Editor’s note: The following article is a guest contribution from Betty Beard, RN, MSN, PhD. Dr. Beard, Professor Emeritus at Eastern Michigan University, is the Project Director for HVO’s nursing education project at Hai Duong Medical Technical University in Vietnam.
The World Health Assembly, governing body of the World Health Organization, chose 2020 as the Year of the Nurse and Midwife. The year also commemorates the 200th anniversary of the birth of the person who most influenced contemporary nursing: Florence Nightingale. HVO joins with global organizations to celebrate the profession that represents over half of all health care providers worldwide. This is the year to not only honor nursing but to also help people be more aware of the actual work that nurses do. In order to achieve and sustain universal health coverage by 2030, the World Health Organization reports a need for 18 million health care providers, half of whom will be nurses and midwives.
Nurses are intimately involved with patients, families and communities from before birth – with family planning, throughout life, and beyond death when they help families work through their grief and loss. In many communities nurses and midwives are the only ones providing health care.
HVO has long recognized the critical role that nurses perform in providing care and has developed projects and programs to support and advance this care by recruiting volunteers who work beside nurses who are performing roles of both educator and provider in their local communities. HVO’s philosophy is to partner with local providers, by invitation, to provide transformative education that will improve health care over the long haul.
HVO currently has specialized programs that seek nursing volunteers, for example, in wound care and lymphedema, hematology, and oncology. HVO also has seven nursing education projects in 5 countries on 2 continents. These nursing projects meet the needs of host country institutions, are sustainable, and all build local capacity. HVO volunteers are nurses who willingly give up their precious holiday and vacation time, at their own expense, to travel overseas to work with their nursing colleagues. Not only are they working with nurses, but they also often team up with medical and nursing students, medical residents, physicians and surgeons, and university faculty. They do this through methods as varied as formal lecturing, seminars and discussions, role modeling, mentoring and coaching, clinical rounds, skills labs, and development of clinical protocols. Volunteers must be flexible as schedules, people, methods, and topics can rapidly change.
Topics are identified either by local hosts or in consultation between providers and volunteers. Over the past few years, HVO nursing volunteers have consulted on wide-ranging areas. Here is a sample: post-partum and newborn assessments; diabetic care; depression; managing ventilators; burn care; domestic abuse; emergency preparedness; patient safety; ICU; peri-operative care; triage; and physical assessment. At universities, volunteers consult with enthusiastic faculty on their programs of research, curriculum planning and evaluation, active teaching and learning methods, development of simulation case studies for both fundamentals of nursing courses and specialty courses, and student clinical evaluations.
Volunteers come away from these experiences humbled by what they see and experience. They describe their colleagues as: bright and eager to learn; tenacious; creative; committed to life-long learning. Nurses stand in awe of other nurses and say that they are “learning together.” Host health care workers are hungry to learn how to improve the care they provide. They are curious about how protocols work in more developed countries and how to integrate those protocols into the care they give. At a major nursing school in Asia, nursing faculty are developing their programs of research to help improve health care in their country. They are working on wound care assessment and revision of protocols for wounds; early breast cancer diagnosis; and assessment of congestive heart failure for patients living in rural areas. HVO volunteers are collaborating with the young nursing faculty to develop their research proposals and implement their projects in the clinical area.
At a hospital in another Asian country, an HVO volunteer said they were shocked when making clinical rounds. They saw patients with advanced tuberculosis, polio, HIV, tetanus/lock-jaw. The severity of disease and the scale of the resources to address them was “eye-opening.” And then the volunteer dug in, as nurses do, to work with the staff to identify the most challenging health issues they see along with creative, sustainable ways to address these to improve their nursing care.
Volunteers frequently comment about the commitment demonstrated by nurses to learn and to share their questions and concerns. Nurses often must come in on their day off to attend workshops, seminars, and discussions. While not every nurse is eager to change their practice, many are.
Not all changes happen to nurses in host countries. Changes happen to and within the HVO volunteers, too. The ‘transformation of lives’ works both ways. In one case, a volunteer nurse was in the Neonatal ICU. There were 60 babies with only 3-4 nurses. One infant was gasping for air. The other nurses were busy so the volunteer grabbed the ambu bag and gave him manual breaths. Heart rate and oxygen were good if he was bagged. The volunteer kept this resuscitation up for one hour and “couldn’t let this baby go.” When the parents showed up the volunteer explained the situation and was on the verge of tears telling the parents how sorry they were while still bagging the baby. The father said, “Don’t worry sister; it is what God wants.” The volunteer stopped and handed the baby to the parents. As the volunteer said, “I can’t really explain how I felt at that moment, but I had gained some perspective.”
In another country, working on another neonatal unit, an HVO volunteer shared some words of guidance for future HVO nurses, “Know that you are not going to always be able to ‘change the system’ but you can share your knowledge and expertise; model care and compassion; be supportive and nonjudgmental. My nursing colleagues here have taught me (and often have to remind me), ‘you can only do what you can do and the work will never be done.’ A baby (patient) or two may survive because you were physically there, but many more will survive because you shared your knowledge.”
About six months ago, an HVO nursing volunteer made rounds on two 18 bed ICU units in a government hospital. After rounds, both head nurses asked the same thing, “What can we do to improve our nursing care? What do you do in the US? ” After a review of patient charts, the volunteer pointed out that pressure sore assessment was only done once per 12-hour shift or even less often. As a result of that short collaboration, nursing care protocols were immediately changed, and standardized charts were revised.
Early on in their basic programs, nurses learn the importance of teamwork. They learn that the best care provided for patients is given within the framework of effective, respectful teams. HVO nurses value this concept as they work with their colleagues to improve the health care that all patients receive, and the education provided for future nurses – wherever those nurses and patients happen to be.
In this year that formally honors nurses and midwives, HVO joins with health care organizations to thank the nurses who willingly give their time, finances, talents, energy, hearts, creativity, and knowledge as volunteers and partners with host institutions overseas. We also celebrate nurses in the work that they do every day in every corner of this beautiful small world we share; well done, nursing colleagues!