8 years ago I started as a nurse in Erasmus Medical Centre. I started at the Gastrointestinal Surgical Unit – and I absolutely loved it! It’s a hectic unit, but I learned so much there. I also loved to develop more and I became an oncology nurse and 2 years later I started my training to become an ICU nurse. At the moment, I work in the Thoracic ICU.
To find a fitting NGO to work for was a hard job. I’m not really a fan of the volunteering where you just walk around the hospital, maybe taking care of a few patients. Its not sustainable for the development of healthcare in a third world country. And I certainly don’t want to take a job from Nepali nurses! Googling ‘NGO’, ‘Nurse’, ‘Nepal’ I found a lot of organisations, and finally I found Nurse Teach Reach! I loved the goal of NTR, “developing nurses in developing countries, give nurses in developing countries the skills and encouragement they deserve”. It’s sustainable, and I didn’t find another organisation (for a shorter time) with the same goals. And Bonobo as background music at the promo video made my decision to go for NTR even more easily! ;)
- Practice head to toe assessments individually with every nurse.
- Support the preceptors to do the Head to Toe assessments with the ICU nurses.
- Planned a bed-side teaching every day, every week a different topic (system). Practically on neurological examination of the patient, assessing sufficient or insufficient breathing, circulation, etc.
- Collecting logbooks; motivate & support the nurses to make the logbooks.
- In collaboration with Lucy, the Nurse Unit Manager, Preceptors and ICU nurses we made a new ‘Nursing Assessment’ chart, which was attached to the chart they already use.
I planned to work with the preceptors and support them in supporting the other nurses with the physical assessments. Also practice and test the physical assessments and make an inventory of the progress of the logbooks.
A proactive and direct attitude is necessary to get somewhere in Nepal. It is not Nepali style to be direct, but because they have agreed to the program in which Nurse Teach Reach provides, guidance is needed. I was very happy that I travelled around Nepal the first month. I was kind of used to the country, the culture the people, the languages, the way they speak English. If you have the opportunity, before start at NTR, travel around it will help you. The culture shock is less, for me it was for sure.
The ICU nurses do take good care of their patients. They are very dedicated in preventing bed sores, bed washing, feeding, medication administration and basic nursing tasks. Most of my time in the ICU there was 7 or 8 beds occupied, and 3 or 4 ICU nurses. They were busy all the time.
The first thing I noticed is that everybody is taking care of every patient. They work task oriented, and that makes it difficult to practice a total head to toe assessment. Some nurses can do the assessment quickly and efficiently with accurate conclusions, some nurses can’t. It’s difficult for them to link the different bodies systems. That, for example, genitourinary system can influent the neurological part and later on the respiratory system. I tried to convince them, in my opinion, that’s the most ‘fun’ thing to do as an ICU nurses, to assess your patient in total and puzzle a conclusion.
A couple of the ICU nurses are really eager to learn more. But they want to know more of the advanced topics at the ICU. At the moment, some of the basics aren’t there, for example, a physical assessment with every patient every shift isn’t done. So it’s hard to provide education on advanced topics. In the second week I found that more GCS were written down in the charts! (Yeah!)
It is impossible to change the way of working (in six weeks), it's something I could not expect from myself. And I think, even arrogant towards the Nepali nurses if you think you change it all, but also just frustrating for yourself. So Lucy, Sunaina, the NUM and nursing director and I had a meeting. We have proposed to develop a Physical Assessment chart to confirm the nursing chart. To stimulate the nursing physical examination in this manner in their daily work. We planned on doing it at the start of the shift, when a patient is admitted, or when a patient deteriorates. To begin, we agreed that the patient gets their own responsible nurse per shift and they were expected to carry out the physical assessment. We got the support of the Nurse Unit Manager and Nursing Director.
It would be ideal if they do this for the doctor rounds to make a plan together for the patient. But it would be great if every patient in every shift has a nurse who does a Head to Toe assessment. This is something im sure NTR will continue in the future.
Unfortunately, after that I could not go on with the program in Patan Hospital. I visited them twice, and thank god, they were all okay. The work we did with NTR changed immediately. We tried to do as much as what was in our power. The team with Lucy, Bridie, Steph, Laura and Alice was incredible & fantastic! We have had so much support to one another. "Work hard, play hard! '.