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Letter from Zambia 8: Building emotional resilience in our students

Since 2014, nurses and nursing students from the UK have been visiting Zambia and working with the Ministry of Health there to help develop critical care nursing. Major Sue Viveash describes how UK students adjusted to an environment in which patients do not receive the level of care expected in the UK, and changed from being upset to admiring the resilience of their Zambian colleagues.

Since 2014, nurses and nursing students from the UK have been visiting Zambia and working with the Ministry of Health there to help develop critical care nursing. Major Sue Viveash describes how UK students adjusted to an environment in which patients do not receive the level of care expected in the UK, and changed from being upset to admiring the resilience of their Zambian colleagues

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Major Sue Viveash with Zambian nursing students. 

Our pre-registration nursing students have now been in clinical practice in Zambia for one week. The students have been working in either the critical care unit or on an acute medical ward.

It is hoped that exposure to an environment where resources are limited, and where patient numbers often exceed the number of beds available and the number of clinical staff to care for them, will build emotional resilience in our students.

It is likely that in their future careers as military nurses our students may face being called on to nurse in situations where patient numbers or severity of injuries could quickly exhaust the capacity of the medical facilities available.

Rationing of treatment

Managing or witnessing the rationing of treatment or care is always difficult, and is something our students have found upsetting during this experience. However, it is a reality that our Zambian colleagues have to deal with on a daily basis.

Often something we would take for granted in the UK, such as pain relief or antibiotics, may well be prescribed by the medical staff here on the hospital wards but is then unavailable when requested from the pharmacy. This almost inevitably means additional suffering for the patient.

I have asked myself what it must feel like to be faced with this scenario on a daily basis.

Our nursing colleagues at the University Teaching Hospital in Zambia demonstrate incredible resilience as they return to their wards and departments day after day to care for their patients.

Huge pressures

They receive a very small remuneration for their work and currently have little chance of improving their position through further education or career progression.

Our students, while initially angry and upset by the experience of seeing patients not receiving the level of care that might be expected in the UK, are now beginning to comprehend the huge emotional and physical pressures that their peers face.

They are becoming proactive in offering their help and knowledge in the care of patients in whatever way they can, and are receiving praise and appreciation from the ward staff for their efforts.


Major Sue Viveash is a Nurse Educator at the Defence School of Healthcare Education, Department of Healthcare Education, which is co-located at Birmingham City University

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