Important Role of Nurses Stressed at Tbilisi Conference

"Our work should be called 'nursing care' because, ultimately, we should provide care for both those who are ill and those who are healthy. When that is accomplished, we will then be quality professionals from the grass roots on up and become a true complimentary profession to our medical colleagues," Gabriela Bocec, president of the Romanian Nursing Association, told the more than 120 nursing leaders from AIHA's NIS partnerships at a conference held April 9-14 in Tbilisi, Georgia. The nurses—along with medical professionals from the NIS, CEE, and United States, and delegates from the Georgian Ministry of Health and USAID—gathered to discuss healthcare reform and the practical applications of primary care nursing, as well as to map out a new paradigm for preparing professionals for the integral role they play in the future of healthcare.

Lia Mamaladze, chief nurse, Ministry of Health of the Republic of Georgia, set the tone for the six-day event in her keynote address. "The first AIHA nursing conference I attended was the beginning of the change in my attitudes toward my profession—I will never forget the tears of joy I saw in the eyes of many of my colleagues as they began to realize what they could accomplish. We who have worked in the AIHA partnerships and continue to do so are pioneers in the field of nursing in our countries—we will become the teachers of the future," Mamaladze stated. As pioneers on this path to change, nurses must gain the trust of individuals, practice good communication skills, be reliable and willing to compromise, and inspire others to strive to achieve greater heights, Mamaladze explained. Encouraging the nurses attending the conference to take advantage of the wonderful opportunity to become leaders in their profession, she warned, "A leader is not the same as a manager—a manager is more robot-like, but a leader must be willing to make adjustments and compromises to better serve the common good."

The event, which was the fourth regional nursing conference sponsored by AIHA, provided participants from throughout the region the opportunity to exchange experiences and build relationships, according to Bocec, who stressed the ever-expanding role nurses play in the field of healthcare. "We must share our knowledge with other nurses and especially with our patients."

Educating Patients: An Integral Responsibility

"I believe the future for nurses is in prevention, promoting healthy lifestyles, research, and taking on increasingly responsible roles in providing healthcare services," stated Nargis Rakhimkova, national expert on nursing for the Somoni Health Reform Project in Tajikistan and member of AIHA's Dushanbe/Boulder partnership. "Improving educational programs, materials, and equipment, as well as implementing national bylaws and regulations, should be among the first steps."

Noting that health promotion must begin on an individual level and that nurses are often the first healthcare professionals patients see when they come to a clinic, Bocec reinforced Rakhimkova's remarks, stressing the important role nurses can play in improving the well-being of their families, their communities, and their nations. "Our responsibility is to take what we learn here and pass it on to our colleagues and patients—the knowledge they need to keep healthy is the greatest gift we can give them."

AIHA board member Dr. Sheila A. Ryan—herself a nursing professional and educator for more than 20 years—charged participants with the task of educating people to realize that their everyday activities and choices affect their well-being. "The nurses of today are information workers . . . We must think of the things our patients need to stay healthy and provide them with the proper knowledge and tools." Encouraging the nurses to take advantage of modern resources that can greatly increase their knowledge and effectiveness, Ryan noted, "Information technology provides a wonderful learning and teaching opportunity for nurses and using the Internet to draw on the knowledge of experts and colleagues from around the world is such a rich and wonderful way to learn from each other."

Admitting that medicine is a very hierarchical and paternalistic system, Ryan implored nurses to resist following the patterns of the past and to take initiative on issues such as health promotion rather than waiting to be told what to do. "You yourselves have to become a driving force for change," she said.

Ryan stressed the fact that problems cannot be solved in isolation, stating, "We need to involve others, [including] people from outside of the profession. For example, the best way to counsel youth on subjects such as pregnancy and substance abuse may be through peer counseling rather than sessions with a doctor or nurse. Our role in this case is to educate these young counselors so they can provide their contemporaries with useful and accurate information then, basically, to step back from the interaction."

Ketevan Garsevanishvili, head of the Department of Nursing Reform and Reorganization at the National Health Management Center in Tbilisi, built upon this theme, explaining that "teamwork as well as independence" are important factors that contribute to how effective nurses are at educating their patients and preventing diseases. "By rebuilding our educational system, we will improve the quality of our work. We need to be more assertive in our profession and we now know that we can learn many lessons from each other." Garsevanishvili urged participants to use the nurses from past partnerships as resources as they begin to build their own programs, to identify the needs of their target communities, and to develop a variety of approaches to help fulfill those needs.

Underscoring the importance of building relationships and mentoring, Galina Kulagina, president of the Nursing Association of Belarus, chief nurse at the Republican Radiation Medicine Institute in Minsk, and one of the presenters, stated, "Our successes so far have been due to new knowledge, new networks, and new friends. Those of us who are members of the older AIHA partnerships have a commitment to share what we have learned with the new partners throughout the region."

New Paradigms Fortified by Traditional Strengths

Conference sessions and workshops ought to incorporate innovative models and theories with the strong commitment to patient care that has traditionally characterized the profession of nursing. Geared toward creating leaders who can teach these new methods and techniques to colleagues in their home countries, sessions delved into topics such as management in a changing healthcare environment, communication skills for nurse leaders, patient education, integration of infection control guidelines, and the role of nurses in primary healthcare.

Speaking in Russian to the delight of the audience, Kent Larson, head of the Humanitarian Response and Social Transition Unit at the USAID mission in the Caucasus, said, "The role of nurses is very important, especially in primary care, because you are the link between the population and the healthcare system. This conference provides you with a great opportunity to exchange information and help determine the strategies your respective countries will use to improve nursing care. Having gained new knowledge, you will become the leaders who will make healthcare accessible to everyone."

In her presentation, Ryan extolled multidisciplinary collaboration and a community-based approach to primary care. A good, strong foundation for healthy communities requires primary care for everyone, she said, and is the most efficient and cost-effective way of approaching public health. "The future of healthcare lies in working together to establish programs that address the specific needs of individual communities. . . . We have a huge undertaking ahead of us, but we also have a wonderful opportunity to make a real difference in people's lives."

Stating that nursing as a profession is so influential, so effective, that the board of AIHA insisted that it have a nurse among its ranks, Ryan told participants, "As we work to redefine primary care, you must speak out not only for our profession but for our patients and the health of our communities as well. That is the true power and influence we bring to the table-our ability to speak for the patients."

The problems of our healthcare systems, Ryan noted, have much less to do with our abilities than with the limitations of the systems themselves. "We've got to start thinking of nursing as a business—our business—that we must nurture. Waiting for someone to tell us how to fix our problems is futile because they just don't know. That's where our proven skills, such as coordination of services taken from the hospital setting, come into play." She encouraged participants to realize that change does not have to occur all at once, but by demonstrating a few concrete ways of achieving the goal of better quality care, the process can begin.

During his talk, Amiran Gamkrelidze, first deputy minister of health of the Republic of Georgia, set these concepts in a historical context, stressing the important responsibility of nurses in the delivery of primary healthcare services. Explaining that the modern concept of nursing is radically different from that held during Soviet times and is fast becoming an independent profession, Gamkrelidze told participants that the Georgian Ministry of Health has made a strong commitment to the organization of nursing in his country—partly by compiling new guidelines for pre- and post-graduate training, continuing education, and certification and licensing programs. "We have been working for several years to establish a department of higher nursing education, and already our National Association of Nurses is an intellectual hub for these activities." He also remarked that the outcomes of the conference will be reviewed by the Ministry and could result in the development of special legislation concerning a set of guidelines for the profession of nursing in Georgia.

Participants responded enthusiastically to what they learned at the conference sessions and openly expressed their opinions during animated discussions following presentations and in a number of regional and topical meetings held each afternoon. Calling the conference a huge success and the first step in engaging the participation of AIHA's new nursing partners, Sharon Weinstein, executive director, The Premier Foundation, and principal technical resource for AIHA's nursing program, noted that the faculty and participants truly represented the best of the best of nursing in the NIS and CEE countries.

Kathryn Utan is AIHA's staff writer.