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A Letter from PNEP’s Project Sponsors

 
As we come to the end of the Paediatric Nursing Education Partnership (PNEP), we are proud of the work we have done to elevate the status and profile of paediatric nursing across the country. Together, we have achieved, and in some cases surpassed, all of our set targets. Notably, 501 nurses coming from all 16 regions of Ghana, have graduated from GCNM’s one-year Paediatric Associate Membership Programme at three training sites in Accra, Tamale and Kumasi. This achievement has contributed greatly to the Ghana Ministry of Health’s target to train 1,500 paediatric nurses by 2025 and vastly increased access for children and their families to knowledgable, confident and highly skilled paediatric nurses. These graduates are working in hospitals across Ghana and are being recognized as leaders in paediatric care in their workplaces and in their communities.
 
PNEP’s approach over the last five years has been to strengthen institutional capacity in Ghana to deliver high-quality paediatric nursing education with a focus on long-term impact and sustainability. PNEP was proud to support and partner with GCNM, a strong, credible voice for paediatric nursing in Ghana. GCNM has become a strong advocate for nursing in Ghana and a reliable partner to Ghana’s Ministry of Health to positively influence policy and ongoing investment in nursing education.
 
Strong collaboration between Ghanaian and Canadian partners was reflected in all areas of PNEP including education delivery, program operations, monitoring and evaluation and communications. Meaningful investments in human resources, infrastructure, and curriculum development laid the groundwork for the successful delivery of all educational programming including the one-year Paediatric Associate Programme and all Continuing Professional Development courses and ensured their long-term sustainability and integrity. Notably, gender equality has been at the forefront of PNEP and its operations and contributed to enhancing educational and professional opportunities for women in Ghana. PNEP empowered women to contribute to strengthening paediatric nursing in Ghana, challenging the status quo, changing the perception of nurses’ roles, and advancing the health and rights of women and children in Ghana.
 
While PNEP has officially ended and operations have successfully been transitioned to GCNM, work remains to be done to continually support and elevate paediatric nurses. Demand for the Paediatric Associate Programme remains high, requiring continuing, long-term support and investment in both GCNM and the delivery of high-quality nursing education. Nurses not only provide high-quality clinical care but can be vehicles for societal change around gender and social norms. It is critical to ensure they are continually supported in clinical leadership roles and empowered to be champions and leaders in the care of children through positive and supportive clinical practice environments.
 
2020, a year unlike any other, was designated as the International Year of the Nurse and Midwife by the World Health Organization (WHO) recognizing the vital role nurses play in ensuring the health of their communities and the lasting impact they have on patients and their families’ lives. We thank all of PNEP’s partners for their support over the past five years and are inspired by their dedication to advance nursing education and the profession of nursing in Ghana. Most importantly, we are confident that the efforts of PNEP and continued investments in paediatric nursing will significantly contribute to the long-term goal of reducing preventable childhood deaths and improving wellbeing for newborns and children in Ghana.

Sincerely,


Abigail Kyei
President, Ghana College of Nurses and Midwives
PNEP Project Sponsor



Brian Smith
Director, Capacity Building, SickKids Centre for Global Child Health
PNEP Project Sponsor

5 Years of PNEP Impact


All Targets Achieved!

Click here to download the PNEP Results infographic.

Overview of PNEP Results

501 Paediatric Nurses Trained


PNEP graduated a total of 501 paediatric nurses through the one-year Paediatric Associate Membership Programme across all three teaching sites (exceeding the target of 500).  Residents that completed the Paediatric Associate Programme were recruited from all regions across Ghana with over half (52%) of residents coming from underserved areas. The 501 nurses were recruited from over 200 unique facilities in Ghana including all five teaching hospitals, ten regional hospitals and over 75% of all district hospitals in the country.
Graduates of the Associate Programme by Site and Academic Year
To date, over 99% of graduates from the Paediatric Associate Programme have re-integrated into the Ghanaian health system, and are practising as nurses more than one year after graduation. All graduates report high levels of job satisfaction and higher levels of confidence as paediatric nurses. They are also being recognized in their workplaces as leaders in paediatric care that have statistically significant increases in knowledge and confidence, and changed attitudes towards their patients (e.g. demonstrating more empathy and utilizing the concepts of family-centred care). Their enhanced skills have enabled their clinical facilities to expand services to new clinical areas (e.g. children with chronic conditions), thereby expanding access for patients and families in Ghana and ultimately resulting in better care for children in Ghana. These nurses are also being recognized as change agents beyond their health facilities, using their training and enhanced leadership capabilities to champion gender equality and challenge social norms in their communities. 

After the Associate Programme, graduates recognize the potential impact of the increased clinical and leadership skills they received on their ability to provide patient care. They also see themselves as leaders within their respective health care organizations and communities. In their organizations, they are initiating activities, teaching their peers specific skills and acting as preceptors for incoming residents. 
“GCNM has given us nurses a voice!”

– PNEP Graduate

“…this programme is going to solve a lot of problems because we will have nurses who are competent enough to take care of the children and at the appropriate time refer them.”  


– PNEP Graduate

"Another skill is the history taking and head-to-toe assessment. Way back when I was at my facility, it was only the doctors who were doing the history taking, and nurses just administer medication. But now, I’ve learned that we are also to do our own assessments. So when I go back, I can confidently say that I can do a complete head-to-toe assessment."


– PNEP Graduate

“...the programme will also help us in our hospitals to prevent complication of children’s cases because now we have acquired the skills and knowledge and we know when to act promptly and when to act in emergency cases so it will help to prevent situations from getting worse.”


– PNEP Graduate
Overall, informants within the Ghanaian health system confirm that PNEP graduates have begun to bridge a very important gap in access to child health services. Given the inadequate number of paediatric nurses, the programme has been valuable in producing a critical mass of nurses that can provide essential services, especially in underserved areas. The specialization of paediatric nurses fits extremely well within Ghana healthcare as it aligns with the overarching system priorities of focusing on underserved regions of the country as well as the efforts in reducing newborn and child mortality and morbidity in Ghana. The programme, combined with initiatives to better equip facilities with needed supplies, is the right step towards contributing to the reduction of the neonatal mortality in the country.

GCNM Education Team


PNEP was successful in developing a critical mass of various nursing education roles at GCNM including lecturers, clinical educators, and clinical coordinators. These educators are the backbone of the Paediatric Associate Programme, championing competency-based learning and are now established within the Ghanaian health system to train future generations of paediatric nursing leaders.
Completing the human resources at GCNM, PNEP trained facility-based preceptors to champion integrated continuous learning within the Ghanaian health system. Preceptors in PNEP have distinct value given their location at the facility level and dual role as both clinicians and educators.  By the end of PNEP, 198 unique preceptors had been trained who practice in 30 unique clinical facilities across the three sites and these preceptors will continue to benefit not only GCNM residents but nursing students from various other health training institutions. 

“...preceptors who have been drawn into the program are also going to impact on our students and any other patients I meet and other nurses that I meet. So the impact is not just on the students and the immediate things we may see, but it’s a lifelong impact of millions of students that will go through our hands, it’s a very huge impact.”


 – Faculty Focus Group Participant (Preceptor)

Continuing Professional Development (CPD)


PNEP established a series of Continuing Professional Development (CPD) sessions to train and enhance the competencies of a wider cadre of health workers across the country.  The health workers targeted through CPDs complemented those who could enter the Paediatric Associate Programme. CPD sessions were offered on a variety of topics including nutrition in children, sickle cell disease and newborn care. Collectively, PNEP trained over 1,200 health workers who are now using their skills to enhance their practice. For CPDs in nutrition, sickle cell disease and newborn care, the health workers targeted (clinicians from health centres, other community-level organizations), complemented those who qualified for the Paediatric Associate Programme (diploma-trained nurses working in the district, regional and teaching hospitals) thereby ensuring that PNEP was able to offer programming to and benefit a very large range of nurses in Ghana. 

“I have improved more on technique. I have gained massive improvement in my skills.”
 

– Nutrition CPD Participant

"I have received quality training, which I believe has equipped me well: I’m now in a position to render better services to children who come to me in the hospital with sickle cell disease. With this training, I’ve realized that the care I used to render to these children, there were deficits. So upon my return to my facility, I hope to deal with those deficits and make sure that I give holistic care, and care that will actually tailor towards the benefit of the children that are dealing with sickle cell disease."


– Sickle Cell Disease CPD Participant

Transition Planning


Recognizing the importance of sustainability along with the depth and breadth of PNEP, SickKids and GCNM worked collaboratively to begin transition planning midway through PNEP. This planning was designed to ensure a seamless transition to operations that are solely lead by GCNM.  While many elements of PNEP embedded sustainability considerations from the onset (e.g. integrating the Paediatric Associate Programme into GCNM’s programmes), additional tangible steps were required to ensure the autonomy of GCNM in areas including human resources, infrastructure, finance, and quality assurance. 

Additional work was done with GCNM to enhance the necessary infrastructure (including skills lab equipment and related procedures) and support monitoring & evaluation protocols and tools to enable GCNM to operate the Paediatric Associate Programme well after PNEP ended. A final review of the curriculum was completed in September 2020 to ensure it was up to date, and also to make changes to reflect the COVID-19 pandemic which necessitated more online delivery. 

The results of these discussions have been largely successful as beginning in 2018/19 academic year, teaching was led by GCNM faculty with SickKids playing more consultative and mentoring roles and the outcomes of the programme (e.g. resident learning and satisfaction) remained the same. In the final year of operations, partly due to the COVID-19 pandemic, all operations were successfully led by GCNM with SickKids providing virtual support as required.

Adjustments for COVID-19

Since the start of the COVID-19 pandemic in Ghana, PNEP implemented a range of precautionary measures in accordance with government directives to limit the spread of COVID-19 and to ensure the safety and security of all PNEP stakeholders. GCNM adopted online learning where classes were held via Zoom and residents accessed adapted e-learning modules from home through GCNM’s online portal. In June, the government relaxed restrictions making it possible for PNEP to resume in-person teaching/learning. PNEP partners worked to develop rigorous protocols to guide the resumption of in-person sessions and clinical learning in safe environments and adjusted timelines as necessary. PNEP’s final cohort of paediatric nursing students has now completed the programme.

Faculty participated in a debrief session where they shared their experience with online learning in Block 2. Lessons learned and additional opportunities to integrate online learning into the Paediatric Associate Membership Programme in the 2020/2021 academic year onwards were also identified. Overall feedback from the faculty was positive. They highlighted that the Zoom live sessions were useful and residents were engaged and transitioned well to online learning. Faculty noted that online learning also provided opportunities for their own learning and professional development. Some barriers included technical challenges (e.g. unstable/unreliable internet connection), cost of internet data, and residents’ unfamiliarity with using online tools (e.g. Zoom).

Moving forward, GCNM is well-positioned to deliver education programming in the context of a pandemic by leveraging the resources, tools, and policies that were developed through PNEP.

“Online learning was a big opportunity for our professional development. We worked as a team across sites, built on our strengths and learned from each other. It was great to think of other modalities and approaches to education delivery."

 
– GCNM Faculty

Beyond PNEP

 
PNEP ended on September 30, 2020, however, GCNM continues to deliver the paediatric associate membership programme. The 2020/21 academic year began in October 2020 with a cohort of 99 residents across all three sites which remain operational. The ongoing high demand for the Paediatric Associate Programme demonstrates the success that PNEP achieved in enhancing the profile and status of paediatric nursing in Ghana as well as the credibility of the programme.
 

Our Thanks…

 
On behalf of the entire PNEP team, thank you to all stakeholders for your ongoing support and investment in this important initiative to build capacity among Ghanaian nurses and improve newborn and child health in Ghana.
 
We extend our sincere gratitude and thanks to all members of the PNEP committees and working groups for their time and guidance over the past five years, all our various partners in Ghana who have worked collaboratively to achieve PNEP’s goals, the funders: Global Affairs Canada and SickKids Foundation - for their investment in paediatric nursing and finally to all PNEP graduates that are contributing to the wellbeing of children across Ghana.

About PNEP


The SickKids-Ghana Paediatric Nursing Education Partnership (PNEP) was launched in January 2015 with funding from Global Affairs Canada and SickKids Foundation. The ultimate goal of the five-year programme (2015-2020) was to contribute to reducing preventable deaths and improving wellbeing for newborns and children in Ghana, and advance both child health and the profession of nursing in Ghana through practice-focused paediatric nursing education. PNEP is a collaboration between the Ghana College of Nurses & Midwives (GCNM), Ghana Ministry of Health, Ghana Health Service, and the SickKids Centre for Global Child Health in Toronto, Canada. 
Learn more about PNEP partner organizations:



Copyright © 2020 Centre for Global Child Health, SickKids, All rights reserved.


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