A Training-of-Trainers Program for Nurses in Tanzania: ICU Standards of Care, Documentation, and Communication

We present one method of a Training-of-Trainers (ToT) program supported by a partnership between a low-middle income country (LMIC) hospital and a high income country (HIC) organization through lectures, group discussions, assessments, and bedside coaching over a period of two weeks. The goal was to build capacity in ICU nurses by teaching standards of care and documentation, improving interdisciplinary communication, and scaling up participants’ knowledge and comfort levels in providing quality care. Nurse educators from the Alliance for Global Clinical Training (Alliance) designed the program and conducted the critical care nursing curriculum. Topics were selected by Muhimbili National Hospital (MNH) nursing peers who also provided facility information. Understanding what resources and infrastructure are routinely available is essential to applying concepts to practice. The MNH administrative team and nursing education liaison sought out the best suited participants. Identifying talent in participants for ToT programs is crucial to their success. Nurse participants were chosen as effective representatives of their individual units to be future agents of change. Participants described what they most wanted from the program, including: increased knowledge in documentation, communication, and overall critical care specialized training. Pre- and post-knowledge assessments tested critical care knowledge. The nursing process ADPIE (Assessment, Diagnosis, Problem, Intervention, Evaluation) and SBAR communication (Situation, Background, Assessment, Recommendation) were provided tools for standard operating procedures which enhance interdisciplinary management of care. Clear and consistent documentation with ADPIE requires clinical assessment and evidence-based diagnoses. Standardized communication with SBAR provides an organized framework to professionally relay critical information and provide recommendations. All materials were provided in an open-access format for the program to be easily replicated by the participants. A long-term goal of this training was to assess impact and sustainability.