May 9, 2002
Nursing goes cross-cultural, across Atlantic
Cynthia Scanlon
UW Bothell
At the UW Bothell, nursing students studying ethics get a true cross-cultural perspective. For the past six years, Associate Professor of Nursing Carol Leppa has been taking students in her ethics class — which she has taught for 10 years — to London to meet and professionally interact with their British counterparts.
This year, she took the concept even farther by creating the experience on the World Wide Web.
Initially, Leppa created the ethics course to examine the social and ethical ramifications of rising healthcare and insurance costs, the difficulties and rewards associated with physicians and nurses working together, and the ethical and financial considerations of using high-tech remedies to treat illness.
As an optional part of that class, Leppa, in conjunction with her European counterpart, Terry Louise of Southbank University, takes a group of her nursing students from UWB to London to meet other professional nurses from the UK.
The annual spring trip allows these students from both countries to discuss firsthand the ethical, moral, financial, and cultural challenges arising in these systems, the similarities and differences associated with each system, and the best way to face and solve those challenges.
“These students get a sense of their own system by looking at someone else’s,” says Leppa. “These conversations allow these nursing professionals the opportunity to think about the larger healthcare picture and also to understand the underlying political process in both the U.S. and UK.”
But this year, the trip had to be altered — in fact, completely transformed might be a better word. Like so many things that changed after the attack on the World Trade Center last September, Leppa’s class changed as well. She found many of her students unwilling to fly to London for this year’s trip. So, the two very forward-thinking professors put their heads together and transformed the face-to-face, active interplay into an interactive dialogue on the Internet.
This spring, students in these classes a half a world away are conversing with each other on a variety of issues without leaving their countries. Eventually, the trips will resume, but for now, this optional interactive classroom has preserved the framework for these nursing professionals in both classes to work through the ethical issues they face and to have real conversations about those issues.
“We have a framework that we develop over the course of a quarter that looks at the different principles involved in ethical issues in health care,” says Leppa. “We create a space where we can explore a complex issue together, and my job is to help guide and draw some limits around what we’re going to spend our time on. I learn as much from them as I hope they learn from me.” With the Internet now playing a key role in class, Leppa says she has also discovered that “lots of people like writing down their thoughts and feelings, rather than talking in class.”
The professors have observed other things as well. For instance, they have noticed that nurses in the U.S. have a stronger sense of their legal responsibilities, while nurses in the UK haven’t had the language to articulate or enforce their decisions. This ethics class has begun to illuminate these things, and this unique online reconfiguration now makes the continuing dialogue possible.
Leppa’s interest in ethics stems from her in-depth research into long-term health care, chronic illness and the dying patient. She says she is drawn to the area because long-term nursing care is a nursing controlled environment where, despite heavy regulation, nurses have a great deal of autonomy.
Focusing on long-term care also allows Leppa to focus on what she terms her life’s work, that being palliative, or end of life care. “We are recognizing that everyone dies; the death rate remains one per person,” says Leppa. “Palliative care is not saying we are giving up on you, but rather, how do we bring this into the discussion and do active treatment as well? How much treatment is too much and how do we decide on these particular issues?”
Seventy million baby boomers, who are beginning to grapple with their parents’ chronic illnesses and deaths, as well as looking at their own mortality, will force all of us to have serious discussions focused on the ethical issues of long-term health care and dying, says Leppa. “We’re going to have to have these discussions, and they aren’t easy,” she says. “In 10 years, I hope that nurses are teaching physicians and physicians are teaching nurses, and we’re all working together.”
She adds, “In the future, I would like to have a palliative care approach that is usable and used by people and caregivers making difficult health-care and death-care decisions,” says Leppa. “It’s the only research I care about getting done before I die. I want it to be an approach that people will use with me when I’m in the situation where I have to think about that.”
Students in her class confront these issues in an environment that allows them to reflect on the deeper ethical issues and ramifications each situation poses. As an added dimension to the course, the UW Bothell has just approved a new Master of Nursing program, which will begin in fall 2002. Leppa and Terry plan to involve these new master’s students in the class, bringing together both graduate and undergraduate students to work with their European counterparts.
Last year, the King County Nurses Association named Leppa the 2001 Nurse of the Year. She received the award for outstanding achievement and contributions to nursing and the community. Those contributions are continuing. Currently, Leppa is working on obtaining grant funding to bring nurses from the UK to the United States.
