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Multi-roled critical care nurse

Mass is a registered nurse from The Gambia. Since competing his Diploma, he’s had a number of responsible and dynamic roles that are all involve emergency care or critical care. Mass is always in charge of the three bed ICU, because he works on his own, calling for assistance from a nearby ward, when necessary. He undertakes a role that contains elements of the Paramedic, Outreach Nurse and an Advanced Practitioner role within the UK.
In my experience, Nurses like Mass, who work in Developing Health Systems are largely self-taught from the moment they graduate. They often stay up-to date by accessing resources on the Internet, through their smartphone. I have delivered a BLS update with some components of advanced life support. The ICU has a crash trolley with a selection of recycled oropharyngeal airways and a well-used Bag-Valve-Mask. Likewise, the AED is battered but its maintained and is always available. Finally, Mass and his nursing colleagues already cannulate and give IV adrenaline according to the resuscitation guidelines. Mass and his colleagues handle clinical emergencies like a cardiac arrest with minimal equipment and minimal drama, albeit they need support from colleagues in surrounding areas.
The ICU nurses are undertaking training to assist with intubation and in some cases, this has progressed to doing basic intubation. A recent case demonstrates the pragmatic working practices that can occur in DHS with limited resources. A patient was admitted to a clinic in status epilepticus. The only available anti-convulsant was diazepam; 10 mg was given over 30 minutes. The patient was transferred to ward where he appeared to have a further convulsion with some respiratory depression. Mass took some emergency equipment and undertook the patient-transfer to the ICU. During transfer, the agonal breathing was relieved by using an oral airway and BVM to provide ventilation. Upon admission to the ICU, it was apparent that the airway was ‘congested’ and the nurse could hear bilateral crepitations. The doctor (non-anaesthetist) who left his clinic to attend ICU , was aware of the recent training for nurses and assisted Mass to intubate the unconscious patient. This was an uneventful procedure and Mass had recited the instructions he had previously been given, while he undertook his first intubation. By the time I arrived at the ICU, everything was set up and the patient was safe. It would be easy to criticise this situation as hasty but Nurses in Developing Health Systems need training that befits their unique circumstances, and this is an example of ‘needs-must’ clinical training. Nurses in developing health systems work without the infrastructure associated with ICU. However, it is an emergent sub-speciality that needs to address its own working methods and practice.
Mass hopes to spend some time working in the UK and has saved hard of nursing in a high-income country to improve health care provision in his home country.

David Muir

RN BSc DipTN MA ODE MRes PhD candidate
Clinical Educator – BASICS Instructor
Critical Care Nursing in resource-limited environments

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