TRAINING FOR NURSES ON GERIATRIC CARE

5th to 12th November 2017

Kathmandu, Nepal

AGEING NEPAL

House No. 340, Ramchandra Marg, Battisputali, Kathmandu, Nepal

PH.: +977-01-4485827

Email ID: ageingnep@gmail.com

Website: www.ageingnepal.org

Facebook: https://www.facebook.com/proudtobeold/

Twitter: https://twitter.com/AgeingNepal

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ACKNOWLEDGEMENT

Ageing Nepal expresses sincere thanks to Ageing Nepal Switzerland and the Nelumbo

Foundation for the opportunity provided to conduct a Training for Nurses on Geriatric

Care.

In addition, we would like to recognize following people and organizations without

whom this training could not have been successfully completed.

• Mr. Sumant Banjade, Cardiologist, practicing at Government Hospital of Bhaktapur;

Ms. Kabita Pandey, Hospital Nursing Administrator at Lumbini Zonal Hospital and

Ms. Rosa Shrestha, Nurse and Chairperson at Harmony Home Care for their support

in the design and implementation of the training.

• Three nurses, Ms. Theres Luder, Ms. Ursula Bucher and Ms. Lea Bucher from

Switzerland for their voluntary support as trainers.

• Nursing Association of Nepal (NAN) for their valuable collaboration.

• Fifteen trainers from different hospitals and government offices for their work.

• Ministries, different government and non-governmental hospitals and health care

facilities for availing the participants in the training.

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TABLE OF CONTENTS

Contents Page No.

Acknowledgement ……………………………………………………………....... 1

Background ………………………………………………………………………. 3

Objectives…………………………………………………………………………. 3

Introduction of the Training ……………………………………………………… 3

Preparation …………………...…………………………………………………... 4

Progress of the Training …………………….……………………………………. 6

Pre-Test and Post-Test …..……………………………………………………….. 6

Feedback Collection………………………………………………………………. 7

Lesson Learned …………………………………………………………………... 9

Glimpses of Training …………………………………………………………...... 10

Annexes

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BACKGROUND

Increasing life expectancy and decreasing birth rate is bringing unprecedented growth in the

number of ageing population globally. Currently, it is estimated that more than 13 % of global

population is above 60, whereas the number will be approximately more than 22% by 2050.

According to Central Bureau of Statistic (CBS, 2011) ageing population of Nepal is estimated

at 8.13% of total population and estimated it will be more than 20 % by 2050.

This rapidly changes in the population structure is bringing many challenges and opportunities

at the same time. There is dearth of geriatric nurse and caregivers globally. It is one of the

major challenges to meet the growing need of health services and care for ageing population.

At the same time, the resources of older people could be used profitably in our society in many

ways.

To counterbalance the lack of caregivers and nurses, specifically the ones for the elderly, and

thus gradually closing a gap in the health care system, Ageing Nepal conducted a 7 days

training for 36 nurses on Geriatric Care.

OBJECTIVES

• To develop knowledge and skills of Nurses working in different government and non-

governmental hospitals and health organizations.

• To generate materials that could be developed as a manual for trainings on Geriatric Care

for nurses.

INTRODUCTION OF THE TRAINING

Ageing Nepal in collaboration with Nursing Association of Nepal (NAN) and with support

from the association Ageing Nepal Switzerland and the Nelumbo Foundation, conducted a

seven days Training for Nurses on Geriatric Care from 5th to 12th Nov. 2017 at Lazimpat,

Kathmandu.

The training took place in the hall of Nursing Association of Nepal, Lazimpat, Kathmandu.

The hall had all facilities required for conducting training including projector, white boards,

and chairs.

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The main banner of the programme with training info and logos of Ageing Nepal and the

Nursing Association of Nepal.

PREPARATION

1. Course Development

Ageing Nepal formed a core team of experts to develop Geriatric Care training course that meet

the training need of nurses working at Government Hospitals in Nepal. The team members are:

• Mr. Krishna M. Gautam, Chairperson at Ageing Nepal

• Ms. Lea Frei, Programme Coordinator at Ageing Nepal Switzerland

• Ms. Sanju T. Magar, Programme Officer at Ageing Nepal

• Dr. Sumant Banjade, Cardiologist, practicing at Government Hospital of Bhaktapur

• Ms. Kabita Pandey, Hospital Nursing Administrator at Lumbini Zonal Hospital

• Ms. Rosa Shrestha, Nurse and Chairperson at Harmony Home Care

• Ms. Pabitra Adhikari, Clinical Psychologist at Ageing Nepal

The team reviewed the relevant documents, discussed and agreed on topics that are essential

for the nurses to enhance their knowledge and skills for providing better care to older patients.

Following is the list of topics unanimously agreed and prioritized by the Core Team of Experts.

Session 1: Introduction of gerontology and geriatric care

Session 2: Biology of ageing

Session 3: Common geriatric problems

Session 4: Geriatric counseling & guidance

Session 5: Delirium in hospitalized geriatric patient

Session 6: Nutrition for geriatric people

Session 7: Movement/ Patient Transfer

Session 8: Falls

Session 9: Bed bound patients

Session 10: Palliative care

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Session 11: Dementia

Session 12: Alzheimer’s and related dementia care

Session 13: Geriatric emergencies

Session 14: Complementary and alternative medicine

Session 15: Pain Management

Session 16: National and International Policies

Session 17: Panel Discussion

Time was allotted for each topic according to the importance and contents details. This output

was further spread over the training period of 42 hours in 7 days.

Thus, produced training schedule is given Annex 1.

2. Identification of Resource Persons

Well known or reputed experts on each topic were identified and contacted for their possible

availability to work as trainer. There were fifteen trainers from ministries, health-academic

institutions, service providers and other organizations.

In Nepal also among specialists, knowledge in geriatric care is in many areas not or

insufficiently available to ensure adequate care for the elderly. That is why specialized staff

from Switzerland were called in as well. They all agreed to work on a voluntary basis. Ms.

Theres Luder, who works as a nurse in the nursing home Steinhof in Lucerne, instructed the

Nepalese participants in practical aspects of geriatric care with emphasis on patient transfer.

Two nurses from Switzerland assisted in the classes, Ms. Ursula Bucher, who works in the

nursing institution Ibenmoos in Kleinwangen/LU and Ms. Lea Bucher who works in the

Children Hospital Lucerne. For the panel discussion, on the last day of the training, Mr. Dr.

phil. Beat Vonarburg was invited for the talk.

The slides used by each trainer for presentation of their topic in the class are given in annexes

3-17.

3. Identification of Participants

The core team listed the numbers of government hospitals and organizations. The letter

requesting to nominate participants for the training was prepared. The request letter was sent

to all listed hospitals and organizations.

Request letter in annex 18.

Initially the training programme was planned for 25 nurses only. Because the demand from

care professionals to participate in the training was very large, that is why the number of

participants was expanded to 36. Nurses from state institutions were prioritized.

List of trainees in annex 19.

4. Collaboration with Nursing Association of Nepal (NAN)

Ageing Nepal is an organization working on cross cutting issues of ageing population in Nepal.

But it is not an organization that is specialist in care issue of older patients. For that reason,

Ageing Nepal collaborated with Nursing Association of Nepal (NAN) to conduct the training.

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Nursing Association of Nepal (NAN) is the only professional organization of nurses in Nepal.

With its more than 10 000 member nurses, it aims for quality-nursing service to the people and

protects and promotes the professional rights and interests of all Nurses in Nepal. NAN was

established in 1962 with the Regd. No. 8/018 and became a member of International Council

of Nurses (ICN) Geneva in 1969 A.D.

Collaborating with NAN was important to provide government recognition of the training.

With the certificate of the training on geriatric care participants will earn extra marks in their

career development.

PROGRESS OF THE TRAINING

Trainees were requested to register their name and fill up a set of questions for pre-test in the

first day of the training. Training Coordinator Ms. Kabita Pandey gave a short speech and the

schedule (in Annex 1) was followed sequentially from session 1 to 16. Topics were covered

according to the schedule.

At the end of the programme, a panel discussion was organized with people of 60 above. Mr.

Krishna M. Gautam, Chairperson of Ageing Nepal; Mr. Dr. phil. Beat Vonarburg, team

member of Ageing Nepal Switzerland; Ms. Ranjana Nepal, President of Baristha Nagarik

Samaj (Elderly Organization) and Ms. Tara Pokhrel, President of NAN participated in the panel

discussion. Ms. Sanju Thapa Magar, Programme Officer of Ageing Nepal moderated the

discussion.

PRE-TEST AND POST-TEST

A set of fifteen questions was prepared for pre- and post-tests. Questionnaire is given in annex

19. Participants were asked to fill up the questionnaire on the first day and last day of the

training.

Altogether 1080 answers (15 questions in a set that was filled by 36 participants), 540 from

each of pre- and post-tests was received, checked and counted right and wrong. Following bar

graph shows the numbers of right and wrong answers received from participants’ pre-tests and

post-tests.

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The bar graph demonstrations that the participants altogether gave 233 right and 307 wrong

answers in the pre-test. In the post-test there were 419 right and 121 wrong answers given.

FEEDBACK COLLECTION

A set of four questions was prepared for feedback collection. Participants were asked to fill up

the questionnaire at the end of the training. Following are the questions and feedback from the

participants.

a) Please indicate your level of agreement with the statements listed below:

S.N. Statements Strongly

agree

Agree Disagree

1. The objectives of the training were clearly defined 27 9 -

2. Topic covered were relevant 22 14 -

3. Participation and interaction were encouraged 20 16 -

4. Contents were organized and easy to follow 18 17 1

5. This training experience will be useful in my work 30 6 -

6. The materials used for training were helpful 19 15 2

7. The time allotted for the training was sufficient 10 19 7

8. The meeting room and facilities were adequate and

comfortable

8 18 10

9. Trainers were qualified and well prepared 19 16 1

b) What did you like most about the training?

• Demonstration session

• Time management

• Experts and their presentation

• Interaction

0

50

100

150

200

250

300

350

400

450

Pre-test Post test

Right Wrong

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• Food served

• Encouraging environment

• Experienced trainers (especially trainers from Switzerland)

• Clear presentations

• Session on ‘Programmes and Policies for older persons’

• Session on ‘Poly Medication’

• Session on ‘People living with Alzheimer’s disease’

• Rapport built with experienced nurses

• Training Curriculum

c) What aspects of the training could be improved?

• Setting of the hall

• Sitting arrangement

• More practical based classes

• More explanation in legal aspect of senior citizens

• More information on elderly care centers in Nepal

• Training should be developed as regular programme

• More interaction with participants

• Time management from 8 am to 4 pm rather than 9 am to 5 pm

• Transportation allowances should be provided

• Handouts should be provided during session

• The group of participants could be more homogenous

• Photo session and noise in practical session

• Projector should be changed

• Demonstration place

• Session hour for palliative care should be increased

• Increase training days at least two weeks long

d) What additional subjects would you like to have in future training?

• Physiotherapy and paramedical

• Session for field visit (old age home, day care center)

• Exercise for elderly

• More of psychological counseling techniques

• Session on other cross cutting issues of older persons

• Medication

• Hospice care

• Adequate session on elderly health policies in Nepal

• Geriatric sociology

• Interaction session with elderly client

• Care of unconscious elderly patient

• Session on national and global Polices and programmes on geriatric care

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LESSON LEARNED

Following are the lesson learned based on the feedbacks collected from participants and the

observations of the core team.

a) Initially the training programme was planned for twenty-five nurses only. Due to the great

demand of nurses to participate in the training, the number of participant was adjusted to

36. The high demand to participant shows the importance of trainings on geriatric care in

Nepal. Also, Ageing Nepal starts lobbying with the concerned government and academic

institutions to either offering training course on geriatric care with governmental support

or include the contents of geriatric care in the existing curricula for nursing education.

b) Performance of volunteers from Switzerland was highly appreciated by the trainees. Effort

should be made to involve more trainers from Switzerland in upcoming trainings.

c) Collaboration with Nursing Association of Nepal (NAN) provided government recognition

of the training and certificate. So, it is recommended to collaborate with NAN also for other

such trainings in the future.

d) Eight hours long training in a day was found by some of the participants as too lengthy. It

is to consider if the daily training hours could be reduced by increasing the numbers of

training days. Furthermore, if changes in the training structure could be adjusted to

guarantee variety.

e) Participants suggested additional subjects that weren’t included in the training schedule. It

is planned to revise the training plan in consultation of the target group.

Observing the test results and feedbacks, it is evident that the training has substantially

increased the knowledge level of participants. Most of the trainees shared that they got

opportunity to participate in geriatric care training for the first time. The training on geriatric

care is essential and should be conducted frequently in days ahead.

This was the first time for Nursing Association of Nepal (NAN) to get involved in the subject

of geriatric care. Appreciating the traing programme conducted and its possible implications,

NAN has already expressed interest to conduct again such or similar trainings in partnership

with Ageing Nepal. Similarly, senior officers of Ministry of Health Nepal, who were involved

in the training either as trainer or participants, have expressed their commitment to take

necessary steps to make such trainings, as the from Ageing Nepal accomplished Training on

Geriatric Care for Nurses, a permanent programme of the Ministry of Health.

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GLIMPSES OF THE TRAINING

Ms. Kabita Pandey, Training Coordinator taking class.

Trainers from Switzerland; Ms. Theres Luder, Ms. Ursula Bucher and Ms. Lea Bucher taking

demonstration session in Patient Transfer.

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Nepalese nurses learn

how to transfer a person gently.

From left: Ms. Tara Pokhrel, President of NAN; Mr. Dr. phil. Beat Vonarburg, team member

of Ageing Nepal Switzerland; Mr. Krishna M. Gautam, Chairperson at Ageing Nepal and Ms.

Sanju T. Magar, Programme Officer at Ageing Nepal in panel discussion on the last training

day.

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Feedback of participants was used fort he evaluation oft he project.

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Mr. Edi Frei, Chairperson Ageing Nepal Switzerland giving his vote of thanks on closing of

the training programme.

From left: Ms. Urusla Bucher, Ms. Lea Bucher and Ms. Theres Luder, received Certificates

of Honors by Ageing Nepal.

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Participants receiving certificate from Chairperson of National Senior Citizens Fund.

The successful completion of the Training for Nurses on Geriatric Care was celebrated with

a closing ceremony.