Clinical competency of enrolled community health nurses trained by Kenya Medical Training College in level 2 and 3 public health facilities in Kenya

Abstract

Community Health Nurses (ECHNs) are a significant proportion of Kenya's nursing workforce and are the first point of contact in dispensaries and health centres, but the increasing number of ECHNs, overcrowded classrooms, lack of resources and low faculty to student ratios have led to concerns about the quality of their preparation. This study assessed the clinical competency of ECHN practitioners trained by Kenya Medical Training College (KMTC). A descriptive cross-sectional mixed-methods survey was carried out in level 2 and 3 public health facilities in seven regions of Kenya (Coast, Central, Western, Eastern, North Eastern, Nyanza and Rift Valley) guided by the product component of the Context, Input, Process and Product (CIPP) evaluation model between April and May 2024. Facilities were stratified by region and size, and all available ECHNs were included by census. Forty ECHNs completed an expert-validated questionnaire rating their ability to perform duties safely, proficiency in critical skills, application of theoretical knowledge and communication on five-point scales; 28 supervisors were key informants. Descriptive analysis of quantitative data was conducted using SPSS and open-ended responses were analysed thematically. Most ECHNs were deployed in maternity (22.5%), medical (15.0%) and ward (15.0%) units. No participant rated any competency domain below the moderate level. 60.0% rated ability to perform tasks safely and to standard as high and 5.0% rated it very high (M = 3.70, SD = 0.56); 62.5% rated critical skills as proficient or highly proficient (M = 3.78, SD = 0.70); 70.0% rated application of theoretical knowledge as effective or very effective (M = 3.85, SD = 0.66); and 87.5% rated communication as improved or very improved (M = 4.03, SD = 0.53). The mean for the composite competency was 3.84 out of 5. The most common demonstrations of competency were resuscitation (20.0%), medication administration (10.0%) and patient counselling (10.0%), and the most common skills requiring improvement were leadership and management (42.5%), stress management (25.0%) and care management and patient evaluation (15.0%). The study found that clinical competency of the ECHNs trained by KMTC was high but not uniform, with a significant proportion of the ECHNs in the moderately competent category (30.0% to 37.5% across domains) and the areas of leadership, stress management and clinical reasoning were identified as areas of weakness. It suggests that KMTC should enhance leadership, management, stress management and critical-thinking components in the ECHN curriculum, and that employers should offer structured continuing professional development for ECHNs in service, in resuscitation and emergency care through simulation-based training.