The Faces of International Nursing

         Many of us who belong to Nursing Students for Global Health (NSGH) are in the group because we’re interested in working abroad; however, we’re not so sure what that entails. Although some of us have prior employment experience, we’ve spent - at the very least - the past few months immersed in school.  At the moment, the world outside of NYU nursing school is foreign and somewhat of a mystery; from figuring out the logistics of applying for jobs to knowing what we have to offer domestically or globally, thinking on a larger scale can seem even more overwhelming.  On October 1, NSGH hosted an event titled “The Faces of International Nursing” that offered a glimpse into the life of three different global health nurses, providing us all with information that a classroom might not necessarily offer.

            The first speaker, Deborah Chyun, PhD, RN, FAHA, FAAN spoke about her time in two very different parts of the world – Rwanda and Georgia.  Since the 1994 genocide, Rwanda’s health care system underwent a massive overhaul, now offering universal, quality health care to all its citizens, from the poorest to the richest one.  With all these changes, Rwanda continues to lack a skilled nursing force and so, Dr. Chyun has worked with Human Resources for Health to train future nurses and provide the foundation for a sustainable healthcare system. Dr. Chyun reported that she lived in Rwanda for a year and that salaries for herself or others in her position ranged from $60-$80k with additional stipends being provided for living expenses and family members. 

            In addition to working in Rwanda, Dr. Chyun also briefly spoke about her time in Georgia, a country that faces its own healthcare challenges.  Georgia is slightly smaller than South Carolina and has a population of nearly 4.5 million people with rural doctor/nurse being the primary mode of health care delivery.  There, Dr. Chyun worked with Georgian students to help determine what was lacking in current medical and nursing practice in order to inform future health policy.

            The next speaker, Ella Harris, BA, MS, RN, spoke about her time at a public hospital in Roatan, Honduras. Nurse Harris was there through a program with the Universityof California, San Francisco and Global Healing to determine how best to improve nursing education. Nurse Harris described the hospital in Roatan as a Labor and Deliver Hospital by necessity, with 57% of the admissions being obstetrics, pediatric and neonatal admissions. Working closely with the auxiliary RNs – few had bachelors – Nurse Harris saw first-hand the systemic issues that plagued the hospital. From sparse medical supplies to relying on still water from a warm, blue plastic barrel to administering medications without going through all the proper checks, the resources were extremely limited and the practices, risky. Regardless, the nurses at Roatan were doing their best with what they had.

            Nurse Harris reported that one day she noticed that many of the nurses and students there had access to smart phones and wondered how they could use that to their advantage. In collaboration with the nurses at Roatan, Nurse Harris and her colleague began to make training videos regarding different nursing practices that could be viewed on smart phones.  Effective it was but without patience, listening or remaining open-minded, Nurse Harris reminded us that this idea would not have come into fruition.  Nurse Harris left us with this advice, “Ultimately, lasting relationships transform practice.”

            Last but certainly not least was Robin Toft Klar, DNSc, RN. Nurse Klar spoke extensively about her time researching infant mortality in Ghana and later, lymphatic filariasis in Papua, New Guinea. What I found most fascinating about Nurse Klar’s piece was her inspiration for traveling to Ghana. Nurse Klar journeyed a continent away to learn more about infant mortality in the town she was working in – Worcester, MA. Nurse Klar worked in Pokuase, Ghana, with a microlending non-governmental organization (NGO) that aimed to increase healthcare and education for all women. There, she learned more about how women keep themselves well, the perception of hospitals in Ghanaian society and when it was optimal to schedule visits. By learning about Ghanaian traditions firsthand, Nurse Klar was able to better serve women in her hometown.

            Nurse Klar’s second foray into global health wasn’t so accidental; she was approached by the Global Health Research Expanding Advanced Training (GhREAT) to conduct research in Papua, New Guinea. Nurse Klar briefly spoke about how working with an anthropologist, a mathematician and an entomologist on how to best treat and self manage lympathic filariasis, a disease she compared to elephantiasis, was a fascinating experience and wouldn’t have happened had it not been for her travels to Ghana.

         The event was a hit and with a turn out of over 50 students throughout the evening, I’m certain many of us left on a global health high. We got a taste of what nurses who work abroad do; be it policy level work, interacting with patients at a public hospital or conducting research, the options are endless.  And I left the evening and now, you, with this Zen-like lesson – to be effective in this world, we need to temper our enthusiasm and desire to help with patience, compassion and the ability to listen.

Contact Info:

Deborah Chyun, PhD, RN, FAHA, FAAN

Dc116@nyu.edu

Ella Harris, MS, RN

Ella.Harris@gmail.com

Robin Toft Klar, DNSc, RN

Rtk3@nyu.edu

Did you attend The Faces of International Nursing? Have more questions about Global Health Nursing? Let us know below!

Managing Stress in Nursing School and Beyond

         I met with a good friend from nursing school earlier this week to discuss tips for managing stress the 3^rd semester and approaching the grueling course load she has ahead. While I am no expert in dealing with the anxiety that accompanies our beloved Adult and Elder and NCLEX exams, I have found that over the past 12 months my pre-exam paranoia has diminished significantly.  With stress being one of the many contributing factors leading to depression and depression being listed as one of the World Health Organization’s (WHO) health topics, I wanted to start off writing about what’s helped me to prevent and deal with stress in nursing school. 

            Whether we opt to work domestically or abroad, nurses are in a profession where they and their patients will come to know stress very well.  Stress can surprise you and provide some health benefits but for many of us, it’s scary, awful and we just want it to go away.  Throw being sick into the mix and you have a cocktail of Molotov-ian proportions.  So, without further adieu, here a few of my tips on how to deal with stress in nursing school and beyond.

1.     Know your limits
We all have a personal threshold. While some of us can dedicate our lives to hours on end at Bobst, others find more solace in the comfort of our homes, a coffee shop or Washington Square Park. When it’s enough for you, be okay with it. Studying won’t become a chore or an annoyance and you might get more from the time you devote to it. Developing this awareness might also give you a better sense of what you’re more comfortable with in the future.  Can you do hours on end in one spot? Surgery might be for you. Do you like a little more variety and moving around? Maybe you’ll like ER nursing. However you decide to approach studying or your career, know that none is better than the other so long as it works for you!

2.     Ease up, Eat up and Exercise!
I can’t stress (no pun intended) how helpful getting enough sleep, eating well and exercising has been for me. While I have some friends that can get by on 5 hours a night, I personally need my 6-7. Eating well throughout nursing school has always been a challenge so this semester I decided to spice it up. Each week I’ll make myself a different sandwich to save money and to add some variety to my diet. So far, so good. Nutella, Peanut Butter, Banana, you have done well. I’ll up the veggies next week. As for exercise, yoga has helped me tremendously. From providing me a peace of mind to upping my already high energy level to making me stronger, yoga has done wonders for me throughout nursing school. Happy National Yoga Month everyone!

3.     Prepare, Prepare, Prepare
This advice is the best I’ve ever received in nursing school. It sounds so simple but we all forget to do it. We have pre-sims, IHI modules and Kaplans due that we oftentimes come to clinicals or exams unprepared. Setting your scrubs, watch, stethoscope and name tag out the night before, downloading slides a day or two before class and reviewing them and getting those mandatory assignments out of the way a few weeks head are all habits that will help alleviate stress both now and later. This will also help us focus on the task at hand – whether it is an exam or a patient.

4.     Reward Yourself
No one says it better than Aziz Ansari. Treat. Yo. Self. We all need to decompress after exams, a long day or a rough experience in the hospital and we deserve it! Relish that down time and indulge yourself. Spending time with friends, working out at the gym, staying in and watching Netflix or grabbing your favorite take-out are just examples of how to chill out.  I like the work hard-play hard approach; 4-5 days of school and 2-3 days off. I am that much more excited Monday mornings and blast Friday when the time comes. All in moderation of course.

5.     Ask for Help
I get it. We’re in a competitive nursing program and we’re entering patients where patients’ lives are on the line. This information alone starts as a ball of stress that ends in an anxiety attack or crying into my pillow at night.  “I’m getting the B, not the A. Am I good enough to be here?” “I’m going to fail the NCLEX.” “What if I give my patients too much Digoxin or Insulin?” I wish I were joking when I say that these thoughts have crossed my mind one too many times. With the help of my amazing friends both in and out of nursing school and the Wellness Center, I’ve fortunately been able to work through much of my stress and anxiety. If you need help, seek it. If your fellow nursing students, friends or family can’t calm you down, there are many resources at NYU and beyond that can help. You’re not alone, you’re not crazy and you can get through this.

Do you have your own tips for dealing with stress in nursing school and beyond? Let us know below!

Ebola Panic - Justified or Not?

“ ‘Ebola’ isn't coming to Emory. It's an Ebola *patient*, a human being.” Reading this FB status Friday evening made me feel grateful that at least one other person online was thinking more about the patients affected by the epidemic than the virus itself.  Over the past week, I’ve become increasingly frustrated with the lack of empathy for the Liberians, Guineans, Sierra Leoneans and the two Americans who contracted Ebola virus and more so, with the lack of knowledge surrounding its mode of transmission. West Africa is roughly 4,644 miles away from New York so I wondered what all the fuss was about.

            Rather than wrote this post on the FAQs of Ebola (Gawker does a way better job), I thought I’d focus on the FAQ of my FB minifeed:

“How likely am I, a NYC resident who spends roughly 1-2 hours a day on the MTA in close contact with people who may or may not practice hand hygiene and shower regularly, likely to get Ebola?” With anxiety rising after a male patient was admitted to Mt. Sinai yesterday morning with Ebola-like symptoms, let’s take a look at some facts.

            According to my global health guru, the WHO, Ebola is spread through “direct physical contact with body fluids like blood, saliva, stool, urine, sweat, etc. of an infected person and soiled linen used by a patient.” Ebola is not airborne; it is a communicable disease whose mode of transmission is compared to HIV/AIDS. So, unless any of us have direct physical contact with an infected person, the chances of us getting Ebola are slim to none.  While I find New Yorkers to be very helpful, concerned citizens, I’d venture to say that (aside from healthcare workers) most people take a step back when someone is bleeding out, urinating, defecating or profusely sweating.  And that is probably for the best.

            But let’s tie this back into nursing. How can we protect ourselves from a patient who is exhibiting classic symptoms of Ebola like fever, vomiting and lack of appetite? According to the CDC, my infectious disease go-to, all healthcare workers coming into contact with Ebola affected patients should at minimum, don gloves, gown, eye protection and facemask. Basic contact precautions can protect us from this very virulent virus.

            I’m sure you’re wondering if contact precautions are all it takes to prevent the transmission of Ebola, how is it that 887 people have died from it and 1,603 have been infected to date? Without delving into a discussion on health-disparities in third world countries, suffice it to say that working and medical conditions in Liberia, Guinea and Sierra Leone are less than ideal. In countries where the population lives at 76%, 76.8% and 52.9% below the poverty line, respectively, healthcare workers need to do outreach work to persuade people to come to clinics and most of the time, masks or protective clothing is foregone. Mistakes are made and precautions aren’t always adhered to which, as we are seeing can prove fatal.

            In hospitals like Mt. Sinai, NYU Langone Medical Center and NY Presbyterian, where not complying to strict hand-washing can lead to thousands of dollars of fines by JCO, it is safe to assume that there is almost no risk of an Ebola outbreak and if there was, it would be contained immediately.  Although I find myself huffing at how frequently I have to Purell, this epidemic has made me appreciate how strict infection control is. It protects us as much as it does our patients.

            It’s sad but certainly not surprising that a contagious disease has resurged in third-world countries where sanitation and hygiene practices are inconsistent and limited by other factors. While I am not concerned about an Ebola outbreak in my own city, I am concerned that communicable diseases are a chronic problem in countries struggling to piece together so much, let alone healthcare.  For New Yorkers, an ocean away from the epicenter of the outbreak, to panic about contracting a disease transmitted by physical contact, dare I say suggests narcissism and a disregard for facts and information about the disease. I hope that the global health community continues to keep this in mind as this epidemic persists and others arise.