The first group of little birds will now leave my nest

One more day and then the first cohort, fifteen BN students will be “done” with the training. These guys stuck with it, and still had some panache left at the end.

Four more such groups will join them over the next six weeks here in Nepal, with varying goals and time frames. Three groups will take the three-day version of training….. Quick trip through ECG then lots of arrest response simulations. The Wednesday group of seventy five will chug along every week like a diesel locomotive pulling a mile-long freight train, blowing all the bells and whistles at every road crossing.

After the take-out momo for lunch, we went back upstairs to the large boardroom style table under the chandelier. As people filtered in I asked “So – is my class similar to the way your other teachers do it?” – knowing the answer already.

Executive summary: in a word, “No Sir!”

If they acted in their regular class the way I have *encouraged* them to behave, they would be scolded and asked to leave. So – what did I do?

First, from the git-go the students took turns analyzing the rhythms standing, out loud, with feedback from peers along the way. Can not simply sit and take notes.

I frequently stopped and asked them to discuss things then took questions. (“Turn to the person next to you and talk it over for a minute”).

I did not pretend I was the only person with the answer.

If they needed to blow off steam, they did. I let them.

Lots of side-talk about the subject, which I did not feel I needed to control. Time built in to allow processing, in which the better English-speakers helped the more challenged.

Negotiation about the subjects to be covered. Humor and validation. Lots of psychomotor activities in which I *led* it by demo-ing the response first.

I tend to think I treated them as peers; in turn I like to think the group could sense that.

In short, I’m happy to say I was able to deliver a course that reflected my “A Game”.

What would Paulo Freire say?

Those who know me would say “sounds like Joe” – hallmark of my teaching style. A friend once put it this way: “Joe, every teacher exists on a spectrum of how much order they need in the classroom, and you’re no different. You do have your limits. What is true in your case, is that the maximum *order* you impose, is still further along the spectrum, than the most chaotic class others would be comfortable with”

Okay. Got it! I tend to think this is a good thing. (Others may disagree.)

The approach to learning we modeled will help these students in the kind of responsive free-wheeling approach to critical care emergencies they will need to adopt. They have had a taste of speaking up…..

A highlight of today was to finally confirm the dates for Bhairawa – the 19th, 20th and 21st of June – coming right up. They have lined up 25 students there, both nurses and docs. With this time frame, we stick to the “Onlyest seven rhythms” then go straight to mega-code.

So – I will have a few days to get prepped. I plan to fly there and back, via intra-country airlines – of which of course there is a mystique – I landed there once in 2008. At that time I recall seeing the machine gun emplacements on the roof of the terminal. Not something we have in Honolulu.

I have planned to start my malaria prophylaxis, a few days before.

Part of today was to do mega-code, and I asked one of the better students in the class, to actually direct the mega-code in the way I had been doing. This is a woman with three years of ICU, and who is verbally quick. She did great. I will ask her to help when we do further mega codes with the bigger group. We can develop her as a leader.

It was not all exactly bee yoo tee full – we’re still working. For some of the scenarios I took the more verbal members of the group aside, and forbade them to speak or suggest things. Time to get some of the timid ones to step up and lead. This adds a wild-card element to the scenario.

Today I continued to video each mega-code and to watch it with them afterwards. This tool allowed us to point out areas to work on.

At morning chiya I asked the group about short people who make comments…. They gave a Nepali phrase in which they say “small chili is hotter” – this is applied to short people with quick tongues. That counts as true in our group.

Later in the day the shortest member of our class, always quick to say something, stood up and led a scenario response, finally. She was clearly excited, (finally in charge!) and to my dismay, she started going down the SVT path (CSP, adenosine)when the scenario was unresponsive VT (countershock, CPR). So, I had to cut that scenario short so that we could then compare and contrast SVT (with pulse) vs VT with no pulse. Damage control called for…. A teaching moment.

So – we’re still learning. Overall, though, the group has made tremendous strides.

The Canadian bible group returned from their weeklong trek to Solu Khumbhu region. They did a bunch of laundry and crashed the water system for a bit. They were pleasantly fired up, and after two days here they go to Biratnagar.

And tonight we had an hour of steady rain. In this town, at this time of year, a fine layer of dust covers everything… Maybe not so dusty tomorrow….



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.
This entry was posted in nursing education and tagged , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )


Connecting to %s