What a difference 3 days makes!

This week there was a 3-day nursing training session on Severe Acute Malnutrition (SAM) – malnutrition so bad that the patient needs to be admitted to the hospital to receive life-saving treatment. Unfortunately we see patients meeting that criteria pretty regularly, but they hadn’t been getting very good care at our hospital. The regular nurses felt like they were “just” there to be fed, and didn’t really pay them much attention, while the malnutrition nurses would give them feeding supplies during the day but wouldn’t really work with the other nurses to address their medical problems. The three-day session was aimed at raising awareness of the seriousness of SAM and the steps we can take to treat it appropriately.

The training, which was taken from World Health Organization (WHO) guidelines, was comprehensive in scope and brought to light a lot of areas in which we can make improvements in the unit. But the real effect of the training came to light today.

This morning a severely malnourished girl showed up at the hospital. I began working on her admission, asked a nurse to start an IV and asked if we could get some ReSoMal – the special oral rehydration solution we use for malnourished kids. Several nurses promptly began working on gathering all the necessary supplies, doing all the appropriate assessments, and even reminding me to include all the relevant data in the note I was writing. They had a copy of the malnutrition protocol at the ready, and we quickly figured out how much liquid to give her. When I told them that she would need to be given fluids every 30 minutes for the first two hours (a major imposition on our super-busy nurses) a nursing assistant readily took up the task, and she did give all of those every-30-minute treatments. They got her into a bed and under a warming lamp quickly and appropriately. Every major part of her admission was addressed appropriately and with the promptness that it deserved. I actually felt like we gave her good care.

Yesterday’s post described the difficulty I’ve had getting people to respond to an urgent situation, and just one week ago I had had a nearly identical patient with SAM who arrived just as sick but who received next to no attention from the nurses. There was no ReSoMal, nobody knew how to make it, how much to give or when to give it, and nobody acted with any sense of urgency. L (not a nurse) eventually instructed the patient’s aunt on how to give her the fluids she needed. The contrast between that situation and today’s was like night and day. The training really did impact the care that we are giving, and it is exciting to see that change is possible in such a short time period. We will need to make some additional interventions if that change will be a lasting one, but it was so nice to have a difficult situation go well today. I am so proud of our nurses for embracing the training and really stepping up, and I intend to let them know I really appreciated their efforts today. Happy Friday, everyone!

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  1. I’ve been reading. And reading. And I am just in awe. I don’t know how you do what you do, lady. But I’m so glad you’re out there doing it.

  2. That’s so heartening. Thank you for sharing.

  3. Barbara

     /  February 3, 2012

    Gotta love the WHO and those nurses. So glad you help your patient. Piti, Piti.


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