Positive relationships strengthen nurses' performance in low-income countries

Global health inequities between high- and low-income countries are very persistent, despite advances in knowledge, technology, and international aid investment. Sustainable solutions require strong national health systems, and a strong health workforce.

Alison Hernández, PhD candidate at the Department of Public Health and Clinical Medicine, Umeå University, has studied pathways for supporting the performance of the auxiliary nurses (similar to undersköterska in Sweden) who are on the front-lines serving vulnerable indigenous communities in rural Guatemala.

"Our studies show that working relationships with managers and community supporters that were based in collaboration towards shared goals helped auxiliary nurses to provide better care and respond to local needs," says Alison Hernández.

In her dissertation research, she focused on how the auxiliary nurses' performance in health promotion is influenced by their relationships with key people in the rural communities. The research shows that cooperation between the auxiliary nurses and the local leaders is facilitated by their shared ethnic identity and language.

Auxiliary nurses are managed by professional nurses, and their relationships are most often based on monitoring criteria and standards in the programs of care they implement, and checking on completion of paperwork. Managers in the study who had a more holistic view of patient care, and who tried to understand the auxiliary nurses' needs were more successful in motivating them in their work.

"Interpersonal relationships were the most important factor enabling auxiliary nurses to confront the difficult working conditions that are common in low-income countries. In order to provide care that responds to patient and community needs, it is critical to go beyond standards and give attention to human dimensions of care. Basic professional values of caring can provide guidance for strengthening health service delivery and management, and these values were very meaningful for nurses in this low-resource setting" says Alison Hernández.

She believes that the results of the thesis demonstrate new directions and opportunities to strengthen health care in low-income countries.

"The focus of my research is unique. Most studies of the health workforce have examined how to attract health professionals from cities to rural areas, and what kinds of incentives work to get them to stay there. I started with the health workers who are already there -- the auxiliary nurses -- and I identified ways the health system can strengthen organizational support for their performance," says Alison Hernandez.