Since the Magnet® Vision was published in 2008, it has inspired actions by nurses at Lehigh Valley Hospital (LVH), a Magnet-recognized academic community hospital located in southeastern Pennsylvania. In 2011, when LVH received its third Magnet designation, we dissected the vision statement to stimulate goals to help LVH continue to raise the bar for care delivery and position the institution for its fourth Magnet designation in 2015. One phrase in particular pointed to an opportunity: “Magnet organizations will serve as the fount of knowledge and expertise for the delivery of nursing care globally.”
Because its purpose and functions were already aligned with this opportunity, the LVH Professional Excellence Council (PEC) began investigating options for nurses to influence global healthcare delivery. (See PEC focus on leadership and stewardship.)
The PEC members started their investigation with a literature review. They found several articles that described the personal experiences of volunteer medical personnel providing care in developing countries and others focused on medical missions whose primary purpose was educating local providers to improve access to care. Nurses involved in mission trips were usually part of an interprofessional physician-led team.
The PEC didn’t find any literature that described enduring partnerships between nurses in the United States and developing countries. Nor did they find any articles about telehealth or telemedicine collaboration between U.S. nurses and those in other countries.
Goal and opportunity
The literature review helped PEC members settle on the goal of creating a continuing partnership between LVH nurses and nurses in a developing country. The PEC investigated several opportunities before discovering Hospital Convention Baptiste d’Haiti (HCBH).
The HCBH, located in northern Haiti, has a 250-member staff, including 50 nurses. The facility offers emergency and primary care, with 50 inpatient beds dedicated to maternity, pediatric, medical, and surgical care. In addition, the HCBH campus includes a rehabilitation facility and respite care for special needs children.
In the course of deciding whether to pursue a partnership with HCBH, the PEC learned that physical and occupational therapists from a nearby Lehigh Valley rehabilitation hospital had already been working with the HCBH rehabilitation facility staff. The possibility of traveling with these colleagues, who had experience with trip logistics, offered safety in numbers, and provided an opportunity to practice interprofessional care, influenced the PEC’s selection of HCBH as a partner.
Program development and continuation
The PEC developed a proposal for the partnership, which was endorsed by the LVH chief nursing officer. In November 2014, the LVH nurses made their first visit to HCBH. This weeklong trip included the PEC clinical nurse chairperson and the council’s administrative mentor, who is the organization’s Magnet Program Director (MPD).
During this visit, the LVH team met with the HCBH chief nurse to discuss ideas for their partnership. The chief nurse welcomed the partnership with LVH as a strategy to realize her vision for HCBH: “to be known for the best nursing care in Haiti.” The LVH colleagues expressed their belief that the partnership was two-way and that LVH staff and the community they serve at home would also benefit from the relationship.
Since that first trip, LVH nurses have participated in four more weeklong visits to Haiti. Several months before each visit, the LVH MPD e-mails the HCBH chief nurse to get her input regarding goals for the upcoming visit. These goals determine the specialty expertise of the LVH nurse participants. Interested candidates submit an application to the PEC, which makes the final decision about who goes. Travel, room, and board are covered by philanthropic funds, and staff members are granted 24 hours of paid conference time. The LVH nurses pay for their pre-trip travel medicine appointment and required medications.
Each visit includes three LVH nurses—two who have not been to HCBH and one who has. The returning nurse provides orientation and support to the first-time visitors and renews relationships with their Haitian colleagues. Pre-trip planning includes a video conference between the LVH and HCBH nurses to make introductions and discuss specific plans. In addition, the LVH group meets several times before the trip to bond and learn about HCBH healthcare delivery and Haitian culture.
While in Haiti, the LVH team live in the Volunteer Village, a gated compound of small cinder-block buildings about a mile from the hospital. Each building has two or three sleeping rooms and a bathroom. Meals are prepared by Haitian women from the community and served in a central dining room. The nurses can walk to and from the hospital or travel by ambulance or truck.
To date, 12 LVH nurses have made five trips to HCBH, providing more than 25 inservice and continuing-education programs on a range of requested topics. The LVH nurses have influenced several practice changes at HCBH, including improved handwashing technique using antimicrobial cleanser, wound care and specialty dressings for chronic wounds and pressure injuries, wound prevention through positioning strategies and range-of-motion exercises, and enhanced infection control.
Other projects that have come out of the partnership include:
- Creole patient education posters created by an LVH nurse education specialist. A local printing company donated the production costs and LVH nurses delivered the posters on the next HCBH visit.
- a PEC-sponsored fundraising project to extend the operating hours for the respite care center for special needs children. The money raised will keep the center open an additional 24 hours every week for 1 year.
- an inventory and assessment of all supplies and equipment to help the HCBH staff accurately identify needed resources for purchase or donation.
- recruitment of hardware and software donations to support telehealth between LVH and HCBH.
Challenges and what we learned
The biggest challenge to the partnership is the language barrier. Most Haitians speak Creole and some also speak French, but very few of the HCBH patients and staff speak English. This requires a Haitian interpreter who speaks English and Creole to be with the LVH nurses at all times, including during electronic communication.
Utility services at HCBH are limited, with frequently interrupted electricity, limited hot water, and sporadic internet service. In addition, the heat in Haiti can be oppressive, particularly during the summer months. With no air conditioning on the HCBH campus or the Volunteer Village, LVH visits are scheduled between November and February.
Even with these challenges, we’ve learned a great deal about HCBH, its staff, and how Haitians approach health care. All of the HCBH nurses are baccalaureate prepared and dress professionally in white uniforms laundered on site, white hose, and sturdy shoes. The Haitian and American nurses express similar professional desires and concerns about advanced education, staffing, and communication issues with interprofessional team members.
Haitians travel miles to seek care at HCBH, walking or using public buses and small motorcycles. Most patients are accompanied by at least one family member, who remains with them at all times and provides care in the inpatient setting. Many of the patients and their families seek solace and strength in spirituality. When possible, staff, patients, and families attend a daily service in the campus chapel.
The LVH team has developed several short- and long-range plans. They are working to raise money to ensure continuation of their partnership and collect donations of supplies and equipment. As LVH continues to support three nurses to visit HCBH twice a year, they also are inviting other disciplines to participate in the partnership. In addition, they are establishing nursing grand rounds and telehealth conferences as well as planning to host HCBH nurses at LVH.
Implications for nursing
The LVH nurses who have participated in this program not only gained knowledge about Haitian culture and healthcare delivery, but also enhanced their professional development and satisfaction. (See What the HCBH partnership means to me.) A similar partnership can be replicated between nurses in any U.S. nursing clinical practice setting and nurses in a developing country. A collaboration like this provides humanitarian aid to the developing country and enriches nursing practice in both countries.
Three of the authors work at the Lehigh Valley Health Network in Allentown, Pennsylvania. Kim S. Hitchings is manager of the Center for Professional Excellence, Tonya Kemp is a clinical nurse in labor & delivery, Sharon Kromer is the telehealth clinical coordinator, and Barbara Labriola is a patient care coordinator in the 5T Medical-Surgical Unit. Lori Yesenofski is a clinical education consultant at Spacelabs Healthcare OSI in Hawthorne, California.
American Nurses Credentialing Center. 2014 Magnet Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2013.
Cook M, Howard BM, Yu A, et al. A consortium approach to surgical education in a developing country: educational needs assessment. JAMA Surg. 2015;150(11):1074-8.
Sarisley C, Blozie C. Medical mission volunteering: Ecuador. Gastroenterol Nurs. 2011;34(3):231-4.
Silinzieds A, Simmons L, Edward KL, Mills C. Nurse education in developing countries—Australian plastics and microsurgical nurses in Nepal. Plast Surg Nurs. 2012;32(4):148-55.
Spaulding C. A piece of my mind. What now? JAMA. 2015;314(18):1919-20.