Bangladesh Health Project Plans for 2017

As the Bangladesh Health Project (BHP) progresses, we focus on new priorities and needs. With IUBAT alumni now taking more senior roles as nurse educators and managers, our volunteers offer more mentoring and coaching and less student teaching. Looking ahead, these are our objectives:

1. Provide mentoring support for faculty of IUBAT College of Nursing

BHP has completed mentorship and training of several cohorts of BSN students.  Our next goal is to strengthen nursing faculty capacity.  Through phone contact, e-mail and visiting faculty volunteers, we will assist with program development, classroom teaching, clinical supervision and student evaluation. As feasible, we will continue to supply textbooks and teaching materials. We will provide demonstration lectures for IUBAT nursing students and for staff at our teaching hospital sites.

2. Support IUBAT graduates in their professional development

In recent years, we have supported IUBAT alumni working in hospitals, colleges and NGOs with mentorship for issues related to advanced education, nursing administration and access to technical information. We will continue supporting our graduates as they advance in their careers and undertake leadership roles.

3. Develop resources to promote nurse education in Bangladesh

We will continue to offer textbooks to local nursing colleges, ideally establishing a central library for advanced materials, to be used by faculty and senior hospital staff. We will continue developing our Open Education Resource, an open-source collection of BSN curriculum materials for faculty to use in lesson preparation.

4. Build relationships with colleges and NGOs to improve health services in Bangladesh

We have good relationships with many health care organizations; some are practicum or internship sites for IUBAT, others offer good-quality education or health care services. Most are in Dhaka, while a few are in outlying areas. We will support these agencies as requested, with consultation and educational materials.

5. Support research projects on quality of health education and health services

We will arrange student internships and projects to link local and global researchers. We have the potential to support some applied research projects on quality of health services, particularly for training and mentor-ship in research.

We continue to welcome volunteers, either working from home, or at our guest-house in Dhaka. Please contact us about current opportunities.

Part II – Challenges in the Real-Life Clinical Setting

In our last post, we shared the story and dilemma of one of our graduates, who was recently promoted to a higher office position of Nursing Superintendent.  The wards at her hospital faced many issues, such as coworker discord, lack of patient confidentiality and an absence of aseptic procedures, amongst others.  There were many areas requirimg her focus, and we are glad to report that progress has been made in the workplace since she was promoted. 

She writes: “We had a difficult task at hand, but we believed in ourselves and we worked even harder to improve matters.  After six months of careful observation and assessment by our Nursing Office administrators, it was evident that things needed to change. We proposed many changes to the hospital authorities; some were accepted and some were postponed for the future.  One of the accepted changes was ongoing training for the nurses.  We have recently finished skills and knowledge development sessions.  All of the nurses (including the General wards and the Critical Care wards) were involved in the 3-month long program, however, the content differed slightly for the general ward nurses and the Critical Care nurses.

We were able to involve the doctors for teaching nurses and as we thought, the doctors started to see situations from the nurses’ perspective, which helped build teamwork and camraderie.  So far, it’s hard to gauge exactly how successful the training session has been, but I can see many changes in the wards.  I can see the nurses being interested in knowing the rationale behind procedures.  We also plan to take a small written exam as a part of the evaluation process.  Furthermore, we have also recently introduced the handover format to our nurses.  In it, I referenced the care plan from our classes at IUBAT and modified it for our hospital.  It was challenging for those nurses not comfortable with English, so there was an extra class for those needing more help with the material.  As a team, we go on rounds and note any issues with maintaining the handover sheet.  We hold weekly meetings for each ward to address their problems with workable solutions, and I am overjoyed to say that it is working!

I also noticed that the nurses were demotivated in their roles, so we set out to find out why.  We completed a survey on 100 general and Critical Care nurses, and although there seemed to be a variety of reasons behind this dissatisfaction, the main 3 issues that were raised were the low pay, the low overtime pay, and the attitudes and behaviours of fellow colleagues.  To address this, our Nursing office sought a higher salary and overtime pay rate from the hospital authorities.  After a very long discussion, the request for higher wages was approved, along with the overtime requests, after the hospital authorities realized that they needed to change their part of the problem as well.  Since this wage increase, I have seen a higher amount of respect from the nurses for the Nursing office.  They trust us as a representative for their collective voices and this unity has already been shown to have positive effects in the wards.

I must give credit where credit is due.  The hospital Chairperson, Vice-Chairperson and Director were all very cooperative with me, and consistently supported my work.   Furthermore, I had the chance to work with the hospital Chairperson of International Affairs.  As a part of this close collaboration, we are getting closer to an international joint venture with a hospital in Bangkok wherein annually, five of our nurses will travel to their site in order to learn, experience the nursing standards and apply their knowledge in practice at home.

Our Nursing office had to fight a lot with the hospital authorities for many things, but we never lost hope even if the result wasn’t what we were looking for.  I must say we are progressing and it takes much effort and work to achieve the goals.  I am happy with all we have accomplished so far, but there are still challenges left to solve.  For example, there is still conflict between the nurses.

In one unit, the nurses do not even want to talk to the other unit nurses; they do not have any collaboration and respect for each other.  This is creating a huge problem for the hospital and is even affecting the patients.  It makes me recall the conflict management workshop in the final year of the program at IUBAT.  I never realized that I would encounter such scenarios in my actual life when I was a part of that workshop.  Now, I am experiencing it and everyday I realize that IUBAT has prepared us in every possible way. Frankly speaking, it has been really tough for me to address this issue, but I know it takes time to bring about change in any attitude and behaviour.  I am optimistic that my training from IUBAT will continue to help me in this post and with improving this hospital for years to come.” 

We appreciate this graduate sharing this anecdote with our readers, and explaining how her education at IUBAT set a standard of care that she implemented in her workplace.  It was also revelatory to see how her training helped with the resolution of some of the problems that she encountered in the hospital, both technical and interpersonal.  These experiences that this graduate has shared are not specific to Bangladesh; rather, they appear globally, across a number of different industries, in one form or another.  Interestingly, these conflicts between nurses is not uncommon in Canada either (http://hospitalnews.com/a-hidden-truth-hostility-in-healthcare/).  It is prudent to note that expectations should be set about civil behaviours amongst colleagues; those who work together do not need to like one another, but they must act professionally in the best interest of patients, their families and the hospital.

Part I – Challenges in the Real-Life Clinical Setting

The clinical skills and science learned in the classroom are invaluable for the healthcare workplace, however, it is the soft skills, the art behind the science, that often needs to be applied in the clinical setting as well.  For a real example given to us by one of our graduates, please continue reading.  We will outline the issues that our graduate faced and describe how they continue to work and progress through these factors that impact patient care in a two-part blog series.

One of our nursing students who is now is working in a hospital in Dhaka, began working in April 2015 as a cardiac nurse and was later promoted to the position of Joint-Nursing Superintendent in January 2016.  She has expanded upon her skill set since graduation and has experienced a variety of both triumphs and tribulations. 

She writes, “I was excited to start my position as a cardiac nurse and was eager to work with both new and old colleagues within our ward and other wards.  Since ours was just a four-bed ward, we had a smaller workload in comparison to the other wards.  Nevertheless, it would be so hectic when 4 patients came at once for coronary angiograms!  We had plenty of time to apply the pragmatic knowledge we gained from IUBAT in practice – it made us stand out from the crowd.  We got a lot of compliments from the patients we cared for, from those who were undergoing the coronary angiograms, to the critically ill patients from the Critical Care Unit.  Our patients used to say that they would wait for us to start our shifts during their hospital stay.  The majority of the patients who were stable and getting moved to other wards used to demand for a spot in our ward; they remarked especially on how professional our ward was.  To this day, we have had more than 60 patients who have waited for hours just to say hello to us while they are in for a follow-up.  It really made me proud of myself!

While I was at bedside, I had many experiences that conflicted with my expectations that were formed during training.  I explored many ethical dilemmas and learned by being a curious observer and keen investigator of the physicians and nurses.  Some were very encouraging of our curiosity, but unfortunately, some preferred to neglect.  With Professor Karen Lund’s encouragement, however, I persisted.  We new nurses had many adjustment problems: physicians questioned our use of the stethoscopes, the need for our thorough assessments, and the senior nurses resented that the patients preferred our care.  Because of the intertwined nature of the nursing care, however, it was especially challenging to manage the attitudes and behaviours of the other nurses.  It was very difficult to work alongside some of the senior nurses, some of which had little respect and confidence for our methodology.  At the end of the day, we had argued, we had conflict, but we eventually accepted one another and finally, we mingled.  I learned skills, I developed confidence and I stood firm to my beliefs.  It became easier for me to initiate new ideas and standards once I felt “a part of the team”.

All the while, we were gaining the attention of higher management and the chairperson would often call me for help with translation and special tasks.  Soon after that, I was given an offer letter informing me that I had been selected for interviews for the post of nursing supervisor.  Initially I declined, but they insisted that I at least sit for it.  I did get promoted, however, to joint Nursing Superintendent, not supervisor!  I gladly accepted the job, but was so worried about my duties and responsibilities.  For the first few months, I was totally lost and felt horrible because nothing was clear to me.  I did not receive any guidance nor did I understand what my duties and responsibilities were because the previous Nursing Superintendent had resigned from the post a week before I was appointed.  I faced a worse problem than I had expected; looking after a ward and after an entire hospital was wholly different – I was bearing a huge responsibility.  To complicate matters, my reporting supervisor was not very cooperative; however, I got two newly appointed supervisors as helping hands shortly after.  Though I was well acquainted with this hospital since 2014, I saw things so differently the day after attaining the higher position.  That day I realized that a lot of things have to be changed.  I, along with my team, had to work so much to make things better.

There was chaos in every ward due to huge communication gaps between co-workers. Every day I used to go on rounds and see the things that I never saw before.  There was no proper handover system (which always creates a major challenge in quality care), no use of aseptic techniques for any procedure.  The patient ethics, rights, privacy and confidentiality seemed to be optional, and would take years of training to achieve.”

This graduate wrote to our faculty for recommendations and tips to help ameliorate the problems that she saw in the hospital in regards to nurses and their practices.  Tasked with improving operations, there were many aspects that she needed to work on, but it is always a difficult task to change fully entrenched patterns.  Nevertheless, with the goal of better patient care in mind, it is a worthy endeavour.  In our next post, we will revisit this case and reveal the progress and changes that have occurred at this alumna’s hospital.