Feb 20th, 2015 Read this if you are thinking of working or living in Australia


Feb 21st 2015 UPDATE: This blog entry got about a thousand hits in the first day, including hundreds from Australia. The nurses of Nepal are very interested in keeping open the possibility of going abroad for further study, or for work, and also to be able to send remittance home while seeing the world. In Australia, it seems the government  is dragging on licensure of Nepali nurses, due to inadequate documents. NOT the nurse’s documents – but the ones from T.U. Institute of Health Professions. In the coming days I will blog again about what to do – but for now, please share this widely and become informed on the issues.

Please share.

Here is the beginning of a book review of my novel of Nepal.

द साक्रामेन्ट अफ गोड्डेस्,,अथवा नेपाली मा भन्नु पर्दा देबी को प्रसाद,,एउटा यस्तो नोवेल जसमा माया,जिबन्,त्याग्,आत्मियता जस्ता आध्यात्मिक कुरहरु को मिठो बयान गरिएको छ, यसका लेखक जो निम्जुरा एउटा अमेरिकि नागरिक र पेसामा उनि नेपाल र अमेरिका दुबैमा राजइस्टर्ड नर्स हुन्,,बिगत ७ बर्ष देखी उनि नेपालमा स्वास्थ्य को क्षेत्रमा उल्लेख्हनिय काम गर्दै आइरहेका छन्,.यो किताब उन्कै मिहिनेत को फल हो,,यसमा नेपालमा दस बर्स सम्म चलेको जनयुद्द को बेलाको.. एउटा अमेरिकन सर्जन र नेपाल को बेनी भन्ने ठाउँमा बस्ने साधाराण नेपाली केटी बिचको प्रेम सम्ब्न्ध को बारेमा बयान गरिएको छ,,,,,, एउटा यस्तो पबित्र प्रेम सम्ब्न्ध  To continue reading the review, click here. You can buy this book at Vajra Books on Jyatha in Thamel, or at Tibet Books on Tri Devi Marg.

Oz?   If you have a BN degree, this applies to you

Here is breaking news about Nepali nurses going to Australia and seeking to work as a nurse there. Since February 2014, the rules of Australia have changed and there is now more scrutiny of educational transcript than there formerly was. Several nurses I know have told me that their BN degree is being questioned and this has caused delay in accepting them for licensure in Australia.

The individual nurse’s transcript is not the issue. The overall curriculum is the issue.

I did some research and here is what I was told.

The curriculum for BN degree by TU IOM is described in a detailed book, the one with the green cover, published in 2013.

Every BN program that gives a TU degree, is required to use this curriculum, and IOM takes care to achieve consistency among all the programs it oversees.

Every BN program that gives a TU degree, is required to use this curriculum, and IOM takes care to achieve consistency among all the programs it oversees.

The problem is, at each section, there is a list of books used by the nursing programs in support of the curriculum. Here is a photo of such a list at end-of-chapter.

Can you see the problem here? We are in 2015, and some of the references used are from 1991, which was 24 years ago. If it's true, the textbook is older than the student in most cases!

Can you see the problem here? We are in 2015, and some of the references used are from 1991, which was 24 years ago. The oldest is 1983, thirtytwo years ago. If it’s true, the textbook is older than the student in most cases!

The authorities in Australia say that “a nurse who studies from such old books is not up-to-date enough to be a nurse in Australia.” They won’t grant permission to work as a nurse!

Ouch!

Now, I checked with a librarian friend, who told me that in the library where they work, the editions of the textbooks in use, are newer than the ones listed in the TU IOM curriculum book from 2013, and the actual problem is not so severe. BUT – the nurses who are now in Australia are still having the problem. This issue has been reported to TU, I am told, but I don’t know what the response is, or what the solution would be.  Can we agree that something needs to be done for the future?

The land of the Beautiful Certificate

In Nepal, every one emphasizes the need for a certificate, and no matter what the topic is, it needs to be legitimate, signed by the appropriate authorities, and with a seal or stamp. TU IOM is normally the guardian of such qualifications, but here we have a problem. If this book is not accurate, then every certificate from it, such as a BN degree, can be questioned as to legitimacy. If the authorities in Australia want to question the curriculum, they can also question every single school of nursing to see if they actually own the books listed in the curriculum, and ask for the proof that the school has them in the library, and what edition they are.

Also, if Australia is doing this for the nursing curriculum, it is just a matter of time before they start looking at the MBBS curriculum, and the MBBS library and textbooks. We all need to know whether the nursing or medical education will be up to a standard acceptable abroad. This affects everybody.

What if Australia looked on the actual shelves of every nursing school and medical school library? Would they find the books on the list from the approved curriculum?  They might ask each individual school for some kind of documentation.

Finally, I don’t blame TU IOM.  In the newspapers we all read about the government approving new nursing schools and new medical schools without giving IOM  adequate resources. They do it despite objections from IOM. Each new school needs a library and current books. IOM needs to have a system to make sure the books in the curriculum are the ones the students are using. We should not have new schools  until the ones we have are given adequate books!

If you are reading this

get a copy of the green curriculum book, and take it to your school library. Go through and see which ones your library has and what it needs.  Make sure your school has the books they are supposed to have, and they are up to date books.

And If I am wrong?

That is always my first question to myself……I will be the first to admit, I don’t have all the information!  If there is somebody who knows more about this than me, please write and I will update with corrections when I get them. If you have an idea as to advice for the nurses who now are having the problem, send that here as well. Please share this with everyone. It may be that we need to apply political pressure to make the solution come faster than it would otherwise. We all have a stake in doing the best we can!

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Equipment List to Teach BLS and ACLS in Nepal and any place


I keep my equipment at the Guest House and I go through it before I leave, whether it's teaching across town in Kathmandu, or across the country. It's portable and compact!

I keep my equipment at the Guest House and I go through it before I leave, whether it’s teaching across town in Kathmandu, or across the country. It’s portable and compact!

Improvising Equipment

CCNEPal teaches BLS and ACLS since 2011 in Nepal, and we travel around the country. One time we planned to travel to Biratnagar and the local contact person asked: “How many CPR manikins do you bring?”

My answer was, “Seven.”

“How do you get them on the bus?”

“Easy, they all fit into one suitcase along with every thing else.”

Anyway, the key about teaching ACLS is the knowledge and attitude imparted in the class, not the use of the fancy toys. Toys are nice to have, but don’t let your lack of them prevent you from discussing how to improve critical care response!

The List

Here is what goes in the suitcase, in no particular order.

Another view of all the stuff, laid out so I won't forget something. note the "CPR manikins" deflated in upper left corner  :-)

Another view of all the stuff, laid out so I won’t forget something. note the “CPR manikins” deflated in upper left corner :-)

1) eight rubber balls, the kind that schoolkids use on the playground. These are used instead of a CPR manikin. When I first came to Nepal, I noticed that every school of nursing owned one CPR manikin. If they taught a CPR class, the whole group stood around and only one person at a time got to use the manikin. This is not the best classroom management. Let’s find a way so that every body is active. That’s when I started using the rubber balls.

2) a pump with needles for the balls. I deflate them when I travel, and they become very small and portable.

3) five bag-valve-masks. Airway is important, and as I have previously blogged, not every body knows how to clean and maintain these devices. I bought mine at Thapathali for 2,000 nrs each. You don’t need an “intubation manikin” to demo these, either.

4) two AT -35 rhythm generators from Pinnacle  Tech Industries. Okay, these did cost money. But they are fun! We use a monitor or defibrillator from the host agency, and the AT -35 allows us to show rhythms such as VFib on their own screen.

There are only six rhythms, and since 1980 or so, the AHA ACLS doctrine uses this idea. Here's the flash cards to go with it. you can run a scenario with these quite effectively.

There are only six rhythms, and since 1980 or so, the AHA ACLS doctrine uses this idea. Here’s the flash cards to go with it. you can run a scenario with these quite effectively.

5) Five sets of “Onliest six rhythms”  cards. laminated and colorcoded. each group assitaqnt gets a set and they are used to show “dynamic rhythm response” – i.e., the rhythm changes based on the actions the team took, and now the team must respond to the new rhythm. 5a) Five Sets of the scenario list, one for each assistant.

The "standar5d class size" is thirty. Five are asked to be "assistants" ans then five groups of five each. So, we need five sets of the flash cards! They are colorcoded. Each assistant gets a laminated list of the possible scenarios we will eventually be doing....... this system is impervious to loadshedding.

The “standard class size” is thirty. Five are asked to be “assistants” ans then five groups of five each. So, we need five sets of the flash cards! They are colorcoded. Each assistant gets a laminated list of the possible scenarios we will eventually be doing……. this system is impervious to loadshedding.

6) a couple of shawls, Gorkhali topis, etc – props for role play.

7) The Certificates: The ones for CCNEPal are nice ones, highly desirable.

8) handouts: copies of rythms for practice; the “Guide to the Six Step Method for Ryhthm Interpretation,” the handout on Bag-Valve-Mask,  the ACLS protocol handout.

9) Dissection tools and ET tubes for when we do the Phokso lab.  A box of clean medical gloves.

10) Whiteboard marker pens. I don’t use PowerPoint or a DVD because of the ever present threat of loadshedding. This is a practical, interactive class.

The Bottom Line

In USA when I first started doing this, we did not have the fancy stuff you now see on the Heart Association videos.  We used what we could improvise.

This background is useful for Nepal, because this is a low resource setting, and the typical school needs to find a way to teach the content without spending a lot of money on equipment. SO, here in Nepal, I teach the course without all the fancy stuff.  Hospitals and Schools of Nursing, and Medical Schools, do not need to invest a lot of money in order to teach using these techniques.

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Schedule for 2-day course in Advanced Life Support for MBBS docs Feb 5th 2015


I have been asked to share the hour-by-hour schedule and the objectives,  for the course in Advanced Cardiac Life Support, that CCNEPal uses when we teach a class of MBBS docs.

here it is, in all it’s glory. First, the Schedule:

“Bringing Critical Care Education to the Himalayas”

Critical Care Assessment and Advanced Cardiac Life Support (ACLS) Training

Program Schedule Day One

Date /Time Topic notes
0800 – 0830 Inauguration:

Welcome speech

dignitaries
0830 0915 Overview of course. Assessment of class knowledge and demonstration of successful teamwork (expected class outcome)The “six basic rhythms” and the two ABCD surveys for ACLS. (NSR, brady, tachy, asystole, VF, VT)

Review of CPR algorithm.

Discussion of electrical safety issues and ground rules

How to use scenario and how to use algorithm. For this course we will systematically review the “ten core cases” from American Heart Association. Over next days we will go over these group by group.

rules for good communication during stressful situation. How to be a good team leader and good team member during emergency.Review of CPR (practical) and bag-valve-mask, with sound track.

Short lecture then demonstration by instructors about what successful team will look like after three days.

Break up into groups for

ROUND ONE of guided small group practice with personal feedback and repetition of skills while being videotaped. Use of smartphone video for feedback and critique.

1030 - Break for chiya  
1100- 1230 Four possible outcomes of defibrillation, Universal algorithm.

Short lecture then scenarios with feedback.

R.O.S.C. algorithm.

TWO monitor/defibrillator units are needed for this. ROUND TWO Scenarios will include universal protocol.

Also will need three bag-valve-mask devices and some airway equipment. (will bring the mannikins for CPR)

1230- 1315 lunch
1315 -1400 Short review of morning teamwork skills. Bradycardia algorithm; Acute Coronary Syndromes Algorithm (top half).  Discussion of 12-lead ekg (bottom half of ACS algorithm.) ROUND THREE of small group teamwork skills. “live” manikins for this scenario. Depending on size and skill level of group and number of assistants available, we will break up into groups and rotate between stations.
1400- 1500 Specific supervised practice with defibrillator, for this we will break up into two groups, one goes to ER the other to ICU to familiarize with actual defibrillator. One-to-one supervised practice. Emphasis on safety. Both sync and unsynch.
1500- 1545

 

Use effective teamwork and communication skills for successful intervention in critical situations

 

ROUND FOUR of small group teamwork

Including respiratory arrest with pulse; airway scenarios.

Using tables in classroom or stretchers.

IV pole with no-longer-sterile IV bag and tubing, other props as needed. (see equipment list)

1545- 1600 Description of next days training

Day Two

Date /Time Topic                notes
0800 – 0805 Introduction  
0805 to 1030 Tachycardia algorithm.

Then small group scenarios.

Rhythm review using AT-35 simulator. (two groups)

ROUND FIVE  as above, skills will be reviewed in groups with detailed performance feedback given Small group practice. Handout.
1030 – 1100 chiya  
1100 to 1300 Special scenarios related to unusual conditions. Review of second ABCD survey to determine less-frequently occurring scenarios ( hypothermia, drug overdose, renal failure, weedkiller overdose therapy, etc.) focus on MD role in 5H and 4T ROUND SIX special scenario, also learning to go flexibly from one page of protocol to “put it all together” in megacode
1300 to 1330 lunch  
1330 to 1400 Large group scenario with debriefing Ethical issues regarding resuscitation
1400 to 1445 Group study Work with group members for final review
1445 to 1545 Final exam, group by group  
1545 to 1600 closing  

Prior to class – students will be given large electronic file on ecg rhythms for study, also protocol handouts.

Notes about classroom setup – we need a classroom that can hold about thirty people, preferably with flat floor ( not a sloping auditorium) and no carpeting. Ability to sit at tables so as to work with handouts and sample strips. Whiteboard or blackboard with colored marker pens and or colored chalk.  A computer monitor for powerpoint is ideal but not necessary. When we break out into small groups, it is preferable to use adjacent spaces so as to keep noise level down.  We are flexible about this. Screens can be used.

Notes about equipment: we need two monitor-defibrillator units to which we will attach the AT-35 rhythm simulators.  If you have CPR manikins those would also be good but not mandatory. Also, three or four IV poles with IV bag and tubing (these can be nonsterile ones that would be otherwise discarded) and bag-valve-masks and airway equipment. If you can bring two or three patient stretchers that would be good but if not we can use tables instead.

Students bring a smartphone if they have one with video capability. Their own pen and notebook. Pen drive. Wear clothes suitable for activity including kneeling on floor and bending. Bring a small blanket to lay on floor if worried about getting dust on clothes. See above list of special supplies for day two.

Next, the course objectives and teaching methods:

Course Objectives for 2-day course in ACLS

CCNepal “Bringing Critical Care Nursing Education to the Himalayas”

Joe Niemczura, RN, MS CCNEPal2013@gmail.com  Joe.niemczura1 (Skype) 9801096822

 Summary

This is a training course in  Advanced Cardiac Life Support (ACLS) skills adapted from the American Heart Association specifically for MBBS doctors and interns in Nepal. It is two consecutive days in length, eight hours each day, but could be conducted over three days of about six hours each. I taught this at CMC, CMS and LMC in 2014. Note; it is NOT the “Official” AHA ACLS course.

Objectives   At the completion of this course, the participant will:

Identify the lethal cardiac rhythms on a monitor, and use the “Six Rhythms” method of ecg interpretation.

List the correct dosage and administration for the most commonly used pharmacotherapeutic interventions in Emergency Cardiac Care.

Learn and apply the BLS and ACLS Survey.

Describe elements of initiative and decisionmaking in critical care that apply to the medical leader of a team, and  examine personal goals related to this role in medical practice.

Apply the treatment protocols consistent with the American Heart Association guidelines for Emergency Cardiac Care, in typically recurring scenarios, especially the “ten core cases”

Use effective teamwork and communication skills for successful intervention in critical situations

Instructional Strategy

Students must attend all sessions  of the course. Part of each day will be devoted to lecture, small group work, and discussion. A key feature of this course is “Megacode” – a simulated emergency situation in which small groups of participants are assembled and expected to respond in teams, then given personalized feedback about skills performance. The afternoon session of each day is devoted to megacode practice so that all participants are given time to get feedback.

Evaluation

There will be a final exam at the end of this course, which will consist of a team response to a simulated “Megacode” scenario.

Resources

Handouts are provided by CCNEPal free of charge. Participants will be given course materials on pen drive. CCNEPal and Joe Niemczura do not accept compensation for this course.

YouTube Video

A session of the 2011 course was videotaped and edited for use on YouTube. This is the best description of the teaching style and the focus on Megacode. The URL for this is:

http://youtu.be/FZjqfOdWRb8

Teachers of this course

The Principal Faculty for this course is Joe Niemczura, RN, MS who holds licenses as a Registered Nurse in both USA and Nepal.  During the academic year he is a faculty member in the School of Nursing at the University of Hawaii in Manoa, (part of Honolulu). He has made seven trips to Nepal. In 2007, 2008 and 2009 he taught at Tansen Nursing School. In 2011 and 2013 he was based in Kathmandu and taught critical care nursing skills. He is on leave from the University for the academic year 2014-2015. He has a Bachelor’s degree in nursing from the University of Massachusetts at Amherst (1977) and a Master’s degree in nursing from the University of California at San Francisco. (1981).

Incountry references

Mrs. Radha Bangdel, Campus Chief of Lalitpur Nursing Campus

Mrs. Shakuntala Thanju, Principal of Tansen Nursing School

Rachel Karrach, MD, administrator of UMN Hospital, Tansen Palpa.

Niranjan Sharma, MD, Medical Director of UMN Hospital

Mrs. Sita Parajuli, Matron of Purano Medical College, Bharatpur

Dr. Gautam Bajracharya, Chief of Anesthesia at Nepal Medical College, Jorpati

Dr. Manohar Pradhan, Chief of Emergency Services at College of Medical Sciences, Bharatpur

Dr. Rano Piryani of Chitwan Medical College

Mr. Gopal Pokharel, Lumbini Medical College

Dr. Rajendra Khoju, KUMC in Dulikhel.

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March 2015 dates for 3-day sessions at Lalitpur Nursing Campus announced


UPDATED Feb 19th

We are still registering students for these sessions! From here on, go to Lalitpur Nursing Campus in Sanepa, to the library, and register there.

Session 1, March 1st, 2nd and 3rd – all seats taken, class is full.

Session 2, March 8th, 9th and 10th – 24 seats taken as of Feb 19th, six remain

Session 3, March 29th, 30th, 31st – eleven seats taken, nineteen remain

Session 4, April 5th, 6th and 7th, two seats taken, twentyeight remain – lots of space!

To register, bring 600 nrs, and read policies below.

it's going to be a nice day. I tried to find a spot that every knows, so you are less likely to be confused. The actual sessions will be held at LNC in Sanepa, but they have asked that we register off-campus, to avoid having a crowd that disrupts their normal operations.

it’s going to be a nice day. I tried to find a spot that every knows, so you are less likely to be confused. The actual sessions will be held at LNC in Sanepa, but they have asked that we register off-campus, to avoid having a crowd that disrupts their normal operations.

CCNEPal will once again conduct a series of four sessions of our 3-day course of Critical Care Skills for nurses.

Who: CCNEPal, led by Joe Niemczura, RN, MS from USA

What: the 3-day course that covers basic life support, elementary ecg, airway, drugs, protocols, teamwork and communication. We teach standards that are based on research done by the American Heart Association( AHA); but it needs to be carefully and clearly noted that this is not the “Official” American Heart Association class. It is significantly adapted for the needs of Nepali nurses. At the end of the three days, participants get a certificate from CCNEPal. Mr. Niemczura has taught this course about fifty times throughout Nepal.

When:

session #1 March 1st, 2nd, 3rd (full)

session #2 March 8th, 9th and 10th (Sun-Mon-Tues)  9 a.m. to 4 p.m. (six seats left)

Session # 3 March 29th, 30th and 31st (Sun-Mon-Tues) 9 a.m. to 4 p.m. (nineteen seats left)

Session #4 April 5th, 6th and 7th (Sun-Mon-Tues) 9 a.m. to 4 p.m. (thirty seats)

(note: sign up for just one of the four)

Where: The class will be held in the legendary “Green Ballroom” – complete with crystal chandelier, at Lalitpur Nursing Campus in Sanepa.

Why: to advance the skills of the participants.

IMPORTANT: about the course fee. 600 rupees. there will be chiya at morning and afternoon but it does not include lunch.

OTHER COURSE POLICIES:

Each session is limited to thirty participants only. At the time of registration, it is “first-come, first-served.”

Bring the course fee and a pen drive. we do not accept telephone registrations, and the fee is nonrefundable. If after you register you are unable to attend, you can send a substitute, but you can not get your money back.

for further information: read back entries of this blog – the course objectives and outline are amply described. Browse the FaceBook page for photos of past sessions. Talk with one of the 1,400 previous participants in this training. send all questions to the CCNEPal FaceBook page. Please do not phone or email me directly.

All course announcements will be on the CCNEPal FaceBook page. Be sure to “like” the page.

The L.N.C. sessions have always included an interesting mix of  practicing nurses, nursing faculty, new graduates and the like. We did this in 2011, 2013, and 2014 and each time the classes were fun because of the mix.

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CCNEPal 3-day critical care nursing course in Kathmandu Valley February/March 2015


This will be a brief announcement. we expect to offer a series of the 3-day critical care skills training course in Kathmandu once again ( the fourth such series!) in February/March.

This is the same 3-day course that has now been offered more than fifty times since the beginning of CCNEPal.

The dates have not been confirmed, but each session will be on a Sunday-Monday-Tuesday.

The location is not confirmed, but we are negotiating with LNC, the venue for the three previous series of 3-day classes. The Green Ballroom at LNC has always been a fine venue for this class.

We will again endeavor to keep the course fee low – probably about 1,200 nrs.

details about how to register will be posted once the location and fee have been confirmed.

stay tuned!

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Why Should a Nepali MBBS doc take an ACLS course?


MBBS doc “Role Development” for effective critical care – what is it?

Critical care is not defined by a location (“ICU”) in a hospital. It’s more like a state of mind of the docs and nurses who provide life-saving emergency skill. It takes a certain kind of attitude to succeed.                                                         Joe Niemczura, RN, MS

CCNEPal has now trained about 150 MBBS docs, around the country. We’ve been active in Nepal since 2011, but until now we mainly focused on nurses. The two groups bring different things to the course, and so they do better with an approach that takes the background into account.  Here is what I learned from teaching at MBBS and post-MBBS level in Nepal. 

“Frame” of the ACLS course.

The word “Frame” is handy. It’s the one sentence to describe the overarching goal of the course. For nurses, it’s “we’ll learn about teamwork and communication during an emergency.”

For MBBS docs, the frame is “We’ll learn about confidence, problem-solving and leadership during an emergency.”

Notice that the drug doses, algorithms and ecg are not in the main “frame.” ACLS covers  those things, but the course is designed to focus on small group work for a reason – and the main frame reflects that. The typical beginner, taking the course for the first time, devours the drug, ecg and protocol info, and skips the teamwork chapter. Now, a person can master the technical details through personal study. But, the only way to master the leadership skills is to have a group and try to lead them. In ACLS, you will get that experience.

Role Play

A theme of the feedback from new MBBS docs who are in the “intern” role  is “nobody has allowed us any responsibility yet” – it’s because they are young. And for that reason, they have never given a medical order, or looked at their own style, or needed to actually make a critical decision in real time. In ACLS class we set up our role play scenarios with care so that everyone gets the chance to test themselves out. Even more, there is always a debriefing to get feedback on how they did.

The young doc who takes an ACLS course always learns about the focus and personal concentration that is needed in a critical emergency.

If the doc appears nervous – we tell them. If the doc barks out orders like the guy who stands in the door of a bus, we’ll help them work on this until they find a better way.  He or she learns to direct and control a team. When we have a group composed of a hundred per cent MBBS, they all want to be the leader at once, and it’s important to make sure the lesson about team is reinforced. One leader at a time. it’s not about showing off what you know, it’s about getting the team to work together.

Ke bhayo?

I’m not saying that a doc doesn’t need to know the drugs and protocols! They sure do! In an emergency there are many specific detailed orders that must be given; and for a young new doc, sooner or later they will experience a “ke bhayo moment” where the mind goes blank and no ideas as to how to proceed manifest themselves. It’s better to have it happen in a simulated situation first. We don’t know when during the training it will happen – but it always does sooner or later. When  the doc’s mind goes blank at a crucial moment, (such as forgetting to say “I’m clear, you’re clear, we’re all clear” just before defibrillation)  he or she gets the chance to feel what that’s like.

When we use this interactive approach, they’re less likely to have a brain cramp in the real world scenarios of the future.

Learning to react, learning to be flexible

This is another overarching skill. As you do a complicated medical procedure, you must reassess along the way and adapt your approach. You can’t learn just one recipe and always expect it will play out the same way. Adaptability is a slippery skill to teach! You can’t just say “Be Flexible!” or and over again. The teacher need to give  examples and allow the student to practice and test the parameters. ‎The scenarios impart the idea of how it feels to be in an actual emergency.

Topsy-Turvy

MBBS docs learn a specific way to approach a patient. Start by  introducing yourself; ask their name and why they came; review the HPI, family history and review of systems.  Then and only then do you develop a plan. In ACLS, we learn exactly how to identify a critical ill person who‎ needs immediate intervention; and ask questions later! We turn the usual approach upside down.

Affective Domain

All the things listed above go under the category of “affective domain” skills – they are attributes of the learner’s personality that go beyond simple memorization of facts. Success is critical care is only achieved when the doc is aware of the context of the patient. If I had to name one reason why every MBBS doc needs to take ACLS, it’s because there is no more effective way to arrive at the self-knowledge it requires from an advanced practitioner. This course teaches how to deal with ambiguity.

ACLS is the answer to a question you may not know you were asking.

And the question is : “where can I sign up for this training?”

Two places 

First, if you are Kathmandu.  There is one  Official American Heart Association International Training Center,  “The Center for Medical Simulation” a new company that specializes in this new mode of teaching.  They’re in Dillibajar.  Call 4616506. If you want to see what they do, “like” their FaceBook page, where you will enjoy the photos of previous classes etc. The Center is  just getting started, after a rigorous phase of setup and staff training. (for example The Center uses all the same equipment you would actually find if you took e ACLS course in New York, Boston or anywhere in USA). Courses at The Center lead to the official AHA ACLS card, recognized all over the world. An “official” card is especially handy for any MBBS doc who wants to compete for post grad work in USA, India, UK or Oz.

Second, CCNEPal offers a two-day course in these skills which is not the “Official” course. CCNEPal travels to various locations outside the KTM Valley. CCNEPal offers a course that is less expensive ( we don’t use the fancy equipment) and which has been adapted to Nepal. CCNEPal awards a nice certificate with the Nepal flag, not the AHA ACLS card.

DISCLOSURE: I am the person who is in charge of CCNEPal, but I am also in support of Center for Medical Simulation. There are 28 million people in Nepal, and there is lots of room for people who teach material with slightly different process.

About preparation for the course:

In USA, you would never simply sign up for ACLS they day of the course and walk in. the “rules” for participants are that each person must get the textbook in advance, and take a pretest. It minimizes stress and maximizes success. When I used to train people in USA, I had a sixweek course!

In Nepal, CCNEPal has not required this, but instead, makes it in to a 3-day course for nurses.

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A Simple Way to Re-Inforce the Message of Global Nursing


Every School of Nursing in USA needs this.

Buy one, or two, or ten. Put it on the wall outside your office. p538_0

It’s a poster from the Syracuse Cultural Workers.  

Think of no one as “them”
Don’t confuse your comfort with your safety
Talk to strangers
Imagine other cultures through their poetry and novels
Listen to music you don’t understand*Dance to it
Act Locally
Notice the workings of power & privilege in your culture
Question consumption
Know how your lettuce and coffee are grown: wake up  and smell the exploitation
Look for fair trade and union labels
Help build economies from the bottom up
Acquire few needs
Learn a second(or third) language
Visit people,places, and cultures – not tourist attractions
Learn people’s history*Re-define progress
Know physical and political geography
Play games from other cultures*Watch films with subtitles
Know your heritage
Honor everyone’s holidays
Look at the moon and imagine someone else,  Somewhere else, looking at it too
Read the UNs Universal Declaration of Human Rights
Understand the global economy in terms of  people, land, and water
Know where your bank banks
Never believe you have the right to anyone else’s resources
Refuse to wear corporate logos: defy corporate domination
Question military/corporate connections
Don’t confuse money with wealth, or time with money
Have a pen/email pal
Honor indigenous cultures
Judge governance by how well it meets all people’s needs
Be skeptical about what you read
Eat adventurously*Enjoy vegetables,
Beans and grains in your diet
Choose curiosity over certainty
Know where your water comes from
and where your wastes go
Pledge allegiance to the earth;question nationalism
Think South, Central, and North-  There are many Americans
Assume that many others share your dreams
Know that no one is silent though many are not heard –  Work to change this

If you are a nurse and you are NOT working for social justice – ask yourself why you are in this line of work.  Why else would you possibly do what you do?

Oh, and while you are at it, listen to the radio interview about my second book.

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