A Commitment to Caring Beyond Hospital Walls

From left, nurses Nadia Raymond, Annie Lewis-O’Connor, Ed Arndt, Cheryl Grove and Deb Pitts in Saint Marc. Inset: Nadia Raymond cares for a patient in Cange

Two weeks after Nadia Raymond, RN, returned from Haiti, she found herself still worrying about a 24-year-old woman she cared for in Cange. The earthquake survivor had lost her 3-year-old son and required extensive care herself; after caring for her for several days, the team sent her to the USS Comfort for more care.

“That look of fear in her eyes when we transferred her stayed with me. I wanted her to see a familiar face,” recalled Raymond, a nurse in the ICU Float Pool and native of Haiti, who spent two weeks caring for patients and educating nurses in Cange. “In the Float Pool, I always go back to see patients I cared for on different units. To this day, I am trying to get word to her.”

The experience of volunteering in Haiti remains strongly in the heart and mind of Raymond, one of dozens of nurses whose first response to the news of the earthquake was, “How can I help?” In the days and weeks following the 7.0 magnitude quake that devastated the country of 9 million people, groups of BWH nurses were deployed with Partners In Health and DMAT-led teams to care for survivors.

The response to the crisis underscores how committed nurses are to global health and helping people in need—wherever they are. “There is so much that our nurses can offer to patients and families around the world,” said Mairead Hickey, PhD, RN, chief nursing officer and senior vice president of Patient Care Services. “This is part of being a nurse. There is a social responsibility that comes with our role, and we weren’t surprised that so many nurses put their hands up almost instantly to help.”

In total, about 50 clinicians from BWH boarded planes for Haiti to participate in relief efforts, and many more helped at home. The Department of Nursing ensured there was a process in place for nurses who wanted to sign up to volunteer, and nurses on many floors helped to cover the shifts of their colleagues. At the same time, Patient Care Services, including Chaplaincy and Social Work, established telephone lines for BWHers to call family and friends in Haiti, organized lunches and meetings with EAP and HR for answers to questions and offered many prayer services and support sessions.

“We came together as an institution to help those in need, both in Haiti and here at home,” Hickey said.

After attending a debriefing session to support clinicians returning from Haiti, Raymond echoed that sentiment. “This crisis didn’t just bring Haiti together with other countries in the world, it also brought the Brigham together,” she said. “Brigham all of a sudden had this new light.”

Teamwork and Communication Critical in Haiti

BWH nurses relied on teamwork, creative thinking and clear communication with their colleagues in Haiti to provide the best care possible to patients without the resources and equipment available at home. In one instance, Annie Lewis-O’Connor, PhD, MPH, NP, and team worked hard to bridge cultures to ensure Betty, a dying patient, could receive comfort measures, though pain medication is not commonly used in Haiti.

“Pain medication in Haiti is not a norm—especially morphine,” said Lewis-O’Connor, who worked at St. Nicholas Hospital in St. Marc with a team including Cheryl Grove, RN, of Orthopedic Surgery, Deb Pitts, RN, of the OR, Ed Arndt, MS, APRN-BC, of the Trauma/Surgery ICU, Suzanne Fernandes, RN, of the ICU Float Pool, and Stephanie Victoria, RN, of Hematology/Oncology. “It is associated with death. Palliative care has no meaning for Haiti.”

Determined to make her patient comfortable, Lewis-O’Connor spoke to a young Haitian doctor and slowly gained his trust. When she asked about morphine, he reluctantly agreed, and she then set about to introduce the concept of a morphine drip to nurses. “I was putting a lot on them—accept that Betty will die, that she has pain, and that she deserves controlled pain management. That was daunting!” she said.

But it turned into a teaching moment with the Haitian clinicians, who, along with Lewis-O’Connor, administered the morphine drip, a comfort measure never used at this hospital. When Betty passed away, her sister thanked the team, saying, “She had the best and if she could have been made well, I know you would have made that happen. I will always remember how you cared for her.”

The team did everything they possibly could for their patients, delivering twins on their first and last day, transferring four paraplegics to Montreal for care and treating many survivors.

About 60 miles south of St. Marc, Trish Powers, RN, and Liz Samson, RN, arrived just days after the earthquake in the devastated city of Port-au-Prince with a team that included other BWH staff.

“This experience in Haiti was life-changing for me,” said Powers, an orthopedic nurse in the BWH OR, who was stationed at University Hospital. “The devastation we witnessed was unbelievable; the hospital was in ruins.”

The team set up four operating rooms inside a building to perform surgery, while patients recovered in tents—some of which consisted of tarps draped from tree to tree. Equipment was scarce, and sterilization was difficult.

“We could not sterilize the drill, but eventually we could have sterile pins,” she said. “I cannot tell you how much a simple thing we take for granted every day meant to me.”

Samson spoke of the resilience of the people of Haiti and how honored and humbled she was to be there. “I felt like there was so much we should be doing to help, and at every turn, the people where thanking us for being there,” she said. “My role was not just as an OR nurse. I became a post op nurse, a friend to hold a hand to when they where scared or to say a prayer with. A playmate to kids by throwing a ball to them for a minute. A runner for supplies when an emergency happened. I was honored to help.”

A Life-Changing Experience

Upon returning from Haiti, many nurses described their experience as “life-changing.” “The nurses I worked with in St. Marc agree that our lives are forever changed, our world view better informed and our work as nurses was never more rewarding,” said Lewis-O’Connor.

Because of the intensity of the experience, BWH offered debriefing sessions for staff, a chance for them to meet other clinicians who had volunteered in Haiti, receive support from EAP and leadership and talk about what they had seen and done.

Raymond felt overwhelmed by a sense of family as she walked into the debriefing session. There, she felt ready for the first time to open up about her experience and say what was in her heart. “When people talk about Haiti now, it sounds so dark. But that’s not the memory I have,” she said. “Haiti was the pearl of the Caribbean with these white sandy beaches and beauty.”

She found it difficult to speak about Haiti, where most of her family still lives, the week following her return, and she went to the debrief intending only to listen to others. But after hearing from them, she felt compelled to share her own experience.

Shaping the Practice at BWH

Participating in volunteer work helps nurses enrich their practice at BWH with new knowledge of different cultures, backgrounds and settings.

“This work helps us understand diversity, an important element in providing culturally competent care at BWH,” Hickey said. “Our nurses, outside of our four walls, bring expertise to patient care and teach other nurses and care providers. They can learn and grow from these opportunities themselves.”

The commitment of nurses to global health was reaffirmed by the responses to the hospital’s first Global Nursing survey in October 2009, with 400 nurses participating and, of those, 333 stating they are interested in global health. In addition, 104 of the responders said they already have participated in global and local nursing-related volunteer work (see chart at left).

Dozens of nurses participate in BWH-led missions, such as with Team Heart to perform heart surgery in Rwanda and Operation Walk Boston to perform knee and hip replacements in the Dominican Republic. Many nurses volunteer on their own or with other organizations locally and internationally. Rhonda Martin, MPH, BSN, RN, of the Float Pool, for example, happened to be volunteering with the Intercultural Nursing Society in the Dominican Republic at the time the earthquake struck Haiti and was able to contribute to relief efforts.

“Nurses are very interested in making contributions around the world and bringing their experiences back to share in their nursing practice at BWH,” said Patrice Nicholas, DNSc, MPH, RN, ANP, FAAN, director of Global Health and Academic Partnerships, who leads a quarterly Global Nursing Interest Group to encourage nurses to speak about these experiences.

The Department of Nursing continues its commitment to global nursing and plans to work with the nursing arm of Partners In Health to identify ways nurses can contribute to health maintenance, prevention and promotion. With ongoing long-term needs in Haiti, many nurses have expressed a desire to continue to help.

Suzanne Fernandes, for one, will never forget her experience in St. Marc. “One of the best things I observed was how the Haitian family is so strong; they lovingly care for their sick and injured family members,” she said. “Everyone I cared for has left an imprint in my mind, in my heart. I hope I have left them with hope.”

Jennifer Lewis, who deployed to Haiti with a DMAT team that also included BWH’s Yaeko Karantonis and Terri Traskos, cares for a newborn in Port-au-Prince.

Jennifer Lewis, who deployed to Haiti with a DMAT team that also included BWH’s Yaeko Karantonis and Terri Traskos, cares for a newborn in Port-au-Prince.

Many clinicians who traveled to Haiti came together upon their return to debrief with and support one another during a session organized by the Employee Assistance Program, Nursing Administration and Social Work.

Nurses who Participated in Relief Efforts in Haiti

• Ed Arndt, Trauma/Surgery ICU

• Barbara Audin, PACU

• Heather Bedlion, Shapiro 7

• Brad Boulanger, PACU

• Suzanne Fernandes, Float Pool

• Karen Foley, PACU

• Cheryl Grove, Orthopedic Surgery

• Yaeko Karantonis, Emergency Medicine

• Jennifer Lewis, Tower 11C

• Annie Lewis-O’Connor, Connors Center for Women and Newborns

• Sergeline Lucien, Hem/Onc/BMT

• Rhonda Martin, Float Pool

• Kristen Panico, Float Pool

• Deb Pitts, Operating Room

• Trish Powers, Operating Room

• Nadia Raymond, Float Pool

• Liz Samson, Operating Room

• Michael Savoy, Emergency Medicine

• Teri Traskos, Tower 3BC

• Stephanie Victoria, 12CH

Many clinicians who traveled to Haiti came together upon their return to debrief with and support one another during a session organized by the Employee Assistance Program, Nursing Administration and Social Work.

Where do BWH Nurses Volunteer?

The first Global Nursing Survey found that nurses who responded have volunteered collectively |in 24 countries spanning four continents. This list includes just a few of the locations and types of work nurses reported.

• Local teen shelters

• Girl Scouts of America efforts in local schools

• Peace Corps

• UMass Boston initiative in rural Kenya

• HIV/AIDS initiatives in the U.S. and abroad

• Several initiatives in Asia and Pacific Islands

• Palliative care efforts, HIV prevention, testing and treatment in Kenya, Ghana, Tanzania, Cameroon, Zimbabwe and South Africa

• Indian Health Service in New Mexico

• Emergency and disaster-relief efforts in forensic nursing in Asia

• Parish nursing work at St. Anthony’s Shrine in Boston

• Primary care nursing, gerontology, pediatric orphan care and midwifery efforts in Cuba, Jamaica, Haiti, Guatemala, Honduras, Nicaragua, Peru, El Salvador, Brazil, Guyana and others