Why on earth am I getting up at this hour on a Friday morning while studying abroad? The answer: I am a nursing student holistically experiencing the Irish approach to nursing education. Monday through Thursday, I am on the campus of the School of Nursing, Midwifery, & Health Systems at University College Dublin taking lecture courses. On Fridays, I have clinical placement.
It has been quite interesting to compare and contrast the educational systems of Ireland and the United States. Speaking objectively, one is not more beneficial than the other; they are simply different, each having its own strengths and weaknesses. Here in Ireland, there are far less graded assignments; I am going into week seven (a total of 12 weeks), and I have yet to have a single graded assignment! The lectures are much larger than Georgetown’s. In terms of clinical differences, Irish students do not undergo placements concurrently with their lecture courses. Rather than having one or two days of clinical per week as occurs at Georgetown, Irish students go out on placement for weeks at a time, often with three long days per week. Additionally, Irish students specialize from their first day at college, either general, pediatric, or psychiatric nursing or midwifery.
I have been asked why I applied to undergo clinical placement in a different country. Primarily, I applied to increase my cultural competence, which is defined as “care that is planned and implemented in a way that is sensitive to the needs of individuals, families, and groups from diverse populations within society” (Taylor, Lillis, LeMone, Lynn, 2011). By working in a different health care delivery system with a broad array of patients, I will learn the skills necessary to adapt and provide care specific to my patient and his/her specific needs.
Thus far, I have spent 60 hours in the clinical setting at St. John of God Hospital, a private mental health facility. According to the Irish Central Statistics Office’s most recent survey, 43.8 percent of the Irish population has private health insurance. Thus, the majority of the population will not have access to specialist, private mental health hospitals like St. John of God. In fact, only two such hospitals exist in the country! (Though, many hospitals do have specific mental health wards). I challenged myself to ask questions in order to get a complete view of the Irish healthcare system from the lens of mental health. As I hypothesized, the stay of mental health patients in private hospitals greatly exceeds that of public hospitals. For example, the Eating Disorder Recovery Program at our hospital lasts 12 weeks for inpatients. In the public setting, the treatment equivalent may be conducted on an outpatient basis.
The Mental Health Commission oversees all mental health services, both public, including Ireland’s Health Services, and private. The commission’s primary focus is to “promote, encourage, and foster high standards and good practices in the delivery of mental health services and to protect the interests of patients who are involuntarily admitted.” The commission was created following the enactment of the Mental Health Act of 2001.
This has been my first clinical experience with mental health nursing, though in my studies at Georgetown, we focused heavily on mental health care and the stigma that surrounds it. Unfortunately, stigma also exists in Ireland; however, through education, the status quo can be changed. If you are reading this, I highly encourage you to keep an open mind.
First and foremost, a patient must never be defined by his or her illness. Instead, they are simply individuals who should be empowered to reach their own personal level of desirable function. This is achieved through the recovery model, which seeks to continually focus upon a state of recovery and maintenance of a new sense of normalcy. With the recovery model, a sense of life balance is also established.
Ireland’s treatment plan is multifaceted including pharmacological and non-pharmacological interventions. I was able to observe electroconvulsive therapy, which is used to treat severe depression and schizophrenia as a final resort after multiple pharmacological agents have shown no success. I was surprised by the procedure’s speed; the shock was only seven seconds! Contrary to my preconceived notions, the patient’s somatic response was minimal, only a twitch of the legs and fingers.
I am eager to continue my clinical placements. Upon return, I will use all I have learned to ensure optimal patient care.
Emily DeMaio graduated from Georgetown's School of Nursing and Health Studies in 2017. Emily’s study abroad experience during fall 2015 revolved around clinical rotations in both private and public Irish hospitals. She compared and contrasted the healthcare delivery system of Ireland with that of the United States, learned cultural competence by caring for Irish patients, and blogged for the Junior Year Abroad Network.
