Volume 1, Issue 3, December 2019

Global HOPE Nursing Newsletter Texas Children’s Cancer and Hematology Centers

Texas Children’s Hospital

Welcome from Marilyn

Volume # 1 | Issue # 3 | Global HOPE Nursing Education Newsletter

Pediatric Hematology Seminars

Nursing Leadership Program

In September Global H O P E N u r s i n g launched monthly pediatric hematology seminars presented by Dr. Rosalind Bryant, a Global HOPE Consu l t ant . Dr . Bryant has practiced for more than 30 years as a PNP caring

for children with hematological and oncological conditions. Topics include an Overview of Pediatric Hematology, Hematologic Assessment, Sickle Cell Disease, Hemophilia and Aplastic Anemia. A case study seminar follows the lectures two weeks later to continue discussion on that month’s lecture topic. These seminars are recorded and available for future nurses.

The Global HOPE Nursing Leadership Program launched in August. This is a 10 month program that meets monthly to focus on building core competenc ies and strategic workplace management skills. Ten nursing leaders from

Global HOPE Malawi, Global HOPE Uganda and Princess Marina Hospital are enrolled in the Leadership Program. The fall course consists of four modules:

• Module 1 Essential Nursing Leadership Skills

• Module 2 Leading High-Performance Teams

• Module 3 Communicating with Diplomacy

• Module 4 Improving Nursing Quality Care

The Leadership Program requires nurse leaders to develop and implement Quality Improvement Projects that are taking place in Malawi and Uganda. The QI projects include: PIV Insertion and Care, Wrist Band Implementation to Improve Safety, Oral Assessment and Mucositis During Chemotherapy, Pediatric Advanced Warning Signs Assessment, and Pain Assessment for Hospitalized Patients. The spring edition of the newsletter will highlight these QI projects.

This third newsletter brings with it our excitement for the numerous activities we have implemented since the formal launch of Global HOPE Nursing in October 2018. In this newsletter we highlight the launch of our Project ECHO, welcome new nursing cohorts hired in Malawi and Uganda, and present our nursing abstracts from the International Society of Pediatric Oncology (SIOP) in Lyon, France. This Fall we began our Global HOPE Nursing Leadership program and 10 nurses are currently enrolled from all three countries. The Hematology Course began in September and continues through February. This is the first course to be implemented live through ZOOM and numerous nurses from all three countries are enrolled. Over the next year each of our newsletters will formally introduce our Nursing Advisory Council Members and this edition highlights two who are very active in Global HOPE Nursing- Michael Pickett and Maureen Majamanda. On behalf of all our nurses in Global HOPE we are grateful for the continuous support we have been given by leaders at the Centers of Excellence and in Houston. We wish everyone a wonderful new year.

Global HOPE Nursing is excited to welcome new cohorts of nurses in Uganda and Malawi. In Uganda a cohort of six nurses started the Essentials of Pediatric Oncology Nursing and the Chemotherapy Course this August. Their training started with a week long in-person intensive education training with Dr. Hockenberry. The nurses engaged in lectures, case studies, and PIV insertion and chemotherapy administration skills labs. Join us in welcoming Racheal Kyarimpa, Cream Musiimenta, Immaculate Nagaddya, Catherine Nkinzi, Suzan Aweebwa and Peace Namamya.

In Malawi two new nurses- Hellen Mbutuka and Emma Segula along with two nurse assistants- Bernadette M'doka and Zione Chinthalo joined the Global HOPE team and have started the courses with their Nurse Educator. We will highlight the new Malawi nurses in the spring.

Uganda Cohort 2 Nurses

Welcome Uganda/Malawi Cohorts

Global HOPE Nursing Pediatric Oncology Project ECHO Seminars for Sub-Saharan

Africa This Fall Global HOPE Nursing launched their inaugural Project Echo monthly seminars targeting nurses caring for children with cancer in sub-Saharan Africa. Project ECHO provides nurses in this region with access to pediatric oncology nursing experts. Seminars enable nurses to develop skills and knowledge regarding how to care for children in their own community. A key focus is to build a knowledge network using case-based learning strategies that will increase the capacity of pediatric oncology nursing experts in this area of the world.

The objectives of the Global HOPE Project ECHO seminars are to provide an education platform for nurses caring for children with cancer to interact with pediatric oncology nursing specialists; increase expertise and skills in the nursing assessment and management of children with cancer; and develop a childhood cancer nursing network for nurses in sub-Saharan Africa.

This first Global HOPE Nursing Project Echo seminar was held on October 10th with a group of 18 nurses from Uganda, Malawi, Botswana and the United States. Aisha Nedege, the Nurse Trainer in Uganda presented on Pediatric Advanced Warning Signs. On November 14th, 33 nurses from 7 countries attended the seminar. Pearl Semetsa from Princess Marina Hospital in Botswana presented on Pain Assessment and Management in Children with Cancer. Our third Project ECHO Nursing Seminar was held on December 12th, with 21 individuals from 5 countries attending. Nurses were from 2 Schools of Nursing, 3 hospitals and all 3 Global HOPE Centers of Excellence. Shannon McCord from Texas Children’s Hospital presented on Wound Management in Children with Cancer. Tadela Mulemba, Nurse Educator from Malawi gave a case presentation on a child with extravasation.

We are excited to see the excellent attendance at our Global HOPE Nursing Project ECHO seminars. This confirms the extreme importance of providing education to nurses caring for children with cancer in sub-Saharan Africa.

Global HOPE Nursing Newsletter

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Global HOPE Nursing Advisory Council Members

Michael Pickett, MSN, PNP Pediatric Nurse Practitioner, Texas Children’s Hospital As a pediatric nurse practitioner, I have worked in primary care pediatrics, emergency medicine, and anesthesia services the past 20 years. I started my nursing career in pediatric oncology and it has

always had a special place in my heart.

What I love about innovation is to expect the unexpected. It was innovation that connected me to Dr. Marilyn Hockenberry and the Global HOPE team. The TCH simulation center informed me that the Global HOPE team liked the PIV trainer prototype and wanted to see if they could get it in a dark tone color. Working with the Sawbones® engineers we were able to make a dark tone PIV trainer that could be used in sub-Saharan Africa. Global HOPE nursing helped me develop the pilot survey, test the new design and were instrumental in providing feedback to finalize the instructions and trainer set-up. My personal goal was to develop a simulation training tool I wish I had 20 years ago when working as a new graduate on the oncology unit. Support from TCH Innovative Solutions Council, TCH Business/Innovation, Global HOPE and many front-line innovators helped exceed my goals.

It has been extremely rewarding to see the PIV trainers and videos being used in the Global HOPE clinics for PIV insertion and maintenance education. It is inspiring to see the amazing outcomes Global HOPE nursing recently accomplished during the QI project to decrease PIV attempts and extravasations. Representing nursing innovation on the Global HOPE Nurse Advisory Council has been a rewarding experience and I look forward to supporting a bright future as the program grows.

Maureen Daisy Majamanda, MSc., BScN. Senior Lecturer, Kamuzu College of Nursing Maureen Daisy Majamanda is a Senior Lecturer at Kamuzu College of nursing, University of Malawi. She is a Child Health Nurse specialist. She has experience in classroom and clinical teaching of students; in service training of health care workers and workshop management. She coordinates child

health modules for undergraduate, post basic and post graduate programs and supervises students’ research work at Bachelors and Masters levels. Maureen has experience and skills in nursing research, consultancy, systematic literature search in electronic databases; systematic reviews; module development; proposal writing; grant application, report writing; interprofessional collaboration; leadership and management. Maureen is a National Trainer in the following short courses/ programs: Clinical Mentorship, Emergency Triage Assessment and Treatment + Trauma (ETAT), bubble Continuous Positive Airway Pressure (bCPAP) and Preceptorship. Maureen participated in the development of a mentoring training manual for the Malawi Health Sector, the Care Of Infants and Neonates (COIN) manual and the ETAT manual. Her passion is in capacity building, evidence based nursing, family and child centered care, child nutrition and interprofessional collaboration. Her vision is to see health care professionals in Malawi working collaboratively to provide quality child health care while involving the family and the child at each level of care in a compassionate manner and utilizing the available resources.

This edition’s Nursing Practice Corner focuses on Global HOPE Nursing’s presence at the International Society of Pediatric Oncology (SIOP)

Conference in Lyon, France. In October, Tadala Mulemba, Nurse Educator, Global HOPE Malawi and Aisha Nedege, Nurse Educator, Global

HOPE Uganda joined Marilyn Hockenberry, Director of Global HOPE Nursing, in presenting two abstracts. Both abstracts are now being

prepared for publication.

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Nursing Practice Corner

Implementing Distance-Based Learning for Pediatric Oncology Nurses in Sub-Saharan Africa T Mulemba, A Nededge, K Madumetse, M Raletshegwana, M Hockenberry

Background. A constant struggle for virtual education programs is how to best create a successful distance-learning environment, especially in

low resource countries. Global HOPE Nursing has created a distance-based learning model for educating nurses caring for children with cancer in

Sub-Saharan Africa.

Methods. The Global HOPE Nursing curriculum is a series of courses developed to teach the basic

principles of nursing care for a child with cancer. Each course involves a series of modules that include

short video lectures, readings, critical thinking activities and case studies. Nurses learn about common types

of childhood cancer and essential components of nursing care management. Key to nursing care is an

extensive understanding of chemotherapy; this is taught as a separate course in the curriculum. To

promote curriculum success, each course is implemented in various ways to meet the unique needs of

nurses in different countries. Courses are taken online through MOODLE, using a computer notebook

where materials are already downloaded, or by uploading onto personal computers. Nurses meet together

by ZOOM or WhatsApp to present case studies and discuss nursing care.

Results. Over 35 nurses involved in the care of children with cancer in Sub-Saharan Africa are currently enrolled. Key to implementation of a

structured curriculum is careful evaluation to determine success. Nurses complete a knowledge assessment and self-efficacy survey of their

confidence in providing care before and after completion of each course. Final written and competency examinations must be passed for

successful course completion. Course evaluations are completed by each nurse to provide feedback for ongoing changes needed to ensure content

is appropriate for nursing care in Sub-Saharan Africa.

Conclusion. This pediatric oncology nursing education program is designed to promote excellence in nursing care. The Global HOPE Nursing

curriculum provides key tools essential for building a specialized workforce in childhood cancer nursing across Sub-Saharan Africa.

Background. Global HOPE nurses at Baylor-Malawi involved in the care of children with cancer have

established specific nursing quality indicators to measure important changes in nursing practice. Using a

quality improvement approach to change and the Plan, Do, Study, Act (PDSA) cycle, projects were

organized to measure excellence in care. An example of our approach to improving care for children

with cancer demonstrates how nurses can lead practice change. In Malawi, all children receive

chemotherapy through peripheral intravenous catheters (PIVC); this administration method increases

risk for extravasation.

Methods. Pre-assessment data revealed a high incidence of extravasation in two separate prevalence

assessments done prior to practice change; 32% of 37 children and 42% of 24 children had evidence of

extravasation. PIVC insertion attempts in 266 children over six-weeks ranged from 0 to >9 with 19%

requiring three or more attempts. Using the PDSA cycle, the plan for practice change was based on

evidence from published research and established PIVC care guidelines. Change strategies were

developed and nurses completed education on proper PIVC insertion, dressing placement, and ongoing

PIVC assessment. Proper dressing procedures using semi-transparent dressings to allow visualization of

the PIVC were implemented. Nurses learned the Touch, Look and Compare (TLC) method to assure

that the PIVC was intact.

Results. Post-assessment data nine months later using two separate assessments revealed 5% of 21

children and 4% of 23 children had evidence of extravasation. PIV insertion attempts in 153 children

ranged from 0-5 with only 1% requiring three or more attempts.

Conclusion. Using an organized approach to nursing practice change and establishing specific quality

indicators to evaluate improved care are essentials aspects of the pediatric oncology nursing role. This project provides evidence that nursing quality

indicators can be used in any setting including countries with limited resources.

Using Nursing Quality Indicators to Improve Care for Children with Cancer T Mulemba, M Sabantini, V Chopi, G Chirwa, S Lemon, R Bank, S Mumba, M Chasela and M Hockenberry

Global HOPE Nurse Spotlight: Botswana

We are highlighting seven of the Princess Marina Hospital nurses currently enrolled in Global HOPE Nursing courses

Mpho Raletshegwana, Nursing Officer I, Princess Marina Hospital

Mpho obtained his bachelor’s degree in nursing and was trained in caring for a child with childhood cancer at the University of Botswana. He also completed a fellowship at the International Hemophilia Training Centre,

Charlotte Maxeke Johannesburg Academic Hospital. His pediatric oncology journey started in 2008 as a student of Dr. Parth Mehta and culminated in becoming a nursing instructor in 2012. He is a local and international childhood cancer advocate. Seeing the survivors and knowing that he somehow contributed to their survival is a wonderful feeling. The experience of seeing patients passing on because of late diagnosis and cancer complications is emotionally draining, yet he has the fondest memories of those that have passed. He believes that you have to be informed, decisive, efficient, resilient, patient and very cooperative when dealing with childhood cancer patients. Being a paediatric cancer nurse teaches you to appreciate the little achievements in life. It also teaches you to be holistic, to care for your body, mind and soul and to treat patients and their families like they are a part of your own family.

Wedu Jacqueline Rebabedi, Assistant Nursing Officer, Princess Marina Hospital

Wedu received her bachelor’s degree in nursing from the University of Botswana. Her first post university appointment was in the pediatric unit. She feels the pediatric oncology ward is the most interesting unit. The

pediatric unit opened Wedu’s eyes to the amazing world of childhood cancers. It captured her heart and ultimately challenged her as a professional to learn more to be able to deliver the best care possible holistically to childhood cancer patients. As a pediatric oncology nurse each day is filled with challenges, but Wedu does the best she can to deliver care and meet the patients’ needs.

Pearl Semetsa, Principal Registered Nurse, Princess Marina Hospital

Pearl received her diploma in general nursing from Deborah Retief Memorial School of Nursing and became a chemotherapy biotherapy provider through APHON. She started her paediatric oncology nursing career in

2008 when she joined the Paeds Medical Ward. It was the first time she became aware of the prevalence of cancer in children and she was compelled to know more. Pearl has been an advocate for children with cancer both nationally and internationally. She is engaged in capacity building of other health care workers, involved in research and published in journals. She participated in the formation of the patient support group “Childhood Cancer Parents Association of Botswana”. As a paediatric oncology nurse Pearl spends a lot of time with her patients throughout their treatment and establishes a bond with patients. As a mother, she holds children close to her heart. When she cannot save a child, she can give them a dignified passing. This challenges Pearl every day to grow academically and personally.

Kitsiso Pediatric Nurse Specialist, Princess Marina Hospital

Kitsiso obtained her masters in pediatric nursing from the University of the Witwatersrand, Johannesburg, South Africa, a post graduate diploma in higher education from Botho University, Gaborone, Botswana, and a bachelor’s

in nursing from North West University, Mafikeng, South Africa. She believes that caring for children with cancer is very emotional and at times can test one's resiliency. When the day is done, the children remain the motivation behind the search for a cure. Children with cancer inspire Kitsiso to continue to care for them making a difference in their lives as a pediatric nurse. She appreciates learning new nursing practices every day. The happy moments for Kitsiso are when a parent receives the news that treatment is working and sees the child improve every day making the child and parent smile for the first time in weeks.

Lebogang Monnagatsalwe, Nursing Officer II, Princess Marina Hospital

Lebogang obtained her bachelor’s degree in nursing from the University of Botswana. Initially it was traumatic for her to see a childhood cancer patient with eye proptosis and it sparked her journey in the pediatric oncology field.

She started to participate in childhood cancer activities and education. Lebogang considers being a pediatric oncology nurse interesting because it keeps her on her toes as there is no room for error. She keeps up to date with current pediatric nursing education and takes her professional development in pediatric oncology seriously. Being a pediatric oncology nurse is challenging, but fun.

Pearl Wame Onneng, Principal Registered Nurse, Princess Marina Hospital

Pearl received her higher diploma in general nursing from Kanye Seventh Day Adventist College of Nursing. As a pediatric oncology nurse, she has gained compassion, sensitivity and empathy, and has learned to be emotionally

resilient when dealing with children with cancer. She has become knowledgeable about the different pathology and biology of childhood cancers. For Pearl, it is exciting to care for children with cancer by administering chemotherapy and other procedures and it is emotionally fulfilling to provide education to pediatric oncology patients and their families.

Dorcas Ramphaleng, Nursing Officer I, Princess Marina Hospital

Dorcas obtained a bachelor’s degree in nursing and received training from the International Hemophilia Training fellowship program and the Introduction to Genomic Medicine for Nurses in Africa. In 2006 she

started working in the pediatric medical ward. Early in her career, Dorcas developed an interest in taking care of oncology and hematology patients. In 2009 she was trained in hemophilia care and has been taking care of both adults and pediatric patients with bleeding disorders. During her time in pediatrics she has had the opportunity to take care of patients with different types of cancers. She actively participates in oncology related activities and trainings. Being a pediatric oncology nurse enables Dorcas to learn new nursing practices every day and provides for continuous professional development.

Volume # 1 | Issue # 3 | Global HOPE Nursing Newsletter

Next Issue: Stay tuned for more information about the Global

HOPE Quality Improvement Projects, the 2020 Global HOPE Nursing Workshop in Malawi and an update on Cohort 2 nurses.

We are excited to announce that the 2020 Global

HOPE Workshop: “Exploring Paediatric Oncology

Nursing and Pharmacy: Bridging Knowledge and

Skills” will take place in Malawi in early February.

Stay tuned for more information in our next issue.