184487 Community nurses in Armenia: Task shifting for a new cadre of nurses

Monday, October 27, 2008: 12:50 PM

Sara Espada, MA , IntraHealth International, Inc., Chapel Hill, NC
Susanna Onanyan, MD , IntraHealth International, Yerevan, Armenia
Karine Gabrielyan, MD , Family Medicine and Quality of Care Team Leader, Primary Health Care Reform (PHCR) Project, USAID/ Armenia, Yerevan, Armenia
Background: Since the Soviet Union's fall, Armenia's health systems have deteriorated. Suffering the most are the rural communities, where nurses provide the only medical services at health posts, Feldsher Acousher Posts (FAPs). Because FAP nurses serve a critical primary care function, the Ministry of Health (MOH) decided to develop them into a new cadre of providers as part of its adoption of a national rural health plan to reform outdated health systems. The MOH identified the skill set a FAP nurse needed—a set broader than family nurses who do not work as independently but instead work alongside doctors. The government sought to retrain existing FAP nurses, but the only qualified training institutes were in Yerevan, and FAP nurses could not afford to be away from their job/family for six months. The USAID-funded Primary Health Care Reform (PHCR) project created a training package to be delivered on-site.

Method: The PHCR training focuses on clinical skill-building and includes: diagnosing cardiovascular, neurological, endocrine and infectious diseases; allergies; tuberculosis; emergency care; palliative and end-of-life care. Also, nurses learn to pro-actively address health problems.

The half-year training—delivered by master trainers and clinical preceptors—utilizes in-service, peer and distance learning formats so that nurses stay in their communities. Classroom trainings are held one week a month in regional nursing colleges. Clinical skills training is provided at nearby clinics or health centers.

Results: The nurses took a baseline knowledge test of 100 questions and scored an average of 31%. Their final assessments averaged 87%; 85% showed excellent results during the oral examination (on ten-point-scale).Upon successful completion of the training, the nurses received nationally recognized certification.

By providing more care independently, FAP nurses have gained confidence, saved time and money and can treat patients for more illnesses and emergencies instead of having to refer patients to hospitals. Trainings have resulted in new communication and support systems between nurses and trainers, doctors, and preceptors to solve medical problems.

Conclusions: Through PHCR, FAP nurses are self-standing specialists and significantly expand their scope of practice, improve performance, and demonstrate their functional and financial value to primary health care.

Learning Objectives:
--Recognize the benefits of training providers on-site --Identify curriculum topics and format to best transfer knowledge to new cadre --Articulate the role of a community-level nurse in rural Armenia and the difference between the community nurse and family nurse

Keywords: Training, Nurses

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I led planning, organizing and monitoring of community nurse training.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.