huffman.745 | Ohio State Global Transformations On-Location: Norway Blog

Day 12: Nursing in Norway

June 6, 2019 at 1:50pm by huffman.745

Written by Kiara Wagner

Today we met with our Norwegian Nursing students for their new Oslo By Night Project. Oslo by night (though not always done at night) is used to serve people that may not typically go out and seek health care during the daytime or those that us as heath care providers sometimes forget about, such as those that do drugs or are sex workers by night. Many of these people that are out in the night could be citizens of Norway but they are also people that are here from different parts of Europe. They may have not been able to find jobs and end up begging and possibly sold into sex trafficking.

Myself and one of our host students Leona Wagner

This Oslo By Night project is the best example I’ve seen of Competency 2B2, Develops program goals and objectives, (The Council on Linkages Between Academia and Public Health Practice, 2014). This is a project that the Oslo students are spearheading with some collaboration from us Ohio State students to reach people. We have spent time reviewing the populations that need help, such as those that have, or are at an increased risk for HIV, learning about what increases a persons risk, how their risks can be decreased, and how we as care providers can help them without putting blame on and judging these patients. A few days ago we learned about a organization called Nurses on Wheels and it was nice to see that the community of Oslo are getting students involved in their second year of school, not waiting for them to graduate to have them make a difference in the community beyond LDUC.

The things I’ve experienced in Norway have really shown me something different than what I know from our health care system in. In America we are used to trying to fix your health issues or letting them always be a constant reminder of what you can and cannot do. In Oslo, their philosophy is really meeting people where they are. This to me aligns with Sustainable Development Goal 3: “Ensure healthy lives and promote well being for all at all ages” (United Nations). They choose to focus on making sure those that do not or cannot seek health care as often still have safe tools that they need by going out into the community and delivering them no matter the conditions these people find themselves in.

While on this trip we also met a few friends studying abroad from Germany, here is Berbe pictured with Kashmere Cooper-Pearson, Emma Zack, and myself

Seeing how Oslo health care workers treat their patients, or partners in health as they like to call them, directly relates to my role as a future Pediatric Nurse Practitioner. I may only have a short amount of time to make a difference in the lives of the kids that I see. This means I need to be very selective and give them the best care I can with the thought in my mind that, I have to get this done because this may be my only opportunity. I am grateful that this unique clinical experience is teaching me to focus on helping and healing instead of always fixing. As future practitioners we need to remember that the more compassion we show, the more we will prove ourselves authentic and patients will want to keep seeing us and allow us to be their partner in health.

Sources:

United Nations (n.d.). Goal 3: Ensure healthy lives and promote well being for all at all ages. Retrieved from https://www.un.org/sustainabledevelopment/cities/

The Council on Linkages between Academia and Public Health Practice (2014, June 26). Core competencies for public health professionals. Retrieved from http://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_Professionals_2014June.pdf%20

Day 10 in Oslo: History and Harm Reduction

June 5, 2019 at 1:56pmJune 5, 2019 by huffman.745

Written by Kashmere Cooper-Pearson

History is the measuring tape for progress. Knowing and understanding the beginning can give great insight into the distance we’ve covered and how far we’ve yet to go. Today started by meeting with the school Chaplin, and for us a key informant in the local community of Oslo. She educated us on the history of nursing in Norway and helped us understand the key principles on which their model of nursing is founded. We also identified some major influencers of nursing in Norway. A woman by the name of Cathinka Guldberg served as the founder and matriarch of nursing in Norway. She was educated as a nurse and deaconess at Kaiserswerth Diakonie in Germany which is also where Florence Nightingale was a former student. Guldberg started the first nursing school here in Oslo, Christiania Deaconess House now known as Lovisenberg Deaconess House, in 1886 which is right next door to where we are staying. Another key influencer was Rikke Nissan, a deaconess, who created the first nursing curriculum and textbook. Together these two women were pioneers for the nursing profession in Norway.

Lovisenberg Deaconess College formally known as Christiania Deaconess House

We took a short break for lunch but the history continued. We visited, Asylet, the first ever hospital on the east side of Oslo which now serves as restaurant. Everyone had their choice of burgers, salads, and shrimp sandwiches along with a tasty dessert.

My bacon burger and potatoes

“Soft ice” and a brownie

Additionally, we learned about the key fundamentals of their nursing profession which are rooted in Christianity. In fact, Diakonia or Diakonale, was described as “ the Christian faith translated into action or easier done than said” which means that the profession of nursing is about serving, showing love, and compassion to everyone. Furthermore, their model of nursing emphasizes human rights and respect for all people.

Later in the day we visited and spoke with key informants from an organization known as Nursing on Wheels which practices harm reduction for individuals addicted to drugs. Their goal is to reduce the incidences of overdose, HIV, and Hepatitis. We were able to speak to some of the nurses and view the set up of the typical Nursing on Wheels van. This clinical activity really embodied sustainable development goal 3, “Good health and well being”(United Nations). Although controversial, Nursing on Wheels provides clean needles, sterile water, and sterile tools to drug addicts who are injecting drugs. The hope is that they are able to decrease the sharing of needles, the use of dirty spoons and water to inject drugs. By providing clean tools and supplies they are reducing the incidences of Hepatitis, HIV, and other infections. This organization is promoting health and well being for those who are often overlooked by the system and society. These nurses also provide wound care, deliver medications, screen for Hep C, and provide resources to those who are hoping to get clean. This organization recognizes that health promotion and disease prevention is important for everyone in the community no matter their circumstance which directly relates to public health competency 5B5, “Maintains relationships that improve health in a community” (The Council on Linkages Between Academia and Public Health Practice, 2014). Nursing on wheels is establishing relationships and building trust with those who may not have any other support from family or friends. Simultaneously maintaining these relationships promote health and well-being for the community as a whole.

Nursing on Wheels logo

Nurses on wheels van and Dianne Morrison-Beedy

Graffiti in the park

River that divides east and west Oslo

This clinical experience really challenged my thinking about those addicted drugs in my own city and country. Often when things don’t apply to us we forget that they are there. I began to really reflect on how the people addicted to substances are viewed in America by healthcare providers, police officers, their family and even strangers. We often stigmatize them as criminals and manipulators before we have had a conversation with them which influences the way we interact with them and incorporate them into our community. As a future Family Nurse Practitioner I will strive to establish and maintain relationships with the people that are at risk of being overlooked by society, healthcare, and the community. I will strive to create a culture that is open, safe, and judgment free for anyone that steps foot in my office.

References:

United Nations (n.d.). Goal 3: Ensure healthy lives and promote well-bring for all at all ages. Retrieved fromhttps://www.un.org/sustainabledevelopment/inequality/

Day 4: My Second Clinical Experience in Norway

June 4, 2019 at 8:31pmJune 4, 2019 by huffman.745

Written by Katie Gorbold

Sara, Alexis, Ane, and Katie (me!) outside of the home health practice near the school.

I woke up feeling prepared for our fourth day in Norway since we had already begun our clinical practice with Norwegian students. Jet lag was diminishing, and our normal energy was returning. I felt good and ready to engage with this unique nursing experience as much as possible. We continued the same type of care that we provided the previous day. After the morning meeting and changing into our scrubs, our group of 4 split into two and divided and conquered the patient list for the day. The nursing care went something like this: walk to the home, knock on the door, let yourself in (the home practices have keys to each residence), greet the patient, provide care, document in a physical binder kept in the home any medication administration or other pertinent information, announce your departure, and lock the door on your way out. Then we were able to access information on our next patient using a facility cell phone. We would walk to the next residence, and start again. It looks something like this (very different from my nursing experience in Columbus!): IMG_5772

This practice of walking from patient to patient promotes Sustainable Development Goal #13 – Climate Action (United Nations). Oslo is an extremely pedestrian friendly urban area with multiple types of public transport available as well. There are abundant bike lanes that coincide with the vehicle paths and sidewalks are everywhere. Ane, the student in the video above, also mentioned that there is a heavy fee for having a car in the city. Parking is no longer free as well. These are all in an effort to promote good environmental practice and reduce the detrimental climate change that we are becoming increasingly aware of the world over.

It didn’t take long to note some of the core values that the Norwegian health system holds for their patients. From my own experience, I noticed that the home nurses promoted independence and autonomy for their patients whenever possible. Although most patients were old and somewhat fragile, nurses allowed them to actively participate in their care if possible. Simple tasks such as brushing teeth, washing during a shower, taking pills (even if it meant very slowly and with patience, one at a time!), and walking around the home were encouraged with as minimal intervention/assistance as possible. This feature of the nursing care here was mentioned during our first clinical debrief by other OSU students as well. Finally, I checked in with my Norwegian clinical partner, and she confirmed our observations. Norwegians value and promote independence as they can attest that their seniors appear to have healthier, more happy and productive lives when encouraged to live independently for as long as they are able. She mentioned that their facility cell phones even have a home-screen reminder for nurses to promote independence in their elderly patients. This value of Norwegian health care falls in line with our Public Health Competency 8A4: “Contributes to development of a vision for a healthy community” (The Council on Linkages Between Academia and Public Health Practice, 2014). Clearly Norwegian nurses are envisioning a community with independent and thriving elders and are putting this vision into practice when they can. In turn I believe their population is benefiting from this vision, as their community of seniors appeared extremely happy and healthy overall.

This promotion of independence and autonomy will remain a high priority in my future practice in Midwifery. I know firsthand and through experiences in the birth world that mothers typically prefer to have autonomy around their birth experience. I am certain that prioritizing patient education and promoting informed decision making for birthing individuals typically yields better results with less birth trauma. I have seen this trend arise in the United States among birthing women and I plan to continue to promote it.

References

United Nations (n.d.). Goal 11: Sustainable Cities and Communities. Retrieved from https://www.un.org/sustainabledevelopment/cities/

Day 9: Sunday

June 4, 2019 at 1:57pmJune 4, 2019 by huffman.745

Written by Kira Mullen

This weekend we had both Saturday and Sunday free to reflect on our first week and explore outside of Oslo if we wanted. I spent the weekend two hours outside of Oslo in the countryside of western Sweden with two other students. We drove across an international border that didn’t even require us to stop in either direction. We stayed in an idyllic tiny house surrounded by birch trees near a quiet cow pasture. During the days we walked through nearby coastal towns and fishing villages. It was the ideal setting to reflect on a busy week and compare and contrast perceptions of health in Norway versus the United States, as we were a bit removed from each location. We also made a mandatory stop at IKEA in Sweden!

Fjallbacka, Sweden

The most valuable aspect of the experience so far has been getting a glimpse into the daily lives of Norwegian nurses and patients. During such a short time it can be difficult to gain a deeper cultural understanding, but thanks to our Norwegian students and faculty we are able to dive in. My clinical days were spent conducting home health visits and entailed everything from delivering medicine, taking vitals, making breakfast, doing laundry, wound care, to one visit for twenty minutes of conversation. The pace of care is different and there is a lot more walking involved here. I have probably walked more since being here than all year on campus, yet still get a lot done! Patients are encouraged to walk as much as they are able to and even at the nursing home we visited on Friday, patients in their nineties walked with us over a mile to a local park and back. Some of the patients walked slower or needed assistance, they were met with patience and encouragement as we traversed the park. The value placed on the outdoors is evident through the numerous green spaces throughout the city. Even in an urban environment it is easy to find solace in nature no matter the neighborhood.

Local park near Lovisenberg

This emphasis on natural environment and community supports Public Health Core Competency 1B1 “Describes factors affecting the health of a community (eg. equity, income, education, environment)”. Whereas there are gaps between the West and East sides of Oslo in terms of equity, education, and income, green spaces still persist and are well kept so that everyone can access them for health benefits and leisure. Norwegians in general seem more encouraged to utilize break time whether it be a lunch break or vacation days, and often spend that time outdoors. Every person I have spoken with (throughout the lifespan) has emphasized the importance of green spaces, time in nature, and exhibited a keen awareness of climate change. Norway will see increasing numbers of climate refugees from vulnerable areas and need to be able to meet the health needs of those growing communities. Another consequence of climate change in Norway relates to the fishing industry, which is the second largest industry in Norway. The fishing industry will likely see a rise in fish populations due to higher ocean temperatures pushing fish north. While this may initially benefit the fishing industry, they also need to be aware of the potential loss of habitat, ocean acidification, and marine dead zones that could drive fish out of Norwegian waters. These are just a couple of the multitude of direct and indirect effects on natural and human systems that climate change poses.

Norway, along with many other countries, recognizes the devastating consequences climate change presents to both humans and the natural world. Norway was among the countries (excluding the U.S.) that adopted the Paris Agreement at the COP21 in Paris. Norway is working towards Sustainable Development Goal (SDG) 13: Take urgent action to combat climate change and its impacts. Norway committed to reducing greenhouse gas emissions by 40% by 2030, promoting the phasing out of fossil fuel subsidies, supporting sustainable urban development, reducing deforestation, supporting renewable energy, and contributing to the sustainable management of marine resources (Norwegian Ministry of Foreign Affairs).

With vast forests that serve as carbon sinks and a growing economy, Norway is in a good position to be a climate leader so that its inhabitants can continue to enjoy the physical and mental health benefits of green spaces.

Betula pendula, silver birch

The clinical experience in Norway has given me new approaches to use in preventive health care that I can apply in my practice as a future family nurse practitioner. I can remember to draw from my home visit experiences and that the health of the natural environment directly impacts human health from access to clean air and water to even being able to exercise safely outdoors. Spending time in nature has been linked to improved physical and mental health and wellbeing. I want to guide people in incorporating more daily walks and time spent in nature, even in urban settings. Overall, the clinical experience has encouraged me to maintain a holistic perspective, to advocate for healthier communities and environment back home, and to contribute to policy and social changes so that eventually everyone will be able to access green spaces and have the time to enjoy them.

References

The Council on Linkages Between Academia and Public Health Practice. (2014, June 26). Core competencies for public health professionals. Retrieved from: http://www.phf.org/resourcestools/Documents/Core_Co

United Nations. (N.d.). Sustainable Development Goals. Goal 13: Climate Action.

Retrieved from: https://www.un.org/sustainabledevelopment/cities/

Norwegian Ministry of Foreign Affairs. Climate change and the environment. Retrieved from: https://www.norway.no/en/missions/eu/values-priorities/climate-env/

Day 3: First Clinical Experience in Norway

May 29, 2019 at 5:11pmMay 30, 2019 by huffman.745

*Written by Alexis Garybush*

Yesterday was my first day working with Norwegian nursing students for our community clinical rotation. After we were briefed and received our assignments for the day, my student and I were off to provide care to residents within the assisted living community (located on the school campus) as well as in their homes around the neighborhood. Rather than logging into a computer to see patient information, my student had an iPhone that gave her the H&P of each patient, what needed to be completed during our visits, and within what timeframe each task should be completed. If we needed directions to a patient’s house, the iPhone was our guide. In some instances, biking to a residence is an option if it is too long of a walk.

It was very interesting to see how the student interacted with each patient; it was almost as if they were taking care of a loved one. We helped patients out of bed, assisted with their ADL’s, gave them medicine and even prepared breakfast for them in some instances. This approach to caring for patients is in line with Public Health Core Competencies 5B4 and 5B5; establishing relationships to improve health in a community (e.g., partnerships with organizations serving the same population, academic institutions) and maintaining relationships that improve health in a community. The dynamic of students working with residents on their campus and within surrounding neighborhoods allows aspiring nurses to know what is needed within the community in which they live. The last assignment of the day was not a home visit, rather a call to an elderly man in the neighborhood to make sure that he was doing alright. The relationships that are built between these students and their patients improve not only the physical health of the community, but the emotional health and wellbeing of the community as well.

During our day, my Fitbit reached 10,000 steps much earlier than it normally does (or somedays, if at all!). It really made me appreciate the walkability of the city of Oslo and how our students reach patients by walking, riding a bike, or taking public transit rather than driving from location to location as we are so accustomed to in the USA. The UN’s 11^thSustainable Development Goal, Sustainable Cities and Communities, is definitely a highlight of my clinical experience here.

Chris, Katie, Kira, and Amanda on foot; ample bike rental stations around the city

Having access to a basic service such as public transportation cuts back on air pollution and energy consumption of cars, and having safe walkways and biking paths are an important component to walking to work or school rather than driving. In some areas of Dayton, OH, there aren’t any accessible sidewalks, and so even if your job is only a mile or so away, it could be dangerous to walk the narrow and busy streets. Two of the target goals that are being met in SDG 11 in Oslo are: 11.2: “Access to safe, affordable, accessible, and sustainable transport systems for all, improving road safety”, and 11.7: “Provide universal access to safe, inclusive, and accessible, green and public spaces…”.

Me, waiting for the bus

My clinical experience relates to my future as an APRN because it allows me to have a better idea of what community and home health care take into consideration. Although I will likely see patients in an office or hospital setting, each of them will have a unique home experience. Some patients may be in need of assistance at home but do not receive any support. Some residents within my community may not have access to public transportation that would allow them to receive the care that they need. I think it is important to keep this in mind as an APRN because outreach is the key to encouraging preventative care, and back home it is even more important to do so as our clients may not have the option to walk to a clinic or have access to public transit get to their provider to be seen.

Yesterday was an amazing opportunity and I am learning so much about Norwegian culture and their perspective of healthcare. I can’t wait to learn more in the coming days!