Chris Carter

Managing a major incident in the critical care unit.

This article analyses recent major incidents using a standardised structured approach and is relevant to nurses working in the critical care unit. Information on responding to a major incident is provided, and the need to support staff after an incident, especially critical care personnel, is discussed. The main themes associated with assisting critical care nurses in preparing to deal with a broad range of situations which they may be required to respond to is described and an overview of major incident training for nurses is provided.

Nursing a critically ill tetanus patient in an intensive care unit in Zambia

The global incidence of tetanus has been gradually reducing. Improvements in vaccination and health education programmes and the World Health Organization campaign to eradicate maternal and neonatal tetanus have all resulted in fewer presentations globally. Unfortunately, tetanus mortality remains a significant problem for many developing countries, owing to inadequate vaccination programmes or to conflict or humanitarian disasters during which vaccination programmes are stopped or there is sporadic cover. This case study explores the care of a tetanus patient in an intensive care unit in Zambia, a lower-middle-income country in sub-Saharan Africa.

Strength through adversity: developing resilience though international working

International Nurses Day provides an opportunity to celebrate the achievements of nurses around the world. Each year the International Council of Nurses (ICN) focuses a year of activities; last year’s was about increasing organisational and personal-resilience (ICN, 2016). This resonated with an ongoing project we have running in Zambia, which assists critical care nurses in developing their own professional support network. The project to develop critical care nursing in Zambia commenced in 2014. A national critical care faculty was formed and since then a variety of projects have been undertaken, such as: developing up-to-date educational resources, developing professional peer support and encouraging strategic developments in order to promote this specialty. Last year, in conjunction with the Ministry of Health, we conducted a national needs assessment of critical care facilities across the country. We found, in many locations, nurses were working independently in often challenging environments as the sole qualified critical care professional (Carter, 2016). In response to this, using social media, we encouraged the critical care nurses to establish a closed Facebook page to enable them to contact each other to discuss clinical and professional issues. For example, one unit had issues with connecting oxygen to their new ventilators; through the medium of Facebook a solution was explored from within the group’s substantial experience and knowledge. The solution was shared immediately with the few biomedical engineers within the country, so benefiting other critical care facilities and ultimately saving lives across the country. The group also shares best practice and has developed professional and educational resources to support their peers. To coincide with World Sepsis Day (13 September), the network developed a standardised teaching resource to alert clinicians to the signs of sepsis, which was shared and delivered in hospitals both in Zambia and in the UK. Establishing a social media network for critical care nurses in Zambia to facilitate communication has increased their access to information in a simple, fast and userfriendly way. Furthermore, the network is now recognised as associate members by the World Federation of Critical Care Nurses. This, undoubtedly, will promote the specialty further by providing contact with critical care nurses throughout sub-Saharan Africa, so further sharing appropriate practice for the benefit of patient care (Chair and Papathanassoglou, 2016).

Launch of the Zambian Network of Critical CareNurses

Chris Carter RN; DiPHE, BSc(Hons), PGDip, Associate Nurse Lecturer, Faculty of Health, Education and Life Sciences, Birmingham City University, United Kingdom Kevin Crimmons RN; BSc(Hons), PGDip, FHEA, Associate Professor & Head of the Department of Adult Nursing, School of Nursing and Midwifery, Birmingham City University, United Kingdom Pelile Gambwe RN, Registered Critical Care Nurse, Main Intensive Care Unit, University Teaching Hospital, Lusaka, Zambia

Chest drainage: A CPD article reinforced Chris Carter’s knowledge of the care required for a patient with an intrapleural chest drain

As an intensive care nurse with experience of caring for critically ill patients in the UK and on deployed operations overseas, I found the CPD article useful in reviewing the pathophysiology of a pneumothorax, use of intrapleural chest drains, observations that should be recorded, and nursing care and management of a patient with an intrapleural chest drain. Reflecting on the time out activities in the CPD article was valuable.