Student stories of their education experience abroad in their own words
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Day 12: Nursing in Norway
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
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:
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
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/
Key Informants (Day 11)
Today we had an opportunity to learn from several key informants involved in organizations working within Norway to improve the health of the community. Our informants included two people from Aksept (Center for Living with HIV); a social anthropologist working with the aid organization, CARE in Norway; and a social welfare nurse from Prindsen Mottakssenter, a safe “consumption house” for drug users. The marginalized groups focused on today were people living with HIV, women, and people struggling with drug addiction. The intent of our work with the individuals from these organizations was to achieve a wider understanding of these marginalized groups and to also challenge our own values and assumptions when working with individuals from marginalized groups. The knowledge acquired from this interaction allowed us to gain deeper insight on the health issues facing the community and ultimately will help lead us toward creating interventions and inform the care we provide.
Working with these key informants provides us with an opportunity to practice communication skills in line with the Public Health Core Competencies 3A3 and 3B3, which involve gathering information from individuals, organizations, and populations served with the goal of improving community health. Additionally, addressing the needs and welfare of marginalized groups in the community does important work to reduce ineqalities which is a focus of the UN’s Sustainable Development Goal #10. Targets within this goal include working toward the inclusion of everyone and the reduction of inequalities that are present based on differences such as age, sex, disability, health status, etc. Learning about marginalized groups and their struggles enables us to work to mitigate the effects of the elements that segregate them, advocate for their inclusion, and reduce the inequalities they face in the community.
An overriding theme of working with marginalized groups from today’s experience was the importance of respect and honoring human dignity. It is essential to see the individual as a human being, rather than seeing them by their diagnosis or another type of label that removes their humanity. For example, to see the person living with HIV, instead of the person who is HIV positive. It may seem like a subtle distinction, but saying the person is living with HIV allows them to be a person- a human being- first. Saying someone is HIV positive puts a label on them with an identity solely tied to their HIV status. When working with marginalized groups, we must focus first on our shared humanity and not on what marginalizes people.
Another important theme closely related to respect and human dignity was the concept of non-judgement. When working with marginalized groups it is critical to check our own biases and assumptions and interact from a place of non-judgement. For example, when working with people who are struggling with drug addiction, we must see the person as a human being with a unique life story that led to their struggle with drug abuse. We must withhold any judgements that our own biases, personal history, and assumptions may tempt us to entertain. Judgement can negatively interfere with our ability to interact, connect, and care with people from marginalized groups and impairs our ability to treat them as human beings worthy of respect and dignity.
Insights gained today from these key informants helps us to create a fuller picture of marginalized groups and the struggles that they face in the community. This gives us the knowledge to design appropriate interventions, but also informs our interactions and enables true human connection and inclusion. Making a connection and building a relationship helps us to better understand the person we are working with and is an important first step to any interventions or care that we provide. These are insights and tools that I will certainly carry with me into my future practice as a midwife and women’s health nurse practitioner. My background is as a community health worker in a women’s health center with the mission of providing care to the underserved segments in the Dayton, Ohio community. I hope to continue this important work as a health care provider. The lessons that I take away from today’s experience continue to fuel my passion for meeting people where they are without judgement and to always see the good, to see the human being, in every person that I encounter. Whether we are serving the needs of the community in Norway, or back in Ohio, people everywhere desire the same thing- to be seen and treated as human beings worthy of respect and dignity regardless of their story or struggles in life.
MEET THE AUTHOR:
Christina Sutherland
Student Nurse at The Ohio State University in Columbus, Ohio
Graduate Entry Program: Women’s Health Nurse Practitioner/Midwifery tracks
References:
The Council on Linkages between Academia and Public Health Practice. (2014). Core competencies for public health professionals. Retrieved from http://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_Professionals_2014June.pdf
United Nations. (n.d.). Goal 10: Reduce inequality within and among countries. Retrieved from https://www.un.org/sustainabledevelopment/inequality/
Day 4: My Second Clinical Experience in Norway
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
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
United Nations (n.d.). Goal 11: Sustainable Cities and Communities. Retrieved from https://www.un.org/sustainabledevelopment/cities/
Day 9: Sunday
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/
Nursing in Norway- Saturday, June 1st
This morning around 8am, nine other students and I ventured down to the waterfront to catch a ferry to take us to Drøbak, a small coastal city in Norway. It was a dreary morning, so a few classmates and myself napped during our hour and a half ferry ride, but I did manage to snap some shots of the views during our trip:
Dock at the waterfront
Views from the many stops made on the way to Drøbak.
Once we arrived, we headed to a Christmas store filled with every size Santa gnome you could ever imagine. (Rumor has it Santa is actually from Drøbak!)
After we purchased some souvenirs, we headed to Crocodile Corner for lunch. It was an Italian restaurant inside what felt like a cozy log cabin that even included a (fake) fireplace.
Kash and I sharing a colossal calzone.
Throughout our stay here in Norway, I’ve noticed that there are a lot of Tesla’s on the streets. I’ll see one every so often in Columbus, but it feels like here it’s every 5th car I see. After talking to my Norwegian nursing partner and doing a bit of research, I discovered that Norwegians get, “subsidies, free parking, and toll-free roads” as part of a package deal when purchasing a Tesla (Reid, 2018). By offering this package, Norway is contributing to Sustainable Developmental Goal #7, Affordable and Clean Energy (United Nations, n.d.). By offering a discount on electric/hybrid cars, people will not need to use as much fossil fuels and can transition over into using more clean energy.
While today was a free day so there was not any clinical experience, the Core Competency for Public Health Professionals I saw the most this week during my clinical time was Communicaiton Skills. There was one patient in particular where we arrived at her home and she was very confused and hypoglycemic. Her blood sugar was 2,6 mmol/L (or 37 mg/dL). We then looked around her apartment to find some food we could give her to increase her blood sugar. We settled on a jar of chocolate spread, but she was so confused that she didn’t understand what the nursing student was saying to her. Since she was not comprehending her words, the student then demonstrated what she wanted her to do, which was put the spoon in her mouth and eat the chocolate. This is a prime example of Core Competency 3A7, which is, “Facilitates communication among individuals, groups, and organizations” (Council on Linkages between Academia and Public Health Practice, 2014). The nursing student recognized the patient was not able to understand how she was communicating, and then adjusted her approach in communication so the patient could understand. She then called the urgent care to explain the situation to see if they should come bring her in or if she was okay to stay at home. They ended up deciding she could stay as another nurse was coming to check on the patient in an hour.
As a future pediatric primary care nurse practitioner, communication skills are something that I will need to practice regularly. I will need to recognize where they are at developmentally and adjust my approach accordingly. Similar to my experience on the home visit with the hypoglycemic patient, I see myself needing to demonstrate often what I want my patient to do. For example, demonstrating on a doll proper teeth brushing or practicing how long to wash our hands.
References
Reid, David. (2018). The country where a luxury Tesla has become the budget option. Retrieved from: https://www.cnbc.com/2018/01/30/norway-where-the-electric-tesla-has-become-the-budget-option.html
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
United Nations. (n.d.). Sustainable Development Goals. Retrieved from https://www.un.org/sustainabledevelopment/cities/
Day 7 in Oslo: one week down!
We went to the nursing home today. Our group baked waffles and planted flowers with the residents at the nursing home. It was a beautiful day outside and supposed to be the warmest day of the trip! The residents at the nursing home really enjoyed the sunshine and company. After lunch, our group took them to the park. It was nice to see how Norwegian culture promotes independence for their citizens. We were allowed to walk with them to a park and get them out for a little. Their staff really appreciated us being an extra set of hands to allow the residents to go to the park. We pushed them in wheelchairs and walked beside those that needed the help. We had to climb up a hill to get to the park, but we had ice cream and got to see a beautiful view at the top. For dinner, a group of us met up with some of the Norwegian nursing students and went to the restaurant Oslo street food. They had numerous food stands with a lot of food from different cultures. It was nice to go out around town with the Norwegians and find a fun and new place. I felt like I was living like a local!
The clinical activity of the day fit public health competency 5A6 in that it, “engages community members (e.g., focus groups, talking circles, formal meetings, key informant interviews) to improve health in a community” (The Council on Linkages Between Academia and Public Health Practice, 2014). In addition to baking waffles and planting flowers with the elders, we just took the time to talk to them. We served them coffee and tea and listened to their stories they were eager to tell. They were so happy to go to the park and have an ice cream party at the top. Many of them would not have gotten away from the nursing home if we hadn’t been there helping to assist them. All these activities truly engaged the elders and gave them stimulation they need to be in good spirits. We did meaningful activities to them and had fun along the way. We promoted their independence which is crucial to their well-being and health.
Our clinical day at the nursing home followed Sustainable Development Goal number three, good health and well-being (United Nations). I think we promoted health and well-being by interacting with the residents. We not only had a great time, but also gave purpose to the residents lives. A lot of elders get depressed because they feel they are no longer needed in society. I think our activities were a great way to provide joy in their lives and keep them busy. We took the time to talk to them and it was the highlight of their day. Good spirits lead to good health! We also got them walking outside to the park. Being outside can really boost your spirits. Also, these residents worked on their physical fitness and got their steps in as we certainly had quite a hill to climb to get to the park!
I am in the pediatric primary care specialty of our program. My favorite part of the day was learning that the nursing home did activities pairing residents and children together. I thought this was a brilliant way to keep the life in the residents alive and boost their spirits. The nursing home did a great job of providing meaningful activities to the residents to give them a high quality of life. Many women in their old age have very high maternal instincts and this is a perfect way to bring this out in them. The pool at the home even hosted swimming lessons for babies. Having that interaction between youth and the elders can provide well needed stimulation to keep the minds of the residents sharp and well. The children also benefit by getting the extra attention and love from the residents they need. I want to provide this kind of care in my future practice as a pediatric primary care nurse practitioner. I will think of innovative ways to make sure the kids I take care of are healthy emotionally. The care you get as a child will provide the foundation for the rest of your life. Neglect can damage a child forever, and I want to make sure the children I work with are happy and healthy!
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_Competencies_for_Public
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/
Oslo street food
Norwegian waffle we made!
view from the roof of the nursing home
Day 5: Psychiatric and Mental Health Care in Oslo, Norway
Today was my last day working alongside a Norwegian nursing student out in the community of Oslo, Norway. We were in an outpatient psychiatric clinic for three days, and I really enjoyed learning about how they work with psychiatric patients in Oslo. At this clinic they are able to do home visits and give medications, as well as provide basic home care needs for the patients. They also will go to patient’s homes to evaluate them and see if they need to be institutionalized or need treatment. They primarily work with drug abuse and psychosis, as well as patients who are’t able to work because of their mental illness. They will help them apply for financial needs through the government to make sure sure they are able to pay for their care. Today specifically, we went to a patients home to do an evaluation on him to see if hospitalization would be better for him than home care. He is actively using drugs, and he is on required treatment that they do here in Norway. His evaluation went well and he has been taking his medication, so he did not need to be hospitalized. After that, for the rest of the afternoon, we hung out with a patient downtown. At this clinic, on certain days they have patients come to the clinic to meet with some of the staff and then they will take them out and hang out with them. It was such a great experience. We went to get coffee with him and hung out by the waterfront, which he loved! I could see how happy he was to have some company and outdoor time. I truly loved this clinical placement, and I am so happy I got to experience a little bit of what their psychiatric care is like here.
Throughout this clinical experience I thought a lot about SDG 10, reduce inequality within and among countries, especially with the type of population I saw. This goal is something I want to take back to America from Norway. Reducing inequality means that policies should be made while paying attention to the needs of disadvantaged and marginalized populations. Individuals with mental illness may have a very hard time getting jobs, or even being able to afford treatment. Here in Norway, individuals who can’t work due to any illness can get on welfare and have all their basic needs paid for and met. This aligns with the Public Health Core Competency 1C13: Ensures development of community health assessments using information about health status, factors influencing health, and assets and resources. This clinic is helping these patients within their community get housing and food as well as treatment paid for so they become healthier. If patients need help and can’t afford much due to their situation, the physicians and healthcare workers figure out the funding from the government for them. I think that is so helpful for the patient so they don’t have to worry about that. The Norwegian communities have higher taxes because of this system; however, they are filled with joy to pay taxes towards helping people in their community. I think that is something our country can work on and learn from. That helping our community is so wonderful and so helpful to grow as a country and world. While in this community, there are still downfalls as it isn’t perfect, mental illness doesn’t seem as stigmatized in the community here as in Ohio, or even America.
As a future neonatal nurse practitioner, I may have the opportunity of working with many mentally ill families. This clinical experience was great for me because I want to primarily work with babies who have Neonatal Abstinence Syndrome, and help the mothers receive the care they need if they are abusing substances. I was able to work with many patients who abused substances and learn how the Norway communities care for them, and I can now take many of the great ideas I learned back to America. This was such a great way to be able to expand my knowledge of different cultures and different communities in a different part of the world! I am excited to share all these experiences and suggestions with my peers and I look forward to learning even more about this great community!
Me, taking the electric bike to a patients home.
Social worker entering patients apartment building.
View from the waterfront while hanging out with the patient.
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
United Nations (n.d.). Goal 10: Reduce inequality within and among countries. Retrieved from https://www.un.org/sustainabledevelopment/inequality/
Day 4: Psychiatric and Mental Health Nursing in Norway
My clinical assignment for this week is psychiatric and mental health within the Bydel St. Hanshaugen district. Today I had the opportunity to work with a program they call “Flexible”. In this program there are several types of professionals, including nurses and social workers, who help Norwegians who have a severe mental illness and a history of violence due to their mental illness. Because these patients have severe mental illness issues, they are unable to hold a job. These patients are, however, able to live independently in city owned apartment flats, which are scattered throughout the district, and the patients live among the general population, with the theory that allowing the patients to live in a normal environment is good for their mental health. Many of the patients have been institutionalized and/or imprisoned previously – they are known within the healthcare and law enforcement communities. The patients must sign contracts with the Flexible program; these contracts include the agreement to receive an intramuscular injection once every two weeks which contains an extended release antipsychotic medication (the specific medication depends on their illness), and the Flexible program also keeps a copy of their apartment key in case they need to get the door open to check on the patient during their weekly visit. All patients in the program are known to have a substance abuse problem (amphetamines are the most commonly used street drug in Norway). Interestingly, patients are not required to stop substance abuse to be a part of this program. Recreational drug use is illegal in Norway, however, it is not common for a person to go to prison for using drugs, and if they are in the Flexible program drug use will be tolerated as long as they continue to abide by the contract.
One aspect of the Flexible program is the program tries to connect patients to resources to utilize skills they already have and to do things they enjoy doing. The activity I got to help with today was a bird and bat house project. There is a skills program offered to Norwegians who do not complete high school and one of the skills taught is wood working. These students in the skills program build wooden bird houses and bat houses which are then given to the Flexible program. The patients in the Flexible program often enjoy artistic activities. The patients paint the houses, which are then taken out in to the community and hung up for birds and bats. The patients enjoy the activity, and it makes them feel good that they contributed something valuable to society. This project not only benefits Norway, but also impacts healthcare goals on a global scale. In 2015 the UN introduced 17 Sustainable Development Goals (SDG’s), with the mission to improve lives for everyone on this planet and to help take care of our Earth. The bird and bat house project contributes toward multiple goals – Goal 3 Good Health and Well-Being, Goal 8 Decent Work and Economic Growth, Goal 10 Reduced Inequalities, and Goal 11 Sustainable Cities and Communities (SDGs, n.d.). More information about SDGs can be found here: https://sustainabledevelopment.un.org/sdgs. In addition to meeting the SDGs, the Flexible program and projects that it sponsors also meets the Public Health Core Competencies set forth by the The Council on Linkages Between Academia and Public Health Practice. As a Tier 1 program, they contribute to competency 5A6, Engaging Community Members as part of the Community Dimensions of Practice Skills Core Competency (Core competencies for public health professionals, 2014). By offering activities like the bird and bat house project, the Flexible program engages their patients to improve health within their community. More information about Core Competencies for Public Health Professionals, visit: http://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Health_Professionals_2014June.pdf.
My experience with the Flexible program will certainly have an influence on the way I practice nursing care and, in the future, as I become an NP. One of the program workers was explaining to me a patient who hasn’t been opening up to their counselor during therapy sessions may find a level of comfort with the Flexible workers as they paint and have a casual conversation, which then allows that patient to begin to open up and share what they are experiencing or going through, providing valuable information and insight into the patient’s progress.
Apartment Flats in Oslo
A birdhouse ready to be painted.
Birdhouses painted by patients in the Flexible program.
References:
Core competencies for public health professionals. (2014, June 26). Retrieved May 28, 2019, from http://www.phf.org/resourcestools/pages/core_public_health_competencies.aspx
SDGs: Sustainable Development Knowledge Platform. (n.d.). Retrieved May 28, 2019, from https://sustainabledevelopment.un.org/sdgs