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Inspiring Nursing Education at Sihanouk Hospital Center for HOPE, Cambodia

By Patti Nicks, RN, MSN

I have maintained an active connection to HVO since I first volunteered for an assignment in Vietnam in 2019. I closely followed the HVO website to keep track of opportunities to volunteer my services for nursing education. Finally, in June 2023, I was excited to see that HVO was offering on-site volunteer assignments again, and one of the sites was Cambodia! I had traveled to Cambodia the year before, and the culture and kindness of the people I met were incredible. To work and learn with the nurses in Cambodia would be an incredible opportunity. I applied to volunteer as a nurse educator and met with the HVO project director by Zoom to discuss the needs of Sihanouk Hospital Center of HOPE (SHCH). I learned that one of the main objectives of the project was to offer educational sessions to the nursing staff of the hospital to help them meet the license renewal requirements of the Cambodia Council of Nurses (CCN), which includes 20 hours of continuing education. HVO has teamed up with SHCH to provide trained educators to support CCN education in the hospital. SHCH determines what educational sessions volunteers should offer based on both the needs of the Cambodian nurses and the expertise of the educator.

While preparing for my trip, I noted that Cambodia is experiencing a severe nursing shortage. I discussed the status of the nursing shortage with medical and nursing directors at SHCH. They told me that stressing professional values during my visit would inspire students to feel that nursing is a prestigious career path for young Cambodians.

The main request for my volunteer services in Sihanouk Hospital was to give lectures to the hospital nurses. The lectures I created had to be approved by the CCN. My area of expertise is in public health and nursing student education. Therefore, I chose to update the nurses on rashes and rabies in Cambodia as well as professional communication. The nurses were invested in and participated in the sessions. I worked in the gynecology unit one day, and the nurse stated that previously she hadn’t thought of rashes as indicators of treatment and diagnosis, and that she now looks at rashes in a new light based on my lecture. I was thrilled to hear her say that!

Each day, I took a tuk tuk to the hospital. Nurses would greet me with “Good morning, Teacher,” or “Good morning, Professor,” and I would feel such incredible pride. I would begin the day at the glucose screening station or at the urgent care triage station. When I arrived, the hospital was completing a one-month long glucose screening program for community members who had no previous diabetes diagnosis. By the end of the month, the site had gathered over 1,200 samples of individual glucose results to enter into a database for analysis. One patient I helped screen had a result of over 350 mg/dL, proving the screening was needed.

I spent two days working in urgent care triage. Sihanouk Hospital assesses and treats approximately 300 to 400 patients a day, including follow up care and new emergency care. Wait times could be hours and the patients are sitting outside in 30 – 40 C temperatures. In triage, decisions are made about who is seen by a physician and who is directly admitted to the hospital. It was amazing to see the nurses in action under difficult circumstances. I didn’t see more than three nurses working this station at any given time.  I completed many vital sign assessments, and, with the help of an interpreter, I was also able to do brief assessments. I did have one patient who spoke English and I was excited to be able to assess her needs! I felt so proud to be part of her care. I also spent time working in the emergency room with the charge nurse of the unit. I was able to care for a man with GI pain. The respect and trust I felt from the patients’ family, nurses, and physicians regarding suggestions for care was amazing! The physician ordered bowel care as I suggested. The nurses were so knowledgeable and working with very little advanced equipment or technology. The nurses complete all their charting by hand.

I was asked to meet with the daughter of a nurse at Sihanouk Hospital for support as she planned her future career path. She was considering either following her father’s path in nursing or becoming a teacher. There is an ever-increasing need for nurses in Cambodia partially because of the 1970s genocide of intellectuals and partially because nursing is often not considered a respected career. I talked with the young woman about the profession of nursing and how nursing is a prestigious and respected career in Canada, where I’m from. I encouraged her to think about what the profession of nursing could become in Cambodia with continuing professional growth through the CCN. At the end of our conversation, I felt that she was motivated to think about choosing nursing as a career with a bright future in her country.

I was also asked to give a lecture at a local nursing school in Phnom Penh about professional nursing values and how these values could have an impact on the future of nursing in Cambodia. One nursing student approached me after I spoke on professional communication, and we discussed how she felt when a nurse was dismissive when a student was learning a new skill. We talked about how to communicate her need to learn, the need for patient safety, and the importance of respecting the nurse’s knowledge. This experience was a great opportunity to connect with a future nurse to discuss what professional behaviors, including mutual respect and kindness, mean to nursing in Cambodia.

During my volunteer assignment at Sihanouk Hospital, the kindness shown to me when working as a nurse in urgent care, blood glucose station, and the ER was heart-warming. The nurses all were kind and took time to show me the way nursing care is given in Cambodia. At no time did any nurse appear irritated that she/he had to work with a nurse who didn’t speak the language, even though it was obvious this did take away from their routine. I am grateful to the nurse manager, Kolenine Meak, who encouraged me to integrate into the nursing culture at Sihanouk Hospital. I am also grateful to the nurses, physicians, and patients who showed such kindness to me and for the laughter that we had when we communicated together. It was an experience never to be forgotten.