UPDATED calendar for CCNEPal summer 2019 as of May 24th 2019 – dates for added sessions are available


I am presently in Bharatpur, finishing up the 3rd session of the summer. This week it was three groups of MBBS for two-day sessions. I will be here another three weeks.

Remaining Sessions in Bharatpur

4) May 26, 27 & 28 three-day session for nurses and/or nursing students.

5) May 29, 30, &31 three-day session for nurses and/or nursing students.

6) June 2 &3; two day session for MBBS and Medical Officers.

7) June 4 & 5; two day session for MBBS and Medical Officers.

June 6th, 7th & 8th – short holiday.

8) June 9th, 10th & 11th h last three-day session for nursing staff at CoMS

I am exploring the idea of going to Birgunj for a week or two; this is not final.

I have been requested to return to Bir Hospital College of Nursing for two 3-day sessions. I loved that group during my two previous visits there, and I deeply respect the mission of Bir Hospital; this is also not final

Dates available are:

(please note: because I am already in Terai I would prefer to add sessions in Terai. It’s less bus travel for me)

June 12, 13 & 14th – 3-day

June 16th, 17th & 18th ( three-day)

June 19th, 20th and 21st ( three day)

June 23rd, 24th and 25th; (maybe Butwal?)

June 26th, 27th & 28th; (maybe Butwal?)

June 30th, July 1st & 2nd; ( possibly at Bir)

July 3rd, 4th & 5th. (possibly at Bir)

Nepalgunj in July

July 9th and 10th – two -day course for MBBS and Medical Officers (thirty seats)

July 11th and 12th – two-day course for MBBS and Medical Officers (thirty more seats)

July 14th, 15th and 16th – three day course for nurses, especially critical care nurses ( thirty seats)

July 17th and 18th – final two-day session for MBBS and Medical Officers. (thirty seats).

Location – not yet finalized in Nepalgunj.

How to host a training session with CCNEPal summer 2019

Contact me by sending email to  joeniemczura@gmail.com

I will travel to locations outside Kathmandu if the host can do the following:

  1. provide a class space suitable for the program. This  needs to be a big space. We move around a lot during this class. It needs: 1) a whiteboard (I do not use PowerPoint) 2) thirty chairs, 3) five patient beds or trolleys for the role play scenarios. 4) air con if possible. The classroom needs to be away from a patient care area. ( we make a lot of noise).
  2. provide a roster of thirty nurses and/or doctors or MBBS students for each session of two, or three days. Nurses take a 3-day sessions and MBBS take the 2-day/ Each participant must attend all sessions of the same class to get the certificate (in other words, the three day class is a three day class – not three one-day classes). arrange for morning chiya and lunch, if there is not a cafeteria.
  3. The sessions are for PCL nurses, B SC nurses, or MBBS. I do not register ANMs in the class. It’s okay if the person is a recent graduate, but the persons need to be working in acute care or intending to work there.
  4. while at a place outside of KTM Valley, the host provides fooding and lodging. I live simply, it can be at a guest house, no need for finest hotel in town. I eat  DBT etc so I’m okay with local food. At some locations, they lodge me in a private room on cabin ward. ( they do not need to check my vital signs though!)
  5. My preferred schedule is to teach six days per week, either two three-day sessions (for nurses) or three two-day sessions (for doctors). I travel on Saturday and repeat. In summer 2016 I stayed two weeks in Pokhara, two in Bharatpur, two in Janakpur, and three in Biratnagar before returning to Kathmandu.
  6. I try to make a “circuit” of sessions, not go out-and-back from Kathmandu all the time. It’s more efficient.
  7. I supply the certificates. I keep a minimum amount of photocopy but we need about six pages per person.
  8. My Nepali is poor ( I am ashamed to admit). Strange as it may seem, that is not an insurmountable obstacle if there are some English speakers. I adapt my teaching techniques so as to “Code Switch” in a certain way. If a person has no English, this may not be the class for them.
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Two links to cross-posted blogs on the subject of midwifery in Nepal


Many of you know that I also write occasionally for a USA blog named “DailyKOS” – it’s a blog with a million subscribers. It’s focused on electing political candidates from the Democratic Party. But since it’s so big I can reach a larger audience when I post there.

I posted two blogs. The First one was about Chauppadi. It also covered various aspects of women’s health.

The second one was about strategies to help Nepali women by training midwives.

I leave for Terai early tomorrow. I will take the Tourist Bus from Surkhotte just north of Thamel. The route is The Prithvi Highway.

Wish me luck!

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CCNEPal will visit Nepalgunj in July for five sessions


Since 2011, CCNEPal teaches critical care skills to nurses and doctors. Sessions have been conducted in Kathmandu Valley, and also in Dulikhel, Biratnagar, Janakpur, Bharatpur, Butwal, Palpa, Pokhara, and Bhairawaha. We have logged more than 120 sessions and given about 4,000 certificates. But until now, we have never been to western Terai.

Dr Binod Karn of Nepalgunj Medical College invited CCNEPal to teach at the medical college in Nepalgunj. We accepted the invitation. Hooray! Nepalgunj is a shining jewel of the western Terai!

Additional Sessions

The last session in Bharatpur will be July 4th and 5th. Then we get on the East-West Highway via bus…

The teaching hospital of the Medical College in Nepalgunj

July 9th and 10th – two -day course for MBBS and Medical Officers (thirty seats)

July 11th and 12th – two-day course for MBBS and Medical Officers (thirty more seats)

July 14th, 15th and 16th – three day course for nurses, especially critical care nurses ( thirty seats)

July 17th and 18th – final two-day session for MBBS and Medical Officers. (thirty seats).

Location – not yet finalized. the hosts are exploring the idea of using a resort or banquet hall as the classroom. We need a large space.

Because this is the first time CCNEPal will visit the region, we hope that the participants will come from a range of hospitals and agencies.

To register: as of this writing, the roster will be populated by Doctor Karn. His email is drbin2007@gmail.com and inquiries as to available seats should go to him. It is possible that Medical Officers from outside the medical college can also register. Stay tuned for further information.

There is ample information about the content of the training, on this blog as well as the FaceBook page for CCNEPal and the YouTube channel.

We use a scenario-based approach with lots of role play:

these are staff nurses from a Kathmandu Hospital and the scenario is based on USA training methods for critical care.

We start with teaching CPR and basic response:

We don’t use manikins.

we teach people how to use a defibrillator:

We have one rhythm simulator, and we teach three different practical ways to use ecg in an emergency:

No matter which language you use, the ecg is the same throughout the world.

Feel free to browse the resources. Feel free to share this with any persons you know who are practicing in the region of Nepalgunj!

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List of CCNEPal sessions summer 2019 – start planning now


As previously announced, CCNEPal will be in Bharatpur at College of Medical Sciences (CoMS) for about six weeks in a row and we will offer sixteen sessions of our critical care course. For nurses, the course is three days in a row. For MBBS the course is two days. Most of each batch will be staff from CoMS, but we will also register doctors and nurses from other hospitals or health posts. (see below for instructions).

One of the batches of CoMS nursing students from a previous session. This is a BSc program and the group was enthusiastic and wellprepared.

This is a large air-conditioned classroom that can seat a maximum of thirtyfive participants. Our plan is to fill each roster with that number.

The session is very active. We sit and takes notes and discuss; then we go to beds in the back to do role-play of each scenario. We are fortunate to have a large classroom with air con. You will learn teamwork and communication skills in addition to the protocols. students really enjoy the “Hands on” practical focus. We use the protocols of the American Heart Association as adapted for Nepal.

The dates are as follows:

  1. May 19th & 20, 2019 – two day session for MBBS and Medical Officers.

2. May 21st & 22nd; two day session for MBBS and Medical Officers.

3. May 23rd and 24th two day session for MBBS and Medical Officers.

4) May 26, 27 & 28 three-day session for nurses and/or nursing students.

5) May 29, 30, &31 three-day session for nurses and/or nursing students.

6) June 2 &3; two day session for MBBS and Medical Officers.

7) June 4 & 5; two day session for MBBS and Medical Officers.

8) June 6 &7th two day session for MBBS and Medical Officers.

8) June 9, 10 & 11th; two day session for MBBS and Medical Officers.

9) 12,13 & 14th three-day session for nurses and/or nursing students

10) June 16,17 & 18; three-day session for nurses and/or nursing students

11) June 19, 20 & 21 three-day session for nurses and/or nursing students

12) June 23,24 &25; three-day session for nurses and/or nursing students

13) June 26, 27 &28th three-day session for nurses and/or nursing students

14) June 30 & July 1 two day session for MBBS and Medical Officers.

15) July 2 &3; two day session for MBBS and Medical Officers.

16) July 4 & 5 two day session for MBBS and Medical Officers.

After that? We go to Nepalgunj! For the first time ever!

At the end of the session there will be a certificate for those who pass the final exam.

How to register

a. If you are a CoMS student or employee, your in-charge or faculty member will pick the date and assign it to you. CoMS personnel will be the first priority. If you are among this group, you do not need to do anything else. Just show up on the assigned dates.

b. If you are a student from another college or employed as a Medical Officer or Staff Nurse, check with your own campus chief or your in-charge. If such persons register in groups of four or five and the campus chief guarantees that all the slots will be filled, the names of group members will be sent to CoMS. You must attend all three days; actively participate; and pass the final exam to get the certificate.

c. If you are an individual Medical Officer, nurse or health assistant, you must pay a fee of 500 nrs to register. The fee will be used to defray the cost of aircon. We will not accept telephone registrations. You will forfeit the fee if you do not attend – there will be no refunds. We do not accept ANMs in this class.

Contact person for all the above: Dr. Dipendra Khatiwada, Department of Community Medicine, College of Medical Sciences. email is: dipendra.khatiwada@gmail.com and the phone number is: (to be announced).

When you register, be sure to tell us your name; the number and dates of the session as listed above; whether it’s the two-day or the three-day; and how many persons. Include your contact phone number and email. If you are paying the fee in person go to the Department of Community Medicine at CoMS.

Bring: a pen drive. Wear comfortable clothes. Meals are not included with the program but there are many kitchens nearby. classes start at 0900 and end at 4 PM.

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January 5th Update for summer 2019 teaching schedule of CCNEPal



CCNEPal offers a threeday course in critical care skills to nurses of Nepal since 2011. Browse past blog entries on this site to learn about our activities.

As of January 2019, the plan is to arrive in Nepal around May 11th. We will spend time running around Kathmandu for a few days then head to the Terai.

From about May 16th to June 30th we will in Bharatpur, Chitwan “The Medical City of Terai.” We will be based at College of Medical Sciences (“CoMS” also known as “Purano”) in their dedicated classroom and offer about 16 sessions. (yes, sixteen). This is the best classroom we have ever had in Terai.

New Registration Option for Outside Participants

In the past, when CCNEPal has been hosted by a large organization we limited the seats to just the persons from the host organization. This meant we did not always have a consistent class size, and the managers strained to accommodate all the requests from staff while still running the wards. CoMS is eager to solidify their status in providing continuing medical education for the region. In summer 2019 we will reserve five seats per session ( possibly more) for nurses or doctors not affiliated with CoMS. This will allow people from District Hospital, NP Hospital, Cancer Hospital or CMC to send a few nurses or doctors at a time to enroll, for example. It becomes easier to continue to staff the units when a few people at a time go off for training. CCNEPal is excited to have this arrangement. To reserve those seats will require a small cash deposit at the time of registration. We have not yet worked out the specifics as to who to contact to register. We will not accept phone-only registrations or email-only registrations.

We expect to teach other sections of our course in July, possibly as many as six. On a recent blog entry, we described the requirements to host us.

Feel Free to Pas this Along

Locations and dates of additional sessions To Be Announced. Send an email to joeniemczura@gmail.com https://www.facebook.com/2013KtmCriticalCareNursingCourse/

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Ten Rules for the “Flipped Classroom”


Ten Rules for the Flipped Classroom in Nursing School

By Joe Niemczura, RN, MS

Without lot of introduction, this is a tool to help students get into the mindset needed to thrive in a flipped classroom. These are not “rules” – More like guidelines. Except for #8.

Come prepared. Do the reading and homework in advance and watch the videos.

Prepare to interact, part one. Passivity is the enemy to the type of learning we strive for in class. When you do the home work, interact with the material to develop questions on the areas you need to understand.

Prepare to interact, part two. Bring your questions to class and engage in dialog. Study with a group.

Think about “meta-cognition.” You are training your brain to think like a nurse. This involves a system of logic. You can speed this along by thinking about how you think. Put it on the table.

Talk with more than just the teacher. You can learn a lot from the person next to you.

Stay to the end. If you have already mastered the material, you have an obligation to help your peers. Leaving the dialog is a selfish act.

Stay engaged. “Being present” is more than just being present. Put the smartphone down and nobody will get hurt. Exhibit attending behavior at all times.

Respect those around you. Incivility has no place in this classroom.  Examples of incivil behavior can be found in Pearson Volume II page 2650. 

Find a way to use nursing therapeutic communication in all that you do. Every peer; the faculty; the patients; hospital personnel; your own family.

Develop a personal “centering practice” and cultivate it. Remember the “First Rule of Knowledge” from the Buddha.

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Plan now for course with CCNEPal in summer 2019


Destination – the future!

Now that Christmas is over, it will fade out of sight in the rearview mirror as we hit the gas for our destination – 2019. Naturally it starts out as a year full of promise.

Destination – picking up the USA team.

Every good road trip benefits from companions. As in the past, I am willing to bring others with me to experience Acute Care Global Nursing. I am particularly interested to find people to teach PALS and pediatric critical care. The ability to “Code Switch” or learn how, is essential. If this is you, contact me.

Destination –  Kathmandu!

CCNEPal will return to Nepal in summer 2019 for about ten weeks, beginning in mid-May – the day after my teaching job here in Florida wraps up the spring semester. I will fly into Kathmandu of course, spend a day or two organizing things, then head off to the Terai.

Destination – Widespread Clinical Competence!

The main question for me is how to maximize the teaching of the course I do so as to reach the widest possible audience. Last year I had the pleasure to re-connect with persons who I taught five or more years ago and I was flattered when they relayed how important that course had been for them, in terms of building confidence and competence in emergency situations. At this point, I have trained about 4,000 nurses and doctors. It’s true that many joined Nepal’s medical “brain drain” – I bet that 300 are now using those skills in Australia. But most are still in Nepal and there has been progress in shifting the mindset.

Since I first started going there specifically to teach critical care skills, there have been many positive developments. The Nepal Society of Critical Care Medicine has gained prominence and taught more short courses – The one titled BASIC has become more accepted. The Critical Care Nurses Association of Nepal was formed and they have helped develop critical care preceptorship models that are now being adopted more widely.  The Center for Medical Simulation came into being and they run a fully-certified American Heart Association International Training Center, along with having all the manikins and simulators we take for granted in USA. Many nursing faculty from schools around the country of Nepal have taken the course and they too, will bring new confidence passing the skills to their students. During the 2015 earthquakes, hundreds of nurses and doctors trained by me were able to use their skills to save lives. Also as a direct outcome of my training, many Emergency Rooms and Critical Care Units are now equipped with the communication skills and de-escalation techniques that mitigate the threat of “thrashing.”

Destination – the Terai!

As in the past, most of my efforts are centered in the Terai as opposed to Kathmandu. When I left Nepal in 2018, I was talking with my main partners in Terai about ways to use one of the medical colleges as a more well-defined home base so that nurses and doctors in the region could come there.  I need to see if this is still on the agenda. If we can collaborate effectively,  we will be able to schedule twelve or fifteen sessions of the course right from the git-go and each one will have the maximum number of enrollees.

To arrange a session of training with CCNEPal in 2019

I will still have availability to go to other regions to teach. A few years back I wrote the terms under which I will deliver a session. Here they are, again.

 *   *   *   *   *   *   *   *   *   *   *   *   *   *   *

How to host a training session with CCNEPal summer 2019

Contact me by sending email to  joeniemczura@gmail.com

I will travel to locations outside Kathmandu if the host can do the following:

  1. provide a class space suitable for the program. This  needs to be a big space. We move around a lot during this class. It needs: 1) a whiteboard (I do not use PowerPoint) 2) thirty chairs, 3) five patient beds or trolleys for the role play scenarios. 4) air con if possible. The classroom needs to be away from a patient care area. ( we make a lot of noise).img_20160710_144458_panorama_edit
  2. provide a roster of thirty nurses and/or doctors or MBBS students for each session of two, or three days. Nurses take a 3-day sessions and MBBS take the 2-day/ Each participant must attend all sessions of the same class to get the certificate (in other words, the three day class is a three day class – not three one-day classes). arrange for morning chiya and lunch, if there is not a cafeteria.
  3. The sessions are for PCL nurses, B SC nurses, or MBBS. I do not register ANMs in the class. It’s okay if the person is a recent graduate, but the persons need to be working in acute care or intending to work there.
  4. while at a place outside of KTM Valley, the host provides fooding and lodging. I live simply, it can be at a guest house, no need for finest hotel in town. I eat  DBT etc so I’m okay with local food. At some locations, they lodge me in a private room on cabin ward. ( they do not need to check my vital signs though!)
  5. My preferred schedule is to teach six days per week, either two three-day sessions (for nurses) or three two-day sessions (for doctors). I travel on Saturday and repeat. In summer 2016 I stayed two weeks in Pokhara, two in Bharatpur, two in Janakpur, and three in Biratnagar before returning to Kathmandu.
  6. I try to make a “circuit” of sessions, not go out-and-back from Kathmandu all the time. It’s more efficient.
  7. I supply the certificates. I keep a minimum amount of photocopy but we need about six pages per person.
  8. My Nepali is poor ( I am ashamed to admit). Strange as it may seem, that is not an insurmountable obstacle if there are some English speakers. I adapt my teaching techniques so as to “Code Switch” in a certain way. If a person has no English, this may not be the class for them.

Destination – home again!

I have loved the past trips to teach in Nepal, but I also love my present teaching job.  At the end of the summer, the jalopy pulls into the driveway, we shake the dust out of our clothes, and resume our “normal” lives.

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