Translating research into action: ALIMA’s experience in improving women and children’s health care in rural Niger

Ms Sonia Girle1, Mr Matt Cleary1, Dr Nikki Blackwell1,2

1ALIMA (The Alliance for International Medical Action), Dakar, Senegal,

2Department of Critical Care, University of Queensland, Brisbane, Australia

 

Purpose

Providing medical care in remote, fragile contexts like rural Niger presents many challenges. We will report on research into simple interventions that can easily be scaled-up.

Nature of topic

Since 2012, ALIMA has conducted research in Niger’s Mirriah District. A non-inferiority trial looked at the effectiveness of training mothers to screen children for malnutrition by using mid-upper arm circumference (MUAC) bracelets. A prospective cohort since 2015 assessed maternal risk factors for perinatal mortality.

Issues under consideration

Children often present late for malnutrition treatment, resulting in higher rates of hospitalizations. Currently, community health workers (CHW) screen children by MUAC in the community, but ALIMA saw potential for mothers screening in the home. ALIMA also works with traditional birth attendants to try to increase use of reproductive health services, and a prospective cohort analysis found maternal factors associated with perinatal mortality.

Outcomes and Conclusion

The zone where mothers screened children by MUAC, cases were detected earlier than in the CHW zone, with median MUAC at admission 1.6 mm higher (95%CI 0.65-1.87). (1) Children in the mothers’ zone were less likely to be hospitalized, especially at admission (RR: 0.09; 95%CI 0.03-0.25; p<0.001). In the prospective cohort, ALIMA found four maternal factors associated with perinatal mortality: ≥ 4 antenatal consultations (ANC) decreased risk (aOR: 0.59; 95%CI: 0.35–1.01; p=0.05); first pregnancy (aOR: 2.15; 95%CI: 1.30–3.55; p<0.01) and positive malaria test during ANC doubled risk (aOR: 2.61; 95%CI: 1.32–5.18; p<0.01); and severe anemia tripled risk (aOR: 3.05; 95%CI: 1.08–8.65; p=0.04).

Based on these results, training mothers to use MUAC bracelets is now being scaled-up in Niger, and risk factors for perinatal mortality can be easily identified during ANC.

(1) Alé FG, et al. Mothers screening for malnutrition by mid-upper arm circumference is non-inferior to community health workers. Arch Public Health. 2016 (74:38).


 

Developing the rural and remote nursing and midwifery workforce for today and tomorrow

Prof. Sabina Knight1

1Centre For Rural And Remote Health, James Cook University, Mount Isa, Australia

 

This presentation explores the rapidly changing face of rural nursing and midwifery practice in the context of outback Queensland.

The evolution of funding models, PHC teams, rural generalism and technology both supports and demands nurses to reconfigure their practice to meet emerging local need. AHPRA will cease rural and isolated practice endorsement (RIPEN) in the near future and an education framework that meets both credentialing needs as well as public health and practice demands of rural and remote nurses is upon the sector. Those in the current workforce require access to ‘scaffolded’ training and CPD that results in appropriate confidence and competence.

Rural nurses need to be proactive in providing care in times of economic hardship and drought or post cyclone. They also need to recognise emerging public health problems of significance such as Q Fever, agricultural accident trends such as Quad bike related injury, mine dust lung disease, opioid and ice abuse and bore water parasite related encephalitis. Nurses and midwives also need to continue to  provide routine PHC services to both young and aging populations. The significance of public health in advanced practice is emerging as central to rural nursing.

MICRRH, JCU has embarked on a CPD program which will articulate with post graduate  studies in rural and remote nursing practice and  aims to develop a network of supervisors who will support nurses to develop rural generalist skills and practice to best meet the needs of the rural towns, services and communities and the profession.

This paper will detail the approach, the curriculum, funding and discuss challenges and progress to date.

The program is significant to the conference as it serves  to inform other rural or remote areas and services that need to quickly adjust to emerging service, legislative and practice needs.


Biography:

Professor Sabina Knight is the Director of the Centre for Rural and Remote Health, one of an Australian national network of fifteen University Departments’ of Rural Health. A founding member and past president of CRANA, she is an internationally recognised veteran of rural and remote health and health workforce.

Her leadership roles have included the Council of Remote Area Nurses of Australia; the National Rural Health Alliance; Central Australian rural Practitioners Association; the Regional Women’s Advisory Council, the National Health and Hospital’s Reform Commission and the Townsville and North West Queensland Regional Development Australia board.

Nurse Navigation in the Torres and Cape – “Unique Population = Unique Model of Care”

Mrs Rachel Sargeant1, Ms Michelle Maguire2, Mrs Natalie Thaiday3

1Torres And Cape Hospital And Health Service, Cairns, Australia,

2Torres and Cape Hospital and Health Service, Cairns, Australia,

3Torres and Cape Hospital and Health Service, Cairns, Australia

 

Coordination of complex care provision across Torres and Cape Hospital Health Service (TCHHS) has been historically challenging due to its geographical area and diverse population group. The TCHHS is approximately 130 336 Sq. km with 89% of the population identifying as Aboriginal or Torres Strait Islander. There are over 28 indigenous clan groups with 18 different languages spoken with English often the second language. The challenges when trying to access health services include:

–              Poor communication systems

–              Limited health literacy/health services

–              Poor local infrastructure, limited housing

–              Climate e.g. cyclones, flooding

–              Dirt roads, limited flights (dinghy is sometimes only means of transport).

The Nurse Navigation initiative uses a multi-disciplinary, holistic approach to facilitate patient-centered care, improve health systems by being the central point of communication, engagement and coordination of services in the patient’s journey. The service aims to deliver respectful culturally safe care.  TCHHS is the first in Queensland to have generated the Indigenous Nurse Navigator Support Officer roles. This model of care has positively impacted on the population by building relationships with patients and families, increasing health services access and demonstrate a significant financial saving to the health system.

The benefits of implementing Nurse Navigation in the vast area of the Torres and Cape are outstanding and extensive. They include but are not limited to:

–              Decreasing complexity of health systems for clients

–              Improving health literacy

–              Advocating for the client

–              Half a million dollars in savings to TCHHS in first year of service delivery

–              Increasing appointment attendance and decreasing hospital readmissions

A single point of communication and coordination such as Nurse Navigation services, links care providers and delivers improved patient care outcomes. The Indigenous Nurse Navigator Support Officer expands the impact of this service further empowering the clients in this service.


Biography:

There are ten Nurse Navigators, one Nurse Navigator project officer and two Indigenous Nurse Navigator Support Officers within the Torres and Cape Hospital Nurse Navigator Service. All Nurse Navigator positions are Clinical Nurse Consultant level, delivering generalist care. The Indigenous Nurse Navigator Support Officer based in Cairns is an Enrolled Nurse currently undergoing undergraduate studies for Bachelor of Nursing.  Nurse Navigation role supports clients with complex care needs, facilitates specialist appointments, coordinates appointments, telehealth and referrals. Improving access and engagement of clients and families with health service and providers in and out of community.

Presenters:

Michelle.maguire@health.qld.gov.au

Natalie.thaiday@health.qld.gov.au

Rachel.sargeant@health.qld.gov.au

Indigenous Primary Health Care Workforce Safety in Remote Australia – Understanding the Unique Challenges

Ms Kristy Hill1, Ms Tarneen Callope

1CRANAplus, Cairns, Australia

 

Promoting the safety of the primary health care workforce in remote Australia poses many challenges. One area that is not well understood is the workforce safety issues pertinent to the Aboriginal and Torres Strait Islander workforce in remote Australia.

As part of the Community Night Patrol Workforce Safety Project, CRANAplus conducted a review of the workforce safety issues relevant to the Community Night Patrol (CNP) workforce in the Northern Territory and in Anangu Pitjantjatjara Yankunytjatjara (APY) Lands in South Australia. The review involved both a literature review and a series of consultations with key stakeholders including community night patrollers, their managers, training organisations, police and health services and a range of other community organisations.

The Community Night Patrol Workforce Safety Report identified a number of significant safety issues that are worth exploring, with regards to better understanding Indigenous primary health care workforce safety. These included the concept of ‘dual accountability’; a term used to describe the challenges of fulfilling employer obligations whilst balancing cultural/family/community obligations. The other priority safety concern for this workforce was the impact of witnessing significant amounts of trauma whilst on the job, and how this trauma is inextricably linked to the patrollers proximity to the community (being related/connected to the client). This experience was magnified by patrollers own personal experiences of trauma, and the unresolved loss and grief associated with multiple layers of trauma that has spanned the generations.

This paper will summarise our experience of remote Indigenous workforce safety issues. We will pose the question whether these issues are relevant across remote primary health care practice in general; and indeed, across the globe. Finally, it is hoped that exploration of these unique challenges will assist in improving our ability to support remote Indigenous primary health care workforce safety.


Biography:

Kristy Hill (Master Public Health; Bach Occupational Therapy). Kristy is a public health and health promotion planner and project manager with expertise in workforce development and capacity building. Over the past 20 years she has worked across a range of primary health care contexts including social and emotional wellbeing, AOD, maternal and child health and cultural safety. She has significant experience working in Aboriginal and Torres Strait Islander workforce development in north Queensland.  Kristy is currently employed with CRANAplus as the Project Manager, Community Night Patrol Workforce Safety Project. E:kristy@crana.org.au

Mental Health for Health Professionals- Supporting the Nursing and Allied Health Workforce

Miss Amy Wenham1

1National Rural Health Student Network, Mascot, Australia

 

The poor mental health of our health professionals is a topic that is of global concern. Increased responsibility and often less resources, puts our nursing and allied health professionals in rural and remote communities, at an increased risk for poor mental health outcomes.

Rural and remote clinical practice can be an incredibly rewarding experience, allowing practitioners a broader scope of practice, a close connection with their community, and many other positive experiences. However, with rural and remote area practice comes a variety of negative factors such as the stigma around accessing mental health, burnout, isolation, minimal access to clinical support, increased responsibility and decreased new graduate support that all impact the overall mental health of our nursing and allied health professionals. Support services around mental health issues for new graduates as well as long term practicing individuals are limited in these areas, and for some not accessible. These themes have shown to also have a strong correlation in the decreasing retention rates in rural and remote Australia.

National Rural Health Student Network’s (NRHSN) position paper ‘Mental health within Nursing and Allied Health workforce in Rural and Remote Areas’, aims to outline the importance of mental health and wellbeing for Nursing and Allied Health professionals and put forth recommendations on how we can better support our rural and remote area workforce. Our recommendations are aimed around three key areas; mental health within rural and remote areas, stigma around mental health and retention rate of rural and remote practitioners.


Biography:

Amy Wenham is a final year Bachelor of Nursing (Advanced Studies) student at the University of Sydney. Currently serving as the National Rural Health Student Network Secretary and MIRAGE Rural Health Club President, Amy has a strong passion for rural and remote health. Having grown up in rural areas across the globe, this passion is something that she strives to employ with her nursing degree in the future.

secretary@nrhsn.org.au

Using contemporary educational practice to improve rural and remote practitioners’ responses to mental health presentations

Ms Amanda North1, Ms Julie Moran1

1Cranaplus, Cairns, Australia

 

This presentation will outline the design and delivery of a new Mental Health Emergencies course, which aims to improve rural and remote practitioners’ response to the often-marginalised people who present with mental health needs.

With increased remoteness availability of mental health professionals decreases (AIHW 2015), with generalist health practitioners often being required to provide mental health care, particularly for acute presentations. However, we know that nurses consistently identify they do not have the skills or knowledge to assess and treat mental health presentations (Clark, Parker and Gould 2005 pp.210-211).

Several issues can prevent practitioners from accessing high quality and hands-on upskilling that is contextualised for rural and remote practice. These include: travel, accommodation & course costs and difficulty getting released.

The isolation issues are compounded by learning barriers including: poor internet connectivity, low digital literacy, limited time for study, courses that are content heavy and limited access to industry expertise and practice opportunities.

The presentation will demonstrate how the MHE course:
1. Provides a simple, easy to remember framework to guide clinical practice.
2. Aligns with clinical practice guidelines (such as CARPA and PCCM). Our aim is to meet local, state, national and global audience needs.
3. Creates visually scaffolded content for online scanning.
4. Uses scenario based and critical reflection approaches to promote deeper learning that is transferable.
5. Provides practice and coaching/mentoring by industry expert/s.
6. Provides multiple delivery methodologies e.g. blended (online plus face-face workshop), fully online i.e. with virtual workshop, access to content online or via USB.
7. Promotes networking and support between practitioners.

Australian Institute of Health and Welfare (AIHW). 2015. Mental Health Workforce. https://www.aihw.gov.au/getmedia/39ef59a4-4bb3-4f90-b117-29972245ca95/Mental-health-workforce-2015.pdf.aspx.

Clark, C., Parker, E. & Gould, T. 2005. Rural generalist nurses’perceptions of the effectiveness of their therapeutic interventions for patients with mental illness. Australian Journal of Rural Health. 13: 205-213.


Biography:

Julie Moran BAppSc GradDipAdultEd

Curriculum Development Officer CRANAplus

Amanda North RN BNurs MNurs (Mental Health)

Remote Clinical Educator Mental Health CRANAplus

Caring for the carers, are we there yet? Reaffirming resilience, redesigning and revealing the 4P’s remote workforce safety training road trip

Mrs Brenda Birch1

1CRANAplus, Wonga, Australia

 

If you’ve ever spent any time with the remote Australian health workforce, you will very quickly conclude that they are some of the most resilient, inspiring and committed people you’ve ever met.  But how resilient are the system in which they work? Are they adaptable to such complex and dynamic environments?  The purpose of this presentation is to challenge the need for a safety maturity model designed specifically for remote and isolated health sector.

This presentation will inform participants of the current journey to transition workforce safety and security legislation, research and guidelines into practice within the remote and isolated health workforce in Australia with a specific focus on aggression and violence.  The 4P’s approach is an inclusive and innovative risk assessment methodology to create a shared understanding of preventative, recovers and supportive controls.

How will remote or isolated clinicians, managers, educators, researchers and decision makers know if we are doing enough to protect the health and safety of remote and isolated workers? Are we measuring what matters?

Imagine having certainty of a resilient safety culture supported by a maturity assessment tool that alignments  patient, workforce, systems and community safety.   It’s time to transition global knowledge and work with communities to develop, deploying and be proud of safety strengths and a shared safety the vision for the future.

References:

  1. Foster, P., & Hoult, S., (2013) The Safety Journey: Using a Safety Maturity Model for Safety Planning and Assurance in the UK Coal Mining Industry. Minerals, 3(1), 5972.
  2. Law, MP et al (2010) Assessment of safety culture maturity in hospital setting. Healthcare Q Spec No: 110-5.
  3. Reason, J. (1998). Achieving a safe culture: theory and practice. Work and Stress, Volume 12(3), 293-306.
  4. Hollnaguel, E., et al (2006) Resilience Engineering, Concepts and Precepts. Aldershot, UK: Ashgate.

Biography:

Brenda Birch (National Remote Safety and Security Educator)  is passionate about safe, high quality and inclusive healthcare for both patients and the people who provide the care.   Brenda has held several key quality, safety and risk leadership roles in VIC, NT and QLD  health sector.   Brenda has implemented risk management across a large and diverse health service which has been externally recognised as having areas of advanced maturity.

Qualifications include: RN, non-practising RM, Certificate IV Training and Assessment, Green Belt Six Sigma, Lead Auditor in Quality Management System, Certificate IV WHS, Graduate Certificate Health Service Management and Graduate Diploma Engineering.

Damned if I do, damned if I don’t. Registered Nurses in very remote Australia, medicines and the law

Mrs Katie Pennington1, Dr Kimberley Clark1, Professor Sabina Knight2, Assocaite Professor Jacques Oosthuizen3, Dr Yaqoot Fatima2

1Edith Cowan University, Joondalup, Australia,

2James Cook University, Mt Isa, Australia,

3Edith Cowan University, Joondalup, Australia,

 

Introduction: Have you ever felt unsure about whether you are working within your legal professional boundaries as a Registered Nurse?  You are not alone.  Registered Nurses (RNs) work in complex and changing legislative and regulatory environments.  RNs are a mobile workforce and historically little has been known about how Australia’s fragmented system of medicines and poisons legislation has impacted on the ability of RNs to deliver healthcare in the remote context. This paper will place the current Australian legislative and regulatory arrangements with regards to RNs and medication management in an international context and present preliminary findings from a national anonymous questionnaire exploring the knowledge, attitudes and practices (KAP) of RNs in very remote Australia with regards to medication management, legislation and organisational requirements.

What is happening in the Project: Registered Nurses in very remote Australia, medicines and the law is a mixed methods research project utilising an explanatory sequential design that commenced in early 2018.  The first phase of data collection involving a national anonymous questionnaire exploring the knowledge, attitudes and practices (KAP) of RNs in very remote Australia with regards to medication management, legislation and organisational requirements is due for completion in June 2018.  These preliminary results will be presented and discussed in terms of a RNs professional obligations according to the Nursing and Midwifery Board of Australia’s Code of Conduct, current Australian legislative arrangements and central objectives of the National Medicines Policy.

Conclusion: Initial findings from the first phase of data collection will be presented and used to highlight the impact that current legislative arrangements are having on Registered Nurses in very remote Australia, their ability to deliver care and to highlight factors that currently support RNs to provide safe and timely access to medications in the very remote context.


Biography:

Katie currently works part-time in a Continuous Quality Improvement role with Puntukurnu Aboriginal Medical Service where her work focuses on improving clinical and organisational systems and supporting staff in remote clinics.

She holds a Bachelor of Nursing from the University of Tasmania, a Graduate Diploma in Remote Health Practice and a Graduate Certificate of Nursing (Child and Family Health Nursing) from Flinders University and is currently undertaking her Masters in Public Health (Research) through Edith Cowan University

We can work together, talk together: Reforming Primary Health Care in a remote Aboriginal community

Mr Greg Smith1

1Maningrida Health Centre, winnellie, Australia

 

The purpose of the presentation

Aboriginal peoples, particularly those living in remote and very remote areas, experience poor health – higher rates of chronic illnesses and avoidable hospitalisations compared to non-Aboriginal Australians. Improving access to and effectiveness of primary health care (PHC) is critical to improving these health outcomes. The Australian Government’s Health Care Home reform is a PHC model associated with improved access, better clinical outcomes and reduced costs. Simultaneously, national accreditation standards and Northern Territory Government policies mandate increased patient involvement in service design and delivery of care to assure cultural safety.

 

The nature and scope of the topic

Qualitative enquiry was guided by an Aboriginal advisory group in a large Arnhem Land community. We undertook focus groups co-facilitated by an Aboriginal co-researcher. The project structure ensured representation from the major language groups. Dual coding and deductive thematic analysis identified desired PHC service improvements during Health Care Home implementation.

 

The issue or problem under consideration

Current PHC delivery is poorly aligned with patients’ cultural beliefs and expectations of care, limiting acceptability and access to care.

 

The outcome or the conclusion reached

Patients desire a PHC delivery model based on the concept of “Gurrutu” – love and respect. This could be achieved by establishing multidisciplinary care teams for patient panels based on language groups. Language group-based Aboriginal Health Practitioners (AHP) are needed in new roles: self-management support, care navigation/coordination, health coaching and as cultural mentors to non-Aboriginal staff.

Community members identified PHC delivery reforms that align with comparable best-practice Health Care Homes models of care internationally. Implementation would require transitioning the nursing workforce from vertical program delivery to generalist panel managers working to the top of their license.


Biography:

Greg has worked at Maningrida Health Centre as a Primary Health Care Nurse since 2010. Interested in alternative service delivery models that supports greater Aboriginal involvement in health care, Greg completed a community consultation to understand the community’s experience of health care, and to elicit opportunities for improvement.

Nominal s: Ba Nursing, Grad Dip Quality Management, Grad Dip Mental Health Nursing, Master Public Health

Email: gregory.smith@nt.gov.au

Factors associated with responsive feeding among infants 3 months old in Northern Taiwan

MS Tzu-Ling Chen, MS Li-Yin  Chien

1Department of Nursing, National Yang-Ming University, Taipei, Taiwan,

2Institute of Community Health Care, National Yang-Ming University, Taipei, Taiwan

 

Introduction: With the global trend of increasing obesity among children, healthy feeding pattern is being emphasized. Responsive feeding refers to a reciprocal relationship between an infant and caregiver that is characterized by the infant communicating feelings of hunger and satiety through cues, followed by an immediate response from the caregiver by the provision of appropriate food in a supportive manner in an appropriate feeding environment.

Objective: The study aimed to describe responsive feeding among infants 3 months of age and examine factors associated with responsive feeding.

Methods: This study applied a cohort design. A total of 800 second-trimester pregnant women were recruited from March 2015 to May 2017 and followed at 1 and 3 months postpartum. Responsive feeding at 3 months were measured by a scale of 10 likert-scale items with a possible score range of 0-40 and higher score indicating higher level of responsive feeding. Related factors included socio-demographics, feeding method (exclusive breastfeeding, partial breastfeeding, and formula feeding), infant growth, and maternal postpartum depressive symptoms. Infant growth was categorized into 4 groups based on weight-for-height Z scores from birth through < 3 months; they are no change, increase but in normal range, increase to overweight, and decrease.

Finding: Mean responsive feeding scores were 28.96±5.74.”I am depressed if the baby can not finish the prepared amount” and” I only feed the baby at the fixed time” were the two items with the lowest score. Multiple liner regression revealed that postpartum depressive symptom, primipara, maternal age >=35 years, and decreased


Biography:

Ms. Chen is now a PhD student in Department of Nursing, National Yang-Ming University, Taiwan. She also works as the head nurse of a busy clinic located in Bali District of New Taipei City. Her responsibility at the clinic includes providing patient education, health promotion and prevention, training new nurses, and nursing administration. Bali is a remote town in the northwestern part of New Taipei City. Her interest is in primary health care, health promotion, and family care in township.

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