746 ETAT+, the next chapter: an exploratory study identifying behavioural factors affecting the delivery of quality healthcare for critically ill children in Sierra Leone. (17th August 2022)

• Record Type: Journal Article
• Authors: Sousa, Paula de; Ayeebo, Atinga; Sesay, Jebetty; Muzard, Clemence; Taylor, Sebastian; Bell, Nellie; Mustapha, Ayeshatu; Dodd, Madeleine
• Is Part Of: Archives of disease in childhood. Volume 107(2022)Supplement 2
• Page Start: A326
• Page End: A326
• Publication Date: 2022-08-17
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2022-rcpch.527
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aims: High quality nursing care reduces inpatient morbidity and mortality. Interventions that aim to strengthen health systems often focus on improving the skills and knowledge of nursing staff. In Sierra Leone, notable achievements in the quality of nursing care have been achieved. In 2016 the Sierra Leone Ministry of Health and Sanitation adopted the 'Emergency Triage, Assessment and Treatment' (ETAT+) Programme as a national guideline to improve the way children are triaged, assessed and treated at inpatient facilities throughout Sierra Leone. This programme is led and implemented by Sierra Leonean Nurses. Although achievements have been made, Sierra Leone continues to have one of the highest under 5 mortality rates of 122 deaths per 1000 live births. 1 The current study aimed to assess how best to implement an acute care nursing programme to complement ETAT+, called the 'Care of the Critically Ill Child' programme (CCC). Methods: Based on pilot delivery of the CCC programme, qualitative interviews were conducted with 27 key informants. One focus group discussion (FGD) was performed with 8 ETAT+ Nurse Mentors and 19 In-depth Interviews were conducted with Sierra Leonean nurses enrolled in the Care of the Critically Ill Child programme. Findings were analysed using the COM-B Behaviour Change Framework. This framework identifies that behaviour change is dependent on three main categories – Capability, Opportunity, and Motivation. Results: Deductive analysis uncovered six integral behaviours for effective behaviour change. These included Capability - Physical and Psychological, Motivation - Automatic and Reflective, and Opportunity - Physical and Social. This analysis identified the following intervention functions as the most effective way to target these behaviours - 'Training', 'Education', 'Persuasion', 'Incentivisation', 'Coercion', 'Enablement', 'Modelling' and 'Environmental Restructuring'. Conclusion: Overall, this study provides a better understanding of behaviours that are needed to enable high quality nursing care and a combination of micro, meso and macro-level factors required to support sustainable change in those behaviours. To ensure nursing education is translated into practice, it is essential that nurses are provided with ongoing clinical mentoring, a work environment that encourages reflective practice, systems of accountability, adequate human and technical resources, and leadership that models best practice. Reference: Hands, S., Verriotis, M., Mustapha, A., Ragab, H., and Hands, C., Nurse-led implementation of ETAT+ is associated with reduced mortality in a children's hospital in Freetown, Sierra Leone. Paediatrics and International Child Health, 2020: p. 1-8.