Working with colleagues who are resistant to change is a challenging situation anywhere, but it can be even more so in a materially poor setting with cultural customs that may conflict with our view of best practices.
Mark Stambovsky, adult ICU nursing director at St. Paul’s Hospital Millennium Medical College, in Addis Ababa, Ethiopia, described his experience rebuilding their ICU during “Trials and Tribulations of Transforming a 3rd World ICU into a 1st World ICU,” on Tuesday. The session will be repeated today from 11:30 a.m. to 12:30 p.m., in room 153A.
“I was going to have to build an ICU from scratch if I was to achieve any sort of success implementing contemporary ICU nursing practices,” he says. “And it was abundantly clear that my success would hinge upon my ability to actually unweave some of these die-hard traditions.”
One of the barriers Stambovsky encountered is the custom of all workers leaving the unit for every meal.
“Ethiopians are enormously warm, social people, and this dining habit generates great social bonds and camaraderie,” he says.
Different standards in nursing education and a lack of experienced ICU clinicians and preceptors also impact their ICU care, contrasting starkly with ICU care in more technologically advanced countries.
“How can you compare a new Ferrari with a 1965 Volkswagen Beetle?” Stambovsky asks.
In rebuilding St. Paul’s ICU, it was important to “keep an eye on the ICU prize of reducing suffering and mortality,” he says, and to be flexible and patient with timelines of change. It was also imperative to “be humble, respect everyone and embrace dignity for all.”
These concepts are crucial for any unit that seeks sustainable change. Stambovsky hopes attendees will gain the courage to step out of their comfort zones to confront a healthcare or personal challenge.
“We all live, and we all die,” he says. “But I can’t think of a better legacy for a nurse than facing a challenge that then positively ripples across the lives of others.”