Date of Award

2013

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Alison Buttenheim

Abstract

SUSTAINABLE EMERGENCIES: THE PARADOX OF COMMUNITY

MANAGEMENT OF ACUTE MALNUTRITION PROGRAMS

Kelly Delaney, RN, MS, PHD

Alison Buttenheim, PHD, MBA

In 2008, the World Health Organization (WHO) formally endorsed the community management of acute malnutrition protocol as the preferred method of treatment for the approximately 13 million acutely malnourished children in the world (Collins, 2007; WHO, 2008). This protocol reflected a change in treatment strategies from the hospital to the community. Health care providers who respond to nutrition emergencies (referred to as emergency nutrition workers for the purpose of this study) were tasked with understanding the complex nature of a community's structure and culture, in addition to providing medical treatment for acutely malnourished children. To implement the WHO protocols successfully, emergency nutrition workers must be able to translate international standards into a culturally and contextually appropriate emergency nutrition program. This qualitative descriptive study describes the experience of emergency nutrition workers regarding community participation in program assessment, design, and implementation following declaration of a nutrition emergency.

There is a lack of understanding concerning what personal and professional beliefs and structures influence how emergency nutrition workers interpret their environment and define the community structure they are working within when developing assessment and implementation strategies. Bronfrenbrenner's (1977) social ecology theoretical framework was utilized to guide a review of literature concerning environmental influences that may affect community participation during emergency nutrition programs. In the study, a cross-sectional qualitative descriptive design was utilized in a deterritorialized setting. English speaking emergency nutrition workers who responded to a nutrition emergency as an employee of an international non-governmental organization in the previous twelve months were recruited through a maximum variation, purposeful sampling technique. Participants were recruited through professional networks, NGO headquarters, and an online professional forum until saturation is reached. Semi-structured interviews conducted by the researcher were the primary form of data collection for this study. Interviews were conducted over the Internet using voice over Internet protocol (VOIP) technology. Directed content analysis was utilized for data analysis.

The study results included an identification of five themes that influence the ways in which an emergency nutrition worker engages with local communities during Community Management of Acute Malnutrition (CMAM) programs: (1) Dimensions of Community in CMAM; (2) Learning Through Field Experience; (3) Partnerships for Success; (4) Disconnects in Funding Priorities; and (5) Sustainability in Emergencies.

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Nursing Commons

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