 Yr wyf yn ymlaen i ymddangos. Rydym hynny, daethaf yma yma, yn ymwneud hynny'n gwybod trwy'r cyfrifodol a'r cyfrifodol 21 miliwn cyfrifodol ar gyfer meddwl yn gweithio'r cyfrifodol. Cyddi'r cyfrifodol? Yn gyfrifodol, 42 miliwn cyfrifodol ar gyfer meddwl sydd fath o'r cyfrifodol ar gyfer meddwl yn gweithio'r cyfrifodol. Fath o'r cyfrifodol yn gweithio'r cyfrifodol ac ymddiolwyd ymddiolwyd yn ymddiolwyd. Mae'r 7 ysgol y meddwl meddwl yn y gweithio'r 20 ymddiolwyd o'r cyfnodol a'r cyfnodol. A'r hynny, 50%-21 miliwn yn ymddiolwyd. A dyna'r gweithio'r ysgol yn ymddiolwyd ymddiolwyd yn y gweithio'r gweithio'r gweithio'r gweithio. So, what are the possible solutions? What options do we have to start reducing the amount of these injuries? Nurses. Now I am a nurse, so obviously I'm a little biased. But nurses make up 80% of all healthcare professionals in developing countries. They are the largest and costliest group of healthcare professionals. They are the largest cohort of expats that MSF sections send to the field. And they are considered the largest untapped potential for improving quality medical care and reducing those 21 million injuries. And this is what's been keeping me awake at night. So, what did I do about it? I dedicated three months to understanding what we were missing. Where were we going wrong? I conducted a qualitative evaluation in Magbaraka Hospital on the Pediatric Ward in Sierra Leone. It's an MRH hospital supported by MSF. I spent time there getting to know the nurses and the caretakers. Caretakers being family members or friends who stay with the patient throughout their time in hospital. I really got to know their perspectives and opinions on what quality medical care was. I also was with the nurses throughout their shifts, seeing first hand the barriers they face in delivering quality medical care and hearing about those that I wasn't seeing. I also spent time looking at how quality nursing care can be evaluated to add to existing theory. And I did all this with the aim of understanding how nursing is critical to the provision of quality medical care in humanitarian settings. Nursing, like many professions, is complex and difficult to evaluate. So I developed a theoretical framework outlining the fundamental components of nursing care. And this helped me to develop interview questions and observation checklists. Like all research, I followed the usual steps. I received ethical approval from the London School of Hygiene and Tropical Medicine and local approval from the Ministry of Health in Magbaraka. I did a literature review, developed a theoretical framework, and I did data collection over a two week period where sampling was purposive and voluntary. I did 26 interviews, semi-structured, with both nurses and caretakers, and observation occurred throughout. I then analysed the data as soon as the data had been collected and used an inductive framework for themes to emerge naturally. And following the rule of three, three themes emerged. The first being holistic care. Nurses outlined holistic care as revolving around the administration of medication, fulfilling nursing tasks such as taking vital signs and communication, the cleanliness of the hospital and providing psychosocial care. But what we often forget is what happens when the nurse's attention is elsewhere. The patient is left in the hands of the caretakers, and I really wanted to know what their perspective on quality medical care was. Like nurses, caretakers outline the importance of the administration of medication. They also highlighted that for them it needed to be free. As this quote shows, a caretaker mentioned, some people, because of money, they are going to pay their children are dying at home. And he's highlighting the point that some caretakers don't bring their sick children to the hospital because of fear of the costs they will incur. Again, like nurses, caretakers highlighted the importance of nurses fulfilling nursing tasks such as taking vital signs, the cleanliness of the hospital and being offered psychosocial support. However, what they also mentioned, that the nurses had not mentioned, was the need for their child's and their own basic needs, food, water, shelter and sanitation to be met. And this brought to light two important points. Firstly, nurses were not involved in delivering care that met patient needs, and they were also unaware of where the patient's needs had been met. And secondly, caretakers were delivering this care. They were washing, dressing, feeding, mobilising and toileting patients, and therefore actually playing a critical role in providing quality medical care. The second theme to emerge was the nursing community. Here, nurses outlined a lack of leadership, support and motivation as impacting their ability to provide quality medical care. As you can see here, one nurse mentions, nurses need to be encouraged. Yes, if a nurse does a good thing, you need to give the nurse a plus. Now, this might not always be a medical priority, but it is an essential human need to get out of bed in the morning and want to do a good job. The final and third theme was organisational and systematic structures of care. Here, nurses outlined current limitations to the organisational and systematic structures of care, including the lack of resources such as medication and materials, but also a lack of systems such as communication. They would have to leave the ward to get any assistance from another nurse or a doctor. You may be sitting there thinking, Jaycee, we've heard that before, we've all seen it in the field, and sometimes it's just a matter of time before those systems and organisational structures get fixed. But sometimes it's those really obvious things that also get forgotten. This theme also outlined the prerequisites of what nurses and caretakers considered to make a good nurse. And both caretakers and nurses highlighted the need for training, with a caretaker outlining, because if you're trained good, you are going to do a perfect job. And very interestingly, and maybe ironically, it was actually the caretakers that highlighted more frequently the need for nurses to have a good salary. So, again, like all research, I had limitations. Participants during interviews may have given answers they thought would have been accepted, and during observation, nurses could have changed their behaviour. Also, I only interviewed caretakers who had brought their children to the hospital, and therefore the caretakers that were in the community, their opinions and perspectives could have differed. The findings are also only directly transferable in Sierra Leone. To conclude, in order to start reducing those 21 million preventable injuries I mentioned at the beginning, we need to start looking at nursing differently. Nurse managers need to acknowledge and take action regarding the barriers nurses are facing in delivering quality medical care, the organisational and systematic structures of care, and the lack of a nursing community. Evaluations of quality nursing care need to take everybody's perspective into account. This is really beneficial, understanding what the patients, the caretakers, the nurses, MSF and the MOH all think. Finally, a nursing model that is inclusive of the role of caretakers and is patient-centred, meaning that the care provided is based around meeting the patient's needs, would support nursing care to be more effective and therefore lead to improving the quality of medical care in Sierra Leone. Thank you.