Neonatal Mortality in Nigeria: The Impact of Nurse Work Organization

Abstract

Neonatal Mortality in Nigeria: The Impact of Nurse Work Organization Yolanda Ogbolu, Doctor of Philosophy, 2011 Dissertation Directed by: Jeffrey V. Johnson, PhD, Professor, Director of Office of Global Health Background: The 4th Millennium Developmental Goal (MDG-4) commits the international community to reduce child mortality by two-thirds between 1990 and 2015. Neonatal mortality accounts for 30-40% of worldwide child mortality. Globally, 99% of these deaths occur in low and middle income countries, like Nigeria. In developing countries nurses are the backbone of the health care system, however, there is a scarcity of research examining how nurses contribute to reducing neonatal mortality. Although, nurse organization factors, such as nurse staffing and the nurse practice environment have demonstrated significant relationships with patient outcomes in resource rich countries, these findings cannot be generalized to the developing countries of Sub-Saharan Africa. Purpose: The purpose of this study was to examine associations between nurse work organization factors with nursing care practices and inpatient neonatal mortality in Nigeria. Methods: Utilizing Aiken's Work Organization and Outcomes Theoretical Framework, a cross-sectional, organizational study was conducted in 27 Nigerian hospitals. MCH nurses (n=223) completed anonymous surveys to collect data on their care processes, the practice environment, and staffing characteristics. Hospital administrators (n=27) were also surveyed using the WHO Safe Motherhood Assessment Tool to collect data on the availability of material resources and facility level in-patient neonatal mortality data. Results: This study revealed extremely high patient to nurse ratios, a severe lack of neonatal material resources, and high neonatal mortality rates across the various levels of care. Staffing was found to be significantly associated with neonatal mortality. However, the direction was reversed from earlier studies using the Aiken model. The Nurse Practice Environment and the Nursing Care Processes scales both lacked variation in this sample and no significant relationships were detected between the scales and neonatal mortality. Conclusions: This study provides descriptive data on the work environment of nurses and presents evidence of poor nurse staffing, lack of material resources, and significant variations in neonatal mortality across levels of care. This study was the first, to our knowledge, to assess the nurse work organization using the Aiken model in sub-Saharan Africa.