Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) is a referral facility (level 5) in Kisumu County, Kenya. It is about 3km from Kisumu town Centre on the shores of Lake Victoria. JOORTH has an inpatient bed capacity of 600 and a total of 241 nurses. As a Kenya registered nurse, my role in the hospital is mainly supervisory.

Of the 241 nurses, at any one time some are engaged in administration, others may be on annual/maternity/study or sick leave and of course others will be off duty. As a result, there is always a gross shortage of nurses in all departments of the hospital severely compromising the quality of care. For instance, the nurse patient ratio is estimated at 1:20 instead of the recommended 1:5. Tasks such nursing documentation are never thoroughly completed. Close attention to the very sick patients is not possible. Patients at different severity levels of illness have been lumped together making it difficult to give close attention to the very sick. Patient assessments by nurses are poorly done.

These challenges have necessitated those of us in the nursing department to embark on an advocacy process to try and improve the quality of care using the numbers of nurses available in the hospital. Through collaboration with the Chief Nursing Officer and the Medical Superintendent (a medical doctor) we came up with five strategies that have enabled us to improve quality of care to our patients despite the constraints.

1) The ABC concept. A concept of categorization was adopted. Patients were put into groups of A,B and C:

Group A – Very sick patients that totally rely on the nurse are kept close to the nurses’ station. This reduced the distance the nurse had to walk to check on the patient. The nurse is able to make several short trips to check on the patient.

Group B – Fairly sick patients. These patients need less support from the nurses, but must be closely observed.

Group C– Stable patients (discharged patients waiting to go home, those admitted for planned surgeries, and patients that are still on care but need less support and can follow instructions.

The nurses’ close focus is mainly on group A patients.

2) Use of the nursing process. The idea of applying nursing process to deliver care was strengthened since it would help meet different needs of the patients. The hospital supported training of all the ward in-charges and their deputies because this would help them supervise the others.

3) Team nursing. Nurses are allocated to a number of patients’ rooms. They have to concentrate in these specific rooms. This allows reasonable contact time with the patients, thereby providing cluster and individual care to each patient.

4) Hospital report. The nurse in charge of night duty hands over the report to the nursing director every morning, using nursing process. During the report, emphasis is put on two priority nursing diagnoses of the reported patients in each ward, creating in depth understanding of the patients by all the staff involved. During the day, the units in charges perform rounds to strengthen continuity of care.

5) Weekly nursing process continuing medical education (CMEs) to give updates and remind nurses of the concept.

Through advocacy and intensified support supervision, the nurses have been able to improve care that the patients receive.

Milka .A. Ogayo, Kenya Registered Nurse (KRCHN), BScN
Deputy Director of Nursing
The Surgical Unit Manager
Secretary in the Department of Quality and Standards
Chair of Nursing Research Committee