Ministry of Health Moves to Boost Capacity in Nephrology Care

In another two months, the Ministry of Health will turn out its first four certified nephrology nurses, as it embarks on a sustainable course towards building quality and efficiency in the island’s state-run renal units.
The nurses in training – Lisa Miller, Sophia Henry, Maxine Simpson, and Leset Stephenson – who have experience in renal care, look forward to their new status and appreciate the expanded role they will play in assisting the Ministry to grapple with the growing cases of renal kidney disease.
From their classroom adjacent to the Renal Unit of the Kingston Public Hospital, the four registered nurses, who, for the past five months, have been participating in the inaugural nephrology nurse training programme, spoke candidly with JIS News of their experience to date.
“For me, knowledge has been increased . I feel more competent going back to the field,” says Nurse Simpson.
For Nurse Stephenson, the studies have expanded her horizons. “You get a chance (to attend to) the person as he enters this acute renal failure, which is an opportunity that I’ve never been exposed to, being in the Dialysis Unit where the patient is at the end stage of renal function. Now you’re seeing the patient when you can actually do something to reverse the phase, and I think that is just fabulous,” she notes.
As the ladies talk, it soon becomes evident that they love what they do. Demonstrably competent, intelligent, professional and compassionate about nephrology, it is clear that they deserve the distinction of being the first to benefit under the training programme.
Nephrology nursing is concerned with the prevention, care and assessment of health needs of the adult and paediatric patient and their families, who are experiencing the real or threatened impact of acute or chronic renal failure. The focus of the course is on the provision of replacement therapy; self care teaching and assisting the individual to make informed choices.
The decision by the Ministry of Health to establish a formal training programme was taken following a needs analysis, which found that there is a shortage of nephrology nurses in the island, says Yvonne Young-Reid, the Ministry’s Training and Development Officer for Nurses.
“Out of this needs analysis, we recognized that there was a need to expose some of our nurses to nephrology training. The programme was not available locally. A proposal was submitted to the National Health Fund, and funding was approved. As a consequence, we’re now able to develop our own local institution,” she informs JIS News.
This training programme, which was launched in June, is expected to increase the cohort of certified specialist nurses in the field, and concomitantly, enhance the efficiency of the country’s renal care units. The training centre is managed by the Critical Care Unit at the Kingston Public Hospital. Of the four nurses in training, two are from the KPH and the other two from Cornwall Regional Hospital in Montego Bay.
Underscoring the importance of the certification/training programme, Acting Chief Nursing Officer at the Ministry of Health, Dr. Leila McWhinney-Dehaney, says it comes at a time when the health system is grappling with an increase in chronic lifestyle diseases, such as diabetes and hypertension, which she notes, is causing end-stage renal disease. “Hence, to address the issue of renal disease, we have determined the need for specialist care for (these) patients,” she points out.
The training programme comprises seven months of dedicated study, where the nurses are being exposed to didactic and clinical teaching and field training.
Following an initial four weeks of full classroom training, the nurses have a schedule of two-days of classroom teaching and three days of clinical experience in renal settings such as dialysis wards, clinics, and transplant and intensive care units and operating theatres. The final component of the curriculum, which according to Dr. McWhinney-Dehaney, is comprehensive and competitive with any other curriculum anywhere in the world, will see the nurses visiting the Jackson Memorial Hospital in the United States for one week of observation.
The training programme, she says, is not only aimed at improving the technical competence of the nurses in terms of renal care, but “we believe these nurses ought to be able to educate the patient, the family, the community in terms of prevention and also management of illnesses that will contribute to end stage renal disease, and also to manage their condition as they are dialyzed.”
The move to boost capacity in renal care will ensure the long-term sustainability of health service in this field. “The more we train is the more the capacity of our hospitals will be boosted, and we are looking at long-term sustainability . so right across the island, eventually, we will be able to give service to patients, who fall victims of renal disease. And we are also hoping that with our education of patients, that we will also prevent more patients reaching that stage. So the more trained professionals we have, is the higher likelihood of us stemming the tide of this disease process,” the doctor postulates.
She adds that at the end of this course, the newly certified nurses will be asked to supervise the next batch of trainees, which is expected to increase to eight registered nurses next year, in keeping with the Ministry’s two to one student/tutor policy. Only two certified nephrology nurses are presently in the island.
The Ministry is hoping that the highly prepared nurses, will be so equipped to conduct research that will guide the Ministry in determining policy and how patients are managed.
Daphne Bartley, a veteran nephrology nurse of some 30 years, who helped to formulate the curriculum for the training programme and is the first certified nephrology nurse in the profession, heartily endorses the introduction of the Jamaican-based training programme.
She recalls her early days as a nurse working in the KPH’s Renal Unit in the 1970s, when no specialist nursing care was available. The hospital has offered renal transplant service since 1970. “I had to do a lot of reading to care for the (patients) because they needed special care,” she tells JIS News. She notes that her desire to pursue training led her to the United Kingdom, where she endured seven months of “quite intensive” and “in-depth” studies and “would not have made it” without the background experience she had acquired in the Renal Unit.
Nurse Bartley, along with noted consultant nephrologist, Professor Lawson-Douglas, have been working over the years to address the shortage of nurses and trained staff. Together, in the absence of a formal training programme, the two have been providing supervision and in-service training for scores of registered nurses operating in the Renal Units of the KPH and Cornwall Regional Hospital, as well as agitating for the enhancement of renal services. Their commitment to patients of renal disease is at the heart of the work they both do with the Kidney Foundation founded by the Professor.
Today, patients with acute/chronic renal failure, end-stage renal disease can access renal placement therapies in the form of haemo-dialysis, peritoneal dialysis and kidney transplants, at the government’s two renal units.
Haemo-dialysis, one of the effective treatment methods, involves a mechanized process of removing excess fluids and toxins from the blood of patients suffering from kidney failure. Without this critical procedure, patients can get very ill and die. Most patients require three sessions a week with each session lasting between three and five hours, depending on their needs.
In the meantime, as the first training programme draws to a close, a new cohort of nurses are preparing for the second run of the programme. It’s a course that has been in demand for a long time, Mrs. Young-Reid points out, noting “we didn’t even have to advertise the programme. Immediately, they understood that this was going to be happening locally, interest was so aroused.”
And understandably so, concurs President of the Nurses Association of Jamaica, Edith Allwood-Anderson, who notes that “the nephrology course, is.very necessary. As a matter of fact, it is very vital and essential at this time, because the lifestyle diseases – diabetes, hypertension, all of those things sometimes affect the kidneys and the circulatory system, and so this course at this time will assist Jamaicans in getting a higher level of improved care.”
“But even as we train just about four of these nurses at this time, we have need for maybe another 50 renal nurses throughout Jamaica, so we’re hoping that the programme itself will be intensified .that we seek to twin with other areas, whether in America or the Caribbean to have this kind of training that we can maximize training of nurses in the care of these patients,” she suggests.
Mrs. Allwood-Anderson tells the JIS New that the Association will be pushing nurses within the system to take up the formal training now being offered. “Overall, it is very dear to our hearts. We have been lobbying this for years, and we want to see this maximized,” she says.
Nurses seeking entry into the course must have six to 12 months experience in a renal setting. They have to also be registered nurses with current licences, have a minimum of two to three years post registration experience, well developed verbal and written communication skills, basic life support certification, and have demonstrated the ability to adapt to a new environment.
Critical care experience is useful but not compulsory. Students can submit all applications through the relevant authorities by December of each year and attend an interview in March of the following year.