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Fostering Continuity of Care During Covid-19: Nurse Leader Ladwong Atim Mary providing nursing care to Preterm baby in Anaka Hospital NICU. Photo used with permission.

The Nurses and Midwives Letter Issue 8

THE NURSE & MIDWIVES LEADERS’ THINK TANK Year of the Health and Care Workers 2021

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Table of Contents New Year Message From Sr. Beatrice Amuge, Commissioner Nursing And Midwifery Services………………………………………………………………………………………...3 An Insight Into The Delayed Implementation Of The Schemes Of Service For The Nursing And Midwifery Cadre ................................................................................................................. 4 Coping Mechanisms For Our Mental Health Well Being During The Covid 19 Pandemic ...... 7 Fostering Continuity of Care during Covid-19………………………………………………..11 Stories From The Frontline ....................................................................................................... 13 International Year Of The Health And Care Worker 2021....................................................... 14 Resource List For Nurses And Midwives ................................................................................. 14 Learning Opportunities And Academic Resources................................................................... 15

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NEW YEAR MESSAGE FROM Sr. BEATRICE AMUGE, COMMISSIONER NURSING AND MIDWIFERY SERVICES

It is my pleasure to salute all of you in this New Year 2021. We in the department of Nursing and the entire Ministry of Health do appreciate your dedicated service in delivering Nursing, Midwifery and Public health services to the entire country. Nursing and Midwifery remains pivotal and a backbone of the health care services.

As a people of a unique profession, we have remained focused on our duties and have strived to deliver quality Nursing, Midwifery and Public health services; we have worked extra hard amidst the COVID-19 pandemic.

Your enormous contributions cannot be overlooked or taken for granted. Your hard work makes us WHO WE ARE, AS A DEPARTMENT AND THE MINISTRY. In this year 2021, we need to invest in quality improvement strategies and evidence-based practices through research. This will allow us to reduce emerging and re-emerging infections in our communities. We need to have inter and intra-professional collaboration for visibility and competitive advantage.

I look forward to the year 2021 which evokes thinking, determination, and unity. Time is our most precious resource and can never be recovered once lost, NOW IS THE TIME! Every contribution from each and every one of us counts.

From Beatrice Amuge, Your Representative Commissioner Nursing and Midwifery Services.

Ministry of Health, Uganda

In this year 2021, we need to invest in quality improvement strategies and evidencebased practices through research…Commissioner Amuge 3

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AN INSIGHT INTO THE DELAYED IMPLEMENTATION OF THE SCHEMES OF SERVICE FOR THE NURSING AND MIDWIFERY CADRE By: Ms. Catherine Odeke, National Coordinator, Nursing Now Campaign Uganda (Photo courtesy of Agha Akan) The Government of Uganda recognizes that Human Resources for Health (HRH) are a key input in the provision of high-quality health services. The sector is labor-intensive and therefore the availability of adequate and skilled human resources is central to the achievement of the health sector objectives. Nurses and midwives constitute seventy-three percent (73%) of the skilled health workforce and as such lack of a clear Scheme of Service. This gap can greatly compromise delivery of quality health services and the achievement of Universal Health Coverage (UHC).

The health sector reforms, including the decentralization of health services, the proliferation of training institutions across the country preparing Nurses and Midwives at certificate, diploma, bachelors and postgraduate degree levels, regrading of jobs and other policy shifts have all necessitated the need for a cost effective, competent and skilled Nursing and Midwifery workforce, capable of delivering preventive, promotive, rehabilitative and therapeutic health care services at all levels of health care.

In view of these reforms the Scheme of Service (SOS) for the nursing and midwifery cadre was revised to provide for a clearly defined career progression, professional advancement, streamlined job descriptions and specifications to attract and retain an adequate supply of nursing and midwifery professionals who are appropriately educated and skilled to meet the health needs of all Ugandans wherever they are deployed.

This exercise has addressed the issues that the Health Service Commission (HSC) had earlier raised through their chairperson to a meeting held at the Ministry of Health headquarters (level 111 board room on 24th June 2014), to discuss the implementation of the nursing and midwifery SOS; a meeting which was chaired by the then Hon. Minister of health Dr. Rukahana Rugunda.

The process of revising the Nursing and Midwifery SOS was highly consultative through workshops and meetings with Senior officials of Ministry of Health and representatives of several key stakeholders including Line Ministries, Professional Councils, Health Training Institutions, Development Partners, as well as Nursing and Midwifery practitioners and Educators at different levels of the healthcare system.

The Ministry of Public Service approved the new revised SOS for nursing and midwifery cadre in November 2017 and passed out a circular for its implementation on 27th December 2017. Submissions on all serving officers 4

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for redesignation to District Health Service Commissions (DHSCs) and HSC should have been done by 30th March 2018 whereby on receipt of these submissions, the DHSCs and HSC should have undertaken the exercise to redesignate all officers accordingly. But to date, only a few districts have implemented the SOS. Majority of the DHSCs have not implemented or picked only the title of Assistants and redesignated their officers as such, irrespective of whether they have required degrees or not. The same applies to the HSC. What are the bottlenecks to the implementation of the SOS? •

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Personal responsibility: Majority of Nurses and Midwives, irrespective of having received the SOS and Circular, have not internalized the document and are relying on their Human Resource Officers to guide them instead of them owning the document and leading its implementation.

HSC is combining the issue of staffing and restructuring with redesignation and they say officers cannot be redesignated without restructuring being completed.

The restructuring is being done in phases; it is only the headquarters where it has been completed, and it has just been started at the Regional Referral Hospitals.

Redesignating Nurses and Midwives will open up slots for recruitment and promotions as vacant positions will clearly be identified, others will retire, and new officers will be recruited and promoted when the structure is completed.

Officers are to be redesignated to the given Public Service titles of their salary scales - so they are already in Public Service earning their monthly salary given by Public Service or Local Government and even after redesignation, they will continue earning their same salary so it does not require one to be interviewed because it is not a promotion but only ones’ documents for the title will be validated.

Some Nurses and Midwives think redesignation is a demotion such as if s/he is a Senior Nursing Officer with a degree in the old Scheme of Service on salary scale U4 then she is to be redesignated to a Nursing Officer, to her/him this is a demotion and prefers to remain with the Senior title so to her/him better the Senior Assistant Nursing Officer title which should be for the one without a degree.

The delay in implementing the SOS is disadvantageous to nurses and midwives since other cadres were able to implement this swiftly.

A unified approach by nurses and midwives is urgently needed: Although not perfect, the SOS is a tool that helps streamline some differences such as being an Officer on a salary scale of a diploma holder; or a Senior Nursing Officer in title only but at a salary scale of a Nursing Officer. Currently, Public Service recognizes one as an “Officer” when one has secured the relevant degree for the profession, they are in.

Persons without the relevant degree education are to be re-designated with the title of “Assistant”.

Individuals holding the title of Assistant are considered “Person-to Holder” until they retire or go back to school to pursue a degree.

What needs to be done to have the SOS fully implemented?

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All Nurses and Midwives need to understand and interpret this document very well to defend it rightfully and advocate for its implementation.

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Nurses and Midwives involved with the Health Service Commission both at the district and Health Service Commission HQ need to internalize the SOS correctly, interpret it and guide their committees on proper implementation of it.

The In- charges should submit the names of their officers to their Human Resource Officers to be submitted to the DHSCs and HSC for redesignation with immediate effect. Commissioner Health Services – Nursing and Midwifery should call for immediate meeting of Nurse and Midwives leaders to discuss on the immediate implementation of the SOS. KNOW MORE. EMPOWER YOURSELF

For more details on the Schemes of Service, please visit the link below:

Image by Dreamstime.com

http://library.health.go.ug/publications/human-resources-health/schemesservice-nursing-and-midwifery-cadre

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COPING MECHANISMS FOR OUR MENTAL HEALTH WELL BEING DURING THE COVID 19 PANDEMIC

Image: Mental health and wellness during Covid-19: Energy resourcing 2020

Yedidah Biribonwa Sentongo, A Master of Counseling Psychology, BSc.Nursing, Dip Health Tutor, Dip G.N, Dip Psyc. Nur. Shares with us here Some Mental Health/Psychosocial Tips for Nurses and Midwives During the COVID-19 Pandemic Throughout the COVID-19 pandemic, nurses and midwives, plus other health workers have remained focused on supporting their patients/clients and continuing to do their jobs during this very trying time. In some cases, this may mean nursing, care-taking (whether for children, spouse or other loved ones), since as a nurse you are those people’s reliable expert and continuing to work through these challenges that anyone else is. While resources related to mental health have been (rightfully) front and centre for supporting the populations, less focus has been paid to maintaining the mental health of the nurses/health workers who are also trying to find balance in the new way of living. By nature of their calling, demand from those they serve and complexity of nursing care which by all means must be hands on: nurses /midwives cannot carry out their service virtually.

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In the line of duty, COVID-19 health workers will encounter a number of extreme stressors or demands. These stressors/demands can impact upon an individual’s capacity to do their work. In highly interdependent teams, like those working in ICU, the impact of stressors/ demands at the individual level can have onward implications for the safety, performance, and health and wellbeing of others, including other staff members and patients.

Stress during an infectious disease outbreak can cause the following: ✔ ✔ ✔ ✔ ✔ ✔ ✔

Fear and worry about your own health and the health of your loved ones, your financial situation or job, or loss of support services you rely on.

Changes in sleep patterns, difficulty sleeping, or workers may have to do long, consecutive shifts leaving little time for sleep.

Worsening of chronic health problems/ mental health condition Increased use of tobacco, and/or alcohol and other substances.

Tiredness/fatigue due to lack of sleep and high workload Hunger and dehydration or change in eating patterns: workers may not have the time to eat or when they do have time, they are too tired to prepare healthy meal.

Interdependence: working closely with others for long periods and being reliant on each other can lead to tension

Amidst all what is being said here are some mental health tips that can help during COVID-19 1. Control the Controllable During COVID-19 There are certain things that you simply cannot control right now for example: who will be impacted by COVID-19, whether it will be you, how things will evolve. But there are some things that you can control: how you spend some of your time, what you choose to prioritize, what types of media you consume (and how frequently) and your mindset, to name a few. Encouraging individuals to focus on what is within their control and minimize the extent to which they are forecasting to the future can help reduce threat. Focusing attention on processes rather than speculating on outcomes might help. By focusing on the things that you can control and prioritizing the ones that are healthy, you can help to put your mental wellness front and centre.

2. Curve Out Time for Self-Care to Maintain Your Mental Health Now, more than ever, we are acutely focused on physical health, and preventing illness– washing hands, social distancing, and engaging in healthy practices. But it is just as important, for maintaining mental health, to try to curve out some time to prioritize the other things that help us feel balanced: for some, it is exercise, for others, it is reading nice articles, the bible or Qur’an, journaling, meditation, or spending time doing a hobby.

And, if you are someone who is a workaholic, requesting for off duty time is very important during which time you will need to do those things that give pleasure like watching a nice movie or dancing at home with your family. Still if you are one who isn’t sure of what you can do for your self-care, simply the act of doing something e.g. telephoning a friend to converse, talking to your household about SOPs as a reminder to them can help maintain your mental health.

3. Get Your Body Moving to Help Your Mental Wellness 8

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One of the biggest challenges for many nurses and midwives during this time is how hard it is to be away from family if you are a front line COVID-19 health care worker or even in any other health care department for you cannot tell who is having the virus. As you work around your schedule, set a timer or create breaks for you to specifically move around– this might mean moving around your house, or taking a walk around your building or neighbourhood– obeying physical distancing recommendations, of course. Anything to get your body moving will help maintain your mental wellness.

4. Model Self-compassion Now, more than ever, we need to be incredibly kind to ourselves to help maintain mental wellness. We teach ourselves, colleagues and households all of the time– the basics of self-compassion, kind self-talk, kind selfconsideration. Now is the time to also turn it inwards to look at and consider our mental/psychological wellbeing; by doing so, you’ll benefit your own mental wellness and also be able to model it for others in your life. Workers should be encouraged to think about and develop good sleep routines. This might include limiting the use of mobile devices just before bed and avoiding social media that might lead to raised activation levels. Under conditions of sleep deprivation, napping can help minimize sleep debt and contribute to maintained function.

5. Set Reasonable Expectations (for yourself and others) Collectively, we need to acknowledge that we are in the midst of a pandemic with many restrictions– and that it is not business as usual. Things are already different or even going to keep changing and that is okay. We can’t expect to be as productive, or on top of it, or gather together as we once did. If you are one of those, like many, who is trying to balance nursing work with other extra duties, there is no possible way that you can do all things for all people all of the time. By setting small, realistic goals and expectations around what you actually could be capable of, you will be setting yourself up to feel much more fulfilled and help maintain your mental health.

6. Communication is Vital for Maintaining Mental Health To reduce feelings of threat, individuals should have an outlet to share their concerns and know that their worries are being noted. Where solutions are possible, these should be quickly implemented. Let people know what is going on– especially colleagues and supervisors. Being transparent about what you are experiencing, may be helpful, and potentially expand your own network of resources and support. You may also be modelling healthy communication for other colleagues to follow suit. Do not keep problems e.g. feeling unwell/sick, thinking you might have contracted Covid-19 yet not but then you are getting sleepless nights.

7. Be unapologetic.

We live in an “I’m sorry” culture. During this time, consider how often you apologize, and ways in which you can stop. Be unapologetic about taking time for yourself, setting realistic goals, setting boundaries, and being clear and transparent about what you are capable of (and what you need). This is one of the hardest things to do for many, but yet so important for maintaining mental health and wellness. If issues are encountered, discussing them in a calm and controlled manner is advised. A psychologically safe environment, created by leaders, will enable open and honest conversations. So, this means that one has to find ways of expressing kindness, patience, and compassion to self. This is a hard time for everyone.

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Humans across the world are sharing this experience with you. We are in this together and all of us may emerge with a renewed appreciation for our interconnectedness. Helping others in need is both critical to get through this well, and also creates more purpose to our well-being.

8. A Dedicated Workspace Can Improve Mental Wellness This is a psychological trick that helps you to be both more productive, and to disconnect from work more easily. When working especially during the COVID-19 pandemic, we can quickly fall into an unhealthy balance between work and life, especially if you are working in the areas far from your home in which you’re required to travel especially by public transport. By creating a dedicated workspace: even if it is just one corner of the health care facility/ infrastructure that you designate as “work only,” you can do two things: you can send an outward message to those in your life that when you are in that space you are working, and also an internal message to your own brain that signals when it is work mode and when it is time to disconnect.

9. Limit media to reduce anxiety.

By now you have heard this recommendation many times and there is research behind it: Watching or scrolling through the media makes us even more anxious. An excess of news and visual images about a traumatic event can create symptoms of post-traumatic stress disorder and poor health years later, according to research by UC Irvine's Roxy Silver, PhD, and others. Try to limit COVID-19 media exposure to no more than twice a day (e.g., checking for updates in the morning and before dinner) and try to avoid reading about COVID-19 before bedtime. Take a vow not to forward (and thus propagate) alarming headlines to friends and family. The media often creates an exaggerated impression of global panic.

Get and provide warm, comforting, social support by video, phone, or text is critical.

10. Reach Out If you feel as if you are having a tough time in your mind, and are struggling in any way with enjoying things, balancing your mood, or finding time to take care of yourself– or if you have any thoughts of hurting yourself– please reach out to a counsellor. Ask your health provider or facility that will help you locate a counsellor, most of whom have switched to offering online counselling services. What we are experiencing right now is hard– and trained professionals across the country continue to mobilize to serve as front line responders for our minds in the same way doctors have for our bodies during the COVID-19 pandemic. Below are contacts of professionals that will help and offer you psychosocial support: Dr. Abbo on 0700700470, Dr. Nakasujja on 0772419700, Dr. Muron on 0783998841, Florence on 0776403177, Mutibwa on 0705550863. If you are upcountry, there is a mental health/psychosocial support person on the task force.

There is hope so pray with me:

"Dear Jesus, I feel so anxious about my life. I am tired of thinking about everything going wrong. I need to change the way I live and think. Please forgive me for the wrong things I have done. I want 10 You to be My Lord and Saviour. Help me make a new start in life. Please take my anxiety and help me discover peace that comes from knowing You. In Jesus’ name, Amen!"

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References: 1. Edmondson, A. C. (2018). The fearless organization: Creating psychological safety in the workplace for learning, innovation and growth. John Wiley & Sons.

2. Newman, A., Donohue, R., & Eva, N. (2017). Psychological safety: A systematic review of the literature.

Human Resource Management Review, 27(3), 521-535.

3. Donnelly, E., & Siebert, D. (2009). Occupational risk factors in the emergency medical services. Prehospital and disaster medicine, 24(5), 422-429.

4. IASC. (2008). Guidelines on Mental Health and Psychosocial Support in Emergency settings: checklist for field use.

Retrieved from:https://interagencystandingcommittee.org/system/files/legacy_files/Checklist%20for%20field%20use %20IASC%20MHPSS.pdf

FOSTERING CONTINUITY OF CARE DURING COVID-19 We are delighted to introduce a new pictorial segment for the Nurses and Midwives letter which showcases images of nurses and midwives around the country at work. During Covid-19, every nurse and midwife has been on the frontline either directly involved in the care of Covid-19 patients or fostering continuity of care for millions of Ugandans who continue to experience ill health. We salute you all for your dedicated work. In this issue, we highlight two nurses at work: On the front page: Nurse Leader Ladwong Atim Mary providing nursing care to Preterm baby in Anaka Hospital NICU. Photo used with permission.

On page 12, below: Midwife Akello Evelyn okok, Enrolled Midwife in Anaka hospital NICU. Photo used with permission.

Send us your picture of your story reflecting the work you do every day. In those silent, and often unrecognised moments of our daily routine: is where we make a difference. Protect. Invest. Together.

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2021 Protect.

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Fostering Continuity of Care During Covid-19: Nurse Akello Evelyn okok, Enrolled Midwife in Anaka hospital NICU. Photo used with permission.

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STORIES FROM THE FRONTLINE Baluku Yosiah, a Research Coordinator looked at Why the Presidential guidelines may not work in Ugandan communities to prevent COVID -19 way back in August 2020.

I commend the President and the ministry of Health for the efforts that have been undertaken to ensure that Ugandans remain safe from COVID-19. I believe that if at the very beginning of the announcement of the pandemic the Presidential guidelines on combattingCOVID-19 had been more focused on equipping and training all Health Centre fours (IV) and district hospital staff in Uganda on the management of COVID-19, the impact would have been more meaningful to the people. As opposed to the centralisation of the COVID-19 response to the government, which made it expensive for the government and gave the impression of a dictatorial management structure lacking community involvement and sustainability.

The Ministry of Health was, at that time, closing the facilities that were found with positive health staffs, I believe this was due to lack of knowledge and skill towards the management of COVID-19 but still wondering how many Health Centre’s were closed and where the community or people that were being saved from that facility went to for treatment of other conditions from now that the facility that was saving them is closed?

People think and believe that COVID-19 doesn’t exist and if it exists then the disease is in Kampala because they have never seen anyone with the disease, the LC 1 OR other leaders are breaking the presidential guidelines who too have abandoned the Presidential directive.

COVID-19 was treated with much more concern without equipping the lower facilities and staff and lower level facilities have been abandoned without staff being trained and no single preparedness has been put in place.

More so the preparedness of these lower facilities is about 30% and screening Infrared thermometers give wrong results hence making it very difficult to identify high fevers.

The other gap is with the government relying on security organizations like the Uganda Police Force (UPF) and Local Defense Unit (LDU), these people are important but not in the fight against this deadly disease since the public doesn’t believe in their expertise in handling pandemics like COVID-19. For decades, Ugandans have always celebrated their political local leaders and village health teams, these people would take the message to the last person in the community since they understand their people better than the uniformed men, who have on several occasions been accused of breaching the guidelines they are effecting.

It is important that the Ugandans remain on high alert and diligently exercise preventive measures to avoid contracting COVID-19. The tendencies of leaving some people out of this drive shall affect our goal to flatten the curve. Now that we have a number of community transmissions, let's empower our local leaders and revamp community participation in the fight against COVID-19.

For God and My Country Baluku Yosiah, Health Tutor- Coordinator Research KIU - SONS Kampala International University- Western Campus Tell: +256782835901/756013899 E.mail: balyos766@gmail.com

Please note that some of the important issues raised in this article have been taken into consideration by the MOH and other respective bodies.

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INTERNATIONAL YEAR OF THE HEALTH AND CARE WORKER 2021 2021 has been designated as the International Year of Health and Care Workers (YHCW) in appreciation and gratitude for their unwavering dedication in the fight against the COVID-19 pandemic. WHO is launching a year-long campaign, under the theme – Protect. Invest. Together. It highlights the urgent need to invest in health workers for shared dividends in health, jobs, economic opportunity and equity.

You can find more information about the campaignhttps://www.who.int/campaigns/annual-theme/year-ofhealth-and-care-workers-2021

RESOURCE LIST FOR NURSES AND MIDWIVES Please find below a list of useful contacts to forward your concerns appropriately.

UNMC queries:- info@unmc.ug UNMU:- info@unmu.ug CPD APP concerns: martin@unmc.ug National organisations Education and training Standards:- Department of Nursing at Ministry of Health BTVET (Min of Education and sports) QUESTIONS? CALL: 0417 893600 (PRO) Mobile 0777108170 Benevolent fund:- Department of Nursing at Ministry of Health, Uganda Some of the associations AGNMU: graduates@agnmu.org Critical Care Association:president@ccnau.org Midwifery Association: nationalmidwivesassociationug@gmail.com Nursing and Midwives Society: info@nursesandmidwivessociety.org Emergency Care society of Uganda:- admin@ecsuganda.org Palliative care Association of Uganda:- pxau.admin@pcau.org.ug Others NMLTT (Think - Tank Leaders):- uganursemidwife.leaders@gmail.com Writing articles for publication on NHCC Uganda website:- editors.nhccuganda@gmail.com Global networking Nursing Now Campaign Uganda:- nursingnowuganda@gmail.com 14

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LEARNING OPPORTUNITIES AND ACADEMIC RESOURCES Access to Health Care journals (Discounted at 30%) In partnership with UGANDA NURSES and MIDWIVES ASSOCIATION UK (UNMA-UK), Markallen group UK (https://www.markallengroup.com/ma-healthcare/) has offered a 30% discount on their online subscriptions (MA Healthcare titles only) for UNMA-UK members. This has also been extended to Nurses and Midwives in Uganda as per UNMA-UK mission.

Use the confirmed discount code [UNBA30] to access a range of their healthcare journals.

NMLTT ON GOING ACTIVITIES NMLTT continues to work in collaboration with the National Task Force in the Management of COVID- 19.

The Think Tank Newsletter editing team accepts articles on a rolling basis under the sub themes below.

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Research and Innovation Continuing Professional development (CPD) Policy Leadership/Governance Clinical Practice Covid-19 Response.

The Think Tank will resume the regular meetings soon to check on progress and formulate strategies to support and advocate for Nurses and Midwives. We would like to thank Seed Global Health for the continued support for hosting our zoom meetings and webinars. We urge all nurse leaders to attend the meetings. Please send us your current email address in order to be included in a timely manner.

Our faith in you is steadfast. May you continue to rise up to the challenge in this International year of the Health Care Worker by WHO - 2021. More than ever, this nation needs you. We thank you and May God bless you.

Please feel free to contact us with your concerns. If you find this Nurse & Midwife Letter useful, we would really like to hear from you. We continually evaluate and assess the progress of our communication channels with you.

Please email us at the address above.

Copy to:

The Hon Minister for Health The Permanent Secretary, Ministry of Health The Ministry of Education and Sports The Chairperson, NATIONAL TASK FORCE COVID 19 The President of Uganda Medical Association Commissioner Nursing Services, Ministry of Health All Nurses and Midwives in Uganda

Compiled and Edited by Think Tank Debrief Team on behalf of NMLTT: Dr Rose Clarke Nanyonga, Elizabeth Pearson, Irene Atuhairwe, Tracy Kobukindo, Judith Hope Kiconco, and Sr. Christine Alura. Chairperson: Dr. Safinah Kisu Museene 15