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Currents: a global perspective

Student Nurses Gain a Global Perspective

This year Colby-Sawyer's Nursing Program moved in a brave new direction, incorporating Pokuase (poe-KWA-see) Village in Ghana, Africa, as one of its community partners in educating student nurses. Through the WomensTrust—a Wilmot, N.H.-based, non-governmental organization focused on micro-lending, education and health care in Pokuase—the Nursing Program has built an international collaboration that will enable the college's student nurses to address global health issues in their senior Community Capstone projects.

All Colby-Sawyer seniors are required to complete a Capstone as the culmination of their work in their major field of study. In the Nursing Program, teams of student nurses work with area organizations on Community Capstones, which focus on health care needs of a specific community or population.

The Nursing Program has established six community partnerships around New Hampshire through which nursing students complete their senior projects each year. These include three sites in New London—New London Hospital, Lake Sunapee Region Visiting Nurse Association and Hospice, and Baird Health and Counseling Center at Colby-Sawyer College. Three other community sites at the Newport Health Center, Tiger Treatment Center at Newport Middle-High School and the Adult Day Out Program in Newport are also included.

In the 2007-2008 academic year, three student nurses—Kristin La Rochelle, Stephanie Shamel and Lindsay Mulcahy—were the first to take on an international community partnership with WomensTrust and Pokuase Village for their Community Capstone. The project opened their eyes to the challenges and opportunities of public health issues in a third-world nation and set the stage for future students at Colby-Sawyer to gain global perspectives in nursing.

The Global Community

In the fall of their senior year, nursing students are introduced to the community organization that will become the focal point of their Community Capstone. The students conduct broad assessments of their organization and its community, which involves interviews, surveys and reviews of related health, socioeconomic and demographic research.

By semester's end, each student team presents a preliminary plan for their project—identifying a specific community health issue and how they plan to address it. In the spring semester, each team works closely with their community organization to successfully implement and evaluate their plan.

Shari Goldberg, the assistant professor of nursing who directs the Community Capstone projects for the Nursing Program, says the year-long project widens the lens of students' nursing experience. “After several years of working in hospitals with individual patients in maternal health, pediatric, oncology, neurology and psychiatric rotations, the students take on a Community Capstone in which they treat a community or population as a patient,” she explains. “It deepens their insights into settings where patients come from and will return to, and adds depth to their body of knowledge and experience.”

Professor Goldberg points out that these projects require future nurses to hone their communication skills and think broadly about what's lacking in an environment and what could be added to promote health. “The students have to communicate with a lot of different individuals and agencies,” she explains, “and in the process they strengthen their communication and leadership skills. It opens a whole new window for looking at ways to address the health needs of a community.”

Early in 2007, Professor Goldberg attended an American Association of Universities and Colleges (AAUC) conference that provided the impetus for bringing an international dimension to the Nursing Community Capstone program. The conference focused on ways to introduce public health issues into undergraduate education, and Professor Goldberg was drawn to the forums that dealt with global health issues.

“I started thinking about how an international site would fit wonderfully into our Community Capstone program and help students to gain a global perspective, which is part of the college's mission and also the mission of the American Association of Colleges of Nursing,” she says.

When Professor Goldberg presented her ideas to the Nursing Department, she was met with enthusiasm and support from her colleagues. The faculty began to discuss the possibility of deepening its connections with WomensTrust, the local organization whose original mission involved micro-lending to women in business in Pokuase Village. WomensTrust has recently expanded its work in Pokuase to encompass new initiatives in education and health care.

“Micro-lending remains the foundation of our program; you give women access to capital and they'll inevitably help the family,” says WomensTrust founder Dana Dakin. “But we soon realized that most girls in Pokuase didn't get past fourth grade, and because education is so important to families' sustainability, we added another component to our program that provides scholarships for girls.

“As we asked more questions, we found that healthcare is also extremely important: the women in Pokuase are suffering from anemia, high blood pressure and diabetes, and one in five of them dies in childbirth. We began looking into what we could do with the minimal resources we have to help the community of women of child-bearing age.”

WomensTrust embraced the opportunity to build a partnership with Colby-Sawyer's Nursing Program to help meet the health care needs of the women and children in Pokuase Village. “We work in large circles to engage as many people and organizations as we can in our mission,” says Dakin.

The Challenge for Student Nurses

Seniors Kristin LaRochelle, Stephanie Shamel and Lindsay Mulcahy were excited about an international Community Capstone, but they were also aware of the logistical challenges and heightened expectations for their project. Initially their greatest obstacle was that they would not be able to meet directly with their patients, the women of Pokuase, and would instead need to rely on information from WomensTrust staff and volunteers, as well as from online research, to conduct their community assessment.

The students' research findings confirmed that the women of Pokuase face serious health problems and also revealed related issues that have posed obstacles to their successful treatment. They found a high incidence of severe anemia (low iron levels in the blood) among women of child-bearing age and a corresponding high incidence of maternal and infant mortality in childbirth.

Additionally, women in Pokuase had high rates of illiteracy and innumeracy and often lacked the proper medication and nutritional supplements to treat their anemia and other health problems. Severe anemia can cause excessive bleeding during childbirth, which is the leading cause of maternal mortality in Pokuase.

The team learned that WomensTrust had sent the president of the New Hampshire Nurse Practitioner Association, Linda Messenger, for her first visit to Pokuase in 2007, when she conducted her own community assessment and brought some much-needed medical supplies and vitamins for the village's only clinic. Messenger worked with the clinic staff conducting medical tests on women and creating records for each patient. She gave a long-term supply of vitamins to the many women who tested positive for anemia, yet she was unsure that the patients, most of whom could not read, would follow their treatment plans.

Once their community assessment was complete, the team needed to sift through the information and hone in on a project that was manageable in scope and would directly benefit their clients. “It was kind of overwhelming to see all the problems and just choose one,” Stephanie admits.

The team determined that women of child-bearing age needed “enhanced knowledge” of how to follow their medical treatments. When the students presented their preliminary plan to the Nursing Department and community partners in December 2007, they outlined a plan to develop visual aids—a video and a pictorial guide or pictogram—that would be used to instruct women patients on the proper procedures for taking medications and vitamin supplements. Their goal was to raise awareness among the women about the importance of medical treatment and help to ensure that they successfully complete their treatment regimens.

In January 2008, one of the team members, Kristin, traveled to Ghana with WomensTrust staff and volunteers and worked in Pokuase's clinic for two weeks. (See sidebar on “A Cultural Awakening in Ghana.”) She brought some of her Capstone team's sample pictograms to test on the patients, and with the help of interpreters, the women's feedback helped to shape her team's final product. The team's preliminary plan to create a video was dropped once Kristin saw first-hand that most Pokuase families lack electricity (and video or DVD players) in their homes.

In the spring semester, the team worked on the implementation of their plan—with Lindsay focused on organization, Stephanie on creating images for the pictogram, and Kristin on research and leadership. By May, the team members had completed a colorful, versatile and easy-to-use set of pictograms that they hope will improve the health of women in Pokuase. They will now leave it to others—WomensTrust and their student successors in the Nursing Program—to carry out their plan and introduce, test and refine the pictograms.

“I hope we actually make an impact,” says Lindsay, “and that the following classes will continue this work and make a difference in Pokuase.”

Kristin feels confident that her team met the challenges of a new international community site, with strong support from Professor Goldberg, and set the stage for an important long-term international partnership in nursing. “We've made the connection with WomensTrust. Laying the groundwork was really important,” she concludes.

These three student nurses have now graduated and are beginning their careers in the healing profession of nursing. Their international Community Capstone project taught them many lessons they will integrate into their practices and has extended their sense of community to include the women of a distant Western African village called Pokuase.

-Kimberly Swick Slover