AANN Member Shares Nursing Knowledge Abroad
As we enter the season of giving, many nurses are considering ways to give back to their communities by organizing food drives, giving charitable donations for underprivileged families, and providing gifts for families in need. These community-based efforts can provide hope to local families, but one neuroscience nurse made the choice to donate her time to advance neuroscience nursing care thousands of miles away.
AANN member Karen March, RN MN CCRN CNRN, who also serves as the secretary to the World Federation of Neuroscience Nurses (WFNN), has been involved in an effort in sub-Saharan Africa, where care for neurological patients isn't limited by insurance authorization but rather by more concerning needs. An experienced provider may located several days of travel away, patients share oxygen, pediatric patients often sleep on the floor, and an ICU nurse may care for as many as 14 patients.
"People are dying needlessly from preventable and treatable diseases like simple trauma and neural-tube defects. East African health workers often function with limited resources, medications, and equipment. If a CT scanner is available, the patient may not be able to afford the test or it may be delayed until the family can raise the funds, therefore, delaying definitive treatment," says March.
Modern conveniences we often take for granted, such as ventilators, oxygen delivery masks, and basic medical staffing, are often unavailable due to shortages. "Oxygen is delivered by a compressor and shared by several patients. There was one pulse oximeter and no ambu-bags, except in the operating room where patients were hand-bagged throughout the case," March observed.
Severe staffing shortages are common, resulting in a ratio of one to three nurses for every 14 patients in the ICU and two to three nurses caring for 40-50 patients on the wards. Life-saving neurosurgery is currently being performed by a young general surgeon being trained by visiting neurosurgeons.
A tremendous opportunity exists to improve nursing knowledge and overall delivery of care. Currently, care is very basic and the nurses are task oriented. The nursing process has only recently been introduced into the curriculum, so nurses are just beginning to incorporate critical-thinking skills rather than relying on simply following orders.
In March 2009, U.S. and African physicians met in Kansas City, MO, to discuss a collaborative approach to building capacity for care of the neuroscience patient. From this meeting, a nonprofit organization was born, Madaktari Africa. Madaktari is a consortium of individual and academic healthcare partners from the United States, Europe, and Africa with the common goal to free East Africa of their dependence on humanitarian aid for neurological care.
Out of this effort will come an improvement in many aspects of care including basic nursing care, education, and the development of neurosciences and critical care nursing. All this work is being carried out in partnership with the governments of the targeted countries.
Initial relief efforts centered on several centers in East Africa, including Uganda and Tanzania. Mulago is the National Hospital and only one of two centers providing neurosurgical care in Uganda. "I was overwhelmed by what I saw, especially when I went to the pediatric ward. There were so many children with hydrocephalus, encephaloceles, and myelomeningoceles—cases I had only seen in textbooks! One case was a 4-day-old baby [who] had an encephalocele as big as her head," March recalls.
"The ICU and operating theaters had little to no equipment. Our group brought 9 tons of equipment and outfitted the ICU, operating theaters, and recovery room. We did 30 surgeries that week, just scratching the surface of what was needed. The nurses do their best but have little training in neurological nursing and no ICU training."
The critical need for nursing mentorship and humanitarian aid was demonstrated in follow-up visits to Tanzania. "Neurosurgery is performed in a modern ICU and operation theater thanks to the help of a German group focused on orthopedics. The wards were even more crowded than Uganda, with 2 children per bed in the pediatric ward and as many mattresses on the floor as beds in the adult wards," stated March. ICU nurses received critical-care training in South Africa but they have had little mentorship since returning.
"On my last visit in June, I evaluated another site in Tanzania. Each had its own unique needs and challenges. Teaching varies at each site but ranges from the basics at of raising the head of the bed, taking care of the ABCs, performing a Glasgow Coma Score and pupil [evaluations]—and we had to supply penlights—fever management, performing a primary and secondary assessment, managing brain injury using parenchymal intracranial pressure monitors, and ventriculostomies without external transducers. Our goal is to develop Mulago and MOI into centers of excellence and training sites for the countries," hopes March, who volunteers twice yearly.
Though the project started with neurosurgeons, it cannot succeed without the development and support of nurses. "My hope is that, through training and the development of international partnerships with the hospitals, schools of nursing, and the Ministry of Health, we can raise the level of care not only for the neuroscience patients but for all patients. The project is not only to create a model for developing the capacity for neurosciences but also a model that can be reproduced to develop capacity for other specialties," March points out.
As you develop your professional goals for 2010, please consider this WFNN-supported project aimed at making a difference in this underserved region. Experienced nurses at every level of care are needed to serve as teachers and preceptors. If you would like to share your expertise in neuroscience nursing or want more information, visit www.madaktari.org or contact Karen March at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .