about fear of participating in ACLS

Fear of ACLS

My blog post yesterday was prompted by a nurse who said she was afraid of doing ACLS. She felt fear. Ahhhh… I know this fear……. we all do.

I suppose more questioning is needed. We are dealing with the skills needed to prevent death in a patient who ought to live – if only we can save them. Is it fear? or anxiety? to what degree are they mixed? what is the past history that may have caused the person to dislike being in those situations? is it that somebody shouted at her when some step may have been done wrong? is it that she is afraid her mind will go blank? was it dealing with the emotions of family, or perhaps triggering her own feelings about a critically ill loved one?


I don’t have the plan to address each of these, I think it’s important for everyone to do their psychological work. Here in Nepal, there are some subtle but longstanding taboos about dealing with intimate body functions when the patient is of another caste, and people have been conditioned culturally to avoid at all costs. I do think this is a factor. Also, the family of a patient may be angry or emotional and this is a source of stress.

Scenario-based training

The basis of my course here is simulation. and scenario-based training. We use the scenarios of typical situations developed by the American Heart Association. (A.H.A.) A.H.A.  has been doing this in USA for decades, but though people periodically offer courses in Nepal, it is still new here. The beauty of simulated training is that it is okay to make a mistake in this setting. You can’t hurt the manikin, because it is not alive. we are talking about complicated things here and everyone needs to learn them somehow. it is better to learn them in a controlled environment where the people around you are relaxed, than to learn them on the job with no advance study or coaching. we will drill on the scenarios over and over until you feel comfortable. In a real-life situation, you will often feel like there is no time to ask questions. with scenario-based training we can debrief and start over again. we can eliminate the emotional component during the time you are learning.

Brain Cramp

there is a term that most Nepali nurses have not heard, but which all USA nurses know. it is called “Brain Cramp” – and it tells about when you are supposed to recall something but your mind goes completely blank. it is caused by adrenaline surge. Scenario-based training will help you to overcome this and use the wisdom of the group to function.



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 The Hospital at the End of the World and tagged , , , , , , , , , , . Bookmark the permalink.

Leave a Reply

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

WordPress.com Logo

You are commenting using your WordPress.com 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