Updated hour-by-hour schedule for 3-day course on critical care nursing

Executive summary

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.
1230 lunch
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.

Page 5.

How to assess awake victim.

30 and 90 minutes to strepto or cath lab respectively.
1500- 1600


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.

Day Two

Date /Time Topic                Speaker
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.
1230- 1315 lunch  
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  

Day Three

Date /Time Topic                Speaker
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
1230- 1300 lunch  
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.

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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