Bi-Lingual Nursing Education – English and Nepali

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 Tuesday marked three days with the fifteen BN students, they will now have a day off while I do class #2 with the larger group. My goal was to maximize time spent teaching while here, and I am certainly doing that this week. I wore my topi to class today.

 In the corridor outside our class overlooking the inner courtyard,  three undergraduate nursing students were using a particular test prep study method. They were reading out loud or reciting, notes on the topic at had, while they paced back and forth. From a distance it sounded like the humming of bees. It’s an interesting  manifestation of the emphasis on rote memory in schooling here. I once saw a TV documentary in which Buddhist  monks were studying in a similar way – it beats sitting in a hard chair at a desk the whole time I suppose.

 The smaller class size lends itself to a different style, and for the BN group we set up the large formal Board-room-style conference table under the crystal chandelier and everyone puts their papers on it as we work. Mornings are spent alternating between short lectures and ECG practice, working our way through the sequence of 130 ecg strips in the work book I brought.

 To do detailed ECG analysis is new, and everyone gets called on to stand and recite. In my Blackberry the thumbnail photo file includes everyone’s picture and name; I use it to call on people by name even with no name tags (and I am getting better at the names). At this point, if other members of the group analyzed it differently, they are expected to state their area of difference. So a discussion ensues. In this way, the group gets to practice the ECG  problemsolving as if they were at work. Each day they are more comfortable with it….. We had a distinct shift today regarding this. The students started doing their recitation in Nepali, and the discussion as well. I thought this was cool, and I was happy I could still catch the drift.

 Likewise, today there was a segment about 12-lead ECG, correlating the various two-dimensional leads with the three -dimensional cardiac  surfaces and septum.  After I’d described  it, there were blank faces.  One of the students with better English skills came up to the whiteboard,  and re-delivered what I said, in Nepali this time. I could never have delivered the concept in Nepali, myself. It seemed to help the others.  This group has got some really bright and clever kids in it, there are three who have strong ICU skills and background already, they add a lot to the discussion and I give them positive feedback. I’m happy we had that level of trust and did not allow the language to be the barrier. Most importantly of all, the entire class grasped the concept I was trying to impart. As you might imagine I “namaste’d” the student who helped.  I asked her later if she did it because she already knew the material. She said, “No I never heard it explained that way before, but you made it sound so simple”. – so I think I am still delivering good stuff.

 Afternoons have consisted of practice with mega-code scenarios. This BN  group is divided into three teams of five. One team at a time they go out in the corridor and wait and confer. Inside the room I explain to the observers what the goal of this scenario would be. For example, a scenario would be a patient with chest pain and evident M.I. Who is bradycardic, hypotensive and hemodynamically impaired; the goal is to address the M.I., and treat bradycardia. If the team gives nitroglycerin though, it’s considered to be an error in judgement. So the observers are engaged in the step-by-step as well.

 BTW the group that faced this scenario made the correct choice.  🙂

 I am told that nobody did this kind of ACLS-related simulated emergency scenario in their PCL program. This is new, here. At the one and only heart hospital, they drill on the skills but that seems to be the only hospital that does so.

 When I brought each group out to the corridor yesterday I said “by the way, you guys are the best of the three groups, but just don’t tell the others I said so.” This helped lighten the mood – they soon caught on – “are you also saying that to the other groups?”

 Of course not.  😉

 Shirley Evans is an expat who teaches an NCLEX review class here, a Honolulu friend had told me about her. Shirley  has shared her local network with me. Delightful person. Tuesday evening we went to Putalisadak and met a doc who is involved in prepping MBBS medical graduates to apply for US residencies. He owns a CPR mannikin, which I wanted to borrow. So he’ll come to class Friday with it, and stay to observe. I will show him the ACLS materials I brought.  He wants to offer an ACLS-style prep course for forty of  his MBBS-prep students, and I told him I would do it. Probably in July. Now, this gets a bit afield from the goal of teaching nurses; but hey, during the time they await going abroad, this cohort of docs are working in hospitals here and they too need the skills.  By the time July rolls around, I will have a small cadre of nurses trained enough to help me deliver. Nurses teaching docs in Nepal?  – that would be cool.

 My USA readers will be interested to know that many of the Nepali students are now reading this blog. And why not? It’s not a secret. There is no “me” and “them” – there is no “East or West”  – there is only – “us.”



About Joe Niemczura, RN, MS

These blogs, and my books, and videos are written on the principle that any person embarking on something similar to what I do will gain more preparation than I first had, by reading them. I have fifteen years of USA nursing faculty background. Add to it fifteen more devoted to adult critical care. In Nepal, I started teaching critical care skills in 2011. I figure out what they need to know in a Nepali practice setting. Then I teach it in a culturally appropriate way so that the boots-on-the-ground people will use it. One theme of my work has been collective culture and how it manifests itself in anger. Because this was a problem I incorporated elements of "situational awareness" training from the beginning, in 2011.
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3 Responses to Bi-Lingual Nursing Education – English and Nepali

  1. sunita says:

    Hello Joe Namaste. Thank you so much for sharing western Nursing skills to Nepali Nurses. The way of nursing care In Nepal and in Western huge difference.. Thank you so much for your wonderful effort.

  2. M A says:

    Joe-I was curious to know about what smells you encounter in Nepal. I don’t
    mean in the hospital, but on the streets as you walk somewhere. For
    example, it didn’t take me long as a student in Germany to smell the
    smelly armpits in the trolley and subways. They only had deodorant for sale
    because it wasn’t “natural” to use anti-perspirant. Beer and cigarette
    smoke permeated most places in those days. Today the smoking laws are
    finally catching up. Farms really had a strong manure smell as you drove
    through the countryside. Those were some of the things I am talking about.
    I picture many of the things you talk about, but food as it cooks usually
    has a distinct odor such as baking an apple pie.

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