Technology and critical thinking: What can American and Haitian nursing students learn from each other?

Lessons learned from our annual journeys to Haiti

Kristofer Splints Willow
Tim Bristol’s son Kristofer, a nursing student, provides a splint for a patient in Haiti.

Nicole is a senior nursing student from Viterbo University in Wisconsin. Like many US nursing students, she has access to high-quality technology and up-to-date information.

But today she’s working in Haiti with a partner nurse from the region. In the emergency department, they see the ravages of motorcycle accidents, untreated wounds and severe infections as well as stroke.

They perform their assessments and morning cares, working together to meet the needs of each patient, swapping comments and suggestions to arrive at the best solution. In the surgical area, they assist patients with the basics and, in many cases, buy food and medications for patients in need. In maternity, they provide care to moms and babies under the supervision of American and Haitian nursing professors.

Together they discuss the evidence base and what is possible for the client. Nicole discusses strategies such as fetal monitoring, but she’s not sure the hospital has the necessary technology. Her Haitian partner shows how they can closely replicate the very advanced processes in America with few resources, using a rudimentary monitor much like one you might buy at Walmart.

Crossing nursing cultures: what we learn from each other

Nicole was one of 80 people who joined me on a trip to Haiti earlier this year as part of an ongoing program to improve healthcare in Haiti and the US. I made my first trip in 2007 in hope of finding a nursing school to collaborate with internationally. I believed I could share my experience and knowledge from the US and, in return, learn about the way medicine was practiced in Haiti.

I met with the dean, faculty and students of the Faculté des Sciences Infirmières de Léogane (FSIL) nursing school in Leogane, Haiti, and began teaching classes in pharmacology and medical-surgical nursing. I used online course materials, including Elsevier’s Evolve platform, which which the company provided for free. Having access to a suite of nursing education tools, clinical evidence, and testing programs provided an essential backbone for the classes I was teaching. Elsevier also provided mobile access to its Clinical Decision Support tools to use in clinical settings with Haitian nurses and students. In an environment with many outdated tools and resources, giving these students and nurses instant access to an up-to-date evidence base was crucial.

While teaching, I soon realized the power of creating a sustainable relationship that would empower both Haitian and American nurses, students and faculty. Bringing US nursing students together with Haitian students was a way for us to learn from each other.

Since that trip in 2007, I have led over 550 people on trips to FSIL in Leogane. First it was groups of American nursing students. Then it expanded to members of my church and other professionals. Now the groups are mixed, flexible and have a broad reach.

In January 2010, a devastating earthquake destroyed Leogane (the epicenter of the earthquake) and took the lives of over 250,000 people. FSIL was a beacon of light and drew international attention by providing care for over 16,000 people. The Haitian nursing students stood by their faculty and Dean Hilda Alcindor. I led two teams of surgeons, nurses and workers during that time. We worked hand in hand with the US Marines and were witness to the strength and determination of these nursing students.

On these trips, I see how Americans learn about a critical thinking approach from the Haitian students. There’s a risk that unlimited access to technology and information can cause critical thinking to be neglected in the American nurse. When they see the Haitians working with so few resources and tools and solving problems in the midst of great adversity, it really challenges those critical thinking muscles to wake up and become more engaged.

On the flip side, when a Haitian nurse sees the Americans quickly accessing technology and the evidence base Elsevier provides through tools such as ClinicalKey, it really helps them begin to imagine how they can find ways to do the same. While getting to resources and information is much more difficult in Haiti, these nurses are very creative in how they find access in the most surprising of ways. For instance, when they are in a big city and able to access needed information, they may take a picture of it with their phone to use at the point of care. This exposure also helps them understand how to better use the clinical tools Elsevier has donated.

Most recently, we hosted 80 professionals, families and children from America in March. My wife, our four children and I had the honor of seeing these 80 Americans learn from, live with, and eventually develop lifelong friendships with our Haitian friends and family.

Taking nursing to higher levels

My son Kristofer is a BSN student who has been to Haiti dozens of times. When he was 15, on a trip to a clinic in the mountains, he decided he wanted to become a nurse. He now travels to Haiti twice a year and works with Haitian nursing students. He will go to clinical with them in the hospital. He serves remote communities in mobile clinics. He also helps with school health screenings on children and teens. For every clinical experience, he works next to Haitian nursing students from FSIL. His favorite service is pediatrics, and he says he feels called to serve children in the benevolent hospital near the nursing school. Working shoulder to shoulder with Haitian nursing students has proven very beneficial to him as he worked through nursing school. After completing his Doctor of Nursing Practice (DNP) degree, he wants to return to Haiti and work in primary care clinics.

American and Haitian nurses team up to deliver a course on first aid at a benevolent hospital in Haiti.

Other participants have persuaded their families to get involved. Karin Sherrill is on the nursing faculty at GateWay Community College in Phoenix, Arizona. On her second trip, she brought her husband, Mike (a technician) and their son Bryan (a civil engineering student). Karin’s main objective was to work with three other American professors to provide training for 15 of the FSIL nursing faculty. For the first three days, Karin taught clinical with the Haitian faculty. Together, they oversaw the clinical practice of Haitian and American nursing students in the local benevolent hospital. Together, they would encourage the students to dig deep, ask tough questions, and ensure that all the client needs were met. Next, they spent two days in a faculty retreat, where they collaborated on the latest evidence base in teaching nursing, looking at a number of Elsevier resources to prepare for the experience and to help frame out how the Haitian faculty can teach better in their areas of influence.

Through role play and games, Karin worked with the American and Haitian instructors on how to promote higher order thinking in the students and conduct effective assessments.

While Karin worked in clinical, her husband led a construction team to build school desks for a local elementary school. They were able to partner with their Haitian translators and share ideas as well as skills in the process. Her son was involved in evaluating local wells for integrity and safety. He observed water sources in a number of communities and partnered with local organizations to identify safety concerns. Karin and Mike have chosen to sponsor a Haitian nursing student and help to cover her tuition, room and board while she is in nursing school.

Another one of our partners – Keith Brooks – is a nursing professor at Shorter University in Rome, Georgia. Keith partnered with another faculty to bring 29 junior nursing students to Haiti. They worked alongside Haitian nurses and nursing students to train nearly 80 high school teens and teachers in CPR and first aid. With no “911” in Haiti, this training is very important.

After that, they spent three mornings in the benevolent hospital. Then they did annual physicals on over 250 children in a local school for the poor, diagnosing many issues with malnutrition, skin disease, and stomach problems. Finally, they made home visits to the families of 26 children. These children were living in shantees with little to no food; their parents were desperate. Each family visit was accompanied by an interview and followed by a gift of two week’s of food for the child’s family.

The students Keith brings all get clinical credit hours for the experience.

Making healthcare sustainable

When you travel to a developing country, it is often hard to appreciate the impact or see a difference in the buildings and structures. It can even be frustrating if you focus on what you see on the side of the road. This is why we invest in people at FSIL and in children and teens in local schools. We can see these students grow and learn and become leaders in a desperate community. When we travel to Haiti and work hand-in-hand with Haitian professionals and students, we leave part of us behind – talents, skills and hearts. We hope that will have a long impact into the future.

When you administer medication to a sick person, you help them to heal. When you administer medication to a sick person with another professional next to you, you help many people in the future.


Written by

Tim Bristol, PHD, RN, CNE, ANEF

Written by

Tim Bristol, PHD, RN, CNE, ANEF

Internationally known educational consultant and nurse educator Tim Bristol is a faculty member at Walden University, a consultant for the Haiti Nursing Foundation and the Faculté des Sciences Infirmières de Léogane (FSIL) nursing school in Leogane, Haiti, and owner of NurseTim Inc.

Dr. Bristol helps empower schools around the world at all levels of education and accreditation. He has led teams through initial program approval, interim reports and reaccreditation as a faculty member, administrator and consultant. He specializes in active learning for class, clinical and lab environments.

Schools and government organizations around the world consult with Dr. Bristol to integrate new standards, introduce curricular innovations, make education more accessible, and develop strategic plans. As a faculty development and curriculum design specialist, he is an expert in bringing the evidence base of nursing, healthcare and education to students and faculty in the United States and Haiti.


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