abstract: 'Introduction In many African countries, including Kenya, a major barrier

  to achieving child survival goals is the slow decline in neonatal

  mortality that now represents 45\% of the under-5 mortality. In newborn

  care, nurses are the primary caregivers in newborn settings and are

  essential in the delivery of safe and effective care. However, due to

  high patient workloads and limited resources, nurses may often

  consciously or unconsciously prioritise the care they provide resulting

  in some tasks being left undone or partially done (missed care). Missed

  care has been associated with poor patient outcomes in high-income

  countries. However, missed care, examined by direct observation, has not

  previously been the subject of research in low/middle-income countries.

  Methods and analysis The aim of this study is to quantify essential

  neonatal nursing care provided to newborns within newborn units. We will

  undertake a cross-sectional study using direct observational methods

  within newborn units in six health facilities in Nairobi City County

  across the public, private-for-profit and private-not-for-profit

  sectors. A total of 216 newborns will be observed between 1 September

  2017 and 30 May 2018. Stratified random sampling will be used to select

  random 12-hour observation periods while purposive sampling will be used

  to identify newborns for direct observation. We will report the overall

  prevalence of care left undone, the common tasks that are left undone

  and describe any sharing of tasks with people not formally qualified to

  provide care.

  Ethics and dissemination Ethical approval for this study has been

  granted by the Kenya Medical Research Institute Scientific and Ethics

  Review Unit. Written informed consent will be sought from mothers and

  nurses. Findings from this work will be shared with the participating

  hospitals, an expert advisory group that comprises members involved in

  policy-making and more widely to the international community through

  conferences and peer-reviewed journals.'
affiliation: 'Gathara, D (Corresponding Author), Kenya Govt Med Res Ctr, Dept Publ
  Hlth Res, Wellcome Trust Res Programme, Nairobi, Kenya.

  Gathara, David; Serem, George; Murphy, Georgina A. V.; Abuya, Nancy; English, Mike,
  Kenya Govt Med Res Ctr, Dept Publ Hlth Res, Wellcome Trust Res Programme, Nairobi,
  Kenya.

  Murphy, Georgina A. V.; English, Mike, Univ Oxford, Nuffield Dept Med, Oxford, England.

  Murphy, Georgina A. V.; English, Mike, Univ Oxford, Dept Paediat, Oxford, England.

  Abuya, Nancy, Nairobi City Cty, Dept Curat \& Preventat Serv, Nairobi, Kenya.

  Kuria, Rose, Kenya Med Training Coll, Dept Nursing, Nairobi, Kenya.

  Tallam, Edna, Nursing Council Kenya, Dept Registrat \& Licensing, Nairobi, Kenya.'
article-number: e022020
author: Gathara, David and Serem, George and Murphy, Georgina A. V. and Abuya, Nancy
  and Kuria, Rose and Tallam, Edna and English, Mike
author-email: DGathara@kemri-wellcome.org
author_list:
- family: Gathara
  given: David
- family: Serem
  given: George
- family: Murphy
  given: Georgina A. V.
- family: Abuya
  given: Nancy
- family: Kuria
  given: Rose
- family: Tallam
  given: Edna
- family: English
  given: Mike
da: '2023-09-28'
doi: 10.1136/bmjopen-2018-022020
files: []
issn: 2044-6055
journal: BMJ OPEN
keywords: neonatology
keywords-plus: 'QUALITY EVALUATION; LEFT UNDONE; HOSPITALS; COUNTRIES; HEALTH; PATTERNS;

  WEEKEND; DEATHS; NURSES'
language: English
month: SEP
number: '7'
number-of-cited-references: '38'
orcid-numbers: Gathara, David/0000-0002-0958-0713
papis_id: cca50ea7d5eb992e27f177619ca0737e
ref: Gathara2018quantifyingnursing
times-cited: '7'
title: 'Quantifying nursing care delivered in Kenyan newborn units: protocol for a
  cross-sectional direct observational study'
type: article
unique-id: WOS:000446181900181
usage-count-last-180-days: '0'
usage-count-since-2013: '4'
volume: '8'
web-of-science-categories: Medicine, General \& Internal
year: '2018'