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Implementing a nurse leadership fellowship in palliative care in Uganda

Author: Professor Julia Downing, Honorary Professor, Makerere University,Uganda
15 February 2016

In Ugandan palliative care, nurses have a key role to play within the multi-disciplinary team, with many of the services throughout the country being led by nurses.

There is therefore a need for nurses to be trained and mentored in leadership skills, so they are equipped not only to provide palliative care services, but to lead, develop and manage those services, and to have a national and international role as change agents, teachers, and role models. Hence the development of the Uganda Palliative Care Nurse Leadership Fellowship.

The nurses

Twenty nurses commenced the Fellowship programme in August 2015 and the programme is set to continue until January 2017.

Eighteen of the nurses already had a specialist training in palliative care (Diploma or Degree); the remaining two have degrees in nursing alongside palliative care training.

The nurse Fellows come from a variety of settings including government hospitals, non-governmental organisations and specialist palliative care organisations, some of whom are working within a multi-disciplinary team for palliative care and others are working as sole practitioners. They come from different parts of the country, with four working in Northern Uganda, one in the East, five from the south/ south west, nine from in and around Kampala and one from the Army – the Uganda People’s Defence Force.

Components of the programme

The first of the taught weeks was held in August 2015 and focused on the self as a leader, exploring self-awareness, learning styles and conflict management. The second was held in January 2016 and focused on mentorship, self-care and leadership styles.

The remaining taught components of the fellowship programme will focus on influencing regional and national organisations, engaging others, coaching, media tips and communication and negotiation skills.

During the first taught week, the nurse fellows developed individual action plans, with actions focused on their own personal leadership styles, as well as implementing leadership projects in their workplace.

These were reviewed and revised in January 2016 and the nurses will continue to develop their leadership skills through their work plans and through national level projects, which they are undertaking over the coming months.

The mentorship programme

A core component of the programme is a mentorship programme, where mentors from the UK will be supporting the nurse leaders in Uganda, through a combination of face-to-face mentorship and remote mentorship via Skype, email and WhatsApp.

Funded as part of the Tropical Health and Education Trust (THET) Health Links Programme, this mentorship is key in developing both the nurse leaders but is also expected to impact on the learning of the mentors themselves.

Mentors come from a variety of backgrounds, some of whom have worked in Uganda and international palliative care before, for others it is an entirely new experience.

Mentor hubs have been set up to support groups of nurse leaders, including mentors from St Columba’s Hospice in Edinburgh, Princess Alice Hospice in Surrey, Hospice in the Weald in Kent, the Dorchester Palliative Care Team and individuals working in a variety of settings.

Initial Skype calls were held between mentors and mentees during the face to face training in January 2016, and mentors attended a mentor preparation day in December 2015.

Expanding a nurse link programme

Alongside the nurse leadership and mentorship programme, the grant is also supporting the expansion of the Mulago Hospital/Makerere University Link nurse programme to at least six other hospitals in Uganda, including some in the North – Nebbi, Yumbe and Adjumani Hospitals, some in Kampala itself – Kibuli Muslim Hospital and Naguru General Hospital, one in the East – Tororo Hospital, and also two in the South in Kibaale and Kasesse.

Work is also being undertaken by the Palliative Care Association of Uganda with the Uganda Nurses and Midwives Council to look at the role of the specialist palliative care nurses and the competencies required for them to work at the specialist level.

The impact

Whilst the programme is still in its early stages, with the Fellows having just completed their second taught module, it is clear that it is already having an impact.

Each of the nurses has been implementing their work plans, with strides being made both in terms of individual leadership goals, and workplace goals.

Six of the nurse leaders have begun the implementation of a nurse link programme with another three to follow shortly.

Others have implemented activities such as daily reporting on patients, training within their hospitals, support for others to provide palliative care and supervision of other sites. 

Looking to the future

Thus initial progress is exciting and it is hoped that the Leadership Fellowship progamme will be the start of ongoing leadership training for palliative care nurses. It aims to enable nurses to develop their skills and lead the development of palliative care in Uganda and offer a model and framework to extend to other cadres and countries.

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