Creating a Global Nursing Fellowship: Improving Pediatric Health Worldwide through Nursing Excellence 201 7 ANCC National Magnet Conference Within Session: C 547 Nursing's Global Focus Thursday, October 12 , 201 7 : 1100-1200 Marilyn Moonan, MSN, RN, CPN Boston Children’s Hospital, Boston, Ma.
The presenter for this presentation has disclosed no conflict of interest related to this topic 2
Development of BCH Global Health Program: Strategic Priorities Quality Care Delivery – Become a leader in improving the quality of clinical care for children in resource limited areas Education – Build on our strengths in clinical training and excellence in education Research – Clinical innovation and research for resource limited settings Advocacy – Advocate for child health policies locally, nationally and internationally at all sites of work 3
Global Health Nursing Fellowship Values: • Community: Target resource limited regions • Excellence: Strive for excellence in clinical care, education & research • Leadership: Be leaders for improving healthcare in global settings • Sensitivity: Recognize needs of pediatric patients and their families regardless of where and in what capacity we are working • Partnership: Develop strong partnerships & foster multidisciplinary collaboration • Sustainability: Work with partners for sustainable change & knowledge transfer • Outcomes: Develop strong metrics to evaluate all global health initiatives 4
Nuts and Bolts of the Programs • Nurses selected annually through competitive application process • Fellows: 1 year term; Director: 3 year term • Key elements of the Fellowship include: – curriculum with seminar series – research day – clinical skills week – participation in networking – travel to international sites to implement sustainable projects. 5
• Nuts & Bolts of the Program • Fellowship provides funding and protected time for education & field work • Each GH nursing fellow receives a discretionary fund of $8,000 for: • Global health education • Field work • Program building 6
Nursing Challenges in Resource Limited Settings Nurses are the largest work force in health care yet face significant challenges • High patient: nurse ratios • High nursing workload associated with poor patient outcomes • Lack of specialized education and clinical training • Poor image/understanding of professional nursing in many parts of the world • Hierarchical structure of healthcare limits nurses’ role in decision -making • Perceived authority/directives of physicians hinders independent role of nurses • Absence of interprofessional teamwork • Low salaries • Limited sub-specialty opportunities for nurses 7
2015 Nursing Fellows Global Projects • Myanmar- “Just in time” & formal pediatric nursing seminars Yangon, Myanmar • Ghana- Nursing education, IQIC & long term patient follow up • Haiti- Development & implementation of nursing NICU/PICU curriculum 8
Formal Teaching & “Just in Time” Teaching 10
Myanmar Education Topics • 15 nurses: Helping Babies Breathe • 20 Nursing students & nurses: The child with respiratory dysfunction, The child with GI dysfunction, Pediatric health assessment, Pediatric growth & development, Infection control,, IV infiltration & phlebitis • 26 Nurses, Pediatric Surgeon, Nephrologist: The child with renal dysfunction & transplant • 68 Nurses: Error prevention training, Pressure ulcers, Recognition & management of shock 11
12 Helping Babies Breathe
Error Prevention Tool Kit
Haiti 14
Developed and implemented a NICU/PICU curriculum for Haitian nurses Combined didactic and clinical experiences over several months Evaluation of nurses included exams, competencies, course project and class performance Team composition from BCH 41 nurses 1 pharmacist 1 physician 1 project coordinator 15
Curriculum Content Communication Cardiology I & II Ethics Infectious Disease Growth & Development Gastrointestinal Disease Medication calculations & safety Endocrine Disease Pulmonary I & II Integumentary disease Neurology I & II Renal disease Fluid, Electrolytes & Nutrition Genitourinary disease Hematology Trauma Pediatric Resuscitation Sepsis Care for the Family in Crisis Bereavement Care 16
Haitian Nurses Impacted • 26 nurses participated in neonatal course • 22 nurses participated in pediatric course • 11 hospitals represented across Haiti • Nurses selected for course participation were identified as leaders in their respective areas • Upon completion of course, participants will provide training at their local hospital 17
• 1200 clinical hours (1140 hours by nursing) • 960 lecture hours directly spent teaching: (912 hours by nursing) • 240 hours on student evaluations, debriefing and handoff (228 hours by nursing) 18
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Komfo Ankoye Teaching Hospital (KATH) in Kumasi, Ghana • Since 2007, over 1000 children have been screened for congenital heart defects • 99 cardiac surgeries and/or procedures have been performed (Tetralogy of Fallot, closure of ventricular septal defects and ligation of patent ductus arteriosus) • Goal: – To identify & care for pediatric patients with congenital heart disease – To provide hands-on training to local caregivers and medical professionals so that a self-sustaining pediatric cardiac center can be established 20
CAMEO Purpose: To utilize acuity tool that measures complex care & cognitive workload performed by pediatric cardiovascular nurses in global setting Results: 64 CAMEOs on 13 children who underwent cardiac surgery – Revealed high level of direct care workload for nurses in Ghana – Multiple procedures performed during one shift – Ghanaian nurse was task orientated • CAMEO captured importance of precepting, teaching, & consulting • Further analysis will help identify specific key components that drive the cognitive complexity of nursing workload in a global setting 21
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International Quality Improvement Collaborative for Congenital Heart Surgery (IQIC) • Mission: To reduce in-hospital and 30-day mortality and major complications for children receiving congenital heart surgery in developing world programs • Phase 1: Data collection and analysis, benchmarking • Phase 2: Implement quality improvement strategies targeted at drivers of mortality (monthly educational modules and webcasts broadcasts from BCH) 23
April Collaboration Trip 19 Nurses- Pediatric Emergency Assessment Recognition & Stabilization 26 Nurses- The child with renal dysfunction 26 Nurses- Error prevention training 26 Nurses- Helping Babies Breathe 26 Nurses- Medication Safety 24
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Accomplishments & Outcomes at Home • Designed clinical nursing skills stations for Global Health Skills Week • Launched a quarterly Global nursing Forum • Contributed to Notes (Boston Children's Hospital's blog for health care providers) • Led concurrent sessions at Global Health research day • Created Global Health Orientation for nurses • Facilitated “Helping Babies Breathe” programs locally • Taught at universities and global health seminars 26
Lessons Learned • Candidates for the fellowship should be intrinsically motivated, with a vision for the upcoming year. • Although time and managerial support are built into the fellowship, in times of high census, it has been difficult for fellows who are bedside nurses to leave their units to attend seminars or networking events. 27
• Foster global projects & networking Looking ahead opportunities for BCH nurses throughout enterprise • Strengthen partnerships with global nursing leaders at local, national and international academic institutions and health care organizations • Represent nursing on interprofessional global health committees, forums, educational and research initiatives throughout the enterprise • Develop a sustainable framework to measure nursing outcomes at international nursing partner sites 28
• Continue to partner with our colleagues in Myanmar, Haiti & Looking ahead Ghana through continued visits and telehealth • Mentor new nursing global health fellows, with sites in Rwanda and Tanzania • Publish our experiences • Continue as global health faculty at BCH 29
30 Thank You!
Contact Information Marilyn Moonan, MSN, RN, CPN Marilyn.moonan@childrens.harvard.edu 617-355-3379 31
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