Good practice, education and teamwork, Maldives

Decent Work and Economic Growth Quality Education
Case Study Submitted by: Fathimath Rasheeda, Ward manager (RNM, BSN, CCN), Indhira Gandhi Memorial Hospital (IGMH), Kanbaa Aisaarani Hingun, K. Male’
Mariyam Shaukath, Deputy Ward Manager Zileena Mohamed Didi, Deputy Ward Manager Aminath Rishfa, Deputy Ward Manager
Country: Maldives
Explore the manager and leader within yourself because that’s what nurses are.

In many clinical settings, nurses are overworked and undervalued, caring for patients who are highly dependent on their care, but lacking the time for adequate patient care or interaction.

Fathimath Rasheeda, Ward manager at the Indhira Gandhi Memorial Hospital in Male, Maldives observed this in her medical ward. There was a high uncertainty of daily events, since many tasks are highly interdependent or dependent on the condition of the patient in question. With 5-6 nurses working a 8-9 hour shift, caring for 35 patients, most of the nurses were not able to take their one hour break. Approximately 75 to 80% of the patients were bedridden and highly dependent on nursing care.

Low morale amongst staff led to conflicts, and many nurses felt they were running around like “headless chickens”. They had ineffective communication and poor teamwork among themselves and other units in the hospital. Some critical care patients on mechanical ventilators were placed in cubicles where they were not properly observed and where their safety was compromised.

After a close analysis of the situation with the deputy ward managers and other nurses in the ward, Fathimath suggested to the nursing director to merge the medical ward with a small general ward unit of more than 10 nurses caring for patients who were fit for discharge. This resulted in an increase in the number of nurses in both of the units and enabled some nurses to be posted for a week or two in the intensive critical care unit to learn how to care for critical care patients.

and two other nurses joined the critical care nursing advanced diploma course and established an education session for all nurses during the monthly staff meeting of medical ward. The sessions included critical care topics such as interpretation of ABG results, Interpretation and recognition of abnormal ECGs, and physical assessment (system wise assessment; cardiovascular, pulmonary, gastro intestinal, neurological exams, etc.). In addition, body system examinations and care planning were taught to nursing students posted to the ward for clinical practice.

Fathimath established a new “priority cubicle” especially for critical care patients and informed all the doctors about the criteria for admission or transfer to this cubicle.

As a result, a new environment was created where nurses showed competence in clinical practice and a better understanding in managing critical care patients. Complaints in the unit decreased and better teamwork and respect was observed amongst the multidisciplinary team. The medical ward became a place to learn and to grow; a place where nurses love to work and new graduates and nursing students look forward to join and work.


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