international relief team the s.t.a.b.l.e. program's ...€¦ · care affects not only the...

International Relief Team (IRT) &

the S.T.A.B.L.E. Program's

"Healthy Baby" Project Vietnam

Bridget Cross, MSN, APRN, NNP-BC

Barbara Levy, BSN, RN, RNC-NIC

Disclosure Information:

Bridget Cross & Barbara Levy

• No financial interest or other

relationships that could be

considered a conflict of interest by

participants

• No discussion of unlabeled uses of

a commercial product, or an

investigational use of a product not

yet approved for this purpose

Agenda

1. Describe the International

Relief Team’s “Healthy Baby”

Project-Vietnam’s Goal

2. Discuss the process of training

Vietnamese professionals as

S.T.A.B.L.E. Lead Instructors

Agenda

3. Share highlights of this unique

international teaching experience

4. Explore perinatal & neonatal

S.T.A.B.L.E. interventions from

this international experience that

may be applicable to practice in

the United States

Describe the International Relief Team’s

(IRT) “Healthy Baby” Project-Vietnam’s Goal

• IRT’s “Healthy Baby Project”

• gives healthcare providers the

knowledge & skills needed to

save newborn lives

• “Project Vietnam” is a

nonprofit humanitarian

organization

• creating sustainable pediatric

healthcare

• providing free healthcare & aid

to impoverished rural areas



• IRT’s partner in Project “Health Baby”=

Project Vietnam Foundation (PVF)

• PVF is registered as a non-

governmental organization

• established excellent working relationships

with authorities & institutions at all levels of

the Vietnamese health system

• Mission

• healthcare assistance to children at-risk in

poor rural communities in Vietnam

• medical training to Vietnamese health

professionals



• Project Vietnam Statement of Need:

• number of Vietnamese babies who die

during their first year of life = up to 64

deaths per 1,000 births in the rural areas

(compared to 6.5-8.5-1000 in Western

countries)

• worse for children living in rural areas, poor

(2x higher), or ethnic minorities (3x higher)

• lack of uniform, nationwide standards for

providing effective post-resuscitation care

to the critically ill newborn



• Project Vietnam Statement of Need:

• Infants in rural communities born prematurely

or with unanticipated complications

• may be miles from facilities with specialized

technology & highly trained staff

• Vietnam’s natural terrain & congested highways

makes for difficult rapid infant transport to higher

level of care hospital



LOW TECH SOLUTIONS SAVE BABIES’ LIVES

• Teaching techniques such as trans-illumination is an

inexpensive and quick way for Doctors without many

resources, like in rural communities in Vietnam, to

diagnose babies with a collapsed lung

• This technique teaches low tech solutions which can

help save babies lives.



• Critical for the staff in rural or lower

level hospitals to know

• how to not only resuscitate a newborn in

acute distress (NRP)

• also provide effective post-resuscitation

care to the critically ill newborn at that

rural facility (S.T.A.B.L.E.)

• Project “Health Baby”-Vietnam Goal

• lower neonatal & infant mortality in Vietnam

• establishing uniform standards in post-

resuscitation care of the newborn by training

Vietnamese neonatal clinicians



• Trains “trainers” in Neonatal

Resuscitation (NRP) & Infant

Stabilization (S.T.A.B.L.E.)• targeting the critical neonatal period,

when most infant deaths take place

• Establishes self-sustaining

regional instructor groups • who provide ongoing training to other

practitioners who deliver or provide care

for newborns





• Train up to 200 Vietnamese neonatal

professionals as S.T.A.B.L.E. instructors

• 12 training sessions (5 days of training per

session)

• Organize the instructors trained into

instructor groups

• goal of establishing 1-2 S.T.A.B.L.E.

instructors in each province of Vietnam

• Equip instructors with training materials

& books

• Require all instructors report results of all

trainings conducted to both S.TA.B.L.E

program & IRT by online roster

• Since 1996, IRT has trained

in NRP

• 269 NRP instructors

• these NRP instructors have

trained more than 5500 in NRP

• Since 2015, IRT has trained

in S.T.A.B.L.E.

• 107 S.T.A.B.L.E. lead

instructors

• these lead instructors have

trained more than 648 in

S.T.A.B.L.E.



Discuss the process of training Vietnamese

professionals as S.T.A.B.L.E. Instructors

“Hundreds of times each day, in hospitals and

communities around the world, newly born infants

become ill and require specialized care. Each member

of the health care team—nurses, physicians, therapists

and assistants—must know what to do for the sick

infant. Their care must be provided in a timely, efficient,

anticipatory, and effective manner. This early transitional

care affects not only the immediate health of the infant,

but also the infant’s long-term outcome. The

S.T.A.B.L.E. Program was developed to meet the

educational needs of health care providers who must

deliver this important stabilization care. S.T.A.B.L.E.

education is critical to the mission to reduce infant

mortality and morbidity and to improve the future health

of children and their families.” www.stableprogram.org



• The S.T.A.B.L.E. Program was

founded & authored in 1996 by

Kris Karlsen PhD, NNP-BC

• Most widely distributed & implemented

neonatal education program that

focuses exclusively on the post-

resuscitation/pre-transport stabilization

care of sick infants

• Endorsed by the March of Dimes

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiF2J3r9MLRAhXFiFQKHZARApYQjRwIBw&url=http://www.rhochizeta.com/marchofdimes#!&psig=AFQjCNEzezNdOPeCDDgD19RVDZ4bBopDiw&ust=1484526929719638

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiF2J3r9MLRAhXFiFQKHZARApYQjRwIBw&url=http://www.rhochizeta.com/marchofdimes#!&psig=AFQjCNEzezNdOPeCDDgD19RVDZ4bBopDiw&ust=1484526929719638



• Has grown internationally to include

instructor training & courses in greater

than 45 countries• Argentina, Bahamas, Belarus, Bolivia, Canada,

Colombia, Congo, Costa Rica, Dominican

Republic, Egypt, El Salvador, Eretria, Faroe

Islands, Germany, Ghana, Guam, Guatemala,

Honduras, Ireland, N. Ireland, India, Israel, Italy,

Japan, Kenya, Kiribati, Kosovo, Latvia, Lithuania,

Mexico, Nepal, Netherlands, Nicaragua, Panama,

Philippines, Qatar, Romania, Spain, Thailand,

Uganda, U. Arab Emirates, UK, & Vietnam

• Program translated:• Spanish, Lithuanian, Latvian, Romanian &

Vietnamese

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjQjLnm9cLRAhXIrFQKHaWwAmUQjRwIBw&url=http://www.worldatlas.com/worldmap.htm&psig=AFQjCNHEmHUy2Wo6k1ZIxZOJqrjE236XkA&ust=1484527431937423

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjQjLnm9cLRAhXIrFQKHaWwAmUQjRwIBw&url=http://www.worldatlas.com/worldmap.htm&psig=AFQjCNHEmHUy2Wo6k1ZIxZOJqrjE236XkA&ust=1484527431937423



• Taught in didactic-interactive format

• Optional S.T.A.B.L.E. simulation

scenarios available

• simulation-based education is used to

train for emergencies, improve team

performance and communication &

ultimately improve patient safety



• Based on a mnemonic to optimize

learning, retention & recall

• 6 assessment & care modules:

• Sugar, Temperature, Airway, Blood

pressure, Lab work, & Emotional

support

• 7th module: Quality Improvement:

stress professional responsibility of

improving & evaluating care provided

to sick infants



• Stabilization is a team effort!

• Any health caregiver involved with

post-resuscitation and/or pre-transport

care of sick newborns benefits

• Physicians: Pediatric, ER, family practice,

and obstetric physicians including

residents

• Nurses: RNs working in L&D, postpartum,

nursery, ER, Nurse midwives, LPNs,

Nursing assistants

• Others: RTs, EMTs & Paramedics



• S.T.A.B.L.E. instructors worldwide

are greater than 4200

• S.T.A.B.L.E. student roster program

launched 1/1/01 to track student

participation learner courses

submitted worldwide

• Student participant stats: 1/01-1/5/17

• total students=454,657

• total classes=46,811



• Teaching S.T.A.B.L.E. in Vietnam:

• 6th edition translated Vietnamese Learner

manual & slides for new instructors & learners

• U.S./English speaking instructors/mentors

• utilized Vietnamese expert interpreters for lead

instructor classes

• 5 day format for each week (Hanoi & Saigon)

• 3 days for S.T.A.B.L.E. instructor course training by

U.S. mentors

• included clinical skills & learner course roster

• 2 days for learner course by new Vietnamese

S.T.A.B.L.E. instructors

• timely use of feedback from U.S. mentors

• successful roster submission



• Challenges for the U.S. mentors in

presenting S.T.A.B.L.E. to the

Vietnamese instructors • flow of the timing of the presentation

• use of euphuisms & humor not easily transferable

due to difference in cultural norms

• differences in health care delivery system

• differences in medical/nursing patient care

• hierarchical, teamwork & chain of communication

differences

• differences in availability of medical

resources/equipment



• Flow of the timing of the

presentation

• slower & longer due to Vietnamese

interpretation

• challenging using both English &

Vietnamese slides simultaneously

• Use of euphuisms & humor not

easily transferable due to

difference in cultural norms

• “slang” & jokes not easily

transferrable & possibly offensive



• Differences in healthcare delivery system

• currently working towards universal

healthcare system

• government invests 0.9% of its Gross

Domestic Product (GDP) on healthcare

• only about 30% of the population

• most have to pay for private health care

• quality & availability varies dramatically on

whether in the city or in rural areas

• majority of hospitals/clinics

located in larger cities (very crowded!)



• Differences in medical/nursing

patient care

• uncertainty of Vietnamese translation

accuracy by translator

• difficult to relate “typical” clinical

cases due to medical, nursing &

cultural differences

• differences in agreement of

“evidenced based care”

• agreement of proper care but inability

of Vietnamese to provide

• possibly due to financial, geographical

and/or cultural differences



• Hierarchical, teamwork & chain

of communication differences• majority of Vietnamese neonatal docs

are female

• all procedures done by doctors

• nurse to patient ratio ~ 8 level 2-3 NICU

neonates to 1 nurse

• nurses task oriented due to high patient

load

• discouragement for use of chain of

command

• shifting hierarchical changes with

increasing western influences



• Differences in availability of medical

resources/equipment

• Vietnamese practitioners do not usually

have access to:

• Meconium aspirators

• Stylets

• Flow inflating bags

• T-piece resuscitators

• CO2 detectors

• LMAs

• 3-way stopcocks

• Epinephrine diluted to1:10,000

• Rh negative blood

Share highlights of this unique


• Vietnam Geography• country’s total length=1025 miles

• slightly larger than New Mexico

• Population: 86,116,560 (2008)

• Capital: Hanoi

• Government Type: Communist state

• Languages• Vietnamese (official), English,

French, Chinese, & Khmer

• Total Fertility rate• 1.86 children born/woman (2008)



Fall 2016 Vietnam IRT/STABLE Teaching Team

Audrone LaForgia, Nannette Laufik, Barbara Levy & Bridget Cross



New S.T.A.B.L.E. Instructors in

Hanoi, Vietnam



New S.T.A.B.L.E. Instructors in

Saigon, Vietnam

Clinical videos to

highlight this unique,

& challenging

international teaching

experience.

Explore perinatal and neonatal S.T.A.B.L.E. interventions

from this international experience that may be applicable

to practice in the United States

S.T.A.B.L.E. provides evidenced based

medical & nursing knowledge leading to

the improvement in perinatal &

neonatal outcomes through technical,

cognitive & behavioral solutions

applicable in both

Vietnam & the United States.




• Technical Solutions: • Transillumination: phone, pen,

or flash light

• Needle Aspiration: chicken or

duck

• ETT insertion: mannequin

• Xray Interpretation: Use of

S.T.A.B.L.E. slides

• Umbilical line placement




• Cognitive Solutions: • Attempts to reduce variances in evidence

based practice

• Venous & arterial placement, securement &

usage

• Assessment of glucose need & delivery

• Thermoregulation

• Airway & ventilation management

• Perfusion & cardiac management




• Behavioral Solutions:

• Difference in medical training

• Differences if medical & nursing practices

• Hierarchical challenges

• Family, societal & cultural differences

The following video clip, from our

Vietnamese colleague, brilliantly

demonstrates the joy and

similarities discovered through

this educational collaboration!

Thank you for attending & we look forward to

answering your questions.

Bibliography/References• Black, R. E., R. Laxminarayan, M. Temmerman,

and N. Walker, editors. 2016. Reproductive,

Maternal, Newborn, and Child Health. Disease

Control Priorities, third edition, volume 2.

Washington, DC: World Bank

• General Statistics Office and UNICEF, 2015. Viet

Nam Multiple Indicator Cluster Survey 2014, Final

Report. Ha Noi, Viet Nam

• Global, regional, and national levels of neonatal,

infant, and under-5 mortality during 1990-2013: a

systematic analysis for the Global Burden of

Disease Study 2013. Lancet. 2014 Sep

13;384(9947):957-79

• International Relief Teams S.T.A.B.L.E. Team -

Fall 2016: Vietnam Country Manual

Bibliography/References

• Kendall AB, Scott PA, Karlsen KA. “The

S.T.A.B.L.E. Program. The Evidence behind the

2012 Update. J Perinat Neonatal Nurs. 2012

Apr-Jun;26(2):147-57

• Lee HY, Van Do D, Choi S, Trinh OT, To KG.

Trends and determinants of infant and under-five

childhood mortality in Vietnam, 1986-2011. Glob

Health Action. 2016 Feb 29;9:29312

• Målqvist M, Hoa DP, Persso LÅ, Ekholm Selling

K. Effect of Facilitation of Local Stakeholder

Groups on Equity in Neonatal Survival; Results

from the NeoKIP Trial in Northern Vietnam.

PLoS One. 2015 Dec 29;10(12):e0145510

Bibliography/References

• McKinnon B, Harper S, Kaufman JS, Bergevin Y.

Socioeconomic inequality in neonatal mortality in

countries of low and middle income: a multicountry

analysis. The Lancet Global health. 2014; 2(3):

e165–73.

• The S.T.A.B.L.E. Program: www.stableprogram.org

• Wallin L, Malqvist M, Nga NT, Eriksson L, Persson

LA, Hoa DP, et al. Implementing knowledge into

practice for improved neonatal survival; a cluster-

randomised, community-based trial in Quang Ninh

province, Vietnam. BMC Health Serv Res. 2011;

11(1): 239.

http://www.stableprogram.org/

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