Teaching Classes

My main purpose for coming to Cambodia and volunteering at Angkor Hospital for Children was to develop, and possibly teach, a curriculum for nurse preceptors. A nurse preceptor is an experienced nurse who directly supervises the orientation to direct patient care of a nurse new to the hospital unit. Like most hospitals in the United States, AHC uses experienced nurses to be preceptors; but they did not have a formal training program for how to be a preceptor. Neither did my hospital when I started as a nurse 14 years ago.

My curriculum ended up being almost a full day of classes. Yesterday and today I taught that class, once in the Satellite hospital and today at the main hospital. I won’t lie – it was a challenge. Overall, though, I think it went very well. The nursing staff at AHC are required to learn English as part of their training and hiring, primarily because all the documentation at AHC is in English. Still, giving my presentation to them in English and having them understand me has been difficult. I suspect part of it may be my accent. But the biggest challenge is lecturing about complex medical topics at a college level to an audience whose English vocabulary may be close to grade-school level. The more experienced the nursing staff here at AHC, the better their English. So, because nurses selected to be preceptors are the more experienced nurses, this group generally were able to pick up most of my lecture. Mr. Vibol, who is the head of nursing education here at AHC, helped me out by translating sections of my lecture throughout the day.

This week was not the first time I gave a lecture at AHC. The beginning of last week I presented a lunch lecture on the management of pain in children. The AHC nursing department has lectures for their nursing staff every Tuesday at lunch time; and they provide a free lunch to everyone who attends. So, naturally, Mr. Vibol asked me to come up with a topic for one of those lectures. I picked pain management because the AHC approach was so different from Western practice.

I somehow had the idea that maybe 10-20 nurses would show up for my talk. But the morning of my presentation the nursing administration secretary showed me the sign-up list, and it went on for two pages!! Afterwards, she told me there were 72 nurses in the audience, including the head of nursing, and several of the nursing unit managers!! That’s a new record for me.

I could tell that I lost a significant portion of the audience within the first five minutes. I’m sure it was because of the language barrier. So I just concentrated on speaking to the managers, and to the more experienced nurses who I had met during my first week at the hospital. Toward the end, Mr. Sophol, the head of nursing, helped me out by fielding some of the questions, and by translating into Khmer some of the more complicated parts of my lecture. And I received some excellent questions at the end of my lecture. So, overall, I was very pleased with the result.

So about the Satellite hospital. About 25 kilometers outside of Siem Reap the Cambodian government has a small country hospital that is part of their national network of rural hospitals. But pediatrics was not their strong suit; so AHC worked out an agreement with them that they would run the pediatric ward if the government would provide the building for it. The result is the AHC Satellite Hospital, an off-shoot of AHC staffed by the same doctors at AHC and by nurses trained and supervised by the AHC nursing department.

Before I go on, I should explain a little bit about the typical work day in Cambodia. My regular schedule has been to arrive at AHC around 8 a.m., which is when the administrative staff normally start their work day. At 11:30 a.m. the AHC staff (and I) go to lunch, and we don’t return to work until 2 p.m. That gives everyone enough time to eat lunch, and then take a good nap. Our work day ends around 5 p.m. On that first day of giving the Preceptor curriculum program presentation, the AHC asked me if I would give that presentation AND my pain management presentation over lunch. That meant that Tuesday was a long day! I spent the morning giving my Preceptor presentation – for the first time. Then, after a 15 minute break to eat the free lunch provided, I gave my one hour pain management lecture to about 35 nurses and doctors. After another short break, I then presented the rest of the Preceptor lectures. Everything went smoothly, though, and we finished up by 4 p.m., and were able to return to AHC and end our day by normal quitting time.

Then Wednesday I gave the same Preceptor curriculum presentation to fifteen more nurses at the main hospital. That was also a long day, even though I was able to take a regular Cambodian lunch break. Again, Mr. Vibol was a great help in translating sections of my lectures into Khmer. It was also nice to spend some more time with some of the nurses that I followed around during my first week here as I tried to get a feel for how nurses practice here at AHC.

So, my work here is done. I am finishing up a report on a variety of topics related to nursing practice. Basically, it will be my recommendations to AHC that I feel would improve nursing practice and improve patient outcomes. This has been the biggest challenge by far as I attempt to navigate the cultural barriers Cambodians have to perceived criticism. So far I’m not sure I’m doing a very good job.