Daily Pennsylvanian, PA
Dec 2 2004

Exchange program brings modern nurses to Eurasia
By carly weinreb

Penn Nursing professor and researcher Linda Aiken recently finished
directing a three-year program aimed at bringing four Eurasian
hospitals up to Western standards of health care and nursing.
The Nursing Quality Improvement Program was designed to improve the
quality of nursing and health care in former Soviet Union and
Armenian hospitals and sought to elevate the status of nurses -- who
are often viewed more like janitors than professionals -- in the
targeted hospitals.

After the program was completed, the hospitals were awarded the newly
created Journey to Excellence Award, which identifies them as
superior health care institutions.

The program is part of the Nursing School's overall directive to
research and improve health care both in the United States and around
the world.

"If you don't have good nursing, you can't have good quality of care
in hospitals," Aiken said.

The three-year program, which was mainly funded by the Population
Studies Center at Penn and the U.S. Agency for International
Development, paired four hospitals in the former Soviet Union and
Armenia with four U.S. hospitals of "magnet status" -- some of the
best hospitals in the United States.

The program was run like a "nurse-exchange program," sending American
and Eurasian nurses back and forth between the paired hospitals.

The American nurses found they had a lot to address with their
Eurasian counterparts. According to Aiken, many of the Russian and
Armenian hospitals did not have a code of medical ethics. For
example, nurses were still using leather restraints to handle
distressed patients -- a practice now known to produce more injuries
than it prevents.

Many of the hospitals did not have updated equipment and medical
supplies and lacked a closed, sterile environment. According to
Aiken, some nurses were using plastic Coke bottles, which were not
necessarily sterilized, for drainage.

"It was like going back 50 years in time," Associate Executive
Director for North Shore University Hospital Margarita Baggett said.

Baggett was the team leader of her hospital for the program and said
that, at Erebouni Medical Center in Armenia, there were no privacy
curtains or screens, flies swarmed everywhere and the plaster walls
were falling down.

In order to improve the quality of care at these hospitals, the
program set up an intercom system to enable better communication
between nurses and doctors and established a code of medical ethics
and a patients' bill of rights.

American nurses introduced evidence-based practice -- nursing based
on scientific principles -- to their Eurasian counterparts. They also
taught them how to read an electrocardiogram, put together a plan of
care and maintain a daily flow sheet.

And to address the lack of privacy curtains, the Armenian and Russian
nurses sewed some themselves.

"There's a great deal of interest in helping to empower nurses in
economically developing countries to deliver more professional
nursing care," post-doctoral fellow in the Center for Health Outcomes
and Policy Research Mary Powell said. "Nurses are indeed
professionals that make a difference."

After the program concluded, each of the Eurasian hospitals was
evaluated and determined to have achieved the 14 standards of magnet
accreditation, thus marking the program a success.

"It was one of the most thrilling things I've ever seen. The
rapidness of the change there was so impressive," Aiken said.

The Journey to Excellence Award ceremonies were highly publicized and
were attended by politicians and dignitaries.

"It was the first time these nurses were on TV," Aiken said. "Nurses
are kind of invisible there."

Baggett was similarly enthusiastic about the experience.

The Armenian nurses "touched us so deeply. It was so great to share
the great practice of nursing," she said.

Plans are in the works to continue the program in other economically
developing countries, and Aiken is in the process of talking to
potential donors.

And one of the researchers, first-year Penn Nursing graduate student
Lusine Poghosyan -- who helped collect data for the project while she
was getting her master's degree in Armenia -- will soon be the first
person in Armenia to earn a Ph.D. in nursing. After her earning this
degree, Poghosyan plans to return home and become involved in
expanding nursing education.