Embedding the WHO-ICRC Basic Emergency Care course as a sustainable curriculum innovation in pre-service nursing education in Uganda

In hospitals around the world, the moment a patient's condition suddenly worsens is a critical turning point. Whether it is a severe infection, a traumatic injury, or a complication from a chronic illness, the first few minutes often determine whether a person survives. In many places, especially where resources are limited, the first person to notice this change and begin life-saving care is not a specialist doctor, but a nurse. These nurses work in busy wards, maternity units, and community clinics, often acting as the primary decision-makers when a patient begins to fade. For decades, the training these nurses received focused heavily on general medical knowledge, leaving a gap in their preparation for these specific, high-pressure moments. They might know the theory of how the body works, but they often lacked a simple, repeatable system to follow when a patient was in immediate danger. This gap meant that even well-meaning, skilled graduates could hesitate or miss the early signs of a crisis, simply because they had never practiced a structured response in a safe environment before facing a real one.

To address this, a team of educators and health professionals in Uganda set out to change how nurses are trained before they ever graduate. They focused on a specific program called the Basic Emergency Care course, a practical guide designed to teach frontline workers how to assess a sick or injured person using a clear, step-by-step method. The course teaches a system known as ABCDE, which stands for checking the Airway, Breathing, Circulation, Disability, and Exposure of a patient. It also covers how to take a quick history, how to sort patients by urgency, and how to perform life-saving actions like cardiopulmonary resuscitation. The goal was not just to teach these skills in a short workshop, but to weave them permanently into the regular university curriculum for nursing students. By doing this, the team hoped to ensure that every new nurse would leave school with the confidence and the specific tools needed to act immediately when a patient deteriorates.

The story of this change began in 2018, when the project started as an external pilot program supported by international partners. At that time, a small group of about thirty-five fourth-year nursing students and four faculty members took part in a five-day intensive training. The students practiced on mannequins and in simulated scenarios, learning to work together as a team to manage emergency situations. The results were encouraging. The students reported feeling much more capable, and the faculty noticed that the trainees were better able to recognize danger signs and communicate clearly. However, the team realized that a one-off training session was not enough. If the skills were not reinforced and if the training remained dependent on outside funding, the progress would likely fade once the project ended. They needed to make this a permanent part of the university's education system.

The turning point came in 2019, when the university reviewed its nursing curriculum and decided to formally include the Basic Emergency Care course as a required unit for all fourth-year students. This was a strategic move. By placing the training in the final year, the students had already learned the basics of medicine and had spent time in hospitals, so they could understand the urgency of the lessons. Yet, they had not yet started their careers, meaning the skills would be fresh in their minds as they transitioned to real-world practice. The team worked hard to build local capacity so that the university could eventually run the course on its own. They trained faculty members and experienced ward nurses to become instructors, ensuring that the knowledge would stay within the institution even after the initial external funding stopped.

To understand how this change affected the students, the researchers gathered feedback from thirty-two fourth-year students who had completed the course after it had been embedded in the curriculum. The students shared their experiences through anonymous forms, and the researchers analyzed these responses to find common themes. The feedback revealed that the training did more than just add new facts to their memory; it gave them a structured way to think. Students described how the ABCDE framework helped them move from a state of general worry to a clear sequence of actions. They felt they could now look at a patient, quickly identify what was most urgent, and start the right treatment without freezing. One student noted that the course equipped them with specific skills for assessment and intervention, while another mentioned that they could now distinguish between emergency signs and non-emergency signs with greater certainty.

A major part of the students' success came from the way the course was taught. Instead of sitting in a lecture hall listening to a speaker, the students spent their time in simulation labs, practicing skills on mannequins and working through realistic scenarios in teams. They described these sessions as lively and memorable, allowing them to make mistakes and learn from them in a safe space where no real patient was at risk. They valued the workbook that guided them through the material and the opportunity to rehearse complex tasks like resuscitation and handover communication. This hands-on approach seemed to be the key to building the confidence they needed to act when the pressure was on.

However, the students also pointed out that training alone was not a complete solution. They expressed a strong desire for more time to practice, particularly for difficult skills like resuscitation, noting that repeated practice was essential for building true competence. They also highlighted a gap between the classroom and the hospital ward. Several students suggested that to keep their skills sharp, they needed to be placed in emergency units immediately after training, so they could use what they had learned right away. They worried that if they waited too long to apply these skills, they might forget them. This feedback suggested that for the training to truly work, the hospital systems needed to support the new graduates, giving them the chance to use their skills regularly and receive guidance from experienced mentors.

The researchers concluded that embedding this emergency care course into the pre-service curriculum was a successful step toward better patient safety. The process showed that it was possible to move a specialized training program from a temporary, donor-funded project to a sustainable part of a university's core education. By training the trainers and making the course a standard requirement, the university ensured that future nurses would graduate with a common language for emergency response and the confidence to act. The study did not measure whether patients lived or died as a result, but it did show that the students felt better prepared, more confident, and ready to handle the complex, high-stakes situations they would face in their careers. The work suggests that when nursing education includes structured, hands-on emergency training before graduation, it creates a stronger foundation for the entire health system, preparing a workforce that can recognize and respond to crises from day one.