The importance of international initiatives
Article Outline
BRENDA C. ULMER
I long have been a proponent of participating in the global nursing community. A recent experience with perioperative nurses in Honduras helped reinforce those beliefs. As we celebrate Perioperative Nurse Week this month, I want to dedicate this column to perioperative nurses in Honduras and throughout the world. As I share the following experience with you, I hope it will inspire you to reach higher and stretch further than you ever have to ensure that every surgical patient has a perioperative nurse.
THE ADVENTURE BEGINS
In July of this year, I received a message from Doreen Wagner, RN, MN, CNOR. Suburban Atlanta AORN member and chair of the Recommended Practices Committee. Doreen had been contacted by Georgia Perimeter College (GPC). Atlanta, and was asked to contact me regarding a request the college had received from some Honduran nurses. (As it happens, I graduated from GPC with an associate degree in nursing in 1974.) Members of the GPC faculty traveled to Honduras last summer to teach RNs there nursing skills. When plans were underway this year for return trip, the Honduran nurses requested that perioperative classes be included. I said “yes” immediately. I have had the opportunity to make such trips in the past and have always found it a rewarding experience.
Planning time was short. Doreen and I met on July 21 with GPC faculty members; Fran Lewis, RN, of Honduras Outreach; and Reina Grogran, an RN from Honduras. Reina explained that it was her vision that someday there would be a perioperative specialty in Honduran hospitals and at the School of Nursing in Honduras.
Nurses work in ORs in Honduras, but there currently is no continuity of care among preoperative, intraoperative, and postoperative areas. The only perioperative training nurses receive is on the job. Reina wanted to change that, so she came to us for help. She explained that she wanted Doreen and me to work with a group of nurses from all over Honduras who then would return and teach nurses in their individual facilities.
Doreen and I were excited about the opportunity, and the wheels started rolling immediately. We both contacted organizations and manufacturing companies asking for supply and equipment donations. We worked feverishly the last week of July and the first two weeks of August to put everything together. We had help from some wonderful people and companies. Valleylab, Inc, donated a generator and accessories. Anita Shoup, RN, MS, arranged for Regent Medical to give us gloves. Kathryn Halverson-Carpenter and Eileen Ullmann, RN, MHS, CNOR, from AORN Headquarters, graciously put together didactic materials to ease the preparation burden for us.
Pat Palmer, RN, MS, MNM, CAE, AORN's Executive Director, also offered some much needed assistance. Through a coincidental conversation with Nathalie Walker, RN, CNOR, she arranged to have some of the didactic material translated into Spanish. We then had help from Pat Hickey, RN, BSN, MS, CNOR, in transferring the Spanish translations onto slides. The translations proved to be a lifesaver during our teaching efforts.
Doreen also met with members of AORN of Suburban Atlanta, and the chapter decided to participate in the project in honor of Perioperative Nurse Week. They were interested in exploring the possibility of establishing a sister AORN chapter in Honduras.
Cynthia Spry, RN, MSN, MA, CNOR, and members of the International Advisory Board contributed fact-finding questions for our use during a focus session to determine needs in Honduras. Gwinnett Medical Center, North-side Hospital, and GPC, all in Atlanta, donated supplies for us to use during the classes. Many people made it possible for us to achieve a great deal of work in a short period of time. The characteristic helping hand and open heart of perioperative nursing was ever-present.
AUG 29, 2000
In the early morning of Aug 29, faculty members from GPC, including Rosemary Robertson, RN, MSN; Verna Rauschenberg, RN, MSN; Willa M. McGarity, RN, MSN; Sarah Keeling, RN, MSN; and Eva Parra, a nursing student, met Doreen and me, along with Fran Lewis, at the Atlanta airport to travel to Tegucigalpa, Honduras.
Arrival in Tegucigalpa was interesting and a little frightening. Mountains surround the city, and, as the plane approached the landing strip, it looked like we were brushing the treetops. Then suddenly, we dropped down to the landing strip. The airport is old, small, and in a state of disrepair, but a new one is being built. Reina met us and brought us into the diplomatic lounge. I am told this is much easier than going through the normal customs routine. We waited while someone took our passports, gathered our luggage, loaded it into a van, and took us to the hotel. I discovered much later that the lock on my luggage was cut off, and everything in my suitcase had been searched.
Our first evening in Honduras, Reina arranged for us to meet the first lady of Honduras, Mary Flores. Flores was born in the United States and speaks perfect English and Spanish. She and her husband, President Carlos Roberto Flores, met at Louisiana State University in Baton Rouge, La. We walked through armed guards into her offices, which consist of two beautifully decorated rooms. We spent about one and one-half hours talking and exchanging information.
Flores is very interested in health care, especially for children. She currently is raising money for a new children's hospital. She shared her visions on ways to improve conditions in Honduras. Hondurans still are trying to recover from the devastation that occurred in October 1998 when Hurricane Mitch hit the country. She thanked us for taking our time and resources to travel to Honduras and work with nurses. She stated that we could arrange to ship supplies and equipment to Honduras through her tax-free foundation. It would help to ensure that anything shipped to Honduras reached its final destination.
It was a great honor to meet Flores, and I was very impressed that she spent so much time with us, even serving coffee. The president of the Honduras Nurses Association, Maria Elena Caceres, MS, joined us in our visit to the First Lady. Following the meeting, Caceres treated us to a Honduran meal courtesy of the Honduras Nurses Association.
AUG 30, 2000
Our first day of class consisted completely of lectures. We covered perioperative nursing as an overview, aseptic technique, OR attire, scrubbing, gowning, and gloving. We started with 38 nurses, none of whom spoke English. We had two wonderful translators; one was Eva Parra, the student from GPC. The other was Nelly Tracy, a Honduran nurse who is married to a US citizen and who speaks English very well. The group seemed interested and enthusiastic as we roasted in a classroom with no air conditioning, broken desks, and old audiovisual equipment. It did not seem to bother them, nor did it hinder Doreen and me.
AUG 31, 2000
Day two began with more didactic and hands-on education in the OR at the public hospital across from the nursing school. As we walked to the hospital in the afternoon, we found that it was surrounded completely by high fencing, and armed guards were posted at the entrance and at spots along the fence. We entered through an emergency room that looked old and that was filled with rundown equipment and many sick and injured patients. Flores had told us the day before that a majority of Honduran citizens use the hospital and emergency room for primary health care. It was a sobering sight to see so many people in need of so much and so few care providers. We were told that there usually is one nurse per shift assigned to work in care areas. The nurse-to-patient ratio was said to be about 40 to 1 on the patient floors, as well.
As Dolores de Chirinos, RN, the OR supervisor at the hospital, guided us to the ORs, we saw family members walking into the restricted areas of the OR (right in front of the posting board) and even into the postanesthesia care unit (PACU). Adults and children in street clothes seemed to come into and leave the OR at will. Dolores told us that she is trying to change that behavior.
After we arrived in the OR, Doreen and I demonstrated how to set up and maintain a sterile field, using supplies we brought with us. We saw no disposable supplies in the OR. The shoe covers looked like ankle boots with strings attached to tie them over shoes. After our demonstration, the group practiced. Dolores took the lead, gathering linen and proceeding to show us how to set up a sterile field. The students did a good job of setting up the sterile field, but I was surprised to see that the circulating nurse used a sponge stick soaked in a solution to open the green linen packs. The towel given to the surgeon to dry his or her hands actually is a hand towel included in the pack.
I learned on this afternoon that the group had been having a good laugh on me. All week, whenever one of the nurses did something good, I said “Muy bueno.” The group had even started to repeat it after me and then laugh. When I did that on this day, one of the translators told me that they actually were poking fun at my incorrect use of the term. “Bueno” refers to food, and the correct term should be “Muy bien”—very good. We all had a good laugh about my error.
Our session in the OR went well. One of the ladies commented that it was good to know that they were doing some things correctly, and indeed they were. As we were waiting for our group to reassemble at the close of the session, a surgeon and nurse were pushing a patient into the PACU. The unit was crowded, and much of the ceiling was missing or falling out. The surgeon came over to us and warmly welcomed us. He knew who we were and said it was wonderful that we would travel to Honduras to help. He asked how long we would be in the country and wanted to know what we were teaching. He was very friendly and wanted us to know how much he appreciated our presence.
SEPT 1, 2000
Our last teaching day started like the previous two—late.
Punctuality never seems to be an issue in Honduras. Doreen led the group in a case study that they all seemed to enjoy. The reports given by each of the five groups were good and covered all the points in the case study questions. When we completed the group activity, we asked the group members if they were interested in forming a perioperative association in Honduras. They unanimously and enthusiastically shouted that they did. As soon as they said that, one member of the group went to the blackboard and started the procedure to elect officers.
Doreen and I stood back in awe at how quickly they moved to make the process their own. It was accomplished democratically by nominations from the floor and a vote by every member. Interestingly, the group members elected de Chirinos, who appeared to be the informal leader during the week, as their first president. It truly was delightful to see people who had sat in class all week take the reins and run. There was much celebration and a festive mood when the elections were over. Rita Medina, the nurse who was elected to the treasurer position, completed a membership form for AORN and gave it to us to mail. The group then proceeded to choose a name for the new organization. The name they chose was ANEPH—Association Nationale Enfermeras Perioptiva Honduras. In English, it is the National Association of Perioperative Nurses Honduras.
After lunch, we conducted a focus group and collected some good information about the state of health care and nursing in Honduras. They have little and need much, but the desire to see and do more is apparent. We ended class at 2 PM to begin graduation ceremonies. The general nursing attendees and the perioperative class members participated in this together. We started the session with three couples, including some of our class members, performing four Honduran dances. It was so hot in the room I could not imagine dancing, but everyone seemed to enjoy it. Several people, including me, were asked to give speeches. Reina acted as the master of ceremonies. Three of us, Doreen, Sarah Keeling, and I, were inducted as honorary members of the Honduran Nurses Association. We were pinned, given diplomas, and asked to sign their record book to make it official.
When it was my turn to speak, I told everyone how proud we were that our perioperative class had decided to officially organize. I asked the new officers and Doreen to join me at the podium where we gave them seed money for their new treasury. The most amazing thing happened next. Caceres, as president of the Honduras Nurses Association, came forward to recognize the new organization and give the new officers the oath of office. Doreen and I were asked to stand with Caceres as witness to the oath of the officers. As I listened to Caceres' words, I could not believe we were watching the birth of a new association. I was deeply touched and could not hold back the tears. As I stood there, I thought this must be how our 17 founding RNs felt on Jan 28, 1949, at the very beginning of AORN.
It was very special to have the opportunity to witness such an occasion. We were a part of the beginning steps by the Honduran nurses to change the landscape of perioperative care in their country. When the ceremony ended, the perioperative class members were asked to stand, and everyone cheered them. Our group shouted “Muy bueno!” It had become a rallying cry, and when something good happened, everyone would repeat it and then laugh. The afternoon closed with the awarding of the certificates and presentation of gifts to the instructors. The afterglow of the events of the day followed us into the evening. Everyone fully realized how very special the day had been. We were pleased for the Honduran nurses and personally thankful to have been part of such a fantastic beginning in a country that has so much less than we do. Plans currently are being made to send one Honduran nurse to Denver to attend the Perioperative Nursing Course 101. This country truly is interested in raising standards for their patients.
Let us all give thanks this November for all that we are privileged to have in the United States. But please, pause to think about the excitement and enthusiasm when something new is started. Pause to renew your commitment to our profession and our organization. We have a standard that is only a dream in some places around the world. Let us celebrate the dream of some that is a reality in the United States with the newness of experiencing a “first step.” Have a wonderful Perioperative Nurse Week.
PII: S0001-2092(06)62002-4
doi:10.1016/S0001-2092(06)62002-4
© 2000 AORN, Inc. Published by Elsevier Inc All rights reserved.
