Improving Nursing & Midwifery Care in Liberia

Improving Nursing and Midwifery Care in Liberia            

A Synopsis of FOL-LHT Third CPD and Consequent Follow-up

By: Edwin Beyan, DHSc, MSNEd/Team Leader

           Accurate reporting systems and follow-ups are essential to a funded project to assess the impact of the project on beneficiaries. The Friends of Liberia-Liberia Health Team (funded by Friends of Liberia-USA and GlobalGiving) has conducted three separate annual continuing professional development (CPD) workshops. In this document, we discuss what necessitated the CPD workshops in Liberia and the need for follow-up visitations. 

           There are 21 undergraduate accredited nursing/midwifery schools in Liberia with 50% of these accredited schools located outside the nation’s capital city Monrovia where the only two masters in nursing education schools are located. The number of graduate students who enroll in the Master of Science in Nursing/Midwifery Education Program at the Mother Patern College of Health Sciences has dropped from 20 to eight due to the lack of donors to provide scholarships for all students. The decreasing number of master’s prepared nurse/midwife-educators plus the lack of teaching/learning resources, especially in rural Liberia, to provide evidenced-informed nursing/midwifery teaching/learning methodologies and clinical practices largely triggered the need for continuing professional development in Liberia. Evidence shows that competence can be assured through initial education along with continuing professional development. 

           After the online needs assessments and using the “cascade” model of training events, FOL-LHT, with support from FOL-USA and GlobalGiving, conducted its third annual CPD workshop from 10-14 January 2022 in Bong County, Liberia. The Health Team facilitated a workshop that covered: (a) Issues Related to Testing and Evaluation, (b) Nursing Education Through Distance Learning, (c) Faculty Roles in Accreditation, (d) Program Evaluation and Accreditation, (e) Using Preceptors in Teaching, (f) Linking Theory with Clinical Experience, (g) Quality Improvement in the Clinical Settings (h) Decision-Making and Problem-Solving, (i) Transitioning Graduate Nurses/Midwives to Practice. 

           Twenty nursing/midwifery faculty plus staff from the Liberian Board for Nursing and Midwifery (LBNM) attended a three-day workshop and twenty nursing/midwifery practicing nurses/midwives including the President of the Liberian Nurses Association (LNA) also attended a three-day workshop during the January 2022 annual CPD workshops. These figures bring to approximately 60 nursing/midwifery faculty and 40d practicing nurses/midwives who have attended the past three CPD workshops conducted by the FOL-LHT.

           As we mentioned early, a follow-up to assess the impact of a project on beneficiaries is an essential component of quality improvement and appreciative inquiry. Therefore, after conducting three consecutive annual CPD workshops, FOL-LHT, again with support from FOL-US and GlobalGiving, opted to conduct a follow-up assessment in institutions from where workshop participants came from. The objectives of the follow-up were to:

1. Collect data on the impact of the CPD workshops on the Liberian Healthcare system which included teaching/learning methodologies and clinical practices. 
2. Conduct an on-site needs assessment for the 2023 CPD workshop
3. Get an opinion from nursing schools and health facilities about the FOL-provided nose masks.   

           With these objectives and the notion that follow-up initiatives are intended to strengthen the retention and transfer of learned strategies or skills, we planned our follow-up as follows:

1. Planning effective follow-up with support from our sponsors i.e. FOL-US and GlobalGiving. 
2. Mapping up visitation plans and giving prior visitation notifications. During this phase, we collected additional data from participants to help us identify the best follow-up options.
3. Implementation. As evidenced by the visitation pictorials, follow-up in easily accessible and hard-to-reach areas has been implemented and ongoing. Our follow-up is designed to be an ongoing event over time and may change as nurses/midwives’ skills and needs change. Our options may include cost and how much time is needed, participants’ locations, and availability of resources such as virtual evaluations.    

Our Findings

1. Over 90% of participants have rolled out learning resources through either in-service workshops or uploading of learning resources on faculty personal laptops or institutions’ desktops. 
2. Overall, participants strongly agreed that the FOL-LHT facilitators have the knowledge, skills, and attitudes in conducting CPD workshops
3. They also agreed that the CPD workshops have greatly contributed to the quality of nursing/midwifery teaching methodologies and clinical practices in Liberia.
4. An outstanding recommendation from one urban nursing school was that new nursing/midwifery faculty should now be given priorities since they have little if any, knowledge, skills, and attitudes in teaching and evaluation and are in institutions where opportunities are rare to enhance their knowledge and skills.
5. The lack of resources and funding to conduct in-service workshops or to roll out teaching/learning resources obtained from our workshops has been a major hindrance for some institutions. An alternative option in some of those institutions was uploading workshop presentation slides on institutions’ desktops and/or personal laptops of faculty. 
6. The need for further CPD workshops was re-emphasized. 

1. Testing and test items analysis
2. Job burnout and satisfaction
3. Linking theory with the practice via preceptorship
4. Classroom management
5. Curriculum Development
6. Developing course syllabus
7. Leadership and Management
8. Critical care nursing management 
9. Writing project proposals 
10. Clinical Reasoning
11. Ethics in the workshop
12. Customer Service
13. Maternal and Newborn Care
14. Cardio-pulmonary Resuscitations
15. Post-Partum Hemorrhage   

1. The provision of nose masks by FOL-US was a notable gesture from all institutions that were supplied.

           In conclusion, there exists a shortage of qualified and competent nursing/midwifery instructors and practicing nurses/midwives in Liberia. Although over 90 % of nursing/midwifery schools have at least a nurse/midwife educator, there are limited resources and funding to conduct in-service workshops in their training institutions. Additionally, the shortage of nurses/midwives to provide evidence-based nursing/midwifery care is a challenge due to the lack of knowledge and skills to search for evidence to support their practices. To mitigate these challenges in the Liberia nursing/midwifery educational and clinical practicing settings, a professional CPD is required. In that regard, the FOL-LHT, a local non-profitable organization, has made and will continue to make frantic efforts to augment the efforts of the Liberian Board for Nursing and Midwifery and the Liberian Nurses Association to improve the quality of the Liberian Healthcare system. 

           Additionally, the organization's leadership has been instrumental in promoting scholarships among top nursing/midwifery leaders in Liberia. For instance, the FOL-LHT leadership served as a mentor to the secretary of the Liberian Board for Nursing and Midwifery, the President of the Liberian Nurses Association, and the Nursing Directress of the John F. Kennedy Medical Hospital during their respective participations in the International Council of Nurses’ Global Nursing Leadership Institute (ICN-GNLI) program and are now scholars of this noble Global Nursing Leadership Program.