Yale University School of Nursing International Study

INTERNATIONAL PROJECTS OVERVIEW 2010-2011

2010-11-08T12:58:00.007-05:00

Here are the International Nursing Opportunities for Spring 2011.

MANAGUA, NICARAGUA
Title: Pediatric Clinical Experience in Managua, Nicaragua
Location: La Escuelita Managua, Nicaragua
YSN Faculty coordinator: Pat Ryan-Krause, Mikki Meadows-Oliver
Site Preceptors: same

This is the fifth year of an ongoing commitment from YSN to provide complete health screenings for the children of La Escuelita and to develop a referral and follow-up system for identified health issues. In addition to the health assessments, a strong educational component for teachers and parents is developing so that in this environment of extreme poverty and limited access to health care, basic needs may be met by parents and teachers. Based on needs identified over the past 4 years and at the request of teachers and our community liaison, expansion of services this year will include mental health evaluations and on-site small groups and the development of a neighborhood health fair for families in the neighborhood of La Escuelita.

HONG KONG, CHINA
Title: Traditional Chinese Medicine (TCM) and the APN
Location: Hong Kong Polytechnic University School of Nursing (HKPU), Hong Kong, China
YSN Faculty Coordinator: Pat Jackson Allen, RN, MS, PNP, FAAN
Site Preceptor: Pat Jackson Allen, RN, MS, PNP, FAAN
Site Faculty: Sunshine Chan

This international program will offer YSN advanced practice students an opportunity to explore Traditional Chinese Medicine (TCM) and its relationship to “Western” medicine. Chinese health and illness beliefs and management plans for common conditions will be presented and compared with western beliefs and medical practices. Integration of beliefs and treatment modalities for a holistic approach to health care will be stressed. In addition, students will have an opportunity to develop traditional Chinese assessment skills and compare findings with assessment techniques previously developed in their YSN educational program.

For more information on these programs, please contact YSN Center for International Nursing Scholarship and Education. http://nursing.yale.edu/Centers/International/

Children of "La Esquelita"

2009-07-07T08:24:00.012-04:00

"La Escuelita" is a school established to provide education to children and adults who cannot afford to attend public school in Managua. The Yale School of Nursing is in its third year of a five year partnership with La Escuelita. YSN students and faculty provide health screenings and work with community organizations to provide follow up care. Donations to the project fund food, medical and school supplies for the children who attend La Escuelita.To learn more: http://www.littleschoolnicaragua.com/

YSN students spent time in Nicaragua in March 2009.

More to see of Hong Kong

2009-06-19T12:33:00.007-04:00

Photos by Rick Allen.

TCM-Traditional Chinese Medicine

2009-06-19T12:03:00.011-04:00

YSN Students studied various forms of TCM while they participated in an Integrative Health Program in Hong Kong this spring.

Cupping

Accupuncture

Chinese Herbal Medicine

Photos by Rick Allen.

YSN visits Hong Kong Polytechnic University

2009-06-19T11:45:00.008-04:00

YSN Students in Action

Hong Kong Polytechnic University

Photos by Rick Allen.

Intergrative Health-Traditional Chinese Medicine and the APN

2009-06-18T10:31:00.005-04:00

Hong Kong

March 6-17, 2009

Participants

(top to bottom, left to right)

YSN Student Leslie Wheeless, Faculty Preceptor Patrica Jackson Allen, YSN Students Cathryn Kokonowski, Sarah Comeaux, Katherine Gonzalez, Susan Wasseluk, and Miriam Lundy.

Photo by Rick Allen.

One of the best experiences of my life...

2009-06-02T09:24:00.006-04:00

The trip to Nicaragua was one of the best experiences of my life. I left feeling hopeful about the future of these families. Despite the current social and political turmoil in the country, the children at “La Escuelita” were happy. Their parents exhibited a great amount of perseverance just to survive each day. I learned a lot from our preceptors, who were knowledgeable and resourceful in finding solutions for the healthcare problems in the school. I realize more than ever that as Nurse Practitioners, we have so much to offer our patients and we have a responsibility to the global community.

Paula Rosales

Team Nicaragua 2009!

2009-06-01T12:02:00.004-04:00

Step by step...

2009-06-01T11:05:00.008-04:00

A recent trip to Hong Kong to study Integrative Health and Traditional Chinese Medicine is not the first time Leslie Wheeless has been away from her U.S. home. She traveled quite a ways, seeking to find the best way she could make a difference in the world. The YSN International Nursing Experience provides but a stepping stone to students in what can turn out to be a very global outreach in one's nursing career. Read more about Leslie's experiences in Yale Nursing Matters.

Yale Nursing Matters Volume 9 Number 2

Photography by Rick Allen.

Not just another international traveler...

2009-06-01T10:45:00.008-04:00

Brandon Ko was one of seven students that made the excursion to Managua, Nicaragua this spring break to play an integral part of the Pediatric Clinical Experience at "La Escuelita". But, Brandon's effect shows up in more than just Nicaragua as he narrates about other experiences on his journey to becoming a Pediatric Nurse Practitioner. His intense reflection of one such experience made him a recipient of one of the 2009 YSN Creative Writing Awards.

See Brandon's Submission

We applaud his efforts and are proud to say that he, as well as his fellow international students, are Making A World of Difference!

The International Nursing Experience - Interview with Sivan

2009-05-22T11:29:00.009-04:00

Sivan Doron spent Spring Break this year in La Romana, Dominican Republic. Here are some of her thoughts on the nurse midwifery experience:

What did you think of your international nursing experience?

It was an experience who kept me going for a while after I got back. There was a lot to digest.

What did you learn?

I learned about a different culture, about practicing women's health with zero resources. I learned how access to care is not only having services available to you, but also the physical ability to get there. The people we reached out and took care of would otherwise need to cross (by foot) miles and miles of sugar canes to get to the nearest hospital.

What surprised you?

Witnessing birth at a public hospital in La Romana, DR was a suprise and not for the good. One could get over the low resources (no running water in the bathroom, patients providing their own sheets) but doctor-patient power dynamics were hard to overcome.

How did your participation inspire you as a nurse?

I now know how gratifying it is to come with my own philosophy of care and practice it on women that otherwise have limited access to care.

Would you want to do it again? Why or why not?

Yes. Actually after having done that once I feel even more ready to go on and do that again. There's an mandatory "get out of the shock: period in the beginning of every new experience. I'm over that now, I can go straight to work!

Yellow School Bus

2009-05-21T10:49:00.018-04:00

This yellow school bus is not your average means of transportation.
It converts to a clinic on wheels!

YSN Midwifery Students in Dominican Republic.

Three New England Universities and 1 Dominican Hospital.
U . Mass Nurse Practitioner and Medical students with their faculty; YSN and Harvard faculty with YSN NM students; Good Sam staff

Patient Screening
Mara Evans and Hilda (interpreter) taking patient histories in English, Spanish, and Creole!

Screening the Patients:
Christy Wilson, Christina Fleming, and the doctor/interpreter screening patients at the back door

“Constructing” our “Exam Rooms” on the Yellow School Bus
Yale Midwifery Student
U. Mass Medical Student

Prenatal exams on the backseat of a yellow school bus!
Christy Wilson doing Leopold’s.

Fetal Heart Rates on a Yellow School Bus!
NM students teaching U. Mass medical student how to find/listen to the fetal heart rate.

Post-Counseling on a Yellow School Bus
Sivan Doron doing WW/GYN/FP post-counseling in English, Spanish, and Creole!

La Romana with YSN Nurse Midwives

2009-05-21T10:33:00.009-04:00

YSN Midwifery International Experience

La Romana, Dominican Republic

March 9-20, 2009

Newborn Exam

Sivan Doron, SNM

Gonzalva Hospital

Christy Wilson, Head Nurse, Nurses, Angelina Chambers, Mara Evans

Newborn Assessment

Mara Evans

Postpartum Assessement

Christy Wilson, SNM

Tradional Chinese Medicine - Sarah's thoughts

2009-05-20T12:47:00.006-04:00

We did learn some about health preservation today, much of it having to do with balancing emotions, “harmonizing visceral and bowels” (which is related to balancing emotions, as imbalance of emotions can hurt the viscera), and maintaining a balanced diet (with the five tastes, instead of food groups or the food pyramid. The maintenance of balancing Qi and its flow throughout the body is vital to preserving health. Our lecturer explained that being calm, controlling breathing, and balancing emotions are vital to keeping Qi balanced. I love the concepts of Qi and Yin/Yang because they both maintain that balance is vital to a person’s life. I see this in my patients at home and I feel it in my own life.

Sarah Comeaux (TCM Journal March 13, 2009)
Photography by Rick Allen

Traditional Chinese Medicine - Leslie's thoughts

2009-05-20T12:44:00.006-04:00

Today was our last day and we spent the afternoon visiting the Haven of Hope Hospital. This was our first visit to the Western Medicine side of a Hong Kong Hospital and it was really interesting to see how similar Hong Kong hospitals were to U.S. hospitals. I thought we were going to visit a hospice and see how TCM played a role in palliative care. It turned out that the hospital had a hospice unit, so I guess I wasn’t completely mistaken.

The tour of the hospice care was perhaps my favorite part of the day. I never worked in or visited a hospice, so this was my first experience seeing one in operation. I thought it was wonderful how the hospice nurses spoke of the importance in getting the patients outside to feel the sunlight and smell the fresh air --- it’s something that we often forget to consider when patients become non-ambulatory or otherwise dependent on machines and devices. The fact that they had designed the ramp to the courtyard to accommodate hospital beds spoke highly of their determination that all patients have the opportunity to spend some of their last days outside the confines of the hospital walls.

Leslie Wheeless (TCM Journal March 17, 2009)

Photography by Rick Allen

Traditional Chinese Medicine - Miriam's thoughts

2009-05-20T12:41:00.005-04:00

Today, we had our first clinical site visit to a TCM (traditional Chinese medicine) clinic at Kwong Wah Hospital. This was an exciting day very much filled with interesting interactions and eye-opening clinical observations. Before this trip, I saw TCM as being an alternative way of treating health problems, but I began to think today that TCM may be an "alternative", but it is a very big and important alternative here in Hong Kong.

As we toured the pharmacy, I began to dismiss old ideas I had about TCM. I had seen herbal medicine as being a medicine that was not a science like our drugs/medications. What I saw in this pharmacy was just the opposite. The drugs were not pills, but were specific combinations, personalized for each patient. And, like the pills that we prescribe people in the U.S., these people are given specific instructions about how to take the medicine (ie. how long to boil an herb, or to heat a packet that had already been soaked in herbs). Very impressive.

Miriam Lundy (TCM Journal March 11, 2009)
Photography by Rick Allen

Traditional Chinese Medicine - Susan's thoughts

2009-05-20T12:39:00.009-04:00

Our day began with a lecture on the causes of disease. This was a basic explanation of the concepts of excess and deficiency; internal and external forces. The next lecture took place in the Medicinal Nursing Laboratory, which was a room with glass jars full of traditional herbs and various tools for cupping/ moxibustion/ acupuncture on display.

Another lecture was on Chinese diagnostic skills including tongue and pulse assessment. I wanted to continue so we could really have a chance to take and describe each others’ pulses and tongues, but time was too short and we were not able to do more than quickly try each of the pulse machines. After lunch in the staff canteen, we learned about meridians. I love the way various theories are explained in naturalistic terms – rain cycles and seasonal cycles; it makes it really easy to understand.

Susan Wasseluk (TCM Journal March 10, 2009)
Photography by Rick Allen

Traditional Chinese Medicine - Katherine's thoughts

2009-04-27T12:49:00.017-04:00

After a weekend packed full of sightseeing and exploring Hong Kong, I was eager to start classes. Today we learned about the basics of TCM, including the theories of yin and yang and the five elements. A second lecture focused on how TCM views the structure of the human body. I am most struck by the similarities between the ancient view, based in nature and founded on observations and the western one based on autopsies and scientific experiments. I also find the concepts of the triple burners very interesting, defining those areas of the human form that don’t correlate to organic structures.

Katherine Gonzalez (TCM Journal March 9, 2009)
Photography by Rick Allen

YSN International Experience Makes News In China

2009-04-20T10:08:00.012-04:00

Photos submitted by Rick Allen.

2009 International Nursing Experience

2009-03-17T09:25:00.009-04:00

Some YSN students recieved the opportunity to spend their spring break in other parts of the world. This is all a part of the International Nursing Experience offered here at YSN. This spring, students traveled to Nicaragua, the Dominican Republic, and China.

In Managua, Nicaragua, this pediatric clinical experience helps to provide complete health screenings for the children of La Esquelita. http://nursing.yale.edu/Centers/International/files/MANAGUA.2009.pdf

To learn more about La Escuelita, go to http://www.littleschoolnicaragua.com/

Students traveled to La Romana, Dominican Republic to provide and support nurse-midwifery care. http://nursing.yale.edu/Centers/International/files/LaRomana.2009.pdf

The ongoing collaboration between YSN and Hong Kong Polytechnic University School of Nursing created an opportunity for students to gain hands-on exposure to nursing in Hong Kong, Chinese culture, the Hong Kong healthcare system, and Traditional Chinese Medicine.
http://nursing.yale.edu/Centers/International/files/HONGKONG.2009.pdf

Yale School of Nursing provides opportunities each year for students to gain extensive knowledge and experience in an international clinical setting. Please keep watch for stories and pictures of these international nursing experiences and much more.

Photos From Life

2008-11-21T12:10:00.011-05:00

On the left is a group of people who prepare meals at the river where my friend and I spent our day a couple of Sundays ago. We bought fried plantians, fried bread and some fried dough with dried fish and vegetables in it.

To the right, is my "office' in the bateys. I sit on the upsidedown carton, my translator and study participants sit in the chairs. This day, I had my study supplies lined up on the ledge and I keep medications (iron and vitamins) in little bags on the floor. All of my consent forms are in the backpack.

The picture below is the pharmacy in the mobile clinic. This day, it was staffed by nursing students from California.

Photos and excerpt from 7/25/08 - Jessica Pettigrew

Ina Mae in Zambia

2008-11-21T11:02:00.014-05:00

A Zambian Midwife and the baby bundle in Chipata >>>

In my last week here I have been reading a copy of Ina Mae Gaskins Spiritual Midwifery from 1977. This book is groovy in the true Simon and Garfunkel late 1960’s sort of way. Besides being an integral component of the midwifery cannon of literature, it is a fierce, if not dated, reminder of the potential pleasures of having a baby – and the essential role that trust, sensuality, and surrender has in birthing.

During a presentation I made, I talked about the ubiquitous ‘baby bundle’ – as I call it. After the baby is born, it is whisked away and wrapped in a cloth diaper, then a towel, then a crocheted blanket, then a huge fuzzy adult size blanket – so it looks like an overstuffed burrito baby – which is so large in diameter that it is tough for two adult arms to completely wrap around it. I talked about how that baby bundle reduces any skin-to-skin contact that the mother-baby pair gets, and I included in my list of recommendations that more emphasis be put on the importance of skin-to-skin contact in the hours following birth.

After the presentation, an American woman expressed her dismay in this reduced skin-to-skin time due to the baby-bundle, to which her Zambian colleague responded "everyone in this room was born into a baby bundle. We all survived." Which is true. It’s a good point. And it calls into question that, which I think, from my midwifery background, is ‘essential.’

So what is the answer? Should each clinic around the world strive to create the groovy experiences as Ina Mae and her team does? Or should it be a strictly safely first approach? Or is it an obvious combination of the two that is important?

It is this question of mother-friendly services that brought me into midwifery in the first place, back in 2002 in Tanzaniza, inspired by Mary Kroeger. I think it is this question that will keep me active and passionate about this profession. I think one thing is clear – there is no harm in providing mother-friendly-fulfilling birth experiences. So why not include it? We could all use a bit more Ina Mae.

Excerpt from blog 8/15/08 - Rosha Forman

Research Continued

2008-11-21T10:36:00.019-05:00

This week I have found myself in front of a classroom, full of health professionals, professors, and students, as an english teacher. My colleague and research angel was responsible for planning a training session, and she invited me to be a guest lecturer for medical english classes. My being rather unfamiliar with the art of teaching, i'm not sure what help I can be. But the students are cheerful, respectful, and their english is excellent already, so we can have discussions. Today's topics included everything to do with toileting (I'll be intentionally vague here for those who are not intimately involved in health care and may be wary of all this description entails). much to my surprise, I'm actually enjoying myself. I finally have a skill (though being an American, it's difficult to not speak english) that people are interested in and can use in their professions. I hope I can one day feel the same as a nurse practitioner.

Excerpts from blog 7/16/08 - Erin Luskatoff

Community Health Experience, Esteli, Nicaragua - July 2008

2008-11-20T10:21:00.016-05:00

Team Nicaragua 2008

Centro de Salud

Casa Materna

Photos contributed by Janna Ekholm

Let This Love Wash Over Me

2008-11-12T11:29:00.005-05:00

There is something about birth, about being privileged, honored to participate in one of the most intense and intimate experiences in life that humbles me like nothing else. Why me? Why am I the chosen one? What have I done to deserve this honor? It brings tears to my eyes…what have I done to deserve the trust that women give me, that allows me to assist in the most transformative of life events? After births, while I’m coming down from the so-called “birth high” (which, to me isn’t a high at all. I associate “high” with being in another world, dissociated with reality. When I participate in birth, I feel as if I am so much in this world that the intensity of life in the moment is almost too much, it crushes me, it washes over me, it consumes me. Afterward, I don’t feel high at all but acutely mindful, so aware of everything in the world.) I crave water. I want it to rain so heavily that I’m soaked to the bone. I want to swim, have my head under water so that I hear nothing at all. I want to shower and feel the cool water wash over me. I put my fingers in my ears and hear the water wash over my head. It is cold, but quiet…all I hear, feel, sense is water. The harshness with which I perceive all other stimuli is silenced by water. The day begins with water splashing on the floor (or today with my fingers scratching away at a bag of waters) and ends with me in water, allowing it to consume me as my body, mind, and hands were consumed by the splash on the floor.

So one day in the public hospital = 4 births, 2 of them which I did. One was a direct OP. 2 repairs. Lots of practices that made me want to jump up and down and scream in horror (slapping of the belly, fundal massage during second stage, literally pushing the baby out by applying pressure on the fundus, delivery on a 12in wide delivery table with feet in stirrups), but there were a lot of things that weren’t done that pleased me equally (no medications on board = nicely reactive babies, no bulb syringe suctioning, no insistence that the baby cry it’s head off, no epidurals, no sections, no inductions, no episiotomies, intermittent/no auscultation). In fact, by the end of the day, women wanted to deliver with us, the three “comadronas americanas”. Tomorrow we’ll go back and I’ll be humbled once again by the honor bestowed upon me for reasons I don’t understand.

Excerpts from 6/25/08 blog - Jessica Pettigrew

A Week Under My Belt

2008-11-12T10:03:00.009-05:00

Each day this past week I visited a clinic here in Lusaka and hung out with the midwives in the Labor Wards. It has been the best week so far - and it feels all warm and tingly to be doing that which I set out to do. My initial sense? The midwives here are overworked and under paid. They are passionate like midwives around the world about what they do. They are skillful and are hungry for more techniques to save lives and reduce morbidity. They LOVE oxytocin and active management. The only reason they are not using it is if there is not oxytocin available. In some of my interviews, which I expected to be a careful unpacking of attitudes and barriers, I have been getting answers like "I love it" and "It works." The interviews that I expected to last an hour are barely 15 minutes. One midwife actually said "Why do you keep asking me about the same thing?" Hmmm...

But not all is well in the clinics. Mothers are separated from their babies almost immediately and are asked to get up, clean themselves off, and wash their own linens about 10 minutes after delivery. The babies stay stacked on an empty bed, wrapped in a HUGE bundle of blankets and towels, waiting for their mother to nap and rest before they come together. There is very little attention paid to the post partum period. Women are discharged 6 hours after delivery. When I explained that in the US they stay for 2 days post partum there were gasps. "What do you do with them for two days??" Ah, America.

I will spend a few more days observing in Lusaka this week - and then will take off for a series of trips to observe further out. Thursday I'm leaving for the Eastern Province, bordering Malawi... then will return Tuesday to head South to Choma and Mumbwa... then North to Ndola. I have expanded my sites because a) why not? and b) a few days in one place seems like enough time to become acquainted with the culture and the practices of a place. So, 25 births later, I'm feeling like a researcher in Lusaka at last. Time is moving fast now and I just hope I can finish that which I set out to do.

Excerpts from 6/29/08 blog - Rosha Forman

Emancipation Day

2008-11-11T12:00:00.006-05:00

So, yesterday we headed to the National Park, which is really more like a city park as we name things in the States, for the festivities celebrating Emancipation Day. This is the day celebrating the end of African slavery in Guyana. There were many booths with food, and crafts, a main stage with children performing dances, and the most exciting was seeing families dressed in African attire. Many families were all dressed in the same pattern, but with varying styles, so you could easily delineate which people were there together. I was interviewed by a reporter from one of the local television channels. We also saw the manatees in the pond at the park.

Excerpt from 8/2/08 blog - Regina Longinotti

Research

2008-11-03T11:25:00.013-05:00

So. My purpose in China all along has been to conduct research with older adults, living in the community.

I am using a survey tool called the Reminiscence Functions Scale, which was developed in the USA and Canada, and tested originally on college students. Recently, though, reminiscence has emerged as a possible modality to improve self-esteem and decrease depression in older adults. So, what is reminiscence? In a simple sense, it is recalling past events from one's own life, re-visiting old memories, pleasant and painful, and processing them emotionally. Why is this important? Because as older adults age, there is sometimes an increase in isolation and depression, and a general decline in quality of life. Reminiscence may be a promising way to alleviate these events, without medication, and with human interaction, and perhaps affection.

This was a banner week for me, for data collection. After more than a month of revising the scale, which had been translated from English to Chinese while I was still at school this spring, we finalized the survey tool a few weeks ago. While the language may be Chinese, the cultural and linguistic appropriateness was not achieved, according to at least 3 focus groups we conducted. So, we made vocabulary changes in an attempt to simplify the scale, we consulted linguistic experts within the university, we consulted psychiatrists at the local hospitals and university departments...all in an effort to make the scale the best possible tool. So, for now, we are using a finalized version of the original scale. My colleagues here have been endlessly supportive and helpful. I think, ultimately, the scale may have to be completely revised to be appropriate for older adults in China, but sadly, this is out of my project's scope, as a master's student and novice researcher here for only a few months.

However, that being said, when things happen, they happen fast. We distributed probably over 200 surveys this week, with the most rewarding (for me) including outings to local parks early in the morning (6:30...this, for me, is early! but it certainly affords the opportunity to avoid the excessive heat in subtropical Changsha, and older adults are out en force doing their morning exercises). It is simply blissful for me to observe the flurry of activity, cheerful smiles and greetings in reply to my shy "ni hao?", bustling around the parks and sidewalks...people simply going about their day, living their lives.

I am content.

Pictures and excerpts from 7/6/08 blog - Erin A. Loskutoff

"My Dear - this is Africa!"

2008-11-03T11:00:00.020-05:00

It's amazing how much can happen in a week. I feel like I'm standing in a very different pair of shoes than I was during my last post - although in reality it's the same warn pair of Dansko clogs. I returned from Ndola - on a bus - after waiting 4 hrs for the bus to fill to capacity and FINALLY leave the station. No sooner was I done thanking God for the departure than on came the terrible Nigerian soap operas played at unimaginable decibels. After covering my ears and whimpering for a while - the man behind me laughed. "My dear - this is Africa!"

Ndola was a beautiful little city - with wide tree-lined streets, a 'Shop Right' super market, and a nice woman selling hard-boiled eggs and delicious oranges on the corner between my guest house and the hospital. I spent a full three days there - and in total - only observed 7 births. I decided, as most babies are born in the wee hours of the morning - to switch my day shifts into evening/night shifts. My plan all but failed there - as in 11 hours - I only saw one normal delivery. Although my eyes were tired, my confidential envelope was all but empty. Ndola hospital was very well equipped however, and did not buck the trend that I have been seeing: Active Management is used and loved by the midwives.

The last morning of my trip, acknowledging my bad luck at the hospital, I hopped a cab to see the busiest clinic in one of the surrounding compounds. What luck! I saw two beautiful deliveries in one morning. Both done by students- with the midwife looking over her shoulder. So - my total number of birth observations is at 58 (6 higher than expected). I am now heading into the next phase of my project - the analysis and the closure of sites. I have spent the day coding - and making thank you cards. As a gift I am giving protective eye glasses - as all the midwives wanted mine. In my interviews, when asked about what was needed, many said "protective clothing." While 30 pairs of goggles won't save anyone necessarily, hopefully it can prevent one splash from getting in a midwifes eyes. Wednesday I leave on a canoe trip for a few days. Time to see some hephalumps and woozels.

Excepts from 7/21/08 blog - Rosha Forman

Simple Logistics?

2008-11-03T09:46:00.014-05:00

Here I am again. Monday was a national holiday here, so I was excited to start my study today but still needed to print my survey with a few adjustments from a review by the head nurse at one of the clinics. I was finally able to print an original copy yesterday on the nurse's association computer- which was a challenge in itself for some odd reason. The next step was to make MANY copies of the 15 page document which includes, a sociodemographic survey, consent form, microbicide acceptability survey, and my 8 interview questions. I need one copy for each study participant, and I have anticipated a minimum of 100 participants (with many less interviews). So, big issue: how to make all these copies. Oh how I wish I could just run to the copy shop on Whitney. Of course no businesses were open in Georgetown yesterday because of the holiday, so here I am this morning trying to get the copies made so I can get started... I just dropped off the 15 pg document at a copy place and when I requested 50 copies (I really wanted 100) the woman working there looked shocked. Reason being, that amount of copies will be quite expensive (about the same price as it would be in the States) which is a lot of money here. I was too nervous to ask for 100 copies because of the amount of cash I'd have to pull out when paying. So, as it goes I am in limbo as I had to drop off the order & they said to call in 2-3 hours to check on it...

Will I become a researcher really one day, this afternoon maybe? Am I already a researcher? It seems a bit surreal: me being a researcher. I was emailing my friend Eden yesterday who is beginning to conduct her own research in Uganda. She mentioned how she really just wanted to be a clinician, and here she was putting so much thought & work into becoming a researcher (I am paraphrasing of course). I empathized, and her words definitely got me thinking about the many roles of a nurse, and how I see myself. I realize that I spent all year in a dual world. I was preparing myself clinically, to see patients and attend to their healthcare needs, advocate for lifestyle changes that might prevent disease, perform skills and tests that sometimes felt like magic, understand the body and its intimacies, and learn to listen, listen, listen- to determine diagnosis. And at the same time, I was formulating my research proposal and later protocol. Working through many drafts and many, many hours of literature review, preparation, interviews, ethical review. Through my first year working toward becoming an Advanced Practice Nurse, I was simultaneously navigating the language of research protocol, and the language of nursing and medicine: a 'triangulated' study versus 'phenomonology', this as foreign to me as the subtleness of the variation in heart sounds, murmurs, and the words used to describe and define them. How to write a 'protocol' of my proposed, hypothetical, research, as mind boggling as the art of conjuring the correct descriptors, to formulate the verbose, almost poetic, details necessary to 'chart' what I previously might have called a simple, 'pink rash' on an extremity.

The familiarity I am still only grasping, of how to incorporate nursing theory into my research design, and how to assess 'normal' when palpating the ever-challenging, ever-individualized, thyroid. This was all new territory for me, challenging me, on both fronts: clinician & researcher- a novice in both. Dealing with certain logistics, I have decided, might make you question anything.

What is my role as a nurse? Am I forgetting my newly acquired clinical skills while being here in Guyana, considering so many other things, none being the innumerable adaptations that occur in the female body during pregnancy or the countless maneuvers to perform during a musculoskeletal exam. Should I review the cranial nerve exam when in the taxi? I have not felt divided until now. I was caught for a moment with my clinician guard down. Is that OK? I know I am a nurse. Because I routinely remind myself of this relatively, newly acquired role: 'You are a nurse. You are a nurse.' I am also a researcher (note to self) as I sit here in a wireless cafe in a foreign country awaiting some of the logistics of my study.

Excerpt from 7/8/08 blog - Regina Longinotti

Awareness

2008-10-21T10:01:00.007-04:00

Nature must have had a plan

for you to give me all you can.

"So ends a frequently run commercial here in Guyana about exclusive breast-feeding for infants up to 6 months of age. So regular is the commercial, that the lines from it come easily to memory as I write this. I am using a line from this, oh-so-catchy, commercial slogan, not just because it gets stuck in my head on a regular basis, but also to highlight a point. This commercial which is narrated with the distinctive voice of a small child's, and begins by saying: "When I was smaller than a pea, you gave me food to keep me safe and nourish me...," is on throughout the day and evening. It is on even during what one might call "prime time" if I might borrow that term from the States. Most notably, in this commercial, a public service announcement, if you will, women are shown, very uninhibitedly, breast-feeding their babes. It is a great commercial and one that we should envy in the States. I do not think I have ever seen a close up of a breast-feeding woman and baby in a commercial in the United States. The Guyanese commercial shows this intimate, completely natural exchange so plainly, that it almost shocked me at first. How comfortable the commercial was with showing the woman's breast. Shocked me!? I am a women's health specialty nurse and huge supporter of breast-feeding!? This just reveals to me, how I have been subtly influenced by, what?, my culture in the States?, the media?, I am not even sure.

What I do know, is that I have been pleasantly impressed with the overall awareness of many health related topics here in Guyana. One of these being breast-feeding, and another of these being, HIV/AIDS related issues. The country and its health care leaders, have done an excellent job, I feel, of discussing HIV with the people. After several weeks of interviewing women for my surveys and data collection, it dawned on me, that the women are impressively comfortable and unfaltering when I ask them the questions related to sex and prevention of HIV. Almost all the women have been very educated on the topic of HIV transmission and prevention. There is very rarely ever a time when I need to go too much into background education to preface my survey questions. The women are considerably aware enough, to meet me right where I am, in the discussion. The women are never offended and not only respond thoughtfully, but often also offer great insight. I cannot help but ponder how reviewing the same questions might be different in a clinic in the United States. The awareness here impresses me."

Photo and excerpt from blog 7/28/08 – Regina Longinotti

Revelations on the Road

2008-10-21T09:52:00.008-04:00

“Academically I have realized a dream of mine that I didn’t know would be such a source of pride and accomplishment for me. Learning of this country (the Dominican Republic), the Haitians here, the phenomenon of pica, the hematology, and then coming here and putting it all together has been truly magical. This is something I dreamt up and did. I created this and nurtured it along. This is my baby.”

Picture and excerpt from blog 8/10/08 – Jessica Pettigrew

Welcome!

2008-10-20T11:24:00.002-04:00

Welcome to the YSN - Center for International Nursing Scholarship and Education student experience blog. Here we will share some of the thoughts, pictures and experiences of nursing students who have traveled internationally to do training in their field of interest. We hope their stories will inform and inspire.