April 5, 2018

Nursing education program making a difference in Guyana

VUMC nurses have developed and are administering a bachelor’s degree in emergency nursing program for nurses in the South American country of Guyana, the first of its kind in the region.

These nurses at Georgetown Public Hospital Corp. in Georgetown, Guyana, are seeking to attain a new bachelor’s degree in emergency nursing being offered through a partnership of the University of Guyana and Vanderbilt.

Vanderbilt University Medical Center nurses have developed and are administering a bachelor’s degree in emergency nursing program for nurses at Georgetown Public Hospital Corp. (GPHC) in the South American country of Guyana, the first of its kind in the region. The program was developed in collaboration with GPHC and the University of Guyana.

A class of 15 Guyanese nurses are scheduled to graduate in November with the degree, which will be awarded by the University of Guyana. It will be the culmination of nearly 10 years of planning by Vanderbilt nurses and their counterparts in Guyana. Another 14 students are in their first year of the program, for a total of 29 students.

The goal of the two-year bachelor’s degree program is to improve the quality of nursing care, which came at the request of medical professionals in the developing country, said Ali Grubbs, MSN, RN, nurse manager on the Neurosciences unit  at Vanderbilt University Adult Hospital.

“This is about the patient,” she said. “This program came from a need to take care of patients.”

Nurses in the program, who range in age from 22 to 50, work in a challenging environment of patients with tropical infectious diseases like malaria and dengue, as well as trauma, snakebites, complicated pregnancies. There are also pediatric patients, cardiac and stroke patients, and a high number of pesticide poisonings that are part of Guyana having the highest per capita suicide rate in the world.

GPHC is a free public hospital and the largest hospital in Guyana, a country bordering Venezuela on the Atlantic Ocean, roughly two times the size of Tennessee with a population comparable to Davidson County. Most patients receive care from government-run medical facilities in the capital, Georgetown, with some taking days to reach the city from homes in rural areas.

The emergency nursing curriculum focuses on the fundamentals of critical patient care assessment and triage, development of nursing skills and procedures, as well as a range of didactic lectures that encompass both clinical pathophysiology as well as aspects of advanced nursing practice.

Lectures include a wide range of topics including airway management, pain emergencies, burn care and resuscitation, toxicology, fluid and electrolyte emergencies, pediatric and neonatal emergencies and fundamentals of shock and sepsis.

Second-year residents participate in specialty-based rotations in such units as OB/maternity, intensive care and pediatrics. They also participate in a community heath rotation at a rural hospital and ride-along with emergency medical personnel.

Each student participates in a quality improvement project designed to improve delivery of patient care prior to graduation.

One of the biggest changes there has been is to incorporate basic life support (BLS) and advanced cardiac life support (ACLS) into nursing practice.

As a result, the Accident and Emergency Department has the highest percentage of nurses trained in CPR and advanced life support in the hospital.

“We also strive to incorporate research and evidence-based practice, leadership and professionalism and pharmacology into the curriculum on a quarterly basis,” said program director Jessica Van Meter, DNP, RN, a Vanderbilt LifeFlight nurse who spends part of her time each month in Guyana.

GPHC helps fund Van Meter’s time in Guyana, as well as travel expenses for other Vanderbilt nurses who volunteer and use vacation time to come to teach.

Van Meter is assisted by Sally Dye, RN, a nurse in the adult Emergency Department, who plans to travel there quarterly, as well as five other core faculty members, and two senior GPHC nurses, Sister Patricia Lewis and Sister Noshella Lalckecharran.

The program is getting international recognition. Van Meter is being honored for her work at the second annual International Nurses Day event at the United Nations Headquarters in New York City on May 11.

Vanderbilt emergency nurses working in Guyana include, from left, Sally Dye, RN, Jessica Van Meter, DNP, RN, and Ali Grubbs, MSN, RN. (photo by Anne Rayner)

Vanderbilt has had a relationship with GPHC since 2006, when John Paul Rohde, MD, assistant professor of Emergency Medicine, started an emergency physician education program in Guyana. Rohde, whose parents were missionaries, spent his childhood in the country and wanted to give back.

“Growing up with my family in Guyana, I knew first hand that Guyanese professionals certainly had the ability to develop their own high quality medical training programs, and it has been extremely gratifying to see my Vanderbilt Emergency Medicine family take up this life-saving collaboration.”

Led by Nico Forget, MD, assistant professor of Emergency Medicine, whom Rohde recruited to serve as residency director, the physician program was so successful that discussions began about how to raise nursing care to the same level.

“Part of our initiative is to build a faculty of Vanderbilt nurses who are willing to volunteer their time,” Van Meter said. “They’re not paid for anything. We are building a faculty of nurses here, and then we also want to help to build a faculty of nurses there in Guyana who can help teach.”

The long-term goal of the nursing program is to become self-sustaining, Dye said.

“We’re going to start focusing on leadership development and capabilities so that eventually we can pull out and allow this program to continue on with Guyanese in the leadership roles,” she said.

The program has transformed nursing practice, Dye said. “I have witnessed nurses in our program more quickly recognizing when certain interventions should be enacted, and then feel confident advocating for the needs of the patient,” she said. “The empowerment is inspiring.”

Intentional efforts have been made to create interdisciplinary training opportunities with physicians and nurses learning together. Van Meter said that there is now a more collegial environment between nurses and doctors, which is very gratifying for her.

“My own residency training is what has made me into a truly well-rounded professional, and it has been my longstanding goal to develop the same opportunity for our emergency nurses for the benefit of all of our patients,” said Zulfikar Bux, MD, the first graduate of the Vanderbilt-affiliated Emergency Medicine program in Guyana and the Head of the Emergency Department at GPHC, who has been a major supporter of the nursing program.

“Our partnership with Vanderbilt University Medical Center around emergency medicine and nursing education has allowed us to save many lives together.”