ANMJ Featured Story

Pacific Power: Nursing partnerships across the blue continent

Thursday 23rd February, 2017

Since it was first formed 35 years ago, the South Pacific Nurses Forum has been working to improve cross-cultural understanding and regional cooperation in nursing. Despite overwhelming health challenges in the Pacific, nurses and midwives are banding together to strive for universal access to quality healthcare, writes Karen Keast.

Often referred to as the blue continent, the South Pacific is home to thousands of islands scattered from Papua New Guinea, Australia and New Zealand all the way to South America.

It’s a region home to nations including New Caledonia, Vanuatu, the Solomon Islands, Nauru, Wallis and Futuna, Fiji, Tonga, Niue, Samoa, Tuvalu, Tokelau, the Cook Islands and Tahiti.

The South Pacific is as culturally and economically diverse as it is vast. Many nations in the Pacific have their own languages and cultures, developed over centuries, and face a wide range of challenges that affect the health of their communities.

Despite their differences, South Pacific nurses and midwives share a common bond - a determination to improve the health outcomes of their nation’s peoples.

South Pacific Nurses Forum

Every two years, hundreds of nurses, midwives and health leaders from across the South Pacific gather to discuss and debate the issues at the heart of nursing and midwifery’s contribution to the region’s healthcare.

The South Pacific Nurses Forum (SPNF) first began in 1982. Last year, the 18th forum was held from October 31 to November 4 in Honiara, in the Solomon Islands. More than 300 delegates attended from 10 Pacific nations, including Australia, the Cook Islands, Fiji, Kiribati, PNG, New Zealand, Samoa, Tonga, the Solomon Islands and Vanuatu.

Featuring the theme Towards Nursing Excellence for Universal (Pacific) Health, the forum showcased presentations which brought together the latest evidence, experience and innovations in nursing throughout the South Pacific.

But the SPNF is much more than a biennial conference event - it’s a collective of nursing and midwifery leaders working to advance the development of nurses and midwives, and the professions internationally.

The forum promotes closer links between nurses and midwives throughout the South Pacific, forging friendships and partnerships between nurses and midwives in a bid to foster cooperation and activities - designed to problem solve, strengthen the professions, and improve public health services.

As a conference, the SPNF is a colourful showcase of local culture, from cultural dress and prayers to ceremonial singing and dancing. It brings together a range of dignitaries, such as Solomons Prime Minister Manasseh Sogavare, who officially opened the 2016 forum.

And it features some of the world’s pre-eminent nursing leaders, including International Council of Nurses president Dr Judith Shamian, and representatives of the region’s National Nursing Associations (NNAs), including the Australian Nursing and Midwifery Federation (ANMF), which has been elected Secretariat of the SPNF.

ANMF Assistant Federal Secretary Annie Butler says the forum provides a vital voice to nurses and midwives throughout the South Pacific, enabling nurses and midwives to work together to address the issues impacting the health of their local communities.

“We’re working to achieve better health and universal health for all of the communities in the South Pacific,” Ms Butler says.

“It’s very difficult for these smaller island nations to be able to make the changes that they need but as a group we can collectively work for implementing change that will actually allow nurses and midwives to bring about the differences they need to, for the health of their communities.”

Health challenges

Many nations in the South Pacific face a barrage of health challenges, from nursing and midwifery workforce shortages to limited resources and often a double burden of communicable diseases and noncommunicable diseases (NCDs).

They also face incredible geographical hurdles. Pacific nurses and midwives work to provide care to an estimated 10 million people spread over thousands of islands, many of which are hindered by unreliable access to internet and irregular transport links.

The Solomon Islands alone features 900 islands and a fast growing population of more than 600,000 people. Eighty per cent of the population lives in rural and remote areas. To access a hospital, many residents must travel via boat but the distance between the islands often hampers timely access to care.

More than 1000 kilometres away on the smallest state in the Pacific, the oval-shaped island of Nauru, 10,000 residents live in a 21 square kilometre area with one hospital. Once known for having one of the highest rates of obesity in the world, Nauru has been battling escalating rates of type 2 diabetes as a result of poor nutrition, alcohol consumption, smoking and physical inactivity.

Adding to the mounting health challenges, many South Pacific nations are suffering from the effects of poverty, fragile environments, water and sanitation problems. Climate change is also taking a toll. Pacific island countries are known to be among the most vulnerable in the world to climate change - and it’s feared some of these nations may completely disappear under water.

A 2015 report from the World Health Organization (WHO) revealed climate change is threatening the health of Pacific Islanders, as well as impacting on their economic and social development. Extreme weather events, such as cyclones, floods and droughts, are not only displacing communities but causing injuries and psychological trauma. 

‘Hotter and wetter climates are increasing the risks for vector-borne disease. Disasters related to climate change are disrupting the delivery of healthcare services and are increasing the risks of disease and death among vulnerable groups, especially young children, women of reproductive age, older people and people with disabilities,’ Dr Shin Young-soo, WHO Regional Director for the Western Pacific, writes in the Human health and climate change in Pacific island countries report.

“Climate change is a defining challenge of our time and could prove to be the most significant human health threat of the 21st century. For future generations in high-risk locations in the Pacific, climate change presents a risk to their survival. We must
act now.”

Nursing advancement in Tonga

Jill White AM, Professor of Nursing and Midwifery at the University of Sydney, says Australia has an absolute responsibility to assist our closest neighbours - one of the most overlooked regions in the world.

“I think some of that is because of the way maps are drawn with most maps that put America and Europe front and centre. The Pacific tends to fall off the edge of the map and I think it falls out of people’s minds as well,” she says.

“But also in terms of natural disasters, in terms of effects of trade agreements, in terms of effects of climate change, they are absolutely battered by both natural and man-made disasters and I think we have a real responsibility in that.”

Professor White, who gave three presentations at the SPNF, has not only been instrumental in nursing education, policy and regulation nationally, her work has impacted beyond Australian shores. Professor White founded the South Pacific Chief Nursing and Midwifery Officers Alliance (SPCNMOA) on the back of a series of conferences with Chief Nurses from the Pacific.

Professor White has also worked with the Polynesian Kingdom of Tonga, which spans 169, mostly uninhabited, islands on a range of initiatives, including the development of a novel NCD curriculum for nurses.

The NCD curriculum produced the nation’s first 20 nurses with Advanced Nursing Diplomas in the prevention, detection and management of NCDs in 2013.

“Tonga had the highest obesity statistics in the world but, with the NCD program, every community has an NCDs nurse and they are absolutely making a difference to obesity, diabetes and cardiovascular disease and a lot of that really has been nurse-led,” she says.

Professor White and Professor Mary Chiarella recently collaborated with Tonga Chief Nurse and immediate past Chair of the Alliance, Dr Amelia Afuha’amango Tuipulotu, to review the nation’s nursing and midwifery regulation.

The work focused on reviewing, evaluating and assessing the Nurses Act 2001, and identifying any gaps or amendments before embarking on consultation meetings with key stakeholders.

The end result is a comprehensive Nurses Act that describes the criteria for registration, the standards for professional practice, notifications and complaints, and the accreditation of education programs and providers.

While Australia is home to an established and well-resourced health system, Professor White says we can learn a lot from nurses in the Pacific, particularly when it comes to primary healthcare.

“Primary healthcare is the basis of the health systems in all Pacific countries and I wish that it were here as well. It does make you realise that we’re a bit too hospital focused - we’re too much about the ambulance at the bottom of the cliff rather than building the fence at the top.”

Chief Nurses and Midwives Alliance

Alongside the forum, the chief nursing and midwifery leaders joined senior leaders in regulation and education from across the region for the seventh South Pacific Chief Nursing and Midwifery Officers Alliance. The Alliance, which runs in conjunction with the SPNF, has been meeting since it was founded in 2004.

With the support of and in partnership with WHO Western Pacific Regional Office, the Alliance aims to bolster nursing and midwifery to improve population health in the Pacific. Commonwealth Chief Nursing and Midwifery Officer Adjunct Professor Debra Thoms, who attended the Alliance meeting, says both the SPNF and the Alliance are crucial to improving the health of the region.

“It is that opportunity to bring together nations from across the Pacific to look at shared issues, to share learnings, also to share successes, and that there are some very specific challenges for that part of the region,” she says.

“We know that many of the countries are still building their systems, there is also the impact of climate change for some of them, and I think countries like Australia and New Zealand have things that we can offer but also things that we can learn.”

At the recent meeting, Alliance leaders made a raft of recommendations, prioritised to address the Pacific health challenges - charting a new direction until the Alliance meets in the Cook Islands in 2018.

Recommendations included reviewing each nation’s legislations and regulations impacting on nursing and midwifery services, and exploring regulatory mechanisms to enable registered nurses, midwives and educators to gain clinical experience through country to country agreements.

The Alliance also prioritised a recommendation to work with the SPNF to establish two working groups to explore opportunities to not only align regional regulatory frameworks but for postgraduate education requirements to be developed in line with health workforce needs.

WHO support

Michele Rumsey is director of the WHO Collaborating Centre for Nursing, Midwifery and Health Development at the University of Technology Sydney. The centre has contributed to more than 50 projects in 25 countries working towards universal health coverage, and has also been the Secretariat of the Alliance since 2008, supporting member countries and coordinating actions in a bid to strengthen nursing and midwifery throughout the region.

Since 2009, the Collaborating Centre has led an Australia Awards Fellowship leadership study program, funded by the Australian Government, which has assisted more than 100 nurses and midwives from Pacific nations to build their leadership skills while developing, implementing and strengthening projects for their own health systems.

“The program is a mentorship model so although the participants run a project, they are actually coordinated by their Chief Nursing and Midwifery Officer. Years later we can see nine of those fellows hold very senior positions now within the Pacific,” Michele, a registered nurse, says.

“The program has been very much a leadership program but it’s also been about succession planning for the Ministries, to enable them to have colleagues who can continue the good work.

“One of the reasons this is really important is that for many of the Pacific islands, people have to retire at 55 - so you just get to a point of knowledge, expertise and ministerial credibility, and then you have to retire. It’s really important that there’s some succession planning.”

Also involved in research, the Collaborating Centre recently worked on a project examining how climate change is impacting on Australia’s capacity to respond to disasters in the Pacific, and provide humanitarian assistance such as nutrition, sanitation and healthcare.

Among its findings and recommendations, the research showed an urgent need for specific training and capacity building, particularly for nurses as the first responders.

Creating perioperative standards

When Sally Sutherland-Fraser and Menna Davies launched their Sydney nursing consultancy, Health Education and Learning Partnerships, four years ago, they never imagined their business venture would enable them to work with their nursing colleagues in the Pacific.

For the past 18 months, the experienced perioperative nurses have worked with Fiji-based, and Australian Government funded, organisation Strengthening Specialised Clinical Services in the Pacific (SSCSiP) to develop a practice bundle of infection prevention standards in perioperative nursing.

With support from the Australian College of Perioperative Nurses (ACORN), Sally and Menna used ACORN’s latest standards for perioperative nursing as a basis for developing standards for 14 Pacific nations - Fiji, Solomon Islands, Vanuatu, Federated States of Micronesia, Kiribati, Marshall Islands, Nauru, Palau, Cook Islands, Niue, Samoa, Tokelau, Tonga and Tuvalu.

In collaboration with nursing colleagues spanning the nations, Sally and Menna developed the Pacific Perioperative Practice Bundle (PPPB) featuring six standards, practice audit tools and practice audit instructions - specifically designed to suit the operating theatre practice environments of the different Pacific nations.

The standards cover hand hygiene, perioperative attire, aseptic technique, protective apparel, scrubbing, gowning and gloving, along with skin preparationand draping.

While ACORN has more than 20 standards for perioperative nurses, Sally says it was important to target the standards that would have the biggest impact, in the shortest amount of time, to improve the health of patients.

“We believe if you can improve compliance with those practices then you will get a difference in the outcomes of the patients because these standards are designed to minimise infection risk,” she says.

“Equally because the standards are also about protecting the staff, you can improve staff outcomes by reducing occupational exposure.”

Sally joined SSCSiP project coordinator Mabel Hazelman Taoi to co-present on the PPPB project at the SPNF.

Mabel says having Sally and Menna’s support has been a stroke of good luck for the Pacific.

“Not only are they very experienced perioperative nurses but they also understood the Pacific context as they have worked in several Pacific Island countries,” she says.

Sally and Menna are now working with SSCSiP through key elements of the standards and strategies for implementation.

Despite a few obstacles, Sally says the standards are now being audited in the Solomon Islands, Fiji and Samoa, and she hopes that the practice audits will be underway right across the nations within the coming year.

Nurses in the Pacific regularly demonstrate “awe-inspiring” resilience and resourcefulness, Sally says.

“In some nations, they may not have sterile gowns some days, they may not have water coming out of their taps, they can have really unexpected injuries, for example shark bite injuries, and they very often have to work in a situation where they have no protective equipment, such as eye shields.

“Within those conditions they do a mighty job - they adapt and they provide the safest care they can.”

A voice on the world stage

As a leading light for New Zealand’s Indigenous nurses, Kerri Nuku says a collaborative working relationship, with member states and NNAs across the South Pacific, is key to elevating the voice of regional and Indigenous nurses to the global decision-making table.

The Kaiwhakahaere of the New Zealand Nurses Organisation (NZNO), who has worked as a nurse and midwife, manager and nursing advocate for more than 30 years, is standing for election to the board of the International Council of Nurses this year, the highest authority in nursing, in a bid to take the issues facing Pacific nurses to the world.

While health is a fundamental right of every human, Ms Nuku says nurses across the Pacific are bracing for a major health crisis, with a nursing workforce shortage and a rapid rise in NCDs compounded by the impact of climate change, natural disasters and underlying poverty.

Ms Nuku, who presented on the challenges facing Indigenous nurses at the SPNF, says there is a lack of Indigenous autonomy or ‘mana motuhake’ - “to have our own power, to make our own decisions, for our own people”.

She says it’s crucial to build and support a resilient Indigenous workforce to ensure nurses are able to respond to the changing health needs of Indigenous populations.

“Particularly here in New Zealand, our Indigenous workforce is 7% of total workforce population, it has been since the 1990s, and we need to respond to an ageing Maori or Indigenous workforce with complex co-morbidity. We need to be able to respond to, retain and recruit Indigenous nurses into the workforce.”

Learning in the Pacific

With her mum and her sister working as nurses in critical care, it’s little surprise Lucy Osborn, with a name similar to Nightingale-trained Australian nursing pioneer Lucy Osburn, wanted to follow in their nursing footsteps.

The 22-year-old from Adelaide is also determined to carve out her own niche in the profession, particularly after a two week study tour in the Cook Islands, jointly funded by the Australian Government New Colombo Plan and the University of South Australia, opened her eyes to the possibilities of nursing in the South Pacific.

Lucy was one of 10 University of South Australia third year nursing students selected to travel to the island paradise as part of a novel primary healthcare nursing placement in April 2016. The group of students worked with Rarotongan health professionals and Cook Island nursing students to screen more than 2000 school children for rheumatic heart disease, while recording and collating data for the nation’s Ministry of Health. They also worked with public health nurses as they completed postnatal visits, home care and wound management.

Lucy says it was a unique experience that enabled the students to develop their clinical and personal skills, knowledge and practice while gaining an international perspective of nursing.

And that was just the beginning. The experience propelled Lucy on to the region’s nursing stage, where she became the first student to speak at the SPNF in its 34-year history.

Lucy, who recently began work at the Queen Elizabeth Hospital in Adelaide, for her graduate year, has now been selected to participate in the Australian College of Nursing’s 2017 Emerging Nurse Leader program. While Lucy’s SPNF presentation has generated interest in expanding the study tour initiative to other nations in the South Pacific, her adventure has also prompted her to encourage other nursing students and early career nurses to embrace the nursing opportunities on offer among Australia’s nearest neighbours.

“International health is something that needs to be considered - to be more connected with our South Pacific neighbours, to learn from each other and to help each other provide the best standard of care we can.”

Working in partnership

At the end of the forum, NNA nurse leaders called on Pacific governments, health funders, policy planners, health educators, economists and Chief Nursing Officers to invest in nursing.

Among the range of initiatives, the forum leaders called for entry to practice programs for new nurses, policies for tackling the causes of climate change, exchange of nurses and students for clinical placements, education, training and professional development for all nurses, and an investment in information technology and internet connectivity to support nurse education and care delivery.

With the Cook Islands set to host the next SPNF in 2018, Ms Butler says the ANMF will continue to work with forum members and participate on the steering committee to advance nursing and midwifery in the Pacific.

“We’ve really started a listening and a communication process. We are going to work on the resolutions and the key issues, and we understand that this is going to take time,” she says.

“It’s important for nurses and midwives everywhere - in Australia, our region and in the world to take the lead on issues we know are critically important to the health of our communities.

“It really is time we supported the nurses and midwives working right beside us.”

* For more information on the SPNF visit

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