International Relief Team (IRT) & the S.T.A.B.L.E. Program's "Healthy Baby" Project Vietnam Bridget Cross, MSN, APRN, NNP-BC Barbara Levy, BSN, RN, RNC-NIC
Disclosure Information: Bridget Cross & Barbara Levy No financial interest or other relationships that could be considered a conflict of interest by participants No discussion of unlabeled uses of a commercial product, or an investigational use of a product not yet approved for this purpose
Agenda 1. Describe the International Relief Team s Healthy Baby Project-Vietnam s Goal 2. Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Lead Instructors
Agenda 3. Share highlights of this unique international teaching experience 4. Explore perinatal & neonatal S.T.A.B.L.E. interventions from this international experience that may be applicable to practice in the United States
Describe the International Relief Team s (IRT) Healthy Baby Project-Vietnam s Goal IRT s Healthy Baby Project gives healthcare providers the knowledge & skills needed to save newborn lives Project Vietnam is a nonprofit humanitarian organization creating sustainable pediatric healthcare providing free healthcare & aid to impoverished rural areas
Describe the International Relief Team s (IRT) Healthy Baby Project-Vietnam s Goal IRT s partner in Project Health Baby = Project Vietnam Foundation (PVF) PVF is registered as a nongovernmental organization established excellent working relationships with authorities & institutions at all levels of the Vietnamese health system Mission healthcare assistance to children at-risk in poor rural communities in Vietnam medical training to Vietnamese health professionals
Describe the International Relief Team s (IRT) Healthy Baby Project-Vietnam s Goal Project Vietnam Statement of Need: number of Vietnamese babies who die during their first year of life = up to 64 deaths per 1,000 births in the rural areas (compared to 6.5-8.5-1000 in Western countries) worse for children living in rural areas, poor (2x higher), or ethnic minorities (3x higher) lack of uniform, nationwide standards for providing effective post-resuscitation care to the critically ill newborn
Describe the International Relief Team s (IRT) Healthy Baby Project-Vietnam s Goal Project Vietnam Statement of Need: Infants in rural communities born prematurely or with unanticipated complications may be miles from facilities with specialized technology & highly trained staff Vietnam s natural terrain & congested highways makes for difficult rapid infant transport to higher level of care hospital
Describe the International Relief Team s (IRT) Healthy Baby Project-Vietnam s Goal LOW TECH SOLUTIONS SAVE BABIES LIVES Teaching techniques such as trans-illumination is an inexpensive and quick way for Doctors without many resources, like in rural communities in Vietnam, to diagnose babies with a collapsed lung This technique teaches low tech solutions which can help save babies lives.
Describe the International Relief Team s (IRT) Healthy Baby Project-Vietnam s Goal Critical for the staff in rural or lower level hospitals to know how to not only resuscitate a newborn in acute distress (NRP) also provide effective post-resuscitation care to the critically ill newborn at that rural facility (S.T.A.B.L.E.)
Describe the International Relief Team s (IRT) Healthy Baby Project-Vietnam s Goal Project Health Baby -Vietnam Goal lower neonatal & infant mortality in Vietnam establishing uniform standards in postresuscitation care of the newborn by training Vietnamese neonatal clinicians
Describe the International Relief Team s (IRT) Healthy Baby Project-Vietnam s Goal Trains trainers in Neonatal Resuscitation (NRP) & Infant Stabilization (S.T.A.B.L.E.) targeting the critical neonatal period, when most infant deaths take place Establishes self-sustaining regional instructor groups who provide ongoing training to other practitioners who deliver or provide care for newborns
Describe the International Relief Team s (IRT) Healthy Baby Project-Vietnam s Goal Train up to 200 Vietnamese neonatal professionals as S.T.A.B.L.E. instructors 12 training sessions (5 days of training per session) Organize the instructors trained into instructor groups goal of establishing 1-2 S.T.A.B.L.E. instructors in each province of Vietnam Equip instructors with training materials & books Require all instructors report results of all trainings conducted to both S.TA.B.L.E program & IRT by online roster
Describe the International Relief Team s (IRT) Healthy Baby Project-Vietnam s Goal Since 1996, IRT has trained in NRP 269 NRP instructors these NRP instructors have trained more than 5500 in NRP Since 2015, IRT has trained in S.T.A.B.L.E. 107 S.T.A.B.L.E. lead instructors these lead instructors have trained more than 648 in S.T.A.B.L.E.
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Hundreds of times each day, in hospitals and communities around the world, newly born infants become ill and require specialized care. Each member of the health care team nurses, physicians, therapists and assistants must know what to do for the sick infant. Their care must be provided in a timely, efficient, anticipatory, and effective manner. This early transitional care affects not only the immediate health of the infant, but also the infant s long-term outcome. The S.T.A.B.L.E. Program was developed to meet the educational needs of health care providers who must deliver this important stabilization care. S.T.A.B.L.E. education is critical to the mission to reduce infant mortality and morbidity and to improve the future health of children and their families. www.stableprogram.org
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors The S.T.A.B.L.E. Program was founded & authored in 1996 by Kris Karlsen PhD, NNP-BC Most widely distributed & implemented neonatal education program that focuses exclusively on the postresuscitation/pre-transport stabilization care of sick infants Endorsed by the March of Dimes
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Has grown internationally to include instructor training & courses in greater than 45 countries Argentina, Bahamas, Belarus, Bolivia, Canada, Colombia, Congo, Costa Rica, Dominican Republic, Egypt, El Salvador, Eretria, Faroe Islands, Germany, Ghana, Guam, Guatemala, Honduras, Ireland, N. Ireland, India, Israel, Italy, Japan, Kenya, Kiribati, Kosovo, Latvia, Lithuania, Mexico, Nepal, Netherlands, Nicaragua, Panama, Philippines, Qatar, Romania, Spain, Thailand, Uganda, U. Arab Emirates, UK, & Vietnam Program translated: Spanish, Lithuanian, Latvian, Romanian & Vietnamese
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Taught in didactic-interactive format Optional S.T.A.B.L.E. simulation scenarios available simulation-based education is used to train for emergencies, improve team performance and communication & ultimately improve patient safety
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Based on a mnemonic to optimize learning, retention & recall 6 assessment & care modules: Sugar, Temperature, Airway, Blood pressure, Lab work, & Emotional support 7th module: Quality Improvement: stress professional responsibility of improving & evaluating care provided to sick infants
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Stabilization is a team effort! Any health caregiver involved with post-resuscitation and/or pre-transport care of sick newborns benefits Physicians: Pediatric, ER, family practice, and obstetric physicians including residents Nurses: RNs working in L&D, postpartum, nursery, ER, Nurse midwives, LPNs, Nursing assistants Others: RTs, EMTs & Paramedics
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors S.T.A.B.L.E. instructors worldwide are greater than 4200 S.T.A.B.L.E. student roster program launched 1/1/01 to track student participation learner courses submitted worldwide Student participant stats: 1/01-1/5/17 total students=454,657 total classes=46,811
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Teaching S.T.A.B.L.E. in Vietnam: 6 th edition translated Vietnamese Learner manual & slides for new instructors & learners U.S./English speaking instructors/mentors utilized Vietnamese expert interpreters for lead instructor classes 5 day format for each week (Hanoi & Saigon) 3 days for S.T.A.B.L.E. instructor course training by U.S. mentors included clinical skills & learner course roster 2 days for learner course by new Vietnamese S.T.A.B.L.E. instructors timely use of feedback from U.S. mentors successful roster submission
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Challenges for the U.S. mentors in presenting S.T.A.B.L.E. to the Vietnamese instructors flow of the timing of the presentation use of euphuisms & humor not easily transferable due to difference in cultural norms differences in health care delivery system differences in medical/nursing patient care hierarchical, teamwork & chain of communication differences differences in availability of medical resources/equipment
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Flow of the timing of the presentation slower & longer due to Vietnamese interpretation challenging using both English & Vietnamese slides simultaneously Use of euphuisms & humor not easily transferable due to difference in cultural norms slang & jokes not easily transferrable & possibly offensive
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Differences in healthcare delivery system currently working towards universal healthcare system government invests 0.9% of its Gross Domestic Product (GDP) on healthcare only about 30% of the population most have to pay for private health care quality & availability varies dramatically on whether in the city or in rural areas majority of hospitals/clinics located in larger cities (very crowded!)
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Differences in medical/nursing patient care uncertainty of Vietnamese translation accuracy by translator difficult to relate typical clinical cases due to medical, nursing & cultural differences differences in agreement of evidenced based care agreement of proper care but inability of Vietnamese to provide possibly due to financial, geographical and/or cultural differences
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Hierarchical, teamwork & chain of communication differences majority of Vietnamese neonatal docs are female all procedures done by doctors nurse to patient ratio ~ 8 level 2-3 NICU neonates to 1 nurse nurses task oriented due to high patient load discouragement for use of chain of command shifting hierarchical changes with increasing western influences
Discuss the process of training Vietnamese professionals as S.T.A.B.L.E. Instructors Differences in availability of medical resources/equipment Vietnamese practitioners do not usually have access to: Meconium aspirators Stylets Flow inflating bags T-piece resuscitators CO2 detectors LMAs 3-way stopcocks Epinephrine diluted to1:10,000 Rh negative blood
Share highlights of this unique international teaching experience Vietnam Geography country s total length=1025 miles slightly larger than New Mexico Population: 86,116,560 (2008) Capital: Hanoi Government Type: Communist state Languages Vietnamese (official), English, French, Chinese, & Khmer Total Fertility rate 1.86 children born/woman (2008)
Share highlights of this unique international teaching experience Fall 2016 Vietnam IRT/STABLE Teaching Team Audrone LaForgia, Nannette Laufik, Barbara Levy & Bridget Cross
Share highlights of this unique international teaching experience New S.T.A.B.L.E. Instructors in Hanoi, Vietnam
Share highlights of this unique international teaching experience New S.T.A.B.L.E. Instructors in Saigon, Vietnam
Clinical videos to highlight this unique, & challenging international teaching experience.
Explore perinatal and neonatal S.T.A.B.L.E. interventions from this international experience that may be applicable to practice in the United States S.T.A.B.L.E. provides evidenced based medical & nursing knowledge leading to the improvement in perinatal & neonatal outcomes through technical, cognitive & behavioral solutions applicable in both Vietnam & the United States.
Explore perinatal and neonatal S.T.A.B.L.E. interventions from this international experience that may be applicable to practice in the United States Technical Solutions: Transillumination: phone, pen, or flash light Needle Aspiration: chicken or duck ETT insertion: mannequin Xray Interpretation: Use of S.T.A.B.L.E. slides Umbilical line placement
Explore perinatal and neonatal S.T.A.B.L.E. interventions from this international experience that may be applicable to practice in the United States Cognitive Solutions: Attempts to reduce variances in evidence based practice Venous & arterial placement, securement & usage Assessment of glucose need & delivery Thermoregulation Airway & ventilation management Perfusion & cardiac management
Explore perinatal and neonatal S.T.A.B.L.E. interventions from this international experience that may be applicable to practice in the United States Behavioral Solutions: Difference in medical training Differences if medical & nursing practices Hierarchical challenges Family, societal & cultural differences
The following video clip, from our Vietnamese colleague, brilliantly demonstrates the joy and similarities discovered through this educational collaboration! Thank you for attending & we look forward to answering your questions.
Bibliography/References Black, R. E., R. Laxminarayan, M. Temmerman, and N. Walker, editors. 2016. Reproductive, Maternal, Newborn, and Child Health. Disease Control Priorities, third edition, volume 2. Washington, DC: World Bank General Statistics Office and UNICEF, 2015. Viet Nam Multiple Indicator Cluster Survey 2014, Final Report. Ha Noi, Viet Nam Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014 Sep 13;384(9947):957-79 International Relief Teams S.T.A.B.L.E. Team - Fall 2016: Vietnam Country Manual
Bibliography/References Kendall AB, Scott PA, Karlsen KA. The S.T.A.B.L.E. Program. The Evidence behind the 2012 Update. J Perinat Neonatal Nurs. 2012 Apr-Jun;26(2):147-57 Lee HY, Van Do D, Choi S, Trinh OT, To KG. Trends and determinants of infant and under-five childhood mortality in Vietnam, 1986-2011. Glob Health Action. 2016 Feb 29;9:29312 Målqvist M, Hoa DP, Persso LÅ, Ekholm Selling K. Effect of Facilitation of Local Stakeholder Groups on Equity in Neonatal Survival; Results from the NeoKIP Trial in Northern Vietnam. PLoS One. 2015 Dec 29;10(12):e0145510
Bibliography/References McKinnon B, Harper S, Kaufman JS, Bergevin Y. Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis. The Lancet Global health. 2014; 2(3): e165 73. The S.T.A.B.L.E. Program: www.stableprogram.org Wallin L, Malqvist M, Nga NT, Eriksson L, Persson LA, Hoa DP, et al. Implementing knowledge into practice for improved neonatal survival; a clusterrandomised, community-based trial in Quang Ninh province, Vietnam. BMC Health Serv Res. 2011; 11(1): 239.