Canadian nursing professionals help update Ukraine's health care

OTTAWA - In the past four years, Canadian nursing professionals - most of them with a Ukrainian background and from the western provinces - have traveled to Ukraine to help this former Soviet republic update its nursing programs. And Ukrainians have come to North America to look at the Canadian way of doing things.

The exchange is proving to be a learning experience for both sides - an opportunity for Ukrainians to gain the knowledge and nursing skills they require to cope in a post-Communist, market-based economy, and for Canadians to widen their view of the world and gain a foothold in an emerging global market.

Aimed at supporting the transition to a democratic society in Ukraine, the Canada Ukraine Partners Program was launched in 1992 with funding from the Canadian International Development Agency. It has three components: health, public administration and civil society.

The Canadian Society for International Health is administering the health component of the program, Partners in Health. The nursing segment, in the first few years focused on individual placements of Canadian nurses and nursing specialists in Ukraine. However, these single placements provided only a beginning. Ongoing links between institutions were needed for continuity in capacity-building.

The objective of the third phase, which began in January, is to foster exchanges between Canadian and Ukrainian health institutions for mutual benefit, provide training in leadership skills, and help Ukraine develop baccalaureate and master's nursing educational programs. The over-all objective is to help Ukraine's nursing curriculum meet international standards.

Ukraine has 110 schools of nursing, but only four are college-based and have four-year programs; at most schools, training lasts two years. There are no professional organizations, so there is little networking. And the nursing schools are run by physicians rather than nursing professionals.

Canadian nursing professionals say Ukraine is "where Canada was 50 years ago." The aim is to increase knowledge and develop leadership skills among Ukrainian nurses so they can take over the schools and improve nursing education.

Collaboration among Ukraine's Ministry of Health, the University of Alberta, Grant MacEwan Community College and the Canadian Nurses Association has already resulted in major revisions to Ukraine's national nursing educational curriculum. This will lead to significant reform in the nursing profession.

The University of Alberta's faculty of nursing and Grant MacEwan Community College are the main Canadian partners, and Gerri Nakonechny, dean of health and community studies at Grant MacEwan, is the Partners in Health nursing project's coordinator. A third-generation Canadian, she is from a Ukrainian background and speaks the language.

Ms. Nakonechny became involved in Partners in Health in 1992, and the following year visited Ukraine with three other people to do an assessment of potential placements. As a result, a number of Canadians were placed for one to three months in Ukraine. Ms. Nakonechny herself went to Lviv to assist with curriculum development and implementation.

In early 1994, Partners in Health hosted Dr. Tetyana Chernyshenko, chief specialist with Ukraine's Ministry of Health. Responsible for nursing education in Ukraine, she split her two months in Canada between Edmonton and Ottawa, and was keynote speaker at an Edmonton conference attended by 65 Canadians interested in a strategy for training Ukraine's health professionals.

The following year, two nursing professionals from Lviv visited Canada to look at facilities and nursing education.

"We developed a very good relationship, a good trusting relationship," said Ms. Nakonechny. "One of the realities of sending over Canadians who speak Ukrainian is that both sides feel very comfortable. It's wonderful to bring the Ukrainians to Edmonton because there are people here who can collaborate with them in their language. They get a great deal of community support."

Ms. Nakonechny added: "Now we actually want to get some content, information and knowledge transferred, and we need continuity. That's why we are concentrating on links between institutions."

In May 1995, Ms. Nakonechny was back in Ukraine with a colleague to assist in planning the first nursing conference at the request of the Ukrainians. The conference, held last September in Chernivtsi, was attended by eight Canadians. All were nurses or educators, with representatives from the Canadian Nurses Association, McMaster University, the University of Alberta faculty of nursing, and Grant MacEwan Community College. More than 400 Ukrainian nursing representatives attended the conference, and more than 400 were at a workshop held afterwards in Vinnytsia.

"The objective of the conference was to bring nurses together for the very first time in the hope that they could come up with recommendations to address the issues facing nurses in Ukraine," said Ms. Nakonechny. "It was an enormous task, but by the end of the conference they had come up with 12 specific recommendations."

During the program's third phase, Canadian nursing specialists in psychiatry, obstetrics, program management and nursing education will visit Ukraine, and nursing leaders from Ukraine will visit Canada. Camille Romaniuk, a psychiatric nurse from Edmonton, has already spent two weeks giving a seminar in Ukraine, and three Ukrainian specialists - including Dr. Chernyshenko on a return visit - spent three weeks in Edmonton and Ottawa in April. The two other specialists were Dr. Volodymyr Tarasiuk, director of Cherkasy Medical College, and Dr. Inna Hubenko, director of Vinnytsia Medical College.

Particularly interested in the Canadian system of nursing education, they were given an overview of the educational system, visited nursing schools involved in undergraduate and higher education of nurses, and were shown a range of community nursing placements. They also spent time in Ottawa, meeting with the Canadian Nurses Association (CNA), Health Canada and the Canadian Association of University Schools of Nursing (CAUSN).

"Even though the program was short, it was well planned, so that we had a chance to learn about the university school of nursing system and also to see medical colleges and nursing departments," said Dr. Chernyshenko at the end of the visit. "We were able to familiarize ourselves with the practical aspects of the nursing education system and the activities of the national nursing association on the federal and provincial levels. We also visited Health Canada to become familiar with the strategy of policy development, and we were at hospitals."

The delegation was shown the different levels of nursing education in Canada. "This was very important to us since in Ukraine we only recently started a bachelor's program, and we have no graduates yet," Dr. Chernyshenko explained. "We don't have a master's or doctorate program at the moment."

Nurses in Ukraine have historically been viewed as physicians' assistants, she added. "Nursing in Canada is a separate, distinct profession. With the experience we have gained in this short period of time, we are hoping to implement our new knowledge in Ukraine. Because our stay was short, we realize that we were not able to learn all the details, but we got a good general overview of the system. As a result of the visit, we hope to broaden our links with Canadian institutions."

She admitted it will not be easy to "reorient the public perception of nurses in Ukraine" and implement a new approach to the profession. "However, we realize that everything begins with education, and we have to implement a good educational system to produce qualified nurses in order to begin the process of change."

Intense work is now under way in Ukraine to create a national nursing association, and Ukraine's Health Ministry is planning to conduct workshops and seminars on nursing education and will be inviting Canadians specialists to participate, Dr. Chernyshenko added.

Colleague Dr. Tarasiuk said that, as a result of what he had seen in Canada, he would be taking an active part in the creation of a national nursing association in Ukraine and would be implementing changes to nursing education at his college.

The Ukrainians are not expected to replicate Canadian nursing programs. "They can't depend on any one country for their resources, nor should they," said Ms. Nakonechny. "They should take the best of what is available. There are other countries doing a lot of work in the health area. Our role is to ensure that they are familiar with what we are doing and offer our assistance. But the choice is really theirs."

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For more information on Partners in Health, the Canadian Society for International Health and its other projects, contact Paulette Schatz, PIH program manager, (613) 230-2654; fax, (613) 230-8401; or e-mail, [email protected]

Copyright © The Ukrainian Weekly, June 23, 1996, No. 25, Vol. LXIV

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