A Project Director's Reflection on the Impact of the Vietnam Nursing Project: Ten Years Later

To provide additional leadership capacity and expand the Project’s activities and involvement of other faculty and graduate students, two faculty in the SONHP joined the Project as Associate Directors; Professor Gregory DeBourgh, EdD, RN in 2008, and Associate Professor Susan Prion, EdD, RN, in 2009. In 2013, Dr. Prion was awarded a prestigious Fulbright Scholarship, establishing a six-month residency in Hanoi to work with nursing staff in the intensive care unit of the Thanh Nhan Hospital to establish evidence-based patient care protocols for nurses to use in prevention of pressure ulcers among the critically ill patients. Dr. Prion’s work was so successful that her research-based standards and procedures have been disseminated for use by the Project’s other partner hospitals that are owned and operated by the Hanoi Department of Health.

Enough cannot be said about the dedication and commitment of Drs. DeBourgh and Prion to advancing the practice of nursing in Vietnam. Both professors are active participants in designing and delivering the Project’s international initiatives and activities in addition to their full teaching schedule at the SONHP, and their other professional, academic, and practice engagements in local and national venues. In addition to Drs. DeBourgh and Prion, the VNP has had the honor to welcome over 100 registered nurse volunteers to date from across the U.S. to join us for our annual teaching and consultation visits in Hanoi. These volunteers give their own time and resources to participate in the Project’s activities and represent the University of San Francisco. Without volunteers, the work of the VNP could not be accomplished.

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Enthusiastic students in Hanoi engaged in learning new knowledge and skills.

The VNP’s principal partners in Vietnam are five medical centers in Hanoi, and the country’s professional nursing association: Thanh Nhan Hospital, Viet Duc Hospital, Bach Mai Hospital, National Hospital for Tropical Diseases (Vietnam’s equivalent of the U.S. Centers for Disease Control), the National Burn Hospital (a military hospital), and the Vietnam Nurses’ Association. In addition to our practice and education partners in Hanoi, the VNP actively supports the provision of resources and primary health care to the children of the St. An’s orphanage in association with Project Being There, Nashville, TN.

The orphanage support program was started by Robert Geibert, EdD, RN and Ann Nguyen, RN, CNL; both VNP volunteers. Ann is a graduate of the USF SONHP’s graduate nursing program and a recognized wound care expert. The initial focus of the Project’s work at the orphanage was to complete physical assessments for all 80 children (ranging in age from newborns to 18 years), and for the 27 staff members. Each child and staff member now has an established medical record that is documented in both Vietnamese and English.

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Project volunteer Vera Komisarjevsky provides primary health care services at St. An’s Orphanage

The most recent support activity is to help finance the installation of a clean-water system at the St. An’s Orphanage. Prior to the installation of the new water system, the orphanage got its water from a small pond located on the grounds. Two VNP volunteers from Florida, Erin Rainey, RN, MSN and Marcia Sweasey, RN, MSN, raised over $2,000.00 from their hospital’s National Nurses’ Week celebration as part of their institution’s annual “Pay It Forward” program. Both Erin and Marcia returned to Hanoi this January 2016 for their second visit to serve on the VNP’s Team Hanoi annual service visit, and provided leadership to coordinate the St. An’s Orphanage primary care services visit.

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Vietnam Nurse Project volunteers prepare for a visit to the St. An’s Orphanage

To date the VNP has enjoyed the participation of three SONHP doctor in nursing practice (DNP) students to complete their DNP practice improvement projects in Hanoi. Current Assistant Professor Dr. Helen Nguyen, DNP, RN, completed her project on the introduction of evidence-based standards and simulation instruction for neonatal resuscitation procedures at the Bach Mai Hospital neonatal intensive care unit. Her work remains the standard for neonatal resuscitation at the Bach Mai Medical Center.

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USF Assistant Professor Helen Nguyen introduces the instructional use of simulation at Bach Mai Hospital

Another SONHP graduate, Arunee Nakhongsri, DNP, RN, completed her practice improvement project, introducing the first multidisciplinary, evidence-based protocol for the prevention of ventilator associated pneumonia (VAP) in the intensive care unit at Thanh Nhan Hospital. Dr. Nakhongsri’s project is now standard practice in all intensive care units throughout the 37 health care institutions owned and operated by the Hanoi Department of Health, and has been disseminated by the Vietnam Nurses’ Association throughout the entire country of Vietnam.

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USF Doctoral student Arunee Nakhongsri introduces new clinical protocols for oral care

Additionally, nurses from Thanh Nhan Hospital were asked to visit their colleagues at the nearby National Hospital for Tropical Diseases to introduce the protocol and educate the medical center staff in use of this patient care protocol. This request has great significance as it is the first time Hanoi Department of Health hospital staff were asked to visit a Ministry of Health hospital to teach their colleagues best practices.

Another of the SONHP’s graduates, Amy Ly, DNP, RN also conducted her project at the Thanh Nhan Hospital, Endocrinology Out-patient Department. Dr. Ly’s project focused on establishing assessment protocols and teaching nurses in the diabetic primary care clinic how to perform foot assessments on newly diagnosed type-2 diabetic patients to result in the early diagnosis and implementation of preventive health care practices to minimize diabetic foot injuries.

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Amy Ly, DNP student from the SONHP delivers live, interactive broadcast to nurses in Hanoi

Prior to Dr. Ly’s project, nurses at Thanh Nhan Hospital were not permitted to perform initial physical assessments in the Endocrinology Department. The leaders of the Thanh Nhan Hospital were so pleased with the outcome of Dr. Ly’s project, that this expansion in the scope of nurse practice has become a new performance standard in the Endocrinology Department. Dr. Ly’s documentation model for primary care foot assessments was also the first to be designed by a foreign nurse and integrated as a permanent record in all Hanoi Department of Health Medical Centers patient records. All three of the USF SONHP DNP projects introduced the concept and practice of evidence-based care, an expanded role for Vietnamese nurses, and has advance the professional contributions and clinical practice of nurses into areas formerly controlled by physicians.

In 2012, the Vietnam Nurse Project in cooperation with Hanoi’s Thanh Nhan Hospital, implemented the country’s first-ever Virtual Nursing Grand Rounds (VNGR). This monthly, real-time interactive video conference platform uses Zoom software to broadcast educational programs and provide clinical consultation services to staff in the hospital. The “grand rounds” sessions are recorded for distribution to other Vietnam health care facilities. This design and implementation of this Project activity has been so successful that we have invited our other Hanoi practice partners to join the live broadcasts. We currently broadcast to 5 major medical centers in Hanoi.

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Wound care expert and USF graduate Ann Nguyen teaches staff in the intensive care unit

The nurses identify a patient they wish to be presented for clinical management consultation during the VNGR broadcast, and VNP leaders invite school faculty and DNP students, as well as nurse experts from the greater San Francisco Bay Area to present programs and provide resources to promote the evidence and “best clinical practices” to expand the impact of nursing practice and promote improved patient outcomes. In 2016, the Project plans continued support of the VNGR broadcasts through a planned “handover” of production and presentation by our partner Vietnamese colleagues and leaders of the Vietnam Nurses’ Association to amplify the distribution and impact of this developmental activity. The future “in-country” production of the VNGR broadcasts will be produced in Vietnamese, by Vietnamese nurses.

For the 2016 VNP annual Hanoi visit, the project leaders and the 14-member volunteer Team Hanoi returned with a very busy schedule. The team was engaged in 33 educational events in 6 different venues in 5 days, plus a two-day visit to St. An’s orphanage to provide primary health care services for the children and staff.

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Dr. Crow meets at the Thanh Nhan with the First Nurse Practice Council in Vietnam

A highlight of the 2016 visit was the invitation to present to hospital leaders and the professional community at Thanh Nhan Hospital original research conducted by Drs. Gregory Crow, Nguyen Thanh (the physician director of the Thanh Nhan Hospital ICU), Gregory DeBourgh, and Paul Smith of Merritt University. The research team conducted a qualitative study to explore the meaning of being a nurse in the Thanh Nhan Hospital ICU. This research was also presented at the Vietnam Nurses’ Association’s annual research conference in October 2015 by Drs. Crow and Nguyen. It is hoped that the findings of this study will inform insights for appropriate contributions by international educators wishing to support the expansion and professionalization of nursing practice in Vietnam.

In cooperation with our Vietnamese partners, SONHP DNP students, and the Vietnam Nurse Project volunteers over the past 10 years, the following are highlights of our success and impact. It is with great pride as the Vietnam Nurse Project Director, that I share these highlights.

Impact Highlights of the Vietnam Nurse Project:

• Introduction of evidence-based practice and best-practice clinical protocols to improve the quality and safety of patient care services provided by colleagues in Vietnam
• Support for leadership development using the shared governance model
• Supported launch of the first Nurse Practice Council in Vietnam in the Intensive Care Unit at the Thanh Nhan Hospital; the innovative model led to establishing of the first Hanoi Nurse Collaborative Council with representatives from each of the VNP partner facilities. The purpose of the Collaborative Nurse Council is to coordinate changes and advances in practice, and share knowledge and skill resources among their respective hospitals.
• Introduction of the first Virtual Nursing Grand Rounds in Vietnam
• Modeled and taught educator colleagues to use student-centric instructional strategies to promote active engagement of learners
• Provided and modeled use of competency-based nurse education and clinical practice
• Introduced and reinforced use of the Nursing Process to plan, implement, and evaluate nursing care managed by nurses
• Mentorship of the SONHP’s DNP students to develop, deliver, and evaluate their practice change projects in Hanoi
• Ann Nguyen, RN, CNL (a USF graduate) becomes the first nurse ever invited to present at the National Burn Association meeting in April 2015 in Ho Chi Minh City
• Completion of two faculty-led research projects at the Thanh Nhan Hospital
• To date, over 10,000 Vietnamese nurses and leaders have attended VNP workshops
• Honoring their work as recognized by the VNP leaders, in 2014 the very first DAISY Award ever presented in Vietnam was given to the nurse team in the intensive care unit of Thanh Nhan Hospital in celebration of the extraordinary clinical skill and compassionate care given by nurses every day; the award founders, Mark and Bonnie Barnes, flew to Hanoi to personally present the award to the nurses
• Established an ongoing professional relationship with the Vietnam Nurses’ Association and their three sub-groups: educator branch, practice branch, and the newly-formed surgical branch to promote the professionalization and advance the knowledge and skills of practicing Vietnamese nurses

With the progressive and ongoing support of Dean Judy Karshmer, the Vietnam Nurse Project has enjoyed significant success and impact over the past 10 years working with nurse and physician colleagues in an international setting to advance the health care expertise of our Vietnamese colleagues. The Project is grateful not only for the leadership support at the University of San Francisco, but for the dedication of the Project’s volunteers, and for the active involvement of our own students-our future leaders-who have helped us to support an emerging future in a developing international health care setting, and to advance our University’s mission to “change the world from here”.