The Ottawa Charter Twenty Years On –

an International Nursing Student

Exchange Program Perspective

19th IUHPE World Conference Vancouver 2007

Inequalities in health and access Inequalities in health and access to health care for rural to health care for rural

communities – an EU/Canada communities – an EU/Canada funded student exchange funded student exchange

programprogram

International PartnersInternational Partners

• CanadaCanada

Mount Royal College CalgaryMount Royal College Calgary – Pam – Pam Nordstrom, Maureen MitchellNordstrom, Maureen Mitchell

Universite de MonctonUniversite de Moncton – France – France Marquis and France ChasseMarquis and France Chasse

University of Prince Edward IslandUniversity of Prince Edward Island – – Kimberley Critchley and Barb CampbellKimberley Critchley and Barb Campbell

International PartnersInternational Partners

• EUEU England, Bournemouth UniversityEngland, Bournemouth University – Ann – Ann

Hemingway and Eileen RichardsonHemingway and Eileen Richardson Sweden, University of UppsalaSweden, University of Uppsala – Clara Aarts – Clara Aarts

and Eva Bergknutand Eva Bergknut Finland, University of Applied Sciences Finland, University of Applied Sciences

SavoniaSavonia – Liisa Koskinen – Liisa Koskinen Estonia, Tallinn Health CollegeEstonia, Tallinn Health College – Tiina – Tiina

JuhansooJuhansoo

The focus of the student exchangeThe focus of the student exchange

To enable students to experience To enable students to experience public healthpublic health

focused focused practicepractice in another country, specifically in another country, specifically focusing on rural inequalities in health and focusing on rural inequalities in health and access to health care.access to health care.

To enable students to undertake a meaningful To enable students to undertake a meaningful exchange program enabling them to gain exchange program enabling them to gain insights into, and experience of another culture.insights into, and experience of another culture.

This presentation will cover how the This presentation will cover how the students used the Ottawa Charter to students used the Ottawa Charter to try to better understand inequalities.try to better understand inequalities.

Duration and extent of the projectDuration and extent of the project

• From Oct 2004 to Sept 2007From Oct 2004 to Sept 2007

• A total of 24 EU students and 40 Canadian A total of 24 EU students and 40 Canadian students will undertake an exchange students will undertake an exchange

• Each exchange visit lasts approx. 12 Each exchange visit lasts approx. 12 weeksweeks

While the students were away they While the students were away they were expected to:were expected to:

Write an academic assignment focusing Write an academic assignment focusing on one of the on one of the Ottawa CharterOttawa Charter areas. areas.

The area the student chose from the The area the student chose from the charter then acted as a framework for charter then acted as a framework for them to consider inequalities in access them to consider inequalities in access to health care and health improvement to health care and health improvement work.work.

Developing personal skillsDeveloping personal skills (n=11)(n=11)

Changing of attitudes, empowerment skills.Changing of attitudes, empowerment skills.

Re-orienting health Re-orienting health servicesservices (n=11) (n=11)

Consideration of the social determinants of health Consideration of the social determinants of health e.g. the importance of cultural issues to the health e.g. the importance of cultural issues to the health of native people, collaborative working.of native people, collaborative working.

Strengthening community Strengthening community action (n=10).action (n=10).

Enabling people to choose healthy lifestyles, Enabling people to choose healthy lifestyles, improving the infrastructure: bicycle tracks, improving the infrastructure: bicycle tracks, footpaths, sidewalks, evening light along walk footpaths, sidewalks, evening light along walk tracks. tracks.

Creating supportive Creating supportive environments (n=6)environments (n=6)

Supportive caring environments for staff Supportive caring environments for staff and patients.and patients.

BBuilding healthy public uilding healthy public policypolicy (n=3)(n=3)

Parental leave, lack of access to Parental leave, lack of access to contraceptives, abortion or medicines.contraceptives, abortion or medicines.

Areas Chosen from Ottawa Charter

Munich Declaration Nurses and Midwives: A Force Munich Declaration Nurses and Midwives: A Force for Health (2000)for Health (2000)

Islamabad Declaration on Strengthening Nursing Islamabad Declaration on Strengthening Nursing and Midwifery (2007)and Midwifery (2007)

Nurse education needs to enable nurses to Nurse education needs to enable nurses to “contribute to decision making at all policy levels “contribute to decision making at all policy levels (development and implementation) and to be (development and implementation) and to be active in public health and community active in public health and community development”, particularly in relation to the development”, particularly in relation to the development of positive practice environments.development of positive practice environments.

Did students not Did students not address address building healthy building healthy public policy and public policy and practice environmentspractice environments in their assignments in their assignments because what they saw because what they saw in practice was health in practice was health education?education?

OrOr

Was it because the Was it because the nurse education system nurse education system prepared them to focus prepared them to focus on health education not on health education not policy development policy development within their within their undergraduate undergraduate programmes?programmes?

Inequalities/inequitiesInequalities/inequities

• This area was poorly developed in This area was poorly developed in the student assignments with no the student assignments with no definitions given.definitions given.

• Examples given: the health of Examples given: the health of Aboriginal populations, less access to Aboriginal populations, less access to medical doctors in rural areas, and medical doctors in rural areas, and inequalities between economic inequalities between economic classes, genders, and age groups. classes, genders, and age groups.

• Students view RN’s as part of an Students view RN’s as part of an interdisciplinary team that improves interdisciplinary team that improves community healthcommunity health

• They did not articulate a unique role for RN’s They did not articulate a unique role for RN’s in primary healthcare or tackling inequalities in primary healthcare or tackling inequalities (at odds with Munich Declaration 2000, and (at odds with Munich Declaration 2000, and Islamabad Declaration 2007)Islamabad Declaration 2007)

• They considered RN roles in other countries They considered RN roles in other countries and were beginning to analyse and compare and were beginning to analyse and compare one health system to anotherone health system to another

Implications for NursingImplications for Nursing

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

Students need to be introduced to Students need to be introduced to international policy relevant to their roles and international policy relevant to their roles and responsibilities as a global practitioner.responsibilities as a global practitioner.

Implications for Nursing EducationImplications for Nursing Education

Implications (con’t)Implications (con’t)

The presence of faculty at the visiting site who The presence of faculty at the visiting site who understood primary care, and health inequalities understood primary care, and health inequalities helped to facilitate the students’ learning during helped to facilitate the students’ learning during their exchange to another country.their exchange to another country.

Faculty need to work diligently at understanding Faculty need to work diligently at understanding the intentions of colleagues at other institutions. the intentions of colleagues at other institutions. While we might use similar language we don’t While we might use similar language we don’t always mean the same thing! always mean the same thing!

ConclusionConclusion

• Enabling health students to gain practical placements in Enabling health students to gain practical placements in public health focusing on health inequalities during their public health focusing on health inequalities during their initial education does not happen universally.initial education does not happen universally.

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

• Giving students this opportunity (not necessarily overseas) Giving students this opportunity (not necessarily overseas) supported by formal assessed educational input would help supported by formal assessed educational input would help to ensure that future health professionals see tackling to ensure that future health professionals see tackling inequalities in health as a key part of their role and have inequalities in health as a key part of their role and have both the experience and insight to underpin their both the experience and insight to underpin their responsibilities in this area.responsibilities in this area.

I missed my bicycle

I missed my car

I missed my boyfriend

The Ottawa Charter Twenty Years On –

an International Nursing Students

Exchange Program Perspective

19th IUHPE World Conference

Vancouver 2007