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Clinical Practice Development Projects

Reaching out to work with nurses in neonatal and paediatric services at Rundu State Hospital in northern Namibia - June 2019

In June 2019, four Master of Nursing in Child Nursing students from UCT travelled to Namibia on an outreach programme to the paediatric and neonatal service at Rundu State Hospital. The group, Akua Dwomoh Boateng (from Ghana), Ireen Muleya (from Zambia), Winnie Njuguna (from Kenya) and Jabulani Kgasapane (from South Africa), brought the knowledge and skills acquired in this clinical master’s programme as well as their combined experience from four African countries. In Namibia the nursing team was led by Beatrix Callard a programme graduate who now heads the neonatal nursing service at Windhoek Central, Namibia’s largest referral hospital.

Aim/Purpose: The Child Nurse Practice Development Initiative at the University of Cape Town (UCT) is commited to build Children’s Nursing in Africa for Africa. The aim of this visit was an opportunity to serve and contribute to the support of neonatal and children’s nurses in a relatively new clinical service for neonates and children in the north of Namibia. They contributed to assisting with how to help strengthen services by ensuring good clinical practice, good clinical leadership and clinical governance.

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Context: Rundu State Hospital is the government run hospital in Rundu. It serves the Okavango region (west and east), which is in the Northern part of Namibia. Rundu is next to the Angola border and sometimes serves the Angola patients who cross the border in need of medical assistance. The team visited the hospital’s paediatric and neonatal unit (also known as prem unit) which serves children from birth to 12years of age. The hospital has a bed capacity of 330 beds; however, this number is often exceeded due to large patient numbers.

Neonatal unit: This unit is referred to as the “premie unit” at Rundu hospital, however, they admit both preterm and term babies. The Cape Town team initially worked in the neonatal unit where they were oriented on how the unit operates.  This 25 bedded unit, with incubators as well as open cots, provides basic newborn services as well as CPAP machines for advanced respiratory support.

In June 2019, the unit received its very first mechanical ventilator from Prof Berger, who represents an organization called Neo For Namibia. Whilst we were there, he was training the doctors and nurses how to use the equipment and select patients for ventilation. They successfully had their first ventilated patient on the 14th July with a good outcome.

We found the nurses at Rundu to be very hard working.  They work effectively as a group and there is a harmonious atmosphere. The nurses displayed eagerness to learn and were able to share insight on how they work.

The team got to interact with other nurses and doctors in the unit, in addition to mothers with babies. They also familiarized themselves with some of the paperwork & documents used in the unit. To assist the unit staff, they collected data on neonatal unit statistics from January to May 2019.

People involved: The team met with the Pediatrician, Dr Kamara who gave them a brief overview of the current situation of Rundu state hospital. Dr Kamara was very happy to work with them over the two week period. The team was warmly welcome by the hospital matron, Sr Priscilla Shiwegdha, who took them round the hospital and introduced them to all the units. Also, they spent time with Prof Berger who ran training on invasive ventilation.

Referral data: Low referral rates to other hospitals could be an indicator of good care and is certainly a good governance outcome. The hospital refers patients to Windhoek Central State hospital and Katutura Hospital in Windhoek Region. This is approximately 715 kms away, and transportation is mainly by road and this takes an average of 7 hours to get there. The conditions commonly referred to these hospitals include those that require surgical interventions, patients with cardiac anomalies and other congenital abnormalities that Rundu Hospital are not equipped to handle. Referral statistics from Jan to May 2019 indicated that few babies were up-referred.

Conclusion: The team felt very welcome and were grateful to experience how things are run in Rundu Intermediate hospital NICU and pediatric departments.

Thank you to everyone from the CNPDI office who facilitated the project, and the management of Rundu intermediate hospital for allowing us into their space, To the staff (medical and nursing) in NICU and pediatric departments as well as emergency unit who allowed us to be part of their team and work with them. Beatrix Callard for you input and guidance much appreciated. Professor Berger for allowing us to give input on the project he was busy with. THANK YOU.

 


Visit to CURE Hospital, Uganda - May 2015 

To date, two nurses from Uganda have undertaken training with the Child Nurse Practice development Initiative. Both have returned to service leadership roles in Uganda, and we continue to work with them to support the implementation of practices learned on the programme to improve care for children. 

Visiting Initiative Staff: Minette Coetzee & Angela Leonard (pictured left and right, respectively)

The brief: 

The Executive Director of the CURE Children's Hospital, Uganda invited us to facilitate a 4 day combined teaching and facility-wide practice development process with the multidisciplinary staff teams from the hospital. The pathway of a child through the hospital was tracked; the roles of both health care workers and parents were articulated; organizational and communication norms were discussed and opportunities for developing practice and improvement were capitalised. Visual graphic harvesting (see behind Lydia in the picture to the right) made their current practice visible; staff identified opportunities for refining practice and saw their triumphs displayed. The use of the employee engagement tool complimented the process. 
 
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Feedback from the hospital: 
Lydia Ssenyonga, Assistant Director of Nursing at CURE Children’s Hospital (pictured centre in picture above), shared:

“As a Masters prepared nurses with postgraduate paediatric nurse training, the relationship has always been between the Initiative and me, but, by the end of the visit, there was lots of buy-in from other staff members. The visit helped me and the CURE staff to track our patient pathway; we had never had someone observe and reflect back to us our model of care before. We are hoping that the Initiative can help the nursing staff to write and publish what we do at CURE and to help us keep current with new models of care and ways in which to improve our practice.”

 


Visit to Windhoek Central Hospital, Namibia - 22nd - 24th June 2014 

The Child Nurse Practice Development Initiative welcomed the first student from Namibia in 2012. Since then we have trained 3 nurses as child or child critical care nurses. We continue to work with service leaders in Namibia (at Windhoek Central Hospital, WCH) to prepare for the establishment of in-country training as soon as this becomes feasible.

Visiting Initiative Staff: Candice Bonaconsa & Minette Coetzee (left in the picture)

The brief: 
The Initiative was asked to facilitate a three day collaborative multidisciplinary workshop by programme graduate Beatrix Callard (right in the picture), Acting Matron of Windhoek Central Hospital Maternity Ward, using graphic facilitation, to identify the care pathway of an ill child to and from home, and through peripheral care facilities to the Windhoek Hospital Complex. The elements that pose and decrease risk along the care pathway were identified; the complexity of the pathway became apparent and led to discussions to improve communication in and between departments; networking in the paediatric community was achieved, and the ministry of health was briefed on the outcomes of the workshop.

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