Robin Toft Klar headshot

Robin Klar

Clinical Assistant Professor

1 212 992 7013

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

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Professional overview

Dr. Toft Klar has focused her work on the environmental context of nursing for decades. This work has evolved and her research focuses on the influence of the built environment on population health outcomes and care delivery locally and globally. She has a portfolio of health workforce projects in LMIC’s in West and East Africa.


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

Honors and awards

Educational Achievement Award, University of Massachusetts - Worcester (2009)
Leadership Award, Fitchburg State College (2003)
Comprehensive Geriatric Education and Mentoring Across Settings Program Grant, Fellow, University of Massachusetts, Worcester, MA (2013)
Career Development Institute: The Rosalie Wolf Interdisciplinary Geriatric Healthcare Research Center Fellow, University of Massachusetts, Worcester, MA (2008)


Community/population health
Nursing workforce
Oral-systemic health

Professional membership

American Public Health Association
Boston Medical Services, Ghana
Massachusetts Public Health Association
Sigma Theta Tau International, Epsilon Beta



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.