Lori A. Spies

Graduation Semester and Year




Document Type


Degree Name

Doctor of Philosophy in Nursing



First Advisor

Jennifer R Gray


Task shifting is an approach to meeting population health needs in developing countries that is encouraged by the WHO and increasingly embraced by Ministries of Health. Task shifting has been implemented formally and informally for years in areas of human resource shortages. While often used, there is a lack of published information available about how best to prepare nurses to take on the expanded role. The nursing intellectual capital (NIC) theory was the theoretical framework for this study. NIC is derived from a business model and is used to represent the manner in which investments in the nurse and healthcare infrastructure that supports the nurse increases the nurses' knowledge and skill set, thereby positively impacting patient outcomes. Nurse leaders in Kenya, Ethiopia, Uganda, and Tanzania were interviewed to explore task shifting practices and preparation. Fourteen interviews were conducted in person, via web-based communication, and telephone. Transcripts of the interviews were analyzed for themes. The major themes were "nurses' burden," "patient perception," "regulatory needs" and "nurse preparation". These reflect the common themes surrounding task shifting as conveyed by the nurse leaders. The major themes include those related to the nurses' burden in the presence of extreme healthcare provider shortages and the WHO push for task shifting. The best practice in education was explored in some detail and the need to create site and task specific education was clearly articulated by the nurse leaders. The theme that emerged was an undergirding for all aspects of task shifting related to policy and regulatory support. The need for clear policies about task shifting and a clearly defined nursing scope of practice were overarching and consistent themes.


Medicine and Health Sciences | Nursing


Degree granted by The University of Texas at Arlington

Included in

Nursing Commons