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Rwanda is a landlocked country with an area of 26,338 square kilometers located in East Africa. The total population is 10,537,222 with a growth rate of 2.6% (National Institute of Statistics of Rwanda (NISR), 2012) and a life expectancy of 65 years at birth (World Health Organization [WHO], 2014). In Rwanda, there exists a significant shortage of health professionals (WHO, 2006) which is reflected in a current ratio of six nurses per 10,000 people (WHO, 2014).
Nurses, who constitute the foundation of the health care workforce worldwide (Wirth, 2008), contribute significantly to the provision of neonatal care and to the reduction of neonatal mortality especially in developing countries (Sousa, Dal Poz, & Boschi-Pinto, 2013). Despite an overall decline of neonatal deaths among countries, the global neonatal mortality rate (NMR) (the number of newborns who die before or at their 28thday after birth per 1000 live births per year) remains unacceptably high. Neonatal deaths are particularly excessive in developing countries where approximately 99% of global neonatal deaths, estimated at more than three million each year, occur (Blencowe & Cousens, 2013). There is a gap of NMRs between developed and developing countries. For example, in 2013 the NMRs per 1000 live births were estimated at 47 in Angola and 20 in Rwanda, compared to Denmark and Canada where the NMRs were approximately 2 and 3 per 1000 live births respectively (World Bank, 2015).
In many developing countries, newborns often die from preventable deaths due to conditions such as birth asphyxia (Kinney et al., 2010). In particular, neonatal asphyxia is the leading cause of neonatal mortality accounting for 38% of all neonatal deaths in Rwanda. The Helping Babies Breathe (HBB©) course, which uses the ‘train the trainer’ model, was introduced by the American Academy of Pediatrics (AAP) in 2010 to help reduce neonatal mortality in resource limited settings (AAP, 2010). This course equips nurses and other health professionals with basic resuscitation knowledge and skills through the use of available and inexpensive materials (Korioth, 2013). In the last few years, a number of HBB© courses were provided to nurses in the Eastern Province of Rwanda.
Purpose: This study was conducted in 2014 to explore nurses’ experiences of translating the competencies gained from HBB© courses to nursing practice in hospitals of the Eastern Province in Rwanda.
Methods: This study used a qualitative descriptive design (Sandelowski, 2010). A purposive sample of 10 nurses participated in individual interviews, which were audio recorded with participants’ permission. NVivo qualitative software was used for data management and categories were identified from the data through content analysis of audio-recorded transcripts.
Results: Three categories emerged from the analysis: 1) application of competencies acquired from education sessions to practice, 2) benefits of continuing professional development (CPD), and 3) facilitators and barriers to the application of competencies into practice.
Conclusion: The findings suggest that newborn care and resuscitation could be improved if nurses were enabled to apply all of the nursing expertise gained from CPD courses. Also, there is a great need to provide fundamental resuscitation materials to enable nurses to effectively utilize their competencies acquired from CPD courses. The results from this study provide insights about the need to address issues such as nurse shortages, nursing shortage is currently perceived in Rwandan district hospitals where this study was conducted, and the practice of deploying nurses to a variety of units where knowledge and skills developed through participation in CPD about maternal and newborn health might be infrequently applied. It is recommended that future studies are undertaken in Rwanda and other developing countries to explore how structural barriers might prevent nurses from fully applying their acquired competencies into practice.