Building a Sustainable Clinical Nursing and Midwifery Research Network to Improve Health Outcomes in Southern and Eastern African Countries

Purpose: Worldwide, nurses comprise the largest proportion of health care professionals and are the backbone of health care systems. To address the large global health disparities and provide universal coverage at the primary care level, the development of a robust nursing profession needs to be a critical goal in countries and regions with minimal human resources for health and huge disease burden. The African region bears 25% of the disease burden and only 1% of healthcare workers.  Many gains have been made in nursing/midwifery clinical practice, such as nurse-initiated and managed HIV care in Sub-Saharan African countries, and in competency-based nursing education to increase the quantity, quality and relevance of new graduates.  Increasing the depth and quality of nursing research is central to validating outcomes of nursing care provided. This requires research expertise to collect and critically analyze data and identify priorities and gaps for improved clinical practice. 

Methods: In collaboration with Columbia Global Center/Africa, the Forum of University Nursing Deans of South Africa (FUNDISA), the University of Malawi, Kamuzu College of Nursing, and the University of Nairobi School of Nursing Sciences, the Columbia University School of Nursing is helping to build a cross-regional core group of nurse and midwifery researchers in selected Sub-Saharan African countries that will be able to provide mentorship for clinical research.  Methods include conducting an environmental scan (including a scoping review and grey literature search), Delphi survey and network analysis. 

An initial scoping review of all indexed published research in African countries by nurses and midwives regarding clinical practice was conducted in the fall 2014 to identify current research topics and gaps in African countries. This followed methods established by the Cochrane Public Health review group. Upon completion, it was clear that many important sources of research were not identified through traditional means, so a review of grey literature (for example, un-indexed journals, sources identified by clinical nurse research experts from southeastern African countries, and information found through universities within the region) was done.

Using contacts identified in this environmental scan, as well as through core collaborators, a screening survey was performed to establish “expert” status (connection with a university, publication of clinical nursing research, bachelor’s degree or higher), identify need for mentorship, and provide a foundation for a Delphi survey.

A Delphi survey was then conducted with identified experts in the southern and eastern African countries to establish clinical nursing and midwifery research priorities.  Next, the results of the scoping review and grey literature search were combined with the results of the Delphi survey to determine whether or not expert opinion of research priorities correlates with current clinical nursing and midwifery research topics in southern and eastern African countries. Furthermore, a network analysis of participants (to determine which networks exist formally and informally amongst nurses/midwives involved in clinical research) was conducted (January 2015) before the summit (July 2015) and will be conducted again in January 2016 to determine whether the project influenced the connections of the participants.

Results: The collaborative group is developing a database of nurse and midwife leaders involved in regional research, using the results of the screening survey.  This will culminate in a regional research summit in July 2015 to reach consensus on gaps in knowledge and priorities for nursing and midwifery clinical research to address essential population health needs. The group will also develop an implementation plan to support nursing and midwifery research with a mentorship strategy. Additionally, a program evaluation will evaluate the success of the project, both in terms of those who participated in the research summit and those who participated in the development of the program.

Conclusion: We are engaged in the development of sustained networks of nurse and midwifery researchers in southern and eastern African countries as a central component to strengthen the impact of nurses and midwives on the frontline clinical arena. This will be adapted and replicated with Columbia Global Center/Jordan and nursing researchers in the Eastern Mediterranean region. Strengthening and expanding research under the leadership of nurses and midwives engaged on the ground will improve clinical care and communities’ health at this critical time.