(Geertz 1973) and so the search was not governed by the need for direct or concise `answers’. Text was manually coded, and organised under initial descriptive themes. These themes were iteratively improved through discussion between the reviewers. Due to the paucity of qualitative research on task shifting in sub-Saharan Africa, there was a great deal of variety between texts, and so line-?2016 The Authors. Journal of Clinical Nursing Published by John Wiley Sons Ltd. Journal of Clinical Nursing, 25, 2083?H Mijovic et al.by-line coding would have been tedious and potentially distracting. As such, codes were generated inductively and organised under 29 `descriptive themes’ (Thomas Harden 2008). A table showing the listing of these original descriptive themes is included in Appendix Table A3.Synthesis statementSuccessful task-shifting interventions are mindful of the professional jurisdictions of the staff who will be affected by the planned change and design the intervention in cooperation with them. Category 1 ?The professions involved must be aware of the need for a change, and their own role and professional identity should not be diminished as a result of the reform Task-shifting programmes introduced new professional and lay cadres of health workers, or changed the job roles of existing cadres. It should perhaps be obvious that such changes resulted in jurisdictional tensions between the professionals affected (Abbott 1988). An overarching theme emerging from both senior and frontline staff was the sentiment that the role of doctors and nurses in the healthcare system was being diminished through the task-shifting process. The mechanisms attributed to the role erosion included pushing highly skilled professionals out of the workplace (Study #1, #4, #5, #9), changes to one’s workload and work role (Study #3, #11, #12) and Ro4402257 site allowing for suboptimal quality of healthcare (Study #1). Although the specific categories of workload and suboptimal care are described in the next sections, it is important to remember that, more generally, the professions affected by the reform must be an active component of the change process rather than being alienated from it. Category 2 ?The intervention must result in a manageable workload for all affected staff Task shifting was widely welcomed and acceptable when it involved delegation of nonclinical tasks, including data collection, administrative work, ensuring treatment compliance and patient counselling. Health professionals felt that this kind of task shifting enabled them to focus on their `real’ work including clinical tasks and managerial duties. Introduction of a Monitoring Evaluation (M E) cadre in Botswana provided a particularly good example of a taskshifting intervention that health workers perceived as overwhelmingly beneficial to their work:So, when the district M E officers came in, they relieved the community health nurse in such a way that the community health nurse is able to go to facilities to attend to such programmes as child health and others. The district M E officer then took up [data responsibilities] for different HIV programmes. (District Manager, Botswana, Study # 8)SynthesisTo move beyond simple description and towards theory, the descriptive themes were then subjected to a further round of analysis. Again, following Thomas and Harden (2008), the aim was to generate `N-hexanoic-Try-Ile-(6)-amino hexanoic amide mechanism of action analytical themes’. Here, it was also possible to reintroduce the aims of the overall project ?to deriv.(Geertz 1973) and so the search was not governed by the need for direct or concise `answers’. Text was manually coded, and organised under initial descriptive themes. These themes were iteratively improved through discussion between the reviewers. Due to the paucity of qualitative research on task shifting in sub-Saharan Africa, there was a great deal of variety between texts, and so line-?2016 The Authors. Journal of Clinical Nursing Published by John Wiley Sons Ltd. Journal of Clinical Nursing, 25, 2083?H Mijovic et al.by-line coding would have been tedious and potentially distracting. As such, codes were generated inductively and organised under 29 `descriptive themes’ (Thomas Harden 2008). A table showing the listing of these original descriptive themes is included in Appendix Table A3.Synthesis statementSuccessful task-shifting interventions are mindful of the professional jurisdictions of the staff who will be affected by the planned change and design the intervention in cooperation with them. Category 1 ?The professions involved must be aware of the need for a change, and their own role and professional identity should not be diminished as a result of the reform Task-shifting programmes introduced new professional and lay cadres of health workers, or changed the job roles of existing cadres. It should perhaps be obvious that such changes resulted in jurisdictional tensions between the professionals affected (Abbott 1988). An overarching theme emerging from both senior and frontline staff was the sentiment that the role of doctors and nurses in the healthcare system was being diminished through the task-shifting process. The mechanisms attributed to the role erosion included pushing highly skilled professionals out of the workplace (Study #1, #4, #5, #9), changes to one’s workload and work role (Study #3, #11, #12) and allowing for suboptimal quality of healthcare (Study #1). Although the specific categories of workload and suboptimal care are described in the next sections, it is important to remember that, more generally, the professions affected by the reform must be an active component of the change process rather than being alienated from it. Category 2 ?The intervention must result in a manageable workload for all affected staff Task shifting was widely welcomed and acceptable when it involved delegation of nonclinical tasks, including data collection, administrative work, ensuring treatment compliance and patient counselling. Health professionals felt that this kind of task shifting enabled them to focus on their `real’ work including clinical tasks and managerial duties. Introduction of a Monitoring Evaluation (M E) cadre in Botswana provided a particularly good example of a taskshifting intervention that health workers perceived as overwhelmingly beneficial to their work:So, when the district M E officers came in, they relieved the community health nurse in such a way that the community health nurse is able to go to facilities to attend to such programmes as child health and others. The district M E officer then took up [data responsibilities] for different HIV programmes. (District Manager, Botswana, Study # 8)SynthesisTo move beyond simple description and towards theory, the descriptive themes were then subjected to a further round of analysis. Again, following Thomas and Harden (2008), the aim was to generate `analytical themes’. Here, it was also possible to reintroduce the aims of the overall project ?to deriv.
