Fieldset
Innovation: A day in the life of a humanitarian nursing team – The Pilot Project

Around the world, Médecins sans Frontières / Doctors Without Borders (MSF) nurses are caring for people whose lives have been impacted by conflict, epidemics or disasters. Josie is part of a project using smartphones to help us understand more about humanitarian nursing and ultimately save lives. In this fourth part of her blog, she begins piloting the project in Bangladesh.

And we’re off!

I arrive in the hospital in Cox’s Bazar, Bangladesh, for 7:30 am on the first day of the pilot project, ready to hand out the phones to the nurses on the day shift.

The aim of the project is to get the nurses on two of the wards here recording every task they do on a smartphone app we’ve designed especially.

The first task the nurses record is the handover – where the team from the night shift tell the day shift team everything they need to know about the patients in their care.

Then, with Helal, we talk the nurses through filling out the shift demographics on the app.

Severity score

For the study, we developed a "patient severity score". As the severity of the patient affects the amount of nursing care they need, it’s important to know.

The severity scoring system is new for both the nurses and MSF, so over the next few days, I’ll be with the nurses talking them through it.

The pocket problem

The nurses pick up using the app really quickly and find their own natural solution to not having pockets is to leave the phones on the nursing station.

"The nurses are also very accepting of me constantly looking over their shoulders and asking 'Ki koro?' which means 'what are you doing?' in Bengali."

The nurses start a task on the app at the nursing station, then leave the phone with the task running on the app while they go to carry out the task. Once they have completed the task, they then come back to the nursing station and complete the task on the phone.

This solution is also great as it means the phones are not a distraction to nurses while they are fulfilling nursing tasks, which was one of the research team’s biggest concerns.

With the “pocket problem” solved, we squeezed in a celebratory snack mid-morning. All the nurses tabbed on “taking a break” on the app and we had delicious coconut snacks that Helal’s wife had made for us. A great way to start.

“Ki Koro?”

The nurses are also very accepting of me constantly looking over their shoulders and asking “Ki koro?” which means “what are you doing?” in Bengali. This and “Dhonnobaad”, or “Thank you”, are currently the only phrases I know.

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MSF Nurse Masuma Akter measuring the blood pressure of a patient in the Kutupalong Clinic
MSF Nurse Masuma Akter measuring the blood pressure of a patient in the Kutupalong Clinic

But, as I’m asking “Ki koro?” – when I see our teams doing a new task – it’s really interesting for both me and the nurses to realise how many different tasks they are doing and how often they do them.

It’s something that, as a nurse myself, I never really thought about.

You have your list of things to do and are reacting to patients’ needs. You just keep going until your shift is done. So, I’m fascinated to see what the results will show.

Fine-tuning

During both the training, and the time I had to sit on the ward with the nurses, we had already started noting down the tasks they conducted that had not been included on the app.

For example:

  • Changing the ice blocks in the cooler box – as it’s so hot in Bangladesh that Intravenous medications are often kept in a cooler box to ensure they do not pass their temperature limit.
  • Preparing the ward round book – including writing out the patient’s details, name, bed number and diagnosis and ensuring that there’s space to plan for that patient’s care during ward rounds.
  • Recording how many nurses are working on a task – as nurses often need to work together to provide care or take vital signs, which can require two people to document.

Although these changes had been made, it was clear that further fine-tuning was needed. Luckily, that’s the purpose of a pilot, and it was great to have the nurses coming to me already and saying “Where do I put this task, Josie?” or “What does this task come under?”.

One example is that nurses hand out food cards to patients three times a day for them to be able to receive breakfast, lunch and dinner in the hospital dining room. However, without a specific place to put this task in the app, for now, nurses had to record it under the “Other” task and provide a brief description.

One hundred tasks a day

Despite a few changes needing to be made, and for me to continue providing support on using the app, the first day is a huge success.

The four nurses on the day shift in the two wards log over 100 tasks on day one!

This was much higher than we had expected and showed how committed the nurses are to using the app and really showing what a day in the life of a humanitarian nursing team looks like.

With two more weeks of the pilot to go, I’m already really excited about what we could achieve during the rollout.

Want to read more about this project? Read Josie’s first post here, where she outlines what she and the team are hoping to achieve.