knowledge assessments tested critical care knowledge. The nursing process ADPIE (Assessment, Diagnosis, Problem, Intervention, Evaluation) and SBAR communication (Situation, Background, Assessment, Recommendation) were provided tools for standard operating procedures which enhance interdisciplinary management of care. Clear and consistent documentation with ADPIE requires clinical assessment and evidence-based diagnoses. Standardized communication with SBAR provides an organized framework to professionally relay critical information and provide recommendations. All materials were provided in an open-access format for the program to be easily replicated by the participants. A long-term goal of this training was to assess impact and sustainability.
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坦桑尼亚护士培训员培训计划:重症监护室护理、记录和沟通标准
我们介绍了一种培训培训师(ToT)计划的方法,该计划由一家中低收入国家(LMIC)医院和一家高收入国家(HIC)机构合作支持,通过为期两周的讲座、小组讨论、评估和床边指导来进行。目标是通过传授护理标准和文件记录、改善跨学科交流以及提高参与者在提供优质护理方面的知识水平和舒适度,增强重症监护室护士的能力。来自全球临床培训联盟(Alliance for Global Clinical Training)的护士教育工作者设计了该计划,并开设了重症监护护理课程。主题由 Muhimbili 国立医院(MNH)的护理同行选定,他们还提供了设施信息。了解日常可用的资源和基础设施对于将概念应用于实践至关重要。MNH 行政团队和护理教育联络员寻找最合适的参与者。发现 ToT 项目参与者的才能对于项目的成功至关重要。护士学员被选为其所在单位的有效代表,成为未来变革的推动者。参与者描述了他们最希望从项目中获得的东西,包括:增加文档记录、沟通和整体重症监护专业培训方面的知识。前期和后期知识评估测试了重症护理知识。护理流程 ADPIE(评估、诊断、问题、干预、评价)和 SBAR 沟通(情况、背景、评估、建议)为标准操作程序提供了工具,从而加强了跨学科护理管理。使用 ADPIE 进行清晰一致的记录需要进行临床评估和循证诊断。使用 SBAR 进行标准化交流为专业地传递关键信息和提供建议提供了一个有组织的框架。所有材料均以开放获取的形式提供,便于学员复制。此次培训的长期目标是评估其影响和可持续性。
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