Career advice

Overseas education exchange: what we learned about investing in nurse leadership

Six-month trauma management teaching trip to Myanmar was a rich learning experience

Six-month trauma management teaching trip to Myanmar was a rich learning experience

Olivia Rees leads a learning session on the ICU. 

We recently spent six months in Myanmar, working on projects to improve the intensive care management of trauma patients.

The trip was part of a partnership between Cambridge University Hospitals NHS Foundation Trust and Yangon General Hospital (YGH) in the Myanmar capital.

Our trip, beginning in September 2018, was part of the Cambridge Yangon Trauma Intervention Project, a collaboration funded by the Tropical Health Education Trust (THET) that aims to improve the treatment of severely injured trauma patients in Myanmar.

Healthcare teaching exchange programme

The collaboration has been established for several years and involves UK delegations leading multidisciplinary teaching courses, as well as Myanmar health system leaders visiting Cambridge.

As part of the project’s development, we volunteered to go to the intensive care unit (ICU) at YGH to lead research and improvement projects.

‘Relatives do most of the personal care, leaving the nurses to administer medicines, perform chest physiotherapy and assist with clinical interventions’

Our aims were to make clinical improvements possible by empowering local nurses and build our shared knowledge of local trauma pathways to encourage sustainable improvements.

Although we had some basic information about the hospital and the ICU, as the first long-term volunteers, we didn’t know what methods we could use and how easy it would be to affect change.

What we encountered was a fascinating challenge.

The familiar activities of an ICU in an unfamiliar cultural setting

Yangon General is a huge red-brick building in the centre of the city. What we would consider to be old-fashioned ambulances queue with taxis and private cars to deliver trauma patients to the emergency department (ED) where an effective triage system awaits them.

The red-brick facade of Yangon General Hospital.

Patients and relatives visit a market stretching along one side of the hospital for drugs, prosthetics and other medical products. When we were led into the ICU on our first morning, we passed families sleeping on mats and cooking in the corridors.

The ICU has 20 spaces for a 2,000-bed hospital and is almost always at capacity. Trauma patients are a large part of the caseload, with many requiring treatment and ventilation for tetanus.

Five or six nurses work an average shift. Relatives do most of the personal care, leaving the nurses to administer medicines, perform chest physiotherapy and assist with clinical interventions. As government salaries are small, many of the nurses work overtime in private hospitals to provide for their families.

Teaching sessions on the unit

We were warmly welcomed and impressed by the nurses’ clinical skills and knowledge, which left us wondering what we could teach them and how.

Early on in the project, we led afternoon bedside teaching sessions on spinal cord injury, a subject the nurses had proposed. We played the role of patients to demonstrate spinal precautions, and soon many staff were laughing and participating.

We built on this by establishing regular Friday afternoon teaching in the ICU to maximise attendance. Throughout the six months, we taught on subjects proposed by the local nurses and introduced topics we felt were worthwhile, such as sepsis or infection control.

‘Feedback was positive – we saw how much the nurses gained from dedicated time to learn and practise their skills’

We encouraged and assisted senior nurses to prepare and teach sessions, hoping we could stimulate a culture of learning that would continue in our absence.

A nurse holds one of the new
information folders on the ICU.

These sessions were used to launch a quality improvement project in which we collaboratively designed and implemented a care bundle to reduce incidence of line-associated infections in the ICU, an area we had noticed where practice could be improved.

Improvements were achieved through diverse teaching methods

Through group teaching, one-to-one learning, the dissemination of educational materials and promotion of infection control ‘champions’, we achieved big improvements in hand hygiene, documentation, line decontamination and the use of personal protective equipment. 

Nurses and doctors on the ICU also learned much about clinician-led quality improvement.

The nurses had little experience of simulation training, so we implemented a resuscitation skills programme, training 40 nurses and students in CPR (cardiopulmonary resuscitation), basic airway management and defibrillation.

We collected some interesting data on their experiences and confidence levels, and feedback was positive – we saw how much the nurses gained from dedicated time to learn and practise their skills.

Our time in Myanmar, while occasionally challenging, was a rewarding and transformative experience. The health service is under-resourced and nurses face big challenges to provide safe and effective care to trauma patients.

The same challenges… whether you’re a nurse in Myanmar or the UK

Despite what seemed at first to be vast differences between the UK and Myanmar, many barriers to nurse-led improvements are the same: organisational rigidity, lack of time and resources and inherited hierarchies

Our project worked most effectively when we thought creatively about ways to overcome these issues, including bringing teaching to the bedside, empowering respected clinicians and introducing new forms of learning.

Observing the students made us realise the value of investing in nurse leadership. Picture: iStock

Give nurses the time and skills to lead

We also tried to empower the nursing team by acknowledging their skills, involving them in decision-making and actively collaborating at every step – methods that can also work in the NHS.

But these improvements can only go so far without dedicated long-term investment to sustain projects and give nurses time to lead.

Towards the end of our project, seeing a nurse on the ICU teaching students with pride about their line care bundle made us appreciate more than ever the value we gain by investing in nurse leadership.

With the right support and creativity we can lead change, at home and abroad.

Stuart Tuckwood is a former critical care outreach nurse at Addenbrooke’s Hospital in Cambridge. In September 2019, he was appointed national nursing officer for Unison



Olivia Rees is a staff nurse in the neuro critical care unit at at Cambridge University Hospital's NHS Trust



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