Meeting the Growing demand for Home Based Care Part 2:

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Meeting the Growing demand for Home Based Care
(Part 2))

• The Experience of having Nursing Students from
  Lovisenberg Deaconal University College (LDUC,
  Oslo) in ClinicalHome Based Care practice in
  Moshi, Tanzania
• Lightness Kaale and Ellen A. Lothe
• Bergen, Norway, January 11, 2007

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Nursing Students from Lovisenberg Deaconal
University College (LDUC, Oslo) in ClinicalHome
Based Care practice in Moshi, Tanzania

• Norwegian governmental Quality Reform
  (Stortingsmelding 27, 2000-2001) encourages
  Norwegian institutions of higher learning to
  cooperate with institutions abroad
• Final year nursing students from Lovisenberg must
  complete 8 weeks of mandatory home based nursing
  care before graduation
• Since september 2004, 4 groups with 4 students in
  each group have had this clinical practice in
  Moshi

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Home Based Care Policy

• Home Based Care (HBC) is defined as any form of
  care given to chronically ill people in their
  homes
• WHOs definition includes physical,
  psychological, social, and spiritual activities
• The objective of HBC is to provide continuity of
  care for persons with chronic conditions,
  including persons living with HIV/AIDS
• Community ownership and involvement in HBC is
  seen as important
• Local public health facilities appoint staff
  members to act as contact persons, and also have
  trained HBC supervisors at district level
• Community HBC providers come from the Tanzanian
  government, different NGOs, Faith Based
  Organisations or the community at large

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Voluntary Home Based Care

• Kilimanjaro Women Against HIV/AIDS (KIWAKKUKI)
• Network of voluntary members trained in providing
  Home Based Care services
• Provide a wide range of basic chores which
  patients need on a daily basis
• domestic tasks fetching water, cooking, cleaning
• health care tasks administering medicines,
  bathing patients, taking patients to the hospital
  
• matierial tasks bringing food from the World
  Food Programme resources, contributing even from
  their own kitchens and cupboards
• Children of patients receive similar care

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Students Field Practice

• Patients are selected by local HBC providers and
  care givers
• Two day orientation period in which students
  visit patients together with local care givers
• Purpose to familiarize students with patients
  home
• Do relationship building
• Students explore and assess each patients
  problems, challenges, and concerns, and prepare a
  nursing plan
• Patients are nursed according to prevailing
  conditions
• Preventive nursing, regarding complications
• Dressing wounds, bathing patients, providing
  comfort, sometimes spiritual comfort
• Students bring material things food, toys for
  children - just as the local HBC providers do
• For patients with temporary or permanent
  paralysis, students also assist with
  physiotherapeutic exercises

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Student Experience

• Students stay for 8 weeks, in groups of four
• Students selected based on academic results,
  knowledge of English, attitudes toward
  multicultural nursing, personal maturity and
  motivation
• Students pay their own costs
• 30 hour mandatory language course in Swahili
• Each student group continues the nursing process
  started by the previous group, so as to maintain
  a certain continuity for the patients

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Getting to work
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Nurses efforts
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A patients house
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Ethical considerations

• Respecting patients right to privacy
• Patients are asked if they want to have Norwegian
  nursing students visiting them on a regular basis
• The students are aware of HIV and AIDS still
  carrying significant social stigma, and seek to
  behave accordingly

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Challenges

• Language barriers
• A new world for students
• They were surprised and very unhappy to see
  their first client. They were shocked and said
  they had to go back and discuss what to do.
  Another time they wanted to stop outside and not
  enter with us, because the shock and the
  impressions were too strong for them, says local
  supervisor
• Short stay Local nurses want students to stay
  longer, in order to develop sustainable patient
  relationship

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Benefits (1)

• Patients and their families say
• I will die dry thanks to the diapers you have
  provided me, thank you
• I cant feel my bones any longer, the diapers
  are like part of my body
• Is it all for me? (regarding food distributed
  from the World Food Programme)
• Thank you for your encouragements! After having
  started on the AntiRetroViral drugs, my hair is
  back to normal, I can wear my old nice clothes,
  which did not fit me for a year now, and I can go
  to church again

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Benefits (2)

• HBC providers encourage patients family members,
  social network and neighborhood to render care
• Thank you for bathing me! Since you did so the
  last time you were here, my whole family is now
  doing it, too
• I did not know that the day would come when I
  would again be able to eat at the same table with
  my family. This happened, but only after you had
  eaten with me once when you came to visit me.
• I thank KIWAKKUKI for starting a group in our
  village. All patients here are now taken good
  care of. My wife was admitted in the hospital,
  and these women went in turns to sleep with her
  there. My mother who used to stay with her in
  the hospital was very thankful and joined the
  group. She is now a very active member of the
  group, even if she is well into her 80s

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Benefits (3)

• Holistic Nursing
• One stroke stricken patient depended on another
  person to lift her whenever she wanted to move
  from her sitting position.
• The students, like good carpenters, constructed a
  supporting rail in her house the patient can now
  walk about, supporting herself.
• This was entirely on the students own
  initiative, and
• they covered the economic costs.
• The students found one house leaking, and
  promptly bought a few iron sheets for the house
  to be repaired.
• One student writes
• I have become aware of the role of the nurse in
  a different way than before. Holistic Nursing has
  got a meaning for me now. Nurses in Tanzania have
  to be so creative, and often do not have anyone
  to refer the patients needs to. I admire the way
  they find solutions

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Benefits (4)

• Local Home Based Care supervisors have evaluated
  cooperation with Lovisenberg Deaconal University
  College students
• The parents have felt blessed by having these
  students come home to them during these weeks.
• the students took care of one patient who
  died, and even went to the funeral, it shows the
  full participation. This is one of the outcomes
  of the HBC, that you cant stop abruptly, you
  follow up even after death and even at the
  funeral.
• The students ask a lot of questions. They were
  not very familiar with the problem of AIDS but
  now they know more, and have a new approach of
  handling HIV/AIDS, they familiarised themselves
  with this problem because most of our clients
  belong to this category. They gained much
  experience by being the link between us and
  them.
• They bring equipment for HBC, dressing equipment,
  medicines, particularly antifungus medication,
  and medicines against herpes simplex and herpes
  zoster, which are the most common opportunistic
  infections for people living with HIV and AIDS.
• The students represent an increase in our HBC
  manpower
• We like to get new ideas from abroad

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Students, Patients, HBC providers
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Conclusions

• The Norwegian Lovisenberg students have acquired
  a new meaning to the concept Holistic Nursing
  during their clinical practice in Moshi
• One student writes
• I have become aware of the role of the nurse in
  a different way than before. Holistic Nursing has
  got a meaning for me now. Nurses in Tanzania have
  to be so creative, and often do not have anyone
  to refer the patients needs to. I admire the way
  they find solutions