The Regis College Haiti Project (RCHP) is an international partnership between Regis College School of Nursing, Science, and Health Professions, the University of Haiti, and Haiti’s Ministry of Health. In February 2014, with completion of a three-year program, 12 nursing faculty members were awarded Master of Science in Nursing (MSN) degrees from the University of Haiti. Through the commitment of Regis College, three cohorts over the course of seven years will obtain their master’s degree and provide sustainable nursing education advancement to all nurses in Haiti.
With this strategic plan, the RCHP enables us to build a dynamic and mutually beneficial, sustainable nursing program where faculty members in Haiti will be qualified to teach as well as produce educated nurses to serve in primary care areas and assume leadership positions with colleges, hospitals, and other health care organizations. Nurses are the key component in a health care system, and providing sustainable nursing education to a developing country is the cornerstone to the betterment of health care delivery.
Building a Relationship with Haiti
The initial stage of this international relationship began in 2007 when the president and several faculty from Regis College travelled to Haiti to meet with the ministry of health and nursing leaders to determine how they could establish a collaborative agreement to improve nursing in Haiti. A primary goal in the strategic plan of the college, among many objectives, is to establish an international footprint through interdisciplinary academic programs, the spirit of collaboration, and student-centered values. The vision statement of the college inspires all to work within its multicultural community and to be actively engaged as leaders and ambassadors of social change.
To develop a strategy, nursing leaders from both Haiti and Regis College consulted and discussed schedules, time commitment, action plans, and long-term sustainability. The mission of the RCHP is incorporated in developing an international nursing partnership. Through this vision of partnership is the goal to improve the health and well-being of the people of Haiti by elevating the level of nursing education and the sustainability of advanced nursing practice.
The RCHP is designed for the registered nurse in Haiti to earn both the baccalaureate and the master’s degree. Its purpose is to prepare nursing educators and nursing leaders to assume a guiding role in the effort to address Haiti’s pressing health care needs. Nurse administrators with advanced nursing education have a unique perspective in the assessment of health disparities and challenges faced in providing care to a vulnerable population. After completion of this program, they will be able to collaborate with local professionals; assist in the creation of sustainable, community-focused programs; practice collaboratively as members of interdisciplinary teams; and deliver population-focused care while reflecting on the impact of poverty and socioeconomic factors.
Specifically, this project seeks to address the acute nursing shortage in Haiti and overall advance the level of nursing education in the country. A 2003 study published in The Journal of the American Medical Association concluded that nurses prepared at the baccalaureate level or higher have significantly better patient outcomes. Partnering with our Haitian neighbors provides a new and expanded role for nurses in a developing country. Upon graduation with a MSN, this first cohort of Haitian faculty will lead the institutionalization of the master’s program for all future Haitian nursing faculty.
Currently, the public nursing schools prepare three-year diploma graduates with their focus on hospital-based care. The objective of this program is to educate Haitian nursing faculty, who can then provide baccalaureate education to all nurses in Haiti and be role models in nursing leadership.
In order to produce a new generation of nursing leaders in Haiti, capacity building is necessary. This entails a society enhancing their abilities to “perform core functions, solve problems, define and achieve objectives; and understand and deal with their development needs in a broad context and in a sustainable manner,” as described in the International Institute for Educational Planning’s Guidebook for Planning Education in Emergencies and Reconstruction. The strategies needed to accomplish this mission include the following: enhancing professional development through curriculum building; analyzing the relationship between theory, practice, and evidence-based research; synthesizing the organizational structure of nursing leadership; and promoting innovative educational methodologies.
Project Planning and Implementation
The RCHP is committed to educating three cohorts of Haitian nursing faculty over the course of seven years, with two overlapping cohorts in the summer of the third year, which would serve as transition and mentorship periods. The sidebar outlines the three years of the program and the required coursework for each cohort (see page 42).
The program began in the summer of 2011 with 12 Haitian nurse faculty from nursing schools across Haiti coming to Regis College in Weston, Massachusetts, for a six-week intensive program of study where orientation and tutorials on computer systems were provided as well as weekly graduate student dinner seminars. Each Haitian nurse faculty was paired with a Regis College nursing faculty member who remained the nurse’s mentor throughout the course of the program. The match of mentors was based on professional experiences and shared interests. The mentors served as academic and professional advisors as well as social support, and they offered guidance throughout the academic year.
When the Haitian nurses were at Regis College during summer sessions, there were opportunities for in-person interactions between mentors and mentees. In addition, the Haitian faculty had the opportunity to shadow nurses at several of the large metropolitan hospitals where they observed cutting-edge technology in both medicine and nursing. During the fall and spring semesters, the mentors and mentees maintained contact via e-mail, Facebook, Adobe Connect, and Skype, and they received technical support through Regis.
During the first year of the program, Regis College nursing faculty traveled to Haiti, where they taught in an intensive five-day format addressing trends affecting community health nursing—specifically, societal and population shifts in the different regions of Haiti following the 2010 earthquake. Morbidity and mortality concerns were also addressed in conjunction with the changes and evidence of population shifts into the cities secondary to the aftermath of the earthquake and the environmental changes. In conjunction with the Regis College philosophy of nursing—which identifies the four central concepts of the nursing discipline as person, environment, health, and nursing—each of the 12 Haitian nursing faculty identified a specific health problem endemic to their community. This was followed by identifying priorities, establishing goals, and determining interventions based on the central tenets of the philosophy. In order for the Haitian faculty to analyze a community health problem comprehensively, we introduced the epidemiologic triangle, the traditional model for infectious disease addressing the external agent or the cause of the health problem, the susceptible host identified in the community, and the environment in which the host and agent came together leading to a specific problem or outcome.
During the second year of the program, the 12 Haitian nursing faculty returned to the campus for a five-week intensive session of clinical and classroom learning over the summer of 2012. The following spring, Regis faculty traveled to Haiti for a one-week intensive training supplemented by online learning.
At the start of the third year, the 12 Haitian nursing faculty returned to the campus in the summer of 2013, where they took part in another five-week intensive session of clinical and classroom learning. Simultaneously, the 12 Haitian nursing faculty who were selected for the second cohort also arrived to the Regis campus for the first time to begin their first year of the program. With the help of Regis nursing faculty, the first cohort became the mentors for the incoming cohort and worked together to teach two out of the four courses taken by the second cohort. The first cohort continued to take two courses alongside the second one.
In February 2014, Regis nursing faculty returned to Haiti during the mentorship period. The first cohort of Haitian nurses assumed the role of educators as they taught nursing theory, nursing leadership, and community health to the second cohort of nurses. With awareness of the shift away from traditional hospital-based care and movement toward the community, they introduced new models of care supported through collaboration in practice and education.
An example presented by the second cohort was Roy’s Adaptation Model, as it was reconceptualized and expanded in order to provide a framework for the delivery of community-based nursing. Using this theoretical framework, they encompassed population-based assessments that related to the physical, psychological, and social integrity of their community. Through this model, they identified the central concepts of the discipline of nursing with the understanding that every person has inherent dignity and worth as well as a right to receive comprehensive, compassionate health care. They viewed the person in the community as a unique biopsychosocial, cultural, and spiritual being who continuously interacts with the environment.
Using Roy’s Adaptation Model as an adjunct in the coordination of community health in Haiti offered the nurses an organized approach in the assessment of their community, incorporating the philosophic components of person, environment, health, and nursing. Through discussion of the physical integrity, their view was broadened as they identified topics incorporating nutrition, the environment, available resources, and government regulation. In discussion of the biopsychosocial characteristics, identifiers such as age distribution, gender, education, and economics were discussed.
The social integrity of the community presented another perspective in assessment of a specific community by focusing on vital statistics, such as births, deaths, prevalence of communicable and chronic disease, leading causes of mortality, and health resources. Using these guidelines in data analysis assisted with community care planning by identifying a community diagnosis, an awareness of the problem, community motivation, and realistic interventions to resolve the problem.
Challenges and Outcomes
A course challenge in our collaborative efforts of educating our Haitian colleagues was the language difference. This was addressed using a bilingual educational platform. Educational material using PowerPoint was introduced with French translation. In addition, an in-class translator was present to translate lectures, questions, and small group discussions. Through the use of Adobe Connect, Moodle, an internet connection, and e-mail, we were able to provide effective international collaboration. This also allowed rigorous evaluation that strengthened the educational models used in promoting effective community health systems for the Haitian nursing faculty. The inability to access French-translated textbooks on community health nursing and nursing theory posed another challenge, but we were able to address it by utilizing a French publishing company.
Through enhancement of scholarship and curriculum development, the new graduates will increase community awareness as well as strengthen and analyze how the environment and personal health behaviors are interrelated. Being part of the community afforded the Haitian nursing faculty the opportunity to influence and motivate others. Their understanding of Haitian lifestyle, culture, and social skills provided them practice opportunities and professional collaboration in addition to critical analysis within the community. It allowed them to be part of effective community action by contributing to the resolution of a problem.
The outcome of the first cohort came to fruition in February 2014 when the University of Haiti awarded master’s degrees to all 12 faculty members representing nursing schools across Haiti from Gonaïves, Les Cayes, Port-Au-Prince, Jérémie, Cap-Haïtien, and University of Notre Dame d’Haiti. Subsequent to achieving the master’s degree, many of the first cohorts have assumed leadership roles in their schools of nursing. One in particular was appointed dean of her nursing school, while others are taking an active role participating in professional conferences in order to enhance the international influence of nurses. Others are enhancing course content through curriculum development and are reaching out to community leaders in order to develop collaborative relationships with interdisciplinary teams. In addition, membership in professional associations has offered the Haitian nurses recognition of their expertise through certification—providing them an opportunity to make a difference and lobby to influence laws affecting nursing.
In providing new and expanded skills in nursing education, this international partnership will help ensure that nursing education in Haiti continues to progress throughout the 21st century with the use of critical thinking, problem solving, and evidence-based practice. Through collaboration, the Haitian nurses have the capacity to build sustainable nursing programs that are beneficial and dynamic for the Haitian society.
To learn more about the Regis College Haiti Project, visit www.regiscollege.edu/global/haiti-project.cfm.
Susan S. Sawyer, PhD, RN, CPNP, Allison Bernard, DNP, MSN, Cynthia Bashaw, MS, APRN, BC, FNP, Kellie LaPierre, MS, APRN, BC, GNP, Cherlie Normilus, MS, APRN, BC, FNP, and Nancy Street, ScD, APRN, BC, PNP