Evaluating the Effects of Supplementing Ward Nurses on Quality of Newborn Care in Kenyan Neonatal Units: Protocol for a Prospective Workforce Intervention Study

Evaluating the Effects of Supplementing Ward Nurses on Quality of Newborn Care in Kenyan Neonatal Units: Protocol for a Prospective Workforce Intervention Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating the Effects of Supplementing Ward Nurses on Quality of Newborn Care in Kenyan Neonatal Units: Protocol for a Prospective Workforce Intervention Study ABDULAZEEZ IMAM, David Gathara, Jalemba Aluvaala, Michuki Maina, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1757045/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Data from High Income Countries have now linked low nurse staff to patient ratios to poor quality patient care. Adequately staffing hospitals is however still a challenge in resource-constrained Low-middle income countries (LMICs) and poor staff-to-patient ratios are largely taken as a norm. This in part relates to limited evidence on the relationship between staffing and quality of patient care in these settings and also an absence of research on benefits that might occur from improving hospital staff numbers in LMICs. This study will determine the effect on the quality of patient care of prospectively adding extra nursing staff to newborn units in a resource constrained LMIC setting and describe the relationship between staffing and quality of care. Methods and Analysis: This prospective workforce intervention study will involve a multi-method approach. We will conduct a before and after study in newborn units of 4 intervention hospitals and a single time-point comparison in 4 non-intervention hospitals to determine if there is a change in the level of missed nursing care, a process measure of the quality of patient care. We will also determine the effect of our intervention on routinely collected quality indicators using interrupted time series analysis. Using three nurse staffing metrics (Total nursing hours, nursing hours per patient day and nursing hours per patient per shift), we will describe the relationship between staffing and the quality of patient care. Discussion: There is an urgent need for the implementation of staffing policies in resource constrained LMICs that are guided by relevant contextual data. To the best of our knowledge, this is the first study to evaluate the prospective addition of nursing staff in resource-constrained care settings. Our findings are likely to provide the much-needed evidence for better staffing in these settings. Trial registration: This study was retrospectively registered in the Pan African Clinical Trial Registry (https://pactr.samrc.ac.za/Default.aspx?Logout=True) database on the 10th of June 2022 with a unique identification number -PACTR202206477083141. Nursing staff Health systems strengthening Newborn units Human Resources for Health Quality of care Missed nursing care Full Text Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1757045","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":114584609,"identity":"836fecd4-9684-4214-9588-5c55414f88c6","order_by":0,"name":"ABDULAZEEZ IMAM","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8klEQVRIiWNgGAWjYDACCQYDhgcGQAZ7Y8OBhAoGBgOitCSAlPEcPvjgwRmitYAZacmGD9uI0MI/u3mbRELBNnndhhwzicR5h+XN2ZsPMPyo2IbbkjvHyiQSDG4bbjtwBqhl22HDnT3HEhh7ztzGbc0NoOFALYzbDvaAtTBuuJFjwMzYhluLPFSL/bbDPEAtcw7bE9RiANWSuO0YW7JBYsPhRIJaDO8cK7YAaknedob54IOEY+nJG84cSziIzy9yt5s33vjw57bttvsPGw7+qLG23XC8+eCDHxV4vI8GmsHkAaLVA0EdKYpHwSgYBaNghAAAoLdnMHuuIrkAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0001-5070-3060","institution":"Univerity of Oxford Nuffield Department of Medicine","correspondingAuthor":true,"prefix":"","firstName":"ABDULAZEEZ","middleName":"","lastName":"IMAM","suffix":""},{"id":114584610,"identity":"f9ac3d19-fce7-4a33-bc8f-eecd4a3a4cb7","order_by":1,"name":"David Gathara","email":"","orcid":"","institution":"KEMRI-Wellcome Trust Research Programme Nairobi","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Gathara","suffix":""},{"id":114584611,"identity":"99e2f995-3f93-4278-b616-e37d023f9ac0","order_by":2,"name":"Jalemba Aluvaala","email":"","orcid":"","institution":"University of Nairobi Faculty of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Jalemba","middleName":"","lastName":"Aluvaala","suffix":""},{"id":114584612,"identity":"a2ecac72-183d-4dc9-98d3-bf5366575b2e","order_by":3,"name":"Michuki Maina","email":"","orcid":"","institution":"KEMRI-Wellcome Trust Research Programme Nairobi","correspondingAuthor":false,"prefix":"","firstName":"Michuki","middleName":"","lastName":"Maina","suffix":""},{"id":114584613,"identity":"aac65581-e504-432d-92d8-1d78f186c0d7","order_by":4,"name":"Mike English","email":"","orcid":"","institution":"Univerity of Oxford Nuffield Department of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Mike","middleName":"","lastName":"English","suffix":""}],"badges":[],"createdAt":"2022-06-14 11:04:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1757045/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1757045/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":23292124,"identity":"b7290766-5288-4541-9961-468b181220b4","added_by":"auto","created_at":"2022-06-30 18:39:47","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":471963,"visible":true,"origin":"","legend":"","description":"","filename":"IMPSD2200363reviewerclean.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1757045/v1_covered.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003eEvaluating the Effects of Supplementing Ward Nurses on Quality of Newborn Care in Kenyan Neonatal Units: Protocol for a Prospective Workforce Intervention Study\u003c/p\u003e","fulltext":[{"header":"Full Text","content":"This preprint is available for \u003ca href='/article/rs-1757045/latest.pdf' target='_blank'\u003edownload as a PDF\u003c/a\u003e."}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Nursing staff, Health systems strengthening, Newborn units, Human Resources for Health, Quality of care, Missed nursing care","lastPublishedDoi":"10.21203/rs.3.rs-1757045/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1757045/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction : Data from High Income Countries have now linked low nurse staff to patient ratios to poor quality patient care. Adequately staffing hospitals is however still a challenge in resource-constrained Low-middle income countries (LMICs) and poor staff-to-patient ratios are largely taken as a norm. This in part relates to limited evidence on the relationship between staffing and quality of patient care in these settings and also an absence of research on benefits that might occur from improving hospital staff numbers in LMICs. This study will determine the effect on the quality of patient care of prospectively adding extra nursing staff to newborn units in a resource constrained LMIC setting and describe the relationship between staffing and quality of care. \u003c/p\u003e\u003cp\u003eMethods and Analysis:\u0026nbsp;This prospective workforce intervention study will involve a multi-method approach. We will conduct a before and after study in newborn units of 4 intervention hospitals and a single time-point comparison in 4 non-intervention hospitals to determine if there is a change in the level of missed nursing care, a process measure of the quality of patient care. We will also determine the effect of our intervention on routinely collected quality indicators using interrupted time series analysis. Using three nurse staffing metrics (Total nursing hours, nursing hours per patient day and nursing hours per patient per shift), we will describe the relationship between staffing and the quality of patient care. \u003c/p\u003e\u003cp\u003eDiscussion: There is an urgent need for the implementation of staffing policies in resource constrained LMICs that are guided by relevant contextual data. To the best of our knowledge, this is the first study to evaluate the prospective addition of nursing staff in resource-constrained care settings. 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