Nurse (Gap Filler)

WHAT IS MSF ?

Médecins Sans Frontières/أطباء بلا حدود  بلا أطباء (MSF) is an international, independent, medical humanitarian organization that delivers emergency aid to people in 70 countries who are affected by armed conflict, epidemics, natural disasters and exclusion from healthcare. MSF offers assistance to people based on need, irrespective of race, religion, gender or political affiliation and our actions are guided by medical ethics and the principles of neutrality and impartiality.

We offer basic healthcare, perform surgery, fight epidemics, rehabilitate and run hospitals and clinics, carry out vaccination campaigns, operate nutrition centers, and provide mental healthcare. Our activities include the treatment of injuries and disease, maternal care and the provision of humanitarian aid. Where necessary, we set up sanitation systems, supply safe drinking water, and distribute relief to assist survival.

A FEW WORDS ABOUT THE PROJECT

The project started in Sept. 2013 in Shatila, where MSF currently manages an outpatient center for chronic non-communicable diseases (NCDs), vaccination services with transversely integrated mental health services and health promotion, and referrals for patients who require services beyond the scope of MSF activities. Additionally MSF opened a women’s health center with sexual and reproductive health care.
During 2018, low risk deliveries were relocated from Shatila to Rafik Hariri University Hospital compound, where MSF runs a Birth Centre. MSF took this as an opportunity to work together with external partners as catalyst for change around midwifery model of care and demedicalization of deliveries. The antenatal care services remains in the camps, to serve the most vulnerable women.
In Bourj el Barajneh camp, besides the above mentioned activities, MSF provides in addition home based care for those patients who are housebound or bedridden often due to an advanced NCD disease.

Main Responsibility:

Providing nursing care, treatment and follow-up of patients, according to doctors’ prescriptions, protocols applied in service and universal hygiene standards/precautions, in order to ensure the quality and continuity of care for the targeted population

The work will be in our PHC clinic located in Shatila camp.

Accountabilities

• Knowing, promoting, implementing and following up the universal hygiene standards/ precautions, bio-hazard prevention and infection control, security rules and other protocols and procedures in the medical premises and ensuring high standards of hygiene of his/her working environment. Respecting medical secrets and confidentiality at all times.
• Organizing and carrying out care and treatments according to medical prescriptions, and assisting during consultations, daily rounds and other medical procedures. Participating in health education of the patient (and family) when necessary.
• Identifying Sexually Gender Based Violence victims and referring them to the medical team so they can receive the necessary treatment. Knowing and is aware of the importance and appropriate use of the Post Exposure Prophylaxis (PEP) Kit
• Ensuring patients are properly received and installed and that those with lack of autonomy are assisted, especially regarding their feeding, personal hygiene, movements and comfort. For ER and OPD nurse, ensuring triage of patients in waiting areas, wards or during emergencies, detecting the priority acute/emergency cases, carrying out first aid care and referring them to the doctor when necessary
• Sending material to be sterilized and recuperates it from sterilization
• Carrying out admission, surveillance and follow-up of patients (i.e. assessment of the evolution of their state of health and the identification of any emergency situation or deterioration
• Carrying and supervising administrative procedures and documents (fill in patient’s files, forms, consumptions, statistics, registers, health files, etc.), ensuring an appropriate written/oral handover, and reporting any problematic situations and cases that may arise. Participating in data collection and keeping doctors/supervisors informed.
• Participating in the department-related pharmacy and medical equipment control and maintenance (quality and its functioning, storage conditions, follow-up of expired drugs inventories, stock takes of medicines and material at every team changeover ensuring no material is taken out of nursing area/wards without prior authorisation, etc.)
• Perform cleaning and minor maintenance for biomedical equipment used. Following the user manual and protocols and alert supervisor in case of malfunctioning.
• Supervising and training nurse-aids, nutritional assistants, cleaners and other related staff under his/her supervision, ensuring teamwork and adherence to all appropriate protocols and procedures

ADDITIONAL ACCOUNTABILITIES

The nursing roles in the PHC include triage/nursing room, labs, vaccination, NCD consultations and wound care.  There is a deliberate move away from having a nurse work in only one area and instead all nurses are expected to be trained and proficient in at least three of these roles, such that they can be rotated to do different activities during the working week and continue to maintain the necessary skills in a range of nursing activities. This has been done to allow increased job satisfaction and ensure there is sufficient cover for all nursing activities in the clinic during periods of leave.

Vaccination:

• Take vaccination history and evaluate the need for vaccinations according to the vaccination schedule as per MoPH EPI schedule
• Screen for contra-indications for vaccination and consult with MAM if needed
• Know, implement and promote the catch-up schedule of vaccinations for under-vaccinated patients
• Inform the patient/caregiver about side-effects of vaccination and next vaccination appointment
• Monitor vaccinated patients for side effects including anaphylaxis for a minimum 15 minutes following vaccination - if anaphylaxis occurs manage promptly and alert doctor accordingly
• Provide vaccinations to patients using high quality care and universal hygiene standards, bio-hazard prevention and infection control
• Manage and take responsibility (in liaison with the Pharmacy Supervisor and Nursing Team Supervisor) for the cold chain process according to the MSF protocols and procedures, communicating issues efficiently and effectively through relevant communication lines
• Report vaccination activities through the established channels for both internal data collection and the MoPH MERA reporting system
• Manage and take responsibility (in liaison with the Pharmacy Supervisor and Nursing Team Supervisor) for the vaccine stock, carrying out inventories stock takes and consumption reporting

NCD consultations:

• Consult patients agreed as suitable for NCD nurse consultation, assess condition of patient through history and appropriate examination, arrange labs if these are due and prescribe medications
• Review all medications being prescribed including adherence and ensure any medication taken by the patient from other sources is included in the prescription list and removed when the patient stops taking this (discuss with MD if any concern about the appropriateness of  any additional medication taken by the patient)
• Identify any significant deterioration, any unexplained/troublesome symptoms or emergency presentation and refer to MD or MAM as appropriate
• If uncertain how to manage a patient speak to MD or MAM and record details of advice given with initials of MD/MAM
• Follow MSF NCD guidelines including making prescribing decisions in accordance to these guidelines or other guidance applicable to the PHC as advised by MAM
• Demonstrate actions taken to optimize care for each patient including trying to reach BP and HbA1c targets each time the patient is seen
• Calculate eGFR according to the patient’s creatinine result and record this in the patient file
• Provide health education to patient and/or caregiver and identify need and refer to patient support and mental health when needed
• Document each consultation clearly in the patient file showing history and examination findings, decision making, reason for any medication changes and action plan for the patient
• Follow prescription guidelines on the correct way to write a prescription
• Make a written record of any telephone contact with the patient, any case discussion or relevant information received from other sources to ensure a complete record of the patient’s medical condition
• Perform annual diabetic check including foot check, eye check and check of injection sites according to trainings given, accurately record examination findings and take appropriate actions as needed
• Perform spirometry according to training given, accurately record findings and inform MD requesting spirometry test of result
• Participate in any other documentation needed for the patient and for data collection
• Participate in the tracking and follow up of patients who miss their appointment
• Participate in arranging transfer of patients agreed to be eligible for transfer to URDA, YMCA and other NGOs, ensuring the patient is fully informed about this process

Wound care:

• Refer to and implement the OCB MSF Wound Care Protocol (2018) for the management of all wounds
• Ensure patients with more complicated and chronic wounds are managed by nurses who have completed specific wound care training
• Follow the ‘Protocol for Wound Management in Shatila PHC’ for recording history of the wound, assessment of the wound, treatment given and follow up arrangements each time the patient is seen 
• Identify if deterioration or lack of improvement in the wound after a reasonable period of intervention, worsening pain or signs of systemic infection and refer to  Nursing Team Supervisor or MAM for further assessment to consider if any additional action is needed
• Perform wound dressing for patients using high quality care and universal hygiene standards, bio-hazard prevention and infection control
• Record pain assessment for each dressing and if scoring results suggests moderate to severe pain, provide  pain management before starting wound care procedure
• Educate patients and their caregivers about wound care and provide appropriate items when needed for the patient to do home dressing with a written record of all items issued
• Participate actively in the follow up of patients who miss their appointment
• Participate in any other documentation needed for the patient and for data collection
• Manage and take responsibility (in liaison with the wound care focal point nurse, Nursing Team Supervisor and Pharmacy Supervisor) for dressing stock, carrying out inventories, stock takes and consumption reporting

Triage and emergency care:

• Triage and manage all patients according to PHC triage criteria
• If patient is triaged in the “red” category, start prompt management according to OCA NCD guidelines and inform MD appropriately and Nursing Team Supervisor as needed
• Adhere to MSF Nursing guidelines for all nursing procedures
• For patients requiring emergency admission to hospital ensure emergency sheet and other documentation is filled in correctly and legibly and communicate with Nursing Team Supervisor to arrange transfer to hospital as needed
• If necessary accompany patient to hospital and provide a good handover of the patient
• Participate in any other documentation needed for the patient and for data collection 
• Manage and take responsibility (in liaison with the Nursing Team Supervisor) for nursing room stock, carrying out inventories, stock takes and consumption reporting

Laboratory:

• Prior to any lab procedure explain to patient what is about to happen and ensure they have consented to testing
• Ensure PHC SOP for Lab Pathway is followed
• Perform labs using universal hygiene standards, bio-hazard prevention, infection control and AEB protective measures
• Ensure all patient information and date on sample tube and labs form is correct and legible
• Promptly report all POC lab results to the requesting doctor
• Ensure samples are managed according to protocols including storage prior to transfer to external lab to avoid degradation and contamination
• Review lab results and ensure these are transcribed accurately and legibly in the patient file and then received by the MD
• Check list of labs done and identify and follow up any pending results
• Ensure any discrepancies or delays regarding lab results are reported to Nursing Team Supervisor
• Participate in any other documentation needed for the patient and for data collection
• Manage and take responsibility (in liaison with  Nursing Team Supervisor and Pharmacy Supervisor) for lab stock, carrying out inventories, stock takes and consumption reporting

Common responsibilities:

• Follow the IPC protocols of the PHC in relation to all activities
• In case of AEB ensure information is shared in time and reported to Nursing Team Supervisor and MAM to consider need for PEP
• Follow the protocols for use, care and maintenance of biomed items
• Participate fully in MSF trainings and any external trainings
• Actively engage in case discussions, significant event analyses and audits

REQUIREMENTS

Education : Essential - recognized nurse degree/diploma + MOH authorization to practice. Desirable Bachelor in Science of Nursing.

Desirable experience : A minimum of 2 years’ of previous experience and desirable previous experience in other NGO’s

IT skills: Essential computer literacy (word, excel)

Soft Skills: Results and Quality Orientation,  Teamwork and Cooperation,  Flexibility,  Commitment,  Stress management