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A NICU nurse goes where she has never gone before

Jane Thompson |

After a crash landing, she arrives in the nick of time.

Jane Thompson and nurses in Nepal

Opportunities and careers in nursing are endless. In my 36 years as a nurse, I have worked in medical-surgical and newborn intensive care, and I’ve also taught in a healthcare-professions program for high school students. I never anticipated that my nursing experience and educational skills would lead to teaching at an international conference in Nepal. I almost didn’t make it to the conference—more about that later.
Jane ThompsonFaculty members at my diploma school of nursing encouraged us to work on medical-surgical units for experience and development of critical thinking skills. In my heart, I always wanted to work in newborn intensive care but, as a prudent new graduate, I was excited to accept a job in medical-surgical nursing at LeBonheur Children’s Hospital in Memphis, Tennessee, USA.
Two years later, when positions became available in our hospital’s Level III newborn intensive care unit (NICU), I decided to apply, even though leaving my comfort zone on the medical-surgical unit was bittersweet.
NICU is a different world. Caring for patients who weigh two pounds instead of 200, starting IVs with 26-gauge catheters instead of 18-gauge, and taking care of ventilated patients instead of the occasional oxygenated patient were new challenges. Attending planned and unplanned deliveries made every day exciting. Hearing an infant’s first cry after delivery is such a relief—no words can describe the experience. The learning curve was exhilarating—I knew this was the area of nursing where I could excel.
Living in a rural community with my husband—a farmer—was a wonderful experience for our children, but commuting to school and after-school activities with hospital nursing hours became difficult. When our local high school offered me the opportunity to develop and teach a medical-professions education program for students in Grades 10-12 who were interested in a healthcare career, I accepted it. I taught classes that prepared students for their senior year, when they could work in various healthcare facilities in our community.
Teaching high school students was a difficult but rewarding experience. While teaching, I continued in a PRN position in my NICU to keep my skills current. The skills I learned in the classroom helped me develop programs to teach resuscitation and stabilization of infants after birth.
Ten years later, with our children preparing for college, I left the classroom and returned to the NICU full time. After 28 years as a bedside nurse, I became the patient care coordinator (PCC) for our unit, now a Level IV NICU. The PCC is responsible for anything pertaining to patient care. My responsibilities include coordinating transports, admissions, bedside procedures, and surgeries as well as teaching the Neonatal Resuscitation Program (NRP) and the S.T.A.B.L.E. Program.
When one of our neonatologists, Rajesh Dudani, MD, asked if I would be interested in teaching a class at a conference, I said yes, thinking it would be a local event. He then told me it was an international conference at the university in Dharan, Nepal, where he had graduated from medical school. I again said yes, thinking how exciting the experience would be.
The opportunity to teach at the international conference in Nepal was an outgrowth of my participation in the Maternal-Child Health Nurse Leadership Academy (MCHNLA), an 18-month program presented by the Honor Society of Nursing, Sigma Theta Tau International (STTI) in partnership with Johnson & Johnson. Although the Academy had encouraged me to seek opportunities, such as the Nepal workshop, for professional growth, the more I thought about the class, the more my excitement turned to concern about communication.
Would the nursing students speak English? If they did, would they be able to understand my Arkansan accent? Dudani assured me that all the students spoke English, and if he could understand me, anyone could. Reassured, I made travel arrangements to attend the 2015 International Conference of Neonatology in Nepal. I wouldn’t be the only one at the conference from the southeastern part of the United States—I would be joining faculty members from the University of Tennessee (UT) who would also be presenting. Because of our varied schedules, each of us made our own travel arrangements.
My flight to Nepal—the shortest one available—included a layover in Istanbul, Turkey. Everything went well until we were about to land in Nepal. What had been an uneventful flight changed abruptly when we attempted to land at Tribhuvan International Airport in Kathmandu, Nepal’s capital.
Dense fog caused the pilot to overshoot the runway during the initial landing attempt. After circling the city for about an hour, hoping the fog would lift, the pilot made a second attempt. The nose of the plane slammed down several times before the aircraft skidded off the runway and landed in a grassy field between the runway and taxiway. As the aircraft came to a violent stop, passenger screams turned first to silence and then—as smoke began to fill the cabin, and it became clear that no instructions were forthcoming from the pilot to either passengers or crew—to yells to open the emergency exits.

Image of plane skidded off runway. The impact caused overhead luggage to fall on passengers, but none of the 224 people aboard was seriously injured. All I could think about was locating my overhead bag with my materials for the class in Dharan. Fortunately, I found my bag with materials intact. Because of the crash, Tribhuvan, the only international airport in Nepal, was closed for four days while the aircraft was moved.
My flight to Dharan was delayed one day. I arrived at the B.P. Koirala Institute of Health Sciences (BPKIHS) just one hour before my class began. Professor Rupa Singh, chair of the Division of Neonatology, greeted me. I was impressed that she had contacted me on Facebook before my arrival to ensure I was well after the crash.
Located between protected forest areas and mountain ranges, BPKIHS was established in 1993 and obtained university status in 1998. The institute offers a Bachelor of Science in Nursing degree and university certificate nursing programs as well as Master of Science and Doctor of Medicine postgraduate degrees.

The team from UT presented several workshops. The nursing students seemed curious but afraid to engage in a conversation with me. When the UT medical director sat with the nursing students discussing their nursing practices, I saw a great photo opportunity and snapped a picture. That was all it took for the students to start engaging with me.
Thompson_Nepal_Group_Caption_SFWTeaching nurses and nursing students can be a challenge when distractions such as personal cellphones interfere. Most of the nursing students had phones, but they used them only on breaks—and even then, they used them for taking pictures with me. Their attention and respect for my presentation motivated me to provide as much information as I could. When the class ended, I remembered Florence Nightingale’s quote:

The most important practical lesson that can be given to nurses is to teach them what to observe—how to observe—what symptoms indicate improvement—what the reverse—which are of importance—which are of none—which are the evidence of neglect—and of what kind of neglect. (Nightingale, 1969, p. 105)

I agree with Nightingale and hope the students are able to use the information from the class in caring for their neonatal patients.
The final day of my stay at BPKIHS ended with a late-night tour of the NICU, located in the maternal center, a building next to the main hospital. Family members sleeping on pallets made from quilts lined the sidewalk surrounding the building. Before entering the main hospital, I heard a scream. Looking back, I saw family members running to an open window to see their baby. Family-centered care has a different look in Nepal, but the meaning is the same.
Before entering the NICU, we were instructed to cover our clothes with a surgical gown and wear the provided community flip-flops instead of our shoes. The infants had been diagnosed with respiratory distress and were greater than 34 weeks’ gestation. The neonatal fellow said the survival rate for infants less than 34 weeks was very low. Nepal’s estimated infant mortality rate in 2015 was 39.14 deaths per 1,000 live births, compared to 5.87 deaths per 1,000 live births in the United States. Equipment and supplies were limited, but through innovative ideas, the staff provided the best possible care for patients.
What caught my attention was that only the infant’s oxygen saturation was being monitored. When I questioned the neonatology fellow, he said they could not afford the leads necessary to monitor the heart rate and respirations. He further explained that the saturation probe did monitor the heart rate, and if the infant’s respiratory rate declined, so would the saturation level. The rationale was correct. I realized, however, how fortunate our unit at LeBonheur Children’s Hospital in the United States is to have the equipment and supplies we need to take care of our babies. Leaving BPKHIS, I reflected on what I had learned not only from the conference but also from the Nepalese people.
Mount Everest, part of the Himalayan mountain range, borders Nepal and Tibet. At 29,035 feet, it is the highest mountain above sea level in the world. Viewing Mount Everest from my airplane window reminded me of the mountain climbers I had traveled with from Istanbul to Kathmandu. Their goal was to reach the world’s highest mountain summit. My nursing journey has never included reaching such lofty mountain altitudes, but it—and MCHNLA—has brought me to places and opportunities I never imagined.

Sharon Harris with Jane Thompson, MCHNLAWhy I appreciate my MCHNLA experience
MCHNLA inspired and directed me to develop my leadership role and further my education, providing tools to help me develop projects and improve collaborations with co-workers. The communication skills I learned have helped me listen to and understand the needs of my co-workers and patients' families. The Academy also challenged me to recognize behaviors I needed to change to “model the way” in my leadership position.

Jane Thompson, BSN, RNC-NIC, CNML, is patient care coordinator, NICU, at LeBonheur Children’s Hospital in Memphis, Tennessee, USA.

Nightingale, F. (1969). Notes on nursing: What it is, and what it is not. New York, NY: Dover Publications.

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