Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana
Identifieur interne : 000181 ( Pmc/Checkpoint ); précédent : 000180; suivant : 000182Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana
Auteurs : Emma Sacks [États-Unis] ; Soumya Alva [États-Unis] ; Sophia Magalona [États-Unis] ; Linda Vesel [États-Unis]Source :
- Human Resources for Health [ 1478-4491 ] ; 2015.
Abstract
A strong health system requires a competent and caring workforce. A more satisfied and motivated health workforce should be more willing to serve in difficult areas, have lower turnover, and theoretically provide better care to patients. This paper examines the motivation, satisfaction, and correlation with clinical knowledge, of community health nurses (CHNs), a cadre of provider focused on maternal, newborn and child health in rural Ghana.
This study employed three methods of evaluation. Two quantitative measurements were used: (1) a survey of health worker satisfaction and motivation and (2) a clinical knowledge assessment focusing on maternal, newborn and child health. Both were administered to all rostered CHNs working in the five sampled districts in the Greater Accra and Volta regions in Eastern Ghana (
CHNs desired more training, especially those who were posted at the community level (a Community-based Health Planning and Services post or “CHPS”) versus at a health facility. CHNs working at CHPS believed their work to be more difficult than those posted at health facilities, due to challenges associated with foot travel to visit patients at home, and they were more likely to report having insufficient resources to do their jobs (48% vs 36%). However, CHNs posted at health facilities were more likely to report insufficient opportunities for career advancement than the CHPS nurses (49% vs 33%). CHNs generally reported good relationships with colleagues and being respected by patients but desired more respect from supervisors. The median score on the knowledge assessment was 78%. On average, subgroups of CHNs with different reported levels of satisfaction did not perform differently on the knowledge assessment.
CHNs in Ghana were satisfied overall but desired more training, more guidance and supervision, fair pay and opportunities to advance in their career. Improving health worker satisfaction and morale may be important for health worker retention and certain aspects of care but may not have a significant influence on clinical knowledge or performance.
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DOI: 10.1186/s12960-015-0082-7
PubMed: 26450085
PubMed Central: 4599654
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana</title><author><name sortKey="Sacks, Emma" sort="Sacks, Emma" uniqKey="Sacks E" first="Emma" last="Sacks">Emma Sacks</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St., E8011, Baltimore, MD 21205 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Maryland</region></placeName><wicri:cityArea>Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St., E8011, Baltimore</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="Aff2">USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington, DC USA</nlm:aff><country>États-Unis</country><placeName><region type="state">District de Columbia</region></placeName><wicri:cityArea>USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington</wicri:cityArea></affiliation></author><author><name sortKey="Alva, Soumya" sort="Alva, Soumya" uniqKey="Alva S" first="Soumya" last="Alva">Soumya Alva</name><affiliation wicri:level="2"><nlm:aff id="Aff3">John Snow, Inc., Rosslyn, VA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Virginie</region></placeName><wicri:cityArea>John Snow, Inc., Rosslyn</wicri:cityArea></affiliation></author><author><name sortKey="Magalona, Sophia" sort="Magalona, Sophia" uniqKey="Magalona S" first="Sophia" last="Magalona">Sophia Magalona</name><affiliation wicri:level="2"><nlm:aff id="Aff3">John Snow, Inc., Rosslyn, VA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Virginie</region></placeName><wicri:cityArea>John Snow, Inc., Rosslyn</wicri:cityArea></affiliation></author><author><name sortKey="Vesel, Linda" sort="Vesel, Linda" uniqKey="Vesel L" first="Linda" last="Vesel">Linda Vesel</name><affiliation wicri:level="2"><nlm:aff id="Aff4">Concern Worldwide US, New York, NY USA</nlm:aff><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Concern Worldwide US, New York</wicri:cityArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26450085</idno><idno type="pmc">4599654</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4599654</idno><idno type="RBID">PMC:4599654</idno><idno type="doi">10.1186/s12960-015-0082-7</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000154</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000154</idno><idno type="wicri:Area/Pmc/Curation">000153</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000153</idno><idno type="wicri:Area/Pmc/Checkpoint">000181</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000181</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana</title><author><name sortKey="Sacks, Emma" sort="Sacks, Emma" uniqKey="Sacks E" first="Emma" last="Sacks">Emma Sacks</name><affiliation wicri:level="2"><nlm:aff id="Aff1">Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St., E8011, Baltimore, MD 21205 USA</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Maryland</region></placeName><wicri:cityArea>Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St., E8011, Baltimore</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="Aff2">USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington, DC USA</nlm:aff><country>États-Unis</country><placeName><region type="state">District de Columbia</region></placeName><wicri:cityArea>USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington</wicri:cityArea></affiliation></author><author><name sortKey="Alva, Soumya" sort="Alva, Soumya" uniqKey="Alva S" first="Soumya" last="Alva">Soumya Alva</name><affiliation wicri:level="2"><nlm:aff id="Aff3">John Snow, Inc., Rosslyn, VA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Virginie</region></placeName><wicri:cityArea>John Snow, Inc., Rosslyn</wicri:cityArea></affiliation></author><author><name sortKey="Magalona, Sophia" sort="Magalona, Sophia" uniqKey="Magalona S" first="Sophia" last="Magalona">Sophia Magalona</name><affiliation wicri:level="2"><nlm:aff id="Aff3">John Snow, Inc., Rosslyn, VA USA</nlm:aff><country>États-Unis</country><placeName><region type="state">Virginie</region></placeName><wicri:cityArea>John Snow, Inc., Rosslyn</wicri:cityArea></affiliation></author><author><name sortKey="Vesel, Linda" sort="Vesel, Linda" uniqKey="Vesel L" first="Linda" last="Vesel">Linda Vesel</name><affiliation wicri:level="2"><nlm:aff id="Aff4">Concern Worldwide US, New York, NY USA</nlm:aff><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName><wicri:cityArea>Concern Worldwide US, New York</wicri:cityArea></affiliation></author></analytic><series><title level="j">Human Resources for Health</title><idno type="eISSN">1478-4491</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>A strong health system requires a competent and caring workforce. A more satisfied and motivated health workforce should be more willing to serve in difficult areas, have lower turnover, and theoretically provide better care to patients. This paper examines the motivation, satisfaction, and correlation with clinical knowledge, of community health nurses (CHNs), a cadre of provider focused on maternal, newborn and child health in rural Ghana.</p></sec><sec><title>Methods</title><p>This study employed three methods of evaluation. Two quantitative measurements were used: (1) a survey of health worker satisfaction and motivation and (2) a clinical knowledge assessment focusing on maternal, newborn and child health. Both were administered to all rostered CHNs working in the five sampled districts in the Greater Accra and Volta regions in Eastern Ghana (<italic>N</italic> = 205). Qualitative interviews (<italic>N</italic> = 29) and focus group discussions (<italic>N</italic> = 4) were held with selected CHNs in the same districts. These data were analysed using NVivo (Version 10) and Stata (Version 13.0) based on domains of extrinsic and intrinsic motivation including general satisfaction, work environment and access to resources, respect and recognition received and opportunities for advancement.</p></sec><sec><title>Results</title><p>CHNs desired more training, especially those who were posted at the community level (a Community-based Health Planning and Services post or “CHPS”) versus at a health facility. CHNs working at CHPS believed their work to be more difficult than those posted at health facilities, due to challenges associated with foot travel to visit patients at home, and they were more likely to report having insufficient resources to do their jobs (48% vs 36%). However, CHNs posted at health facilities were more likely to report insufficient opportunities for career advancement than the CHPS nurses (49% vs 33%). CHNs generally reported good relationships with colleagues and being respected by patients but desired more respect from supervisors. The median score on the knowledge assessment was 78%. On average, subgroups of CHNs with different reported levels of satisfaction did not perform differently on the knowledge assessment.</p></sec><sec><title>Conclusions</title><p>CHNs in Ghana were satisfied overall but desired more training, more guidance and supervision, fair pay and opportunities to advance in their career. Improving health worker satisfaction and morale may be important for health worker retention and certain aspects of care but may not have a significant influence on clinical knowledge or performance.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Alhassan, Rk" uniqKey="Alhassan R">RK Alhassan</name></author><author><name sortKey="Spieker, N" uniqKey="Spieker N">N Spieker</name></author><author><name sortKey="Van Ostenberg, P" uniqKey="Van Ostenberg P">P van Ostenberg</name></author><author><name sortKey="Ogink, A" uniqKey="Ogink A">A Ogink</name></author><author><name sortKey="Nketiah Amponsah, E" uniqKey="Nketiah Amponsah E">E Nketiah-Amponsah</name></author><author><name sortKey="De Wit, Tf" uniqKey="De Wit T">TF de Wit</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Binka, Fn" uniqKey="Binka F">FN 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Hum Resour Health</journal-id><journal-id journal-id-type="iso-abbrev">Hum Resour Health</journal-id><journal-title-group><journal-title>Human Resources for Health</journal-title></journal-title-group><issn pub-type="epub">1478-4491</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26450085</article-id><article-id pub-id-type="pmc">4599654</article-id><article-id pub-id-type="publisher-id">82</article-id><article-id pub-id-type="doi">10.1186/s12960-015-0082-7</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research</subject></subj-group></article-categories><title-group><article-title>Examining domains of community health nurse satisfaction and motivation: results from a mixed-methods baseline evaluation in rural Ghana</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Sacks</surname><given-names>Emma</given-names></name><address><email>esacks@jhu.edu</email></address><xref ref-type="aff" rid="Aff1"></xref><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Alva</surname><given-names>Soumya</given-names></name><address><email>Soumya_alva@jsi.com</email></address><xref ref-type="aff" rid="Aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Magalona</surname><given-names>Sophia</given-names></name><address><email>Carmela_magalona@jsi.com</email></address><xref ref-type="aff" rid="Aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Vesel</surname><given-names>Linda</given-names></name><address><email>linda.vesel@concern.net</email></address><xref ref-type="aff" rid="Aff4"></xref></contrib><aff id="Aff1"><label></label>Department of International Health, Johns Hopkins School of Public Health, 615 N. Wolfe St., E8011, Baltimore, MD 21205 USA</aff><aff id="Aff2"><label></label>USAID Maternal and Child Survival Program (MCSP)/ICF International, Washington, DC USA</aff><aff id="Aff3"><label></label>John Snow, Inc., Rosslyn, VA USA</aff><aff id="Aff4"><label></label>Concern Worldwide US, New York, NY USA</aff></contrib-group><pub-date pub-type="epub"><day>8</day><month>10</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>8</day><month>10</month><year>2015</year></pub-date><pub-date pub-type="collection"><year>2015</year></pub-date><volume>13</volume><elocation-id>81</elocation-id><history><date date-type="received"><day>6</day><month>1</month><year>2015</year></date><date date-type="accepted"><day>28</day><month>9</month><year>2015</year></date></history><permissions><copyright-statement>© Sacks et al. 2015</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>A strong health system requires a competent and caring workforce. A more satisfied and motivated health workforce should be more willing to serve in difficult areas, have lower turnover, and theoretically provide better care to patients. This paper examines the motivation, satisfaction, and correlation with clinical knowledge, of community health nurses (CHNs), a cadre of provider focused on maternal, newborn and child health in rural Ghana.</p></sec><sec><title>Methods</title><p>This study employed three methods of evaluation. Two quantitative measurements were used: (1) a survey of health worker satisfaction and motivation and (2) a clinical knowledge assessment focusing on maternal, newborn and child health. Both were administered to all rostered CHNs working in the five sampled districts in the Greater Accra and Volta regions in Eastern Ghana (<italic>N</italic> = 205). Qualitative interviews (<italic>N</italic> = 29) and focus group discussions (<italic>N</italic> = 4) were held with selected CHNs in the same districts. These data were analysed using NVivo (Version 10) and Stata (Version 13.0) based on domains of extrinsic and intrinsic motivation including general satisfaction, work environment and access to resources, respect and recognition received and opportunities for advancement.</p></sec><sec><title>Results</title><p>CHNs desired more training, especially those who were posted at the community level (a Community-based Health Planning and Services post or “CHPS”) versus at a health facility. CHNs working at CHPS believed their work to be more difficult than those posted at health facilities, due to challenges associated with foot travel to visit patients at home, and they were more likely to report having insufficient resources to do their jobs (48% vs 36%). However, CHNs posted at health facilities were more likely to report insufficient opportunities for career advancement than the CHPS nurses (49% vs 33%). CHNs generally reported good relationships with colleagues and being respected by patients but desired more respect from supervisors. The median score on the knowledge assessment was 78%. On average, subgroups of CHNs with different reported levels of satisfaction did not perform differently on the knowledge assessment.</p></sec><sec><title>Conclusions</title><p>CHNs in Ghana were satisfied overall but desired more training, more guidance and supervision, fair pay and opportunities to advance in their career. Improving health worker satisfaction and morale may be important for health worker retention and certain aspects of care but may not have a significant influence on clinical knowledge or performance.</p></sec></abstract><trans-abstract xml:lang="fr" id="Abs2"><title>Résumé en français</title><sec><title>Contexte</title><p>Un système de santé solide nécessite un personnel de santé compétent et attentionné. Un personnel de santé plus satisfait et motivé sera mieux disposé à servir dans les zones difficiles, aura un meilleur taux de rétention, et théoriquement offrira des soins de meilleure qualité au patients. Ce document examine la motivation, la satisfaction et leur corrélation avec les compétences cliniques des infirmières dénommées Community Health Nurses (CHNs), personnel en charge de la santé maternelle, néonatale et infantile dans le Ghana rural.</p></sec><sec><title>Méthodologie</title><p>Cette étude utilise trois méthodes d'évaluation. Deux mesures quantitatives ont été utilisées: 1) une enquête de satisfaction et de motivation du personnel de santé, et 2) une évaluation des compétences cliniques sur la santé maternelle, néonatale et infantile, toutes deux appliquées à chaque CHN des cinq districts des régions Grand Accra et Volta dans l’est du Ghana (N=205). Des entretiens qualitatifs (N = 29) et discussions de groupe (N = 4) ont été organisés avec certaines CHNs dans ces mêmes districts. Ces données ont été analysées à l'aide de NVivo (version 10) et STATA (version 13), en se basant sur les domaines de motivation extrinsèque et intrinsèque comme la satisfaction générale, l’environnement de travail et l’accès aux ressources, le respect et la reconnaissance reçus, et les possibilités d'avancement.</p></sec><sec><title>Résultats</title><p>Les CHNs ont exprimé un désir de formation, en particulier celles qui travaillent dans les communautés (CHPS) plutôt qu’au sein d’un centre de santé. Les CHNs travaillant dans les CHPS estiment que leur travail est plus pénible que celui des CHNs travaillant dans les centres de santé, ceci en raison des difficultés de déplacement effectué à pied pour les visites à domicile de patients, et dénoncent plus fréquemment l’insuffisance de ressources pour effectuer leur travail (48% vs 36%). Cependant, les CHNs travaillant dans les centres de santé sont plus susceptibles que les CHNs de CHPS de déclarer insuffisantes les possibilités d’avancement professionnel (49% vs 33%).</p><p>Les CHNs font généralement état de bonnes relations avec les collègues et déclarent être respectées par les clients, mais demandent plus de respect de la part de leurs superviseurs.La note médiane en ce qui concerne l’évaluation des compétences était de 78%. En moyenne, les sous-groupes avec niveaux différents de satisfaction ne se comportent pas différemment en ce qui concerne l’évaluation des compétences. </p></sec><sec><title>Conclusion</title><p>Les CHNs au Ghana ont été satisfaits en général, mais ils ont désiré plus de formation, plus de directives et de la supervision, la salarie équitable et la possibilité d’avancer dans leurs carrières. Améliorer la satisfaction et le moral des travailleurs de la santé peut être important pour la rétention des travailleurs de la santé et pour des certains aspects des soins, mais ne peut pas avoir une influence sur le niveau de soins cliniques donnés.</p></sec></trans-abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Human resources for health</kwd><kwd>Community health nurses</kwd><kwd>Health worker motivation</kwd><kwd>Knowledge assessment</kwd><kwd>MCH</kwd><kwd>Maternal health</kwd><kwd>Neonatal health</kwd><kwd>Rural health workers</kwd><kwd>Mixed methods</kwd><kwd>Ghana</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2015</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc><affiliations><list><country><li>États-Unis</li></country><region><li>District de Columbia</li><li>Maryland</li><li>Virginie</li><li>État de New York</li></region></list><tree><country name="États-Unis"><region name="Maryland"><name sortKey="Sacks, Emma" sort="Sacks, Emma" uniqKey="Sacks E" first="Emma" last="Sacks">Emma Sacks</name></region><name sortKey="Alva, Soumya" sort="Alva, Soumya" uniqKey="Alva S" first="Soumya" last="Alva">Soumya Alva</name><name sortKey="Magalona, Sophia" sort="Magalona, Sophia" uniqKey="Magalona S" first="Sophia" last="Magalona">Sophia Magalona</name><name sortKey="Sacks, Emma" sort="Sacks, Emma" uniqKey="Sacks E" first="Emma" last="Sacks">Emma Sacks</name><name sortKey="Vesel, Linda" sort="Vesel, Linda" uniqKey="Vesel L" first="Linda" last="Vesel">Linda Vesel</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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