Robin Klar


Robin Toft Klar headshot

Robin Klar

Clinical Associate Professor

1 212 992 7013
Accepting PhD students

Robin Klar's additional information

Robin Toft Klar is a clinical associate professor at NYU Rory Meyers College of Nursing. Her work focuses on the environmental context of nursing for decades. As nursing has evolved, her research has focused on the influence of the built environment on population health outcomes and care delivery locally and globally. She has a portfolio of health workforce/capacity-building projects in low- and middle-income countries in West and East Africa. Her capacity-building projects have supported a robust South-to-South shift, furthering their sustainability. She is a fellow of the American Academy of Nursing.

Among her many awards, Toft Klar received the Nurses with Global Impact Award from the United Nations in 2019, and a recognition award in 2016 from the Rwanda Ministry of Health-Human Resources for Health Division.

Toft Klar earned her DNSc at Yale University, MS at Boston College, and BSN at Fitchburg State College. She completed a post-doc at Case Western University.

Post-Doc - Case Western University (2012)
DNSc - Yale University (2002)
MS - Boston College (1980)
BSN - Fitchburg State College (1979)
Diploma - Worcester City Hospital School of Nursing (1975)

Community/population health
Nursing workforce
Oral-systemic health

American Public Health Association
American Nurses Association
Boston Medical Services, Ghana
Eastern Nursing Research Society
Global Nursing Caucus
NGO Health Committee
Massachusetts Public Health Association
Massachusetts Nurses Association
Sigma Theta Tau International, Upsilon Chapter

Faculty Honors Awards

Fellow, American Academy of Nursing (2019)
Awardee, Nurses with Global Impact 3rd Annual International Nurses Day, United Nations (2019)
Recognition, Rwanda Ministry of Health-Human Resources for Health Division (2016)
Fellow, Comprehensive Geriatric Education and Mentoring Across Settings Program Grant, UMass, Worcester (2013)
Educational Achievement Award, University of Massachusetts - Worcester (2009)
Fellow, Career Development Institute: The Rosalie Wolf Interdisciplinary Geriatric Healthcare Research Center, UMass, Worcester (2008)
Leadership Award, Fitchburg State College (2003)


Facing COVID-19 in Liberia: Adaptations of the resilient and responsive health systems initiative

Marsh, R. H., Plyler, C., Miller, M., Klar, R., Adeiza, M., Wachekwa, I., Koomson, F., Garlo, J. L., Kruah, K., Lake, S. C., Matte, R., Cook, R., Maweu, D., Kerr, L., Ogbuagu, O., Talbert-Slagle, K., & Dahn, B. (2021). Annals of Global Health, 87(1). 10.5334/aogh.3245
The 5-year Resilient and Responsive Health Systems (RRHS)-Liberia Initiative, funded by PEPFAR via HRSA, launched in 2017 and was designed to support the implementation of Liberia’s National Health Workforce Program as a means to improving HIV-related health outcomes. The COVID-19 pandemic, arrived in Liberia just five years after Ebola and during RRHS-Liberia’s fourth year, impacted educational programs and threatened the project’s continued work. This paper presents the challenges that the COVID-19 pandemic posed to the RRHS partners, as well as adaptations they made to maintain progress towards project goals: 1) contributing to Liberia’s 95-95-95 HIV targets via direct service delivery, and 2) building a resilient and responsive health workforce in Liberia via instruction and training. Direct health service impacts included decreased patient volumes and understaffing; adaptations included development of and trainings on safety protocols, provision of telehealth services, and community health worker involvement. Instruction and training impacts included suspension of in-person teaching and learning; adaptations included utilization of multiple online learning and virtual conferencing tools, and increasing clinical didactics in lieu of bedside mentorship. The RRHS team recommends that these adaptations be continued with significant investment in technology, IT support, and training, as well as close coordination among partner institutions. Ultimately, the RRHS Liberia consortium and its partners made significant strides in response to ensuring ongoing education during the pandemic, an experience that will inform continued service delivery, teaching, and learning in Liberia.

How clinicians manage routinely low supplies of personal protective equipment

Ridge, L. J., Stimpfel, A. W., Dickson, V. V., Klar, R. T., & Squires, A. P. (2021). American Journal of Infection Control, 49(12), 1488-1492. 10.1016/j.ajic.2021.08.012
Background: Recommended personal protective equipment (PPE) is routinely limited or unavailable in low-income countries, but there is limited research as to how clinicians adapt to that scarcity, despite the implications for patients and workers. Methods: This is a qualitative secondary analysis of case study data collected in Liberia in 2019. Data from the parent study were included in this analysis if it addressed availability and use of PPE in the clinical setting. Conventional content analysis was used on data including: field notes documenting nurse practice, semi-structured interview transcripts, and photographs. Results: Data from the majority of participants (32/37) and all facilities (12/12) in the parent studies were included. Eighty-three percent of facilities reported limited PPE. Five management strategies for coping with limited PPE supplies were observed, reported, or both: rationing PPE, self-purchasing PPE, asking patients to purchase PPE, substituting PPE, and working without PPE. Approaches to rationing PPE included using PPE only for symptomatic patients or not performing physical exams. Substitutions for PPE were based on supply availability. Conclusions: Strategies developed by clinicians to manage low PPE likely have negative consequences for both workers and patients; further research into the topic is important, as is better PPE provision in low-income countries.

Infection Prevention and Control in Liberia 5 Years After Ebola: A Case Study

Ridge, L. J., Stimpfel, A. W., Klar, R. T., Dickson, V. V., & Squires, A. P. (2021). Workplace Health and Safety, 69(6), 242-251. 10.1177/2165079921998076
Background: Effective management of health emergencies is an important strategy to improve health worldwide. One way to manage health emergencies is to build and sustain national capacities. The Ebola epidemic of 2014 to 2015 resulted in greater infection prevention and control (IPC) capacity in Liberia, but few studies have investigated if and how that capacity was sustained. The purpose of this study was to examine the maintenance of IPC capacity in Liberia after Ebola. Methods: For this case study, data were collected via direct observation of nurse practice, semistructured interviews, and document collection. Data were collected in two counties in Liberia. Data were analyzed using directed content and general thematic analysis using codes generated from the safety capital theoretical framework, which describes an organization’s intangible occupational health resources. Findings: Thirty-seven nurses from 12 facilities participated. Ebola was a seminal event in the development of safety capital in Liberia, particularly regarding nurse knowledge of IPC and facilities’ investments in safety. The safety capital developed during Ebola is still being applied at the individual and organizational levels. Tangible resources, including personal protective equipment, however, have been depleted. Conclusions/Application to Practice: IPC capacity in Liberia had been sustained since Ebola but was threatened by under-investments in physical resources. Donor countries should prioritize sustained support, both financial and technical, in partnership with Liberian leaders. Occupational health nurses participating in disaster response should advocate for long-term investment by donor countries in personal protective equipment, access to water, and clinician training.

Normal physiologic birth continuing professional development: From a national health priority to expanded capacity

Shakpeh, J. K., Tiah, M. W., Kpangbala-Flomo, C. C., Matte, R. F., Lake, S. C., Altman, S. D., Tringali, T., Stalonas, K., Goldsamt, L., Zogbaum, L., & Klar, R. T. (2021). Annals of Global Health, 87(1). 10.5334/aogh.3247
Background: The Republic of Liberia has experienced many barriers to maintaining the quality of its healthcare workforce. The Resilient and Responsive Health Systems (RRHS) Initiative supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has responded to Liberian identified health priorities. Liberia’s maternal morbidity and mortality rates continue to rank among the highest in the world. Recent country regulations have put forth required continuing professional development (CPD) for all licensed healthcare workers for re-licensure. Methods: The Model for Improvement was the guiding framework for this CPD to improve midwifery and nursing competencies in assisting birthing women. Two novel activities were used in the CPD. We tested the formal CPD application and approval process as this is a recent regulatory body policy. We also included the use of simulation and its processes as a pedagogical method. Over a two-year period, we developed a two-day CPD module, using didactic training and clinical simulation, for Liberian midwives. We then piloted the module in Liberia, training a group of 21 participants, including midwives and nurses, including pre-and post-test surveys as well as observational evaluation of participant skills. Findings: There were no significant changes in knowledge acquisition noted in the post-test. Small tests of change were implemented during the program, supporting the stages of the Model of Improvement. Observation of skill acquisition was done; however, using a formal observation checklist, such as an Observed Structured Clinical Evaluation (OSCE), would add more robust findings. The CPD and follow-up activity highlighted the need for human and financial support to maintain the simulation kits and to create sustainability for future trainings. Videotaping the didactic and simulation two-day continuing professional development train-the-trainer workshop expands the sustainability beyond newly prepared trainers. Simultaneous with this CPD, the Liberian Board for Nursing and Midwifery (LBNM) worked with a partner to create a CPD portal. The CPD partners created modules from the videos and have uploaded these modules to the LBNM’s new CPD portal. Conclusions: Using a quality improvement model as a framework for developing and implementing CPDs provides a clear structure and supports the dynamic interactions in learning and clinical care. It is too soon to determine measurable health outcomes resulting from this project. Anecdotal feedback from clinicians and leaders was not directly related to the content of the CPD; however, it does demonstrate an increased awareness of examining changes in practice to support expanded health outcomes. Further research to examine methods and processes to determine the quality and safety outcomes of CPD trainings is necessary.

Structure, process, and outcomes of liberian national nursing and midwifery curricular revisions

Kpangaala-Flomo, C. C., Tiah, M. W., Clinton Zeantoe, G., Loweal, H. G., Matte, R. F., Lake, S. C., Altman, S., Mendoza, M., Tringali, T., Stalonas, K., Goldsamt, L., Kurz, R., Zogbaum, L., & Toft Klar, R. (2021). Annals of Global Health, 87(1). 10.5334/aogh.3248
Background: The Republic of Liberia has had major disruptions to the education of its health care cadres. Post Ebola, the Resilient and Responsive Health Systems (RRHS) initiative began a new era of capacity building with the support of PEPFAR and HRSA. Nursing and Midwifery serve as the largest healthcare cadres in Liberia. The national nursing and midwifery curricula were overdue for the regulated review and revisions. Methods: The Science of Improvement was used as the framework to accomplish this multilateral activity. The Institute for Healthcare Improvement’s (IHI) stages of improvement included: 1) Forming the team, 2) Setting the aims, 3) Establishing measures, 4) Selecting measures, 5) Testing changes, 6) Implementing changes, and 7) Spreading changes. These stages served as the blueprint for the structures and processes put into place to accomplish this national activity. Findings: The RN, Bridging, and BScM curricula all had redundant content that did not reflect teaching pedagogy and health priorities in Liberia. Courses were eliminated or reconfigured and new courses were created. Development of Nursing and Midwifery Curricular Taskforces were not as successful as was hoped. Two large stakeholder meetings ensured that this was the curricula of the Liberian faculty, deans and directors, and clinical partners. Monitoring and evaluation tools have been adopted by the Liberian Board for Nursing and Midwifery to serve as another improvement to check that the new curricula are being implemented and to identify gaps that may require future cycles of change for continued quality and improvement.

Nurse Educators as Agents of Change in the SARS-CoV-2 Pandemic

Klar, R. T. (2020). Nursing for Women’s Health, 24(4), 253-255. 10.1016/j.nwh.2020.05.010
The coronavirus pandemic caused a rapid and seismic shift in the provision of nursing education. In this commentary, I provide examples of how faculty and students at my university made the shift and what we have learned from the experience thus far.

Traditional and Nontraditional Collaborations to Improve Population Health Using Geospatial Information SystemMaps: Analysis of the Opioid Crisis

Hallas, D., Klar, R. T., Baldyga, J. A., Rattner, I., Waingortin, R., & Fletcher, J. (2019). Journal of Pediatric Health Care, 33(3), 309-322. 10.1016/j.pedhc.2018.10.006
Introduction: The study aims were to analyze interprofessional practice collaborations among traditional and nontraditional health care providers and to educate nurse practitioner preceptors and students on population health, specifically, implementation of geospatial information system (GIS) maps and the correlation with the opioid crisis. Methods: A descriptive analysis was used to examine New York State data on the opioid crisis in comparison to outcome data from GIS maps of opioid use in two boroughs in New York City. Web-based modules were designed for analysis of GIS maps of opioid use near practice settings. Results: New York State data provided context for local opioiduse, while GIS maps identified specific areas of the New York City boroughs that were most affected by the opioid epidemic. Discussion: The importance of local GIS maps is that the information is available in real-time, and thus interventions can be designed, evaluated, and changed quickly to meet the immediate needs of the community.

Continuous professional development of Liberia's midwifery workforce—A coordinated multi-stakeholder approach

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Health professional training and capacity strengthening through international academic partnerships: The first five years of the human resources for health program in rwanda

Cancedda, C., Cotton, P., Shema, J., Rulisa, S., Riviello, R., Adams, L. V., Farmer, P. E., Kagwiza, J. N., Kyamanywa, P., Mukamana, D., Mumena, C., Tumusiime, D. K., Mukashyaka, L., Ndenga, E., Twagirumugabe, T., Mukara, K. B., Dusabejambo, V., Walker, T. D., Nkusi, E., Bazzett-Matabele, L., Butera, A., Rugwizangoga, B., Kabayiza, J. C., Kanyandekwe, S., Kalisa, L., Ntirenganya, F., Dixson, J., Rogo, T., McCall, N., Corden, M., Wong, R., Mukeshimana, M., Gatarayiha, A., Ntagungira, E. K., Yaman, A., Musabeyezu, J., Sliney, A., Nuthulaganti, T., Kernan, M., Okwi, P., Rhatigan, J., Barrow, J., Wilson, K., Levine, A. C., Reece, R., Koster, M., Moresky, R. T., O’flaherty, J. E., Palumbo, P. E., Ginwalla, R., Binanay, C. A., Thielman, N., Relf, M., Wright, R., Hill, M., Chyun, D., Klar, R. T., McCreary, L. L., Hughes, T. L., Moen, M., Meeks, V., Barrows, B., Durieux, M. E., McClain, C. D., Bunts, A., Calland, F. J., Hedt-Gauthier, B., Milner, D., Raviola, G., Smith, S. E., Tuteja, M., Magriples, U., Rastegar, A., Arnold, L., Magaziner, I., & Binagwaho, A. (2018). International Journal of Health Policy and Management, 7(11), 1024-1039. 10.15171/ijhpm.2018.61
Background: The Rwanda Human Resources for Health Program (HRH Program) is a 7-year (2012-2019) health professional training initiative led by the Government of Rwanda with the goals of training a large, diverse, and competent health workforce and strengthening the capacity of academic institutions in Rwanda. Methods: The data for this organizational case study was collected through official reports from the Rwanda Ministry of Health (MoH) and 22 participating US academic institutions, databases from the MoH and the College of Medicine and Health Sciences (CMHS) in Rwanda, and surveys completed by the co-authors. Results: In the first 5 years of the HRH Program, a consortium of US academic institutions has deployed an average of 99 visiting faculty per year to support 22 training programs, which are on track to graduate almost 4600 students by 2019. The HRH Program has also built capacity within the CMHS by promoting the recruitment of Rwandan faculty and the establishment of additional partnerships and collaborations with the US academic institutions. Conclusion: The milestones achieved by the HRH Program have been substantial although some challenges persist. These challenges include adequately supporting the visiting faculty; pairing them with Rwandan faculty (twinning); ensuring strong communication and coordination among stakeholders; addressing mismatches in priorities between donors and implementers; the execution of a sustainability strategy; and the decision by one of the donors not to renew funding beyond March 2017. Over the next 2 academic years, it is critical for the sustainability of the 22 training programs supported by the HRH Program that the health-related Schools at the CMHS significantly scale up recruitment of new Rwandan faculty. The HRH Program can serve as a model for other training initiatives implemented in countries affected by a severe shortage of health professionals.

Macrocognition in the Healthcare Built Environment (mHCBE): A Focused Ethnographic Study of “Neighborhoods” in a Pediatric Intensive Care Unit

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