Preliminary report of CCNEPal 2013
The CCNEPal 2013 summer critical care nursing project is winding down. A single one-day training event remains, then we pack up our tents.
This was an extension of the 2011 summer program which trained 190 nurses in critical care skills.
It should be noted that the lead instructor holds a Nepali RN license and is legally able to teach in Nepal in accordance with the laws. This project was conducted on a voluntary basis.
Needs assessment was conducted from 2007 to 2009 while the principal was doing bedside teaching of nursing students at PCL level in Nepal, and through interviews with a wide range of stakeholders familiar with standards of acute care in Nepal.
It became obvious that there is presently a paradigm shift in acute care in Nepal, with the desire to offer more sophisticated services that rely on critical care nurses, as opposed to the longstanding focus on public health-oriented preventative care which accepted a lower level of acute services. This has many implications, not the least of which is the issue of sustainability of the funding model.
A related issue is a change in tobacco use among youth, which will cause an epidemic of heart disease in the next ten to twenty years. Government policies about tobacco are in place but need to be strengthened as well. Tobacco is a ticking time-bomb in Nepal.
Present systems to train nurses in this skillset are not meeting the manpower needs.
Description of program:
We did sixteen 3-day sessions of critical care skills training between May and August 2013. These sessions were based on the American Heart Association (AHA) standards for Advanced Cardiac Life Support (ACLS) modified to meet the needs of Nepali nurses. We did not use PowerPoint or DVD resources due to unreliability of local electricity and technology and the learning style of Nepali students.
The 3-day course also included basic science not generally taught to nurses in Nepal. For a course outline and objectives, click on the link. A FaceBook page and YouTube provides ample photographic and video documentation of events.
Teaching style and classroom management
The CCNEPal project was designed to deliver skill content but as a corollary benefit, the style of classroom management is universally considered to be new to Nepal. Many participants were working as nursing instructors in schools of nursing. For these, the course modeled an active teaching and learning style. Specific further efforts to work with nursing teachers may be a worthwhile related project in the future.
Low tech equipment
Teaching an “Official” ACLS course in Nepal is cost-prohibitive due to detailed requirements for specific expensive equipment. Certain standards of AHA have limited applicability for Nepal (AEDs). We improvised various methods of teaching which used low-tech substitutes. We did bring 2 “A.T. 35” rhythm simulators (Pinnacle Technologies, Michigan USA) which were extremely worthwhile. These will be in the custody of one of our major partners until we return.
The project distributed donated nursing textbooks at various locations. There were not as many books as in past years.
The project relied on a FaceBook page to market the program, and the main site counted more than 3,200 “likes.”
Some sessions were sponsored by teaching hospitals associated with medical schools in Nepal, some were hosted by schools of nursing, and one was conducted for a consultancy sponsoring an NCLEX prep course. Four of the sessions in Kathmandu were offered at Lalitpur Nursing Campus (LNC) on a “first-come first-serve” enrollment basis. Interest in the course continued to grow as the summer progressed. Hospitals continued to request the training for their location after the schedule was full, based on highly positive word-of-mouth. Likewise, not all nurses could be accommodated.
Several one-day sessions were added as well which did not lead to a certificate.
The 3-day session was offered at 5 locations outside Kathmandu Valley during a 19-day “Road Trip” in June, and a return trip to Pokhara (Nepal’s second-largest city) in August. The Road Trip would not have been possible without the logistical support of the hosts in the out-of-Valley locations, especially since the final schedule was improvised with a short planning frame. At each location the session included an assessment of hospital learning needs with the nursing matron and administrators.
Amanda Giles, RN,BSN
In the early part of the project, a nurse from Canada, Amanda Giles, RN, was involved and also did some training on the hospital wards of various locations. She was excellent but was not able to stay for the duration.
As the summer progressed, we relied on Nepali nurses to help run each session of the program, which was invaluable. With that approach we directly mentored almost two dozen nepali nurses in scenario-based teaching of ACLS mega-code and teamwork skills. These are future leaders. In the long run, every step to promote Nepali “ownership” of teaching must be taken and this is a beginning.
Final exam and certificate
Course completion included a final exam in which a team of nurses performed a practical exam based on ACLS megacode, in front of their peers. A certificate was given to each participant who passed the final exam. The numbers were as follows:
Shahid Gangalal National Heart Center (SGNHC) 31
Secured Life International Group (NCLEX group) (Chaubahil) 25
Sumeru Hospital (Dhapakhel) 18
College of Medical Sciences (CMS) (Bharatpur) 39
Chitwan Medical College (CMC) (Bharatpur) 34
Kaski Sewa (Pokhara) 34
Lumbini Medical College (LMC) (Palpa) 32
Mayadevi Technical College (MTC) Butwal 30
Lalitpur Nursing Campus (LNC) #1 29
Nepal Medical College (NMC) (including 15 MDs) 45
Kist Medical College (KMC) 31
Iwamura Health Science Institute (Bhaktapur) 28
Kaski Sewa (repeat) 64
Final total number of certificates:
519 nurses and 15 MDs.
There were many people whose assistance and support of project goals eased the path of CCNEPal 2013, and it is simply not possible to acknowledge all of them. At times, this project seemed to be riding a wave of good karma in which many conspired to remove obstacles from the path. This is an indicator of the deep desire of Nepali health professionals to offer the best for their fellow citizens and patients, in the highest traditions of medicine and nursing. In a deep sense we were able to make room for joy during the learning process.
Names of specific contact persons:
Matron Mrs. Nita Dongol Shrestha, RN (SGNHC)
Mrs Shirley Evans, RN, BS (SLI group)
Deputy Matron Mrs. Susan Maharjan, RN (Sumeru Hospital)
Matron Mrs Sita Parajuli RN and faculty Mrs Arju Naraula, RN (CMS)
Medical school faculty Moti Chapagain, MD (CMC)
Matron Sushila Neupane, RN (Kaski Sewa Hospital, Pokhara)
Matron Bandana Pokharel, RN (LMC)
Campus Chief Mrs Bedana Thulung, RN (MTC)
shweta shakya, rn
Campus Chief Mrs Radha Bangdel, RN, (LNC)
Campus Chief Mrs. Kalpana Shrestha, RN (NMC)
Matron Mrs. Urmila Shrestha,RN(NMC)
Chief of Anesthesiology Gautam Bajracharya, MD (NMC)
Matron Mrs. Ambhika Ghimire, rn (Kist)
Nursing faculty Ms. Manisha Daubangour, RN ( Iwamura).
Prospective future hosts or participants are encouraged to contact these individuals to gather their perspective as to the project. Of course, the 519 nurses and 15 doctors who enrolled are likely to also have an opinion.
There is more to share regarding how this project interfaces with nursing education in Nepal, as well as the complicated manpower/labor market issues in the country.
The emphasis on large training numbers was partly intended to demonstrate the need among a wide swath of nurses in the hopes of creating public opinion that would favor this area of education.
Time will be taken to reflect on the structure and goals of future efforts before another project is planned. Clearly, a network of people now exists, contacts have been made, and good will has been established.
This report will continue to evolve. Feedback and ideas are welcome. It has been an honor and privilege to work with so many fine people dedicated to the advancement of medical care in Nepal.
Joe Niemczura, RN, MS