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

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)


Integrating Climate Change in the Curriculum: Using Instructional Design Methods to Create an Educational Innovation for Nurse Practitioners in a Doctor of Nursing Practice Program

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Design and outcomes of a nurse practitioner preceptor development program

Hallas, D., Haber, J., Biesecker, B., Hartnett, E., Toft Klar, R., Djukic, M., Apold, S., Vetter, M. J., McMillan, A., Brilliant, M., Baldyga, J. A., Waingortin, R., & Fletcher, J. (2021). Journal of the American Association of Nurse Practitioners, 33(11), 1007-1016. 10.1097/JXX.0000000000000570
ABSTRACT: Nurse practitioners (NPs) are educated to provide high-quality patient- and family-centered care to underserved, culturally diverse, medically complex populations. Nurse practitioner faculty plan curricular activities that challenge NP students to critically assess individuals and populations with the goal of preparing NP students to be "practice-ready" upon graduation. Nurse practitioner clinical training occurs in practice settings with NP preceptors, with specific areas of clinical expertise. However, there is a lack of NP clinical preceptors educationally prepared to clinically teach and evaluate NP students. This article presents the design, implementation, evaluation, and outcomes from a 3-year grant funded by the United States Human Resources and Administration Services that featured a web-based Primary Care Nurse Practitioner Preceptor Development Program. Ninety percent of NPs who precepted NP students completed all web-based learning modules. Preceptors with educational preparation via online modules to guide NP student learning in clinical settings are a critical resource for faculty to prepare NP students to be practice-ready upon graduation. This web-based learning platform for online NP preceptor education may be a successful approach for expanding and improving the NP preceptor pool nationwide.

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.

Gaps and opportunities in hiv service delivery in high volume hiv care centers in liberia: Lessons from the field

Adeiza, M. A., Wachekwa, I., Nuta, C., Donato, S., Koomson, F., Whitney, J., Plyler, C., Kerr, L., Sackey, G., Dunbar, E., Talbert-Slagle, K., Klar, R., Marsh, R. H., Caldwell, S., Toomey, J., & Ogbuagu, O. (2021). Annals of Global Health, 87(1). 10.5334/aogh.3246
Background: Human Immunodeficiency Virus (HIV) infection continues to have a profound humanitarian and public health impact in western and central Africa, a region that risks being left behind in the global response to ending the AIDS epidemic. In Liberia, where the health system is being rebuilt following protracted civil wars and an Ebola virus disease outbreak, the Resilient and Responsive Health System (RRHS) is assisting with quality HIV services delivery through support from PEPFAR and HRSA but gaps remain across the cascade of care from diagnosis to viral load suppression. Objective: To highlight gaps in HIV service delivery in Liberia, identify opportunities and offer recommendations for improving the quality of service delivery. Methods: A narrative review of relevant literature was conducted following a search of all local and online databases known to the authors. Findings: Antiretroviral therapy (ART) has transformed the HIV response in Liberia by averting deaths, improving quality of life, and preventing new HIV infections but critical gaps remain. These include weak HIV prevention and testing strategies; suboptimal ART initiation and retention in care; low viral load testing volumes, commodity supply chain disruptions and a HIV workforce built on non-physician healthcare workers. In the context of the prevailing socioeconomic, heath system and programmatic challenges, these will impact achievement of the UNAIDS targets of 95-95-95 by 2030 and ending the epidemic. Conclusion: Combination prevention approaches are necessary to reach the most at risk populations, while a robust health workforce operating through facilities and communities will be needed to reach people with undiagnosed HIV earlier to provide efficient and effective services to ensure that people know their HIV status, receive and sustain ART to achieve viral suppression to maintain a long and healthy life within the framework of overall health system strengthening, achieving universal health coverage and the sustainable development goal.

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

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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

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

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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.