Class is in Session!

     Well, last week I started lectures in the ICU for the course I'm teaching (that I'm making up as I go along) aptly named the ICU Accreditation Course. So far so good! 11 of my 15 nurses currently working (I have one out on maternity leave and another in school) came to class last week. They are very interested in learning. Sometimes it is a bit of a negotiation to get them to come to lecture, but once they're there, they are very engaged.
     Last week I taught two lectures. One on accreditation and the other clinical audit results for August and September that I had done. If I haven't mentioned it, CHUB (we do not say chub instead we pronounce each letter in French, so it sounds like Say-Ach-OO-Bay) is working towards accreditation by the South African group called COHSASA (Council for Health Service Accreditation of Southern Africa). It is quite the process, for instance, just a few weeks ago the first hospital wide policies were rolled out... there isn't a single policy written for ICU care... yet. Next week I am going to start working with my In-Charge (manager) for ICU on writing simple policies. We'll see how that goes! The clinical audit that I did was compliance of charting. Jessie (predecessor) worked hours upon hours on end last year in developing an ICU flowsheet for the nurses to chart. They rolled it out in July and I wanted to see how well the nurses were doing with the new material. Turns out, they aren't doing so bad! They document everything about 50% of the time, which I realize isn't perfect or anywhere near perfect, but considering that prior to this flow sheet they didn't chart an assessment ever... I think we're doing pretty well. Lots of "areas of improvement/opportunities" as I keep positively referring to them, but that's ok. Baby steps it is.

Make-shift classroom in the corner of ICU.

     This weeks lecture is on our October Focus Points, specifically Intake and Outputs/Calculating a patient's Fluid Balance. Each month, based on the audit results I am picking goal(s) to strive for and essentially bribing my nurses with a surprise if the goals are met. I am then doing follow up lectures to clarify and educate on weaker areas that we are focusing on. Already I've witnessed improvement, but I've also witnessed some set backs that I didn't see coming. The ethic of teamwork here is incredible and it puts US nursing to shame. Never does someone complain when another asks for help, nor do they ever complain about listen for all the patients for each others 2 hour lunch breaks (the majority of my nurses go home, eat, and return and they live a distance). However, I've discovered that while fabulous, it hinders a few aspects of nursing. Mainly, they don't like to see each other fail so they cover for each other. The idea of individual accountability is non-existent. So when I mentioned that one area of improvement for the future would be to update our nursing assessments on night shift (or indicate clearly that nothing has changed overnight) I never expected to catch a dayshift nurse putting lines through the night shift assessment, thus indicating that there had been no changes overnight. I have no idea how I'm going to approach this topic. May need to consult some higher ups in the hospital organization to figure it all out and to have a better understanding of the practice. Always hiccups when you're teaching. I never expected this one and it will be hard to develop a solution without damaging the fledgling relationships I am building here.
     Anyway, last week was successful and the weekend fun. Our newest roommate Joe who is living in the guest house had a grill made and we had a little BBQ Sunday evening. It was very nice to have other faculty over to hang out for beers and brats!

Facetimed my dad to check in while mom was away.

Sunset from our yard.

Moonlit clouds

A fly really liked my Coke one day at lunch.

Sunrise from my bedroom window.

Afternoon rain at the hospital.

This is short rainy season (hospital)

Storm clouds clearing as I head home from work.

Joe BBQing

I'll write another post about this week later today if I can. Love to all at home!

Lessons Learned:
1) It's best to give the same lecture multiple times... you learn quickly what needs to be edited as I was informed that my phrasing of "print and sign names" is incorrect. To print is to print something from a computer :)

2) Again, hiccups will occur that you never expected. It's good to always look for solutions!