Fieldset
Innovation: A day in the life of a humanitarian nursing team – The roll-out

After a successful pilot, Josie and the team are ready to launch their research project, using smartphones to track the work of Médecins sans Frontières / Doctors Without Borders (MSF) nurses caring for children in Bangladesh …

And we’re off! It’s official, the pilot project is complete and no more changes can be made to the smartphone app. The nurses who are participating in the project are now used to recording all their activities in the app and luckily are still enthusiastic, and so the roll-out begins. 

Fingers crossed the data we collect over the next four weeks will show us what a day in the life of a humanitarian nursing team consists of. We’re hoping to develop a really complete picture, which we can then feed into ideas about safe nursing levels in humanitarian settings such as refugee camps.

Problems with the delivery of care are rarely the fault of the nurse, but instead the systems and resources they are working with

We’re going to be working with the same nurses who were involved in the pilot project: the teams from two paediatric wards in an MSF hospital in Kutupalong, Bangladesh. Kutupalong is the site of a refugee settlement that’s currently home to around 900,000 people

Now that we have the app organised I can start to focus on other aspects of data collection, to ensure we really understand how nurses here look after the patients.

Structures and systems 

My first task is the “structure survey”. This looks at the resources, both human and material, and the systems the nurses have in place for delivering care. For me this is a really important part of the study. 

Problems with the delivery of care are rarely the fault of the nurse, but instead the systems and resources they are working with. However, seeing the problems with the resources and systems is challenging: it’s much easier to see the problems with individuals. 

Problems with systems may be difficult to identify in conventional medical settings, but MSF also works in some of the most stressful medical environments that exist. Our staff come from all over the world, bringing together a a variety of approaches to delivering care. All this can make spotting issues even harder. 

I have to observe as many different nurses at as many different times as possible

So, I spend a day in the hospital going through all the services the team uses (laboratory, pharmacy, sterilisation, the laundry) and all the systems in place that link these services to the paediatric department. 

I then spent a day on the ward going through each piece of equipment and discussing all the systems they have in place. 

It was actually really fascinating to learn about everything and once again the nurses were very patient with my constant questions of, well how does that work? or why does this live here? 

As a nurse in the field I rarely had time to do things like this or would just focus on one specific task or issue. However, covering the whole hospital and seeing the bigger picture gave me a much clearer understanding of why care would be delivered in a specific way, even before I started observing nurses providing the care itself.

Hopefully, combining the results of the structure survey, with the results from the app will help us to gain a better understanding of things like why tasks take a specific amount of time or why nurses sometimes have to leave the ward. It should also highlight the importance of assessing the structure when evaluating nursing care. 

Direct observations

Alongside the app and the structure survey, the observation is also important, to see how nurses currently deliver care with the resources and systems they have. This means watching our nurses in action!

To ensure I get observations that are as true to the situation as possible I have to observe as many different nurses at as many different times as possible. This concept kind of blew my mind! 

It was a real eye-opener to see the difference between the day and night shift

Nursing doesn’t stop overnight, which meant I needed to observe night shifts as well as day shifts. With the day shifts being from 8am to 7pm and night shifts being from 7pm to 8am, I worked out that I could do a week of “earlies” and be in the hospital from 5:30am to 1pm, and then a week of “lates” from 1:30pm to 10:00pm. 

I needed to observe both wards, which I would alternate between, and I would have to note down which nurses I observed each shift, just to double-check I managed to see everyone more than once and at different times. 

So now all I had to do was cross my fingers and hope none of the nurses swapped shifts! 

Early shift

The first “early” came and although it was hard to get out of bed, getting to hospital was a breeze, as there was no one else on the road. 

I arrived at 5:30 and although I had told the nurses I was coming they still seemed quite surprised I’d actually made it. 

I sat on the ward and it was just so different to when I had been there during the day. It was so peaceful. 

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The paediatric ward is decorated with balloons
The children's wards are kept child-friendly thanks to the nurses who decorate them with balloons

The caretakers of the patients were slowly folding away their mosquito nets and the nurses were getting themselves organised to do the vital signs and medication rounds. 

While the rounds were being done, breakfast for the patients and caretakers was delivered. That morning it included a banana, bread and an egg. 

The rounds finished in what felt like record time and I found myself thinking how much I was enjoying being on the ward. There were hardly any interruptions, and everyone seemed really relaxed. 

Then before I knew it, it was 8am and it felt like all hell broke loose. Which wasn’t actually the case at all, it was just a normal morning, but there were suddenly so many more people: more nurses, more doctors, more cleaners, all the international staff, the pharmacy staff, the health promoters, they just kept coming. 

It was a real eye-opener to see the difference between the day and night shift and it will be interesting to see if activity tracking results from the app reflect that, for example if tasks take less time or fewer interruptions are noted. 

A welcome visitor... 

During the period when I was spending time on the wards in the early hours of the day, the nursing advisor and project manager for the research, Vicky Treacy-Wong, came to visit. 

It was wonderful to have Vicky here and she gave a great speech of encouragement to the nurses, highlighting once again that this is the first piece of MSF nursing workforce research and that she was so proud of their enthusiasm to get involved and all their hard work. It was a great boost for the nurses and they really appreciated the recognition.  

After discovering the peacefulness of the “earlies” it became much easier to get out of bed; now I can only hope the “lates” will be similar.