COVID-19 advanced respiratory care educational training programme for healthcare workers in Lesotho: an observational study

  1. Valerie O Osula
  2. Jill E Sanders
  3. Tafadzwa Chakare
  4. Lucy Mapota-Masoabi
  5. Makhoase Ranyali-Otubanjo
  6. Bhakti Hansoti
  7. Eric D McCollum

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Abstract

To develop and implement a ‘low-dose, high-frequency’ (LDHF) advanced respiratory care training programme for COVID-19 care in Lesotho.

Design

Prospective pretraining–post-training evaluation.

Setting

Lesotho has limited capacity in advanced respiratory care.

Participants

Physicians and nurses.

Interventions

Due to limited participation in May–September 2020, the LDHF approach was modified into a traditional 1-day offsite training in November 2020 that reviewed respiratory anatomy and physiology, clinical principles for conventional oxygen, heated high-flow nasal cannula and non-invasive ventilation management. Basic mechanical ventilation principles were introduced.

Outcome measures

Participants completed a 20-question multiple choice examination immediately before and after the 1-day training. Paired t-tests were used to evaluate the difference in average participant pretraining and post-training examination scores.

Results

Pretraining and post-training examinations were completed by 46/53 (86.7%) participants, of whom 93.4% (n=43) were nurses. The overall mean pretraining score was 44.8% (SD 12.4%). Mean scores improved by an average of 23.7 percentage points (95% CI 19.7 to 27.6, p<0.001) on the post-training examination to a mean score of 68.5% (SD 13.6%). Performance on basic and advanced respiratory categories also improved by 17.7 (95% CI 11.6 to 23.8) and 25.6 percentage points (95% CI 20.4 to 30.8) (p<0.001). Likewise, mean examination scores increased on the post-training test, compared with pretraining, for questions related to respiratory management (29.6 percentage points, 95% CI 24.1 to 35.0) and physiology (17.4 percentage points, 95% CI 12.0 to 22.8).

Conclusions

An LDHF training approach was not feasible during this early emergency period of the COVID-19 pandemic in Lesotho. Despite clear knowledge gains, the modest post-training examination scores coupled with limited physician engagement suggest healthcare workers require alternative educational strategies before higher advanced care like mechanical ventilation is implementable. Conventional and high-flow oxygen is better aligned with post-training healthcare worker knowledge levels and rapid implementation.

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  1. Version published to 10.1136/bmjopen-2021-058643
  2. ScreenIT

    SciScore for 10.1101/2021.10.22.21265385: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethics: The Johns Hopkins University Institutional Review Board (IRB00279223) and Lesotho National Health Research Ethics Committee (ID 12-2021) approved this research.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Stata (version 16.1; StataCorp, College Station, Texas) was used for all analyses.
    StataCorp
    suggested: (Stata, RRID:SCR_012763)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are two additional limitations worth noting. First, these results primarily reflect nurses as only three doctors participated. While the backbone of clinical care is nurses and nurses are key to patient monitoring during advanced respiratory care, this training may be more suitable for doctors than nurses. Given the very limited doctor participation we were unable to stratify our analysis by cadre as initially planned. For advanced respiratory care to be successful it will be important for doctors to participate in future trainings and reasons for their lack of attendance need clarification. In addition, given the severe human resource constraints in the health sector of Lesotho, nurses need to function independently when providing advanced respiratory care since doctors are few and unable to be continuously available for all patients. Second, to deploy the training quickly we made assumptions about the baseline educational background and working medical knowledge of providers. Before revising and redeploying this training a deeper understanding of healthcare worker educational backgrounds is needed. In sum, this study illustrates the challenges and lessons learned in designing and administering an advanced respiratory care educational training program in Lesotho during the COVID-19 pandemic. If a LDHF approach is not feasible then future renditions of this training will need to be lengthened to at least two days and better incorporate case based and simulation training...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.10.22.21265385v1 on medRxiv