University of Pécs - Faculty of Health Sciences Institute of Nursing Sciences
Subject: Study Trip Report // Frankfurt, Germany
Date of trip: 21-24 February 2018
Student: Lucía BLANCO (AVNNMZ)

Objective: to provide information for students about the structure of the German healthcare system and study system of Nursing Science. Visit three Frankfurter healthcare institutions: 1. Markus Krankenhaus, 2.Bethanien Krankenhaus and 3.HSB Altenpflegeheim).

Summary: As part of the international exchange programs promoted by the MNE Foundation since 2004, last February, a group of 20 students from the Faculty of Health Sciences, including this time master´s degree and 2 international students, got the opportunity to visit and learn from different practices in the health services in the German System.

Each visit to the different three health locations was preceded by a short presentation + discussion on the most relevant aspects of the health work from the nursing perspective.

1st Visit: Markus Hospital

Presentations:

Overview on the approach and objective given for an integral health management tailored to the patients in accordance to the staff and resources available. From the nursing perspective we had the chance to learn how the task division among the personnel has evolved into a compartmentalized & specialized segmentation of responsibilities & accountabilities. In these hospitals, the nursing department has evolved into the differentiation of the different tasks within the direct provision ofhealth. The division goes from the cleaning to the provisioning, and from thedocumentation to the direct application of treatments. The main advantages of thisscope of work are to allow for the pertinent training and specialization in thespecific areas and the offload of extra tasks among the nurses. On the downside, it isclearly the result of a resourceful system with a respectably large budget, not onlyfor a bigger payroll, but also for continuous training and preparation. Therefore,replicating such good practices would require more than just the good philosophybehind it.

A short, second presentation was given by the doctor of the geriatric department.This was an interesting new concept (maybe not new to all participants) in which heexplained how the objective when treating the elderly is not to cure the sickness(es), but to attain a level of comfort and independence for them.

Emergency ward: In here we had the opportunity to see the physical installations for allemergency cases, the triage area and have a glimpse in action at their inter-hospitalmonitoring system for patient transfers. This was an interesting and dynamic visit in whichwe had the chance to ask about different details directly to the emergency doctor whofacilitated the sighting.

2nd Visit: Bethanien Hospital

Presentations:

There was a short explanation about the Health System in Germany. This included ingeneral how the entire national system is legislated, financed and ultimately how itworks in the practice through the few insurance companies.

We also had a small presentation about the Nursing Study System in Germany.Fundamentally, it differs from the structure of an “academic bachelor” as wecommonly know it in Europe, US and Australia. It is a three years-long education inwhich the practical component is introduced from the very beginning. 2100 hours oftheory and 2300 hours of practice amount for the total load of formation timeduring this period. The career of nursing does not have an academic approach. It isdirectly a technical specialization from the beginning. Later on, for researchers andsuch, a Nurse professional can opt for a masters or PhD and develop the academicaspect of it.

The 3rd presentation was about the recent introduction of the digital patient files.This is a big process in which all written documentation on the patients areintended to be encoded in one big database, which is accessible to all in charge ofeach case. This was about the most interesting discussion because the students ofthe master program all have long experience as nurses and their exchange was veryinsightful. Patient files are key for the management of their recovery and follow up,and due to different aspects, the filling up of all records is not a one-person task, butmany different and it is there where swings between being the most useful tool tobeing a burden of extra work. This systematization is nonetheless a big step in theintegration of the whole aspects of a patient´s history, yet a challenging way until allusers involved can synchronize with its implementation.

Cardiology Unit: We had the opportunity to visit the cardiology department. First we visitthe emergency room and got briefed on the different codes and rapid procedures to bedone based on their preliminary categorization of cases. This unit is linked to the one in theMarkus Krankenhaus and to other smaller clinics in a radius of 50 km and receives in aninformed way all emergency cases.On the top floor is the outpatient cardiology part in which doctors from other specialtiescombine their expertise to treat the patients integral health impairments, and not onlythose of the heart (e.g. DM, cancer, failure in other organs, etc.).

3rd Visit: HSB Altenpflegeheim (Elderly Care Facility)

Presentation:

This presentation was in general about the concept of this alternative for elderlycare home. It is a place where they can live by purchasing their own home. In thiscase they do not buy the apartment, but the “life-long” right to live there. Thismeans, the senior inhabitants will stay there until they are no longer with us, orwhen they can´t live independently. (This was mentioned in the first day´s visit atthe Markus Hospital, when explained that the main objective for a geriatrist is tohelp the patient to reach its own autonomy for living).

This center also has a health care place for the provision of the traditional nursingservices for the elderly people. And in addition, the whole living complex has shops,restaurants, hair dresser, and other amenities designed primarily to fulfill and servecertain special need that older people might need (e.g. wheel chair access at theminimum, emergency-call buttons in showers + bathrooms, etc.).

The concept explored by some Austrian psychiatrists was introduced to us (seemednew to the whole audience) that change the approach in the treatment of dementia.The spin relies in the change of the assumption that people with dementia “runaway”. Instead it has been understood that they do not escape, they actually intendto go somewhere. This requires from the health care personnel to build up asdetailed as possible the biography of the patient and try to discover “where theywant/need to be” and try and recreate that scene in their surrounding.

It was highlighted by the Nurse who guided our visit a bit of the challengesremaining in this field in Germany in terms of specialization. While geriatric studiesare full of the social aspects concerning this group of people, it lacks the scientificknowledge from the health field. And vice-versa for those medically versed, therewas a lack of knowledge in regards to the socio-economic factors relevant for theelderly people.

Elderly living complex: We were given the opportunity to enter and walk around theentire facilities of the elderly center. It was very much pleasant to notice the level of detailand consideration put in the design, decoration, services, food, and attention in general toadequate this space for senior adults. It was perceived in many levels the considerations ofboth, the social and the medical care, aspects concerning the elderly reflected in the designsand services offered in this place.

Conclusion: This trip was surprisingly full of new information, interesting approaches andideas that otherwise it would have been difficult to discover only by chance.Although, I have extensive experience in management of departments of medicalinterventions, the field where I have operated was by no means a regular or normal setting.Emergency contexts during armed conflict or disasters are full of different challenges.

This visit provided an overview of a total different side of the health work and systemsfrom a stable and developed context. It was inspiring in a different way and refreshing tocompare to other regular standards. Based on my last experience in Belarus, working with the National Institute of Tuberculosis, it was also new and informative to compare thatwith the anecdotal stories of the master students from our visiting group, who shared fromtheir experiences in the Hungarian hospitals. I could see the pattern of an eastern/sovietapproach compared to that of a more westernized system like the one we saw in Frankfurt.

Hopefully, more of these types of exchanges can build up for improvements and furtherdevelopments beyond the merely informative part of it. In the past days I came across thisarticle: https://dailynewshungary.com/shocking-stories-hungarian-health-care-bed-bugs-9-hours-waiting-time-2/ . It stroke me to think that those situations are the complaints innumerous of other countries. From the UK NHS fragile and moribund system exploiting thefew nurses left, to a US health care system affordable to middle upper classes and higher,forgetting the rest, are only some of the worrying examples we hear during this newcentury (2018) where the access to health care strengthens as a luxury item instead of thehuman right it should be.

Learning and exchanging good practices should reflect in our attitudes and aspirations asfuture health workers. Aiming to be that agent for change should be strongly incorporatedamong the purely academic approach given to the career of nursing in our context, whichdiffers from the German style. At the end of the day, the change should start during theformation period. It was denoted and emphasized that the task for caring is not about asickness, but about a person as a whole and social aspects are fundamental for molding amore humanized service.