Embrace not Alienate Cultural Differences in Nursing: A study in cultural, ethical and professional differences in Nursing between the UK, Portugal and Romania
Working in the independent sector in Northern Ireland for over 20 years I have seen huge changes in elderly, dementia and palliative care. The introduction of Patient Centred Care, Advancing Care Planning and the Quality of Life and Ageing concept has changed how we nurse people. The National End of Life Care strategy (2008) has influenced the way nurses are educated within this field.
The integration of non UK trained nurses in bulk into the organization I work for has highlighted differences in nursing training that have led to conflict, job dissatisfaction at times and which has ultimately effected staff retention.
My scholarship request with the Florence Nightingale Foundation/ Sandra Charitable Trust was to travel to Romania and Portugal to study the aspects of their training and clinical practice in elderly/palliative and end of life care and compare to UK nursing practice. Romania has proved difficult so the study has centred on Portugal.
The Aim
The aim of the travel was to discover any anomalies (if any) in;
- The Health Care system in the UK, Portugal and Romania
- Identify differences in managing nursing care practices in elderly care dementia and end of life/ palliative care
- Develop protocols and practical support within induction and preceptorship to help staff gain additional knowledge and assimilate the nurses more readily into our regulatory system
- Gain understanding of how elderly care, palliative care and end of life care is taught in their schools of Nursing
The benefits should remove uncertainty and fear of the UK system for new recruits, while not undermining their Professional status and the knowledge they bring
Objective
Visit a selection of the institutions that our EU nurses trained in to
- Discuss with students and tutors concepts and use of Person Centred Care, Advanced Care Planning and Communication.
- Discuss with academic staff and students – to understand issues staff have regarding communication with relatives, residents, and autonomy in decision making.
- Visit Schools of Nursing and learn content of theoretical training, and how care of the elderly/palliative care is taught in the context of the EU directive 2005/36/EC
- Visit clinical settings and see theoretical and simulated clinical training in practice.
- Discuss with patients their understanding and expectations of a nurses role if possible.
Method
Survey of present staff regarding issues and difficulties they encountered in our system of care.
Discussion with Managers and Practice support team regarding issues they encountered.
Visit 2 separate training institutions in Porto Portugal to observe and discuss theoretical teaching with students and tutors
Visit clinical settings to discuss and observe the implementation of theoretical knowledge
Analysis/Conclusion
The information gained was through discussion and personal observation so is subjective.
Concepts in theoretical teaching do not cross over into clinical practice in all avenues.
Patient care is heavily medically led and nursing is veering back towards task orientation, with communication and discussion with patients dominated by the Medical team
There are pockets of nurse lead initiatives of excellent quality that could drive nursing forward if students became involved from an early stage.
Person Centred Care is still in its infancy but is being implemented and recognised.
Lessons to be learnt/ Recommendations
The standards I observed would make me confident of Portuguese nurses clinical skills and abilities in task and interpretation. .
Looking at proposed programmes of inductions from 4 different Health Care Trusts for EU nurses, on a total of 7 days induction only 10 hours appear to be allocated to Person Centred Practice/Palliative, End of Life care and none to Dementia and Elderly Care(appendix 4).
I feel this puts the nurse at a disadvantage as my research has shown that communication on the hard issues, and the implementation of person centred care is uncommon for nurses. Confidence therefore can very easily be undermined. These Trusts and Four Seasons Health Care offer overseas nurses Preceptorship programmes but I feel the damage has been done at the stage.
I feel induction must include;
- Palliative Care/ End of life and Breaking Bad News.
- Dementia Care and Challenging Behaviour
- Patient Centred Care and Customer Care
- Accountability autonomy and advocacy
As an over view of systems in place I also feel that:
- Discuss the reduction in the “re-training” of nurses who already have excellent mechanical clinical skills both centrally and with our regulators
- Construct a survey of our overseas staff regarding documentation, where it helps them in their role, where they feel it lets down patient care, where they feel it is duplicated as it is an issue our nurses also highlighted.
- National strategy with all health care providers on inductions tailored to each country which would save resources and ensure standardization would be of great benefit.
Conclusion
Recruiting from overseas will be a continuous necessity for years to come. To recruit and retain the best staff, we have to be aware of their learning needs to meet the expectations of our service users.
The Health Care system in Portugal is funded and operated very similarly to our own. However aspects of nursing in Portugal such as Person Centred Care, Right to Refuse and Advanced Care Planning, which have developed in our Nurse education, is not a cornerstone of theirs.
To recruit, integrate and retain overseas staff into our system we therefore need to acknowledge their theoretical knowledge but support and encourage them to put this in to practice.
Patient Centred Care is defined as ‘Personalized, Co-ordinated and Enabling’ (The Health Foundation 2014).
Our induction, preceptorship and practice support must also be personalised, co-ordinated and enabling to give our overseas nurses the confidence and skills to work in our health care environment.