1st Intensive Care Refresher Course for Nurses

Ayder Hospital, Mekelle. 18.4.-23.4.2016 and 2.5.-7.5.2016

During my last stay in Adult Intensive Care Unit (AICU) in Ayder Hospital, Mekelle, in October-December 2015 I agreed with the AICU nurses, with the matron Mrs.Hareya, and with the Medical Director, Dr.Amanuel, to conduct a refresher course in order to improve the standard of AICU further. Since none of the nurses working in AICU got a formal training in intensive care nursing and since several new nurses were attached to the ICU it seemed to me very important to improve the theoretical knowledge and practical skills of the nurses specially since they work mostly without guidance of a trained intensivist doctor.

Lecture topics and practical exercises were chosen according to the most common problems faced in AICU during the last years.

Lecture topics were: 1. Basics of respirator management with practical exercises

2. Fluid- and electrolyte balance and imbalances including hypovolemic shock
3. Pharmacology of common critical care drugs (inotropes, vasopressors, sedatives, analgesics, including their practical management.
4. Management of head injuries
5. Enteral feeding including feeding regimes

Practical exercises included basic intensive care nursing procedures, preparation of an emergency trolley, CPR with mask ventilation, positioning of patients, preparation for admission of an emergency patient, and infection control procedures.

Also included were the importance of re-assurance of patients and psychological guidance of patients and relatives as well as some ethical considerations (poor prognosis patients, brain dead patients).

The participants of the course were divided into 2 groups (15 in the 1^st group and 16 in the 2^nd group) since the total number was too big for useful practical exercises.

The teaching was shared by Sr.Teresa Pastor, an experienced Spanish ICU nurse, Sr.Doris Batke, an experienced German ICU nurse, Dr.Judith Rendon, the nutritionist from Ayder Hospital and me.

 

The organization of the course was taken over by Mrs.Hareya with the help of Mr.Hailay, the former head nurse of AICU, and was excellent. The duty rosters of the participants were adjusted that they were off duty for the time of the course, writing and teaching materials were bought and tea breaks (with excellent snacks) organized. The lecture handouts which I sent to Mrs.Hareya beforehand were photocopied and bound in a nice booklet. Rooms for lectures and practical exercises were booked.

The course started with an entrance examination. (MCQ’s about the course contents). The result of the test made the nurses better understand their short comings.

Both groups participated actively and lively in the lectures and practical sessions. All nurses were present from morning 8.30am until afternoon 5.30pm from Monday to Saturday. Even during the tea breaks discussions continued.

At the end of the course all participants did a post test (MCQ about topics covered in the course). The result of this test showed that all participants had improved their knowledge by 100-200% compared to the entrance test.

The evaluation paper distributed at the end of the course showed that all participants were satisfied with the course contents. Also the ratio between lectures and practical sessions was in average rated satisfactory (some wanted more lectures, some more practical exercises). All nurses stated that the course will help to improve their performance in AICU.

At the end of the course all participants and teachers were invited for lunch in a traditional restaurant. At this occasion Dr.Amanuel presented the certificates for successful participation in the course to all nurses.

 

Conclusion:

Sr.Teresa and I had the occasion to work with the participants of the course in AICU for some days after the end of the course. Both of us were surprised that this short 1 week course resulted immediately in 1. improved nursing care and 2. in more self-confident and independent actions like respirator weaning, fluid management according to central venous pressure measurement and supervision and adjustments of continuous inotrope administration. We think that these newly acquired skills may lead in the near future to decreased morbidity and mortality in AICU when the nurses get the opportunity to deepen and regularly refresh their knowledge and their skills.

Therefore we agreed with Mrs.Hareya and Dr.Amanuel to carry on with a 2^nd refresher course in January 2017. At the same time Witten- Ethiopia through Mr.Ahmedin Idris, MD, agreed to sponsor ICU books for all AICU nurses.

Dr. Reintraut Burmeister-Rother MD

Specialist for anesthesia and resuscitation (retired)