May 19 about teamwork in critical care nursing

And here in Kathmandu we begin teaching this week

CCNEPal 2013’s first 3-day course will begin tomorrow. Most of our courses will be open to “the general public” of nurses – I promise that there will be a registration process that allows a nurse to enroll even if she is not currently working in critical care. In June and July we will have at least four such sessions of thirty each, meaning that 120 nurses will be given the opportunity.

I knew from the beginning that these would take time to organize, so I set up the sessions hosted by specific hospitals, first. This week we will be at Shahid Gangalal National Heart Centre (SGNHC) , and I am honored to work with them. I was there to see the facilities and to meet the nurses this week. So happy to see some of the people who took my course in 2011. SGHNC has a wonderful nursing staff. I was very impressed with the facility, the attitude and the care of patients that I observed.

The Team approach

I pre-mailed  them a free resource on ecg weeks ago, and they will have studied it before we get there. Because of the volume of patients with continuous heart monitoring there, they are likely to ask a higher level of questions. Sometimes I do more ecg teaching, but pre-study will allow us to move on to more exciting things. and – that means looking at team work skills.

the American Heart Association ACLS manual has a set of specific do’s and don’t related to teamwork.

they are:

use closed-loop communication – repeat orders back so as to avoid confusion

clear messages – no mumbling!

clear roles – somebody has to be in charge

know your personal limits practice things beforehand

share knowledge – and up-to-date data

use constructive intervention if a team member is uncertain about a skill. everyone watches each other and helps each other.

re-evaluate and summarize on a periodic basis ( two minutes)

exhibit mutual respect – no shouting, no sarcasm

Stating the obvious?

Some people may say, “of course I am a good team worker!” but are you really?

These may seem really obvious, but we go out of our way to teach these skills in USA, and we will bring that same goal to Nepal.  People can come to the course prepared with ecg knowledge and pharmacology, and if they do, we can spend more time working on teamwork skills. The best is to do some roleplay situations (“scenarios”) and discuss. as an added element, we will use smartphone video to guide the feedback we give. There are samples from 2011 on YouTube, and I will add some from this year (I hope).


We will also deal with fear. Fear of appearing to be stupid, fear of failure, fear of being ridiculed, fear of making a mistake. The nice thing about simulation in ACLS is that nobody actually gets hurt. You learn from your mistakes.

fear.  hate-this-and-don’t-want-anything-to-do-with-it fear.

wanna-run-and-hide fear.

wanna-throw-up fear.

fear of body fluids ( some fears are valid…)

I-made-a-mistake-and-killed-somebody fear.

We know we are trying to teach you how to be at your best during the most difficult possible time you can have – trying to prevent the premature death of a fellow human being. Feeling the weight of the death you are trying to prevent..

Teamwork is the answer to fear.

Fear faced by respondents during an ACLS event  will be something to talk about during a future blog. and during the course.


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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2 Responses to May 19 about teamwork in critical care nursing

  1. kripa sankhi says:

    Hello! I want to know whether the training is starting from may 20 at Sahid Gangalal National Heart Centre? I want to participate in the course.What should I do to participate? Thankyou.

    Kripa Sankhi

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