9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

EVALUATION OF THE LINK NURSE

PROGRAMME

Florence Nalutaaya

On behalf of the Evaluation Research

Team

Background • PC should be available to all who need it, regardless of where

they live, their culture, nationality or illness.

• A needs assessments revealed that 25%-45% of patients in Ugandan Hospitals have unmet PC needs.

• Integrated strategies for PC are therefore urgently needed.

• The Link Nurse Programme (LNP), developed in Mulago National Referral Hospital has successfully increased access to PC through building capacity of nurses on the wards.

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Background (2)

• As part of the Nurse Leadership Fellowship (NLF) programme in Uganda, the LNP was implemented in 8 hospitals across the country with 153 link nurses being trained.

• Alongside this the LNP was extended to Kabale, Gombe and Gulu Hospitals and also to hospitals within Rwanda and Kenya

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Aim and Objectives of the LNP within the leadership programme

Aim: To extend the Palliative Care Link Nurse Programme to hospitals in Uganda

Objectives :

• To increase access to PC service provision to all in need.

• To strengthen the capacity of nurses on the wards.

• To link patients, multidisciplinary team members e.g. clinicians and palliative care specialists

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Some of the Link Nurses

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Evaluation Methodology:

• The LNP was implemented in 8 hospitals by the nurse leadership fellows: • Naguru, • Kibuli, • Tororo, • Kasese, • Kibaale, • Adjumani, • Nebbi • Yumbe

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Evaluation

• An evaluation of the LNP was undertaken by 4 of the Nurse Fellows, as part of their leadership training & involvement in national level projects and advocacy.

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Data Collection: • Mixed Methods

including:

• pre and post course assessment and confidence rating,

• course evaluation forms,

• review of link nurse activity data,

• focus group discussions (FGDs), and

• interviews

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Results • 153 link nurses were trained

and >1,500 patients received generalist PC from them

• 60% of the nurses used the MoH approved PC clinical guidelines

• 15 FGDs and 8 interviews were conducted

• Link nurses have become members of PCAU, and thus part of an ongoing system of mentorship and supervision

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

0

50

100

150

200

250

300

350

Adjumani(Jan16)

Yumbe(Dec15)

Nebbi(Feb16)

Kibaale(May16)

Kasese(May16)

Kibuli(Sep15)

Naguru(Sep15)

Tororo(Mar16)

NumberofPCPatientsseenbyLink-NursessincestartofTraining

Pre and Post Test Results

0

20

40

60

80

100

120

140

160

Naguru(Sep15)

Kibuli(Sep15)

Yumbe(Dec15)

Adjumani(Jan16)

Nebbi(Feb16)

Tororo(Mar16)

Kibaale(May16)

Kasese(May16)

NumberofPatientsseenbyLink-NursessincestartofTraining

0

10

20

30

40

50

60

70

80

90

PalliativeCareKnowledgeScore(P<0.001)

PainKnowledgeScore(P<0.001)

PalliativeCareConfidenceRating(P<0.001)

PreandPostCourseScores(Means)

Pre-course Post-course

• A significant difference was seen in nurses’ knowledge/ confidence after training (p<0.001).

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Themes Identified

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Participant Quote ” This has helped to improve the quality of

patients life and family members, they give us feedback appreciating us that their patients had

a peaceful death so it has improved on the quality of life of the suffering.”

(Participant 6 Hospital B)

Participant Quote ” This has helped to improve the quality of

patients life and family members, they give us feedback appreciating us that their patients had

a peaceful death so it has improved on the quality of life of the suffering.”

(Participant 6 Hospital B)

Participant Quote ” This has helped to improve the quality of

patients life and family members, they give us feedback appreciating us that their patients had

a peaceful death so it has improved on the quality of life of the suffering.”

(Participant 6 Hospital B)

Challenges

• Challenges faced by the Link Nurses include:

1. Deployment being that many Link nurses are under public services

2. Managing complex issues

3. Stock outs of palliative care drugs especially Morphine and adjuvants

• However the link nurses are aware of their limitations and when they need to refer

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Conclusion

• The LNP is a practical and successful model for integrating PC into generalist services with and without a specialist PC team.

• Key to its success is involvement of the multidisciplinary personnel and hospital leadership.

• This model can be used in a variety of settings, including linking hospitals and their surrounding health centres.

• Empowering nurses to provide generalist PC is important in health systems strengthening and integral to the integration of PC as per the World Health Assembly PC resolution (2014)

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary

Thanks…..

• We recognise and appreciate: • Those who were involved in setting up this programme.

• Those who took part in the evaluation

• Funded through a health partnership grant from the British Government through THET to a partnership led by the Global Health Academy, University of Edinburgh with Makerere University and the Palliative Care Association of Uganda (PCAU).

9th&10th August 2018 ‘Building Momentum’ Makerere and Mulago PC Unit 10th anniversary