Getting Serious About Nurses: Health

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Getting Serious About Nurses Health Safety
in the Workplace
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• Gregory Grevera, MSN, CRNP, AACRN
• Board of Directors, ANAC

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• Adele A. Webb, PhD, RN, ACRN, FNAP, FAAN
• Executive Director, ANAC

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ICN Wellness Centres for Health Workers and
their FamiliesPresented at ANAC Satellite 6
August 2008International AIDS ConferenceMexico
CityTesfamicael Ghebrehiwet,PhD, RNConsultant,
Nursing and Health PolicyInternational Council
of Nurses
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Wellness Centres for Health Care Workers and
their Families
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Wellness Centre rationale/concept

• Since September 2006 the Wellness Centre provides
  dedicated health services - HIV, TB, prevention,
  treatment and care PEP stress management
  occupational safety training capacity building
  for HCWs and families
• So that
• Keep HCWs healthy, in their jobs and in the
  country
• Strengthen health systems under tremendous
  pressure
• Demonstrate health workers are valued
• Maintain the relationship of trust
• Build a catalogue of good practice

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Wellness Centres for Health Care Workers in
Swaziland

• Delivering health and wellness services to health
  workers their families

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Swaziland Wellness Centre Services

• Prevention, education
• HIV TB testing, counseling, treatment
• Stress management
• Training
• Occupational health and safety injection
  safety, PEP
• Healing Garden
• PMTCT
• Work place services

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Partners/funders
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Implementation planning

• First-ever Wellness Centre opened in Swaziland in
  September 2006
• Lesotho opened in fall 2007
• Zambia and Malawi in 2008
• Committed to Wellness Centres where locally
  requested across sub-Saharan Africa

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Some results to date - Swaziland

• Reached 6,225 health care workers (HCWs),
• 77 of the total health workforce.
• Outreach programme brings staff to
• outlying health facilities.
• Zero reported cases of nurse migration
• over the past year.
• 65 increase in uptake of services
• per month.
• HTC increased among health workers.

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Results contd

• TB and MDR-TB training programme for
• nurses initiated.
• Wellness for workers is now incorporated
• in government policy.
• 80 increase per month in clients
• seeking psycho-social services.
• Support workers (kitchen, maintenance,
• cleaning) receive training on HIV and TB.
• Wellness Centre educational programmes
• reach the public via radio broadcast.

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Results Lesotho

• Opened in November 20007
• More than 1 300 HCWs reached with services and
  training
• Training includes, stress management, behaviour
  change, PEP, IMAI
• Accredited for and delivering ART
• Nurse counselling and wellness checks

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Identified gaps/needs

• Reliable access to mobile capacity for delivery
  of services and training in the work place
  outlying areas
• Strengthened lab/monitoring capacity, including
  TB
• Increased capacity in
• Occupational health and safety
• Financial project management
• Development of services related to diabetes and
  other chronic diseases

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View from Swaziland

• Video

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Protecting health workers from occupational
exposure to HIV through global campaigns Dr.
Jorge R. Mancillas Public Services
International 6 August 2008 International
AIDS Conference
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Health Worker risk of HIV infection

• Health workers are at high risk of occupational
  exposure to HIV
• The incidence of HIV infection amongst health
  workers is highest where the prevalence
  of HIV is highest

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Global shortage of health workers
Current global shortage 4.3 million health
workers (WHO)
The infection of a HCW with HIV is not only
another human tragedy, but also the loss of vital
human resource needed to effectively fight the
epidemic
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The need for international structures
WHO and other intergovernmental organizations
Health workers unions professional
organizations Global and local perspective.
Policy, advocacy, implementation monitoring PSI
structure Congress ? EB, HSTF ? Weblog
publications 651 affiliates, 24
sub-regional and regional networks a) Survey,
monitor and communicate to identify concerns of
universal nature integrate local (frontlines)
to global (HSTF, sub-regional meetings and
networks) b) Research or develop solutions
share resources c) Plan and implement campaigns
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Protecting health workers the process

• 1. Research solutions and tools of universal
  applicability and
• identify partners, goals and targets
• Sources PSI affiliates, PSIRU, WHO, ILO,
  research institutes
• 2. Global campaigns
• a. Implementation of preventive measures
• - AIDS guidelines WHO/ILO
• b. Ensure treatment of infected health workers
  PEP ART - PEP guidelines WHO/ILO
• c. Prevent workplace exposure by addressing
  major mode of transmission of BBPs
  needlestick injuries

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Needlestick injuries
Healthcare workers suffer 2 million exposures to
Hepatitis and HIV/AIDS per year due to needle
stick injuries
Needle stick injuries are the mode of
transmission for over 30 other blood borne
pathogens (Malaria, Ebola, Hep C)
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Retractable syringes
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Retractable syringes

• Safe for health care workers
• Safe for waste collectors
• Safe for patients non-reusable (Prevent 1.3
  million deaths, 535 million)
• Benefits of a campaign to make safe devices the
  universal standard
• Protection of health workers and patients,
  retain AIDS work force

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WHO strategy
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Safe devices campaign

• GOAL Achieve widespread shift to safe devices by
  building economies of scale and eliminating price
  differential
• Retractable syringes
• Develop disseminate information and materials
  to affiliates
• Negotiate with government or employers, build
  public support
• Negotiate lower prices with manufacturer build
  sales volume
• First successes
• a) Democratic Republic of Congo decreed
  mandatory standard
• b) Nigeria
• c) Angola

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Protecting health workers the process

• Advocate at global bodies WHO, Global Fund, IFIs
• ? Develop solutions
• ? Policy carry weight of international body (WHO
  SIGN)
• ? Involve multiple participants
•  
• b) Pursue multiple mechanisms to change policy
• ? International organizations (WHO, World
  Bank) Financing and guidelines
• ? Regional bodies EU Directives
• ? National DRC, Nigeria, Angola Decrees,
  agreement
• US, UK Legislation
• ? State/province Brazil Rio, Santa
  Catarina Legislation
• ? Employers Negotiations of CBAs
•  
• c) Create conditions Education, public
  relations, policy and financing

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Thank you
Dr. Jorge Mancillas PSI Health Services
Officer Jorge.mancillas_at_world-psi.org 33 450 40
11 50 33 617 54 38 74
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Chisomo Zileni, RN

• Program Officer
• National Youth Council
• of
• Malawi

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International AIDS Conference Mexico 2008
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• ANAC Satellite Getting Serious About Nurses
  Health and Safety in the Workplace

Christine Mutati Zambia Union of Nurses
Organization ZUNO/NNO Nurses HIV/AIDS Project
Zambia
Sulwe Isaac Hamuchele Zambia Union of Nurses
Organization ZUNO/NNO Nurses HIV/AIDS Project
Zambia
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Issues
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• Confidential access to health care for and health
  care workers
• Wellness centers for health care workers and
  development of supportive networks for nurses

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Patient/Client Confidentiality
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• Definition
• A conscious effort by every healthcare worker to
  keep private all information revealed by the
  client while receiving healthcare, this include
  clients identity, physical or psychological
  condition, emotional status and financial
  situation.

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Patient/Client Privacy
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• Definition
• Privacy entails a state of being free from
  unauthorized intrusion (a persons right to
  privacy)
• A state in which one is not observed or disturbed
  by unauthorized others
• The quality or condition of being secluded from
  the presence or view of others

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Whose responsibility to maintain client privacy
confidentiality?
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• Just like nurses provide privacy and
  confidentiality to their clients, they likewise
  deserve and are entitled to privacy and
  confidentiality when accessing healthcare from
  public and private care providers (all healthcare
  providers).
• Thus
• Confidential pre/post exposure prophylaxis
• Confidential and accessible treatment(including
  ART)
• Confidential and fairly distributed care and
  support which include follow-up services

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Observation
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• Nurses by nature of their work are mostly
  stigmatized especially when it comes to seeking
  health care services from public institutions.
  This is despite them being human beings who get
  sick just like any other humans with rights to
  accessing confidential and affordable health care
  services from any sources available.

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Call for Action
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• It is a requirement for any government in any
  country to avail nurses with accessible
  confidential and affordable health care services.
• It is prudent for any government and many other
  stakeholders to formulate and implement policies
  that will promote equitable distribution of care
  and support to all health care workers.
• Countries/Governments should adopt the wellness
  centre concept for assured comprehensive
  provision of healthcare package tailored
  specifically for nurses and other health workers.

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Wellness Centres for Health care workers
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• Wellness centers are intended to provide a
  comprehensive healthcare package well tailored
  for health care providers.
• Proved useful and successful in
• Swaziland
• Lesotho
• Zambia

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Wellness centres comprehensive services include
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• Counseling
• ART,TB and Malaria clinics
• Laboratory services
• Compliance and community follow-ups/outreaches
• Skills building trainings
• Stress management
• Care and support programs
• Recreation
• Drug supplies
• etc

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Support groups/networks for nurses
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local support group
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Nurses support/networks activities
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Sick nurses
Orphans
Retired Nurses
Piggery
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Support networks
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• Wellness centre activities are linked with
  nurses local support groups for assured coverage
  of nurses in remote areas
• NB- Nurses are availed the necessary privacy and
  confidential, accessible and affordable
  healthcare services through wellness
  centre/local support groups linked service
  package.

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• ACTION SHOULD BE NOW
• THANK YOU FOR YOUR LISTENING

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• Carl A. Kirton, RN, MA, ACRN, ANP-BC
• President, ANAC

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• Pat Daoust, MSN, RN
• Health Action AIDS Campaign Director

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A Global Call

• Please support our statement on the rights of
  all health workers to a safe and healthy work
  environment