Implementing a change process to support respectful communication in newborn units in Kenya: A qualitative study

Background: In contexts of high workloads, resource shortages, and environmental inadequacies, neonatal nurses in many low- and middle-income countries face high levels of stress and burnout, as well as significant communication challenges. Advancing care in these ‘on the edge’ emotionally fraught contexts requires a multi-layered systems approach, including context-sensitive courses that support respectful communication. 

Methods: We share our learning from the implementation of a communication and emotional competence training process in two public hospital newborn units in Kenya. We adapted an existing course in collaboration with newborn unit nurse managers, with the aim of enhancing relationships among staff and with parents, as well as improving the quality of care. We drew on course data, 60 semi-structured interviews, and 70 h of post-course observations in newborn units. We developed a theory of change to inform our research. Data were analyzed thematically using NVivo version 12 software. 

Findings: Even in these highly challenging contexts, we documented positive effects on interactions with parents and colleagues, staff well-being, and management processes. However, there were significant differences between the two hospitals, and some unintended consequences, linked to relational readiness and capacity to create and maintain safe spaces. Key gains across both hospitals were a better awareness of communication behaviors and emotions, greater self-efficacy, and a reignited sense of professional values. Positive signs for spreading and sustaining gains included role-modeling new norms and incorporating modules into wider initiatives. 

Conclusion: There is potential value in incorporating participatory training processes into wider change initiatives. Nevertheless, given the massive workforce gaps and persistent space and resource challenges that undermine staff well-being and contribute to parental distress, tackling resource shortages remains essential.