Mrc Unit the Gambia

MRC UNIT THE GAMBIA

JOB DESCRIPTION

SEN Nurse – KMC STUDY

1. Job Title: SEN Nurse

2. Introduction:

Established in 1947, the Medical Research Council in The Gambia has an international reputation for ground-breaking research into some of the leading causes of morbidity and mortality in the tropics. Achievements include a large trial showing the efficacy of Haemophilus influenzae type B vaccine in The Gambia and the subsequent near elimination of the disease, pioneering studies of the impact of insecticide treated bed nets as a preventive measure against malaria leading up to their worldwide use, studies demonstrating the impact of conjugate pneumococcal vaccines on pneumonia and child mortality and the demonstration of a dramatic reduction in the carriage of Hepatitis B in The Gambia due to the effects of vaccination.

To reflect changes in national and global health priorities and new international funding opportunities a new research portfolio is being organized under three themes: Disease Control & Elimination; Vaccines & Immunity; Nutrition. These themes have been selected to target health needs of developing countries, to reinforce sub-regional and international collaborations and to address some of the major current priorities in the Millennium Global Health Goals.

Complications of prematurity are the leading cause of under-5 childhood mortality, causing 1.1 million deaths/year globally, mostly in low-middle income countries (LMIC). The hospital management of preterm newborns in LMIC is often challenging with limited access to neonatal intensive care facilities and incubators, if available, are often over-crowded or dysfunctional. Kangaroo mother care (KMC) is a low technology alternative to incubator care consisting of prolonged, continuous skin-to-skin (STS) contact between the baby and mother or care-giver. It is recommended by WHO as standard care for all stable preterm or low birth weight (LBW) newborns weighing <2000g in LMIC.

However, evidence for KMC is mostly from older babies aged 2 days or older and there are few studies examining its use during the first day after birth when preterm and small babies are not fully stabilised. Nearly half of all deaths in preterm babies occur within the first day after delivery and there is an urgent need to focus on this period to reduce death rates and improve newborn health.

A clinical trial is planned at the neonatal unit of Edward Francis Small Teaching Hospital, Banjul, to compare the effect of starting KMC early (within 24h after birth) with starting it later (after 24h after birth) in babies admitted who weigh <2000g. The participants will be followed up to age 28 days and mortality rates at 28 days will be the primary outcome of the study. Secondary outcomes will include suspected or confirmed bacterial infection, weight gain, time to exclusive breastmilk feeding, duration of admission and skin colonisation with gram-negative bacteria. The trial will start in Autumn 2017 and it is expected to last for 2 years. In-order to plan this trial there will be a feasibility study from the end of February to the end of May 2017 which will involve collecting information about all babies weighing <2000g who are admitted to EFSTH, including information on outcomes, clinical stability at time of admission and baseline bacterial skin colonisation.

At present KMC is not routinely provided to babies at EFSTH and as part of this research a KMC unit will be established at the study site. EFSTH staff and study staff will be trained in KMC theory and practices and KMC will be introduced as standard care before the main clinical trial begins.

The Unit established a clinical trials support office to conduct and advise others on the conduct of clinical research, to provide professional leadership and training in clinical trials, including support to address the current regulatory environment in relation to Good Clinical Practice and the EU Clinical Trials Directive.

The post-holder will be based at MRC Fajara and at Edward Francis Small Teaching Hospital (EFSTH), Banjul and may have to work in other hospitals in the West Coast Region if needed. 3. Grade: 6-16 Points

4. Purpose of the Job:

The post-holders will normally work at EFSTH neonatal unit and he/she will be required to assist with th e study data collection, support of EFSTH neonatal staff with neonatal care and provision of kangaroo m other care, and sensitisation activities related to the project.

5. Role:

The post-holders will perform the following tasks:

1. Feasibility study (February – May 2017)  Ensure correct documentation of events whilst in the field and proper filing of documents.  Assess potential study participants for eligibility in a timely manner  Obtain informed consent/assent for study participation  Obtain baseline socio-demographic data from care-givers of participants  Perform anthropometry, estimation of gestational age, clinical examination and assessment of cardio-respiratory stability  Obtain neonatal skin swab samples of study participants strictly according to study protocol  Follow study participants up on the neonatal unit, or by telephone, as appropriate  Obtain details of treatments and outcomes at predefined intervals during hospitalisation  Ensure prompt and timely transfer of samples from the field to the relevant laboratories in MRC Fajara.  Retrieve and preserve results of investigations done on subjects.  Ensure that good relations are maintained at all times with study participants, family members and the local community.  Undertake all work strictly following the relevant safety rules and regulations as laid down in the MRC Safety Manual.

2. KMC implementation (May – September 2017)  Assist with community sensitisation about kangaroo mother care and the research project  Undergo training in kangaroo mother care theory and practice  Assist study-site staff with the care of newborns receiving KMC  Perform monitoring and evaluation activities around KMC quality

3. Clinical trial (September 2017 – September 2019)  Assess potential study participants for eligibility in a timely manner  Perform enrollment and randomisation procedures according to protocol  Obtain baseline socio-demographic data from care-givers of participants  Perform anthropometry, estimation of gestational age, clinical examination and assessment of cardio-respiratory stability at time of admission and when necessary through the study  Obtain neonatal skin swab samples of study participants strictly according to study protocol  Assist study site neonatal staff in initiating and monitoring study participants with kangaroo mother care procedures  In the event of clinical deterioration assess study participants in a timely manner according to study protocols  Assist study site neonatal staff to provide education to mothers and care-givers about kangaroo mother care and recognition of the unwell baby  Perform monitoring and evaluation activities of the amount and quality of Kangaroo mother care provided to study participants  Retrieve and preserve results of investigations done on subjects  Ensure that good relations are maintained at all times with study participants, family members and the local community.  Undertake all work strictly following the relevant safety rules and regulations as laid down in the MRC Safety Manual 6. Relationships:

 The post-holders will be a full-time member of the MRC staff.  The post-holders will report to Dr Helen Brotherton.  The Principal Investigator of the study is Dr Zaman.  The Unit Director and Theme Leader for Disease Control & Elimination is Professor Umberto d’Alessandro  The Director of Operations is Mr. Joan Vives Tomas.

7. Appraisals:

Appraisals are held at least annually.

8. Length of appointment:

The appointment is up to 30th April 2018 for the first instance and are subject to a probationary period of 3 months.

9. Any other duties:

To carry out any other duties consistent with the remit and level of the position.

Signed Post Holder: Date:

Signed Line Manager: Date: PERSON SPECIFICATION

SEN NURSE

1. Education and Training

 5 O’levels or grade 12 certificate with credits in English, Science and Mathematics  Completion of the SEN qualification (minimum)  Some training experience

2. Experience and job-related knowledge

 Experience as a supervisor or coordinator  Minimum of 5 years postgraduate working experience  Previous experience working with newborn babies, particularly small and preterm newborns  Knowledge of kangaroo mother care is desirable  Ability to perform neonatal examination  Ability to obtain clinical samples from study subjects  Ability to undertake accurate anthropometry and vital sign measurements  Previous work on clinical trials working to ICH-GCP is essential.  Ability to deal sensitively with patients  Computer literate particularly Excel and Word  Excellent communications skills

3. Abilities and Aptitudes

 Ability to understand the objectives and trial design, including the importance of the objectives.  Ability to work well with the Health Centre Staff.  Excellent organisational and communication skills.  Ability to speak Mandinka, Fula and/or Sarahule fluently and to write reports in English is required.  Ability to anticipate problems and to take initiative in resolving issues in a timely manner.  Ability to develop creative solutions to problems arising in the field  Ability to be critical of his/her own work, striving for excellence  The ability to lead, motivate, supervise, monitor, train and advise the Field Assistants on their work.  Ability to learn relevant standard operating procedures and to ensure that these are met.

4. Other

 Willingness to travel when required  Willingness to work in a shift pattern, including weekends and night shift during the clinical trial