Background
Methods
Study design and setting
Study sample
Data collection tool
Interview Questionnaire (TS) | |
---|---|
Barriers/Challenges | What do you think are the barriers and challenges faced by PHTL while providing assistance to Nurses in the Central Division in Fiji? |
How these barriers has effect on PHTL on the quality of services they provide to Nurses in the Central Division in Fiji? | |
Developments
| What do you think about the Skills and Knowledge in Leadership Styles currently practiced by PHTL in Central Division? |
What do you think about the attitude of the PHTL towards their Nurses? | |
What do you think are the challenges faced by Public Health Nursing Team Leaders on the importance of ethical, professional and psychological development of Nurses? | |
What support can PHTL provide to improve the ethical, professional and psychological development amongst Nurses? | |
Recommendation
| What are the recommendations on how to improve the ethical professional and psychological development amongst Nurses? |
Any Other Factors and recommendations? |
Interview Questionnaire (TS) | |
---|---|
Barriers/Challenges
| What do you think are the main barriers and challenges faced while providing assistance to Nurses in the Central Division in Fiji? |
How these barriers can be addressed? | |
Developments
| What do you think about the Skills and Knowledge in Leadership Styles currently practiced by PHNTL in Central Division? |
What do you think about ethical, professional and psychological development of Nurses? Is it important or not? | |
What can be done to improve ethical development amongst Nurses? | |
Recommendations
| How these recommendations will help with the service delivery of the nurses? |
Any Other Factors? |
Study procedure
Data management and analysis
Study rigor
Ethical considerations
Results
Participants’ characteristics
Characteristics | TSs | TLs |
---|---|---|
Frequency (%) | Frequency (%) | |
Age (years)
| ||
30–40 | 2 (20) | 4 (25) |
41–50 | 5 (50) | 11 (69) |
51 and over | 3 (30) | 1(6) |
Gender
| ||
Male | 2 (20) | 2 (12) |
Female | 8 (80) | 14 (88) |
Qualification
| ||
Diploma | 0 | 2 (12) |
Bachelors | 2 (20) | 7 (44) |
Postgraduate degree | 6 (60) | 7 (44) |
Masters | 2 (20) | 0 |
Current position
| ||
CNMO | 1 (10) |
0
|
Director of Nursing | 1 (10) |
0
|
SDNM | 6 (60) |
0
|
Acting SDNM | 1 (10) |
0
|
NMs | 1 (10) |
0
|
TL | 0 | 14 (88) |
Acting TL | 0 | 2 (12) |
Work experience (year)
| ||
0–3 | 7 (70) |
10 (64)
|
4–6 | 1 (10) |
2 (12)
|
7–9 | 0 |
2 (12)
|
10–12 | 1 (10) |
1 (6)
|
13–15 | 1 (10) |
0
|
16–19 | 0 | 1 (6) |
Themes and sub-themes for TSs and TLs
Theme | TSs | TLs | ||
---|---|---|---|---|
Sub-themes
|
Codes identified
|
Sub-themes
|
Codes identified
| |
Ethical Developments | Challenges faced with ethical developments | Lack of knowledge on nursing scope of practice, code of conduct, and our nursing decree, lack of policy, Remodeling removed some process | Importance of Ethical development | Knowledge on professional ethics, Knowledge on ethical development, Enhance capacity building, |
Support to improve ethical development | Train nurses on scope of practice, code of conduct, and our nursing decree; Mentor them,, in service training on ethical development, | Recommendations improve ethical development | Promote more collaboration and teamwork, More training and awareness, Include ethic in CPD. | |
Professional development | Professional development challenges | Time constraint for PHNTL, Training is not presented to other staffs, Poor Budget allocations. | Importance of Professional development. | Upgrades skills and knowledge, Nurses will be future leaders, To upgrade nursing standards, Lack of knowledge enhance work conflict |
Support to improve Professional development | Identify and address what is lacking, Coaching as monitoring, evaluation of data to help in planning, In-service training, | Support to improve Professional development | more refresher training, evidence based practices are approached, Pathway Presentation after workshops | |
Psychological development | Challenges faced with psychological development | A lot expected from public health nurses and leaders, Counseling not done, no support psychological support | Importance of psychological development | It supports nurse mental health through counselling, Stress decreases nurses output, Provide holistic care |
Support to improve psychological development | Counselling session for PHNTL, MH Gap training is introduced business plan, Counsellors, Networking with counselling unit | Support to improve psychological development | Interact with the staffs, Approve leaves and breaks, Team leaders should give their time to nurses. | |
Recommendations | Enhancing workplace policies and decision making | Create SOPs at workplaces, Involve nurses in policy making, Get well verse with all guidelines or policies | Nursing standards | rotation of nurses, Nurses attached in other peripheries, Knowledge and competent with 15 nursing standards competencies. |
Management function | Involvement in planning, Setting realistic goals by planning, Identification of problems, Assessing needs, Professional ethical development needed to start in school, | Scope of nursing | scope of nursing and refresher training, professional development and training on nursing documentation | |
The importance of supporting TLs and nurses | Need to feel empower in the role, Teach nurses on monitoring and evaluation and how to interpret data, enhance critical thinking |
Themes 1: ethical developments
TSs perceptions
“We mostly go through the procedures, but not knowing that there are guidelines, not knowing that we do have a nursing scope of practice and I’m not sure how many of us nurses here in Fiji have a copy of nursing scope of practice.” (TS7)
“One can be lack of knowledge, lack of policy and the policies we have team leaders don’t understand it so in order for us to implement these policies’ we need to understand and this area is a barrier in terms of ethical development.” (TS5)
“One was implemented by JICA, that’s the coaching but with the implementation of MYAPA we have gone away with it slowly. We are more on business plan but monitoring of nurses is very important.” (TS9)
Support to improve ethical development
“Team leaders to do more regular training on this disciplinary guideline and they need to address nurses code of ethics, code of conduct, disciplinary action, the PSC code of conduct and values. Unethical use of social media. One thing we need to remind nurses that nursing is a profession and we have a code of conduct and we need to abide with that.” (TS4)
“Provide coaching, mentoring and follow up feedback to the nurses to allow the nurses to share their challenges and empowering them. Providing timely support and ensuring the availability of resources for the nurses to use. Acknowledging the nurses for their good work in an email or verbal to show the nurses and letting them know that their supervisors support them all the way.” (TS8)
“Arrange relevant training with professional ethics and sometimes arrange with human resource department for them to talk to our team on ethical issues.” (TS10)
TLs perceptions
Importance of ethical development
“Should start ethical development from nursing school and not learnt from team leaders. It is shown in the service delivered, they have to be fair, welcoming and guard themselves. So that when the client leaves the client is happy with the service.” (TL16)
“We should have regular CMEs or short sessions reminding nurses on the ethical development especially, in terms of our conduct in the workplace, even proper uniform and how we present after hours to our society as a civil servant. So it’s very important for ethical development.” (TL9)
Recommendation to improve ethical development
“To do more training and awareness by inviting qualified personnel to train, Chief Nursing Medical Officer who is higher authority can conduct training and help us with our ethical development and also to add in school curriculum.” (TL6)
“Ahhhh… Should be part of the CPD point for licensing should have it from nursing ethical training in the CPD book... Nursing council should revise the license renewal to empower nurses on ethical development.” (TL16)
Themes 2: Professional development
TSs perceptions
“They don’t have time. Most of the team leaders are part of the team to do the work. They are supervisors, they are supposed to supervise, upgrade themselves and teach, supposed to mentor and coach. But they can’t because of shortage of nurses.” (TS1)
“Team leaders before use to nominate who goes for training and that was positive side but sometimes they were biased and they were just picking their own staff to go for study but now it’s open merit and anyone can go which is an advantage.” (TS4)
Support to improve professional development
“Okay, I think the shift work nurses can’t find time to attend any proper training. So, it’s the job of a team leader, to make a program to choose nurses to come up with topics and rotate, team leaders should identify the nurses and also make a training program with them like in house, continuing program throughout the financial year. It will enhance capacity building of all the staff because medicine is something that is keep changing.” (TS3)
“Coaching as monitoring, evaluating of data, when we present the data we say it’s a report but they don’t want to look at the report to interpret the data. If nurses know how to interpret data we will be having a good public health nurses, they will be able meet plans and forecast.” (TS9)
“Then team leaders should go through the skills of using IT thing, using of computer, using of power point presentation and all those skills. If team leaders are educated on this, they could easily support their nurses.” (TS6)
TLs perceptions
“Nurses will become future leaders of tomorrow so we need to train them to be the better leaders of tomorrow, therefore they need professional development.” (TL7)
“It brings the latest technique, the latest upgrade and we have to practice as a professional person, for example, providing quality care to your patients. Professional development you gain more skills and continue with the good education.” (TL8)
“Because of the lack of knowledge, most of the time nurses starts to have conflict in the workplace so it’s important to upgrade knowledge so that they are confident on the job they are doing.” (TL3)
Support to improve professional development
“During staff turnover, trained nurse gets posted to another station so the replaced nurse should have all the trainings and qualifications e.g. EPIs, family planning before coming to one public health setting.” (TL13)
“We need to do our own facility training and after the training or workshop outside the facility, participant needs to train the others to be on the same standard level.” (TL5)
Themes 3: psychological development
TSs perceptions
“Public health nurse usually were overwhelmed with programs and projects, which can be very daunting, both physically and psychologically, emotionally, they’ve got so much and they cannot achieve everything, and I guess it’s a challenge that everybody has.” (TS2)
“Nobody is there to assist team leaders, they need to have counsellors for team leaders, and these team leaders takes pressure and no one to assist them, which really contributes to their anxiety.” (TS1)
“Mental Health Gap training or postgraduate certificate in mental health and other small trainings was conducted on psychological or mental health training, we have to encourage our nurses to go through that to have positive mental attitude towards work, towards living, back home, and whatever activities that they participate in. (TS7)
“We can establish counsellors in each sub divisions or we can have one counsellor for the division to look after the psychological part of our work, like most of the nurses have social, financial problems and we need to have counsellors to provide support for them.” (TS1)
TLs perceptions
Importance of psychological development
“Psychological development develops yourself to make proper decisions. Like, for example, if your nurses have weaknesses then support them and maturity will come within those developments.” (TL4)
“You have to be mentally fit in order to actually provide the best services, but sometimes when you are in stressed mode, your output will not be good and will affects service delivery.” (TL9)
Support to improve psychological development
“Ahhh… some counselling to be done, we have some NGO providing with the psychological counselling like in a health setting. If we have some counsellors who can come in to talk to nurses and to highlight issues that nurses needed to be counselled on.” (TL2)
“We need to have other stakeholders to teach us or assist us with psychological impact because we have other stakeholders who can help us with psychological effect in our nursing practice.” (TL10)
Themes 4: recommendations
TSs perceptions
“Try and get nurses involved in the decision making, not only in decision making, but trying to get them to be well versed with whatever guidelines or policies that we currently have in the medical field.” (TS7)
“We need to do capacity building and create SOPs in the workplaces to ensure that there is a proper communication channel for everyone, especially when there is any unusual occurrence in the workplace, or immediate need arise in the workplace, we should have proper communication channel.” (TS3)
Management function
“If team leaders are working systematically based on a theory or a model, you will know that there is flows of work but in reality it is not, because it’s not based on literatures, not on evidence-based learning styles, or on models or theories. Recent nurse’s graduate, they already graduated with Bachelor of Nursing but again they know so much but when they join the nursing workforce, they practice again whatever is currently being practiced.” (TS2)
“We don’t know what nurses are learning in school, supervisors should be informed of the curriculum in nursing school, and training and also proper orientation during their induction, professional ethic should be part of their logbook competencies.” (TS4)
The importance of supporting TLs and nurses
“Team Leaders need somebody to mentor them, and they need to understand their role description very well, not only the role description but also the subject that comes under that.” (TS4)
“Teaching nurses on monitoring and evaluation, and how to interpret data. Using of Microsoft, excel need to be understood by nurses. Ethical development will enhance critical thinking.” (TS9)
TLs perceptions
Nursing standards
“Nurses should be rotated and attached in other units such as O&G, foot care, family health to upgrade the knowledge and skills of the nurses, since they are all graduated with general nursing for 3 years and attachment will help them in refreshing and upgrading of their knowledge and skills.” (TL1)
“Nursing standard that we have really need to get through to the nurses, we can have regular rotation of nurses, develop the nurses on the nursing standard and 15 standards that public health nurses should have so all team leaders should be well equipped in order to get the nurses to understand the nursing standards. This standard has all the competencies that a public nurse should know and understand.” (TL9)
Scope of nursing
“Training on our scope of nursing, refresher training for nurses and all those coming in as new graduate to have induction and to remind them that nursing is a profession.” (TL6)
“We should have professional development and training on the scope of practice and also for the competency and standard for registered nurse which will be measured in their output, the work they do, unit plan, or quarterly report.” (TL11)