icu nursing in nepal june 30 2013


Announcement: CCNEPal will once again go to Pokhara, the second-largest city in the country, August 8th, 9th, and 10th. For the first session there were thirty seats and a hundred applicants, this time we will offer a larger number of seats and make other changes to accommodate class size. It’s made possible because Kaski Sewa Hospital is committed to build capacity of nursing workforce in Pokhara. In the previous course, there were nurses from seven different hospitals and four schools of nursing. Let’s all work together!

To register contact Mario Hughes at Kaski Sewa. Bring a pen drive. He will give documents to study in advance.

Halfway point

This week is halfway through the summer. I am halfway through the training and half the certificates have been signed and given to happy participants. I am humbled by the positive responses I have gotten to the training.

Zombies in Nepal?

One recent participant commented that ‘the repetitive drills make everyone into zombies. “You say that as if it is a bad thing” was my reply. Responding to an emergency can be stressful, but if you practice enough, the fear and anxiety is diminished and certain steps become automatic. It is simply the mark of a well-trained nurse that she keeps calm in an emergency.

The Rana-era  Ballroom with the crystal chandelier

In July we will do four sessions at LNC in Sanepa. Their campus is in a former Rana palace. The classroom is – the former ballroom. It’s the best classroom in Nepal if you ask me, and LNC was a wonderful host in 2011.

Road Trip thanks –

Every stop on the Road Trip was fun. People were wonderful toward me. I am reminded that Nepal is more than just KTM. Sita Parajuli, Aarju Niraula, Jeba Davasingh, Usha Maharjan, Ramesh subba, Moti Chapagain, Mario Hughes, Bandana Pokharel, sushila neupane, Shweta Shakya – deserve special mention. I got YouTube interviews with some of these persons, you are invited to view these on YouTube.

“The Doctor-Nurse Game” and attitude of doctors toward Critical Care Nursing in Nepal

Time to stop and step back. The health system of Nepal is changing and many hospitals are opening critical care units (ICUs).

This is a shift. Til recently, everyone agreed that the resources in Nepal needed to focus on preventative care – things such as diarrheal illness and public health. The largest number of preventable “excess deaths” were to be addressed with that focus. That was where the cost-benefit analysis said that programs should be developed.

Now with more foreign-trained surgeons, more medical schools, and the like, Nepal is adopting more of a westernized approach. almost b default

How many ICUs are needed and how many nurses are needed?

The few existing training programs can not possibly meet all the demand for trained nurses, even if the all trained ones stayed in Nepal (many go to UK or Aus…).

Also, nursing education at PCL level is simply not designed to train people for ICU nursing.  The B Sc nurses are much more able to do ICU due to science background.  (My opinion is, Nepal government needs to phase out PCL nursing altogether.)

This is where CCNEPal comes in. Our program fills a gap in nurses knowledge.  We give practical skills that help a nurse be more confident.

I recently read an article about the status of critical care medicine in Nepal published in a medical journal written by a doctor from TUTH. Much of the article was devoted to a survey as to which high-tech medical tools (arterial lines or CRRT for example) are being used. The author devoted a small paragraph to the issue of trained ICU nurses. That was all.

In USA, it’s the training and skill of the nurses to use the ICU equipment that defines critical care.  Nepal needs to recognize this and not only focus on the doctors. I think the nurse labor supply was  overlooked in this article, because there are many male doctors here who do not respect female health workers. Most would deny it, but the truth is, it simply doesn’t occur to them. It’s not on their radar screen. In this culture, boys grow up differently than girls.

This  attitude reflects the culture in which the opinions of women are valued less. Unless a hospital recognizes the value of nursing, it will never have a good ICU. Not ever.  Let’s all work to create a hospital  culture where nurses have their own skill and their own knowledge.

Nurses here are not routinely taught to listen to patient’s lung sounds as part of assessment. Teaching nurses about “rapid response” is missing in a lot of nursing schools. “Failure to Rescue” is an issue here, one that can only be discussed when nurses are in a front seat at the table. If you aren’t familiar with the “failure to rescue” issue, you need to Google it. These elements of critical care extend beyond the ICU into the rest of the hospital.

About Joe Niemczura, RN, MS

Experienced nursing educator and problem-solver. I have fifteen years of USA nursing faculty background. Add it with 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. I travel outside of Kathmandu Valley as well. When the recent violence happened, I knew the cities - I had trained people in those locations. 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. Global Health Nursing is not all sweetness and light; not solely milk & honey and happy moms and babies.
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One Response to icu nursing in nepal june 30 2013

  1. susan says:

    thats true sir

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