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Letter from Zambia: A UK perspective on critical care

The first in a series of blogs from Zambia by Major Chris Carter, Kevin Crimmons and Major Sue Viveash who are working with the country's critical care nurses 

The first in a series of blogs from Zambia by Major Chris Carter, Kevin Crimmons and Major Sue Viveash who are working with the country's critical care nurses

We are three experienced nurses who have specialised in critical care nursing and education, with a background in working in resource-limited environments. Since 2014, a group of nurses from the UK have been working with the Zambian Ministry of Health to help capacity build critical care nursing.


Picture: iStock

Over the years projects have included working alongside critical care nurses in order to understand the context and professional environment in which they practice, conducting strategic needs assessment of provision of critical care and role of nurses in public hospitals and providing coaching and technical advice to developing critical care nurses at all levels of the healthcare system. These projects have been in collaboration with the Zambians and very much driven by their needs.

Whilst we have overall project aims, each of us has a personal area of interest, which we hope to pursue during this visit. Kevin is interested in how specialist nurses working in isolated locations gain support for courageous decisions and the socialisation of newly qualified nurses. Sue is focusing on empowering women to take control of their professional role and further education. Chris seeks to develop critical nursing care delivery and how this translates to a sustainable practice and education environment.

Over the next two weeks, we will be blogging about our trip and our input into this project. Each day will reflect on our experiences and share with readers our successes and challenges. We hope this will raise the profile of working in the developing world and explore lessons we have learnt from this experience and how we can use it in our practice in the UK.

Significant challenges

Zambia is a landlocked country in southern Africa. It borders Zimbabwe, Angola, Malawi, Democratic Republic of Congo, Tanzania and Mozambique. The World Bank classifies Zambia as a low middle income country. There are significant challenges facing nursing in this country often around providing services with limited resources and lack of staff.

Yesterday was our first day of teaching the critical care nursing students at the Lusaka School of Nursing. The course commenced in January 2016 and runs over 12 months. The students are now almost at the end of the course, with their state finals next month. At the request of the principal tutor, we developed a series of teaching sessions which will be delivered over the next two weeks. The sessions include lectures, case study discussions and skills sessions. This will complement the taught elements so far and serve as a revision for next month.

Having never met the students prior to this session, we decided to use an icebreaker.  As part of this we asked our 18 critical care nursing students to tell us what they perceive as their main challenge to be when they return to their hospitals. Interestingly, of the 18 asked only 4 will be returning to established critical care units. The remainder will be either deploying their skills outside of critical care in patient areas or setting up facilities in remote locations with limited professional support and mentorship.

They appear sanguine about their ability to cope with this immense challenge. Why might that be? One reason could be they have limited experience of the challenges of ethical decision making with limited resources, for example the scenario with two critically ill patients and one ventilator.

Another possibility could be that they have gained recent experience at the nation’s national tertiary referral hospital, The University Teaching Hospital. They will shortly be returning to provincial hospitals, where they will be seen as the critical care expert. Therefore their peers in these hospitals will be looking to them as the decision maker for treatment plans for any seriously deteriorating patients from neonates to the elderly.

Conversely, this might just be the interpretation from a developed world critical care nurses lens and perhaps these students, immersed in the culture of the developing healthcare system, know anything they are able to offer is an improvement on nothing, and it is only them that stand between the patient and an uncertain outcome.

These are big concepts that we are looking forward to exploring with our critical care peers over the next 10 days and will share some of these discussions with you. Today we are delivering a series of sessions including evidence-based practice and exploring the management of the shock patient in a resource limited environment.   


About the authors

   

Major Chris Carter (pictured) is a critical care nurse and nurse educator at the Defence School of Healthcare Education, Department of Healthcare Education, which is co-located at Birmingham City University, UK

Kevin Crimmons is an Associate Professor, Head of Adult Nursing, Birmingham City University, UK

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, UK.

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