Abstract
The dissolution of the Soviet Union and the declaration of Independence by the Republic of Armenia created the need for significant changes in the healthcare delivery system in Armenia. The desire to raise the level of health care presented challenges and opportunities for nurses within the Republic. Members of the departments of nursing at Boston City Hospital/Boston Medical Center in Boston, Massachusetts, University of Massachusetts Medical Center, Worcester, Massachusetts, and the Emergency Scientific Medical Center of Yerevan, Armenia, joined forces through a grant written by Boston University School of Medicine and sponsored by the American International Health Alliance under a cooperative agreement with the United States Agency for International Development to expand the role of nursing. This article describes the assessment, planning, implementation, and evaluation of changes to the role of nursing and the development of new roles for nurses within a hospital in the capital city of Yerevan.
Boston University Medical Center, Boston, Massachusetts, University of Massachusetts Medical Center, Worcester, Massachusetts, and the Emergency Scientific Medical Center (ESMC), Yerevan, Republic of Armenia, were partners under a 5-year medical education grant to improve health care in Armenia. The partnership was sponsored by the American International Health Alliance (AIHA) under a cooperative agreement with the United States Agency for International Development (USAID).
ESMC, an 800-bed city hospital and center for the city ambulance service, was partnered with Boston University School of Medicine and Boston City Hospital (later known as Boston Medical Center), an inner city hospital that is a Level-1 Adult and Pediatric Trauma Center and the center for the City of Boston's Emergency Medical Service. The initial focus of the partnership was postgraduate training in emergency medicine and trauma care (Aghababian et al., 1995; Hirsch & Levy, 1996). During the implementation of training programs for prehospital providers and physicians, the level of practice was raised, creating a gap between traditional nurse functions and new physician functions. It became apparent that work needed to be done within the hospital setting as nurses lacked the skills to provide care to patients who once would have died in the field. This article summarizes the experience of the partners in assisting nurses in Armenia to introduce a new direction and vision for nursing in that country.
As part of the partnership activities, the first delegation of healthcare experts sent to Armenia included one nurse. It was the nurse's responsibility to begin assessing the knowledge and activities of nurses at the ESMC and to determine the types of training programs that would help enhance their role in the care of patients. It was also the nurse's responsibility to visit a school of nursing to determine the educational background of nurses in the Republic of Armenia. Subsequent visits by the authors focused on continued assessment, planning, implementation, and evaluation of the expanding role of nurses at the ESMC and throughout the Republic.
The experiences reported here have implications for health program development throughout the Newly Independent States (former Soviet Union) in which common health systems prevail and in which nurses represent a potentially promising domain for system development.