Mina Wayman experience exchange between the Bukovinian State Medical University and Utah Valley State College in relation to preparation of nurses icon

Mina Wayman experience exchange between the Bukovinian State Medical University and Utah Valley State College in relation to preparation of nurses




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НазваMina Wayman experience exchange between the Bukovinian State Medical University and Utah Valley State College in relation to preparation of nurses
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Mina Wayman

experience exchange between the Bukovinian State Medical University and Utah Valley State College in relation to preparation of nurses

Utah Valley State College, Utah (US)

Purpose. To discuss some of the challenges and rewards during the development of a study abroad program. To compare and contrast the health care delivery systems in both countries. To discover the Ukrainian nursing process. And to identify at least one health care issue in this Eastern European country in which nursing students can accomplish an intervention.

Methods. Utah Valley State College (UVSC) sent two nursing instructors and four nursing students to Chernivtsi, Ukraine to compare and contrast the health care delivery systems in both countries, to practice health care in different settings, to discover the Ukrainian nursing process and to identify at least one health care issue in this Eastern European country. They also wanted to learn more about Florence Nightingale and her work during the Crimean War. Students and faculty spent 4 weeks in 2 hospitals and one nursing home in Chernivtsi, Ukraine. Students from Bukovinian Medical University served as interpreters while in the facilities. After four weeks in Chernivtsi the students and faculty spent three days in Crimea to learn more about Florence Nightingale [1].

Salt Lake City, Utah and Chernivtsi, Ukraine are considered sister cities. The mayors of the two cities have worked together for about 15 years in many arenas. Rosemary Holt from Salt Lake City’s Mayor’s office suggested Utah Valley State College (UVSC) try a study abroad program. In November the director of International Studies, the nursing department chair, and the director of the study abroad program from UVSC traveled to Chernivtsi and met with the administrators of Bukovinian State Medical University to make plans for the program. Plans were mode and the decision was accepted to send students from UVSC to Chernivtsi for a study abroad experience.

Further development of the program required communication between both schools which at times proved to be difficult for both sides. Communication was generally through email. Some email seemed to get lost, and even the contract signed and sent to the Bukovian Medical School never arrived. One instance of miscommunication was information about what should be worn while doing practicals. The staff at the Medical University tried to describe what to wear but the contingency from the United States apparently did not understand. Therefore, their first experience in the hospital was rather humorous as they dressed in hospital clothing worn in the United States. They wore “scrubs” and “nursing shoes”, as they walked down the streets of Chernivtsi to their first practical experience. As they found soon their shoes were not acceptable, and wearing hospital apparel was not appropriate while on the streets. The people of the Chernivtsi City Pediatric Hospital were kind and gave them a tour of their hospital and then sent them to purchase the proper clothing.


^ UVSC Nursing Uniforms Figure 2

Ukrainian Nursing Uniforms Figure 1

Nurse in U.S. Figure 3


Figure 1 demonstrates clothing worn while doing practicals in Ukraine. Figure 2 shows clothing worn by UVSC nursing students during their practicals in the United States. Figure 3 shows clothing worn by professional hospital nurses in the United States.

Medical students of the Bukovinian Medical University served as interpreters while in hospitals, on tours, and working with administration. This method of communication proved to be successful and helpful for students and faculty. It was beneficial to have students who understood nursing and medicine because they understood the terminology and the reason for the questions. The Ukrainian students were interested in learning about health care, both in their homeland and in the United States (U.S.). The free flowing exchange of ideas, information, and methods made the experience richer. The faculty of UVSC hopes to use Bukovinian State Medical University students as interpreters again in subsequent years. Also, one Ukrainian student with two American students appears to be an ideal proportion.

One of the main goals was to compare and contrast the health care delivery systems in both countries. It was discovered that there is a vast amount of difference in the two systems. One of the primary differences is entry into the health care system. Although in both countries there is an emergency response team and emergency care system that are similar, the difference lies in care of the client who requires intervention for a non-emergency. In the United States a client will make an appointment and visit with a health care provider of his/her choice. Usually the client will be treated directly in the health care provider’s office. In Ukraine, an individual will go to a diagnostic center first, and if a problem is discovered he/she will go to the hospital for treatment. Treatment for hypertension, otitis media, simple wounds, heart disease, and respiratory illnesses are often cared for in an outpatient clinic in the United States. In Ukraine these would be cared for in the hospital. Also, patients in Ukraine stay in the hospital much longer and families are more involved in providing care.

Equipment, supplies, and medications are quite different in many cases, but whether the patient was receiving health care in the hospital in Ukraine or in an outpatient clinic in the United States the principles of care are the same. Some of the differences in procedure were alarming at first glance, but after seeing wonderful outcomes, and reading some of the policies and procedures it was discovered that the basics are similar, and perhaps the United States health care systems could learn from the Ukrainian Health Care System. Please see below a brief comparison of the health care systems in United States and Ukraine as noted by the students and faculty of UVSC (tabl.).

Provision of nursing care as observed in Ukraine appeared poles apart at first glance from provision of care in the United States. However, there are ways nursing care in Ukrainian hospitals resemble nursing care in American hospitals. These similarities include. The format of the initial survey of the patient’s demographics and health data.

  • The physician order form which prescribes care to be given by the nurse.

  • The large amount of time a nurse spends documenting assessments and care.

  • The management of the units and other nursing personnel.

  • The responsibility of the nurse to perform all necessary care and activities, and the duty of the nurse to provide a soothing, calming environment and provide comfort to the patient.

There certainly are many other areas in which similarities can be found. However, after only 4 weeks in hospitals and one extended care facility, it is difficult to understand all the complexities of nursing care.

Table

Comparison of the health care systems

^ Policy or Practice

United States

Ukraine

Ambulatory Care

This is the point of entry for care. Clients establish a relationship with a “primary care provider” first. If a specialist is needed he/she will be referred. These physicians have an office where they provide this care. Many of the providers own their own business and employ staff to help in their office.

The ambulatory care clinics are “Diagnostic” clinics. Clients receive diagnostic procedures needed. If follow up care is needed he/she will go to the hospital and admitted.

Emergency Room

Each hospital has an emergency department. Clients are treated and either sent home, or admitted to the hospital. The stay in this area is less than 24 hours.

Each hospital also has an emergency department. Patient’s are admitted to the emergency room, and may remain there for weeks or months.

Health promotion & Screening

Private and governmental insurance companies will pay for many health screens and disease prevention strategies. These include but are not limited to: immunizations, mammograms, pap smears, prostate exams, ophthalmology, and colonoscopy,

The people of Ukraine are encouraged to have x-rays of lungs. Screening is done because it is required for employment, driver’s licenses, or admittance to schools. These documents require biannual or annual variations of the following screening:

  • X-ray of lungs

  • Tuberculosis Screening

  • Pap smear

  • Complete Blood Count

  • Vision Screening

  • Urinalysis

  • Psychological testing

Hospital Care

Most hospitals have private and/or semi private rooms. Linens, personal cares, medicines, and treatments are included in the cost of the health care. Insurance companies pay percentages with a copy required by the client. The nurse will care for four to ten patients during one shift. Shifts vary from 4 hours to 12 hours.

Patients are in wards with 3-5 other patients. The patient’s family brings in the medications from an outside pharmacy. The family helps with bathing and provides linens and clothing. Patients are allowed to go home to shower or go home for the weekend. The nurse will care for up to 35 patients. The nurse works 24 hour shifts.

Intensive Care Unit (ICU)

Only the extremely ill who require at least 12 hours of nursing care per day are found in the ICU. Nurses care for one to two patients.

Similar setting to U.S. One nurse will care for two to four patients. There is minimal patient monitoring equipment.

Diagnostics

Hospitals are equipped with a laboratory and radiology equipment. A Health Care provider has some of this equipment in the office, however, if a client needs special studies they will go to the hospital for “outpatient” diagnostics. The tests are run by trained technicians. The information will be sent to the ordering health care provider who will share the information with the client.

The diagnostic clinic is point of entry for care. Laboratory and radiology equipment are housed in this building. Physicians do the testing and provide care in the diagnostic center.

Long Term Care

There are facilities for different levels of care provided. These include rehabilitation, assisted living, and long term care. Each of these areas are subdivided into different levels also.

One level of care provided, much like the U.S. assisted living level of care. Rehabilitation is provided in the hospital.

Operating Rooms

Operating rooms only have one Registered nurse. “Technicians” assist with the surgery. Patients are dressed in hospital attire for the procedure and each suite will only accommodate one patient. All personnel wear only apparel provided by the facility. Equipment comes in packages ready for use, prepared either by technicians or by medical supply companies.

Only nurses and physicians are found in the Operating Room. There are no trained technicians Patients wear own clothing during surgery. 2 patients may be in the same operating suite at the same time. Nurses wear their own clothing covered by sterile gowns as needed. Nurses spend many hours preparing equipment.

The last goal was to provide one health promotion activity while in this country. This became difficult for two reasons. One reason is the language barrier, and the other reason is because there is not a current system for this activity. Provision of a health promotion activity was not done while in Chernivtsi during the summer of 2007. In the United States one will see health care professionals set up blood pressure screening, blood glucose screening, toe nail clippings, ear wax removal, skin checks, and other health promotion activities in senior centers, in shopping centers, or at fairs.

Another goal was to learn more about Florence Nightingale in Crimea where she gained knowledge of caring for soldiers during the Crimean War. Many believe she was able to change nursing from a vocation to a profession. The faculty of UVSC was under the impression that more could be learned about her life and her work while traveling to Crimea. There was very little information about her in the museums and the area where she worked.

Results. Students were able to compare and contrast the health care systems of the United States and Ukraine. They were also able to come to understand nursing care in this Eastern European country. The students were not able to deliver one health promotion intervention while in Chernivtsi however; but faculty hope that during the summer of 2008 a free health care screening of either blood pressures or blood sugars can be set up at one of the new large shopping centers in Chernivtsi. Crimea had minimal information about Florence Nightingale, making the sightseeing trip interesting but the original goal to learn about her was not realized [1].

This was a successful study abroad experience and students enjoyed the five weeks in Ukraine. All fours students describe gaining confidence in their nursing care and in themselves. M. Meyers, one of the students states: “This experience gave me more confidence as a nurse and made me more capable with my skills. I especially enjoyed watching Ukrainian nurses care for their wounds. While I don't use the same chemicals and bandage materials often, it did help me evaluate my skills and gave me incentive to learn more” [4]. Another student, J. Juchau states: “I feel like I am a better person and I will be a better nurse because of this experience” [3].

Another bonus noted was an appreciation and affection for people from many parts of the world. Faculty and students stayed in the ‘Hostel for International Students’ where they met people from many European, Asian and Middle Eastern countries. Student Staci Griner writes: “Being in Ukraine and meeting people from all over the world taught me that people are people. Although cultures may be different people are pretty much the same. You can find good and bad people where ever you go…It doesn’t matter if these people have different ideas or backgrounds from me I like to learn from them”. For this group of students and faculty the “cultural diversity gap” has become much smaller. People who span the globe were concerned for the welfare of these foreigners from America, as demonstrated when one became ill, or another injured [2].

Conclusion. This program will continue in the future, and anyone who is fortunate enough to participate in the hospitality of this great land and country will experience something that will change their life forever. This program will remain a rich and rewarding experience even if no changes are made. Four weeks in the hospitals, and one week sight seeing was an excellent program and should be continued. The faculty of UVSC hopes to use Bukovinian State Medical University students as interpreters again in subsequent years and suggest at least one Ukrainian student is needed for every two American students in order to have an ideal match. In subsequent years, rather than remain in the city limits and share valuable practical experience with students from the Medical University, a trial of visiting hospitals in outlying regions may prove to be as beneficial, if not more beneficial.

Some things Utah Valley State College and other higher education institutions may consider prior to beginning a study abroad program may include using the student interpreters for communication needs through email prior to and after the study abroad experience. Also, as suggested by the group of students who just completed the study abroad experience, teach them some common Ukrainian phrases prior to leaving the United States.

Finally, Health Care Screening, especially of the elderly people may be enhanced in post-soviet Ukraine, and students from the United States can help while studying in Ukraine. A trial of providing free screening to the people of Chernivtsi in a public place will be pursued in 2008 as a joint effort between the two schools. The United States health care system believes in the premise that education of the community will improve health care and prevent disease. This activity can strengthen relationships and help the community of Chernivtsi with minimal cost and effort.


Acknowledgments

Thanks to the staff, students and faculty of the Bukovinian Medical University, Chernivtsi City Pediatric Hospital, Bukovinian Regional Clinical Hospital and the Geriatric Hospice. Their generosity, patience and open mindedness made this experience an educational success. The medical professionals in Ukraine welcomed the students and faculty to their facilities, made it possible to observe their medical facilities, provided information and supplied a significant review of this paper. Also, without the financial and travel assistance of Utah Valley State College this program would not have been possible.

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