The RFM Hospital

I spent most of last week doing clinical teaching, mentoring, guiding, role modeling and what not on several of the wards of the RFM hospital. This hospital dates back to the early 1950's and is very outdated and in need of major renovation. It is also unlike any hospital that we would have back home in the United States, but it is functional and I am amazed at some of the working conditions the nurses have to contend with. I have been working with the level-2 (second year) nursing students who are diong there clinical rotations in the hospital. They slight the groups in two so half on the wards in morning and half in the afternoon. I am also working with the staff nurses on the wards who are assigned to be the students preceptor when they are on the wards. The staff nurses who act as preceptors get no incentive to do so but they do it anyway. RFM is considered a teaching hospital after all. Although it is not officially a "government" hospital because the buildings are all sitll owned by the Nazarence Church so it is a private-public partnership. The government does provide some 90% of the funds that come into the hospital which mainly goes to pay the staff. These wards are separated by gender (Male Medica, Female medical, Male surgical, Female surgical, Pediatrics, Labour and Delivery, Post-partum, ED, and then all of the clinics). They are very open and there is very little privacy in them at all. Few of the wards have curtains but most do not and nurse use portable screens to give some privacy when doing a procedure or when a patient is using a bed pan.

In any event the nurses on these wards are working hard and in unsafe conditions as times. Some of them however are not so well trained if truth be told. I have found that the foreign nurses that are here from places like Zimbabwe, Nigeria, and Zambia are better trained and more knowledgeable about issues such as infection control and clean technique, than the swazi nurses. Case in point I spent one morning observing a young male swazi nurse only one year out of nursing school administering IV medications to patients with the assistance of three male nursing students. He did a few IV pushes and some directly into heplocks with a flush after. The problem is he did wipe any port with alcohol before inserting the needle or connecting the IV tubing and worse yet he re-capped every needle he used after using them and had the students do the same thing. It was all I could do to not ask him if he was insane to re-capping needles on a ward where the majority of the patients have HIV given the risk of a needle stick injury. So what I did in this case was wait until after they were done and we were away from the patients and I asked the students first what they told about re-capping needles and all three of them said at the same time, "We are taught to never re-cap a needle". So I asked why did they and what they thougt would happen if they just happen to stick themselves with a used needle. They were all aware of the risk here and knew they were not doing the right thing. At that moment the young male staff nurse walked up and I said to him I am glad you are here were just discussing the dangers of re-capping needles, "what do you think about that". He said as well you should never do it. I then said so explain to me what happened this morning and how you think we can keep you and the students safe while administering IV medications which you will have to do again at 2PM this afternoon. We agreed that he would not re-cap any more needles and would discard them directly into the big plastic bottle that they were using for a sharps container.

I tell you this scenario above so that you can get a sense of the basic nursing skills that some of the nurses here need assistance with. It was not that he did not know that re-capping was not good practice but I do not think he understood the connection to the real danger a needle stick injury poised. Also I helped him to appreciate that even thouh he is a new nurse that in this case he is a teacher for these students now and he has to show them the correct way of doing things so that they are safe and learn good practice. I went back to this ward the next day to check up on the nurse and students and asked if he had re-capped any needles today he immediatley told me no and pointed to the sharps container. I will go back this again and observe one last time just to make sure. These are the small changes in practice that we attempting to do here with the Nurses SOAR project.

Up above is a picture of the "Medicine Trolley" that is used on the wards. The nurse push the chart around the ward stopping to administer medications to each patient. This is how they do it here.

The second pic is of Dr. Kevin Mallison (the Nurses SOAR PI) cheering up a infant burn patient on the pediatrics ward with a simple ballon. This boy burned his feet and he just lite up when we came in and blew ballons up and played for a few minutes. Such a small thing could have a huge impact.