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Welcome to Critical Care Nursing in Resource Limited Environments

This blog / website has been created for critical care nurses who work in resource limited environments. Initially, there will be an emphasis on the rapidly developing subspecialty of critical care nursing within Sub-Saharan Africa and Indian subcontinent. It is understood that both areas have centres of excellence and advanced health technologies. However, this website is aimed at emerging centres of critical care that work in constrained conditions and yet provide Level 1-3 critical care.

Registered nurses in Low-Middle Income countries (LMIC) need to consolidate their role and expand their ability within a safe, suitable and sustainable service.

In time, the site will be developed to combine the ethos and knowledge bases of  tropical nursing and critical care nursing in all resource-limited environments.

The website is now a spin-off from a current PhD study regarding critical care nursing in resource limited environments (2017-2022).

The content expresses the personal and professional opinions of the Editors and does not represent the view from any Healthcare institution, University or Military Organisation.



Early Enteral Feeding

Early enteral feeding is not dependent on presence of bowel sounds but should be delayed in patients with >500 millilitres gastric residual volume in 6 hour period.

South African Triage Scale (SATS)

Patients become critically ill before they appear on ICU. Ideally, a pre-hospital life support is available within a local ambulance service. In reality, many deteriorating patients simply arrive at a clinic or hospital and join a queue of people waiting to be seen by a doctor or a nurse.

The SATS system is an effective and evidence-based method of sorting and prioritising adults and children according to the severity of their illness. It provides a way of screening the severity of illness of adults and children as they arrive at a clinic or hospital.

The above website contains a large collection of clinical guidelines and learning resources.

The manual is currently under review and a revised version is scheduled for late 2017.

The SATS system has been designed and tested in resource limited environments and the literature and audio-visual guides are full of practical content.

The Silent Child

The silent emergency – the critically ill child. What are the oxygen requirements?

Information about neonatal resuscitation in resource limited environments

Neonatal resuscitation in low resource settings

Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths


Essential Obstetric Care in resource poor settings

Essential Obstetric Care in resource poor settings

Caring for the Critically Ill in the Tropics

This book is published by Macmillan and it is available in the Africa catalogue. It can be difficult to locate as it is currently out-of-print but a reprint is scheduled for July 2011. There is a chapter that discusses the nursing care of critically ill patients in the Tropics, aka, critical care nursing in resource limited environments.

About Me

I am a UK-based Registered Nurse, Lecturer Practitioner Educator and PhD candidate with a particular interest in critical care nursing in resource limited environments.

Critical Care can be delivered in a rudimentary manner, using available resources to save lives and support the structure of a regional hospital. Increasing, critical care services are seen as an essential development within many developing countries. They don’t have to emulate ‘expensive care units’. I hope to demonstrate¬† which aspects of critical care nursing are cost effective and realistic in a resource-variable environment.

In the mid-eighties, the technology within Intensive Care Units in UK was limited. The equipment and technology in use tended to be robust, unsophisticated and often reusable. In contrast, the current technology utilised within UK critical care units is highly sophisticated and utilises single-use items.

In the same era, the Royal Army Medical Corps was developing a medical service for a possible cold-war battlefield; where mass casualties are prioritised in order to maximise the use of limited resources. The equipment levels, resources and build of this era are a realistic aim-point for emerging critical care units in low-middle income countries. With the advantage that we can learn from the past 30-40 years of modern critical care nursing and refine local practice to provide a reasonable level of critical care.

I would like to reevaluate and renew some of the techniques and technology that have previously been used by critical care nurses, that may be applicable to resource-limited environments. Equally, I would like to highlight innovative practices that are undertaken by critical care nurses within resource limited environments.

During my career, I have been a critical care nurse, lecturer practice educator, global health lecturer and combat military technician.[Linked In]. I intend to utilise all these influences to establish the resources, knowledge base and clinical skills that are required for registered nurses that work in a critical care setting within a resource-limited environment.

I am under taking doctoral research on specific aspects of critical care nursing in resource limited environments (2017-2022).

David Muir