Robin Klar


Robin Toft Klar headshot

Robin Klar

Clinical Associate Professor

1 212 992 7013

433 First Avenue
Room 676
New York, NY 10010
United States

Accepting PhD students

Robin Klar's additional information

Robin Toft Klar is a clinical assistant 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

Awardee, Nurses with Global Impact 3rd Annual International Nurses Day, United Nations (2019)
Fellow, American Academy of Nursing (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)


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

Michel-Schuldt, M., Billy Dayon, M., Toft Klar, R., Subah, M., King-Lincoln, E., Kpangbala-Flomo, C., & Broniatowski, R. (2018). Midwifery, 62, 77-80. 10.1016/j.midw.2018.02.023
Background: Maternal and newborn mortality remains high in Liberia. There is a severe rural–urban gap in accessibility to health care services. A competent midwifery workforce is able to meet the needs of mothers and newborns. Evidence shows that competence can be assured through initial education along with continuous professional development (CPD). In the past, CPD was not regulated and coordinated in Liberia which is cpommon in the African region. Aim: To Support a competent regulated midwifery workforce through continuous professional development. Methodology: A new CPD model was developed by the Liberian Board for Nursing and Midwifery. With its establishment, all midwives and nurses are required to undertake CPD programmes consisting of certified training and mentoring in order to renew their practicing license. The new model is being piloted in one county in which regular mentoring visits that include skills training are being conducted combined with the use of mobile learning applications addressing maternity health issues. Quality control of the CPD pilot is assured by the Liberian Board for Nursing and Midwifery. The mentoring visits are conducted on a clinical level but are coordinated on the national and county level. Successes and sustainability: CPD using mobile learning on smartphones and regular mentoring visits not only improved knowledge and skills of midwives and nurses but also provided a solution to enhance accessibility in rural areas through improved communication and transportation, as well as improved career development of health personnel working in remote areas. Mentors were trained on a national, county, and health facility level in the pilot county with mentoring visits conducted regularly. Conclusion: The CPD programme of the Liberian Board for Nursing and Midwifery, currently in pilot-testing by various partners, aims to highlight the positive impact of the coordinating role of both the regulatory body and health authorities. Using regular process and programme reviews to improve capacity, knowledge, and skills of health professionals.

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

O’Hara, S., Klar, R. T., Patterson, E. S., Morris, N. S., Ascenzi, J., Fackler, J. C., & Perry, D. J. (2018). Health Environments Research and Design Journal, 11(2), 104-123. 10.1177/1937586717728484
Objectives: The objectives of this research were to describe the interactions (formal and informal), in which macrocognitive functions occur and their location on a pediatric intensive care unit, to describe challenges and facilitators of macrocognition using space syntax constructs (openness, connectivity, and visibility), and to analyze the healthcare built environment (HCBE) using those constructs to explicate influences on macrocognition. Background: In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple healthcare settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, “macrocognition in the healthcare built environment” (mHCBE) addresses this relationship. Method: A focused ethnographic study was conducted including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data. Results: Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs). Conclusions: Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help increase understanding of how use of the framework of Macrocognition in the HCBE can improve design and support adaptation of interprofessional team practices, maximizing macrocognitive interaction opportunities for patient, family, and team safety and quality.

The meaning of “capacity building” for the nurse workforce in sub-Saharan Africa: An integrative review

Ridge, L. J., Klar, R. T., Stimpfel, A. W., & Squires, A. (2018). International Journal of Nursing Studies, 86, 151-161. 10.1016/j.ijnurstu.2018.04.019
Background: “Capacity building” is an international development strategy which receives billions of dollars of investment annually and is utilized by major development agencies globally. However, there is a lack of consensus around what “capacity building” or even “capacity” itself, means. Nurses are the frequent target of capacity building programming in sub-Saharan Africa as they provide the majority of healthcare in that region. Objectives: This study explored how “capacity” was conceptualized and operationalized by capacity building practitioners working in sub-Saharan Africa to develop its nursing workforce, and to assess Hilderband and Grindle's (1996) “Dimensions of Capacity” model was for fit with “capacity's” definition in the field. Design: An integrative review of the literature using systematic search criteria. Data sources searched included: PubMed, the Cumulative Index for Nursing and Allied Health Literature Plus, the Excerpt Medica Database, and Web of Science. Review methods: This review utilized conventional content analysis to assess how capacity building practitioners working in sub-Saharan Africa utilize the term “capacity” in the nursing context. Content analysis was conducted separately for how capacity building practitioners described “capacity” versus how their programs operationalized it. Identified themes were then assessed for fit with Hilderband and Grindle's (1996) “Dimensions of Capacity” model. Results: Analysis showed primary themes for conceptualization of capacity building of nurses by practitioners included: human resources for health, particularly pre- and post- nursing licensure training, and human (nursing) resource retention. Other themes included: management, health expenditure, and physical resources. There are several commonly used metrics for human resources for health, and a few for health expenditures, but none for management or physical resources. Overlapping themes of operationalization include: number of healthcare workers, post-licensure training, and physical resources. The Hilderband and Grindle (1996) model was a strong fit with how capacity is defined by practitioners working on nursing workforce issues in sub-Saharan Africa. If overall significant differences between conceptualization and operationalization emerged, as the reader I want to know what these differences were. Conclusions: This review indicates there is significant informal consensus on the definition of “capacity” and that the Hilderbrand and Grindle (1996) framework is a good representation of that consensus. This framework could be utilized by capacity building practitioners and researchers as those groups plan, execute, and evaluate nursing capacity building programming.

Working Hard: Women's Self-Care Practices in Ghana

Theroux, R., Klar, R. T., & Messenger, L. (2013). Health Care for Women International, 34(8), 651-673. 10.1080/07399332.2012.736574
Women's health care providers have noted an increased infant mortality rate among Ghanaian immigrants. We conducted focus groups with 17 women in Ghana. We asked them how they maintained their health both before and during pregnancy. When discussing their health, women repeatedly described the conditions or context of their daily lives and the traditional practices that they used to stay healthy. Knowledge of women's lives, the health care system that they previously used, and their cultural practices can be utilized by health care providers to more fully assess their patients and design more culturally appropriate care for this group of women.

Next-of-kin's perspectives of end-of-life care

Boucher, J., Bova, C., Sullivan-Bolyai, S., Theroux, R., Klar, R., Terrien, J., & Kaufman, D. A. (2010). Journal of Hospice and Palliative Nursing, 12(1), 41-50. 10.1097/NJH.0b013e3181c76d53
The purpose of this article was to describe the next-of-kin's perspective of the end-of-life (EOL) experiences associated with the death of a family member or close friend. The quality of EOL care from the next-of-kin's perspective given to their loved one needs further study in the context of a community setting focus. A secondary analysis of data from a survey of a random sample of dying experiences in the community setting included qualitative descriptive analysis of open-ended survey data and content analysis used to count the number of positive, negative, mixed, and not applicable responses. Qualitative content analysis of 186 next-of-kin responses revealed two themes: (1) communication and (2) family values and preferences including three subthemes of having a supportive environment to secure a peaceful death with dignity and respect, the desire to be present at the time of death, and attending to the needs and wishes of the dying individual and family. The need for palliative care services in institutionalized settings, continuity of provider care (physician and nurse), family presence, and support for caregiver and financial concerns with hospice services was identified. Communication remains an essential component in all aspects of EOL care with further examination involving the loved one's perspectives.

The Research Advisory Committee: An Effective Forum for Developing a Research Dynamic Environment

Howland, L., Sullivan-Bolyai, S., Bova, C., Klar, R., Harper, D., & Schilling, L. (2008). Journal of Professional Nursing, 24(4), 241-245. 10.1016/j.profnurs.2007.10.005
This article describes the role of a committee in the Graduate School of Nursing at the University of Massachusetts, Worcester, that is referred to as the research advisory committee. It was developed to sustain the research mission, to facilitate faculty scholarship, and to provide a venue for presubmission grant review (hence called mock review) in a graduate school of nursing that is not considered "research intensive." We present its historical framework, the development of a mock review process, faculty accomplishments thus far, and our plans for the future. It is hoped that our experiences of building and supporting faculty research efforts in a research dynamic environment may provide guidance for others working in similar institutions.