What did 12 CNC nurses in training and two nursing "professors," as we are referred to in India, learn while fulfilling a second year clinical/cultural experience in Bangalore?
It is quite a story actually. It will certainly emerge with more time for reflection or as Shawn Berteig describes it, some "percolating time."
Reflection will add to both their current and future learning opportunities for this group of students.
It is more challenging than I had imagined to collect all the thoughts expressed by so many as well as the many observations made and put them to print in a manner that really captures the full essence of what has transpired while here in India.
With this cultural/clinical experience, and the future nurses who have been involved in this CNC pilot project Nursing Field School, I hoped to adequately share their perspectives by sharing some of their thoughts on experiential learning.
This ambitious group of students delved into a culture very foreign to their own. Through time spent in various areas within Bangalore and Narayana Health, developing an understanding of the hierarchical and social systems was achieved.
Understanding these are an integral part of how India functions, allowing the nurses in training to piece together the unfamiliar healthcare setting, with both the social and cultural aspects and intergrate them into their provision of care.
What will they really take away from five weeks or so spent in Bangalore?
Time was spent observing/learning how the health care system works here in India, as well as working within that system while learning it.
This has been far from easy for them.
It is not an easy task to remove yourself from your comfort zone and the familiarity of home and take newly learned knowledge and skills, learn how to apply them, question why you are doing what you are doing, provide a rationale and determine if the decisions being made have the best outcomes for the patient, given the context.
Both me and Anita Muchalla, my accompanying colleague on this journey, were literally circling the area/students, asking them these question on the spot while the physicians, surgeons, and anesthetists also quizzed them on their knowledge and voiced how impressed they were with their knowledge base.
I think it is fitting to hear some thoughts the students expressed through their various experiences.
Kailey Thompson said "I think we were all also made aware of what it feels like to be an outsider and new and different and I think that that will translate into our lives and nursing practice."
Alana Legeard discussed an enhanced appreciation for the "importance of understanding the rationales behind interventions," when applying the nursing process and providing care.
Jamie Hofsink discussed an appreciation for understanding the association of the rights to medication administration as well as the importance of monitoring the outcomes, such as "red man syndrome and vancomycin."
Additionally she recognized the removal of all (potential or actual) barriers when observing the heartbreaking interactions between families and their loved ones given a poor prognosis, emphasizing the essence of nursing as embracing caring, compassion and empathy.
Haylie Parminter explores her cultural understanding.
"In first year they teach you to be culturally accepting and culturally aware - you believe you understand what this means."
As many of the students have discovered, being immersed in a culture brings out clarity and understanding of other cultures and other people's perspectives, which invites us to explore our own perceptions and ideas of what culture means to them as well as to ourselves.
Through reflection, the students are able to revisit areas of practice or events that have transpired, taking the learning to a more personal level, exploring both values and biases along with their ability as professionals to own their nursing practice.
Additionally this means being assertive, not an easy trait for many people, as well as being an advocate, it's not easy to stand up and go against the status quo.
Owning one's practice was nicely articulated by Rebecca Ellement "...understanding of boundaries and stepping outside of the comfort zone and being an advocate for my practice and patient, this includes being assertive and having the confidence in my knowledge and how adaptable we can be..."
Steve Ferguson also discussed "being uncomfortable in new situations, I think is one of the greatest ways to find out who you are as a person and also how you are able to adapt..."
Additionally, Michaella Wiebe voiced thoughts regarding the provision of care and viewing surgical procedures in the operating room and the importance of remembering "there is a story behind every case and there is a person under every sterile field."
With regards to performing skills in clinical in India, Anna Thalmann shared her experience with the removal of some tubes/lines.
"I was so nervous to take out the lines I was sweating (of course today is the day I forgot deodorant). I tried to look calm and committed, for the sake of the patient. Nurse's face.
"I was almost disappointed at how easy the removals were... suddenly nursing was doable!"
These nurses in training faced many barriers from day one, such as communication and including something as simple as the colour of their assigned uniforms, which provides a brief glimpse of the extent of the hierarchical system since the assigned uniform visually placed them at a higher level of education.
Regardless, they were able to successfully merge themselves into the nursing culture in a private health care facility, and applied their foundational learned theory and skills from their first two years of nursing school.
Overall there is an appreciation for the level of nursing education they have received, along with knowledge of the regulated policies, procedures, routines such as infection control and resources available.
We did leave the resources we brought with us behind for the staff of the wings we visited.
Some parting thoughts shared by Steven Ferguson and reflected by many, if not all of these nurses in training: "it will always be a point in my nursing career that I will be able to reflect on and honestly continue to learn from despite probably never going back (to Narayana Health)."
Both me and Anita have been privileged to see this group of nurses in training, grow both as individuals and as professionals, and how the Nursing Process (assess, diagnose, plan, implement, evaluate), has become a way of thinking versus segmented applications, which is foundational to their nursing practice.
I think the more suitable question regarding their experience of completing a clinical practice in India may be, what have they not learned through this experience.
Crystal Lawrence is a nursing instructor at the College of New Caledonia. She is filing reports from the CNC Nursing Field School in Bangalore, India.
