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PROBLEM
Nursing is at a crossroads in Georgia. There is no nursing program in existence in a higher education setting and there are no nurses in Georgia who have been educated in a university based baccalaureate program.
The current nursing education system is illustrated by this report of a visit to a private nursing school in Tbilisi:
The students are selected by interview and test at the end of the ninth grade or eleventh grade. The ninth graders have three years, with the first being preparatory subjects--biology, chemistry, math, English. The eleventh graders spend two years. The School advertises May through August. The raison d'etre for the nursing school is profit: tuition from the students. Tuition is $300 per year. Outstanding students who cannot pay that much get a scholarship of $150 per year. The curriculum is general nursing, with some specialization--e.g. pediatrics. They have fifty nursing students in the 2nd and 3rd years, 25 each year. There are also thirty midwifery students (with seven faculty for them), 120 dental technicians (!), and 20 pharmacy students. The school began in 1992 after the breakup of the Soviet Union and Georgian independence. Clinical faculty at the hospitals are paid by the school. Many of the texts are 1988 Russian ones; they have a 1995 Russian obstetrics text. State exams are given at the end of the course: 65% of the students pass the first time. They can only take the exam twice.
The major problems in the school: old Soviet curriculum; old books; no learning resources; faculty trained in similar non-baccalaureate program.
The Atlanta-Tbilisi partnership has had nursing very much as a presence in the overall planning of a new healthcare system for Georgia. If the healthcare reform movement is to succeed it will require nurses that are educated in a manner that will support such a system. Well-educated nurses are pivotal in executing a primary care/health promotion/disease prevention model. Nurses can provide health promotion and disease prevention approaches to populations in both urban and rural areas. Prevention of disease in a time of scarce medical resources is a major way to reduce healthcare expenditures.
There are no nursing programs in Georgia now that can educate nurses who are able to function in a modern health care system. Although under development, nursing licensure and nursing standards, which protect the public, have not been implemented. Recommendations from World Bank consultants visiting Georgia in May of 1997 and others have emphasized the need for university based nursing education.
ACCOMPLISHMENTS
Nursing reform efforts by the Atlanta-Tbilisi partnership has focused upon training nurses in practice, physical assessment and skills development, and elevating the professional level of nursing. A nursing infrastructure was begun at the Ministry. During 1997 alone 54 nurses were trained in nursing leadership and 30 in nursing skills in Atlanta at Grady Hospital and Georgia State University. Four nurses spent one month in Atlanta in an advanced leadership and teaching course. The Georgian Nursing Association was founded by the Partnership.
An illustration of what can be and is being done now is given in this report of the activities of Dr. Dodo Shelia, an obstetrician who is Deputy Mayor of Kutaisi, the second largest town in Georgia with a population of around 600,000:
A 'Nurse Communicator' program, or 'Health Prevention in Communities'. There is a nurse in every small village who has been contracted by Dr. Shelia. The nurse gets paid when he or she turns in statistical forms (births, deaths, maternal deaths, vaccinations, diarrhea cases, etc.). The nurse is primarily in charge of women and children's health. Basically, said Dr. Shelia, the nurse is a 'nurse communicator'.
In each village the schoolteacher sets up a Health Committee. The teacher organizes the community leaders into this committee. There are 11 rayons (like counties) in the province. 131 ambulatory clinics. Each of the communities has about 2,500 people.
Dr. Shelia publishes a newspaper, Health, which is given free to high schools.
Kutaisi has 43 schools, and Dr. Shelia has a chief nurse in each one, who is responsible for seeing to the health of the students, including vaccinations, fitness for sports, and so forth.
Now there are 195 of the contract nurses described above. In 60 of the clinics there are MDs; in others nurses provide all the care. Dr. Shelia has a job description for the nurse communicator, which she gave me in Georgian and I will get translated.
Here is a list of all Dr. Shelia's programs, proposed and implemented:
1. Nurse Communicator. Implemented
2. School monitoring by chief nurse. Implemented
3. Women's health program for newly weds. Implemented.
4. Physical status of school children, especially those engaging in sports. Implemented.
5. Community health management. General practitioners. Implemented
6. Pre-school evaluation of children. September 1998.
7. Family planning. Date not set.
8. Family doctor program. Date not set.These activities--partially implemented--illustrate in full measure the crucial role nurses can play in the healthcare system. With a higher level of education their potential for changing the face of public health is limitless.
The nurse participants from both sides of the Atlanta-Tbilisi partnership have put forth a great deal of effort in implementing a three-tiered approach to upgrade the nursing profession. The plan has encompassed the enhancement of skills of practicing nurses, the development of a professional nursing organization to assist in dissemination of education to the community of nurses and the implementation of a university based program for nursing education.
The accomplishments of the Atlanta-Tbilisi partnership exchanges within the nursing profession with respect to establishing high level nursing education in Georgia are:
Ongoing consultation since 1992 regarding the nursing profession with Minister of Health Jorbenadze and his Health Care Reform Team.
Institution of the Georgian Nurses Association, an organization that will write and maintain standards for the profession, offer continuing education for existing nurses and act in an advisory capacity to the Minister of Health concerning nursing as a profession. Examples of US Standards have been provided as a model for Georgian nursing.
Appointment of a nurse advisor to the Ministry of Health.
1996 agreement between Javakishvili Tbilisi State University (TSU) and Georgia State University (GSU) in Atlanta to cooperate in launching a university based, baccalaureate nursing program.
Grant funds from intramural International Program Development at Georgia State University for two years to support Transcaucasus educational projects.
1997 month long visit of two physicians from Tbilisi State University to Georgia State University School of Nursing and Emory School of Medicine in Atlanta to start School of Nursing planning.
Opening of the Nursing Resource Center in the National Information Learning Center in Tbilisi in March of 1998.1998 month long visit of three physicians from Tbilisi State University to Georgia State University School of Nursing plan and develop School of Nursing curriculum.
Return visit to Tbilisi of GSU School of Nursing Director and Undergraduate Program Director to plan school of nursing site.
Promise by the Minister of Health in April of 1998 to furnish 50,000 Lari to assist Tbilisi State University in starting a School of Nursing.
Visit by Dr. Roin Metrevili, Rector of Tibilisi State University to Georgia State University in fall of 2000 to reiterate commitment of both his university and the Minister of Health to implementing the nursing education program at Tbilisi State University.
Workshops in continuing education for nurses and for train-the-trainers
MORE INFORMATION
New Nursing School Proposal by Judy Wold PhD [PDF file]
CONTACTS
Judy Wold <jwold@langate.gsu.edu>
Laura Hurt <tblnsg@igc.org>Leah Mamaladze <gna@nilc.org.ge>
Georgian Nurses Assoc. <nlrc@nilc.org.ge>LINKS:
Georgia State University School of Nursing
[http://chhsweb.gsu.edu/nursing.asp?section=SCHOOLS%20%26%20DEPARTMENTS&option=School%20of%20Nursing]Grady Health System [http://www.gradyhealthsystem.org/]
Georgian Nursing Association [http://212.72.145.221/Maro/nurses/Georgian-nurses.htm]Women's Wellness Center, Kutaisi
[http://www.aiha.com/english/partners/kutaisi/index.htm]
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