We had been working at TUTH for a very interesting three weeks educating the emergency nurses. During this time we established that clinical initiative and critical thinking was lacking. In the first three weeks we made progress in developing these skills with bedside teaching, in-services and simulation season. We finished our third week on a high with the nurses embracing the new concept of patient assessment! It as a bonus for us as they appeared to be having fun too - especially when we were getting them to do CPR compressions to the beat of "Gangham Style"!!!
We found that having the backing from senior management and senior clinical nursing staff influenced the attitudes towards educating the emergency nurses and the importance of critical thinking skills.
After experiencing the earthquake on April 25th and seeing the devastation it was having in Kathmandu, we quickly realised the impact this would have on Tribhuvan University Teaching Hospital. Ironically, the week before we attended the 3rd Nepal Emergency Medicine International Conference (NEMIC) in which we were given a lecture on disaster management by the head of the disaster management team! From this lecture, we had some idea of what was expected if a disaster was to occur. Having an idea of this plan, but also knowing the reality of the resources and staffing available made it a no brainer that we were going back to Kathmandu to see where we could help.
Being Emergency Nurses, disaster management was a long term goal for both of us and so to find ourselves in this situation, although scary at times, was a great opportunity and experience.
The two of us were based in the "Red Zone" which was for the critically unwell. Not knowing what to expect was quite daunting when making the way to the hospital, but the best approach was to just put your had down and get on with it. We became walking observation machines, with all the equipment we needed carried around on us at all times. We got straight to work once we arrived in the department - because we already knew the staff and administration, we were able to start work immediately. We assessed patients and intervened where necessary. One thing became very clear to us - nurses still were extremely task orientated and were not utilising critical thinking skills that we had just taught them! We decided we needed to highlight situations that should have been escalated at an earlier stage.
When a nurse would go and put an IV line in, take bloods or put an Nasogastric tube in, they nailed the task every time. But when we asked them why there were doing those things - the answer we mostly received was because the doctor told them to. As we became more clinical after the earthquake our role as educators also changed. When a patient was deteriorating, we could explain why we would be taking the vital signs more frequently, and what interventions could be done without having a doctors order. We hoped that by seeing what our approach to patient care was would inspire them and give them an insight into what their role as emergency nurses could be.
The hospital was de-escalating the emergency protocol after our second day and NTR decided to organise disaster relief packs to assist local NGOs and Individuals going to affected districts. The money we raised during our earthquake appeal gave us the chance to help villages who had not yet received any aid. Our packs were given to local people through word of mouth and social media and we estimated that we gave out 15packs per day.
Thank you to everyone who supported us and NTR during this time!