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					            The Ottawa Charter
            Twenty Years On –
             an International
             Nursing Student
            Exchange Program

19th IUHPE World
Vancouver 2007
Inequalities in health and access
     to health care for rural
 communities – an EU/Canada
   funded student exchange
International Partners

• Canada
 Mount Royal College Calgary – Pam
 Nordstrom, Maureen Mitchell
 Universite de Moncton – France
 Marquis and France Chasse
 University of Prince Edward Island –
 Kimberley Critchley and Barb Campbell
International Partners
• EU
 England, Bournemouth University – Ann
 Hemingway and Eileen Richardson
 Sweden, University of Uppsala – Clara Aarts
 and Eva Bergknut
 Finland, University of Applied Sciences
 Savonia – Liisa Koskinen
 Estonia, Tallinn Health College – Tiina
The focus of the student exchange

 To enable students to experience public health
 focused practice in another country, specifically
 focusing on rural inequalities in health and
 access to health care.

 To enable students to undertake a meaningful
 exchange program enabling them to gain
 insights into, and experience of another culture.
This presentation will cover how the
students used the Ottawa Charter to try to
better understand inequalities.
Duration and extent of the project

• From Oct 2004 to Sept 2007
• A total of 24 EU students and 40 Canadian
  students will undertake an exchange
• Each exchange visit lasts approx. 12
While the students were away they
were expected to:

  Write an academic assignment focusing
  on one of the Ottawa Charter areas.
  The area the student chose from the
  charter then acted as a framework for
  them to consider inequalities in access
  to health care and health improvement
         Areas Chosen from Ottawa Charter
Developing personal skills   Changing of attitudes, empowerment skills.
Re-orienting health          Consideration of the social determinants of health
services (n=11)              e.g. the importance of cultural issues to the health
                             of native people, collaborative working.

Strengthening community      Enabling people to choose healthy lifestyles,
action (n=10).               improving the infrastructure: bicycle tracks,
                             footpaths, sidewalks, evening light along walk
Creating supportive          Supportive caring environments for staff and
environments (n=6)           patients.

Building healthy public      Parental leave, lack of access to contraceptives,
policy (n=3)                 abortion or medicines.
Munich Declaration Nurses and Midwives: A Force
                for Health (2000)
Islamabad Declaration on Strengthening Nursing
             and Midwifery (2007)

Nurse education needs to enable nurses to
“contribute to decision making at all policy levels
(development and implementation) and to be
active in public health and community
development”, particularly in relation to the
development of positive practice environments.
Did students not        Was it because the
address building        nurse education system
healthy public policy   prepared them to focus
and practice            on health education not
environments in their   policy development
assignments because     within their
what they saw in        undergraduate
practice was health     programmes?


• This area was poorly developed in the
  student assignments with no definitions
• Examples given: the health of Aboriginal
  populations, less access to medical doctors
  in rural areas, and inequalities between
  economic classes, genders, and age
Implications for Nursing
• Students view RN’s as part of an
    interdisciplinary team that improves
    community health
•   They did not articulate a unique role for RN’s
    in primary healthcare or tackling inequalities
    (at odds with Munich Declaration 2000, and
    Islamabad Declaration 2007)
•   They considered RN roles in other countries
    and were beginning to analyse and compare
    one health system to another
Implications for Nursing Education

  Students were so overwhelmed with culture,
  language, and being ambassadors for the
  institutions, etc. that they didn’t always grasp
  the nuances of the assignments related to the

  Students need to be introduced to
  international policy relevant to their roles and
  responsibilities as a global practitioner.
Implications (con’t)
 The presence of faculty at the visiting site who
 understood primary care, and health inequalities
 helped to facilitate the students’ learning during
 their exchange to another country.

 Faculty need to work diligently at understanding
 the intentions of colleagues at other institutions.
 While we might use similar language we don’t
 always mean the same thing!
• Enabling health students to gain practical placements in public
   health focusing on health inequalities during their initial education
   does not happen universally.

• Students don´t see the application of health promotion theory to
   practice within our ´sickness´ based health services currently. They
   don`t see themselves as having a role in policy development to
   improve health either within the health service or elsewhere.

• Giving students this opportunity (not necessarily overseas)
   supported by formal assessed educational input would help to
   ensure that future health professionals see tackling inequalities in
   health as a key part of their role and have both the experience and
   insight to underpin their responsibilities in this area.
               I missed
               my bicycle
I missed
my boyfriend
                            I missed my car
             The Ottawa Charter
             Twenty Years On –
               an International
              Nursing Students
             Exchange Program

19th IUHPE World
Vancouver 2007

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