Dear Editor,
As you know, global health programs in low-resource settings are often designed as partnerships between lower and higher-income countries. These collaborations allow for sharing of resources and aim to strengthen workforce capacity in the under resourced setting. Amidst the current global pandemic, these partnerships are challenged by travel restrictions. Prior to the pandemic we redesigned our own distance education program for nurses needing midwifery skills, which may serve as a model others might want to replicate given the restrictions posed by the pandemic.
In 2011 the University of Colorado Center for Global Health (CGH) collaboratively designed a clinical and research site in the Trifinio region of Guatemala [1]. The clinical program supports nurse delivery of home-based prenatal, postpartum, and contraceptive care and a birth center [1]. For seven years these programs were supported by site visits from CGH trainers and distance education modalities [1]. While the systems were adequate, they were not sufficient to address nursing turnover, travel funding constraints, and technology concerns. Given these recurring limitations, we decided to redesign our systems to achieve a more sustainable support system.
Rather than rely on synchronous distance education that required multiple iterations to reach all nursing staff, which is also complicated by very high staff turnover, we are redesigning nursing education into an asynchronous mentored maternal newborn nursing care (MNNC) course. This MNNC course uses the International Confederation of Midwives (ICM) core midwifery competencies and will consist of ten modules that are designed to be available for new and existing nurses. The modules guide the nurse through readings, videos, quizzes, and simulations with a mentor in place to address questions and support the process.
Using a participatory action approach, a baseline survey was distributed to the 12 nurses. The survey focused on nursing preferences for learning, assessment, mentorship, technology capacities, and time availability for study. Multiple subsequent conversations with the nursing team allowed for further reflections on program components. A pilot module is soon to be implemented to the nursing team. In the pilot, each paired nursing team will be assigned a mentor, either a nurse-midwife or an obstetrician gynecologist. Mentorship can occur by email, text, or using video meetings. Evaluation results of the pilot will drive the final production of the modules (see Table 1).
Table 1.
Implementation Plan for a MNCC.
| ACTION | REFLECTION |
|---|---|
| 1 Site/Community needs assessment, engage stakeholders | Review results with the local team to build site specific education plan |
| 2 Modify ICM competencies to site needs and develop modules | Review proposed program with local team and assess resources (local educators, skills practice materials, funds) |
| 3 Develop handbook on how to complete the modules and access mentors | Review with local team |
| 4 Build team of mentors from collaborating site | Develop handbook for mentors, expectations of mentor and mentee |
| 5 Pilot a module | Get feedback from mentors and mentees |
| 6 Develop the remainder of the modules | Develop modules that meet the needs and resources of the site |
| 7 Implement program | Ongoing evaluation with mentors and mentees |
| 8 Program Evaluation | Knowledge, attitude, satisfaction surveys of mentors and mentees |
While telehealth education is a proven supportive tool in global health projects, use of distance education modalities have not adequately addressed nursing turnover and internet/power issues at our site [2]. This proposed asynchronous course will give the nurses access to educational instruction and mentors, without reliance on in-person educators, internet, and funding for travel. In light of the current global pandemic this may be a strategy to provide ongoing education to populations in underserved low resource areas that do not have adequate access to technology or advanced nursing education. If the asynchronous mentored course is successful, it may be a cost-effective tool that puts the material into the hands of the users. The use of the ICM curriculum sets the stage for nurses to document an education in alignment with global midwifery standards. There is an identified need to train more midwives, and a program that addresses this critical gap in maternal health services is of utmost importance for mothers and newborns [3].
Acknowledgements
We thank all of the nurses that continually provide input and feedback into the educational programs, and dedicate hours-outside of work- to strengthen their skills as skilled birth attendants. Without their devotion we could not improve maternal newborn health, and the health of the community at large.
Funding
Funding for this project comes from the Eunice Kennedy Shriver National Institutes of Child Health and Human Development Women’s Reproductive Health Research K12 award (5K12HD001271) and the Doris Duke Charitable Foundation.
Footnotes
Ethical statement
The Colorado Multiple Institutional Review Board approved this de-identified secondary analysis of data prospectively collected as part of a quality improvement database (COMIRB # 15-0909).
Declaration of Competing Interest
The authors report no declarations of interest.
Contributor Information
Amy S. Nacht, University of Colorado School of Medicine, Department of Obstetrics and Gynecology, United States.
Laura Maurer, University of Colorado School of Medicine, United States.
Lauren Norheim, University of Colorado School Physician Assistant Program, United States.
Emily Himes, University of Colorado School of Public Health, United States.
Emily Barrington, University of Colorado Denver, United States.
Claudia Rivera, Fundacion Integral por la Salud de los Guatemaltecos, Center for Human Development, Guatemala.
Margo S. Harrison, University of Colorado School of Medicine, Department of Obstetrics and Gynecology, United States
References
- [1].Asturias EJ, Heinrichs G, Domek G, et al. The Center for Human Development in Guatemala. Adv Pediatr 2016;63(1):357–87. [DOI] [PubMed] [Google Scholar]
- [2].Kim T, Kim T, Zuckerman JE. Realizing the potential of telemedicine in global health. J Glob Health 2019;9(December (2))02030. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Ten Hoope-Bender P, Renfrew MJ. Midwifery - a vital path to quality maternal and newborn care: the story of the Lancet Series on Midwifery. Midwifery 2014;30(November (11)):1105–6. [DOI] [PubMed] [Google Scholar]