Peer Evaluation of Skills Laboratory Interventions in Malawian Nursing Colleges

Background:
In 2007 the Malawian nursing colleges expressed a need for improving skills laboratories teaching and learning during a national meeting in Mangochi. In addition to this, tutors who went to Norway in that same year experienced the positive role that skills laboratory plays in providing quality education in nursing. (NCA, 2007, p 4, 7) A needs assessment in the existing skills laboratories was agreed upon to be done in 2008 in order to meet this need. Recommendations from the needs assessment resulted into building and renovating nine skills laboratories and procuring skills laboratory equipment. The colleges had a role to play regarding the improvement of the colleges’ skills laboratories.
Year 2008 to 2012 the Improved Health Training in partnership with the colleges has been implementing the recommendations. Therefore it became necessary to know to what extent the recommendations were implemented. An evaluation exercise was then planned whose terms of reference were as follows: Develop data collection tools, training nurse educators as enumerators, conduct pre–test of the tool, supervise the data collection, analyse the data collected and compile an evaluation report. The enumerators were tutors from the 9 CHAM colleges and MCHS.

Purpose/objective:
• To assess the extent to which the recommendations of the skills laboratory needs assessment had been implemented.

Methodology:
A team was selected which was constituted by two tutors who conducted the 2007 needs assessment and capacity building sessions on utilization of the skills laboratory and a program coordinator. These three worked hand in hand with one tutor from each of the colleges that participated in the evaluation. The tutors were heads of clinical departments in the colleges. Prior to data collection the facilitators reviewed the questionnaire which was used during skills laboratory needs assessment in 2008, adjusted it to suit an evaluation tool. The tutors were oriented using the draft questionnaire and further adjustments were made. The two teams together piloted the data collection tool at Nkhoma Nursing College, afterwhich the questionnaire further refined. Sites visited were Ekwendeni College of Nursing, Holy Family College of Nursing, Malamulo college of health Sciences, Mulanje College of Nursing, Nkhoma College of Nursing, St. Johns College of Nursing, St. Luke’s College of Nursing, St. Joseph College of Nursing, Trinity College of Nursing, MCHS Zomba Campus and MCHS Blantyre Campus. The eleven enumerators were grouped in three and each group went to each of their coallegue’s college. At the site the team met the college principal or dean of faculty first, and then visited the skills laboratory with the responsible person and conducted interviews with other faculty members and students.

Key findings:
Norwegian Church Aid, Christian Health Association of Malawi and the colleges cooperated very well in the implementation of the recommendations. This collaboration enabled the colleges to roughly implement 75% of the recommendations.
The eleven colleges have student and faculty population of 2,015 and 269 respectively. In CHAM colleges there are clinical instructors while MCHS does not.  The majority of the clinical instructors in CHAM colleges are registered nurses with a Diploma qualification. In addition, the tutors and clinical instructors were oriented to teaching methodology and attended Nurses and Midwives Council of Malawi induction courses. This means that the students are guided by appropriately qualified personnel. Administratively , nine out of the 11 colleges had rules and regulations for the skills lab although they were not yet approved, skills lab committees are available in 7 colleges which is either chaired by the skills lab coordinator dean of faculty.  Some had incorporated students and members from the hospital while others did not, only 4 colleges had Terms of References for the committee. Disposable supplies were available in all the 11 colleges with a good ordering system in place. Inventory list was available in 10 colleges though half of them were last updated in 2011 and are kept in a folder in the skills lab office. On the other hand, 3 colleges had their inventories updated in July 2012. All the 11 colleges incorporate skills lab resources in their operational budgets and faculty members are involved in the budget preparation. The colleges have managed to buy curtains for the skills lab and disposable resources e.g. gloves, cotton, syringes.  In terms of Maintenance, all the skills lab rooms were clean and most of the equipment had operational manuals. Cleaning of equipment in some colleges is done on weekly basis while others do that soon after a procedure.  All colleges use both college and hospital maintenance department for repair of the broken equipment. Physical teaching and learning resources such as infrastructure, Solid Equipment, Classroom teaching and learning aids made available to the satisfaction of the students and tutors. Pphysical learning space was significantly increased, accommodating more students at a time, thereby reducing waiting time for the students to take turns during practice of skills. However, a store room was not included in the building which has resulted in congested office.

Conclusion and recommendations
Both the project and the colleges were very committed to implement the recommendations made in the 2007 needs assessment. The laboratories now mirror the hospital setting, even students and tutors put on their uniform when using the lab. However it was observed that there are several areas that still need to be improved. These are: all colleges should arrange that students are able to access skills laboratories even after working hours, put labels where appropriete to enhance utilisation of skills lab equipment, have written routine for maintenance and have skill lab committees with terms of reference and should incorporate a student representative. Should NCA construct a skills lab again, it should include a kitchen, store room, fire exit door, scrubbing and sterizing areas.