Utilization of a Structured Tool on Supportive Supervision among Nurses at Thika Level 5 Hospital, Kiambu County, Kenya

Abstract

The Supportive supervision (SS) process aims at improving staff performance through identification of knowledge and skills gaps, giving feedback and on-job-training. Training of managers on SS is therefore required to facilitate this role. Where SS is not done staff performance deteriorate resulting to poor patient care. No study was found on SS at the ward/sections level in Kenya. The objective of this study was to determine the effects of utilization of a structured SS tool among Frontline Nurse Managers at Thika Level 5 Hospital (TL5H) in Kiambu County. The study conducted a baseline survey to determine the level of SS practice among the Frontline Nurse Managers and factors associated with the practice. Baseline results were used to customize and adopt a World Health Organization structured supportive supervision tool. An end line survey was used to evaluate the effects of the intervention which was conducted after training Frontline Nurse Managers on SS and utilizing the structured supportive supervision tool. The study used concurrent triangulation mixed methods where quantitative and qualitative approaches were applied. For quantitative approach, quasi experimental pretest-posttest one group design was used; for qualitative approach, phenomenological design was applied and triangulation of data performed. The study population included the Nursing Services Manager, Frontline Nurse Managers, their deputies, and nursing staff. Census method was applied for sampling Nursing Services Manager, Frontline Nurse Managers and their deputies. Frontline Nurse Managers and their deputies were purposively sampled into Focused Group Discussion (FGD) groups. Nursing staff were sampled through stratified sampling. Questionnaires, FGD guide, Key Informant Interviews (KII) guides and observation checklist were used to collect data. Quantitative data were collected using a semi-structured questionnaire and observation checklist. Qualitative data were collected through (FGDs) and (KIIs). The study used Statistical Package for Social Sciences (SPSS) version 25.0 to analyze quantitative data which were analyzed by use of descriptive and inferential statistics. Quantitative data was presented using frequency distribution tables, and pie charts. Qualitative data were analyzed using NVivo version 12 then presented in themes. Level of practice and associated factors were identified. End line survey were analyzed by use of inferential statistics analyzed using chi-square and paired t-test. Statistical significance was determined using 95% confidence interval and a P-value of 0.05. Dissemination of the results was done through seminars presented to Jomo Kenyatta University of Agriculture and Technology (JKUAT) School of Nursing and Thika Level 5 Hospital (TL5H) Nursing department and publications in different peer review journals. Ethical approval was obtained from JKUAT Research and Ethics Committee and National Commission for Science Technology and Innovation (NACOSTI). Approval to collect data was granted by Kiambu County and TL5H. The study respondents were requested to give informed consent by signing and no names were written to ensure confidentiality and anonymous of the information collected. Frontline Nurse Managers’ SS practice, there were no records for SS activities; knowledge on SS did not meet the expectations, and key institutional factors were: the hospital lacked SS schedules, had not trained Frontline Nurse Managers on SS, there was staff shortage, lack of SS tools such as SS observation checklist and facility for recording SS data. The baseline survey results were used to develop the intervention. Training in and utilization of a structured SS tool were effective on improving SS knowledge and practice. The study therefore concludes that there was no SS practice at TL5H and that Frontline Nurse Managers’ knowledge did not meet expectation. Furthermore the hospital had no SS system and no SS tool. Both Institutional factors and individual factors contributed to lack of SS practice by Frontline Nurse Managers at TL5H. The study recommends adoption of a customized structured SS tool for use by Front Nurse Mangers in their SS role in TL5H. The study further recommends further training of Frontline Nurse Managers on SS and setting up of SS policy and system in the hospital. Additionally the hospital to address staff shortage.