SELF PROJECT REPORT /
Contact details
Name Irene Murray
Role Teaching Fellow
Institution University of Stirling
Address Centre for Health Science, Old Perth Road, Inverness
Tel 01463 255627
Title of the initiative
The Nazareth Student Exchange Project
Key words
Student Exchange; cultural awareness/sensitivity; models of nursing; paradigm shift
Context
This project was initiated by Dr Amal Khazin (Director of Nursing Education) in the Nazareth Hospital, EMMS, Israel. The request to establish a student nurse exchange programme between the Nazareth Hospital and Raigmore Hospital was first mooted with the Project Lead (Irene Murray - Teaching Fellow Midwifery) at the School of Nursing, Midwifery and Health (Highland Campus), University of Stirling, due to her long connections with the Nazareth Hospital having worked there previously for 18 years as a midwife/midwife teacher and in management roles. Following approval of the project by Professor William Lauder (Head of School), and Ms Heidi May (Board Nurse, NHS Highland) the Proposal was implemented. The University of Stirling welcomed the initiative because it supports the QAA aim of supporting the ‘Internationalising of the curriculum’ (http://www.quality.stir.ac.uk/learn-teach/Section2.php#Five). In particular it supports efforts to:
· Increase the number of students on international exchange programmes;
· Increase opportunities for students to work with international communities;
· Ensures an international dimension is promoted in each student cohort ;
· Offers the potential for attracting international students to engage in study at the University of Stirling in the future;
· Encourage Scottish students to participate in international exchange programmes in the future.
Dr Amal Khazin proposed sending three 3rd year nursing students from the Nazareth Hospital to Raigmore Hospital for a 3 week surgical placement. University of Stirling students in the 3rd year of the nursing programme are already welcomed for reciprocal placements in the Nazareth Hospital, Israel, in the Spring of 2014.
Since accommodation and meals were to be provided free of charge for the University of Stirling students who go to Nazareth, reciprocity required a similar arrangement for the Nazareth students on their visit to Raigmore. The University’s SELF fund award of £1000 was a significant contribution towards the cost of providing accommodation and meals for three students for three weeks. These students otherwise pay for all costs of their programme, accommodation and travel in Israel unlike the UK students who receive a Bursary.
Aims/ Objectives
The over-arching goal was for student perspectives to be broadened, thinking changed, differences to be accepted and motivation to study to be increased. Specific aims for Undergraduate nursing students on exchange placements on both sites were to :
· Observe first-hand how nursing is regulated, how professionalism is expressed and how evidence-based practice is integrated in the host country.
· Identify the various political drivers and social influences on the delivery of healthcare:
· Explore a different model of healthcare provision in a foreign culture with the possibility of transferring some aspects of learning to their own environment;
· Engage in an observational capacity as guests alongside a 3rd year student ‘buddy’ in the host clinical placement and will therefore be supervised by that buddy’s named mentor;
· Assimilate some of the societal, cultural, religious and political issues which impact on the delivery of nursing care;
· Participate in knowledge exchange/knowledge transfer through observation, on-going reflection and discussions with ‘buddy’ and mentor which will motivate the desire for life-long learning (reciprocal benefits will be experienced by both ‘buddy’ and mentor);
· Contrast ‘best practice’ and ‘quality improvement’ issues in nursing across the two healthcare systems;
· Develop ideas/questions for (cross-cultural) nursing research.
· Establish cross-cultural professional relationships which will be personally and professionally enriching and challenging.
· Open their eyes to another ‘world view’ providing new perspectives on many aspects of life as well as nursing care.
· Engage in experiences that can lead to a paradigm shift in terms of attitudes and beliefs for the remainder of their careers/lives, assisting them to think ‘outside the box’ in relation to professional, clinical and cross-cultural aspects of health care delivery.
Description
Three students (one male and two female) arrived in Inverness from Israel at the end of June. Preparation for their arrival was tortuous as this was the first Exchange placement of its kind. Occupational Health checks and Criminal Record screening required translation from Hebrew prior to emailing to HR at Raigmore, NHS Highland. Honorary Contracts and Confidentiality documents had to be prepared, sent, signed and returned. Preparation of buddies and mentors was undertaken on a face-to- face basis supported by leaflets specific to each professional, including one for the Ward Managers. Uniform and identification badges were agreed. The Nazareth students forwarded introductions of themselves to their buddies. Letters were prepared by the School of Nursing in Nazareth, the University of Stirling School of N, M & H, and Board Nurse Heidi May to assist the passage of the Israeli students through immigration. Cash from the SELF fund was secured for meals. Various Press releases were arranged. An Induction Day was planned.
On arrival at Edinburgh airport the Project Lead took the students to do some sightseeing in Edinburgh prior to the drive up to Inverness. After a day of orientation / induction on 1st July 2013 the students began their three week surgical placements in Raigmore Hospital. They worked alongside ‘buddies who had been prepared for their role and who had planned specific experiences for them. Both ‘Buddies’ and Nazareth students were under the overall supervision of a mentor. They were aware of the goals they had to achieve and prepared a Presentation accordingly which they delivered at the end of the placement to a small range of clinicians and academics. Evaluation of the Project included the Nazareth student Pre- and Post placement Questionnaires, the ‘Buddies’ Questionnaire and a Mentor’s Questionnaire. These Questionnaires and their collated results and analysis can be provided on request.
Outcomes
Intended outcomes
The students who participated in this exchange Project felt they had achieved most of the aims and objectives as presented above. Their evaluation of the experience was largely positive, however it should be borne in mind that it would not be culturally acceptable for Arab-Israelis to suggest otherwise. Regardless of their true feelings their PowerPoint presentation at the end of the visit was outstanding. They appeared to have had their eyes opened to many new aspects of nursing such as evidence-based practice and quality improvement. Coming from a medical approach to nursing they were amazed at the patient-centre approach which they observed. They were very impressed with the level of communication and the relationships that developed between professional and patient. One student summed it up thus:
“I have learned a lot from this project. Things to improve, things I’ve never seen or thought of before, challenges and achievements.”
As a result of the students’ presentation a proposal has been suggested by another academic to explore the differences in models of nursing education across three nations/cultures (Scotland, Israel, India).
Unintended Outcomes
What was not expected or intended for the Nazareth students was :
· The extreme stress caused due to the timing of the Exchange placement at a time very busy with case studies and exams, and due to the piecemeal approach to the sending of documents for completion and translation prior to the placement.
· The struggle with a different ‘world view’ /perspectives on nursing care and the dis-ease with the significant differences in nursing education and nursing practice between the two cultures.
· The lack of compliance with the 12 hour shifts and subsequent erratic attendance/interest of 2 of the students
· The veiled censure of the University of Stirling’s programme and its students’ knowledge base
· The resistance to a paradigm shift; they did not seem ready to appreciate the cross-cultural aspects of health care delivery
· The perception of the Project Lead that the students did not ever really ‘leave home’ or enter fully into the experience
What was not expected or intended for the ‘Buddies’ was :
· The lack of engagement at times by some of the Nazareth students to engage with the experiences planned for them
· The challenge of not knowing as much of the medical/pathophysiological /pharmacological detail as the Nazareth students appeared to be cognisant of
· The difficulties of the Nazareth students not adhering to the expectation they would do 12 hour shifts, the erratic attendance of some on placement and the apparent lack of interest at times
· The strong reaction/irritation/displeasure that the experience caused one of the buddies who was incensed at the cultural insensitivities displayed – ironically by the student who had the best English and who was the best ‘travelled’.
· The suggestion by a mentor that it was an unfair burden on a student in her final placement to have to ‘buddy’ an exchange student.
Impact
One issue that may have impacted on the overall negative perceptions of clinical staff to the Exchange Visit is the fact that the Exchange students were at the end of their 2nd year rather than the 3rd year as originally agreed. This may have caused the relatively immature reactions and behaviour of the Exchange students. Regardless it will take a significant amount of work to sustain this Exchange Project given the negative reactions of two of the buddies and one of the mentors. It could also be argued that the aims of the Project were unrealistic for 2nd year students in a 3 week placement. Another significant suggestion from the one mentor who responded to the evaluation was that it might be of more benefit for a mentor to supervise the Exchange Student rather than a ‘buddy’.
Important moments in the initiatives
· When all the documentation was finally deemed satisfactory and the students were considered fit to attend a placement at Raigmore.
· The ‘hype’ around all the media attention on arrival and at the end of the placement.
· When I was summoned by the students to an Interim Review during which they aired their concerns about 12 hour shifts and the fact that they had to study for exams on return home and therefore would not be able to join me on some of the tourist activities/invitations planned.
· The Presentation of their impressions/findings
· Their departure at Edinburgh Airport!
· The arrival (at last) of the post-placement evaluations and the buddy evaluations.
Lessons learned
Personal level
· Maintaining communications during the preparation process requires a great deal of time and organisation
· Cultural preparation is required even for the seasoned Israeli traveller with good English……!
· Equally cultural preparation is required for the host buddies as some of their reactions were due to their misunderstanding of the way Arab-Israelis communicate and also lack of awareness that one of the students was sick when she did not appear on duty. I should have visited her at that point rather than trusting the students’ text messages.
Professional level
· The timing of the Exchange visit is crucial and more time is needed for all the preparations.
· Pre-placement documentation needs to be sent with a list/in a package at least 3 months in advance
· 12 hour shifts are too long for an observational placement, but minimum hours need to be agreed between Nazareth and University of Stirling
· A mini OAR (On-going Achievement Record) would help the Exchange students to validate their experiences
· Better preparation in relation to the various models of nursing education would be of benefit.
· Networking with NHS bodies such as Human Resources and Media and senior professionals in nursing (as opposed to midwifery with which I am familiar) was an enriching and interesting challenge.
Team level
· The project offered an opportunity for the Project Lead to develop working relationships with colleagues not previously engaged with. This meant learning new names/roles and better understanding NHS Highland structure and organisation
· Colleagues in Nazareth may need to coordinate the preparation process at an earlier stage.
. Institutional level
· Agreement is needed that this is a worthwhile venture to pursue and that it does indeed achieve University objectives. If that is agreed then appropriate resources need to be made available so that it is not a ‘one-man project’ and financially draining.
Future Work
Short Term
· If the Abstract is accepted there will be opportunity to present the findings of this Exchange Project to date at the ENTER conference at Napier University in November. Discussion around the issues will be appreciated in attempting to determine the value of the Project.
· Applications are in place for University of Stirling students to go on an elective placement to Nazareth this Spring. They will need appropriate preparation.
.
Medium Term
· Preparations for three Nazareth students to come on an Exchange Placement at Raigmore in the summer of 2014 will begin in January 2014.
Long Term
· Continuing evaluation will help to identify if the Exchange Project is worth pursuing long-term. This will take the form of a questionnaire to assess the long–term benefits to the exchange students one year after their visit.
· Implementation of the ideas for research will also help to identify the value of the project.
Key Messages for others
For an exchange placement to be effective an enormous amount of work is required. Only time and experience will tell if it is worth the effort.
.
Irene D Murray Monday 23rd September 2013