Quality of Care Offered by Nurses Trained under the Decentralised Model and Those Trained under the Traditional Model: A Comparative Study

Abstract

Zambia has a shortage of nurses and midwives spanning from early 2000 and the situation is more dire in rural areas, where many young nurses and midwives are reluctant to live. The skill-based shortage is of concern in a healthcare context characterised by global health indicators such as high maternal mortality ratio, high under-five mortality ratio, high HIV prevalence rate, and a life expectancy lower than the global average. In order to address the above challenges, a decentralised placement model in the training of nursing students was introduced at St. Lukes College of Nursing and Midwifery. The aim of this study was to investigate the quality of nursing and midwifery care provided by graduates from the decentralised clinical training model against the cohort of graduates of the traditional model of Nursing and Midwifery training. The study utilised a cross sectional analytical study design involving 143 nurses and midwives from Chitambo and St Luke ’ s College of Nursing and Midwifery working at various selected health facilities across the country between November 2020 and February 2021. The respondents were conveniently selected and in the case where graduates on the list could not be reached, snowball sampling technique was used. Data was collected using a standardi s ed checklist as the respondents performed mandatory procedures. To supplement information obtained from assessment of the candidates, a 5-point Likert scale questionnaire was used to obtain information from their supervisors, on additional aspects of graduates’ clinical competences. The data were analysed using the Statistical Package for Social Sciences (SPSS) version 26. Measures of central tendency were used to analyse the data on demographic characteristics of the respondents, while Chi square was used to determine the relationship between variables. In addition, independent samples t-test was used to determine the significant differences in means between the two groups. Results of the t-test show that there was no significant difference on overall knowledge levels between graduate nurses from the decentralised model of nurse training (M = 3.24, SD = 0.93) and the traditional model of nurse training (M = 2.58, SD = 1.07), p = 3.285. In terms of skills, the study highlighted a significant difference in overall skills levels between graduate nurses from the decentralised model of nurse training (M = 23.52, SD = 3.02) and the traditional model of nurse training (M = 21.72, SD = 3.14), p = 0.018. In addition, results indicated a significant difference in overall attitudes towards patient care between nurses trained from the decentralised model of nurse training (M = 23.52, SD = 3.20) and those trained from the traditional model of nurse training (M = 21.73, SD = 3.15), p = 0.017. Comparison of supervisors’ rating of graduates overall clinical skills revealed no significant difference in nurses trained under the decentralised model (M = 3.34, SD = 0 .88) and those trained under the traditional model (M = 3.21, SD = 0 .77), p = 0.119. From this study, it can be concluded that some specific aspects of knowledge, skills and attitudes of graduate nurses are influenced by the model used in their training. Based on these results, the decentralised model of training can be recommended for scale-up to all nursing and midwifery training institutions.