A Study of Conventional and Competency-Based Methods Used in Training Kenyan Nurses on the Management of Obstetric Emergencies

The goal of training health professionals is to assist them obtain the knowledge, skills and attitudes essential for the provision of safe and high-quality health services to clients. At the time of this study, there was no core curriculum for training Kenya Registered Community Health Nursing students (KRCHN) and yet they sit the same Nursing Council final examination. This descriptive cross-sectional study was undertaken during the students' 3rd block sessions in June and July 2003 and it employed both qualitative and quantitative methods of data collection. The main objective of this study was to compare the performance of KRCHN students who are trained in the management of obstetric emergencies using a competency based approach (that is skills laboratory) with those undergoing the traditional methods. The study used observations at the skills laboratory/demonstration rooms and focus group discussions both with the students and the trainers to fulfill the objectives. Data for the 3 trainees' assessments namely Resuscitation of the newborn, delivery of baby in occipito-posterior position and Bums-Marshall Manoeuvre between KMTC Nairobi, that implements CBLM, and the other two training institutions namely Machakos and Kisumu schools of nursing, that use the traditional methods, were collected, organized and processed using SPSS. To compare the differences in Medians of the 3 different students' assessments between the 3 institutions, Kruskal -Wallis one-way ANOVA was used. Where results were significant, a Post- Hoc multiple comparison test was used to identify which group or groups differed from the other. Focus group responses were used to explain strengths and weaknesses observed in the students' performance. The results of delivering of baby's head when presentation is occipitoposterior position were X2df2=6.9232; P=0.0314 showing that the differences were significant. Those for resuscitation of the newborn were also significant (X2 df2 = 4.0937; P = 0.0355). For Bums-Marshall Manoeuvre, the differences were not significant (X2 df2 = 6.6786; P = 0.129). Using a Post-Hoc multiple comparison tests, Nairobi was found to differ significantly from Machakos in OPP assessment while Kisumu differed significantly from Machakos in the resuscitation of the newborn assessment. As for Bums-Marshall head delivery assessment, no two groups were significantly different at the 0.05 level. These results show that students' performance was not significantly associated with the instructional methods which are currently being used in the three schools of nursing and can be used by policymakers to chart the way forward for the skills laboratory approach or when standardizing the curriculum. In conclusion, competency of a student is may be increased by the provision of an environment, both in the skills laboratory and the clinical areas, that guarantees the practice of skills taught. This study was, therefore, necessary in order to generate data which will assist the Nursing Council and other trainers make a decision as to the best approach to use for training competent nurses. In effect, the well-trained nurses will ensure the success of primary health care programs, which are usually designed to be responsive to the community health needs such as reduction in maternal and infant mortality rates.