In 2013 somebody asked to see the schedule for the course. it’s a reasonable request, but – I had not written it down. so I dashed off a reply. Two weeks ago I updated the schedule to reflect what we actually do. Here it is.
“Bringing Critical Care Nursing Education to the Himalayas”
Critical Care Nursing Assessment and Advanced Cardiac Life Support (ACLS) Training
Joe Niemczura, RN, MS, (Principal Faculty, CCNEPal )
Program Schedule Day One
|Date /Time||Topic||Notes (⃝ = place for mini-lecture)|
|0900 – 0915||Registration (prior registration advised, sign-in)||Give teamwork handout, ask early attendees to read while waiting for late® arrivals. Give 15 minutes for late arrivals due to traffic etc. Go around room and ask each participant to tell their name and introduce themselves to group (language assessment)|
|0915||Overview of course. Assessment of class knowledge and demonstration of successful teamwork (expected class outcome)
Discussion of elements of critical emergency response, with demonstration by instructors about what successful team will look like after three days.
|Teamwork handout. ⃝
⃝ Group exercise in giving receiving, and repeating orders. Use typical med orders that will appear later in class.
Go over where to stand when you arrive at an emergency, division of tasks etc
|0930||Four steps in CPR||As on page eight of protocol. ⃝ Interactive exercise. Use toy balls for manikins, also use music “ Ready” and “Resum Firiri”|
|1000||Bag resuscitator||⃝ Positioning airway, E-C method. Take turns. Double E C method. Use handout of bag resuscitator. Time to disassemble and reassemble bag-valve-mask.|
|1030||Onliest six rhythms The six basic rhythms and the two ABCD surveys for ACLS. (NRS, brady, tachy, asystole, VF, VT)||⃝ Intro to flash cards.
Importance of VFib. 2-step VF drill.
|1045||Division of tasks on arrival.||IV, O2, monitor, saO2.|
|Electrical safety||“I’m clear, etc” – and pulse check.|
|1045||Divide into groups||Choose group name(s)|
|1100||First drill. Explanation of rotation system||ROUND ONE of scenarios.Focus on communication skill.
Scenario number one. (VF – NSR)
|debrief||Gather together for report from assistants.|
|1300||Cardiac conductive system. Electrical activation cycle. Students will be required to draw the four answers from memory at beginning of day two
⃝ Four questions on quiz – chemical cycle, electrical cycle of one cell, PQRST, conductive system with intrinsic rates.
|⃝ Lecture first, then assisted by others to supervise personal guided practice of interpretation in small groups with personal feedback and recitation
There will use of handout with examples of rhythms in which student is guided in interpretation.
|1345||How to read ecg paper||⃝ Large and small boxes, hash marks, six-second sections, etc.|
|1400||six-step method to interpret ECG rhythms using handout. Guided practice using this method. Common problems with monitoring. Choice of lead. Where to place on chest etc. artifacts and problemsolving.||The grid handout. ⃝ How to perform each of the six steps.
⃝ ecg dance
|Break for chiya|
|1430||Rhythm strips, using system|
|1445||How to use scenario and how to use protocol. For this we will use the nine scenarios from American Heart Association handouts. (students will be given a personal copy of eight-page protocol sheet.) Over next days we will go over these group by group.||Short lecture then break up into groups for
ROUND TWO of guided small group practice with personal feedback and repetition of skills while being videotaped. Use of smartphone video for feedback and critique.
TWO monitor/defibrillator units are requested for this. Scenarios will include universal protocol.
Also will use five bag-valve-mask devices
|Four possible outcomes of defibrillation
NSR, Asystole, recurrent VF, PEA.
|Go over steps to respond to each.
5H and 4T (depends on audience)
|Short review of morning teamwork skills.||ROUND THREE of small group teamwork skills. Start with review of scenario number one. Then go to four possible outcomes. break up into groups and rotate between stations.|
|Review of eight-page protocol handout from AHA, being on same page (define)||⃝ AHA handout.|
|1400- 1500||Acute coronary syndromes. ⃝ MONA.
How to assess awake victim.
|30 and 90 minutes to strepto or cath lab respectively.|
|Use effective teamwork and communication skills for successful intervention in critical nursing situations||ROUND FOUR of small group teamwork, assessment of chest pain victim, followed by MONA and possible VF.
|1600- 1615||Description of next days training. Get mobile numbers, explain about phokso.||For second day, each group brings in a phokso.|
|0900 – 0930||Introduction with quiz on cardiac conductive system from first day.||Niemczura, team.|
|0930 – 1000||Rhythm strips. Description and lab of cardiac anatomy||⃝|
|1000 – 1115||Dissection using en bloc heart-lung assemblies of goats (from butcher shop) in small groups, with discussion of how to relate this to nursing assessment and support of goals for medical and surgical intervention.||⃝ Hands-on. For this we need tables in classroom.|
|1115- 1230||Page 5 part two. Acute M.I., twelve-lead ecg, chest pain protocol. How to look at ST segment change. Pharmacology of rx of chest pain according to protocol.||⃝ chaat paati exercise ROUND FIVE mona. Small group practice. Handout.|
|1315 – 1400||Review of atrial rhythms, junctional rhythms. further rhythm practice using sample strips, guided in small groups.||⃝ The grid, and atlas handouts.|
|Steps in defibrillation||⃝ Interactive group practice exercise of ten steps. Quiz on day three.|
|1345 – 1400||Quick review of teamwork, then break into groups again. Students take turns being team leader and team member||ROUND SIX small group practice. Review of previous days scenario and teamwork, using different group members than Day One. Now focusing on chest pain protocol|
|1400- 1500||Bradycardia protocol. Definition of hemodynamic impairment. (Bp, chestpain, sweatiness).||Reminder: find best actresses.|
|1500-1545||Scenario of chest pain with bradycardia.||ROUND SEVEN|
|Introduction to tachycardia scenarios||⃝ Morphine overdose. discussion.
⃝ Treatable causes game.
|1545 – 1600||Cleaning up class room and preparing for final day|
|0800 – 0830||Overview of day, quiz on steps of defibrillation.|
|Depending on availability of defibrillator, guided practice using steps of defibrillation.
Depending on availability of monitor, practice using the grid to interpret ecg via eyeball method.
|Sync button. ⃝ Additional steps in synched current.|
|0830 -0930||Review of tachycardia scenarios with demo.||ROUND EIGHT practice focusing on specific tachycardia scenarios.|
|Final ecg practice using paper handouts and grid.||⃝|
|0930- 1030||Special scenarios related to unusual conditions. Review of second ABCD survey to determine less-frequently occurring scenarios ( hypothermia, drug overdose, renal failure, weedkiller overdose therapy, etc.)||Large role play.|
|Family counseling issues.||ROUND NINE special scenario, also learning to go flexibly from one page of protocol to “put it all together” in megacode|
|1030 – 1100||Debriefing.|
|1100 -1230||Practice with bag resuscitators||⃝ game for speed|
|1300- 1400||Final practice round||ROUND SEVEN – final scenarios in which groups are expected to flow between all pages of AHA protocol sheets with no advance warning or hint of what the problem is.|
|1400-1430||Small group discussion, in Nepali, self-guided.||Gather equipment at this time.|
|1430-1500||Final exam||Large group, names in hat.|
|1500||Presentation of certificates|
Prior to class – students will be given large electronic file on ecg rhythms for study, also protocol handouts.
Notes about classroom setup – we need a classroom that can hold about thirty people, preferably with flat floor ( not a sloping auditorium) and no carpeting. Ability to sit at tables so as to work with handouts and sample strips. Whiteboard or blackboard with colored marker pens and or colored chalk. A computer monitor for powerpoint is ideal but not necessary. When we break out into small groups, it is preferable to use adjacent spaces so as to keep noise level down. We are flexible about this. Screens can be used.
Notes about equipment: we need two monitor-defibrillator units to which we will attach our 2 AT-34 rhythm generators. If you have CPR manikins those would also be good but not necessary. Three or four IV poles with IV bag and tubing (these can be nonsterile ones that would be otherwise discarded) and bag-valve-masks and airway equipment. If you can bring two or three patient stretchers that would be good but if not we can use tables instead. An Overhead projector.
Students bring a smartphone if they have one with video capability. Their own pen and notebook. Wear clothes suitable for activity including kneeling on floor and bending. Bring a small blanket to lay on floor if worried about getting dust on clothes.