Patient safety and quality are at the core of healthcare education across the globe. Over the past year, School of Nursing faculty and Kenya Medical Training College (KMTC) health professionals focused on these concepts in the enhancement of a skills lab at KMTC Kitui’s Centre of Excellence for Family Planning and Reproductive Health Training in Kitui, Kenya, Africa. The skills lab was recently upgraded by Capacity Kenya to include state-of-the-art teaching tools and simulation equipment. UNC SON faculty lent their nursing education and simulation expertise to a skills training program in collaboration with KMTC faculty at the upgraded lab.
Carol Durham, director of the Education-Innovation-Simulation Learning Environment (EISLE), Darlene Baker, assistant director of EISLE, Sonda Oppewal, SON clinical associate professor, and Gwen Sherwood, associate dean for academic affairs communicated regularly via Skype with faculty in Kitui to develop the training program’s educational goals and discuss logistics. Darlene Baker and Sonda Oppewal then traveled to Kitui, Kenya, April 27– May 12, 2012 to assist in the implementation of the program.
Capacity Kenya and KMTC Kitui received USAID funding to create the Centre of Excellence for Family and Reproductive Health Training. The Centre aims to improve health outcomes in Northern Kenya in women’s health, reproductive health, and decreased maternal and infant mortality through strengthening the healthcare workforce. Capacity Kenya was created by IntraHealth International. Its mission is to improve healthcare in Kenya by enhancing the quality of training for healthcare workers in public, private, and faith-based organizations.
SON’s involvement in the project included assistance in outfitting the lab as well as facilitating a two-week training session for nurse lecturers at KMTC. Prior to the visit, UNC’s EISLE researched and made recommendations on simulation equipment to match the needs of the local constituency. IntraHealth purchased equipment including simple contraceptive displays, task trainers, and complex birthing simulators. The equipment was grouped into five categories for training: childbirth, maternal, infant, physical exam, and patient care skills.
The most complex piece of equipment new to the skills lab was Noelle, a human patient birthing simulator made by Gaumard Scientific. Noelle is used at UNC SON and other schools and hospitals to train nursing and medical students as well as professionals. The simulator connects wirelessly to a computer that can be programmed to take students through a range of scenarios that could accompany normal as well as complicated childbirth. At KMTC Kitui, Noelle was renamed Mwende which means “loved one”. Mwende was accompanied by a newborn baby simulator that enabled students to practice newborn resuscitation, a skill which was impossible to practice before the simulator’s arrival.
Darlene Baker led the equipment training, guiding KMTC staff through all stages of use. The local staff helped open the boxes, gaining familiarity with the equipment before learning utilization procedures. To complete the learning cycle, the team went over storage and cleaning, or what Baker called, “long-term considerations for the sustainment of the equipment.”
“I went there to be the boots on the ground,” Baker said.
“My role was focused on facilitating the training process,” Sonda Oppewal said. “This included helping the group identify training expectations and guidelines, facilitating the faculty members’ involvement in developing simulations, and helping them consider ways to integrate the new equipment and simulations into the curriculum.” Dr. Oppewal also helped evaluate the training, and assisted faculty members in identifying ways the project could be evaluated over time and outcomes could be reported to Capacity Kenya. They also developed models to summarize their learning over the two weeks for the faculty to use as a resource.
Dr. Oppewal also followed up on work she and Associate Dean for Academic Affairs Gwen Sherwood did in 2010 with Capacity Kenya on creating an AHEC-like model for improving the healthcare workforce in Northern Kenya. Dr. Oppewal met with the Nursing Council of Kenya and reported that a steering committee and subcommittees had been formed, and partnerships were being investigated to establish the Kenyan AHEC model.
About 15 KMTC Kitui nurse lecturers attended the sessions taught by the UNC team. The training schedule included time for each lecturer to practice using the simulators and to develop and practice teaching simulations. Next, lecturers practiced using the simulators and the simulations they developed as teaching tools with students. Thirteen students were arranged into groups for simulations the lecturers identified as having high priority for student learning: family planning, normal newborn delivery, newborn resuscitation, and normal newborn assessment.
For the lecturers, “It was an opportunity to provide hands-on experience with key patient care skills which previously had only been taught theoretically,” Baker said.
It was a collaborative experience, with KMTC lecturers coming up with their own ideas for simulation training. Baker said of the experience, “It opened my eyes to new ways to use equipment here.” Some of the equipment had never been used before by either UNC or KMTC instructors; these provided new learning experiences for the entire cohort.
Dr. Oppewal said the UNC team benefitted from seeing KMTC lecturers interact with their students. She noted the effectiveness of the Kitui lecturers’ method of having each student demonstrate and verbalize what they were learning, and the students’ recognition of the need for continual practice. “The lecturers were clearly invested in giving the best education possible to their students and the students were eager to learn all that they could.” Dr. Oppewal also remarked that the Kenyan practice of taking a midmorning tea break made room for spontaneous collaborations among colleagues.
By the end of the two weeks, the KMTC Kitui lecturers formed a Skills Lab Committee with the goal of making the skills lab available to the district hospitals and other KMTC campuses. The Committee expressed a desire to expand the skills lab program so that it could be used by nurses in continuing education.
Overall, Baker said the experience was inspiring. “People were already doing so much with so little, and now they have an opportunity to do so much more.”