On-the-Spot in Vilnius and Riga

Vilnius, our first stop, received us with very cold weather. Immediately upon arrival we had a working meeting with Ms. Virginia Kriauziene, the project director of the training center which develops advancement programs for nurses, doctors, physiotherapists and various other health professionals.

The on-the-spot course commenced October 10, 2001, with a group of 35 participants, including head nurses of hospitals, community centers and teachers of nurses. In addition, Mr. Juozas Ruola, the director of the nursing training center for advanced studies, participated as one of the students. This was the third time we had given such a course in Vilnius. The participants were able to take advantage of our expertise, and we planned our week's program, teaching until 9 pm every night. We taught for 8-9 hours every day, and in addition spent 4-5 hours advising in health institutes around the town.

Our second day was spent in the Central Hospital No. 1 in Vilnius. We had a tour of the facility with Head Nurse Violeta Staniuleviciene. Afterwards we conducted a discussion with nurses responsible for comprehensive training, emphasizing the importance of the patient's family support, patient privacy and patient education.

On our third day we visited a hospital for cancer patients and we participated in the patient admissions procedure. We arranged a joint visit to breast cancer patients with Mr. Juozas Ruola, who in addition to his profession as a nurse is an expert in homeopathic methods. It should be noted that in Lithuania alternative medicine is included in the services provided by the government and there is a sense that the people believe in and trust this area of medicine. That same day, in the evening, we met one of the members of the Jewish community of Lithuania, who took us on a tour of Vilna Ghetto. This was a very meaningful experience for us as Jews, as representatives of the State of Israel, and particularly since the family of one of our team had been murdered there during the Holocaust.

The next day we were invited for a working meeting with Ms. Lina Skaburskaite, the president of the Midwives Association of Lithuania. Lina told us of changes implemented within their framework of the Association as a result of the course on Management of Nursing two years ago at Kaplan Hospital's Nursing School in Rehovot in which she had participated. She requested some advice on various problematic issues, such as the very low status of nurses and the shortage of young students because of the low wages. We also scheduled a meeting with the head of the Health Ministry's national personnel division, Deputy Minister of Health Mr. Laimutis Paskevicus. For that meeting we travelled to the city of Trakai, some 30 km distant from Vilnius. Mr. Paskevicus, a young man with a western approach, who has studied management and leadership in various European countries, said that he requested a meeting as a result of positive reports that he had received from the Health Promotion Center where the two previous on-the-spot courses had taken place. He was interested in all that has to do with nursing training, the process of evaluation, development of clinical expertise, development of community services for the elderly and chronically ill. Our meeting ended late in the evening.

On our last day in Vilnius we taught until noon. Afterwards we held a summarizing discussion including an evaluation questionnaire and an open discussion. Representatives of the Foreign Ministry, MASHAV coordinators Ms Sophia Solechnik and Ms. Yolanda Pelle, and the editor of the Nurses Association of Lithuania Monthly were present, as were members of the Ministry of Health and the head of the Jewish community in Lithuania. In light of the success of the course, we decided to publish an article on the subjects studied, an evaluation of the course. Because our visit generated interest among the local journalists, we granted them a joint interview with the president of the Nurses Association of Lithuania.

That last day the participants were particularly enthusiastic about teaching methods unfamiliar to them, such as the combination of frontal lectures with group work, role playing and comprehensive discussion.

During the course we changed the study plan in accordance with participant reactions. There was active participation on their side. We engaged in discussions on the following subjects: Assertive leadership in nursing management, communication in nursing, conflict management, worker evaluation and its importance, management of a complex patient treatment, comprehensive training, use of treatment charts, group work and quality of care.

According to the head of the training center, 94% of the participants expressed great satisfaction from the course. The teaching methods and professionalism of the lecturers, the combination of what and how, and the combination of the experienced teacher of nursing (Zohar Aviv) with a clinical expert (Ela Muller) added a lot and made it possible to turn the theoretical material studied into daily applicable practice.

The biggest compliment to us, the lecturers of the course, was that already at the Closing Ceremony there were requests for additional courses in the same format with the same teachers, but to different nurses. And they had already prepared two lists.

The Closing Ceremony for the On-the-Spot Course in Nursing Leadership and Management was combined with a Shalom Club gathering for some 100 graduates of various MASHAV activities. At this happy occasion, where light refreshments were served, a number of people spoke, the new governing board was chosen and plans were made for meeting again to map out future activities.

Great effort by the Latvian division of the Israeli Ministry of Foreign Affairs and MASHAV went into the planning of the course. The choice of the place for teaching in the two places, Vilnius and Riga, was very good. Participants arrived not only from the local surrounding area but from all over Latvia, as they had in Lithuania. A large proportion of the attendees from outside Riga stayed overnight in the capital. Therefore there was coordination between the local participants and the Embassy in laying the course groundwork in the nursing training center in Riga. We learned from them just as they learned from us.

Although it has already been 10 years since perestroika, disorder is still felt in the health systems of both countries, particularly in Latvia. The Ministry of Health has been combined with the Ministry of Labor as a result. Several important functions of nursing have been dispensed with, like head state nurse who is concerned with upgrading nursing, there are decreased number of students going into nursing, a lower level of quality of care, etc. Important changes have taken place in the education of nurses. On the one hand, a BA university program was opened for nurses and, on the other hand, the very low status of nursing has been maintained, bed space has been taken away, in addition to lack of responsibilities felt everywhere. The head nurses who took part in the course expressed their fears that nurses would become redundant as a result of the cutting of hospital beds and lack of resources.

Here, as in most places, it is extremely difficult to make changes within the system. Head nurses understand that work methods aren't effective since nurses work 24-hour shifts. No one is able to work non-stop for so many hours, and it turns out that on every shift nurses sleep some hours, which means that in 24 hours the nurse sleeps some 6 hours and gets paid for that. Nurses' wages are so low that it effects motivation and the need to work elsewhere to make a living, which diminishes the importance of nursing. In some places nurses keep a farm and come to work in the hospital for extra money. It would seem that what they do is follow the orders of doctors, who themselves have not changed their attitudes to nurses or to the patients. The word "client" was received with shock by nurses, even after a whole workshop session. The concept of providing health services for the patient as the client was especially problematic. They have been accustomed to seeing themselves as patrons and the concept of involving patients in the decision-making process is still new. Even after we had put forward the idea of quality service provision to clients throughout the whole course, it will take some time to close the gap.

At the request of the Latvian nurses, we provided them with a prepared folder of lectures, including: New Theories of Management, Team Work, Case Management and Clinical Pathways and Quality Improvement. We understood from some of the head nurses that they had already studied a few of these theories in neighboring countries like Sweden, Finland and Norway. Once we started to work on techniques, showing ways of implementing theory into practice and giving them live examples from the nursing field and practice, we saw it is always a good idea to put theory into practice.

We are sure that our western approach to nursing and our knowledge of the Russian language gave us a great opportunity for direct communication. Shared language allowed participants to be open, with freer pathways to communication. We feel this gives us an advantage even over other countries that also provide courses and resources for improvement of health education and health services. We feel that the courses that we have developed, emphasizing the integration of practice and theory, contribute to the understanding and implementation of changes in modern, western nursing care, improving client satisfaction and increase of the health status of the population.

Medical Missions - 2001