MTRH Nursing Leads the Way in Care, Education and Research

Moi Teaching and Referral Hospital has been a key partner for the Academic Model Providing Access to Health Care (AMPATH) since its inception in 1989. Key activities of engagement have revolved around promotion of population health through HIV, chronic disease and cancer research, capacity building for healthcare workers and improved access to care for the general population through community empowerment. The impact of the partnership has been tremendous in shaping the culture and model of health care in the Western Kenya region.

Dr. Wilson K. Aruasa, MBS, EBS, Chief Executive Officer MTRH

Strategic partnerships have been established in various multidisciplinary departments including medicine, surgery, pharmacy and nursing.

In nursing, the collaborative activities have focused on nursing care, education and research under the nursing working group within the AMPATH Consortium. The milestones achieved so far have been continuing supportive education, improved care processes and patient outcomes, evidence-based practice and research.

The future is geared towards strengthening partnerships for quality healthcare systems.

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Nursing Education

Multidisciplinary simulation training on managing postpartum hemorrhage

MTRH implemented the Clinical Nurse Education program in 2013 to bridge the gap between theory and practice. This was a unique initiative and the first of its kind in a public tertiary hospital in Kenya. In collaboration with Indiana University School of Nursing (IUSON) and IU Health partners, the initial fifteen Clinical Nurse Educators were trained on staff development in 2016. Five nurse leaders had an opportunity to attend two professional nurse educator conferences in Indiana on an exchange program with IUSON. In addition, the current nurse educators have been trained on preceptorship to mentor new nurses.

MTRH, MUSON & IUSON at the Simulation centre in MTRH

The intended key outcome of the clinical nurse education program is a confident and competent nurse. To achieve this, the nurse educators utilize the Assess, Diagnose, Plan, Implement and Evaluate model to facilitate four core activities:

Weekly unit continuing education sessions
Nursing grand rounds
Competency based orientation for new staff
Simulation based training

MTRH is home to the first Nursing Learning Resource and Simulation Center in western Kenya. The simulation center provides simulation learning experiences for the nearly 1,000 nurses employed at MTRH led by the Clinical Nurse Educators.

Nursing Care

MTRH NURSE LEADERS with Dean Robin Newhouse at IUSON

To improve patient safety linked nurse sensitive patient outcomes, the clinical nurse educators and nursing consortium members collaboratively developed peer-reviewed Standard Operating Procedures on Medication Safety and High-Risk intravenous drugs. These protocols are currently in use across the hospital.

Wound care training and Research

Wound care group was initiated in 2021 at MTRH in collaboration with IU Health.

This group focuses on:

Maureen, Mary and Lorna participating in the International Inter-professional Wound Care Group conference in Abu Dhabi.

Evidence-based wound care
Wound care training for health care professionals including nurses, occupational therapists, physiotherapists, clinical officers and doctors.
Wound care patient education
Wound care research

The multidisciplinary approach in their management of wounds is a key strength for this team. Trained wound care nurses work in collaboration with doctors, physiotherapists and orthopedic technicians to ensure that they do not just treat “the hole in the person but rather focus on the whole person.”

Key achievements for the wound care team:

Quarterly multidisciplinary trainings
Six weeks certificate course in wound and ostomy care
Development of a Pressure Injury Staging quick reference guide in collaboration with AMPATH Nursing Consortium Team
Utilization of the locally produced Unna boot for management of chronic wounds in the institution and the community
Presented at several national and international conferences

Neuroscience Nursing Capacity Building Project

Focused neuroscience nursing training is limited in most diploma, higher diploma and undergraduate nursing courses in Kenya. A survey conducted in MTRH in 2018 showed that none of the nurses working in the Neurosurgical Centre had received any formal comprehensive training in neuroscience nursing care. This prompted the development of a proposal to train four MTRH nurses on neurological assessment, care of the patient with neurological or neurosurgical injury and nursing Research at the neuroscience nursing research center (NNRC) in Texas. The project format is a train-the-trainer model. The four nurses who receive training at NNRC will return to MTRH and train other nurses who are caring for neuroscience patients. The project is funded by MTRH, Indiana University Center for Global Health Equity and NNRC collaboratively. The first nurse will complete the training in August 2023. The nurse trainees will also become members of the American Association of Neuroscience Nurses (AANN) and have access to various continuing education sessions, webinars and neuroscience certification courses.

Through this collaboration the nurses at MTRH have had the privilege of presenting at the International Neuroscience Nursing Symposium and co-authored in publications including “Cultural perspectives in pain management and opioid use: International Neuroscience Nursing Symposium Proceedings”, and “International Challenges and Opportunities of Stroke Nursing Research: Thriving in the VUCA World.”

Epilepsy Care

Monica Murrey, African Region nurse lead and Jane von Gaudecker, ILAE Nursing Section vice chair

To improve capacity in epilepsy care the medical clinical nurse educator joined the International League Against Epilepsy (ILAE). Ms. Monica Murrey is currently the nurse leader for the Africa region of ILAE. The organization is the world’s preeminent association of healthcare professionals working towards improving the lives of people with epilepsy. It is the only WHO recognized organization for professionals in epilepsy care. Her key role is to keep nurses informed on epilepsy care, act as a liaison for the Africa region nurses and ILAE, and encourage outreach within the Africa region.

Clinical Nursing Research

Clinical research drives evidence-based practice and nurses in MTRH are highly engaged in nursing research as evidenced by the variety of conference presentations the nurses have participated in over the years. This year four nurses are presenting at the ICN Congress in Montreal Canada.

A needs assessment survey conducted among nurses in MTRH in 2018 led to the award of a Pfizer grant that enabled over 400 nurses to access over 200 learning modules on the Royal College of Nursing eLearning platform. Post survey feedback after two years of self-paced online learning by the nurses showed that the majority of the nurses were able to utilize this platform and translate the knowledge into bedside practice.

Collaborative research among MTRH nurses and other AMPATH consortium members have also positively impacted nursing care and education. The research on implementation of surgical site infection prevention bundle among mothers who had a caesarian section in MTRH showed a significant decrease in surgical site infection rate post caesarian section from 12% to 5.6% over a period of twelve months.

Other research activities include a study on the effects of vicarious trauma among nurses due to COVID-19 pandemic and research on wound care burden at MTRH.