part 3: teaching critical care. take the quiz about cultural differences in education

People are the product of their environment.

I’m still on the meandering path to describing my inside secrets of how and why I teach critical care nursing the way I do. I am not a person who stands behind a podium and drones on with a PowerPoint, and in USA I never have been. Even in the USA, my style of teaching is considered to be “colorful” and “out of the box” but I get results.

Anyway, one of the beneficial things for me in Nepal has been to be at a school of nursing while I was teaching. I sat in the back of the class a few times, or else  in the library or in the corridors I overheard small groups of students, which gave me some idea of their expectation of “normal.”  It allows me to look at what the expected lecture style is, here.

About the elementary school

okayokayokay I confess, I lied yesterday when I said I went to an elementary  school. I have never visited an elementary school in Nepal as of yet. Oh, I walk past them and I hear them singing or chanting. Nowadays the kids wear uniforms including neckties. Each school has a particular set of matching colors.

Now to the meat of this, and it will be interactive!


make a list of the eleven statements below, and next to each one, answer the question ” How would I change my teaching approach if I knew this?”

real teacher would take these assessment and do this exact thing.

The usual warnings apply. these are generalizations. Not everybody got taught this way. I am not disrespecting anybody just because I am pointing out that people in a Low Income Country need to adjust. if you think I am inaccurate, please reply below, I will accept correction or different perception.

are you ready?

Here Goes!

– It is rare to own a personal copy of a western-style textbook. When the students have a personal textbook, it is a least-expensive version from India. Western books are inordinately expensive. (that’s why I bring them every time I come here, to donate to a nursing library, and you should too).

– The Nepali students learn at an early age to memorize things and regurgitate them. They are far better at rote memorization than any comparable group of USA students.

-the textbooks are in English, as a rule. it is expensive to create a Nepali translation, and this is true in medicine, engineering and other sciences as well as nursing.

– students don’t use the textbook the same way as USA. Since they don’t own a personal book, they study in groups. The student with the best English reads it out loud, then they discuss it in Nepali.

– Students will take notes out of a textbook, copying by hand, and memorize these. Many times I have seen a lone student pace in a circle and recite out loud as a means of nailing it down. They are less good at synthesizing – e.g., comparing the value of what they memorized against conflicting information. This makes it harder for them to improvise.

– every Nepali over the age of 16 that you will meet, has survived the dreaded “SLC” (School Leaving Certificate) exam. This is also known as “The Iron Gate.  The authorities are thinking of changing this system, but for now, it is what they have. A poor SLC score is a catastrophe, and has led to many teen suicides. You only proceed with formal education when you have a good SLC score.

– this is a “collectivist culture” – meaning that the group is more important than the individual. People are reluctant to ever be singled out. It’s also very gender-differentiated, and for many women, this means that they are extremely reluctant to challenge the opinion of a male. It’s also Buddhist, which means that if a person is “senior” to you, you are under pressure to follow their lead. Many people think it is impolite to ask a question of a teacher.

– the certificate is everything. All your education is in a file you keep, and you must show you are qualified, by producing a certificate. preferably signed by a videshi ( foreigner) and nice-looking. a cheap computer printout will not do.

– the expectation for a class is that the teacher stands in front and lectures. People are very very surprised when they see the hands-on nature of what I do, which involves a lot of small group work and personal critique.

– if you teach a class in a school, the students will jump to attention with a “Namaste Sir!” gesture when you walk into the classroom. they will not leave without asking permission, and when they come back, they will again gesture at the door until they receive permission to enter.

– I have the idea that when boys are in a classroom and they act “exuberant” their behavior is tolerated, since  – they are boys. And girls are taught in all segments of life, to be quieter and more respectful. I know this is a generalization.  it is not unique to Nepali society, but it is there. There is a growing movement among fathers, not to limit their daughter’s achievement. which is good.

Do I have your mind churning yet?

This quiz is scored. to see your grade, submit your response in the “reply” section below, in the form of your reaction, and I will assign a grade based on the quality of thought.

For each of the statements above, a trained teacher ought to have an “aha!” moment. how does each of those things change what you might do in a class room? if you think about it, you will find the answer. For those of you who are not teachers, there is a concept known as “classroom management.”


PS you get five extra points on this quiz if you click here and read the whole page.





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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1 Response to part 3: teaching critical care. take the quiz about cultural differences in education

  1. Pingback: CCNEPal Preliminary report for 2015, late May, part one, just the facts….. | CCNEPal 2015

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