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ANNIKA NAMBIAR: What were the goals of the nursing team and the partnership program in Semipalatinsk? PATRICIA HERCULES: Yeah. You know, nursing was. PATRICIA HERCULES: Well, the partnership was really big. PATRICIA HERCULES: For one thing, it had ten initiatives in it.

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PATRICIA HERCULES: And so they had we had ten different work plans, and nursing was one of PATRICIA HERCULES: those nurse initiatives. PATRICIA HERCULES: And the program area was called Nursing Education and Training. PATRICIA HERCULES: So that's what our title was.

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PATRICIA HERCULES: And the reason for that. PATRICIA HERCULES: And I will say that partnership individuals had been PATRICIA HERCULES: over there before we went over there. PATRICIA HERCULES: So we were not there, like, the very first time.

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PATRICIA HERCULES: But the nursing roles are very limited and they PATRICIA HERCULES: focused on the lower end of nursing kinds of activities. PATRICIA HERCULES: In fact, they focused a lot on other kinds of activities other than nursing. PATRICIA HERCULES: So there was a need to expand them in the health care and to

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PATRICIA HERCULES: increase their level of professionalism. PATRICIA HERCULES: And basically what we were asked to do is, and what we wanted to do PATRICIA HERCULES: after we began to look at what was happening, is bridge that gap between where PATRICIA HERCULES: nursing was at the time and the 1990s.

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PATRICIA HERCULES: And remembering that when we went over there, it was PATRICIA HERCULES: 1995, '96, '97 and '98. PATRICIA HERCULES: And so we were we were in the 1990s at that time, and that sounds strange a little bit to PATRICIA HERCULES: hear us say that now, because here we now are in '20.

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PATRICIA HERCULES: Well, you know where we are. PATRICIA HERCULES: So we are far greater ahead than that. PATRICIA HERCULES: But we were to bridge that gap. PATRICIA HERCULES: And that was 28 years ago.

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PATRICIA HERCULES: And so we had we had a lot of kinds of ideas that we were interested in PATRICIA HERCULES: doing. But basically some of the overall goals were to PATRICIA HERCULES: increase that teamship that took place between the physicians and the nurses and PATRICIA HERCULES: to work with them.

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PATRICIA HERCULES: These were things that we knew we had to be one big team PATRICIA HERCULES: and we were working with them, not for them, or not trying to do anything without PATRICIA HERCULES: their wanting to have it happen. PATRICIA HERCULES: But they were very energetic, so we wanted to work with them to increase that

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PATRICIA HERCULES: teamship between the physicians. PATRICIA HERCULES: To provide them more independent roles and to bring their practices up to current PATRICIA HERCULES: standards, and then to work with them to establish a system for PATRICIA HERCULES: continuing education, so that they could provide

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PATRICIA HERCULES: maintenance to whatever happened during the time that we were there. PATRICIA HERCULES: So those were basically what our goals, those were the outcomes that we were looking PATRICIA HERCULES: at doing. So that was that was PATRICIA HERCULES: where we started our approach with them.

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ANNIKA NAMBIAR: All right. Could you could you describe patient care and the role of nursing at the ANNIKA NAMBIAR: time of the project in Semipalatinsk as compared to the United States? PATRICIA HERCULES: Absolutely. PATRICIA HERCULES: Yes. We, well, like I said, our first trip over

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PATRICIA HERCULES: there was in 1995. PATRICIA HERCULES: And we had a plan in place, but there were four PATRICIA HERCULES: hospitals that were part of the partnership when we first went over there. PATRICIA HERCULES: And it was the Central City Emergency First Aid

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PATRICIA HERCULES: Hospital. The region was called the Oblast region. PATRICIA HERCULES: So it was Oblast Children's, Oblast Clinical, Regional, and PATRICIA HERCULES: Inter-Oblast Oncological Dispensary. PATRICIA HERCULES: So those are the four hospitals that we were working with initially.

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PATRICIA HERCULES: But then as time went on the Ophthalmology Hospital was another PATRICIA HERCULES: hospital that was not part of the partnership, but very interested in PATRICIA HERCULES: participating in the activities. PATRICIA HERCULES: And so they became involved in what we did.

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PATRICIA HERCULES: Likewise, the Gynecological Hospital did. PATRICIA HERCULES: And then Kurchatov, which was another hospital PATRICIA HERCULES: that actually was part of the partnership. PATRICIA HERCULES: But Kurchatov was located 93 miles away from Semipalatinsk

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PATRICIA HERCULES: and this particular town was the center of the PATRICIA HERCULES: operations for the Semipalatinsk Test Site and PATRICIA HERCULES: Semipalatinsk. And I know from, you know, probably some of the history is that PATRICIA HERCULES: considered to be the polygon and the primary testing venue for the Soviet Union's

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PATRICIA HERCULES: nuclear weapons. PATRICIA HERCULES: And, according to the PATRICIA HERCULES: data, from '49 to '89, there was an estimated 1.6 PATRICIA HERCULES: million people in Kurchatov and the areas that were exposed to radiation tests.

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PATRICIA HERCULES: So obviously, this whole project was really concerned PATRICIA HERCULES: with the radiation effects of radiation and the health care that surrounded that. PATRICIA HERCULES: And not only the physician care, but the nursing care. PATRICIA HERCULES: So that's how we we took on that opportunity.

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PATRICIA HERCULES: So as we took a look at what their history was and what their culture was, it became PATRICIA HERCULES: very evident that that what their practice was and the kind of patient care that they PATRICIA HERCULES: delivered was a product of their environment. PATRICIA HERCULES: It was a product of what their culture was.

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PATRICIA HERCULES: It was a product of their history with all of the activity with radiation that had PATRICIA HERCULES: taken place. PATRICIA HERCULES: It was a product of their education because the PATRICIA HERCULES: physicians actually taught the nurses how to be nurses, and they

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PATRICIA HERCULES: were the ones that made the decisions about what the nursing role was about. PATRICIA HERCULES: So that's what we felt like PATRICIA HERCULES: caused a lot of what we saw. PATRICIA HERCULES: But we felt like when we went there, it was really important that we had walkthroughs of

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PATRICIA HERCULES: the hospitals. And so we did. PATRICIA HERCULES: And we did an assessment. PATRICIA HERCULES: We felt like a really in-depth assessment so we could know where we PATRICIA HERCULES: were at the time.

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PATRICIA HERCULES: And because we knew where we wanted to be, and we needed to know all that we needed to PATRICIA HERCULES: do to fill that gap. PATRICIA HERCULES: So we took a walk. PATRICIA HERCULES: And they were so gracious and so willing to let us see and go anywhere that

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PATRICIA HERCULES: we wanted to go. PATRICIA HERCULES: But there were three of us on our team when we PATRICIA HERCULES: first went over there in '95. PATRICIA HERCULES: It was me, and my critical care educator that was in my department, Anecita Fadol,

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PATRICIA HERCULES: and Terri Brown. PATRICIA HERCULES: And Terri Brown was an educator that worked at Texas Children's Hospital. PATRICIA HERCULES: But all of us, as we begin to walk through, we felt like we were looking PATRICIA HERCULES: at nursing care and patient care 20 or 30 years ago.

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PATRICIA HERCULES: Sometimes even back to the '50s. PATRICIA HERCULES: We felt like their infection control practices went back sometimes to the '20s PATRICIA HERCULES: and '30s. We felt like their skills were just so PATRICIA HERCULES: extremely limited.

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PATRICIA HERCULES: But we felt like there were reasons for that. PATRICIA HERCULES: And we knew that they didn't have equipment and resources like we do in the United PATRICIA HERCULES: States, and they didn't know what the current practice standards were in the United PATRICIA HERCULES: States, and they didn't have guidance and instruction like that we do.

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PATRICIA HERCULES: But we felt like that really we were looking at the PATRICIA HERCULES: clock turn back, the years turn back. PATRICIA HERCULES: And so we knew that there was a big job that was PATRICIA HERCULES: kind of in front of us.

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PATRICIA HERCULES: As we took a walk, I'll kind of walk you down what we saw. PATRICIA HERCULES: We went into the hospitals. PATRICIA HERCULES: In many cases, and I won't say that it's 100% in PATRICIA HERCULES: every single case of every single hospital that we went into, but I would say for the

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PATRICIA HERCULES: most part what we saw, halls were dark and they were cold. PATRICIA HERCULES: And there were very, very meagerly furnished. PATRICIA HERCULES: Now, going there in November, it was it was cold. PATRICIA HERCULES: It was very cold.

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PATRICIA HERCULES: And so there could be altogether the reason why the halls were so cold. PATRICIA HERCULES: But they were. PATRICIA HERCULES: The environment varied. PATRICIA HERCULES: Now some of the units were very, very crowded and they had a lot of personnel

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PATRICIA HERCULES: standing around and that other units didn't have hardly any patients in it. PATRICIA HERCULES: And there was very much a lack of staff. PATRICIA HERCULES: We looked for nurses stations and some of the nurses PATRICIA HERCULES: stations were really merely a table, and most of the time those tables were in the

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PATRICIA HERCULES: lobby. They didn't have workspaces on them. PATRICIA HERCULES: And we certainly didn't find a place where they could have patient charts so they could PATRICIA HERCULES: go in and look at those. PATRICIA HERCULES: So there was very little evidence of patient records anyway.

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PATRICIA HERCULES: And so when we asked to look at them, you know, they had or sometimes had difficulty PATRICIA HERCULES: finding where they were. PATRICIA HERCULES: In the United States, we were very used to using disposable gloves at that time, PATRICIA HERCULES: as we went from patient to patient as we did this or that skill.

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PATRICIA HERCULES: But there were no disposable gloves. PATRICIA HERCULES: There was there was nothing that we could find that they could use to sanitize PATRICIA HERCULES: themselves. We didn't see hand sanitizers anywhere. PATRICIA HERCULES: There were very limited sinks that they could wash their hands in.

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PATRICIA HERCULES: And so we felt like that they just PATRICIA HERCULES: lacked the opportunity to be able to be as sanitary as they needed to be, to take PATRICIA HERCULES: care of one patient as they went from patient to patient. PATRICIA HERCULES: There was no mention, when we spoke with them, about

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PATRICIA HERCULES: universal blood or body fluid precautions. PATRICIA HERCULES: In fact, they didn't really know what we were talking about when we talked about PATRICIA HERCULES: that. We knew that there was a lot of construction that was PATRICIA HERCULES: going on. In some of the halls, we found that there were electrical wires

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PATRICIA HERCULES: hanging from the ceilings and then we knew that there was a lot of PATRICIA HERCULES: repair that was needed. PATRICIA HERCULES: There was evidence of construction and renovation almost everywhere that we PATRICIA HERCULES: went. And so there was hammering.

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PATRICIA HERCULES: We saw, of course, a lot of nurses PATRICIA HERCULES: and a lot of physicians walking around, and they wore very PATRICIA HERCULES: tall hats. They looked like bakers hats, but that was PATRICIA HERCULES: their symbol of professionalism.

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PATRICIA HERCULES: I mean, that's how they were identified. PATRICIA HERCULES: When we went into patient rooms, we found that most of PATRICIA HERCULES: the rooms were made of linoleum. PATRICIA HERCULES: Most of the floors were linoleum.

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PATRICIA HERCULES: Sometimes there were some tile, sometimes there was some vinyl. PATRICIA HERCULES: But we also saw in many places that the ends of the corners of the linoleum PATRICIA HERCULES: were frayed or torn, and in some cases they were rolled up and allowed dirt to PATRICIA HERCULES: catch underneath it.

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PATRICIA HERCULES: And some of them hadn't been cleaned. PATRICIA HERCULES: What we saw was that patients were in rooms of mixed PATRICIA HERCULES: ages. That when time came to store any of their PATRICIA HERCULES: personal items, the storage areas were very, very tiny.

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PATRICIA HERCULES: So there really there wasn't a place for storage of items, very different from what PATRICIA HERCULES: you find, you know, if you were traveling down the hospitals in the United States. PATRICIA HERCULES: But then again, we were looking back 20 or 30 years ago in terms of what PATRICIA HERCULES: they had to work with.

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PATRICIA HERCULES: The cots were very narrow and they were very thin, and they were crammed close PATRICIA HERCULES: together because sometimes there was more than two patients in the room at the same PATRICIA HERCULES: time. Sometimes we saw that children and adults PATRICIA HERCULES: who were restless or needed to be restrained or held or watched very

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PATRICIA HERCULES: securely with side rails on their beds, those PATRICIA HERCULES: things just didn't happen. They were not supervised very well. PATRICIA HERCULES: And we also found that when we went to the recovery rooms after the patient had PATRICIA HERCULES: had surgery, that the patients recovering were not watched

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PATRICIA HERCULES: very well. We did not see a PATRICIA HERCULES: lot of physicians present on the general care units actually going in and out of the PATRICIA HERCULES: rooms to visit with the patients. PATRICIA HERCULES: But we did see physicians in the intensive care units

00:11:42.650 - 00:11:55.700

PATRICIA HERCULES: because they are the ones who are responsible for the patient and they stayed PATRICIA HERCULES: there all the time. PATRICIA HERCULES: Their equipment was part of their resources, which was very lacking. PATRICIA HERCULES: Their equipment was, a lot of it was old.

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PATRICIA HERCULES: It was malfunctioning. PATRICIA HERCULES: It was sometimes hard to find PATRICIA HERCULES: appropriate equipment. PATRICIA HERCULES: The Department of Defense had spent a great deal of

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PATRICIA HERCULES: time and money depositing equipment for their use, but PATRICIA HERCULES: what we found was a lot of the equipment that the DoD deposited PATRICIA HERCULES: was not being used. PATRICIA HERCULES: And it wasn't being used because there were missing pieces.

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PATRICIA HERCULES: They didn't know how to work them. PATRICIA HERCULES: If there were instructions that were available, the instructions were in English PATRICIA HERCULES: and they weren't translated into Russian. PATRICIA HERCULES: And so it was very difficult to use the modern equipment or

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PATRICIA HERCULES: the near modern equipment that was there for them to use, in the majority of cases. PATRICIA HERCULES: In some cases, we did find that it was being used appropriately. PATRICIA HERCULES: But that was an issue with that kind of equipment and that's one of the things that PATRICIA HERCULES: we tackled as we began to do our work there.

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PATRICIA HERCULES: The defibrillators that we saw were manufactured in in the Soviet Union, the PATRICIA HERCULES: Soviet Republic. PATRICIA HERCULES: They didn't have synchronous buttons for cardioversion. PATRICIA HERCULES: And so what we found that if the patient did undergo cardioversion, it

00:13:09.770 - 00:13:24.350

PATRICIA HERCULES: was up to the physician and just the physician to watch the patient signs and PATRICIA HERCULES: symptoms, to be sure that everything was okay. PATRICIA HERCULES: We didn't find any blood warming equipment. PATRICIA HERCULES: And, what we were told - we never saw it, but what we were told -that if the

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PATRICIA HERCULES: blood needed to be warmed, the bags of blood would be put underneath the nurse's arms PATRICIA HERCULES: or sometimes underneath the patient's arms to get get it warm. PATRICIA HERCULES: If there was massive bleeding and the patient needed to have an auto PATRICIA HERCULES: transfusion under sterile procedure, as best they could,

00:13:42.590 - 00:14:00.210

PATRICIA HERCULES: the blood would be scooped up from the body cavity wherever the bleeding occurred. PATRICIA HERCULES: It was filtered through layers of gauze and into a bottle and then PATRICIA HERCULES: it was auto transfused back into the patient. PATRICIA HERCULES: Sterile processing was very, very limited and

00:14:00.560 - 00:14:18.710

PATRICIA HERCULES: again, they they had some equipment, but it wasn't able to be used because they didn't PATRICIA HERCULES: know how to work it. And the lab equipment, again, was PATRICIA HERCULES: very old, outdated, PATRICIA HERCULES: and really it wasn't any kind of sophisticated diagnosis.

00:14:18.740 - 00:14:34.180

PATRICIA HERCULES: Another one of the initiatives really dealt with lab and pathology. PATRICIA HERCULES: And that would be very interesting to interview with those individuals as well to PATRICIA HERCULES: find out more information about that. PATRICIA HERCULES: As far as patient transport was concerned, if there

00:14:34.660 - 00:14:53.890

PATRICIA HERCULES: were multiple stories on the hospital, multiple levels, PATRICIA HERCULES: we found that elevators, they existed, but most of them PATRICIA HERCULES: didn't work. And so patients and family members had to be transported up and down the PATRICIA HERCULES: stairs. And so we found that patients were up and down

00:14:54.400 - 00:15:07.600

PATRICIA HERCULES: being moved up and down the stairs and gurneys. PATRICIA HERCULES: And that could be very dangerous, trying PATRICIA HERCULES: to do something like that. PATRICIA HERCULES: There we also saw that on the floors there were elevated

00:15:07.600 - 00:15:23.480

PATRICIA HERCULES: thresholds along where the doors and the halls joined and so any PATRICIA HERCULES: patient that was transported in any kind of a stretcher, they had to go over quite a bit PATRICIA HERCULES: of a threshold in order to get from one location to the other. PATRICIA HERCULES: So I think you get the picture of kind of what we saw.

00:15:23.480 - 00:15:40.760

PATRICIA HERCULES: It was really something that that needed a lot of improvement, and they were trying to PATRICIA HERCULES: improve that with the construction that they were doing. PATRICIA HERCULES: As far as family visitation was concerned, family members were PATRICIA HERCULES: allowed to be present mostly if there were children involved, but in other

00:15:40.760 - 00:15:54.050

PATRICIA HERCULES: hospitals they weren't allowed to see the patients. PATRICIA HERCULES: For example, in one of the particular hospitals, we found PATRICIA HERCULES: that patients could be visited for a certain fee. PATRICIA HERCULES: It's kind of surprising.

00:15:54.050 - 00:16:13.130

PATRICIA HERCULES: And in the units that were called reanimation PATRICIA HERCULES: units, which are equivalent to our intensive care units, the PATRICIA HERCULES: physicians did not want the patients disturbed because the PATRICIA HERCULES: physician felt like that it would be too upsetting to the patient, so the visitors

00:16:13.130 - 00:16:27.980

PATRICIA HERCULES: were not allowed in the reanimation units. PATRICIA HERCULES: But what happened was if the patient was extremely critical or about to PATRICIA HERCULES: die, then the family member could come in. PATRICIA HERCULES: Or if they had been there for a long time, there was like a peephole that they could

00:16:27.980 - 00:16:44.390

PATRICIA HERCULES: actually look through the peephole. PATRICIA HERCULES: The other thing, there was a visitation schedule that was posted on the intensive PATRICIA HERCULES: care units and that visitation PATRICIA HERCULES: schedule was really meant for a time when the

00:16:44.480 - 00:16:54.290

PATRICIA HERCULES: physician would talk to the families. PATRICIA HERCULES: Not that they could go in and visit the families. PATRICIA HERCULES: But it was up to the nurse to talk to the family, to get the questions from them about PATRICIA HERCULES: what they wanted to ask the physician.

00:16:54.290 - 00:17:07.470

PATRICIA HERCULES: Then the nurse would tell the physician what the family wanted to know, and then during PATRICIA HERCULES: that scheduled time, the physician would come out and talk to the family about what PATRICIA HERCULES: their questions were. PATRICIA HERCULES: So those are some processes, you know, that we really took a look at.

00:17:08.100 - 00:17:24.270

PATRICIA HERCULES: That was a general care units and the reanimation units. PATRICIA HERCULES: We also went to the operating rooms. PATRICIA HERCULES: The operating rooms was not our focus in 1995, but it became our focus in '96 and PATRICIA HERCULES: '97. But we wanted to take a look at what what

00:17:24.540 - 00:17:38.550

PATRICIA HERCULES: they were like. We found that the operating rooms were basic. PATRICIA HERCULES: There were very minimal. PATRICIA HERCULES: Their equipment was usually old and outdated, PATRICIA HERCULES: like, their basins were very small, and they were very old.

00:17:39.400 - 00:17:58.390

PATRICIA HERCULES: Sterile processing: They had their limitations, of course, with PATRICIA HERCULES: sterilizers. And the other big one PATRICIA HERCULES: that we saw- and I could identify with that because I have seen that in PATRICIA HERCULES: my early years as a nursing student, way back when I was in nursing

00:17:58.390 - 00:18:17.410

PATRICIA HERCULES: school - but they were soaking suture PATRICIA HERCULES: in large containers in a disinfecting solution. PATRICIA HERCULES: So the sutures would be soaking in there and during the surgery, the surgeon wanted a PATRICIA HERCULES: suture, they would dip in there with a sterile item and pull it out, and they

00:18:17.410 - 00:18:33.040

PATRICIA HERCULES: could use that. PATRICIA HERCULES: But when the Department of Defense came, they provided them with a lot of the PATRICIA HERCULES: disposable suture that is used now into in today's world. PATRICIA HERCULES: And they used it, and they loved it, and they thought it was wonderful, but they knew

00:18:33.040 - 00:18:49.280

PATRICIA HERCULES: what was going to run out. And they didn't have any way to get more at the time that we PATRICIA HERCULES: were with them. So they had both PATRICIA HERCULES: options available for their suture. PATRICIA HERCULES: On the vast difference, we went to the Ophthalmology Hospital and

00:18:49.280 - 00:18:58.780

PATRICIA HERCULES: took a tour of that. PATRICIA HERCULES: The Ophthalmology Hospital in the first level was absolutely gorgeous. PATRICIA HERCULES: Its walls and floors were marble. PATRICIA HERCULES: It was absolutely beautiful.

00:18:58.780 - 00:19:10.900

PATRICIA HERCULES: But the reason for that was because it had housed the Communist offices when they had PATRICIA HERCULES: occupied the area. PATRICIA HERCULES: And so when they left, the hospital just moved in. PATRICIA HERCULES: Now, if we went up on the second floor, the second floor is different.

00:19:10.900 - 00:19:26.800

PATRICIA HERCULES: It was like most of the other hospitals and, in fact, in their operating rooms where they PATRICIA HERCULES: did surgery on the patients, there were a lot of times when there were 3 or 4 beds in PATRICIA HERCULES: the same operating room doing eye surgery. PATRICIA HERCULES: So that was that was what their practice was.

00:19:26.830 - 00:19:39.010

PATRICIA HERCULES: We also went to the women's health care, the Gynecological, because - I believe I PATRICIA HERCULES: mentioned that even though these were not in the partnership officially, they they were PATRICIA HERCULES: very much participating in everything they did. PATRICIA HERCULES: And they wanted our input.

00:19:39.340 - 00:19:53.380

PATRICIA HERCULES: And what we found with the Gynecological Hospital was that it was mostly PATRICIA HERCULES: private patients. PATRICIA HERCULES: They did routine surgical procedures and, of course, they did PATRICIA HERCULES: vaginal and they did cesarean deliveries as well.

00:19:57.550 - 00:20:13.420

PATRICIA HERCULES: When the patient came into the hospital, you go to the triage room. PATRICIA HERCULES: And from there, if you were pregnant and going to have a delivery fairly soon, then PATRICIA HERCULES: you would go to the pre delivery room, and then you would go to the delivery room. PATRICIA HERCULES: And the delivery room was equipped with large basins

00:20:14.890 - 00:20:31.870

PATRICIA HERCULES: of supplies that they would need for the delivery. PATRICIA HERCULES: And these basins, if they needed to be soaked in a disinfectant solution, they PATRICIA HERCULES: were, but if not, they were just in the containers. PATRICIA HERCULES: Like, they would have a tape measure or scissors, or they would have bandages

00:20:31.870 - 00:20:47.770

PATRICIA HERCULES: ready, whenever the baby delivered. PATRICIA HERCULES: Now, one thing that we found that when the infant PATRICIA HERCULES: was delivered, the infant was tagged as far as who the PATRICIA HERCULES: baby was. But the mother wasn't tagged.

00:20:47.770 - 00:21:05.560

PATRICIA HERCULES: And so there wasn't that communication between the PATRICIA HERCULES: mother and the infant. Only the infant knew who the mom was, but the mom wasn't PATRICIA HERCULES: tagged, you know. And when that was discussed, PATRICIA HERCULES: they just didn't see the reason why that was an important thing.

00:21:05.560 - 00:21:24.400

PATRICIA HERCULES: But, you know, that's something that they would certainly take a look PATRICIA HERCULES: at. Breastfeeding was encouraged, but there were was PATRICIA HERCULES: very limitations on instruction with the moms. PATRICIA HERCULES: When we took a peek in the delivery rooms, the delivery rooms had very, very poor

00:21:24.430 - 00:21:42.670

PATRICIA HERCULES: lighting. And in several of them we found that the big PATRICIA HERCULES: lights over the delivery area, they had missing PATRICIA HERCULES: bulbs. And so it was really very, very difficult to get PATRICIA HERCULES: that if the patient needed, had a problem or needed to have more

00:21:42.670 - 00:21:54.430

PATRICIA HERCULES: extensive surgery than what they could handle, they would put the patient on a PATRICIA HERCULES: stretcher and send them over to the first aid hospital in order to have that PATRICIA HERCULES: surgery. PATRICIA HERCULES: Physicians are frustrated with their lack of equipment.

00:21:54.970 - 00:22:07.060

PATRICIA HERCULES: They wanted to do laparoscopic surgery. PATRICIA HERCULES: And, you know, there were physicians there. PATRICIA HERCULES: And when we talked with them, they instructions were there. PATRICIA HERCULES: You know, all kinds of literature seemed to be there but the equipment was

00:22:07.060 - 00:22:23.770

PATRICIA HERCULES: not there. The other thing that we got into and later in our PATRICIA HERCULES: initiatives, was the patient education that went out to the community in terms of women's PATRICIA HERCULES: health, in terms of, you know, care when you're pregnant, how you care PATRICIA HERCULES: for your child after the birth.

00:22:23.770 - 00:22:38.330

PATRICIA HERCULES: We just found that that was a big need there, and that was something that they were PATRICIA HERCULES: very interested in having looked at. PATRICIA HERCULES: Let's see the laboratories. PATRICIA HERCULES: I said there was there was very little diagnostic equipment.

00:22:38.330 - 00:22:51.880

PATRICIA HERCULES: I've got some photos of that. PATRICIA HERCULES: We'll take a look at that as we move along. PATRICIA HERCULES: In order for us to get a better handle on what their patient care was like, we wanted PATRICIA HERCULES: to take a look at what their management structure was and

00:22:51.880 - 00:23:08.060

PATRICIA HERCULES: talk with them a little bit about that and how they align their staffs so that they can PATRICIA HERCULES: get the best care possible. PATRICIA HERCULES: So that's one of the things that we did. PATRICIA HERCULES: I had a had a discussion with the physicians because, of course, they were the

00:23:08.060 - 00:23:21.980

PATRICIA HERCULES: ones over the hospitals and the chief nurses. PATRICIA HERCULES: And each hospital had a chief nurse and senior nurses. PATRICIA HERCULES: And that's kind of where nursing fell. PATRICIA HERCULES: The physician was over it all.

00:23:21.980 - 00:23:32.840

PATRICIA HERCULES: And then we had the chief nurse. PATRICIA HERCULES: And the chief nurse, I guess we could equate to our PATRICIA HERCULES: CNO in our hospitals and titles. PATRICIA HERCULES: You know, title changes everywhere.

00:23:32.840 - 00:23:49.280

PATRICIA HERCULES: They change here in the US every year, almost. PATRICIA HERCULES: But there was a chief nurse, there was a senior PATRICIA HERCULES: nurse who reported to the chief nurse, and that senior nurse PATRICIA HERCULES: had a lot of activities and functions that they did.

00:23:49.310 - 00:24:03.980

PATRICIA HERCULES: But most of the functions were not nursing type functions, they were personnel kind of PATRICIA HERCULES: functions. They dealt with staffing. PATRICIA HERCULES: They dealt with attendance. PATRICIA HERCULES: They dealt with the salaries, they dealt with performance,

00:24:04.130 - 00:24:18.320

PATRICIA HERCULES: assessing a performance of the nurse. PATRICIA HERCULES: But yet there were no performance evaluations available that we could PATRICIA HERCULES: look at. So it seemed like their documentation was very limited in terms PATRICIA HERCULES: of what they did.

00:24:18.320 - 00:24:35.150

PATRICIA HERCULES: Now, it's interesting if a nurse, though, did have difficulty performing a PATRICIA HERCULES: procedure and that nurse needed to have re-education, PATRICIA HERCULES: then either the doctor or the senior nurse would do that PATRICIA HERCULES: re-education at that nurse needed it.

00:24:35.900 - 00:24:51.230

PATRICIA HERCULES: Ward nurses. There seemed to be a lot of emphasis on the the nurse that's called the PATRICIA HERCULES: ward nurse because that ward nurse really did nursing, actually. PATRICIA HERCULES: They would do things like attach patients to monitors. PATRICIA HERCULES: They would work with the physicians if procedures were

00:24:51.230 - 00:25:04.550

PATRICIA HERCULES: needed. They would manage aseptic technique. PATRICIA HERCULES: They would clean the instruments. PATRICIA HERCULES: So there were some non-nursing functions as well that they did, but they were very heavy PATRICIA HERCULES: into this particular nurse did a lot of personal hygiene.

00:25:04.700 - 00:25:17.870

PATRICIA HERCULES: And so that was where a lot of the nursing activities PATRICIA HERCULES: focused on a lot of the personal hygiene. PATRICIA HERCULES: And so they were the ones that did that. PATRICIA HERCULES: But they would do things like clean the desk, clean,

00:25:17.870 - 00:25:35.030

PATRICIA HERCULES: sterilize equipment, prepare emergency kits, and so forth. PATRICIA HERCULES: But they would do some medication administration as well. PATRICIA HERCULES: Then there is a procedure nurse, and the procedure nurse would administer PATRICIA HERCULES: medicine. And there would be a responsible for

00:25:35.780 - 00:25:47.900

PATRICIA HERCULES: sanitation and disinfection. PATRICIA HERCULES: And there was another category of nurse called the housekeeping or the sanitation PATRICIA HERCULES: nurse. And these were not nurses at all. PATRICIA HERCULES: They were pretty close to what we call nursing assistants.

00:25:47.900 - 00:26:04.200

PATRICIA HERCULES: And so those nursing assistants, they did a lot of the PATRICIA HERCULES: cleaning functions as well. PATRICIA HERCULES: And, because there were valuable, very valuable to the unit, there were usually two PATRICIA HERCULES: per unit. When we asked them about staffing and how they

00:26:04.200 - 00:26:21.330

PATRICIA HERCULES: staffed, the staffing plan was actually issued by the Ministry of PATRICIA HERCULES: Health. And the Ministry of Health and Economics PATRICIA HERCULES: and the hospital allocated staffing according to the budgets in the PATRICIA HERCULES: hospital. They did not

00:26:21.330 - 00:26:40.220

PATRICIA HERCULES: allocate staffing according to the criticality of the patient or according PATRICIA HERCULES: to the nurse's skill and competency level. PATRICIA HERCULES: And they didn't realize that PATRICIA HERCULES: there were staffing plans out there that would allow for

00:26:40.910 - 00:26:56.120

PATRICIA HERCULES: the non-nursing skills to be delegated out to the non-nurses and that the nurses PATRICIA HERCULES: keep close and tight to themselves those functions that we call nursing. PATRICIA HERCULES: And so that was one of the things that was real significant about the way that they PATRICIA HERCULES: were educated.

00:26:56.780 - 00:27:14.120

PATRICIA HERCULES: The budget was always small and there was always like a staffing shortage, it PATRICIA HERCULES: seemed like. One of the things that we were told that nurses did work for PATRICIA HERCULES: 24 hour shifts, and then they would be off 2 or 3 days after PATRICIA HERCULES: that, and that was very hard on them.

00:27:14.120 - 00:27:28.760

PATRICIA HERCULES: 24 hours straight is very difficult to manage. PATRICIA HERCULES: And so they were leaving. PATRICIA HERCULES: They were leaving the profession and they needed to do something to make a change with PATRICIA HERCULES: that. But they were particularly leaving it in intensive care units because

00:27:28.760 - 00:27:42.710

PATRICIA HERCULES: that's a, you know, it's a fast pace, it's a high volume unit. PATRICIA HERCULES: And what they would do when a nurse would leave, they would pull PATRICIA HERCULES: someone from the floor. PATRICIA HERCULES: And that person from the floor really didn't have the skills to work in the intensive care

00:27:42.710 - 00:27:57.980

PATRICIA HERCULES: unit. So that was a disconnect that happened there. PATRICIA HERCULES: But then also what they would do is they would go to the nursing school and they would PATRICIA HERCULES: talk with the graduating seniors to come and work PATRICIA HERCULES: for them and specialize in the ICU.

00:27:57.980 - 00:28:19.630

PATRICIA HERCULES: So that's how they got their nurses in for the intensive care unit. PATRICIA HERCULES: The when we actually observe their clinical practice on the unit and had the opportunity PATRICIA HERCULES: to talk with the nurses on the unit, we found that PATRICIA HERCULES: the roles of the nurses differ from hospital to hospital and differ from from clinical

00:28:19.630 - 00:28:33.640

PATRICIA HERCULES: area to clinical area. PATRICIA HERCULES: And sometimes even in the same unit the clinical PATRICIA HERCULES: skills would be, their practice would be very different. PATRICIA HERCULES: And of course that would depend on their level of competency and what they had been

00:28:33.640 - 00:28:47.560

PATRICIA HERCULES: able to do and what they felt comfortable doing. PATRICIA HERCULES: So it was like we had a unit with different levels PATRICIA HERCULES: of competency and rather than bring everyone up to the same competency level, it PATRICIA HERCULES: remained in that status.

00:28:47.560 - 00:29:04.990

PATRICIA HERCULES: They were very interested in making those kinds of changes and really they looked for PATRICIA HERCULES: support to do something like that. PATRICIA HERCULES: We did find that some nurses could perform it, those advanced skills. PATRICIA HERCULES: And when we did, well, especially in the intensive care unit, they were asked why they

00:29:04.990 - 00:29:19.450

PATRICIA HERCULES: did what they did. And they really didn't know why they did what they did, because PATRICIA HERCULES: after all, the physician was in charge. PATRICIA HERCULES: And we asked about their PATRICIA HERCULES: ability to make a decision about what was going on with the patient.

00:29:19.450 - 00:29:35.020

PATRICIA HERCULES: And they said, no, they couldn't do that, that that was up to the physician to do PATRICIA HERCULES: that. So as far as patient histories were concerned, PATRICIA HERCULES: they they did pull together assessment data and they would document it, but PATRICIA HERCULES: like vital signs.

00:29:35.020 - 00:29:51.070

PATRICIA HERCULES: And we would ask them then, what do you make of these PATRICIA HERCULES: vital signs? Like if the patient had a very, extremely high blood PATRICIA HERCULES: pressure, what is your understanding of what to PATRICIA HERCULES: do in this kind of case?

00:29:51.070 - 00:30:07.570

PATRICIA HERCULES: And they were lacking in critical thinking skills. PATRICIA HERCULES: And they said, well, what they would do with that is give the information PATRICIA HERCULES: to the doctor, and the doctor would come and take care of it. PATRICIA HERCULES: So, that, I mean, you get the picture of where we were and what the physician practice

00:30:07.570 - 00:30:19.010

PATRICIA HERCULES: was all about there. PATRICIA HERCULES: We also took a look at how they did staff development. PATRICIA HERCULES: They did do an orientation. PATRICIA HERCULES: They did do in services.

00:30:19.460 - 00:30:35.720

PATRICIA HERCULES: And continuing education was required. PATRICIA HERCULES: For new employee orientation, though, it was initiated by the senior nurses, so when new PATRICIA HERCULES: nurses came to senior nurses took over that. PATRICIA HERCULES: And they would supervise the orientee very closely at

00:30:35.720 - 00:30:49.970

PATRICIA HERCULES: first. And then after a while, when they began to prove themselves, that supervision PATRICIA HERCULES: would go less or less. PATRICIA HERCULES: So depending on the nurse and what the skills were, orientation could go from PATRICIA HERCULES: three weeks to three months, and there wasn't a set plan for

00:30:49.970 - 00:31:08.030

PATRICIA HERCULES: orientation. PATRICIA HERCULES: There's a certain set of skills that you need to perform on this unit. PATRICIA HERCULES: There wasn't that kind of a plan to have that. PATRICIA HERCULES: There were very few learning aids that were available,

00:31:08.870 - 00:31:28.730

PATRICIA HERCULES: like almost no audio visual equipment. PATRICIA HERCULES: Pamphlets, or handouts, or papers, or posters, PATRICIA HERCULES: or anything like that was very, very, very limited. PATRICIA HERCULES: In fact the thinking was that those

00:31:28.730 - 00:31:46.490

PATRICIA HERCULES: teaching tools that could be available and could be helpful were PATRICIA HERCULES: not considered to be important, because they were told that PATRICIA HERCULES: memorization was the best way to handle those kinds of issues. PATRICIA HERCULES: So memory was very heavily relied on in order to

00:31:46.490 - 00:32:02.120

PATRICIA HERCULES: implement the skills. PATRICIA HERCULES: There wasn't a centralized orientation so that individuals could float from one place PATRICIA HERCULES: to the next. It was just, you go to this unit or to PATRICIA HERCULES: this unit and if you got pulled, well, hopefully there would be

00:32:02.120 - 00:32:16.490

PATRICIA HERCULES: a nurse, a senior nurse, or another nurse that would kind of show you what to do when PATRICIA HERCULES: you go there. Ongoing in services really were not part PATRICIA HERCULES: of what their plan was. PATRICIA HERCULES: And with all the new equipment that came in from the Department of Defense, if it was

00:32:16.490 - 00:32:30.950

PATRICIA HERCULES: functioning, it was up there was not up to the nurse to work it. PATRICIA HERCULES: It was up to the doctor. PATRICIA HERCULES: So the doctor was the one who could operate the equipment, not the nurses. PATRICIA HERCULES: As far as ongoing continuing education, every

00:32:31.970 - 00:32:49.010

PATRICIA HERCULES: five years there is a requirement for continuing education and the Board of PATRICIA HERCULES: Ministry identifies what that education is all about. PATRICIA HERCULES: And they identify the content, they conduct whatever PATRICIA HERCULES: program it is, and at the end of the time, there may or may not be

00:32:49.010 - 00:33:01.840

PATRICIA HERCULES: an exam to cover the content. PATRICIA HERCULES: So and then it's not documented. PATRICIA HERCULES: But that's what they did for continuing education. PATRICIA HERCULES: So that's kind of where we were with that.

00:33:01.840 - 00:33:17.320

PATRICIA HERCULES: And so we saw just a whole long list of things PATRICIA HERCULES: that they were seeking and that they wanted and that they wanted information about it. PATRICIA HERCULES: And then we felt like we could help them, we could provide it for them, but PATRICIA HERCULES: we could also help them learn to create their own.

00:33:17.320 - 00:33:23.800

PATRICIA HERCULES: And that's what they want to do. PATRICIA HERCULES: They wanted to be very self-sufficient and very independent. PATRICIA HERCULES: It was really great working with them. ANNIKA NAMBIAR: That's amazing.

00:33:24.100 - 00:33:35.830

PATRICIA HERCULES: I think I kind of exhausted that question with what we PATRICIA HERCULES: saw. ANNIKA NAMBIAR: No, no, that's that's perfect. ANNIKA NAMBIAR: This is exactly what we want.

00:33:49.270 - 00:34:07.930

PATRICIA HERCULES: Absolutely. Questions are welcome because like PATRICIA HERCULES: I said, it was fun going through all of this information. PATRICIA HERCULES: And it was like 28 years ago we were sitting back there, I was PATRICIA HERCULES: sitting back there in that environment, talking to them and taking a look

00:34:07.930 - 00:34:20.620

PATRICIA HERCULES: at all of this. PATRICIA HERCULES: So it was it was fun to do that. ANNIKA NAMBIAR: That's awesome and especially to hear about the enthusiasm as well to learn more. ANNIKA NAMBIAR: That's just absolutely fantastic.

00:34:20.620 - 00:34:36.150

ANNIKA NAMBIAR: I am curious, though, after you've described the role of nurses, if you could speak to the ANNIKA NAMBIAR: relationship between the nurses and the physicians in Kazakhstan as compared to the ANNIKA NAMBIAR: United States before the partnership program, just because there were quite a few ANNIKA NAMBIAR: differences that you just illustrated.

00:34:37.350 - 00:34:55.920

PATRICIA HERCULES: Oh, yeah. The relationship actually was a very good relationship. PATRICIA HERCULES: It was it was one of huge respect for the physician because after PATRICIA HERCULES: all, the physician, you know, they were really PATRICIA HERCULES: subservient to the physician and they relied on the physician to give them direction about

00:34:55.920 - 00:35:09.090

PATRICIA HERCULES: what to do. And, and they called on the physician whenever they PATRICIA HERCULES: needed help. PATRICIA HERCULES: And the physician defined what their role was, the physician taught them PATRICIA HERCULES: what their role was.

00:35:09.600 - 00:35:26.740

PATRICIA HERCULES: So obviously, yes, there was a great deal of respect for PATRICIA HERCULES: that position. PATRICIA HERCULES: And as we were there, we we became very cognizant PATRICIA HERCULES: of the fact that change

00:35:26.740 - 00:35:40.850

PATRICIA HERCULES: was imminent because they wanted change. PATRICIA HERCULES: Change was imminent. PATRICIA HERCULES: And the physician said they PATRICIA HERCULES: wanted change and they were

00:35:40.850 - 00:35:56.900

PATRICIA HERCULES: enthused and interested in what was going to be happening to create that PATRICIA HERCULES: change. But on the other PATRICIA HERCULES: hand, PATRICIA HERCULES: when you change the role of a

00:35:56.900 - 00:36:09.980

PATRICIA HERCULES: nurse, or they change the role of a physician, and the way that it's been there PATRICIA HERCULES: for such a long period of time. PATRICIA HERCULES: And there were groups working with the physicians as well. PATRICIA HERCULES: I mean, our role was not to work with the physicians other than to include them in what

00:36:09.980 - 00:36:25.380

PATRICIA HERCULES: we were doing with the nurses. PATRICIA HERCULES: Sometimes there is a little bit of PATRICIA HERCULES: anxiety and stress because things are changing. PATRICIA HERCULES: But overall, you know, I think that

00:36:25.380 - 00:36:44.470

PATRICIA HERCULES: there was a great deal of respect for the physician. PATRICIA HERCULES: But there was also that desire PATRICIA HERCULES: to move away from being a dependent person and being more independent in what their PATRICIA HERCULES: practice was. You know, I had said that they are responsible for their

00:36:44.470 - 00:37:03.310

PATRICIA HERCULES: education and I think that was a big part of why they treated the physician like they did. PATRICIA HERCULES: So right from the outside, as a young person or a new person learning the role of PATRICIA HERCULES: nursing, I mean, the physician had it all and the physician was doing it. PATRICIA HERCULES: What we found with the students is that, well,

00:37:04.330 - 00:37:21.550

PATRICIA HERCULES: the nursing students went to the medical college, which was run and taught by the PATRICIA HERCULES: physicians. And those who wanted to be physicians went to the medical institute, PATRICIA HERCULES: which was run and taught by the physicians. PATRICIA HERCULES: But what we are also told by the nurses and the physicians is

00:37:21.550 - 00:37:38.500

PATRICIA HERCULES: that the curriculum was being reviewed in order to enhance PATRICIA HERCULES: the role of the nurse. PATRICIA HERCULES: And and we found some kind of interesting things about about their PATRICIA HERCULES: education. A person can become a nurse

00:37:38.500 - 00:37:55.120

PATRICIA HERCULES: after eight - or either eight or eleven years of primary and secondary education. PATRICIA HERCULES: If they enrolled in the medical college at eight years, then they had to take some non PATRICIA HERCULES: nursing courses to kind of catch up with the eleven-year ones. PATRICIA HERCULES: But they had one year of constant

00:37:55.960 - 00:38:12.100

PATRICIA HERCULES: theory, just constant theory is what they did. PATRICIA HERCULES: And of course that was taught by the physicians. PATRICIA HERCULES: And then next after the theoretical course is a lot of clinical PATRICIA HERCULES: practice. And the practice they would either do in the skills labs, or they would do on

00:38:12.100 - 00:38:30.700

PATRICIA HERCULES: each other, or they would do on some mannequins. PATRICIA HERCULES: Whatever content they were taught depended on what they wanted to specialize in. PATRICIA HERCULES: So specialization was something that was requested of the young PATRICIA HERCULES: people right away so that they could focus their education on that.

00:38:31.150 - 00:38:50.100

PATRICIA HERCULES: And then after these eleven months of clinical kind of skills, learnings, then PATRICIA HERCULES: they would go to three months in a hospital or a clinic PATRICIA HERCULES: or wherever they could get a place, and then they would PATRICIA HERCULES: do quite a few weeks of training there under the

00:38:50.190 - 00:39:07.110

PATRICIA HERCULES: supervision of the senior nurse and the chief nurses. PATRICIA HERCULES: And then as they reached the end of their time frame, they had at the two month time PATRICIA HERCULES: frame, they received what they called a practice diploma, which allowed them to get PATRICIA HERCULES: out in practice. And what was interesting is they had to identify what their

00:39:07.110 - 00:39:24.630

PATRICIA HERCULES: specialization was at that point, and they would make a decision about what PATRICIA HERCULES: hospital they wanted to work in, and what senior nurse they PATRICIA HERCULES: wanted to work with for this two months practice. PATRICIA HERCULES: And then after that, they were expected to apply for a job in that particular area.

00:39:24.630 - 00:39:39.480

PATRICIA HERCULES: So that was what the expectation was. PATRICIA HERCULES: During the course they had two written tests each month, they told PATRICIA HERCULES: us, and they had a comprehensive test at the end of the time, and then they got a medical PATRICIA HERCULES: diploma when they graduated.

00:39:39.780 - 00:39:56.440

PATRICIA HERCULES: And these diplomas had PATRICIA HERCULES: meaning. And if you happen to be one of the lucky ones that got a red diploma, PATRICIA HERCULES: then you got special treatment. PATRICIA HERCULES: You got to get a preference with your employment and you got a higher salary.

00:39:56.440 - 00:40:09.640

PATRICIA HERCULES: So that must have meant you did really good when you were in school if you got a red PATRICIA HERCULES: diploma. And it's interesting too. PATRICIA HERCULES: There's another group of people that were out there that called fulshers, and they only PATRICIA HERCULES: worked in the emergency units.

00:40:09.850 - 00:40:27.310

PATRICIA HERCULES: They practiced in rural villages. PATRICIA HERCULES: They were not nurses, they were more like, probably PATRICIA HERCULES: our physician assistants, you know, that we have today. PATRICIA HERCULES: The fulsher is directed by the physician, though, so the

00:40:27.310 - 00:40:39.610

PATRICIA HERCULES: physician and the fulsher would work in these emergency clinics in the rural areas, PATRICIA HERCULES: but the fulsher would make decisions about if the patient needed to be transferred PATRICIA HERCULES: to a hospital or not. PATRICIA HERCULES: Now, the other thing is interesting.

00:40:39.610 - 00:40:58.240

PATRICIA HERCULES: The ministry, the Department of Ministry, determined where they would be placed for PATRICIA HERCULES: employment. And if there was not a place for employment, then the fulsher PATRICIA HERCULES: had a choice of going back to the going to the medical college and entering the nursing PATRICIA HERCULES: program. So they were just lots of different things.

00:40:58.660 - 00:41:13.360

PATRICIA HERCULES: There were lots of pieces, you know, that were moving in terms of what was going on PATRICIA HERCULES: with their education. PATRICIA HERCULES: And so that was kind of interesting. PATRICIA HERCULES: Now, one of the things that happened later, like in

00:41:13.360 - 00:41:26.710

PATRICIA HERCULES: 1996, on our second visit, Dr. PATRICIA HERCULES: Tumenova, who was head of the social sphere and very instrumental in the PATRICIA HERCULES: partnership, we met with her. PATRICIA HERCULES: She was a very governmental figure, arranged a meeting

00:41:26.710 - 00:41:44.770

PATRICIA HERCULES: with Lola Fehr, who was PATRICIA HERCULES: a representative from the AORN, and Dr. PATRICIA HERCULES: Musin, who was a leader of the Department of Health and Protective Services. PATRICIA HERCULES: Now, in that meeting, the

00:41:44.770 - 00:42:02.800

PATRICIA HERCULES: comment was shared that nurses are really considered to be of PATRICIA HERCULES: low status and they have no provided incentive to PATRICIA HERCULES: study or improve, and that salaries are fixed by the government. PATRICIA HERCULES: And that was sort of disappointing.

00:42:02.800 - 00:42:20.830

PATRICIA HERCULES: However, in that meeting, there was unified commitment to the health PATRICIA HERCULES: care reform goals that had been put in place in early PATRICIA HERCULES: 1995. And that was before we arrived. PATRICIA HERCULES: We, the nursing team, arrived on the scene, but those

00:42:20.830 - 00:42:36.600

PATRICIA HERCULES: unified commitment was to increase interdisciplinary PATRICIA HERCULES: teamwork. That was major. PATRICIA HERCULES: To provide more advanced education, to have more emphasis on PATRICIA HERCULES: home care, patient education,

00:42:36.600 - 00:42:52.830

PATRICIA HERCULES: and a reduction in the cost of PATRICIA HERCULES: what it was costing individuals to come to the hospitals and care. PATRICIA HERCULES: So there was a big reform that had taken place PATRICIA HERCULES: by the presidential and the national government.

00:42:53.460 - 00:43:07.020

PATRICIA HERCULES: And that all began in early '95. PATRICIA HERCULES: The other comment was made that they were so pleased to find PATRICIA HERCULES: that the nurses had a very quick grasp of knowledge and high energy PATRICIA HERCULES: level to move forward.

00:43:07.020 - 00:43:22.170

PATRICIA HERCULES: So, it just it just seemed like that the timing was right and PATRICIA HERCULES: everybody was tracking to go down a path to improve. PATRICIA HERCULES: And everybody was kind of excited about it. PATRICIA HERCULES: And so it made the environment very interesting to be a part

00:43:22.170 - 00:43:37.790

PATRICIA HERCULES: of. ANNIKA NAMBIAR: And just out of curiosity, was there any parallel to like an emergency medical ANNIKA NAMBIAR: services or EMS like we have here in the United States, or were ANNIKA NAMBIAR: people expected to go to the emergency room themselves?

00:43:40.370 - 00:43:59.240

PATRICIA HERCULES: Well, from what we could tell, it's these emergency clinics that were PATRICIA HERCULES: held mostly out in the community areas where people PATRICIA HERCULES: went for emergency type needs. PATRICIA HERCULES: Now, they did have an ambulance system there, and an ambulance

00:43:59.240 - 00:44:14.480

PATRICIA HERCULES: could bring the patients to the hospitals, but I don't believe that it was PATRICIA HERCULES: very sophisticated. PATRICIA HERCULES: We didn't see a lot of emergency care taking place, PATRICIA HERCULES: but I know it existed because the

00:44:14.480 - 00:44:23.960

PATRICIA HERCULES: equipment was there. PATRICIA HERCULES: We could see the equipment, we visualize the equipment, and we heard about the things that PATRICIA HERCULES: they did, but we actually didn't have the opportunity to see that happening. ANNIKA NAMBIAR: Okay. Thank you.

00:44:25.430 - 00:44:42.650

ANNIKA NAMBIAR: And I know you've already spoken to this just a little bit, but what measures were ANNIKA NAMBIAR: taken to redesign the role of nursing, and what were the physician responses to this ANNIKA NAMBIAR: redefined role in Kazakhstan? PATRICIA HERCULES: Yeah, there were quite a few measures.

00:44:52.230 - 00:45:05.010

PATRICIA HERCULES: We had three trips there. PATRICIA HERCULES: We had 1 in 1995, we had one in '96, and we had 1 in '97. PATRICIA HERCULES: And then we had meetings with the American International Health Care PATRICIA HERCULES: Alliance, both in '97 and '98.

00:45:05.010 - 00:45:22.560

PATRICIA HERCULES: So we did not actually make a site visit in '98. PATRICIA HERCULES: And it was different people at different times as well. PATRICIA HERCULES: But we had, you know, three years of pretty intense work there. PATRICIA HERCULES: And so the measures that we took when we first went there in

00:45:22.560 - 00:45:38.640

PATRICIA HERCULES: 95 was first to do this assessment, which really was a huge PATRICIA HERCULES: help for us getting a handle on what we visualize the needs to PATRICIA HERCULES: be and what we heard them say that their needs were. PATRICIA HERCULES: So that assessment was really a huge measure.

00:45:39.930 - 00:45:54.450

PATRICIA HERCULES: The the other thing, there's a couple of other things that we did on that first PATRICIA HERCULES: visit, and the three of us kind of split up, you PATRICIA HERCULES: know, because we just couldn't cover everything. PATRICIA HERCULES: There was so much, so much that needed to be covered.

00:45:54.840 - 00:46:10.890

PATRICIA HERCULES: And so I sort of took over the administrative PATRICIA HERCULES: management leadership kind of arena, and Anecita took over the clinical arena, and PATRICIA HERCULES: Terri took over the education arena. PATRICIA HERCULES: And we together we would come back.

00:46:10.890 - 00:46:29.800

PATRICIA HERCULES: So but one of the things that we knew would be of great help to PATRICIA HERCULES: actually demonstrate what changes needed to be made was PATRICIA HERCULES: to identify a model unit in each of the four partnership hospitals. PATRICIA HERCULES: And we decided it would probably be best to use the clinical areas first and not go into

00:46:29.800 - 00:46:48.110

PATRICIA HERCULES: the specialty areas for the hospital. PATRICIA HERCULES: So a model unit was PATRICIA HERCULES: identified, and we worked very closely and very PATRICIA HERCULES: intently with the chief nurse, and the senior

00:46:48.380 - 00:47:01.610

PATRICIA HERCULES: nurses, and the nurses on the units. PATRICIA HERCULES: And you have to bring that model unit up to a point where it could be a model PATRICIA HERCULES: unit for the rest of the hospitals, for the rest of the units in the hospitals. PATRICIA HERCULES: So that was a goal of the model unit.

00:47:01.610 - 00:47:15.560

PATRICIA HERCULES: That was a big initiative, a big measure that we took. PATRICIA HERCULES: Another one was to provide education. PATRICIA HERCULES: An education was just like a huge piece of everything because you can't PATRICIA HERCULES: really make change unless you know why you're making the change.

00:47:15.560 - 00:47:30.470

PATRICIA HERCULES: And unless you have a background. PATRICIA HERCULES: And so it seemed to be the best avenue to make PATRICIA HERCULES: a change with education is to have conferences. PATRICIA HERCULES: And so in each of those years,

00:47:30.470 - 00:47:43.490

PATRICIA HERCULES: we had a large conference that was offered. PATRICIA HERCULES: So conferencing was one and our focus. PATRICIA HERCULES: Of course, in the conference was those three areas that that I just shared that PATRICIA HERCULES: we were looking at.

00:47:43.760 - 00:48:00.650

PATRICIA HERCULES: The other was to PATRICIA HERCULES: enhance the plans of their current PATRICIA HERCULES: Semey nursing association. PATRICIA HERCULES: According to what their needs were, in order to grow and to do the kinds of

00:48:00.650 - 00:48:11.840

PATRICIA HERCULES: things that they wanted to do. PATRICIA HERCULES: So. So those are an overview of the measures. PATRICIA HERCULES: The model units. PATRICIA HERCULES: I'd like to talk a little bit about that.

00:48:11.840 - 00:48:26.720

PATRICIA HERCULES: It's like what is a model unit? PATRICIA HERCULES: They wanted to know what what it was. PATRICIA HERCULES: What did that mean? And and what did they have to do in order to be a model unit? PATRICIA HERCULES: And we I tell you what, one of the things that we knew ahead of

00:48:26.720 - 00:48:38.300

PATRICIA HERCULES: time that this was going to happen. PATRICIA HERCULES: And so the office of Dr. PATRICIA HERCULES: Weinberg and Sara Rozin was just so very, very PATRICIA HERCULES: helpful in the translation process.

00:48:38.300 - 00:48:54.080

PATRICIA HERCULES: So we had job descriptions of all the different PATRICIA HERCULES: categories of nurses translated into Russian and different samples from PATRICIA HERCULES: different hospitals. Not just Methodist, but other hospitals as well. PATRICIA HERCULES: So we had job descriptions translated into Russian.

00:48:54.410 - 00:49:11.720

PATRICIA HERCULES: We had a management skills checklist. PATRICIA HERCULES: We had nursing competency skills list translated. PATRICIA HERCULES: We had nursing records translated, documentation PATRICIA HERCULES: forms. You know, they really didn't have a standard form of documentation.

00:49:11.720 - 00:49:26.780

PATRICIA HERCULES: And then we had a lot of educational materials translated. PATRICIA HERCULES: So we went with material in hand that they could actually read and that PATRICIA HERCULES: they could understand and ask questions about. PATRICIA HERCULES: And so these model

00:49:26.780 - 00:49:45.150

PATRICIA HERCULES: units: we talk to them PATRICIA HERCULES: about the kind of structure that might be appropriate to PATRICIA HERCULES: meet their needs, the kinds of skills that they may need to PATRICIA HERCULES: have their own lists for, their policies and procedures, their standards

00:49:45.150 - 00:50:01.170

PATRICIA HERCULES: of patient care, their emergency procedures, their orientation PATRICIA HERCULES: plans, how they deal with students, how they plan PATRICIA HERCULES: to communicate with new people, how they plan to keep the communication open, open, PATRICIA HERCULES: open with the physicians.

00:50:01.170 - 00:50:19.500

PATRICIA HERCULES: So that model unit was was really a key element PATRICIA HERCULES: to actually visualize and demonstrate to all the PATRICIA HERCULES: others in the hospital what was important about PATRICIA HERCULES: bringing their practice up to the 1990s.

00:50:20.040 - 00:50:39.270

PATRICIA HERCULES: So we stress the importance of those units as PATRICIA HERCULES: having protocols for universal precautions, for the use of disinfections, for PATRICIA HERCULES: disease processes, and to identify what disease processes are cared for on PATRICIA HERCULES: which unit, and, and the kinds of

00:50:39.270 - 00:50:52.320

PATRICIA HERCULES: patients that, in terms of their criticality would be the most appropriate ones for their PATRICIA HERCULES: particular unit. PATRICIA HERCULES: In terms of how to take care of patients in isolation, in precautions which which they PATRICIA HERCULES: didn't have a handle on how to do that either.

00:50:53.340 - 00:51:10.860

PATRICIA HERCULES: And then at the other thing, the model unit. PATRICIA HERCULES: The measures that the model unit would demonstrate to them was PATRICIA HERCULES: cleanliness, hand-washing practices, p ersonal PATRICIA HERCULES: protective equipment, the PPE, which they really didn't

00:51:10.860 - 00:51:28.590

PATRICIA HERCULES: have a lot of. And so a lot of the things that we shared with them should have to PATRICIA HERCULES: happen. A lot depended on them having the equipment and resources to make that happen. PATRICIA HERCULES: And so part of the measures, as we move forward was helping them find ways to PATRICIA HERCULES: have the resources to do the kinds of things that we think would be

00:51:28.590 - 00:51:44.220

PATRICIA HERCULES: appropriate for them to develop their units. PATRICIA HERCULES: So so that was the other that was the other thing that we did with PATRICIA HERCULES: with modeled units. PATRICIA HERCULES: I'll move on, unless you have questions about that.

00:51:44.220 - 00:51:59.220

PATRICIA HERCULES: I'll move on to what we did with the measure of providing education through nursing PATRICIA HERCULES: conferences. ANNIKA NAMBIAR: No, yeah. Feel free to move on. PATRICIA HERCULES: Okay. In 1995, the

00:51:59.220 - 00:52:12.030

PATRICIA HERCULES: conference that we offered was called Nursing Practice in Kazakhstan, and it PATRICIA HERCULES: was held in an auditorium. PATRICIA HERCULES: We had 140 attended on one on the first day, and on the next day PATRICIA HERCULES: 75 people attended.

00:52:12.030 - 00:52:27.540

PATRICIA HERCULES: And we talked about all the things that I've discussed that we needed to talk about. PATRICIA HERCULES: Nursing management, clinical practice, and education for patients PATRICIA HERCULES: and for staff. PATRICIA HERCULES: And then they gave us at the end of the conference, you know, we had we had a lot

00:52:27.540 - 00:52:44.730

PATRICIA HERCULES: of open discussions to find out what was helpful, what was not PATRICIA HERCULES: helpful, what would they like to see next year look like? PATRICIA HERCULES: What kinds of things would be good for us to put together on our end, but PATRICIA HERCULES: for them to also contribute to the next conference on their end.

00:52:44.820 - 00:53:02.130

PATRICIA HERCULES: And they came up with a whole long list of the PATRICIA HERCULES: kinds of educational sessions that they would like to have PATRICIA HERCULES: done, which was, which was very, very, very helpful. PATRICIA HERCULES: One of the things that we that we found with this first

00:53:02.130 - 00:53:17.040

PATRICIA HERCULES: nursing conference is that behind the scenes on the conference was the PATRICIA HERCULES: nursing association that had already been formed. PATRICIA HERCULES: And there was the Semey Nursing Association. PATRICIA HERCULES: They had a 13 member board.

00:53:17.040 - 00:53:30.810

PATRICIA HERCULES: They had nine members on the board. PATRICIA HERCULES: They had a president, a president elect, they had a vice president. PATRICIA HERCULES: They had a secretary, and a treasurer. PATRICIA HERCULES: So they had the people in place and they had the

00:53:30.900 - 00:53:47.430

PATRICIA HERCULES: enthusiasm in place for the nurse association, because they had some PATRICIA HERCULES: goals themselves and they wanted to increase their own professional education. PATRICIA HERCULES: They wanted to the association to join together PATRICIA HERCULES: all of the different nursing specialties and bring them together.

00:53:47.430 - 00:54:02.180

PATRICIA HERCULES: Just just like. PATRICIA HERCULES: Well, I guess you could say, like the American Nurses Association is PATRICIA HERCULES: a nursing association for all of nursing in the United States. PATRICIA HERCULES: Well, this was the Semey Nursing Association that wanted to bring them all together.

00:54:02.270 - 00:54:17.510

PATRICIA HERCULES: They wanted to help increase their prestige and retention. PATRICIA HERCULES: And they wanted to create a commission to evaluate the qualifying PATRICIA HERCULES: courses, categories of nurses, kind of like our board of PATRICIA HERCULES: nursing does.

00:54:17.510 - 00:54:34.040

PATRICIA HERCULES: You know, they wanted to have that kind of information. PATRICIA HERCULES: And one of the key things they wanted to do was they wanted to take part in international PATRICIA HERCULES: events, whether they actually went to them or whether they offered them. PATRICIA HERCULES: International was a very big on their list of what their goals

00:54:34.040 - 00:54:48.260

PATRICIA HERCULES: were to do. PATRICIA HERCULES: So as we look back on those three years, PATRICIA HERCULES: the nursing association was a huge factor PATRICIA HERCULES: in the success of the things that happened there.

00:54:48.650 - 00:55:04.810

PATRICIA HERCULES: So we knew that the nursing association had already been formed, PATRICIA HERCULES: but we also knew that they were reaching out and they were searching for PATRICIA HERCULES: help. They needed PATRICIA HERCULES: consultation help in terms of how to function, and they also needed grant writing

00:55:04.810 - 00:55:24.190

PATRICIA HERCULES: skills. And they wanted a United States partner. PATRICIA HERCULES: We took to them, of course, we took a lot of written material to them as well PATRICIA HERCULES: to kind of help them get started with sample bylaws, documents PATRICIA HERCULES: from the American Society of Association Executives and how

00:55:24.190 - 00:55:38.770

PATRICIA HERCULES: associations are organized. PATRICIA HERCULES: We took simple practice standards from a variety of different PATRICIA HERCULES: organizations. And we also told them that as we move forward, PATRICIA HERCULES: we would, explore opportunities.

00:55:38.770 - 00:55:54.730

PATRICIA HERCULES: There were two organizations in Almaty that actually could provide PATRICIA HERCULES: funding for associations. PATRICIA HERCULES: One was called APT and the other was called Counterpart. PATRICIA HERCULES: And then we also tell them that we would look at what international possibilities might

00:55:54.730 - 00:56:08.320

PATRICIA HERCULES: exist out there. PATRICIA HERCULES: And so that was really good and they PATRICIA HERCULES: really helped move along that 1995 conference and that' PATRICIA HERCULES: s just a real positive thing.

00:56:08.500 - 00:56:26.840

PATRICIA HERCULES: Now, between 1995 and PATRICIA HERCULES: 1996, a variety of things happened to PATRICIA HERCULES: help make those measures that we were implementing PATRICIA HERCULES: have more meaning and to feed into the next year when I visit work.

00:56:26.840 - 00:56:36.590

PATRICIA HERCULES: For one thing, in PATRICIA HERCULES: July of '96. PATRICIA HERCULES: So we were there in November '95. PATRICIA HERCULES: And so now we're moved into '96.

00:56:36.590 - 00:56:54.050

PATRICIA HERCULES: In July of '96 there was a team of physicians PATRICIA HERCULES: and nurses that came to the Methodist Hospital. PATRICIA HERCULES: And on the nursing team were there were four chief PATRICIA HERCULES: nurses and a head nurse and Dr.

00:56:54.050 - 00:57:08.930

PATRICIA HERCULES: Galya, who was president of the nursing association. PATRICIA HERCULES: She was a physician. PATRICIA HERCULES: So those those individuals came and we set up a PATRICIA HERCULES: program and a plan for them to move through the various

00:57:08.930 - 00:57:24.770

PATRICIA HERCULES: units and PATRICIA HERCULES: departments at the Methodist PATRICIA HERCULES: Hospital. And we set them up with individuals to talk to, to PATRICIA HERCULES: reinforce what they were supposed to do with their model units

00:57:24.770 - 00:57:41.720

PATRICIA HERCULES: and to reinforce their clinical practice, to reinforce their PATRICIA HERCULES: management leadership styles, and to reinforce the way that they deliver PATRICIA HERCULES: education. So that was a real important thing that happened. PATRICIA HERCULES: Another thing that happened was in March of 1996,

00:57:43.590 - 00:58:00.870

PATRICIA HERCULES: AORN, the Association of Perioperative Nurses, PATRICIA HERCULES: has an annual convention every year. PATRICIA HERCULES: And in March of 1996 they were having theirs in PATRICIA HERCULES: Dallas. And so I had the opportunity before that

00:58:01.800 - 00:58:20.430

PATRICIA HERCULES: meeting, before that convention to speak with the executive director and the PATRICIA HERCULES: president of the association at that time, and expressed PATRICIA HERCULES: the Semey Nurses Association's desire PATRICIA HERCULES: for support, not financial support, but support in

00:58:20.430 - 00:58:36.250

PATRICIA HERCULES: grant writing and in consultation about how to function and how to PATRICIA HERCULES: how to create standards of practice. PATRICIA HERCULES: And would it be something that they would be willing PATRICIA HERCULES: to meet with Dr. Tumenova just to have a discussion?

00:58:36.820 - 00:58:51.620

PATRICIA HERCULES: And they said, yes, of course. PATRICIA HERCULES: And so I went with Sara Rozin and Dr. PATRICIA HERCULES: Tumenova. And Sara was, of course, wonderful about translating and, PATRICIA HERCULES: and yes, that enthusiasm was there on the part

00:58:52.040 - 00:59:08.660

PATRICIA HERCULES: of AORN to move forward and discuss this a little bit more in depth. PATRICIA HERCULES: And then in July, when Dr. PATRICIA HERCULES: Galya was in Houston at the Methodist Hospital, we PATRICIA HERCULES: arranged another meeting and this time in Denver at the AORN national

00:59:08.660 - 00:59:24.770

PATRICIA HERCULES: headquarters, which is housed in Denver. PATRICIA HERCULES: And so intense discussion took place PATRICIA HERCULES: there and it was formalized that the Semey Nursing PATRICIA HERCULES: Association could be an affiliate of AORN and that AORN would

00:59:25.190 - 00:59:44.120

PATRICIA HERCULES: provide that kind of consultation support that they PATRICIA HERCULES: needed. And as a result of that, PATRICIA HERCULES: they had invited Lola Fehr, the PATRICIA HERCULES: executive director, to come to Kazakhstan in 96 when we were back

00:59:44.120 - 00:59:58.820

PATRICIA HERCULES: in '96 to come and be a PATRICIA HERCULES: part of the conference that was there and to be the keynote speaker at the conference. PATRICIA HERCULES: So that is a lot of activity that took place between the two visits, a lot of PATRICIA HERCULES: activity that took place at home.

00:59:58.820 - 01:00:14.710

PATRICIA HERCULES: So even though we were not on site, we were still working. PATRICIA HERCULES: And I mean, it was a constant communication back and forth PATRICIA HERCULES: during the times that we were not physically present. PATRICIA HERCULES: And so we moved into our next visit, which was in '96, that was in

01:00:14.710 - 01:00:30.970

PATRICIA HERCULES: October. And, and we had a variety of different PATRICIA HERCULES: goals. We expanded on everything, of course, that we had already done PATRICIA HERCULES: previously, but, PATRICIA HERCULES: one of the things that happened was, with the

01:00:31.090 - 01:00:47.510

PATRICIA HERCULES: invitation, that Lola came - Lola Fehr from AORN PATRICIA HERCULES: accepted to come and speak. PATRICIA HERCULES: The Semey Nurses Association, between that time they had written the grant, PATRICIA HERCULES: they had applied for the grant, and they had received the grant from Counterpart, which is

01:00:47.510 - 01:01:01.640

PATRICIA HERCULES: a little over $8,000. PATRICIA HERCULES: And that money was used to support their conference PATRICIA HERCULES: and this time they moved it from a local conference to a PATRICIA HERCULES: international conference, which was their goal.

01:01:02.420 - 01:01:13.760

PATRICIA HERCULES: And the Semey Nursing Association was really the one that spearheaded this PATRICIA HERCULES: international conference. PATRICIA HERCULES: And that was just a real plus for them. PATRICIA HERCULES: And they did a magnificent job of putting it together.

01:01:14.540 - 01:01:30.590

PATRICIA HERCULES: And so Lola Fehr did come and she did do the keynote speak, presentation PATRICIA HERCULES: there on, on association management and associations. PATRICIA HERCULES: Another another thing that happened. PATRICIA HERCULES: And the money from Counterpart also, not just for the conference, but it

01:01:30.590 - 01:01:49.940

PATRICIA HERCULES: brought a lot of audio visual teaching aids and equipment and a PATRICIA HERCULES: computer that could be used for ongoing educational needs and so that was PATRICIA HERCULES: great because that helped to be available to the conference presenters PATRICIA HERCULES: in order to make that a little bit more available to all of those

01:01:49.940 - 01:02:06.230

PATRICIA HERCULES: who attended that conference. PATRICIA HERCULES: We we also had another person come with us PATRICIA HERCULES: in 1996, and her name was Lynda Mikalauskas PATRICIA HERCULES: . She was the chief nursing officer at the American Hospital in Istanbul.

01:02:06.920 - 01:02:24.980

PATRICIA HERCULES: And I know we're going to talk about this a little bit later, but she also did a PATRICIA HERCULES: presentation at this international conference on the American hospital, the PATRICIA HERCULES: kind of care that's provided there, the quality is provided there, and she really PATRICIA HERCULES: provided some insight into what that hospital did in terms of patient care.

01:02:24.980 - 01:02:42.800

PATRICIA HERCULES: That was great. Another person that attended, that came PATRICIA HERCULES: with us this time was Paula Hanson, and she was PATRICIA HERCULES: the director of women's health care at the Methodist Hospital. PATRICIA HERCULES: And she was the person who deep dived into the

01:02:42.890 - 01:03:00.560

PATRICIA HERCULES: gynecological hospital's needs with women's health care and patient PATRICIA HERCULES: education and what they could do to improve their practice. PATRICIA HERCULES: So that was a great need that was assessed in that avenue. PATRICIA HERCULES: And then, another individual who joined us.

01:03:00.560 - 01:03:13.700

PATRICIA HERCULES: So we broadened our team considerably in terms of who actually PATRICIA HERCULES: went and Anecita went as well as myself, but Terri from Texas PATRICIA HERCULES: Children's wasn't able to go. PATRICIA HERCULES: But Gwen Sherwood.

01:03:13.700 - 01:03:31.420

PATRICIA HERCULES: Dr. Gwen Sherwood was the associate dean at the University of Texas Health Science Center PATRICIA HERCULES: in Houston. And she joined Larry Lockman, who was also a PATRICIA HERCULES: representative from Houston. PATRICIA HERCULES: And she was asked to go and

01:03:31.420 - 01:03:50.170

PATRICIA HERCULES: present master teaching classes to PATRICIA HERCULES: the physician groups that were teaching in the medical college and in the medical PATRICIA HERCULES: institute, and do an analysis of what the problems were PATRICIA HERCULES: and to work with them with their needs in terms of wanting to change what they

01:03:50.170 - 01:04:07.900

PATRICIA HERCULES: did and improve nursing practice through their education. PATRICIA HERCULES: So it was obvious then that between '95 and '96, the physicians PATRICIA HERCULES: were getting a little bit more enthused about working with nurses and PATRICIA HERCULES: about helping them become higher in

01:04:07.900 - 01:04:26.710

PATRICIA HERCULES: stature and to improve their practice. PATRICIA HERCULES: And so what Sherwood did, she spent a week teaching PATRICIA HERCULES: both of these groups on PATRICIA HERCULES: how to apply adult learning theory, how to apply critical thinking, how to

01:04:26.710 - 01:04:43.690

PATRICIA HERCULES: use maybe equipment to enhance their presentations, testing PATRICIA HERCULES: strategies. And so they really went through a lot of in-depth PATRICIA HERCULES: information, which was very helpful to them. PATRICIA HERCULES: So that was kind of what happened in

01:04:43.690 - 01:04:58.270

PATRICIA HERCULES: 1996. PATRICIA HERCULES: And with our presentations, there were some fun memories. PATRICIA HERCULES: I'd kind of deviate from what the measures were to some fun PATRICIA HERCULES: stuff because, you know, we did enjoy our time there.

01:04:58.270 - 01:05:17.110

PATRICIA HERCULES: The people were lovely, and they were they were fun people and as PATRICIA HERCULES: best as we could have the translation, you know, you can do a lot of nonverbal PATRICIA HERCULES: communication, but some things happened at that first international conference that were PATRICIA HERCULES: really kind of fun. Galya, who was president of the

01:05:17.110 - 01:05:34.630

PATRICIA HERCULES: association, on an occasion, had looked out at the PATRICIA HERCULES: audience. And she was seeing some sleepy eyes, as you usually PATRICIA HERCULES: do in a conference, and she abruptly told the speaker to PATRICIA HERCULES: just stop where you are right now, we'll pick up later.

01:05:34.720 - 01:05:53.560

PATRICIA HERCULES: And she asked the nurses who had been to Methodist in July PATRICIA HERCULES: previously. One of the fun activities PATRICIA HERCULES: in Houston was to learn the Macarena, and so she asked them to come up, PATRICIA HERCULES: she put the Macarena music on, and she asked them to come up and to show the Macarena.

01:05:53.560 - 01:06:10.420

PATRICIA HERCULES: She had the whole entire audience standing up doing the Macarena to wake them up. PATRICIA HERCULES: So that was one thing that was kind of fun. PATRICIA HERCULES: I had presented a program on stress, and I had some stress PATRICIA HERCULES: dots with me and

01:06:10.420 - 01:06:24.580

PATRICIA HERCULES: we had great attendance. PATRICIA HERCULES: It was, I mean, the high officials actually were on the dais, and they did PATRICIA HERCULES: opening presentations and they stayed through many of the presentations. PATRICIA HERCULES: But the Minister of Health's have regular meetings with the governor, and they decided

01:06:24.580 - 01:06:38.590

PATRICIA HERCULES: what they would do with those stress dots. PATRICIA HERCULES: It took a whole package of those things, and they were going to give them to the governor. PATRICIA HERCULES: And they decided that, well, if the governor's stress dot turned black PATRICIA HERCULES: then they were going to call a meeting off and everybody was going to go home, so that

01:06:38.590 - 01:06:55.180

PATRICIA HERCULES: was kind of fun. Another thing that happened was that PATRICIA HERCULES: during the breaks, they would provide music and the Kazakh nurses PATRICIA HERCULES: in their beautiful costumes and they presented their folklore music, PATRICIA HERCULES: and that was just wonderful.

01:06:55.720 - 01:07:12.340

PATRICIA HERCULES: Another thing that happened was AORN, PATRICIA HERCULES: Lola Fehr, presented a gavel to Galya PATRICIA HERCULES: and which was a symbol of the president and being able to PATRICIA HERCULES: conduct a meeting. And so it made a big deal of that.

01:07:12.340 - 01:07:28.980

PATRICIA HERCULES: And then she also supplied t-shirts to every attendee PATRICIA HERCULES: at the conference. They got t-shirts that said "Creating Champions" all PATRICIA HERCULES: across it. And of course, everybody was really excited about that and that made that PATRICIA HERCULES: just a whole lot of fun.

01:07:33.250 - 01:07:44.980

PATRICIA HERCULES: So we had a lot of activity that took place during that visit. PATRICIA HERCULES: So the measures that we took then just really moved us forward, a giant PATRICIA HERCULES: step to get done. PATRICIA HERCULES: Some of the other things that were on our plan to do.

01:07:45.610 - 01:08:03.400

PATRICIA HERCULES: Our third visit was in September of PATRICIA HERCULES: '97, and we changed our team structure again. PATRICIA HERCULES: And this time we had the current PATRICIA HERCULES: president of AORN attend, her name was Ruth Shumaker.

01:08:04.630 - 01:08:22.110

PATRICIA HERCULES: And she also was very skilled and very talented because she was an PATRICIA HERCULES: OR nurse as well, and worked in the ORs. PATRICIA HERCULES: And our focus in addition to participating in PATRICIA HERCULES: the Second International Seminar, workshop.

01:08:22.110 - 01:08:38.380

PATRICIA HERCULES: sponsored by the Civilian Nursing Association again, was PATRICIA HERCULES: to conduct management leadership seminars and special seminars on operating room PATRICIA HERCULES: nursing or perioperative nursing. PATRICIA HERCULES: And so prior to that, we had some breakout small

01:08:39.430 - 01:08:56.560

PATRICIA HERCULES: mini conferences that took place in one of the hospitals, and we offered PATRICIA HERCULES: management leadership course, and we offered perioperative nursing course. PATRICIA HERCULES: And so Ruth and I participated in doing that. PATRICIA HERCULES: And then, also at this time, we

01:08:56.560 - 01:09:11.740

PATRICIA HERCULES: moved into concentrating on the reanimation units to be PATRICIA HERCULES: model units now. PATRICIA HERCULES: And so we had moved from the clinical units into the ICUs and, PATRICIA HERCULES: and Anecita really focused on developing model units with the reanimation

01:09:11.740 - 01:09:27.720

PATRICIA HERCULES: units. So those were the things that happened. PATRICIA HERCULES: Then on the next on that last visit, we had international PATRICIA HERCULES: speakers that presented at that conference. PATRICIA HERCULES: We had internal speakers.

01:09:27.720 - 01:09:44.320

PATRICIA HERCULES: Some of the chief nurses also spoke, and they were really excited about getting to have PATRICIA HERCULES: that opportunity. PATRICIA HERCULES: We had an individual by the name of Nina Vasylyuk. PATRICIA HERCULES: She was a head director of the medical college in Ust, which is the new capital of

01:09:44.320 - 01:09:56.170

PATRICIA HERCULES: the Oblast region. PATRICIA HERCULES: And then we had another nurse who came and did a presentation from PATRICIA HERCULES: Bishkek was the capital of Kyrgyzstan. PATRICIA HERCULES: So we had international visitors coming.

01:09:56.170 - 01:10:11.590

PATRICIA HERCULES: And in the meantime, Lola had also done some exploration into seeing if PATRICIA HERCULES: it was possible that the Semey Nursing Association could join the International PATRICIA HERCULES: Council of Nursing, and all of that work was in process in taking PATRICIA HERCULES: place as well.

01:10:12.460 - 01:10:30.490

PATRICIA HERCULES: So those those really are the measures. PATRICIA HERCULES: And I think you ask about what was the physician's response to all PATRICIA HERCULES: of this? Well, we grew obviously. PATRICIA HERCULES: We grew from '95 to '96 to '97, and a vast amount of

01:10:30.490 - 01:10:48.760

PATRICIA HERCULES: activity and a vast amount of successes that were taking place within the nursing arena. PATRICIA HERCULES: And so the physicians began to take a look at this, and we PATRICIA HERCULES: did know that they verbally spoke about PATRICIA HERCULES: the interest in all of this happening and how positive it was, and this is what they wanted

01:10:48.760 - 01:11:03.100

PATRICIA HERCULES: to do. But there was a lot of mixed feelings, too, PATRICIA HERCULES: because it involved change, PATRICIA HERCULES: and change from the way they were forever. PATRICIA HERCULES: And so they had to deal with what that change was like.

01:11:03.100 - 01:11:18.100

PATRICIA HERCULES: But they were also changing because the partnership was also working with them to go PATRICIA HERCULES: through changes on their own. PATRICIA HERCULES: So the expanded role for the nurse to them was a challenge. PATRICIA HERCULES: It was kind of hard for them to understand when the nurses were now doing CPR on

01:11:18.100 - 01:11:33.040

PATRICIA HERCULES: patients, and the nurses were interpreting EKGs when when they were PATRICIA HERCULES: never allowed to do any of that before. PATRICIA HERCULES: But now they were doing it and they were they were PATRICIA HERCULES: doing it well, they were doing a good job with it.

01:11:33.520 - 01:11:51.490

PATRICIA HERCULES: The physicians also expressed a lot of envy over the nursing PATRICIA HERCULES: association. And the nursing association didn't PATRICIA HERCULES: have ways to earn money like the physician associations there did. PATRICIA HERCULES: So finances was not as big an issue with the physicians as it was with the nurses,

01:11:51.490 - 01:12:08.800

PATRICIA HERCULES: but there was an amount of jealousy there, because the nurses now PATRICIA HERCULES: knew grant writing skills and were going to be using those skills to PATRICIA HERCULES: move forward with other grants. PATRICIA HERCULES: They also were providing education in high volumes

01:12:09.400 - 01:12:24.280

PATRICIA HERCULES: to their staff. PATRICIA HERCULES: The association had a learning resources center in the PATRICIA HERCULES: gynecological hospital, which is big, and it was nice, and they had a lot of AV equipment, PATRICIA HERCULES: and they had a lot of books, and they had mannequins there, and they had nurses coming

01:12:24.280 - 01:12:41.620

PATRICIA HERCULES: there to learn. And the physicians didn't have that. PATRICIA HERCULES: And so they did request that Lola PATRICIA HERCULES: Fehr meet with them and talk with them about how they could do the same kind of thing as PATRICIA HERCULES: well. And so that

01:12:41.620 - 01:12:54.910

PATRICIA HERCULES: was kind of where they were. PATRICIA HERCULES: But overall they did express support. PATRICIA HERCULES: So, you know, it was kind of up and down in terms of what we PATRICIA HERCULES: saw. But it was great.

01:12:54.910 - 01:13:07.150

PATRICIA HERCULES: It was good because things are moving along very PATRICIA HERCULES: positively. ANNIKA NAMBIAR: That's very good to hear. ANNIKA NAMBIAR: And also, you talked about how the nurses learn to read EKGs and do

01:13:07.180 - 01:13:22.930

ANNIKA NAMBIAR: CPR. How did you guys facilitate that learning and ANNIKA NAMBIAR: like what other skills were they able to learn in the process and how did it work with ANNIKA NAMBIAR: the translations? PATRICIA HERCULES: Yeah. I know we have a question coming up about the American hospital in

01:13:22.930 - 01:13:39.940

PATRICIA HERCULES: Istanbul. And that would that would be a good place for me to PATRICIA HERCULES: kind of jump into that one, because we did a lot of work that didn't happen overnight. PATRICIA HERCULES: You know, that's not an easy skill to learn. PATRICIA HERCULES: And so if you don't mind, I kind of

01:13:39.940 - 01:13:51.880

PATRICIA HERCULES: wait until I move into that one. PATRICIA HERCULES: Or we could go ahead and talk about that now. PATRICIA HERCULES: We could do that. Let me do that. ANNIKA NAMBIAR: Sure thing. Do you have any do you have anything else you'd like to say about the

01:13:51.880 - 01:14:09.730

ANNIKA NAMBIAR: previous question? Otherwise, I could ask the Istanbul question. PATRICIA HERCULES: I think PATRICIA HERCULES: we were going to talk separately about the AORN partnership, but I think I've already PATRICIA HERCULES: covered that fairly well because AORN did indeed,

01:14:11.470 - 01:14:25.030

PATRICIA HERCULES: they were a very strong impetus toward moving PATRICIA HERCULES: the nursing association in the right direction by providing them with this PATRICIA HERCULES: information and support. PATRICIA HERCULES: So they played a very strong role in that.

01:14:25.870 - 01:14:40.540

PATRICIA HERCULES: And hopefully you'll get the opportunity to have an interview with Lola Fehr as PATRICIA HERCULES: well. I know she's very excited about doing that, and she can go into a lot of detail PATRICIA HERCULES: with you about that. PATRICIA HERCULES: But yes, let's talk about the American Hospital in Istanbul.

01:14:40.870 - 01:14:53.140

PATRICIA HERCULES: Would you like me to go ahead with that one? PATRICIA HERCULES: Because that was really the impetus for teaching those kind of skills. ANNIKA NAMBIAR: Do you mind if I ask the question for context purposes? PATRICIA HERCULES: Sure, absolutely.

01:14:53.770 - 01:15:08.140

ANNIKA NAMBIAR: Could you explain your experience at the American Hospital in Istanbul and its ANNIKA NAMBIAR: contribution to the continued development of the professionalism of nursing in Kazakhstan? ANNIKA NAMBIAR: And could you also speak to the role modeling and exposure of nurses to a ANNIKA NAMBIAR: different environment?

01:15:09.070 - 01:15:23.440

PATRICIA HERCULES: Yes. You know, Istanbul, with Lynda Mikalauskas PATRICIA HERCULES: attending the 1997 conference and doing the presentation there, it was a really strong PATRICIA HERCULES: impetus to get to get people thinking. PATRICIA HERCULES: But there are some history that went along with that.

01:15:23.830 - 01:15:43.090

PATRICIA HERCULES: Actually the discussions about PATRICIA HERCULES: the American hospital becoming like a partner in this partnership PATRICIA HERCULES: with the Semey nurses actually began in PATRICIA HERCULES: 1995 with the meeting of the CEO at the American hospital, who

01:15:43.090 - 01:16:00.760

PATRICIA HERCULES: was actually a person from the Methodist Hospital. PATRICIA HERCULES: But that conversation actually took place with him, and PATRICIA HERCULES: with the CNO, and with Semahat Arsel. PATRICIA HERCULES: Now Semahat Arsel was actually the owner of the

01:16:00.850 - 01:16:15.790

PATRICIA HERCULES: hospital, but also there is a nursing education and research center PATRICIA HERCULES: named after her. It's called SANERC. PATRICIA HERCULES: What had happened in the past is the Methodist Hospital and the American PATRICIA HERCULES: hospital had a relationship, an ongoing relationship.

01:16:16.870 - 01:16:35.530

PATRICIA HERCULES: And in 1990, PATRICIA HERCULES: the nurses PATRICIA HERCULES: from Turkey came to the Methodist Hospital to study critical PATRICIA HERCULES: care nursing. And then the nurses from Methodist went back

01:16:35.530 - 01:16:52.330

PATRICIA HERCULES: to the SANERC, the learning resource center and they taught a critical PATRICIA HERCULES: care course at the American Hospital in 1990. PATRICIA HERCULES: And the nurses from the US, from our from the Methodist Hospital taught PATRICIA HERCULES: it up until like, oh, several years.

01:16:52.780 - 01:17:10.510

PATRICIA HERCULES: And it had been going on for seven years, since 1990, when we when PATRICIA HERCULES: we actually formalized that partnership. PATRICIA HERCULES: And now the Turkish nurses were teaching that course. PATRICIA HERCULES: Now in the interim, it became imminent that the nurses

01:17:10.510 - 01:17:29.200

PATRICIA HERCULES: in the reanimation units at Semey PATRICIA HERCULES: needed to learn firsthand and PATRICIA HERCULES: coursework and clinic and observation - of course, they couldn't practice in Turkey, but PATRICIA HERCULES: they could certainly do some observation - the skills that would be

01:17:29.200 - 01:17:49.550

PATRICIA HERCULES: needed in order to improve their practice in the reanimation units in Semey. PATRICIA HERCULES: Turkey was much closer in physical proximity to PATRICIA HERCULES: Kazakhstan than the United States was, and we in PATRICIA HERCULES: our partnership felt very comfortable that the American hospital could

01:17:49.550 - 01:18:04.730

PATRICIA HERCULES: provide them with the same quality of a critical care course that we could provide PATRICIA HERCULES: them if they traveled all to the United States, specifically because it was our PATRICIA HERCULES: course. It was the course from the Methodist Hospital, and it was kept updated on an PATRICIA HERCULES: ongoing basis.

01:18:05.550 - 01:18:23.220

PATRICIA HERCULES: So the arrangement was made for PATRICIA HERCULES: nine of the Turkish nurses and two of the physicians to travel to PATRICIA HERCULES: Istanbul and to take a PATRICIA HERCULES: critical care course that had been developed specifically

01:18:24.180 - 01:18:36.870

PATRICIA HERCULES: for them. PATRICIA HERCULES: Anecita, our critical care educator, was allowed a four week PATRICIA HERCULES: leave from the Methodist Hospital to be and teach that course as PATRICIA HERCULES: well in Istanbul.

01:18:36.870 - 01:18:54.360

PATRICIA HERCULES: And so jointly Anecita and the Turkish nurse, who was now teaching that PATRICIA HERCULES: course in Istanbul, taught a four week course to PATRICIA HERCULES: those nurses from the reanimation unit. PATRICIA HERCULES: And the nurses that went to Istanbul were the ones who were working in the reanimation

01:18:54.360 - 01:19:10.050

PATRICIA HERCULES: unit because they were the ones who had experience in critical care, rather than take PATRICIA HERCULES: new nurses that didn't have any experience. PATRICIA HERCULES: So the course was recrafted from the PATRICIA HERCULES: critical care nurse residency program that took place at the Methodist Hospital.

01:19:10.880 - 01:19:24.590

PATRICIA HERCULES: And Anecita, based on the assessments that she had done and the needs that the PATRICIA HERCULES: nurses had said that they needed, helped design that. PATRICIA HERCULES: It was a four week course that took place in Istanbul. PATRICIA HERCULES: And so they taught it.

01:19:24.590 - 01:19:40.490

PATRICIA HERCULES: The nurses went, they had testing, they had clinical practice, they had PATRICIA HERCULES: observation, and they graduated with with certificates. PATRICIA HERCULES: Now they learned the skills of CPR, they learned EKG interpretation, and the PATRICIA HERCULES: other basic critical care skills.

01:19:40.490 - 01:19:55.700

PATRICIA HERCULES: They were then expected to go back to Semey and they teach the other PATRICIA HERCULES: nurses that were there. PATRICIA HERCULES: And so that's kind of how all of those in-depth skills were PATRICIA HERCULES: learned and were brought back to Semey and taught in

01:19:55.700 - 01:20:08.660

PATRICIA HERCULES: Semey, and so that was PATRICIA HERCULES: how they learned those skills. PATRICIA HERCULES: And that seemed to have worked very well. PATRICIA HERCULES: There was talk and plan about bringing them out.

01:20:08.810 - 01:20:27.680

PATRICIA HERCULES: There was an ER course that was also being taught at the American hospital and PATRICIA HERCULES: that had been in place since 1994, and, you know, we were there in 1997 with the PATRICIA HERCULES: Semey nurses. So it had only been there for three years, but the plans were as soon PATRICIA HERCULES: as the Turkish nurses were able to take over that program as well,

01:20:28.220 - 01:20:42.860

PATRICIA HERCULES: to bring the Semey nurses there. PATRICIA HERCULES: And to my knowledge, I'm not sure that that happened PATRICIA HERCULES: because by the time all of that took place, you know, we were PATRICIA HERCULES: out of working one on one with the partnership.

01:20:43.640 - 01:20:56.990

PATRICIA HERCULES: But that's what the plans were: to do something like that and to get them more PATRICIA HERCULES: advanced in their practice there. PATRICIA HERCULES: SANERC offered even advanced cardiac life support. PATRICIA HERCULES: And the nurses were allowed to learn that as well.

01:20:57.650 - 01:21:15.950

PATRICIA HERCULES: So they got a great amount of skill and training PATRICIA HERCULES: at that hospital in a very compact way that was PATRICIA HERCULES: just an excellent way for them to transfer those skills back. PATRICIA HERCULES: Interesting, the Turkish language is kind of similar to the Kazakh language.

01:21:20.180 - 01:21:37.160

PATRICIA HERCULES: There had to be translation so that everybody could understand, but the PATRICIA HERCULES: nurses could sort of understand what the Turkish nurses were saying. PATRICIA HERCULES: And so that was kind of fun. PATRICIA HERCULES: And they did a lot of clinical observation in the intensive care units

01:21:37.160 - 01:21:52.520

PATRICIA HERCULES: that were there and also in the operating rooms, they went there. PATRICIA HERCULES: So we we have a have a couple of pictures of things that they did while they were there. PATRICIA HERCULES: It was a great experience for them. ANNIKA NAMBIAR: Could you also speak, I guess, to what the American hospital in

01:21:52.520 - 01:22:07.320

ANNIKA NAMBIAR: Istanbul looked like? Because, you know, I'm imagining an American hospital, so that would ANNIKA NAMBIAR: be a great context. PATRICIA HERCULES: The hospital was a modern hospital. PATRICIA HERCULES: It was very different and as far as a difference

01:22:07.800 - 01:22:24.690

PATRICIA HERCULES: for my own experience and from our own experience and being PATRICIA HERCULES: there, it was like walking from PATRICIA HERCULES: the practice that went back 20 or 30 years into the PATRICIA HERCULES: 1990s. They had modern equipment.

01:22:24.690 - 01:22:42.000

PATRICIA HERCULES: They had working equipment. PATRICIA HERCULES: They were up to standards in terms of their environmental PATRICIA HERCULES: control with cleanliness and handwashing, and all of those activities. PATRICIA HERCULES: So it was just walking into a hospital that was very

01:22:42.000 - 01:22:55.650

PATRICIA HERCULES: similar to the hospitals in the United States. PATRICIA HERCULES: You know, it was in Turkey. PATRICIA HERCULES: So there was, you know, obviously a difference, but it was PATRICIA HERCULES: an environment that provided a good experience for them to

01:22:55.650 - 01:23:08.100

PATRICIA HERCULES: experience learning in. PATRICIA HERCULES: The nurses were extremely friendly and very willing to help and PATRICIA HERCULES: very positive about having those nurses come. PATRICIA HERCULES: The two physicians that came, Dr.

01:23:08.100 - 01:23:25.560

PATRICIA HERCULES: Tumenova and Dr. Galya. PATRICIA HERCULES: I mean, they participated at the very highest level as well. PATRICIA HERCULES: And so they were happy, you know, to have been there. PATRICIA HERCULES: Istanbul is a big, busy city and it didn't have

01:23:26.580 - 01:23:42.030

PATRICIA HERCULES: the history that Semipalatinsk had with the Communist regime or with the PATRICIA HERCULES: radiation exposure. PATRICIA HERCULES: And so the environment was just very different than the environment PATRICIA HERCULES: that we have been experiencing in the city, in

01:23:42.990 - 01:23:59.440

PATRICIA HERCULES: Semipalatinsk. ANNIKA NAMBIAR: Was this the first time that some of the nurses from Kazakhstan were able to ANNIKA NAMBIAR: leave Kazakhstan and see a new city, and if so, what were their reactions? PATRICIA HERCULES: You know, yeah, for some of them, yes.

01:23:59.440 - 01:24:15.370

PATRICIA HERCULES: You know, it was they were happy, it's PATRICIA HERCULES: like adventure. They receive their PATRICIA HERCULES: meals at the American hospital. PATRICIA HERCULES: There was not room in the dorm, in the American hospital, in the dormitory rooms

01:24:15.370 - 01:24:27.520

PATRICIA HERCULES: that they had. So they put them in up in hotel spaces that were, that were fairly in PATRICIA HERCULES: close proximity. PATRICIA HERCULES: And so, I mean, they were excited. PATRICIA HERCULES: I mean, they were excited, you know, to be out.

01:24:27.970 - 01:24:38.470

PATRICIA HERCULES: They were nervous, you know, obviously they were anxious. PATRICIA HERCULES: They wanted to do well. PATRICIA HERCULES: They wanted to learn. PATRICIA HERCULES: They knew that they had a responsibility, that they were being funded.

01:24:42.790 - 01:24:55.840

PATRICIA HERCULES: They knew it was just a whole different environment for them. PATRICIA HERCULES: So, yeah, it's like anyone who travels for the first time out of your own country PATRICIA HERCULES: or to a new country. PATRICIA HERCULES: There was a lot of excitement and anxiety that was present.

01:24:57.830 - 01:25:20.080

ANNIKA NAMBIAR: And then could you speak on a personal level to your time ANNIKA NAMBIAR: between both Kazakhstan and Turkey? ANNIKA NAMBIAR: What was it like? PATRICIA HERCULES: We

01:25:20.080 - 01:25:34.360

PATRICIA HERCULES: didn't have to deal with the weather, you know. PATRICIA HERCULES: We didn't have a lot of the things that were there. PATRICIA HERCULES: It was actually my first time in Istanbul as well and so I was excited as well. PATRICIA HERCULES: And English was, was spoken quite a bit.

01:25:34.360 - 01:25:52.690

PATRICIA HERCULES: So the language didn't seem to be the barrier that was there. PATRICIA HERCULES: It was more advanced level of practice. PATRICIA HERCULES: The CNO was a very personable and very helpful PATRICIA HERCULES: and made a lot of opportunities for us

01:25:52.690 - 01:26:10.810

PATRICIA HERCULES: to learn more about the American hospital as well as the city PATRICIA HERCULES: itself. It was great to PATRICIA HERCULES: see the activities taking place within the classroom and within the clinical PATRICIA HERCULES: area. And it was fun and it was

01:26:10.810 - 01:26:24.190

PATRICIA HERCULES: exciting for me. PATRICIA HERCULES: It was a great sense of satisfaction. PATRICIA HERCULES: I think one of the things that makes me really, really proud PATRICIA HERCULES: is the the person who- Anecita, who I keep talking about, she is

01:26:24.190 - 01:26:40.630

PATRICIA HERCULES: just an excellent, a wonderful individual, an excellent PATRICIA HERCULES: teacher, an excellent educator. PATRICIA HERCULES: She works so well with them and it makes made me just really PATRICIA HERCULES: proud to see her active involvement and and working

01:26:40.960 - 01:26:54.790

PATRICIA HERCULES: so carefully with them. PATRICIA HERCULES: So I was proud of what was going on. PATRICIA HERCULES: Proud of what we were able to arrange and very PATRICIA HERCULES: happy that when they said they needed this or that,

01:26:55.510 - 01:27:15.210

PATRICIA HERCULES: that we did our best to make those needs be met, you know, as best that we PATRICIA HERCULES: could. It was a nice bridge, you know, it was happy to see that PATRICIA HERCULES: bridge take place between Semey and Istanbul. PATRICIA HERCULES: And there were ongoing discussions about extending that partnership

01:27:15.210 - 01:27:26.970

PATRICIA HERCULES: even after, you know, we were no longer there. PATRICIA HERCULES: So it was great. PATRICIA HERCULES: Their nursing research center, the SANERC, it was a PATRICIA HERCULES: beautiful center.

01:27:26.970 - 01:27:42.270

PATRICIA HERCULES: They had the kinds of things that we would see in the States in our PATRICIA HERCULES: own hospital. And they made it open and available PATRICIA HERCULES: for the nurses to see. PATRICIA HERCULES: So it was an exciting experience.

01:27:42.270 - 01:27:57.870

PATRICIA HERCULES: Everything was kind of exciting and interesting and and new and a challenge PATRICIA HERCULES: the whole time. ANNIKA NAMBIAR: And then also, how about your time in Semipalatinsk? ANNIKA NAMBIAR: I know this was probably the first time that you'd been to Kazakhstan.

01:27:57.870 - 01:28:09.320

ANNIKA NAMBIAR: What were your impressions? PATRICIA HERCULES: Well. Excitement. PATRICIA HERCULES: Excitement for one. PATRICIA HERCULES: W

01:28:14.090 - 01:28:28.650

PATRICIA HERCULES: e had certain things that we PATRICIA HERCULES: had to work through, you know, PATRICIA HERCULES: like weather and transportation and stuff like that. PATRICIA HERCULES: We didn't really know what to expect.

01:28:28.650 - 01:28:48.420

PATRICIA HERCULES: And so it was very helpful PATRICIA HERCULES: to have read up on the history of what was going on in Semey before we PATRICIA HERCULES: arrived there and what was going on in Kurchatov. PATRICIA HERCULES: And with the goals of the International Health

01:28:48.690 - 01:29:07.200

PATRICIA HERCULES: Care Alliance, it was very helpful to understand PATRICIA HERCULES: that. And so getting to Semey for the first time PATRICIA HERCULES: was just an entirely new experience PATRICIA HERCULES: that I was very much looking forward to

01:29:07.200 - 01:29:21.160

PATRICIA HERCULES: and very eager to work with my PATRICIA HERCULES: peers and to work with the nurses there to see what we PATRICIA HERCULES: could accomplish. ANNIKA NAMBIAR: Awesome. That sounds incredible.

01:29:22.060 - 01:29:39.070

ANNIKA NAMBIAR: And then would you mind actually sharing your own past experiences in ANNIKA NAMBIAR: working in education and a diverse team, the obstacles that your team has experienced ANNIKA NAMBIAR: during the project, and then how you guys were able to overcome those? PATRICIA HERCULES: Yeah.

01:29:39.190 - 01:29:51.850

PATRICIA HERCULES: You know, being in the position that I was in at the Methodist PATRICIA HERCULES: Hospital, I was in a very good position. PATRICIA HERCULES: I had 20 years at Methodist, and my background PATRICIA HERCULES: was the operating room.

01:29:51.850 - 01:30:05.800

PATRICIA HERCULES: And then I moved into the Central Education department, and then I became the director of PATRICIA HERCULES: the Central Education department at Methodist. PATRICIA HERCULES: And Methodist, it was an international hospital. PATRICIA HERCULES: It is. It still is an international hospital.

01:30:06.220 - 01:30:22.820

PATRICIA HERCULES: We had a lot of international guests. PATRICIA HERCULES: And I was very fortunate to have a department of PATRICIA HERCULES: very talented individuals working in my department. PATRICIA HERCULES: And almost invariably whenever there was an international guest that came,

01:30:22.820 - 01:30:41.630

PATRICIA HERCULES: whether it was a nurse or a physician, especially if they were from a third PATRICIA HERCULES: world kind of a country, they would want PATRICIA HERCULES: to have a block of time talking PATRICIA HERCULES: with my department, with me or my department or whoever would meet them and talking about

01:30:41.630 - 01:30:59.110

PATRICIA HERCULES: what we did and how we how we did it. PATRICIA HERCULES: And so I had a lot of PATRICIA HERCULES: opportunity to meet with international individuals PATRICIA HERCULES: and to experience some of their diverse needs and some

01:30:59.110 - 01:31:17.890

PATRICIA HERCULES: of what they wanted to get out of being there. PATRICIA HERCULES: So that I was very fortunate to have had that kind of an experience working with PATRICIA HERCULES: international people, international healthcare professionals. PATRICIA HERCULES: From a

01:31:17.890 - 01:31:37.090

PATRICIA HERCULES: personal perspective, during the time that I was director of the department PATRICIA HERCULES: and was exposed to so many, you know, through the hospital perspective. PATRICIA HERCULES: I also was very active in AORN PATRICIA HERCULES: and did some consulting with them to some of the third world

01:31:37.090 - 01:31:57.220

PATRICIA HERCULES: countries. I also had the opportunity to do some PATRICIA HERCULES: consulting with Johnson & Johnson and they of course, they PATRICIA HERCULES: have education needs in with operating room nurses PATRICIA HERCULES: all over. And I had quite a bit of opportunity to travel abroad and

01:31:57.220 - 01:32:12.240

PATRICIA HERCULES: to do some educational consulting- with the approval PATRICIA HERCULES: of Methodist, of course. PATRICIA HERCULES: And some of the countries that were not PATRICIA HERCULES: so modern and up to date.

01:32:12.240 - 01:32:29.560

PATRICIA HERCULES: So I felt like I had a nice background, PATRICIA HERCULES: and I had a department and a team that I was working with that I felt like PATRICIA HERCULES: it was a good match for us PATRICIA HERCULES: to be involved with this project.

01:32:29.560 - 01:32:44.500

PATRICIA HERCULES: And so it was PATRICIA HERCULES: really a privilege and an PATRICIA HERCULES: honor, I think, to have been asked personally, but it was a privilege and honor PATRICIA HERCULES: to have my team be included in

01:32:44.500 - 01:33:02.070

PATRICIA HERCULES: providing the kind of information and education PATRICIA HERCULES: that we provided when we were over there. PATRICIA HERCULES: So it was PATRICIA HERCULES: something that seemed to just work well and smoothly and

01:33:02.070 - 01:33:18.000

PATRICIA HERCULES: working with Doctor Weinberg and Sara Rosen and the other team PATRICIA HERCULES: members who actually, you know, went over there. PATRICIA HERCULES: It was a very educational, very informative, and a really privilege, I PATRICIA HERCULES: think, to have had that opportunity to work with them.

01:33:18.480 - 01:33:30.030

PATRICIA HERCULES: I think you ask about some obstacles or challenges that that PATRICIA HERCULES: we faced when we were there. PATRICIA HERCULES: Am I correct with that question? PATRICIA HERCULES: Was that part of your question?

01:33:30.120 - 01:33:45.230

ANNIKA NAMBIAR: That was. That was. PATRICIA HERCULES: Okay. So we didn't know what to PATRICIA HERCULES: expect. Let me just say that. PATRICIA HERCULES: We were told what to expect and we

01:33:45.230 - 01:34:00.110

PATRICIA HERCULES: were prepared with what to expect. PATRICIA HERCULES: But the reality was we really didn't know what to PATRICIA HERCULES: expect. Especially with the people. PATRICIA HERCULES: We did not know whether they would welcome us with open

01:34:00.110 - 01:34:16.750

PATRICIA HERCULES: arms or whether they would be PATRICIA HERCULES: anxious about us being there or what, but we were PATRICIA HERCULES: greeted. It's very warm and very friendly. PATRICIA HERCULES: We were greeted with a group of

01:34:16.750 - 01:34:33.970

PATRICIA HERCULES: nurses who were very enthusiastic and very interested PATRICIA HERCULES: in interacting with us. PATRICIA HERCULES: They wanted to share what they had done, and they wanted to PATRICIA HERCULES: show us what their accomplishments were, and they wanted to tell us what they thought they

01:34:33.970 - 01:34:46.360

PATRICIA HERCULES: needed to move forward. PATRICIA HERCULES: They were very eager to share their PATRICIA HERCULES: families with us. PATRICIA HERCULES: They were very personable people, and they were fun people.

01:34:46.360 - 01:35:04.750

PATRICIA HERCULES: And and so that was that was a great welcome in terms of how PATRICIA HERCULES: we were met. But there were some challenges. PATRICIA HERCULES: Just in getting over there, that was a challenge. PATRICIA HERCULES: And so I'm going to talk about some kind of interesting things

01:35:04.750 - 01:35:18.370

PATRICIA HERCULES: because some of the obstacles really turned out to be challenges. PATRICIA HERCULES: And we were always willing to take on a challenge. PATRICIA HERCULES: But the travel to get there, you know, we had to to fly. PATRICIA HERCULES: However, we had to get to Almaty.

01:35:18.370 - 01:35:32.980

PATRICIA HERCULES: And then from Almaty we had to get to Semipalatinsk. PATRICIA HERCULES: And it was kind of interesting because in Semipalatinsk, PATRICIA HERCULES: the airport was open to travel only at night because PATRICIA HERCULES: there was construction going on in the airport.

01:35:33.880 - 01:35:52.150

PATRICIA HERCULES: There was weight limitations on the baggages and it was PATRICIA HERCULES: winter so we had a lot of heavy clothes in our PATRICIA HERCULES: suitcases. And because we didn't have a translator going PATRICIA HERCULES: with us over there, AIHA representatives met us and they could do the translation for us,

01:35:52.150 - 01:36:04.090

PATRICIA HERCULES: but they could only go so far in the airport. PATRICIA HERCULES: They couldn't go through security with us. PATRICIA HERCULES: But we had to go from one desk to the other with our heavy luggage. PATRICIA HERCULES: We had to drag our luggage to one desk to have it weighed, we had to have another one

01:36:04.090 - 01:36:15.610

PATRICIA HERCULES: to pay the cost of having heavy luggage, then we had to go back to get a stamp on our PATRICIA HERCULES: tickets and notice that we could get through security. PATRICIA HERCULES: And so we were kind of back and forth. PATRICIA HERCULES: And then we finally got moved into security.

01:36:15.610 - 01:36:33.010

PATRICIA HERCULES: And of course, we had no translators and we couldn't speak their language. PATRICIA HERCULES: And so we, who were very PATRICIA HERCULES: Caucasian looking, had some little difficulty trying PATRICIA HERCULES: to get through the security lines the proper way because we didn't understand what they

01:36:33.010 - 01:36:45.370

PATRICIA HERCULES: were telling us to do. PATRICIA HERCULES: Now, Anecita, on the other hand, is from the Philippines, and she looked PATRICIA HERCULES: very Asian and she looked like the Kazakh nurse, and she had no problem at all. PATRICIA HERCULES: So she would be on the other side laughing at us because we were having all these

01:36:45.370 - 01:36:57.130

PATRICIA HERCULES: troubles. But it was just kind of fun. PATRICIA HERCULES: The airplane itself was a propeller jet. PATRICIA HERCULES: It was jet propelled. PATRICIA HERCULES: It only had 40 passengers on it.

01:36:57.130 - 01:37:09.430

PATRICIA HERCULES: The seats were very low back, and it was very cold. PATRICIA HERCULES: There wasn't any heat in the airplane, and certainly there was no service like coffees PATRICIA HERCULES: or teas or anything like that. PATRICIA HERCULES: It was a two hour flight.

01:37:09.430 - 01:37:24.490

PATRICIA HERCULES: We had to load the airplane on the back, and we had to be responsible for carrying our own PATRICIA HERCULES: luggage up the stairs to the rear end of the of the airplane to get into the plane. PATRICIA HERCULES: And of course, we solicited help with that one because we couldn't lift our suitcases, PATRICIA HERCULES: they were so heavy.

01:37:24.490 - 01:37:37.710

PATRICIA HERCULES: But the weather- that was a challenge. PATRICIA HERCULES: Another challenge was the weather in the hotel that we stayed in. PATRICIA HERCULES: The weather was in the 20 degrees. PATRICIA HERCULES: And so it was very, very, very cold.

01:37:38.160 - 01:37:53.040

PATRICIA HERCULES: But when we got to Almaty and we were greeted PATRICIA HERCULES: by the officials that picked us up. PATRICIA HERCULES: So transportation wasn't an issue, but there was no heat in the PATRICIA HERCULES: city due to the central plant not being put into service.

01:37:53.040 - 01:38:10.980

PATRICIA HERCULES: And so when we got into the hotel, which was actually the largest one, it's the Hotel PATRICIA HERCULES: Irtysh. When we got into the hotel, it was cold. PATRICIA HERCULES: It was cold, but the nurses had provided us space heaters and the PATRICIA HERCULES: rooms were very tiny, small, and they had cots in them, but they did have their own

01:38:10.980 - 01:38:27.810

PATRICIA HERCULES: restroom. But they were small PATRICIA HERCULES: and there weren't any bottom sheets on the mattresses and it was just a different PATRICIA HERCULES: it was a different environment. PATRICIA HERCULES: So the hotel did have a large restaurant in it that we went to breakfast in the

01:38:27.810 - 01:38:45.480

PATRICIA HERCULES: mornings. PATRICIA HERCULES: It was a large dining area, actually. PATRICIA HERCULES: But we were the only ones PATRICIA HERCULES: there, and so we were the only ones on our table, and they would bring us hot water and

01:38:45.480 - 01:39:00.090

PATRICIA HERCULES: we'd been told to bring, like, packets of food and oatmeal and stuff like PATRICIA HERCULES: that. But they did provide us bread. PATRICIA HERCULES: And so that was very nice. PATRICIA HERCULES: And they did provide us hot water, and they were just so friendly.

01:39:00.090 - 01:39:13.440

PATRICIA HERCULES: They did provide us cold water. PATRICIA HERCULES: But that restaurant did on rare PATRICIA HERCULES: occasions cater to large numbers of individuals. PATRICIA HERCULES: I've got a couple of slides that I'll jot through to show you that.

01:39:13.440 - 01:39:26.460

PATRICIA HERCULES: Translation was another challenge PATRICIA HERCULES: that we had. PATRICIA HERCULES: But we did have translators that went with us and PATRICIA HERCULES: that was very helpful.

01:39:26.460 - 01:39:44.040

PATRICIA HERCULES: But we also learned very actively to read nonverbal communication PATRICIA HERCULES: and to learn a lot from facial expressions. PATRICIA HERCULES: Another challenge was the social culture and there PATRICIA HERCULES: are traditions. And we wanted to learn what those

01:39:44.250 - 01:40:00.400

PATRICIA HERCULES: cultures were, and we wanted to learn what their traditions were so we could be PATRICIA HERCULES: accepted and be a part of them. PATRICIA HERCULES: We had to learn how to work with PATRICIA HERCULES: the physicians. That was a challenge.

01:40:00.400 - 01:40:14.240

PATRICIA HERCULES: Not an obstacle. I won't say we had any obstacles, but we had lots of challenges and PATRICIA HERCULES: working with the physicians, because our relationship with our PATRICIA HERCULES: physicians are very different than the relationships that those nurses had with PATRICIA HERCULES: their physicians.

01:40:14.510 - 01:40:28.070

PATRICIA HERCULES: And we didn't want to do anything that that would damage that. PATRICIA HERCULES: We wanted to promote those relationships and have the physicians PATRICIA HERCULES: feel like they were still respected and honored, even though we were making changes PATRICIA HERCULES: with the nurses that work for them.

01:40:28.880 - 01:40:46.460

PATRICIA HERCULES: So those and meals, I guess meals were, we thought that would be a challenge, PATRICIA HERCULES: but it absolutely wasn't a challenge at all, because once we got into the PATRICIA HERCULES: hospitals, the nurses provided us lunches that were PATRICIA HERCULES: extraordinarily beautiful and food from their homes.

01:40:46.460 - 01:41:02.680

PATRICIA HERCULES: And in the evenings, they would invite us to their homes PATRICIA HERCULES: to have food and they would prepare unbelievably PATRICIA HERCULES: wonderful meals. PATRICIA HERCULES: They hosted us unbelievably.

01:41:02.680 - 01:41:21.230

PATRICIA HERCULES: They had local grown fruits, which they had preserved and provided for PATRICIA HERCULES: us. PATRICIA HERCULES: It was never a problem or a challenge and the food was delicious. PATRICIA HERCULES: And it was very interesting eating their food according to what their

01:41:21.230 - 01:41:33.360

PATRICIA HERCULES: culture ate. On one occasion. PATRICIA HERCULES: I will say, though, that we had dinner. PATRICIA HERCULES: It was dinner in the evening. PATRICIA HERCULES: It was on the ninth floor of a building, and it just so happened that they

01:41:33.360 - 01:41:50.020

PATRICIA HERCULES: had turned off the electricity, so there were no lights. PATRICIA HERCULES: So we had flashlights and we had to climb up nine flights of stairs in order to get PATRICIA HERCULES: to the room or the apartment where we were having the dinner. PATRICIA HERCULES: And we walked into the room where the dinner and they had it so beautifully lit up with

01:41:50.020 - 01:42:02.770

PATRICIA HERCULES: candlelight, it was just like remarkable. PATRICIA HERCULES: It was gorgeous. And then the electricity came on after we'd been there a few PATRICIA HERCULES: hours. And so everybody clapped and applauded. PATRICIA HERCULES: And so that was really just kind of fun.

01:42:02.950 - 01:42:17.470

PATRICIA HERCULES: And then we had a couple of the closing receptions in that PATRICIA HERCULES: hotel, which converted overnight from a very barren PATRICIA HERCULES: place in the morning to an elaborate place in the evening. PATRICIA HERCULES: And so that was that was kind of fun.

01:42:17.740 - 01:42:34.390

PATRICIA HERCULES: We didn't have a lot of problem with transportation, but we did end up traveling PATRICIA HERCULES: to Kurchatov in an ambulance, and then we were transported in Jeeps on some PATRICIA HERCULES: occasions. But other than that, they were very nice and provided us PATRICIA HERCULES: good transportation with the cars.

01:42:34.390 - 01:42:54.740

PATRICIA HERCULES: T PATRICIA HERCULES: here were challenges, but there were challenges that were easily overcome and very PATRICIA HERCULES: much appreciated with what we did there. ANNIKA NAMBIAR: That's good. And then what were some of the accomplishments or outcomes

01:42:54.740 - 01:43:10.870

ANNIKA NAMBIAR: for nursing at the end of the project, like broadly for the partnership as a whole? PATRICIA HERCULES: You know, I think some of the biggest accomplishments that were there were the PATRICIA HERCULES: model unit developments. PATRICIA HERCULES: I mean, that was major because that served as a model unit for the rest of the

01:43:10.870 - 01:43:29.350

PATRICIA HERCULES: hospitals. We we spent a lot of time in the gynecological PATRICIA HERCULES: hospital, and we did work with some patient education initiatives, but we only really had PATRICIA HERCULES: one year to work with with that gynecological hospital. PATRICIA HERCULES: But, but I think we did make a little bit of a pathway

01:43:29.350 - 01:43:45.730

PATRICIA HERCULES: there. We worked with them with the equipment PATRICIA HERCULES: from the Department of Defense, and I think that helped. PATRICIA HERCULES: I think the nursing association was a major accomplishment because it PATRICIA HERCULES: seemed like everything centered around the nursing association.

01:43:45.730 - 01:44:04.450

PATRICIA HERCULES: They were the body that was responsible for developing their standards of practice. PATRICIA HERCULES: That was for pulling the groups together, for providing their education. PATRICIA HERCULES: And all the hospitals came to the PATRICIA HERCULES: nursing Learning Resource Center, and the nursing association advanced their

01:44:04.450 - 01:44:20.770

PATRICIA HERCULES: practice. So that was that was a huge accomplishment, I think. PATRICIA HERCULES: The clinical practice overall did improve. PATRICIA HERCULES: I think we helped them move their practice further up the scale. PATRICIA HERCULES: They had more to go.

01:44:20.770 - 01:44:38.350

PATRICIA HERCULES: But we did help them improve their practice. PATRICIA HERCULES: And I think the development of clinical educator roles, PATRICIA HERCULES: we did learn that instead of everybody having to double duty and do double PATRICIA HERCULES: jobs so that education could be provided, they did have funded

01:44:38.350 - 01:44:52.390

PATRICIA HERCULES: education roles, people that were dedicated to education. PATRICIA HERCULES: And so that was really good. PATRICIA HERCULES: And like I said, that Learning Resource Center was a great. PATRICIA HERCULES: The teaching classes with the medical college, I think that was a major impact.

01:44:52.390 - 01:45:11.350

PATRICIA HERCULES: And I think one of the other accomplishments was, PATRICIA HERCULES: I do believe that that relationship and the teamship PATRICIA HERCULES: work that took place between the physicians and the nurses improved PATRICIA HERCULES: significantly. So I think our charge with education and

01:45:11.350 - 01:45:25.060

PATRICIA HERCULES: training and with moving them to help bridge that gap for PATRICIA HERCULES: the between where they were and where they needed to be. PATRICIA HERCULES: I think we moved that upward, and I consider that pretty much of PATRICIA HERCULES: accomplishment over there.

01:45:27.820 - 01:45:45.580

ANNIKA NAMBIAR: And then could you give an example or two of how you might have changed something in your ANNIKA NAMBIAR: own work back here in Houston, based on the partnership experience? PATRICIA HERCULES: Oh, yeah. For sure. PATRICIA HERCULES: You know, when you have almost everything you

01:45:45.700 - 01:45:57.730

PATRICIA HERCULES: need in your own work setting, and your work environment, PATRICIA HERCULES: you sometimes don't appreciate it. PATRICIA HERCULES: You take it for granted. PATRICIA HERCULES: And having been there, and coming back home,

01:45:58.930 - 01:46:13.790

PATRICIA HERCULES: and seeing what we have made, made me personally appreciate so PATRICIA HERCULES: much more of what Methodist was providing for us. PATRICIA HERCULES: It also stimulated, increased in better utilization PATRICIA HERCULES: of what we had.

01:46:13.790 - 01:46:30.680

PATRICIA HERCULES: To not be so frivolent and not that we were frivolent, but, you know, PATRICIA HERCULES: you can always do better with conserving. PATRICIA HERCULES: And so with the PATRICIA HERCULES: physical things, with the equipment and supplies, we I think we were very

01:46:30.680 - 01:46:48.650

PATRICIA HERCULES: cognizant of what we had and very cognizant of not being wasteful. PATRICIA HERCULES: Also because of the fact that communication was an issue, and we did learn to PATRICIA HERCULES: pick up on nonverbal cues a whole lot quicker PATRICIA HERCULES: than what we did if we were having that one on one communication, yeah,

01:46:49.910 - 01:47:09.020

PATRICIA HERCULES: our interactions and our consciousness and our consideration of others obviously had to PATRICIA HERCULES: improve. And then also if PATRICIA HERCULES: we had people from different cultures, patients PATRICIA HERCULES: from different cultures, colleagues from different cultures, I think

01:47:09.020 - 01:47:25.400

PATRICIA HERCULES: the growth in the respect for different cultures PATRICIA HERCULES: is always something that you learn from having spent time in another culture. PATRICIA HERCULES: So I think those are some PATRICIA HERCULES: ways that we all

01:47:25.400 - 01:47:36.230

PATRICIA HERCULES: changed in our practice. PATRICIA HERCULES: Once we got back, we took a look. PATRICIA HERCULES: We took a look at that. ANNIKA NAMBIAR: Do you have any examples of either the nonverbal cues or

01:47:36.230 - 01:47:52.200

ANNIKA NAMBIAR: like any patient interactions? PATRICIA HERCULES: I don't have any personal examples of nonverbal PATRICIA HERCULES: cues, or different patient reactions that I can remember, because that was really PATRICIA HERCULES: quite a while ago.

01:47:52.200 - 01:48:09.150

PATRICIA HERCULES: But I do remember for sure that any time that we did PATRICIA HERCULES: interact with others, even in business meetings. PATRICIA HERCULES: But, you know, business meetings when sometimes that you can pick up PATRICIA HERCULES: on a nonverbal clue in terms of a

01:48:09.150 - 01:48:25.230

PATRICIA HERCULES: person's like or dislike or approval or disapproval PATRICIA HERCULES: of some decisions that are made overall. PATRICIA HERCULES: You know, when you're on a team and the decision is made by the team and you don't PATRICIA HERCULES: like that decision, you're still part of the team and you accept that decision.

01:48:25.230 - 01:48:39.990

PATRICIA HERCULES: But there's going to always be some nonverbal kind of thing that comes through PATRICIA HERCULES: that says it. But I don't really have any specific PATRICIA HERCULES: patient interactions that I can that I can say that PATRICIA HERCULES: give you an example of that.

01:48:39.990 - 01:48:52.320

PATRICIA HERCULES: Sorry. I wish I could. ANNIKA NAMBIAR: Not an issue. I understand it was several years ago. ANNIKA NAMBIAR: And then what was the lasting impact of the relationships both ANNIKA NAMBIAR: with those abroad and here at home?

01:48:53.840 - 01:49:06.950

PATRICIA HERCULES: I think respect, for one thing, to the PATRICIA HERCULES: the relationship is one PATRICIA HERCULES: that, PATRICIA HERCULES: it was solid.

01:49:06.950 - 01:49:22.160

PATRICIA HERCULES: I think it was solid. PATRICIA HERCULES: The impact of the relationships was solid. PATRICIA HERCULES: It was a sense of satisfaction, a sense of appreciation PATRICIA HERCULES: for them, and hopefully appreciation for us.

01:49:22.160 - 01:49:36.710

PATRICIA HERCULES: It was mutual. PATRICIA HERCULES: I don't think there was ever a time when we didn't work as a team. PATRICIA HERCULES: And we never wanted to not PATRICIA HERCULES: be a part of of them or them be a part of us.

01:49:36.980 - 01:49:47.450

PATRICIA HERCULES: We worked together. PATRICIA HERCULES: We planned together. PATRICIA HERCULES: And we supported each other. PATRICIA HERCULES: I think like, very often I wanted to know.

01:49:47.450 - 01:49:59.240

PATRICIA HERCULES: And especially now going back through all of this information, PATRICIA HERCULES: I wanted to know how they are. PATRICIA HERCULES: Like, where are they now? PATRICIA HERCULES: Did they stay?

01:49:59.240 - 01:50:06.620

PATRICIA HERCULES: Did their where are their hospitals now? PATRICIA HERCULES: What kind of practice? PATRICIA HERCULES: What does Semey look like now? PATRICIA HERCULES: What are their hospitals look like?

01:50:06.680 - 01:50:22.530

PATRICIA HERCULES: Are there, you PATRICIA HERCULES: know, it's like there were people and we sometimes feel like we made PATRICIA HERCULES: friends with a lot of them. PATRICIA HERCULES: And so we couldn't communicate because we couldn't speak their language.

01:50:22.530 - 01:50:37.440

PATRICIA HERCULES: And, and sometimes communication was different, you know, like the telephone PATRICIA HERCULES: service was very difficult when we were in Semey, that was an obstacle kind of in a way. PATRICIA HERCULES: I didn't even think about that then, but we couldn't even communicate with them, you PATRICIA HERCULES: know, very much to keep in touch.

01:50:37.440 - 01:50:52.170

PATRICIA HERCULES: And it's a sense of wanting to know what happened, where are they now? PATRICIA HERCULES: And that's the lasting impact of just wanting. PATRICIA HERCULES: It's an unanswered question. PATRICIA HERCULES: I just kind of want to know where are they now and what has happened?

01:50:52.170 - 01:51:02.730

PATRICIA HERCULES: And did they move forward with their changes? PATRICIA HERCULES: What is their nursing association like now? PATRICIA HERCULES: You know, what are they doing? PATRICIA HERCULES: They were recognized as

01:51:02.730 - 01:51:17.580

PATRICIA HERCULES: the most active and progressive nursing association in all of Kazakhstan, PATRICIA HERCULES: and they wanted to represent the country as the leading PATRICIA HERCULES: organization. Did that ever happen? PATRICIA HERCULES: Did they ever join up with the International Council of Nurses?

01:51:17.580 - 01:51:33.480

PATRICIA HERCULES: I just I would like to have answers to a lot of those kind of questions. PATRICIA HERCULES: So it was a good strong PATRICIA HERCULES: impact of accomplishment on both sides. ANNIKA NAMBIAR: Wow. And I'm sure a very memorable experience from what it sounds like.

01:51:33.480 - 01:51:50.010

PATRICIA HERCULES: Oh, very much. ANNIKA NAMBIAR: And, I'm to understand that you have a slide presentation ANNIKA NAMBIAR: to show some of the pictures. PATRICIA HERCULES: I do, I do.

01:53:21.200 - 01:53:39.710

PATRICIA HERCULES: It PATRICIA HERCULES: was the Semeypalatinsk Houston Healthcare Partnership. PATRICIA HERCULES: The program area was nursing education and training, and the time span lasted until PATRICIA HERCULES: 1998. These were the participating hospitals

01:53:41.400 - 01:53:58.010

PATRICIA HERCULES: that I mentioned before that were part of what what we did. PATRICIA HERCULES: So the Children's Regional, Emergency First Aid, Oblast PATRICIA HERCULES: and, Ophthalmology, Gynecological, and Kurchatov. PATRICIA HERCULES: Okay. So, talked a bit about the government,

01:53:58.100 - 01:54:14.330

PATRICIA HERCULES: Dr. Tumenova, and the government and the part that they played. PATRICIA HERCULES: So this is just a picture of the building that they housed in. PATRICIA HERCULES: It was not too far from the Hotel Irtysh that we stayed in, and we could have been PATRICIA HERCULES: walking distance, but they actually picked us up and took us over there when we went to

01:54:14.330 - 01:54:30.080

PATRICIA HERCULES: meet. And a lot of the kind of important meetings PATRICIA HERCULES: with the physicians and amongst our team were held there so that we could all be on the PATRICIA HERCULES: same plate. These are just a pictures of some of the hospitals that were part of PATRICIA HERCULES: the partnership.

01:54:30.080 - 01:54:45.380

PATRICIA HERCULES: And in a couple of the nurses that were standing out there. PATRICIA HERCULES: So I just thought it might be interesting to see. PATRICIA HERCULES: And there's a hospital and PATRICIA HERCULES: it looks like not a hospital in the background here, but these

01:54:45.380 - 01:55:00.110

PATRICIA HERCULES: individuals we thought were waiting to go into the hospital, PATRICIA HERCULES: and they could have been sitting on these steps and looking at the hospital with that PATRICIA HERCULES: behind. Okay. PATRICIA HERCULES: So this is just an entryway to one of the floors

01:55:01.160 - 01:55:18.470

PATRICIA HERCULES: and a waiting area in one of the hospitals. PATRICIA HERCULES: We talked about the physicians and the importance and the PATRICIA HERCULES: relationship. And it was extremely important. PATRICIA HERCULES: So I just wanted to show some of our physicians.

01:55:19.070 - 01:55:32.480

PATRICIA HERCULES: These here were very instrumental PATRICIA HERCULES: in keeping us informed. PATRICIA HERCULES: This is Doctor Kurmangaliev. PATRICIA HERCULES: We actually saw him do surgery.

01:55:32.480 - 01:55:45.410

PATRICIA HERCULES: He wanted us to see him do surgery. PATRICIA HERCULES: And so we did. PATRICIA HERCULES: We went into the ORs, and he performed a surgical procedure for us. PATRICIA HERCULES: And I believe that this is a chief nurse in the oncology, and that is

01:55:45.410 - 01:55:59.900

PATRICIA HERCULES: her head doctor. PATRICIA HERCULES: This is Central City, where PATRICIA HERCULES: Natalya was a chief nurse. PATRICIA HERCULES: They did have an organization on a piece of paper - at least she did -

01:55:59.900 - 01:56:18.350

PATRICIA HERCULES: which went through the roles of what all these nurses do. PATRICIA HERCULES: And this is a kind of one that they were going to be taking a look at overall in PATRICIA HERCULES: terms of how would they define their roles, and now that they were not going to be PATRICIA HERCULES: eliminating some of the housekeeping duties that they were doing and

01:56:18.350 - 01:56:31.250

PATRICIA HERCULES: non-nursing functions, they were going to have to do some restructuring. PATRICIA HERCULES: And this is just pictures of the team. PATRICIA HERCULES: This is Galya, Dr. PATRICIA HERCULES: Galya. She was a real prominent person because she was the

01:56:31.250 - 01:56:45.020

PATRICIA HERCULES: president of the nursing association, but also the medical director of the PATRICIA HERCULES: ophthalmology hospital. PATRICIA HERCULES: But she was always with the nurses and always supporting the nurses. PATRICIA HERCULES: And so these are just some snapshots of the chief nurses and their senior

01:56:45.020 - 01:57:01.460

PATRICIA HERCULES: nurses and some of their head nurses. PATRICIA HERCULES: And they really enjoyed having their picture taken. PATRICIA HERCULES: And these are all from photographs that I had PATRICIA HERCULES: that we converted into slides.

01:57:01.460 - 01:57:14.570

PATRICIA HERCULES: So some of them were good, some are not so good. PATRICIA HERCULES: This is a First Aid hospital. PATRICIA HERCULES: Outside one of one of the rooms there. PATRICIA HERCULES: And some of the equipment that I talked about, some of the equipment is, a lot of it

01:57:14.570 - 01:57:26.770

PATRICIA HERCULES: was outdated. PATRICIA HERCULES: A lot of it was old, non-functional. PATRICIA HERCULES: Some was from the DoD that they couldn't work. PATRICIA HERCULES: But this is basically what the rooms.

01:57:26.950 - 01:57:40.390

PATRICIA HERCULES: That's some of the equipment that we saw there. PATRICIA HERCULES: These are some of the rooms look like. PATRICIA HERCULES: And with more than one patient in the room. PATRICIA HERCULES: And the nurses and their caps are very different than than what ours

01:57:40.390 - 01:57:57.910

PATRICIA HERCULES: are. But this shows the PATRICIA HERCULES: cots and the blankets that went on them, and it's just a peep at PATRICIA HERCULES: them. This is Children's Regional Hospital. PATRICIA HERCULES: Lyubov was the chief nurse there, and her doctor was Dr.

01:57:57.910 - 01:58:08.650

PATRICIA HERCULES: Mukhtar Tuleutaev. PATRICIA HERCULES: And they worked very well together as a team. PATRICIA HERCULES: And he was very supportive of everything that we did. PATRICIA HERCULES: The Children's Regional Hospital.

01:58:08.650 - 01:58:22.090

PATRICIA HERCULES: Some more photos of Olivia and her staff. PATRICIA HERCULES: And the Children's waiting area, their play area. PATRICIA HERCULES: And one of the family members. PATRICIA HERCULES: Okay.

01:58:22.090 - 01:58:36.220

PATRICIA HERCULES: So we we did take a trip to Kurchatov. PATRICIA HERCULES: We didn't really do an assessment internally in the hospital from the nursing perspective, PATRICIA HERCULES: but we were provided an opportunity to actually go and see. PATRICIA HERCULES: There it was. Because that was ahead of where the nuclear testing site was.

01:58:36.400 - 01:58:50.800

PATRICIA HERCULES: And this the trip out there and long view looking PATRICIA HERCULES: into it. And some of the poster signs that we saw along the way PATRICIA HERCULES: to the polyclinic and the hospital. PATRICIA HERCULES: And this is the hospital itself.

01:58:50.800 - 01:58:57.820

PATRICIA HERCULES: This was the functioning unit. PATRICIA HERCULES: This was a deserted one. PATRICIA HERCULES: It was no longer functioning. PATRICIA HERCULES: The windows are all blown out on it.

01:58:58.540 - 01:59:11.350

PATRICIA HERCULES: And this is, I believe that this was his office area. PATRICIA HERCULES: And this is Dr. Gorien. PATRICIA HERCULES: I believe he's a PhD-type physician and was doing the research PATRICIA HERCULES: on the effects of radiation.

01:59:11.350 - 01:59:24.980

PATRICIA HERCULES: Had pulled up a lot of archive files, I believe I'm telling you correctly, it's been PATRICIA HERCULES: a long time. PATRICIA HERCULES: But he was very helpful in talking with us. PATRICIA HERCULES: The Ophthalmology Hospital, which I said was beautiful with marble

01:59:24.980 - 01:59:40.100

PATRICIA HERCULES: walls because it had been the offices of the Communists when they were had their PATRICIA HERCULES: offices there. And so this is the chief nurse in the ophthalmology hospital, and she PATRICIA HERCULES: actually participated in patient care as well. PATRICIA HERCULES: Then we moved into the ORs.

01:59:40.100 - 01:59:51.890

PATRICIA HERCULES: We got into the ORs more in the in 1997. PATRICIA HERCULES: We visited them in the previous years, but we actually concentrated on PATRICIA HERCULES: them there. PATRICIA HERCULES: You can see what the attire looks like.

01:59:52.580 - 02:00:10.100

PATRICIA HERCULES: Their disinfection, their sterilization processes PATRICIA HERCULES: would go back so many years to soaking solutions PATRICIA HERCULES: and soaking equipment in the cans and canisters and so we have a PATRICIA HERCULES: couple of sets of that.

02:00:11.280 - 02:00:22.920

PATRICIA HERCULES: And this is a very small sterilizer that they PATRICIA HERCULES: did use, and it was very old, but this is one of the modern ones that came from the PATRICIA HERCULES: DoD, and this was a functioning one. PATRICIA HERCULES: So that was good news.

02:00:22.920 - 02:00:37.210

PATRICIA HERCULES: That was very helpful. PATRICIA HERCULES: These were their scrub sinks. PATRICIA HERCULES: And this was their scrub, one of the the nurses are PATRICIA HERCULES: scrubbing, and then once they got into the room, then they would after they scrub, they

02:00:37.210 - 02:00:53.400

PATRICIA HERCULES: would pour a solution over their hands to finish off PATRICIA HERCULES: that scrub. And then we had PATRICIA HERCULES: just the inside of the ORs. PATRICIA HERCULES: This is the gynecological hospital, actually, and their OR suite.

02:00:53.940 - 02:01:11.550

PATRICIA HERCULES: And just inside the rooms where the physicians, their back PATRICIA HERCULES: table that's already been opened up with their sterile PATRICIA HERCULES: items on it and their their red contaminated waste PATRICIA HERCULES: basket disposal, which was very good because they

02:01:12.060 - 02:01:27.960

PATRICIA HERCULES: they were using disposables, the contaminated waste in red bags. PATRICIA HERCULES: So that was one of the positives. PATRICIA HERCULES: And then we got to visit surgery. PATRICIA HERCULES: Tried not to take any pictures of any patients faces, but

02:01:28.230 - 02:01:43.840

PATRICIA HERCULES: this was an opportunity that we had to go in and actually observe PATRICIA HERCULES: them doing their surgeries. PATRICIA HERCULES: And too, they wore the bakers cats caps on their PATRICIA HERCULES: heads, but they weren't quite in the orders.

02:01:44.350 - 02:01:57.100

PATRICIA HERCULES: This is the one that I spoke of. PATRICIA HERCULES: The suture where they where the suture was being soaked. PATRICIA HERCULES: And this is the DoD disposable suture that is PATRICIA HERCULES: used all the time here, around in other countries.

02:01:57.610 - 02:02:10.000

PATRICIA HERCULES: And when it's gone, they were going to have to go back to this, and hopefully they didn't PATRICIA HERCULES: have to do that. Hopefully they got funding. PATRICIA HERCULES: This is a lab. PATRICIA HERCULES: Just a couple of shots of what their workspaces look like.

02:02:10.930 - 02:02:22.390

PATRICIA HERCULES: And that was Dr. PATRICIA HERCULES: Paul Allison, who was pathologist. PATRICIA HERCULES: He's the one who did a lot of the work there. PATRICIA HERCULES: So the lab was really needed to be upgraded and moved into the next

02:02:22.390 - 02:02:36.850

PATRICIA HERCULES: century as well. PATRICIA HERCULES: This is a trip that they took to the Methodist PATRICIA HERCULES: Hospital. It was a physician group and the nurses group. PATRICIA HERCULES: These are the chief nurses and one of their head nurses, one of the head

02:02:36.850 - 02:02:53.870

PATRICIA HERCULES: nurses. And after we gave them their opportunity PATRICIA HERCULES: to visit and speak with people, then we gave them a PATRICIA HERCULES: certificate of completion, and they were just really happy to have that. PATRICIA HERCULES: This is the staff that worked with them.

02:02:54.110 - 02:03:11.710

PATRICIA HERCULES: And then the nursing association, which did a PATRICIA HERCULES: major significant part. PATRICIA HERCULES: Dr. Galya, who was the president, and this is the Nursing Association PATRICIA HERCULES: team. And this was actually at the 1995 conference

02:03:12.370 - 02:03:28.750

PATRICIA HERCULES: when they actually started the conference off. PATRICIA HERCULES: And this is when in Doctor Tumenova when she went PATRICIA HERCULES: in March of '96 to Dallas to begin the discussions. PATRICIA HERCULES: And this is Dr.

02:03:28.750 - 02:03:40.760

PATRICIA HERCULES: Galya and Lola Fehr when they went to Denver in '96 and sort of sealed PATRICIA HERCULES: up that relationship. PATRICIA HERCULES: The 1995 nursing conference. PATRICIA HERCULES: That's Anecita.

02:03:40.760 - 02:03:55.160

PATRICIA HERCULES: And then this is the conference attendance. PATRICIA HERCULES: It was a good attendance. PATRICIA HERCULES: The conference attendance in '96 was a higher number of PATRICIA HERCULES: attendees. But both were

02:03:55.160 - 02:04:11.600

PATRICIA HERCULES: very productive. But by this time, the Semey Nursing Association had gotten its funding. PATRICIA HERCULES: It was able to provide backdrops and posters and PATRICIA HERCULES: signs, and they had a registration table. PATRICIA HERCULES: And their dais was key officials who came and

02:04:12.270 - 02:04:26.060

PATRICIA HERCULES: welcomed everyone. PATRICIA HERCULES: It was just a beautiful situation. PATRICIA HERCULES: Natalya who was one of the nurses, one of the chief nurses, did a presentation there. PATRICIA HERCULES: This was the audience. A little over 200 came on those days.

02:04:26.060 - 02:04:37.940

PATRICIA HERCULES: That was October of '96. PATRICIA HERCULES: They videotaped this one because it was big time. PATRICIA HERCULES: It was big news in Semey to have a big conference like this. PATRICIA HERCULES: And so the local media came and videoed it.

02:04:37.940 - 02:04:55.760

PATRICIA HERCULES: And so that's just how it showed up. PATRICIA HERCULES: This is the presentation of Lola Fehr giving Galya the PATRICIA HERCULES: gavel, which was a significant event. PATRICIA HERCULES: These were the musical performers that performed during the first

02:04:55.760 - 02:05:11.270

PATRICIA HERCULES: international conference. PATRICIA HERCULES: This is a group that's got up in the middle to wake everyone up to do the Macarena. PATRICIA HERCULES: And these are the PATRICIA HERCULES: t-shirts that were given by AORN to all the conference

02:05:11.870 - 02:05:27.740

PATRICIA HERCULES: attendants that were boxes of t-shirts were distributed. PATRICIA HERCULES: And that was it was fun. PATRICIA HERCULES: We had two presenters, the one the director of the medical college from Ust, PATRICIA HERCULES: Nina Vassiluk, and then the speaker from the Bishkek, the

02:05:27.740 - 02:05:41.840

PATRICIA HERCULES: capital of Kyrgyzstan, came and spoke. PATRICIA HERCULES: The second international conference is the one that we're really focused on management PATRICIA HERCULES: and leadership, and we focused on the OR so, that that was Ruth PATRICIA HERCULES: Shumaker, who was then the president of AORN.

02:05:42.590 - 02:05:57.890

PATRICIA HERCULES: And that was the management leadership workshop that we did that where they we PATRICIA HERCULES: had certificates of completion. PATRICIA HERCULES: And this is a little bit more of the management, the medical students PATRICIA HERCULES: that actually attended that workshop.

02:05:57.890 - 02:06:11.610

PATRICIA HERCULES: And then here we go to Istanbul, which is October of '97. PATRICIA HERCULES: This is Doctor Semehat PATRICIA HERCULES: Arsel. The one in the middle. PATRICIA HERCULES: This is Mickey, the CNO.

02:06:11.640 - 02:06:20.730

PATRICIA HERCULES: This is Sylvette. She was the Turkish presenter. PATRICIA HERCULES: And that was Anecita. PATRICIA HERCULES: And then these were the other two of us, you know, that were there. PATRICIA HERCULES: So

02:06:24.980 - 02:06:42.110

PATRICIA HERCULES: this are just group photos of the PATRICIA HERCULES: presenters in Turkey and the conferences that took place. PATRICIA HERCULES: There was always a conference to sort of summarize what we did. PATRICIA HERCULES: And then the last thing we talked about was challenges, and

02:06:42.110 - 02:06:57.740

PATRICIA HERCULES: this was like the Semey airport, the airplane, and the inside of the airplane. PATRICIA HERCULES: That was a bit of the challenge that we had. PATRICIA HERCULES: We had not ever flown on Aeroflot before. PATRICIA HERCULES: And that was an interesting experience.

02:06:57.740 - 02:07:10.850

PATRICIA HERCULES: Our transportation to Kurchatov and to other places. PATRICIA HERCULES: And there's the Hotel Irtysh. PATRICIA HERCULES: It was pretty barren when we got there. PATRICIA HERCULES: And there were guards throughout the entire time that we were there.

02:07:11.420 - 02:07:21.470

PATRICIA HERCULES: Guards in the entrance. PATRICIA HERCULES: Guards at all doors. PATRICIA HERCULES: The registration area and the halls. PATRICIA HERCULES: The cooks, the attendants.

02:07:21.950 - 02:07:36.370

PATRICIA HERCULES: Very friendly individuals. PATRICIA HERCULES: They did have a lounge area that served like PATRICIA HERCULES: a work area for Sara and Armin and a snack eating PATRICIA HERCULES: area. And then this was our breakfast in the mornings.

02:07:37.130 - 02:07:54.220

PATRICIA HERCULES: We had our rolls, and our water, our cold water and our hot water. PATRICIA HERCULES: And this that is how I turned into the banquets in the evening. PATRICIA HERCULES: The nurses, like I said, provided us lunches throughout the time. PATRICIA HERCULES: And they were so gracious and so courteous.

02:07:54.220 - 02:08:07.200

PATRICIA HERCULES: And we were never hungry. PATRICIA HERCULES: We always had more food than we ever even wanted to eat. PATRICIA HERCULES: And they were wonderful chefs, so they did a beautiful job. PATRICIA HERCULES: And then the these are our two translators.

02:08:07.200 - 02:08:16.830

PATRICIA HERCULES: This was '95 translator Nalyia, and she invited us to her home to eat. PATRICIA HERCULES: And this is her family. PATRICIA HERCULES: And then this is our translator for '96 and '97.