Development of a trauma care assessment instrument for emergency nurses in West Africa

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<h2>Abstract</h2><h3>Background</h3> Strengthening the provision of emergency health services, including the nursing workforce, is progress towards decreasing the burden of injury in sub-Saharan Africa. The WHO Essential Trauma Care Guidelines provide minimum knowledge and skills to ensure quality in-hospital trauma care. Our aim was to develop an emergency nursing trauma care knowledge, attitudes, and skills minimum competency assessment instrument with WHO guidelines for African emergency care settings. <h3>Methods</h3> Constructs anchoring the assessment were defined by an expert panel of six emergency nurses from Ghana, Malawi, South Africa, and Tanzania, with a modified Delphi approach. The panel did each phase of the knowledge, attitudes, and skills instrument creation and validation by: (1) identifying objectives and attributes; (2) narrowing the domain of content previously predefined by WHO; (3) developing survey questions; (4) reviewing questions in the instrument; and (5) pilot testing the survey with 23 emergency nurses in Ghana. <h3>Findings</h3> A four-part instrument was created. Important objectives and attributes of the instrument included easy measurement and discrimination of trauma care knowledge, attitudes, and skills among emergency nurses in sub-Saharan Africa. Domains assessed were primary, secondary, focused, and ongoing trauma assessment and management, including team-oriented practices, nursing analysis, planning, and implementation. The knowledge, attitudes, and skills instrument included ten demographic and 46 attitude questions self-administered on paper, 49 open-ended oral interview questions, and 26 administered in an observed patient simulation format. Pilot results show the instrument was easy to apply, appropriate for low-resource testing, and was able to discriminate knowledge, attitudes, and skills among nurses of various competencies. <h3>Interpretation</h3> In Ghana, the longitudinal assessment instrument should be implemented for cohorts of newly trained emergency nurses. In other sub-Saharan African countries, actively trained emergency nurses the instrument should be locally validated and piloted, then deployed to measure basic trauma competencies between nurses. Ultimately, the instrument should serve as a standard across sub-Saharan Africa for measurement of competency among nurses, thereby allowing multination comparisons or longitudinal assessments. <h3>Funding</h3> Fogarty International Center.