By Erica Bleakley, Beth Price
In April 2022, Erika Bleakley and Beth Price from the NCCTRC Regional Engagement team were invited to the small Pacific nation of Nauru to deliver training for local health staff focussed on acute COVID-19 clinical care and rehabilitation. Here they recount their experience on the island.
The trip was born out of a joint partnership between the NCCTRC and the Pacific Communities’ (SPC) Public Health Division. The partnership is focussed on collaboration to develop, enhance and support the critical care nursing capabilities of health services throughout the Pacific, in response to the COVID-19 pandemic.
Nauru is a microstate in the Southwest Pacific that lies 40km south of the Equator. With a population of 13,000 people, its closest neighbour being the Island of Banaba in Kiribati, 200km to the east.
Training the COVID-19 workforce
While the arrival of COVID-19 on the island impacted our training schedule, it did also provide the opportunity to incorporate a very real-life element into the program.
The Republic of Nauru (RoN) Hospital had developed a new Acute Care Unit (ACU), an 18-bed ward specifically for the care of COVID-19 patients, which was very well equipped with ventilators, high flow oxygen therapy machines (Airvo™), McMonty Hoods, portable bedside monitors, electric beds, a portable x-ray machine, oxygen concentrators, and defibrillators.
Our training focussed on preparing clinical staff to manage severe and critically unwell COVID-19 patients in the ACU. The training was based in the ACU clinical environment with an emphasis on practical skills, including:
- Assessment of severity of COVID-19 illness
- Oxygen administration and titration
- Safe set up, use and disinfection of commonly used oxygen delivery devices (nasal prongs, masks, concentrators, high flow / Airvo™)
- Proning and positioning
- Recognition of the deteriorating patient
- Importance of considering non-COVID-19 related conditions and co-morbidities
- Infection Prevention Control (IPC) practices and safe use of Personal Protective Equipment (PPE)
One of the tools introduced to the ACU clinical staff was the POPOMOP clinical framework for COVID-19 clinical care. This tool has been developed by the NCCTRC during Pacific AUSMAT deployments over the last 18 months. POPOMOP stands for:
- P: Personal Protective Equipment
- O: Oxygen
- P: Positioning
- O: Observations
- M: Medications
- O: Other illnesses
- P: Physiotherapy and rehabilitation
Many of these interventions were already in place at RoN Hospital, however utilising a consistent framework like POPOMOP provides a structured approach to the delivery of care while promoting confidence, teamwork, and sustainability among teams.
The MoHMS employs a Physiotherapist and a Physiotherapy Aidewho are responsible for all inpatient and outpatient Physiotherapy services on Nauru. Key training topics covered with these staff included proning and positioning, the rehabilitation needs of COVID-19 patients, approaches to prioritising acute COVID-19 patients, POPOMOP, clinical observations and oxygen delivery devices.
We were fortunate to spend a morning teaching and learning with the staff at the Naoero Public Health Unit, ,who are responsible for educating the Nauruan community about the presentation and control of COVID-19, and have been working hard to ensure a successful COVID-19 vaccine roll-out.
We had a thought-provoking conversation about how to tackle stigma and misinformation about COVID-19 infections, and the importance of addressing these in order to ensure people with suspected infections seek timely testing and treatment.
Tubwa Kor (thank you) Nauru!
While our trip certainly didn’t go according to schedule (which perhaps should no longer come as a surprise!), we were very grateful to have the opportunity to share our experiences about COVID-19 care with the welcoming anddedicated nursing leadership and ACU team at the RoN Hospital, the MoHMS Physiotherapy staff, and the Naoero Public Health unit. We very much look forward to further developing these relationships and networks.
Thank you to everyone at the MoHMS Nauru, SPC and the NCCTRC whose hard work made this trip possible!
Beth Price
NCCTRC Pacific Critical Care Nurse Education Consultant
Beth is an ICU nurse and educator with postgraduate qualifications in Critical Care and Health Professional Education. She currently works as a Nurse Education Consultant within the Regional Engagement Team at the NCCTRC. Beth has worked in Intensive Care both in the UK and Australia. She has been a Critical Care Educator since 2012. Beth has worked with colleagues throughout the Pacific in collaboration with Pacific Communities (SPC) providing remote and face to face assistance particularly throughout the current Pandemic.
Erica Bleakley
NCCTRC Allied Health & Rehabilitation Coordinator
Erica is an Occupational Therapist with post-graduate qualifications in burn and trauma rehabilitation. She is the Allied Health & Rehabilitation Coordinator at the NCCTRC and is responsible for the development and coordination of AUSMAT’s rehabilitation capability. She is also a member of the NCCTRC’s Regional Engagement Program team. Erica has deployed on multiple occasions with AUSMAT in response to the COVID-19 pandemic, including to PNG, Fiji, Timor Leste and the Solomon Islands. She regularly provides input for World Health Organisation projects involving rehabilitation in emergencies and worked for Humanity & Inclusion (an international NGO) in Yemen in 2019.