A Research Project on Nurse Leadership in Healthcare Systems of LMICs

This research project investigates the multifaceted role of nurse leadership within the healthcare systems of Low- and Middle-Income Countries (LMICs). The project employs a scoping review methodology, adhering to the JBI guidelines, to analyze the contributions of nurses to leadership roles, the chal...Read More

RESEARCH PROJECT

Table of Contents
BACKGROUND.............................................................................................................................3
FINDINGS.......................................................................................................................................5
DISCUSSION..................................................................................................................................9
REFERENCES..............................................................................................................................12

BACKGROUND
The recent research belong to one of the most interesting topic that is several problems in
healthcare system of low and middle-income countries such as lack of leadership capacity that
have lead to poor delivery of services to patients. Number of diseases are increasing at rapid
stage in middle and low income countries and they are unable to delivered qualitative healthcare
facalities due to less availability of staff members or unequal distribution of human resources.
There are several factors that have acts as challenged in implementing effectively healthcare
facalities like social, cultural, political and economical. Lack of leadership capabilities is one of
the biggest reason that have lead to ineffective healthcare system in various countries. Nurse are
integral part of health workforce as most of the people are untrained or unexperienced before
becoming manager or leader. Therefore, it can be intrepretated from identifying various issues
that leadership in nurse in LIMC is important in healthcare system.
Research questions
 What are the different ways in which nurse have contributed in leadership of LIMCs.
 What are several issues faced by nursue in LIMCs.
 How different strategies have contributed nursue to fill leadership roles in healthcare
system in LMICs.
METHODOLOGY
Inclusive criteria
As per guideline of JBI, Population-Concept-Context frameworks criteria will be used in
order to review professional development and nursing leadership. It contained all information
related to the way nursue contributed in leadership in healthcare organisations Skains (2018).
Fiji, wetern pacific regions and solomom island will be focused in context of study related to
LMIC. It also included various factors like scarcity of resources and lack of autonomy in nursing
pratices or factors that are causing poor healthcare system.
Peer- reviewed articles in english language will only be used in order to extract data and
information to conduct research on contribution of nursue in leadership.
Sources of data
Scopus, PubMed and CINAHL are various sources of database that are used for scoping
review. Keywords and abstract present in relevant articles will be used in order to find
additional search term.

Search strategy
Key words
PCC Term Keywords
Participants Nurses Healthcare Professionals
Concept Leadership Competency, Barriers,
Management, Professional
development, Limitations,
Facilitators and others.
Context Middle and Low income
countries.
Third world countries,
Solomon Island, Resource-
limited countries, Western
Pacific Region, LMICs, Papua
Developing countries, Fiji Low
and middle income countries,
New Guinea.
Extraction of results
Microsoft excel sheet will be used to collected various extracted data and information
and include various field such as types of study, key finding, journal articles, conclusion and
limitations.
Presentation of results
Both descriptive numerical and thematical analysis will be used to report results or
outcome of scoping review. The result will be based on the objectives or aims of study that
helps in indetifying various method or ways that have been used by nurses to contribute in
leadership.
Ethical approval
It can be state that ethical approval is not required for complete this research project. It
will be ensured that all information is properly citition and acknowledge or proper reference are
made in order to ensure validity and accuracy of information Murshed and Zhang, (2016).

FINDINGS
Article 1
Results: It has been analysed that nursing leaders have huge impact on patient safety as
described in study. Leaders needs to be engaged in increasing their focus on patients so that
better environment can be provided to them which enhances their well-being and outcome.
Article 2
Results: Nursing leadership in accounting competencies related to HIV patients is really
necessary. This has assisted in increasing them in better implementing the financial strategy
related to PNG HIV. It has supported in arranging better equipment’s for treating patients with
HIV by effective nursing leadership.
Article 3
Results: The study provided that the healthcare providers have to develop the clinical leadership
as the purpose, qualities and the competence of the leaders. As there are different roles to
perform and position to held in organisational hierarchy.
Article 4
Result: After screening the 50 relevant text papers the eligibility the 24 papers excluded in
evaluating and developing clinical leadership intervention (Mianda and Voce, 2018).
Interventions included developing leadership competencies, clinical skills, care environment,
teamwork and patient care.
Article 5
Result: Respondents marked increased intergenerational educational mobility with the 16% and
59% of them achieved qualification of 2 levels above the fathers and mothers.
Article 6
Result: Traumas lead to annual deaths around 5.7 million in which 25% to 33% are
unintentional deaths. Among these the burden is over lower middle-income nations. 88.88% of
participants responded high satisfaction and 100% as very satisfied from trauma lectures.
Article 7

Data collected with the help of the 121 schools that generally had reported that enthusiasm of
developing the leadership is not same. It had been identified that all the nurses at the global level
generally used to play good role in leading health system.
Article 8
To find out the outcome of the research, researcher had gone through the eighteen different type
of the paper related to the topic of the result. Finding pass on the information that skill and
knowledge update associated with curriculum review.
Article 9
The major finding of this article is that the response rate of the health care institution was 90.2
and 80.4% at the baseline of the research. The study was a mixed research and this resulted that
there is need of improving the clinical practices and the workplace policies of the company.
Article 10
The major finding of the article was that database and internet was the major contribution was
the information and because of this the major problem of identifying and recruiting and
developing the strategies for the nurses to become leader and this will assist in managing their
work.
Article 11
Article related to the search strategy generally used to pass on the result that there responsive
HRH can ultimately have a major impact on to the health of the population. Result is identifiy by
evaluating the 25 studies which generally used to reveal the poor mental health of LMIC.
Article 12
Looking at the result of article there were four key theme was derived as a result. Result is
hierarchical leadership, importance of having a structure, contractual barrier and professional
barrier. This result was derived with the help of primary data that is collected by the way of face
to face interview.
Article 13
After going through the secondary data it has been find out that out of the data of 318548 patient
most of the cases were on the same direction as there was a good amount of linkage in the
nursing system, mortality and readmission.
Article 14

To find out the result of Article it was identified that 15 sub themes were made to support the
outcome of the results. There are good variant of themes in general. As Theme starts with
discussion of cultural to observation of reflection. Result was based upon the six nurse leader.
Article 15
Result of the article was based on the primary data collection, it was identified that Nurses in the
7 PHC facilities and one hospital developed the good amount of the knowledge about the initiate
and diagnosed treatment. This programme had register the 3094 patients in the programme.
Article 16
Result generated by the article it was identified that there are some sort of gender structure in the
Bangladeshi society. Not only that Variety of the challenges in relation to the economic barrier
in the Bangladeshi society was also find out.
Article 17
In regards of the current It was identified with the help of the primary and secondary data
collected is that there are almost 14 million new cases of cancer burden was found out.
Surprising element of that is that almost 6 percent of the cases out of the all are of the Africa,
Asia and central & South America.
Article 18
Looking at the result derived and evidence identified with the help of the study that role of the
APN in the environment generally used to suits the primary health care workforce strategy of
Latin Americans in the long run. Also there was finding in regards of the challenges faced by the
organization.
Article 19
With the help of article it was identified that there was a positive influence of mentoring on the
research productivity. This result was passed on the basis of the screened 1775 title and abstracts
which result in 15 different type of studies.
Article 20
Finding of the research was find out on the basis of collecting the 15 different type of CNS job
description with the help of eight DHBS. This job description had generally helped us in
understanding the role of CNS in the New Zeland is very inconsistency in nature. Specially in
relation to the post graduate qualification.
Article 21

From this article it was found that study included 66 studies from which 11 were low or middle
income countries and 55 were high income countries. It was also evaluated that there are several
factors that influence the implementation of the doctor- nurse substitution strategies.
Article 22
With assistance of this article it was found that 34 nurses and midwives participated from 12
different countries. It was found that there are four different themes from which data is gathered
that is country wide objective, learning how to be leader, negotiating barriers and having
effective mentorship.
Article 23
With the household survey it was found that community people are suffering from non-
communicable disease and risk behaviours. It was also found that there is high- priority need are
included such as nutrition, chronic management and behaviour and many others.
Article 24
With this study it was found that distributed leadership lens in order to analyse the mid- level
leadership is very helpful in managing the nurses work. The major reason for this is that
leadership is essential and for nurse it is top priority as this includes professional hierarchies.
Article 25
From the finding of this article it was found that the respondent was patient, nurse leader,
community leader and were selected with help of purposive sampling. The result was gathered
with help of 16 item demographic questionnaire and found that nurses and midwives are
expected to be patient and receptive.
Article 26
With the help of finding of the article it was found that it is very essential for nurses and
midwives to get involved in the making and framing of the policy development within the low
and middle income countries (LMIC). It was found that nurses are the most important people
who are included in the taking care of patient as they have complete knowledge that what is
required.
Article 27
From the article it was found that 69 articles were included from 11 countries which are
published from 1995 to 2019. These articles were generally from high income countries and

some were from rural areas. This study is also resulted in promoting evidence based practices
and the promotion and retention of the new nurse graduate.
Article 28
This articles major finding was that marginal leadership is very helpful in formulating the policy
and the implementation of the policy. The major hindering factors which were seen in the report
were the individual and the institutional barriers which were found in the report.
Article 29
The major finding of this article was the HRH which resulted in the nurses constituting an
important part in the health system. This also resulted in the fact that the in India there is very
less of the nurses in India and this has to be handled by the country so that they can have a better
condition of the nurses in India.
Article 30
The major finding of the article is that there are very few midwives in the country and there are
only two midwives for the whole of the country. This included the finding that midwifery
education program must be included in the post- graduate diploma and the bachelor degree as
well.
DISCUSSION
Understanding the result and finding it has been identified that there are varieties of issue which
is related with the barriers in the nurse leadership. Looking at the another side it had been
identified that this research has open up good sort of the opportunity for the researcher to
undertake the variety of the step to overcome this sort of the issue in the market. At the same
time looking at the negative point of the same it had been analysed that this will impact the
health of patient. Another thing which had been find out with the help of the result is that nurses
in PHC facilities had developed good sort of knowledge in regards of the leadership skill in the
organization. This is good sign as it will help them at the time of developing the professional
career in the coming future.
Another finding which was identified that there are almost 14 million cases which has
been derived in recent past but most of the cases are generally in the Asia, American and African
side. This is very negative side for all the three continents, at the same time it can be understand
by them that they generally used to look at the other continent to adopt the same culture in the
organization.

At the same time, it was identified that there was a positive influence of mentoring on the
research productivity. This is good sign as it will help in overcoming the variety of the different
type of future uncertainty in the organization. Looking at the another aspect of the same it was
also identified that mentoring is a slow process this will have variety of the impact on the growth
of country. As it will increase the cost of the company which will be incurred by the organization
in general.
At the same time, it was also identified that enthusiasm of developing the leadership is
not the same, it has created variety of the issue for different school at initial stage itself. For the
same reason school has to offer variety of the opportunity in regards of building good sort of
enthusiasm in organization.
All description of the interventions for the clinical development of leadership derives from the
studies in HICs. Clinical leadership programmes targeted the novice to the veteran front-line
service providers. Interventions embracing holistic conceptualisations of the clinical leadership
are detailed and provide skilled & trained leaders.
The study provides that nursing education impacts gender, health outcomes and the
economic factors. Nurses are the front-line providers in healthcare services (Brownie, Wahedna
and Crisp, 2018). Provisions for the high quality nursing upgrading programmes enhance the
nursing ability for leadership with improvements in the health outcomes.
The studies over global surgery and WHO provides about emergent need for surgical
capacity creating and improvements of trauma system to address global trauma systems (Muñiz
and et.al., 2017). The training and programmes are required to be conducted for addressing
traumas within the system based care and for facilitating the trauma nursing leaderships.
Thematic depiction of the clinical leadership not be conceptually distinct from the
conceptualisations of the health service leadership. Clinical and health services leadership may
share the conceptualisations and characteristics (Mianda and Voce, 2017). In clinical settings, the
clinical decisions are created by front-line healthcare service providers in the clinical teams.
Better and effective strategies related to accounting has assisted nurses in taking better
measures to treat patients suffering from HIV. Nursing leadership has benefited in doing internal
control which is being linked to treating patients suffering from such adverse non communicable
disease (Brown, 2013). This has helped them in arranging better tools for treating patients

The findings have significant implications for developing countries and it is crucial that
support for patient safety in developing. It has been analysed that leaders needs to be more
attentive when they are being involved in treating patients (Stewart and Usher, 2010). This will
also assist them in reducing down risk faced by patients
From the above finding it was analysed that it is very essential for the nurses to have
proper and effective measures to develop themselves. With the finding of the article it was also
analysed that the major thing for the nurses was find that how can the nurse can manage the work
in effective and efficient manner. Further it was also supported by the literature review it was
also analysed that role of nurse is also very effective in managing the work in the health care
setup. This is effective because of the reason that when the nurse will know what they have to do
then only they will be able to manage their work in proper and effective manner.
Further with the assistance of the finding to was criticized that the midwives and nurses
plays a crucial role in the management and taking care of patient and the whole health care
system. For this the major reason is that nurses and midwives actually know how they have to
work and they know what are the major requirement for making the policies and implement them
in proper and effective manner. Thus, for this the most important thing for implementation of the
policy is the proper understanding of the working environment and the framework going on in
the health care setting.
In the end it was found that majority of the nurses need to have proper mentoring
program so that they can understand what are the major requirements needed to be followed for
development and effective working of the whole health care setting. This was the most effective
thing for the nurses as this mentoring program will assist the nurses and midwives in developing
their skills and attributes in effective and efficient manner. This is particularly because of the
reason that with help of proper mentoring the nurses will develop effective leadership skills and
this will be helpful in the proper management and effective working of the health care setting.

REFERENCES
Books and Journals
Brown, A.M., 2013. Nursing Accounting Competencies Related to HIV in a Papua New Guinea
Context. Journal of the Association of Nurses in AIDS Care. 24(5). pp.e25-e34.
Brownie, S., Wahedna, A.H. and Crisp, N., 2018. Nursing as a pathway to women's
empowerment and intergenerational mobility. Journal of clinical nursing. 27(21-22).
pp.4050-4057.
Mianda, S. and Voce, A., 2018. Developing and evaluating clinical leadership interventions for
frontline healthcare providers: a review of the literature. BMC health services
research. 18(1). p.747.
Mianda, S. and Voce, A.S., 2017. Conceptualizations of clinical leadership: a review of the
literature. Journal of Healthcare Leadership. 9. p.79.
Muñiz, S.A., and et.al., 2017. Preparing global trauma nurses for leadership roles in global
trauma systems. Journal of trauma nursing. 24(5). pp.306-311.
Murshed, F. and Zhang, Y., (2016). Thinking orientation and preference for research
methodology. Journal of Consumer Marketing.
Skains, R. L., (2018). Creative practice as research: discourse on methodology. Media Practice
and Education, 19(1). pp.82-97.
Stewart, L. and Usher, K., 2010. The impact of nursing leadership on patient safety in a
developing country. Journal of clinical nursing. 19(21‐22). pp.3152-3160.