ABSTRACT
Background: One in ten children in Sierra Leone dies before their fifth birthday, often as a result of treatable conditions such as malnutrition, malaria and respiratory infections. Ola During Children's Hospital (ODCH), Freetown, is the only tertiary paediatric referral unit in the country, and nursing staff are the major workforce in the hospital. However, there are no postgraduate paediatric nursing qualifications in-country, leaving gaps in staff's paediatric specific knowledge and skills. ODCH management and Welbodi Partnership developed a programme of Continuous Professional Development (CPD) for nurses at the hospital, aiming to improve their knowledge, skills and the quality of nursing care. Part-funded through an ICATCH grant, a group of nursing staff were trained as independent Trainers, Mentors and Managers, to design and deliver CPD modules independently. Together they co-developed and delivered a series of paediatric training modules. Methods: A mixed methods process evaluation was undertaken, guided by the REAIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) Framework. Descriptive statistics were drawn from training and mentorship registers and semi-structured qualitative interviews undertaken with Key Informants (clinical staff, n = 16) at project end. Results: Reach - 81 nurses were trained as trainers and/or mentors and/or managers. Due to high rates of staff turnover it was not feasible to track the proportion of nursing staff reached, however, the vast majority of nursing staff at the hospital are expected to have received training or mentorship training through the programme (approximately 230 staff). Effectiveness - All Key Informants described positive changes to nurses' performance and improvements to multi-disciplinary working. Nurses reported increased confidence in performing their duties efficiently and effectively, and in working across cadres and with doctors. Adoption - 21 (95%) of the staff trained as Trainers and 46 (82%) of the staff trained as Mentors, subsequently delivered training/mentorship. The primary barrier to adoption was the expectation of financial renumeration, however this was addressed through transparent communication and ongoing encouragement. Implementation - Adaptive programming was required throughout, particularly in response to the COVID-19 pandemic;training was redirected towards new COVID-19 Standard Operating Procedures and training methods altered (e.g. smaller groups and information sharing via WhatsApp) Maintenance - As of June 2021, 7 Trainers (32%) and 17 Mentors (14%) were 'active' (had delivered training or mentorship in the previous month). The primary barrier to maintenance was staff being transferred to other hospitals or being on study leave. Welbodi Partnership will continue to work with the Hospital Management on further embedding these CPD practices and addressing the barriers identified. Conclusion: CPD delivered via training-of-trainers was well adopted at ODCH and perceived to improve nurse's performance and multidisciplinary working. However, staff turnover may pose a significant barrier to maintenance. Further attention is needed to develop a robust strategy to mitigate against this.