Feature

Looking out for new friends

Nursing in Poland is undergoing rapid change and faces many of the same challenges confronting nursing in Britain. Now Polish nurses are reaching out for international support. Martin Gajos reports

On 17 September 1939 the Soviet army invaded the eastern part of Poland. This was the result of a secret pact made by Germany and the Soviet Union on 1 September. Thousands of Polish troops were captured by the advancing Soviet army and transported east to camps where many met their deaths.

After the invasion of the Soviet Union by German forces those Poles who had survived were treated as allies and released. A new Polish army was organised under General Wadislaw Anders, one of the few officers who had survived. This Polish army travelled south to what is now Iran and then west to fight as the 2nd Polish Corps in Italy. The capture of the monastery of Monte Cassino is remembered as a famous Polish victory.

My father was one of the Polish soldiers captured by the Soviets. He left behind his late wife and three children. Two spent the war in a Russian orphanage and one in a German labour camp. He never saw his children in Russia again and saw his other daughter during her two fleeting visits to England in the 1960s. My father died in 1969 never having returned home to Poland.

Communism has not survived in Poland and the recent history of Eastern Europe has given Poland an opportunity to create a new society. My desire to help in any way I could led me to travel to Warsaw last year to deliver a series of lectures and to conduct nursing case conferences with nurses at the Institute of Psychiatry and Neurology, one of Poland’s leading academic and clinical institutions.

I visited the nursing department of the Academy of Medicine in Krakow and was invited to return to Poland to lecture to Krakow’s undergraduate student nurses. This I did at the start of the summer term last year.

I was little prepared for the work involved. I was able to negotiate some time from my lecturing role at West Yorkshire College of Health Studies and at Sheffield Hallam University, but I also used some of my holiday.

The chief nurse at the institute asked me to lecture in management, care of the dying, nursing process, nursing models and communication. These lectures were followed up during the evenings with clinical case conferences demonstrating the application of the theory.

Between lecturing I visited a number of clinical and educational facilities in Warsaw and Krakow, including the clinical areas at the Institute of Psychiatry and Neurology and a specialist unit dealing with autistic children at Ococim, some 70 km from Warsaw.

My visits in Krakow took in the Psychiatric in-patient facility. I also met staff at a new crisis intervention unit and visited a psychiatric day hospital where I had the honour of being invited to participate in a weekly ‘English Club’ for patients.

In Warsaw we were shown much new technology which had been recently installed. Nursing practice was firmly based on the medical model, which dominated the clinical management of the hospital to such an extent that someone suffering from depression would be admitted to a ward which only dealt with depressive illness. Those considered to be at risk during their illness were put into bed and observed by a nurse. We saw one six-bed bay with all its beds occupied by ‘at risk’ patients.

This ‘physical’ approach was reflected by the provision in the ‘depression’ ward of a photo-therapy room where the walls and furniture were all painted white and batteries of neon lighting were placed. A depressed person would spend some time in this room in the expectation that increased light would lift their mood.

The rationale for this method was rooted in the belief that depressive states are evolutionary ‘leftovers’ from a time when early humans hibernated during the winter months and were awakened and stimulated by the return of light in the spring. We did not see any patients using this facility during our stay nor could we discover any reports of the outcomes of this approach.

Nursing practice was clearly based on a task-oriented approach. There were some areas, such as the rehabilitation day unit in Warsaw where nurses were involved in more patient-centred and interactive approaches. But I was told by the medical staff that it was only appropriate for nurses to be involved in the less complicated therapies and the more sophisticated individual and group therapies were still the exclusive domain of the doctor. Nursing was perceived as a very low status occupation — hardly a profession at all.

Doctors and psychologists seemed to dominate in the psychiatric services and many nurses felt frustrated by this. Polish nurses were very keen to develop their profession and recognised many of the problems.

We saw little evidence of nursing autonomy but the foundations for autonomous practice are clearly being laid. There are a number of degree programmes (in Poland a first degree is an MA) and some PhDs have been awarded.

We met three nurses who have travelled abroad for courses and conferences, but the funding for these trips came from outside Poland. The greatest barrier to professional development seems to be the current problems with the economy and the consequent lack of funding.

The question now for Polish nursing seems to be whether to follow professionalisation down the path of medicine or to carve out a path which is more exclusively that of nursing.

In some of my lectures and case conferences I found that nurses were keen to use the nursing process and to apply nursing theory but expressed anxiety about doctors’ reactions. What would the medical staff allow them to do? This problem is not unique to Polish hospitals of course and many nurses in England echo the same sentiments.

There was no evidence of nurse care planning. Nursing records consisted of daily ward reports in a ‘report book’. Verbal reports were made to the chief nurse who would pass them on to the doctors at the ward round. There was great interest in the systems of nursing records I was able to demonstrate.

In Krakow some of the nursing degree curriculum was devoted to problem solving but this was not presented in the particular form of the nursing process. Considerable interest was shown in Krakow in nurse record systems and the application of nursing models. The Polish American Children’s Hospital in Krakow is trying to implement the nursing process and many nurse clinicians attended my lectures in order to gain an ‘English’ perspective on their attempts.

I shall be returning to Poland this year. Polish nursing is reaching out for international contacts and support. Nurses form the largest section of the health service — of 850,000 staff, 144,798 are nurses. They are dealing with health problems typical of an industrialised and developed country. But some of the problems which are receding in the UK are still a major problem in Poland. Life expectancy is 67 for men and 75 for women. 46 per cent of the population smoke an average of 2,644 cigarettes a year and each adult drinks an average of over seven litres of alcohol per year. In 1987 there were nearly 20,000 new cases of TB reported. HIV (1,841 cases) and AIDS (70 cases) are new problems. In the face of this, my help can only be a ‘drop in the ocean’ — but then, oceans are made up of lots of drops.