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Think Globally, Act Locally

International immersion trips can help nursing and medical students understand each other better while making a difference.

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If it weren't for the fact that her brother was a medical student, Sarah Acker isn't sure she would have a clear understanding of what doctors in training actually do or learn.

As a senior undergraduate nursing student, she felt that was a real disadvantage. After all, in a matter of months, she'd be fresh on a unit, interacting with physicians and figuring out on the fly - along with all the other lessons new nurses have to learn - how exactly the nurse/physician relationship should work.

This is why Acker, a student at Loyola University Chicago Marcella Niehoff School of Nursing, decided to look for service opportunities that combined professions before she graduated.

Loyola is already a leader in developing interdisciplinary educational models for medical students and advanced practice nurses. For example, the university recently opened a new center, featuring simulation labs where ABSN nursing students and medical students can practice working together as a team.

So Acker did some homework.

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As a first-year medical student at Loyola, Acker's brother went on a university-supported immersion trip to provide desperately needed healthcare to those in Haiti. She also saw the trip as a perfect mini-opportunity for nurses like herself to also immerse themselves in a real-life situation of working with both doctors and doctors-in-training.

In the past, the trips were offered through the university's Stritch School of Medicine and had only been available to medical students. Acker reached out to Sister Brenda Eagan, director of ministry at Loyola, who oversees the program. "We talked about it," said Eagan, "and decided that she wasn't a lone ranger and perhaps other students in the nursing school would like to participate in this."

Acker spread the word, and two other junior and senior nursing students decided to join up. "The three of them decided something like this would enhance their education and give them an opportunity to serve the underserved population and learn from one another," said Eagan.

Breaking Down Barriers

The three nursing students along with seven first-year medical students traveled to Port-au-Prince, Haiti, for the 12-day immersion trip in late May 2012. Inside a mobile clinic, students worked together at patient care stations to take histories, examine patients and present cases to physicians. They also staffed an in-house pharmacy, mixing and dispensing medications.

For Acker, it was "very eye-opening." "Two years post-quake, there's still a lot of displacement," she said. "It was hard to see the living conditions. . I was just seeing acres of tents, and six people living in a tent. . [But] they put on their Sunday best to come to clinic, and were so thankful for our help. . I think the hardest part was realizing the only difference between [the Haitians] and me is that I was born in America and [they] were born here."

The trip was eye-opening in other ways too. During the first few meetings stateside, Acker recalls sensing stigmas on both sides. For example, she recalls one of the medical students asking her, "Do you own a stethoscope?" "But once we were in Haiti, there were no barriers," she said. "There couldn't be; we couldn't function as a cohesive group if we had barriers."

Armetria Humphrey went on the Haiti trip as a first-year medical student and says it was a "great experience going down there with nursing students." "It helped us get an idea of what the role of the nurse is," she said. "And it gave me more of an appreciation of the hard work and dedication that nurses put into patient care every day."

With roughly 75 patients coming through the clinic daily, both sets of students quickly learned to rely on one another.

And in a way, roles were reversed. As first-years, Humphrey and her fellow students brought a lot of book knowledge and experience doing patient interviews, while the junior and senior nursing students actually had much more clinical experience.

"They taught us so much," said Humphrey. "Coming after the first year of medical school, you hardly know that much information as far as clinical information and physical exam skills go. They came in and helped us refine our physical exam skills, like how to take a blood pressure. They had already had pharmacy classes, and we hadn't gotten to that yet, so they taught us about drugs and how to mix and disperse them. They were lifesavers." In turn, said Acker, the medical students were able to assist the nurses in honing their patient interview skills.

Acker remembers one little girl the students cared for together. Diagnosed with ringworm, she had several wounds filled with pus and dirt, and with their clinical experience, the nursing students took charge in performing the wound care. The medical students observed, grabbed gloves and other supplies, and asked questions. Then, on the next patient - this one with a large gash on his knee - one of the medical students applied what he had learned and took care of the wound.

It was teamwork in action - with not a single barrier in sight. "That was one of the coolest moments for me - to be able to witness all of us working together on the same playing field, knowing each other's roles and knowing our main goal is to provide quality patient care," said Acker. "Once everyone realized that, we were a great team. It was an extremely proud moment for me that this experiment worked."

Future Impact

While this was the first-ever interdisciplinary immersion trip in Loyola's history, the university has brought nursing faculty and medical students together for similar trips to other countries.

For the past 10 years, Judi Jennrich, PhD, RN, the director of the acute care program and director of the Asian program at Loyola, has led a small group of first-year medical students to help provide primary care in Belize, working together with physicians and nurses. And she agrees these types of experiences only help foster positive interdisciplinary relationships.

"In the end, they have a much stronger respect for nurses - not just nursing faculty, but the contributions of nurses in healthcare in developing countries," she said. "I definitely would think most of these students, if asked, especially in Belize, would say, 'Wow, nurses really do it all there.'"

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As more health systems move toward a multidisciplinary model of care, more universities are seeing the value of incorporating these types of experiences at the student level. In fact, thanks to Acker's initiative, Loyola is now including both nursing and graduate school students in all its medical outreach programs, including the immersion trips to Haiti.

And both students and faculty believe the result will be improved communication and expectations between the various disciplines, to better prepare them for real-world experiences.

"I think for both professions, it would be such an easier transition from an undergrad to now I'm a nurse on a unit, or from a med student to now I'm a resident in a hospital, knowing that you can trust your nurse, knowing that you can trust your doctor or resident, knowing how to communicate and where you're at in your skill set. . I think it would be easier for us as new professionals to already know what to expect in that area of communication," said Acker.

"What surprised me the most was that medical students had very little idea what we did in terms of patient care. I'm so glad that we were able to do this. I think it opened their eyes and it opened our eyes, too."

Danielle Wong Moores is a frequent contributor to ADVANCE.


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I've been an RN for 25 years now and have seen so many changes... I am so interested in seeing our healthcare compares to those of other countries I am starting to explore ideas and options any ideas. This article was EXCELLENT and the timing couldnt be better thank you

Kathleen ,  RN ,  Laurel Hill HealthcareDecember 06, 2012
Winsted, CT



As part of my Master's preparation in nursing (geriatric NP)I had the opportunity to travel to India, in the Punjab region. I learned a lot observing how health care is delivered by both MDs and nurses. It was also an excellent cultural exchange. We were able to network with nursing students there and discuss the issues common to both of our nations in delivering good care to patients in need. It was a valuable experience and I would recommend all nursing and medical students seek out international opportunities during their educational experience.

Debra HermanDecember 06, 2012
Port Washington, WI




     

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