Background Improved hospital care is needed
to reduce newborn mortality in low/middle-income
countries (LMIC). Nurses are essential to the delivery of
safe and effective care, but nurse shortages and high
patient workloads may result in missed care. We aimed
to examine nursing care delivered to sick newborns and
identify missed care using direct observational methods.
Methods A cross-sectional study using directobservational methods for 216 newborns admitted in six
health facilities in Nairobi, Kenya, was used to determine
which tasks were completed. We report the frequency
of tasks done and develop a nursing care index (NCI),
an unweighted summary score of nursing tasks done for
each baby, to explore how task completion is related to
organisational and newborn characteristics.
Results Nursing tasks most commonly completed were
handing over between shifts (97%), checking and where
necessary changing diapers (96%). Tasks with lowest
completion rates included nursing review of newborns
(38%) and assessment of babies on phototherapy (15%).
Overall the mean NCI was 60% (95% CI 58% to 62%),
at least 80% of tasks were completed for only 14%
of babies. Private sector facilities had a median ratio
of babies to nurses of 3, with a maximum of 7 babies
per nurse. In the public sector, the median ratio was 19
babies and a maximum exceeding 25 babies per nurse. In
exploratory multivariable analyses, ratios of ≥12 babies
per nurse were associated with a 24-point reduction in
the mean NCI compared with ratios of ≤3 babies per
nurse.
Conclusion A significant proportion of nursing care is
missed with potentially serious effects on patient safety
and outcomes in this LMIC setting. Given that nurses
caring for fewer babies on average performed more of
the expected tasks, addressing nursing is key to ensuring
delivery of essential aspects of care as part of improving
quality and safety.