1. PREPARING NURSING STUDENTS FOR A SHORT-TERM STUDY ABROAD CLINICAL EXPERIENCE IN NICARAGUA Mikki Meadows-Oliver, PhD, RN Patricia Ryan-Krause, MS, MSN, CPNP

2. Background Recent increase in US nursing projects abroad Many projects with undergraduate nurses YSN students all graduate- level advanced practice nurses

3. Benefits of International Projects Acquire enhanced global perspective Gain first-hand experience of the culture of the host country Observe how culture impacts health care Experience health care delivery system Provide health care to families and patients who might not otherwise receive care

4. Objectives of the Project YSN mission : Better health care for all through clinical care, education, scholarship Develop sustainable health services in a stable but resource-limited setting Educate health care professionals – students and local professionals Develop opportunities to share insights about similar projects

5. Ground Work Developed contacts in Managua, Nicaragua who were instrumental in helping to establish the clinical site. Initial site visit – Director of Pediatric Nurse Practitioner program – Associate Director of the Center for International Nursing Scholarship and Education.

6. Needs in Managua Students at La Escuelita – Live in Oriental Market district – Too poor to attend public school Uniforms and books Family situations – Numerous health and nutrition issues identified by teachers/parents – No regular access to health care

7. YSN Student Selection Application process – Good academic standing – Completion of Health Assessment course – Statement of interest and goals for project – Statement of personal contribution to project – Past international travel experience – Language proficiency

8. Student Preparation Independent study registration Weekly student/faculty meetings Education – Student presentations Culture, politics, history, health care, educational system Planning – Fundraising – Goals while at La Escuelita Group reflection time

9. Health and Safety Preparation Meet as group with the University’s bio-safety officer. Fit-tested for respiratory masks Visit the travel clinic for necessary immunizations and medications. Prepare to travel to and from Nicaragua as a group.

10. Supplies Purchased in US Used money from fundraisers – pediatric multi-vitamins – skin ointments to treat common skin conditions – folders and paper to create a “medical record” for each child

11. In Nicaragua Housed at CEPAD Nehemias Guest House Coyuntura Historic tour of Nicaragua Presentations on health by physician from Accion Medica Cristiana (AMC) Tour of Baptist Hospital (this year) Set up the school for the clinical sessions

13. Clinical Education 7 students ( FNP, PNP, 1 st, 2 nd yrs of specialty) 4 faculty preceptors

14. Goals of Clinical Education Understand cultural context of setting Engage families in Spanish or experience use of translator Improve history and physical assessment skills Identify health and developmental conditions Develop acceptable management plans in resource-limited setting

15. Innovative Clinical Care

16. Clinical Care Heights, weights, blood pressures and BMIs Vision screening Complete social, health and developmental histories Comprehensive PEs Human figure drawings

17. Clinical Findings Similar incidence across three years – Respiratory conditions – Skin conditions – GI conditions – Cardiac conditions – GU conditions – Psych/mental health conditions

18. Goals of Teacher Education Empower teachers to promote healthy habits – Hygiene – First aid – Nutrition Instruct teachers in recognition and management of common conditions – Skin – Respiratory – GI

20. Parent Education Asthma care Hygiene Nutrition Safety

21. While Students at Nehemias Daily journaling Daily informal debriefing and reflection sessions Nightly student-led reflection sessions. Final reflection before departure led by Nehemias leader

22. Return to the US Met with faculty to have a final reflection period. Discussed changes that would enhance the upcoming year’s mission. Submitted a written account of their clinical experience.

23. Student Experiences Students commented on the increased clinical skills that they gained. – I pushed myself to do more than I ever thought that I could do. I learned a lot from our preceptors who were knowledgeable and resourceful in finding solutions. – I’ve certainly gained perspective, learned how to examine patients in less than perfect settings. This trip was a lesson in providing the best medical care possible despite difficult circumstances.

24. Student Experiences Students felt changed by their experiences. – The trip inspired me to make a personal commitment not to let this be the only time I participate in something so wonderful and needed. – I hope that I will never forget what I saw in Nicaragua and that I can find the strength to advocate for children who have no voice. The trip to Nicaragua was one of the best experiences of my life.

25. Goals for Maintaining the Vision Identify strategies to integrate new awareness into personal and professional life Journaling Continued contact after return with students and faculty Informal contact among group members Formal: focus groups, mentoring groups with next group, newsletters, on-going projects Curricular changes Content reinforces themes related to social justice Content includes comparative concepts ie poverty at home and in international settings Kirkham, Van Hofwegen, Pankrantz, (2009)

26. Conclusion The faculty at the Yale School of Nursing feel that adequate preparation is the key to having a successful and meaningful travel-abroad clinical experience and that there are ways to maintain and strengthen insights gained abroad after return home.