Hour-by-hour description of Critical Care Response Training for Nurses

NOTE: we are beginning to schedule the actual sessions for the 3-days course, and the first host agency asked me to supply a detailed hour-by-hour description of the class.  I am posting it here as well so as to inform potential participants as to what the course will be like. The actual content is subject to change according to the assessment of group learning needs at the beginning and as we go along.


“Bringing Critical Care Nursing Education to the Himalayas”

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

With the Association of Joe Niemczura, RN, MS and Amanda Giles, RN

 (Instructor, School of Nursing, University of Hawaii at Manoa and University of Alberta Medical Center, Canada) 

Organized by (Host Agency)

Program Schedule Day One

Date   /Time



0730   – 0800 Registration (prior registration advised, sign-in)
May   20 0800   – 0830 Inauguration:Welcome speech

Remarks from Executive director

0830   0915 Overview of course. Assessment of class knowledge and   demonstration of successful teamwork (expected class outcome)Discussion of elements of critical  emergency response, with demonstration by   instructors about what successful team will look like after three days. Niemczura, Giles, Karki, etc Rules   for good communication during stressful situation. How to be a good team   leader and good team member during emergency
0915-   1030 Cardiac conductive system. Electrical activation cycle. Students   will be required to draw these from memory at beginning of day twosix-step method to interpret ECG rhythms using handout.   Guided practice using this method. Common problems with monitoring. Choice of   lead. Where to place on chest etc. artifacts and problemsolving.

assessment of “hemodynamic impairment” and CCF.

NSR, artifact, bradycardia, tachycardia,

Niemczura. Lecture first, then assisted by Giles and   others to supervise personal guided practice of interpretation in small   groups with personal feedback and recitationThere will use of handout with examples of rhythms in   which student is guided in interpretation.
1030   – 1100 Break  for chiya  
1100-   1230 The six basic rhythms and the two ABCD surveys for   ACLS. (NRS, brady, tachy, asystole, VF, VT)Discussion of electrical safety issues and ground   rules

How to use scenario and how to use protocol. For   this we will use the nine scenarios from American Heart Association handouts.   (students will be given a personal copy of these) Over next days we will go   over these group by group.

Short lecture then break up into groups forROUND ONE   of guided small group practice with personal feedback and repetition of   skills while being videotaped. Use of smartphone video for feedback and   critique.

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

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

1230-   1315 lunch
1315   -1400 Short review of morning teamwork skills.Use of defibrillator, with emphasis on electrical safety   and identification of lethal rhythm.

Pharmacotherapy for VF and tricks   to administer drugs.

ROUND TWO of   small group teamwork skills. 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 List the correct dosage and administration for the   most commonly used pharmaco-therapeutic interventions in Emergency Cardiac   Care List important nursing assessments to apply in a critical situation the   treatment protocols consistent with the American Heart Association guidelines   for Emergency Cardiac Care, in typically recurring scenarios.  ROUND THREE   of small group teamworkIncluding airway scenarios and assisting with   airway

Using tables in classroom or stretchers.

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

1500- 1600  Use effective teamwork and communication skills for   successful intervention in critical nursing situations  ROUND FOUR    as above, skills will be reviewed in   groups with detailed performance feedback given
1600- 1615 Description of next days training For second day, each student is to bring a sharp   knife, an apron, a pair of rubber gloves, two towels, and a cutting board.

Day Two

Date /Time



0800 – 0830

Introduction with quiz on cardiac conductive system from first day Niemczura,   Giles

0830 – 0900

Description and lab of cardiac anatomy  

0900 – 1030

Dissection using en bloc heart-lung assemblies of goats (from butcher   shop) in small groups, with discussion of how to relate this to nursing   assessment and support of goals for medical and surgical intervention. Hands-on. For   this we need tables in classroom. See list of personal supplies to be brought   by each student

1030 – 1100


1100- 1230

Acute M.I., twelve-lead ecg, chest pain protocol. How to look at ST   segment change. Pharmacology of rx of chest pain according to protocol. Small group   practice. Handout.

1230- 1315


1315 – 1400

Review of atrial rhythms, junctional rhythms.  further rhythm practice using sample strips,   guided in small groups.  

1400 – 1500

Quick review of teamwork, then break into groups again. Students take   turns being team leader and team member ROUND FIVE part   one of small group practice. Review of previous days scenario and teamwork,   using different group members than Day One. Now focusing on chest pain   protocol  and adding SVT protocol.

1400- 1500

Description of CCF physiology, listening to lung sounds and   predictors. then breakup into small groups  


  ROUND FIVE   part two practice using groups of different members.

1545 – 1600

Cleaning up class room and   preparing for final day  





Please note: Niemczura will obtain and bring goat organs for dissection section.

Day Three

Date /Time



0800 – 0830

Overview of day  

0830 -0930

Ventricular rhythms, using six-step   method and determine how to incorporate rhythm assessment into overall   assessment.  Drug therapy for these.  

0930- 1030

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.) ROUND SIX special   scenario, also learning to go flexibly from one page of protocol to “put it   all together” in megacode

1030 – 1100


1100 -1230

Pacemaker rhythms. How a pacemaker   works. Small group practice with sample rhythm strips on   paper.

1230- 1315


1315- 1400

Final discussion and review of drug   therapy.  


Final scenario ROUND SEVEN – final scenarios in which groups are expected to flow between all   pages of AHA protocol sheets with no advance warning or hint of what the   problem is.


Final exam  


Presentation of certificates  

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 attached the rhythm simulators.  If you have CPR manikins those would also be good but we can a find and bring from other places. Also, three or four IV poles with IV bag and tubing (these can be non-sterile 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. Wear clothes suitable for activity including kneeling on floor and bending. ( do not wear Sari or nice clothes). Bring a stethoscope. Bring a small blanket to lay on floor if worried about getting dust on clothes. See above list of special supplies for day two.


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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5 Responses to Hour-by-hour description of Critical Care Response Training for Nurses

  1. kripa sankhi says:

    Respected sir/madam,

    I am very glad to know that Critical Care Response Training for Nurses is going to be held very soon. I am very much interested in this training. I would be very thankful if you provide me with the information about the requirements to be fulfilled for being eligible for the training and criteria for the registration. I would look forward for your positive response. Thank you.

    Sincerely, Kripa Sankhi

  2. Resh shrestha says:

    Please can i get the registration detail and educational requirement for this training…..i personally want to attend this program….looking forward for the reply…thank you!!

    • there will be various session offered in KTM Valley and elsewhere, over the summer. the datyes and locations ar enot finalized until after I arrive in Nepal May 14th. please subscribe to the FB page and also to @CCNepal2013 if you have twitter

  3. Pingback: CCNEPal 2014 springs into life. And monsoon will arrive tomorrow May 27 2014 | CCNEPal 2014

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