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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.


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


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


Some of the Link Nurses


Evaluation Methodology:

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


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.


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


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


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).


Themes Identified



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


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)


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).


evaluation of the link nurse programmes3-eu-west-1.amazonaws.com/cairdeas-files/168/1_link... ·...

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