Penn Nursing professor and researcher Linda Aiken recently finished directing a three-year program aimed at bringing four Eurasian hospitals up to Western standards of health care and nursing.
The Nursing Quality Improvement Program was designed to improve the quality of nursing and health care in former Soviet Union and Armenian hospitals and sought to elevate the status of nurses -- who are often viewed more like janitors than professionals -- in the targeted hospitals.
After the program was completed, the hospitals were awarded the newly created Journey to Excellence Award, which identifies them as superior health care institutions.
The program is part of the Nursing School's overall directive to research and improve health care both in the United States and around the world.
"If you don't have good nursing, you can't have good quality of care in hospitals," Aiken said.
The three-year program, which was mainly funded by the Population Studies Center at Penn and the U.S. Agency for International Development, paired four hospitals in the former Soviet Union and Armenia with four U.S. hospitals of "magnet status" -- some of the best hospitals in the United States.
The program was run like a "nurse-exchange program," sending American and Eurasian nurses back and forth between the paired hospitals.
The American nurses found they had a lot to address with their Eurasian counterparts. According to Aiken, many of the Russian and Armenian hospitals did not have a code of medical ethics. For example, nurses were still using leather restraints to handle distressed patients -- a practice now known to produce more injuries than it prevents.
Many of the hospitals did not have updated equipment and medical supplies and lacked a closed, sterile environment. According to Aiken, some nurses were using plastic Coke bottles, which were not necessarily sterilized, for drainage.
"It was like going back 50 years in time," Associate Executive Director for North Shore University Hospital Margarita Baggett said.
Baggett was the team leader of her hospital for the program and said that, at Erebouni Medical Center in Armenia, there were no privacy curtains or screens, flies swarmed everywhere and the plaster walls were falling down.
In order to improve the quality of care at these hospitals, the program set up an intercom system to enable better communication between nurses and doctors and established a code of medical ethics and a patients' bill of rights.
American nurses introduced evidence-based practice -- nursing based on scientific principles -- to their Eurasian counterparts. They also taught them how to read an electrocardiogram, put together a plan of care and maintain a daily flow sheet.
And to address the lack of privacy curtains, the Armenian and Russian nurses sewed some themselves.
"There's a great deal of interest in helping to empower nurses in economically developing countries to deliver more professional nursing care," post-doctoral fellow in the Center for Health Outcomes and Policy Research Mary Powell said. "Nurses are indeed professionals that make a difference."
After the program concluded, each of the Eurasian hospitals was evaluated and determined to have achieved the 14 standards of magnet accreditation, thus marking the program a success.
"It was one of the most thrilling things I've ever seen. The rapidness of the change there was so impressive," Aiken said.
The Journey to Excellence Award ceremonies were highly publicized and were attended by politicians and dignitaries.
"It was the first time these nurses were on TV," Aiken said. "Nurses are kind of invisible there."
Baggett was similarly enthusiastic about the experience.
The Armenian nurses "touched us so deeply. It was so great to share the great practice of nursing," she said.
Plans are in the works to continue the program in other economically developing countries, and Aiken is in the process of talking to potential donors.
And one of the researchers, first-year Penn Nursing graduate student Lusine Poghosyan -- who helped collect data for the project while she was getting her master's degree in Armenia -- will soon be the first person in Armenia to earn a Ph.D. in nursing. After her earning this degree, Poghosyan plans to return home and become involved in expanding nursing education.
