about fear of participating in ACLS


Fear of ACLS

My blog post yesterday was prompted by a nurse who said she was afraid of doing ACLS. She felt fear. Ahhhh… I know this fear……. we all do.

I suppose more questioning is needed. We are dealing with the skills needed to prevent death in a patient who ought to live – if only we can save them. Is it fear? or anxiety? to what degree are they mixed? what is the past history that may have caused the person to dislike being in those situations? is it that somebody shouted at her when some step may have been done wrong? is it that she is afraid her mind will go blank? was it dealing with the emotions of family, or perhaps triggering her own feelings about a critically ill loved one?

Factors

I don’t have the plan to address each of these, I think it’s important for everyone to do their psychological work. Here in Nepal, there are some subtle but longstanding taboos about dealing with intimate body functions when the patient is of another caste, and people have been conditioned culturally to avoid at all costs. I do think this is a factor. Also, the family of a patient may be angry or emotional and this is a source of stress.

Scenario-based training

The basis of my course here is simulation. and scenario-based training. We use the scenarios of typical situations developed by the American Heart Association. (A.H.A.) A.H.A.  has been doing this in USA for decades, but though people periodically offer courses in Nepal, it is still new here. The beauty of simulated training is that it is okay to make a mistake in this setting. You can’t hurt the manikin, because it is not alive. we are talking about complicated things here and everyone needs to learn them somehow. it is better to learn them in a controlled environment where the people around you are relaxed, than to learn them on the job with no advance study or coaching. we will drill on the scenarios over and over until you feel comfortable. In a real-life situation, you will often feel like there is no time to ask questions. with scenario-based training we can debrief and start over again. we can eliminate the emotional component during the time you are learning.

Brain Cramp

there is a term that most Nepali nurses have not heard, but which all USA nurses know. it is called “Brain Cramp” - and it tells about when you are supposed to recall something but your mind goes completely blank. it is caused by adrenaline surge. Scenario-based training will help you to overcome this and use the wisdom of the group to function.

 

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May 19 about teamwork in critical care nursing


And here in Kathmandu we begin teaching this week

CCNEPal 2013′s first 3-day course will begin tomorrow. Most of our courses will be open to “the general public” of nurses – I promise that there will be a registration process that allows a nurse to enroll even if she is not currently working in critical care. In June and July we will have at least four such sessions of thirty each, meaning that 120 nurses will be given the opportunity.

I knew from the beginning that these would take time to organize, so I set up the sessions hosted by specific hospitals, first. This week we will be at Shahid Gangalal National Heart Centre (SGNHC) , and I am honored to work with them. I was there to see the facilities and to meet the nurses this week. So happy to see some of the people who took my course in 2011. SGHNC has a wonderful nursing staff. I was very impressed with the facility, the attitude and the care of patients that I observed.

The Team approach

I pre-mailed  them a free resource on ecg weeks ago, and they will have studied it before we get there. Because of the volume of patients with continuous heart monitoring there, they are likely to ask a higher level of questions. Sometimes I do more ecg teaching, but pre-study will allow us to move on to more exciting things. and – that means looking at team work skills.

the American Heart Association ACLS manual has a set of specific do’s and don’t related to teamwork.

they are:

use closed-loop communication – repeat orders back so as to avoid confusion

clear messages – no mumbling!

clear roles – somebody has to be in charge

know your personal limits practice things beforehand

share knowledge – and up-to-date data

use constructive intervention if a team member is uncertain about a skill. everyone watches each other and helps each other.

re-evaluate and summarize on a periodic basis ( two minutes)

exhibit mutual respect – no shouting, no sarcasm

Stating the obvious?

Some people may say, “of course I am a good team worker!” but are you really?

These may seem really obvious, but we go out of our way to teach these skills in USA, and we will bring that same goal to Nepal.  People can come to the course prepared with ecg knowledge and pharmacology, and if they do, we can spend more time working on teamwork skills. The best is to do some roleplay situations (“scenarios”) and discuss. as an added element, we will use smartphone video to guide the feedback we give. There are samples from 2011 on YouTube, and I will add some from this year (I hope).

Fear?

We will also deal with fear. Fear of appearing to be stupid, fear of failure, fear of being ridiculed, fear of making a mistake. The nice thing about simulation in ACLS is that nobody actually gets hurt. You learn from your mistakes.

fear.  hate-this-and-don’t-want-anything-to-do-with-it fear.

wanna-run-and-hide fear.

wanna-throw-up fear.

fear of body fluids ( some fears are valid…)

I-made-a-mistake-and-killed-somebody fear.

We know we are trying to teach you how to be at your best during the most difficult possible time you can have – trying to prevent the premature death of a fellow human being. Feeling the weight of the death you are trying to prevent..

Teamwork is the answer to fear.

Fear faced by respondents during an ACLS event  will be something to talk about during a future blog. and during the course.

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an ambitious goal for CCNEPal 2013


If you don’t dream dreams, then your dreams will never come true.

settling in

The first few days here are consumed with setting up camp in Kathmandu. grocery shopping, getting a Nepali phone number ( which happens to be 980 10 96822)  and starting to meet people in person. You can only do so much with email. ( oh and by the way, if you wanna call me from USA you add 011 977 to the number above). I love my location at Shalom Guest House.

The goal: train 500 people with our 3-day course. By comparison, I trained 190 in 2011. This time I have a team with me and will rely on assistance from people who took the training in 2011. So, it’s not as if I am doing it all myself. Amanda Giles, RN  from Edmonton Canada  is the other main videshi. She and I spent some time going over the teaching approach. We will “tag-team” just about all of the classroom portions – picking up where each other leaves off. This will be incredibly helpful as one person will not need to “perform” on stage the whole time.  I will do a future blog to highlight the main members of the teaching team.

Mega-code is a big part of this

Of course, the course is more than just lecture, and there are others who will help with the mega-code portion. when you are doing guided small group simulated scenarios, we want to minimize the passive time, so with more small-group megacode leaders each subgroup gets more hands-on time.

Simple math

To make the plan into reality, some ciphering is required. If each session is 30 participants, then we need 17 sessions. I now have eight confirmed sessions, but haven’t announced some of them because there are logistical issues remaining. There are six more in the pipeline – details not confirmed.  I have to lay it out in a calendar to visualize. We will be doing back-to-back-to-back sessions for some periods in June and July. we will also be making a “road trip” to the Terai.

Be patient for just a little while longer

we are still negotiating with a variety of host agencies for additional sessions. Within a week or so I will post the list of training sessions on this page and the FaceBook page and it will include the registration process.

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Kunming China is a jewel of the orient – a travel guide


Kunming China will now give Delhi and Bangkok some serious competition for gateway to East Asia.

Kathmandu Nepal has been on the must-see list of world cities for sixty years since it was opened to the west, and now that the civil war is over the country has been working hard to capture more of the tourist industry. Part of the allure is that it is twelve time zones away from New York – as far away as you can get without coming closer. It’s a landlocked country. For may years, there were travel restrictions in China so tourists were routed through Delhi.

 New Route and New Hub

That has changed. There is a new route to Nepal that is destined to gain in popularity for travellers seeking an off-the-beaten-path experience from the western USA who need to fly over the Pacific Ocean to get there.  The stars have aligned and it is easier than ever. In the last year, visa requirements have been eased and a shiny brand new state of the art airport has opened in Kunming China, destined to be a regional air travel hub.

China Eastern

China Eastern airlines has bought a spanking new fleet of Boeing aircraft and re-instituted direct flights to Shanghai from San Francisco and Los Angeles. From there, the simplified get-it-on-the-spot visa rules for domestic travel in China and the multi-billion dollar terminal in Kunming  just made travel in East Asia much less daunting. The changes are destined to open up southwest China, the “golden triangle” area of Burma, Thailand and Laos, Vietnam, Tibet, and Nepal. All of these are reached from Kunming.

Save six hundred dollars? yes, please.

I just got off the flights from USA to Kathmandu via Shanghai (Pudong) and Kunming. I chose the route because it was the least expensive one via online booking (Cheapo Air, if you must know) and the difference in price from the next lowest fares through Bangkok and India was six hundred dollars.

Life in Transit station during a layover is not pleasant, but – surprise!

As a budget-conscious traveler, I resigned myself to visions of a dingy Asian terminal with few amenities, and though the e-ticket said I didn’t need a visa for China in advance, I also resigned my self to staying in not one, but two transit stations. Any traveler who passes through a country just to make a route knows that these can kill your spirit. A transit station is a sort of cage designed to prevent people from entering the country illegally. The one in Delhi has now been completely redone but I once spent sixteen hours there in a white box of a room with three hundred other souls. It was like the never-ending office party from hell, with no amenities, not even TV or alcohol. Now, India needs transit stations I suppose – they have a bona fide history of past terror attacks at airports and there are always wandering vagabonds who want to live in an ashram somewhere – so the Indian government still requires that a tourist apply for a visa in advance. You can’t just go to India on a lark. With two layovers I wondered if China would be that way.

Pleasant surprise

Instead, China had an efficient get-it-on-the-spot visa system and the China leg counted as “domestic travel”  which worked out well even though I had a lot of baggage. The traveler has to collect bags at each landing and re-check them, but is given the run of the entire terminal or is free to exit altogether if the layover is long. These airports are on the far-flung outskirts of  the cities they serve, but in Kunming, China Eastern offers a free hotel stay for overnight layovers, (which I didn’t learn about until the next day.)

Watching the Chinese Travel style

I grew up in a time when China was referred to as “Red China,” with all attendant stereotypes. They were an adversary with Nuclear weapons! Today I saw many Chinese and they didn’t appear the least bit menacing.  Downright friendly, in fact. With their new wealth, the Chinese have taken to travel in a big way, and they embark from Shanghai in tour groups of three hundred, parading through the terminal following their guide who resolutely carries a pennant like the flagbearer leading a  regiment into battle. In Kunming the majority of fliers seemed to be families or business people, and the international tourists were few and far between.

I didn’t leave the terminal in Kunming. For a three-month stay in Kathmandu where I bring boxes of donated textbooks weighing a hundred kilos, the little trolley with the stack of bags served as my personal albatross. (I won’t have this problem on the way back home). The multibillion dollar facility is less than a year old, and from a distance the fabric roof (like Denver) glows like an illuminated golden pagoda. The ultramodern inside is just as shiny and clutterfree as  Bangkok, and well laid out to minimize lines.

Concessions

The food concessions in the terminal emphasized hearty local Yunnan cuisine, and seemed reasonable in price ($10 or so for middle-of-the-menu). It was obvious that few servers spoke English, but every menu showed pictures and an English-language description, and people were eager to help by summoning a coworker who could help.

The took visa but not mastercard, so I got steamed dumplings and beef and bean soup. It was excellent and the nearby seats were full of smiling happy locals. As a coffee addict, I found the Starbucks (I was told there are now six Starbucks shops in Kunming) and I paid the equivalent of three USD for a cup that would have cost $2.04 at home. The airport wifi was too confusing and I gave up trying to access it. I have AT & T which did not work, and the only way to get on required that I accept a text message from the internet service provider.

Oh well, Marco Polo wasn’t able to check his email in China either.

Lacking internet, I resorted to a slower but still-respectable ways of obtaining news, chatting with an expat Brit who was picking up a summer intern for the orphanage she runs for disabled children. Yunnan is among the poorest provinces in China, home to a colorful array of two dozen ethnic minorities, and it is obvious that the government is investing heavily in infrastructure and services, which is admirable. You have seen Yunnan Province, whether you know it or not. On Chinese Restaurants in the USA, there is always wall art that depicts the pagodas, mountain trails, waterfalls, jagged mountains, ethereal clouds.  It’s the home of the pandas as well as the opium trade from the “Golden Triangle” which is nearby.  The government is also working to shut that down.  I suppose an air terminal is not representative of everything, but I saw happy healthy people and a lot of pride in their home. They want the tourists to come here and they have a lot to offer.

Nappies?

This particular Brit was there to pick up one of her three summer interns. She explained that simply keeping the infants clean requires the staff to change about two hundred nappies a day. The interns will work hard, but they also get training on child care. They are not allowed to develop any individual favorite at the expense of any other child. We discussed the paradox of female children in China. There is a deficit of marriageable-age women here, but female babies are not wanted. Latest estimate is sixty million “missing females” – more than the population of the U.K. she told me. We read about this in USA but here they are living it.

I got up and made coffee and I survey the day. There is so much to do.

Kunming to Kathmandu

From Kunming it was a five hour flight on a brand new Boeing 737 which was two-thirds full. Because it seats about a hundred twenty, this also offered the possibility of a smaller wait line through Customs in Kathmandu. I’d brought an extra passport sized photo for this visa, and got the three months option for a hundred dollars.

Where to stay in Kathmandu

There are two districts in Kathmandu that accommodate foreigners in any quantity. Thamel is loaded with restaurants and bars. You can find Israeli backpackers and gap-year college kids mixed with the trekkers. Most of Nepal’s tourists come from India, and there is the occasional alpinist team that has just conquered a Himalayan Peak and wants to relax and party. For me it’s noisy and dirty. (the whole city is choked in dust until monsoon starts, so “dirty” is a relative term I suppose.)

The other area in Patan, where longer-term expats stay when they work for the UN or Non-Governmental Organizations. (NGOs). Patan is humming with life but not as frenetic as Thamel.

I stay at the Shalom Guest House, which has no address. They recently changed location, and I knew the old location but the manager wouldn’t give me directions. “It’s better if I meet you” he said. I gave the number to the taxi driver and he deposited me, boxes of books and all, on the sidewalk of the busiest street. the Locals were walking by and enjoying the sight. Yes, I am a fat westerner sitting on a pile of baggage wearing a Red Sox cap. (“moto 6,” they would mumble..)  Across the street the sign proclaimed “National Headquarters of the Tamang Unity Party” – displaying the red flag of communism. Now, the Maoist party’s flag  showed a hammer-and-sickle as we would recall from Soviet Russia and the cold war, but painted in white on this one was a crossed knife-and-fork with a cup.  If the flag symbolizes the party’s commitment to feeding the citizens, it’s a program we can all support. I will learn more and get back to you.

After a bit the manager came and we reloaded onto a taxi – this is 176 pounds of books we are talking about. And set off for the Guest House. the route twisted and turned – It’s located in a very picturesque maze of alleyways. There is a fire station less than a half-mile away and on past visits I would  always smile to see the 1940s era fire truck. It will never get down this street, the first tight corner will block it three intersections away. In some areas a thick bundle of phone wires droops down to head height as well. No matter. Every building is concrete and  there is not enough furniture to fuel a one-alarm blaze, let alone a big fire. Children use the approach alleyway as a soccer pitch, and though the taxi snuck in to unload my freight, most of the traffic here is motorbikes.

Other guests

There is a nurse from the Bay Area here, and the usual assortment of NGO volunteers. We’ll share a common kitchen and the common rec room. My room is simply but clean and I will pay about nine dollars a night.

Mexican night 

I signed onto the guest house wifi and read 60 emails. I will be joined this summer by Amanda Giles, an ICU nurse from Edmunton Alberta. it turns out that she and her husband finished the Everest base Camp Trek early and will arrive Wednesday (today) – hooray!

The day ended as I joined another guest for dinner at The Happy Gringo,  a Mexican restaurant nearby where I ate for four dollars. On the way back I bought eggs, coffee and bread. And collapsed on the bed. I have reset my clocks and I am getting ready to do the things I came here to do.

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ACLS tip of the day on Twitter in Nepal 2013


Social Media has taken Nepal by storm

executive summary: go to @CCNEPal2013 and follow to get the ACLS tweet of the day.

In 2011 when I was planning my trip to Nepal I set up a FaceBook page in advance to advertise my educational sessions and got about 1,500 “likes” for that page. It was not by accident – I spent about $25 US Dollars to run a FaceBook ad to attract followers. The cost worked out to about ten cents a hit, which is very very inexpensive compared to what it would have cost in USA.

Nobody there uses email. Oh, they all get an email address because they have to have one in order to sign up for FaceBook, but the majority of young people never check theirs. FaceBook, it turns out, has features that fit Nepal really well. A large number  of people go to Cyber Café to access a computer, and FB is what they use.

Since 2011 there are people in Nepal who have set up FB pages for Nepali nurses, some of these have as many as 7,000 followers already. This is new and I hope to tap in to this. Nurses are getting organized!

Smartphones

I was told that during the civil war the government limited the availability of smartphones. Nowadays every one has one. They use them in imaginative ways -texting and taking photos and video like college students in USA. It is easy to have Twitter on a  smartphone.

When we do mega-code drills this summer, I will encourage students to video the mega-code drills of their team, to use for critique. Like we did last time.

Twitter

Contrary to what you may think, I am not a person who jumps on the next tech bandwagon the minute it starts to roll. But I am finally trying to figure out the value of Twitter and to put it to use. At first, I didn’t get it. Still not sure I do.  It seems as though it can help your message go viral faster than anything else out there. So I will use it to announce new blog entries and new events while in Nepal.

But there has to be something more, is what I keep telling myself….

ACLS Tweet of the Day

I do not presently know how many Nepal nurses are on twitter and I need a strategy to encourage people to sign up.  Sending a message that just says “follow me” is not enough to get people to do it. The best way is to show them something practical that will apply to their lives.  Given the 140-character limit, I decided to start a “tweet of the day” and of course, since the CCNEPal2013 project is about nursing critical care, each tweet will be a factoid or Pearl of Wisdom that Critical Care Nurses need to know. (I am a fountain of knowledge when it comes to these.)  I will tailor the daily tweet to the ACLS beginners.

Go to @CCNEPal2013 to look at the first samples. And if you know anybody who might like these, send them along!

 

PS - after you see some samples that show the level of information I am looking for, I invite you to tweet me some of your own….. and I will retweet.

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CCNEPal2013 twitter feed invitation – follow us there


This blog entry will be brief.

CCNEPal2013 now has a twitter account. the address is

@CCNEPal2013

these are no good unless you use them to provide useful information. So, I have started a daily Advanced Cardiac Life Support tweet. If you subscribe, it’s a quick way to remind yourself of some useful bit of info that will help you be a better nurse.

******

ANNOUNCING A TWITTER CONTEST FOR NEPALI NURSES

this goes out to everyone on the CCNEPal 2013 list.

follow @Nepal2013 and win!

I want to promote my new twitter account and I will give two prizes. The first one will be to a follower selected at random. The prize will be a nursing textbook from USA in adult medical-surgical nursing.

the second prize will also be a textbook, and it will given to the person who signs up the largest number of other persons to the twitter feed.

to enter the contest is simple. 1) get a twitter account 2) find @CCNEPal2013 3) follow it.

I will announce the winner Around July 1st, and post photos of them receiving their prize, on the CCNEPal 2013 FB page.

They do have twitter in Nepal, and after some consideration, I think it has some use. Life in Kathmandu is full of twists and turns – local bandhs, problems in transportation, to name a few. Maybe twitter can be a supplement to text messaging.

So – it will be there. For the supporters of this project who are not in Nepal, it’s okay if you don’t subscribe to this – I expect it will have mostly local stuff on it. I know for certain that I will still use the blog and the FB fan page.

The Certificate

I also decided to get this year’s certificate printed in bulk here in Honolulu, strangely enough it was cheaper than waiting til I was in Kathmandu, one of the few things that is not more expensive (even with shipping). If you have read the blog in the past, you can read my thoughts about credentials.

any way, here it is:

four colors on nice card stock. space for two signatures and a handsome color logo. ramro la

four colors on nice card stock. space for two signatures and a handsome color logo. ramro la

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Nursing Education system in Nepal as of April 2013


Note: I will publish this even while in draft stage, in hopes that persons can help me cloudsource the information contained here. For a lot of this I do not have exhaustive research, but I admit I am giving my impression of how the system works. I will accept all feedback and clarification. Also, be sure to click on the hypertext – the underlined or differently-colored text, which provides more detail.

What are the titles given to “nurses” in Nepal?

A.N.M. - Associate Nurse Midwife. analogous to a Licensed Practical Nurse (LPN) in USA. this was a one-year program for nurses, (help me: is it one or is it two?) and there are fewer of these programs than there used to be, which is why most A.N.M.s seem to be “older.”

PCLProficiency Certificate Level – the basic preparation. This is a 3-year program, usually sponsored by a hospital. The curriculum for PCL level nursing is thoroughly regulated and centralized by C.T.E.V.T. – the government agency that controls vocational education.  Historically, CTEVT serves a useful function in standardizing nursing education. Also, CTEVT schools adopted a policy to support enrollment of minority students into PCL level, essentially a quota system. At the CTEVT site is a database of all CTEVT schools including address and contact information.

The language of instruction in many schools is English. the texts are generally from India or U.K.

There is a different agency that coordinates college-based education.

To get admitted to PCL nursing, a young woman needs the School Leaving Certificate – also known as “SLC” – given around age 16. the SLC exams are a big source of anxiety, because the results dictate your future. There is also such a thing as “SLC +2″ – which is essentially the equivalent of a high school diploma. the +2 component adds some science and math classes.

A student  can get admitted to PCL nursing at age 16, and graduate at age 19. Every nurse with PCL is also automatically a qualified midwife and usually has delivered 10 or so babies. The curriculum includes community health classes.

Most often, PCL students live in a hostel provided by the school. On the CTEVT site, one school listed the typical tuition as about 224,000 Nepal Rupees (nrs). at the current exchange rate of 87.2 rupees to the US Dollar, that is  $2,563.03 which may not seem like much to an American, but which is substantial for a Nepali.

The PCL student gets a lot of clinical practice, and in fact, is used as a cheap source of labor by the hospitals. Hospitals in Nepal tend to follow a “functional nursing” pattern, and this is what is taught at PCL level. The functional system is the most successful when the charge nurse  – the “didi” – is effective. The didi is the one person on the nursing staff who knows the whole picture of the patient; other staff mainly function in the role of task workers.

faculty at PCL level are often around 20 years of age – it is not unusual for a faculty to be a recent graduate of the same school where she now teaches. Such a person often relies on perpetuating the same system that was learned and has no further training in teaching pedagogy. The assessment skills are not necessarily any more sophisticated than those of the students. Usually the “Principal Ma’am” is older and more experienced in administration.

B.N. - after two years of clinical practice, the PCL nurse is eligible to enroll in a B.N. class, and this also involves clinical practice along with coursework in research and community health and teaching projects. The B.N. curriculum is two years in length. So in other words, a BN nurse has three years of education, two years of practice, and two years of additional school (seven years!)

For those thinking of going to USA? might as well answer this one right here. If you are thinking of coming to USA to work as a nurse, you will need to complete many many  steps. If you only have SLC and PCL, it is very unlikely that you will get a USA license. The minimum is SLC+2 and PCL; but it is much better to get BN or B SC.  I will do another blog on this topic somewhere else.

B. Sc. - This is new in Nepal. In the past five years there are more programs in which a woman who has SLC+2 can go to a college course for nursing. This trend mirrors the trend in international nursing education. At present, there is considerable controversy within Nepal about the B. Sc. nurses. the problem seems to be that they are viewed as not having enough clinical experience; some people think that the real problem is that the B Sc nurse is more likely to question the doctors and be assertive, which presents a challenge to the patriarchical system of medicine in Nepal. In general, the schools do not have well -equipped libraries or learning labs with manikins and simulated learning the way USA schools do.

Trends: One interesting trend which is still developing is that of young Nepalese citizens who go abroad for further study and get a basic nursing education with a BSN in UK, USA, Aus or India then return to Nepal. To re-adjust to the Nepali system of clinical practice after only working in a USA hospital is not an easy feat.  Likewise, with the growing number of Nepalese nurses practicing abroad due to poor economic outlook of Nepal, there is a question of how these nurses would change Nepal if they ever returned in large numbers when the economy improves.

Future of PCL education is something that is under discussion. There are rumors that all nursing education will be re-designed into some other system but I do not have firm information about this.

M.N., M. Sc, and PhD in Nepal – I will save discussion of this because I do not know enough about trends in this level. I don’t pretend that I am expert on basic nursing for that matter – if you think I have missed something, then help me!

In any case, there are a number of nurses in Nepal who have obtained graduate degrees outside the country, usually in other Asian countries such as Japan, Thailand or the Philippines. Some go to Europe or Australia.

Nurse manpower - It is a paradox in Nepal that many of the nurses use their education to leave the country and seek employment in Australia, India or the U.K. or use it to bolster their chances of getting a more desirable husband via the system of arranged marriage in Nepal. The health sector in the country is heavily dependent on foreign charitable support.

Nursing Associations

- there is a government body known as the Nepali Nursing Council - NNC – which serves as the governing body. This group oversees the system of licensure. At this time, they are implementing a mandatory license exam for new graduate nurses. This is given twice a year. The NNC site provides data as to the number of nurses in Nepal:

  • Current Registration Status Up to  31 January, 2013

  • NURSES  : 19098
  •  ANM : 19851

  •  FOREIGN NURSES : 739

  • TOTAL : 39688

Nursing Association of Nepal

the Nursing Association of Nepal (NAN) is a separate membership group composed of nurses, which is the country’s official member of the International Council of Nurses.

New Nursing Schools and New Hospitals

There has been a recent surge in applications to create new nursing schools, just as there has been a surge in new hospital construction.  In the opinion of this writer, this presents a challenge to the health establishment of Nepal – balancing the need for the student to expect a quality education with the need of the hospitals to exploit inexpensive labor sources.

Issues, Opportunities and Challenges

This is the subject for ten future blogs. Nepal is a country of 26 million people and the government is evolving after years of instability.

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