When Hong Li's father-in-law got liver cancer and became a patient at Peking University Cancer Hospital two years ago, she returned to China and cared for him for several weeks. Like many Chinese with loved ones in hospitals, she brought him food, helped him with his personal needs, and even kept track of blood tests and X-rays.
But Li was no ordinary bystander. She had earned a doctorate in nursing research, and she was starting her career as an assistant professor at the University of Rochester's School of Nursing. Nurses caring for her father-in-law in Beijing were impressed by her credentials and suggested a collaboration. This week, Li returned from a three-week trip to Beijing where the Chinese-American team launched a new type of nursing research project that has never taken place before in China.
With Li's guidance, Chinese nurses will study how families of elderly patients who have cancer help take care of their family members while their loved ones are hospitalized. They'll do this through sophisticated analysis of extensive interviews with families and patients, a type of research that is not currently practiced by nurses in China.
The project has even attracted funding from Peking University Cancer Hospital. While the monetary support is modest by U.S. standards - 10,000 yuan, or about $1,200 - the precedent is noteworthy, Li says, because nearly all medical funding there goes to doctors. The money will cover the cost of phone calls and faxes between China and the United States, as well as expenses for equipment, copying, and some services. The University's School of Nursing is also helping out by paying Li's travel costs.
The collaboration has its roots in a year-long visit Li made to the Oregon Health Sciences University in Portland, Ore., in 1985, after working seven years as a staff nurse at a Beijing Hospital.
"My first year in the United States was an eye-opening experience," says Li, R.N., Ph.D. "I saw that nursing here is something quite different than in China; I realized that nurses can come up with ways on their own to improve the care of patients. In China, we call the nurses the 'doctors' legs' - the doctor tell the nurses what to do. Here in the U.S., nursing is much more professional. It's not only being the 'doctor's legs'; nurses here are well trained in critical-thinking skills to recognize and meet the patients' needs."
The experience convinced her to remain in the United States and pursue a research opportunity unknown to nurses in China, earning her bachelor's, master's, and doctoral degrees in Oregon before joining the Rochester faculty three years ago. About that time she returned to her homeland and presented a copy of her thesis to the Beijing Central Library. At the time she was told that hers was the first dissertation based on nursing research to be completed by a native of mainland China and recorded in the library.
In the United States her research has focused on care of the elderly in hospitals, a topic she ran into personally while caring for her father-in-law. When she returned to Beijing last month, Li helped teach nurses about interviewing, data collection and analysis; both the nurses and the patients and their families were excited to be part of the effort, she says. Like Li, the nurses will be authors of the research findings, which will be published in both Chinese and America nursing journals. Already another Beijing hospital has expressed interest in collaborating with Li's colleagues in the School of Nursing on another project focusing on the health of newborn babies.
Like their counterparts in the United States, nurses in China are pushed for time, but they have even more tasks to complete. Generally they take care of more patients; typically during a night shift, a single nurse takes care of 20 to 30 people. Nurses go to the pharmacy themselves and put together patients' medications, and they typically don't have as much support from other staff like custodians or food-service workers. That makes it vital for families to provide the support they do: feeding patients, getting them to the bathroom, comforting them, bringing food from home, and countless other tasks.
In both nations, Li says it can be tricky for family members and nurses to coordinate their efforts. Communication is often poor. For example, if a patient's condition worsens overnight, his wife might not know it when she visits the next morning unless she talks to the nurses, and she might try to help him sit or stand up. If he's much weaker than usual, he might lean on her too much for support, and they both could fall.
While interviewing families in Oregon, she encountered a woman who had cared for her husband for eight years after his first stroke. The woman had made him a special spoon with an over-sized handle, and she rotated his plate during each meal so he could eat off the same corner, making it possible for him to feed himself. When he subsequently went into the hospital, nurses assumed he couldn't feed himself and began feeding him themselves.
Such situations show that nurses and family members have information that the other needs to care for patients, Li says. "We're trying to show nurses how they can help families, and to show families how they can help patients. Nurses and family members should be partners. Each has something to teach the other. There are formal caregivers, and there are informal caregivers. Both patients and families will benefit from this type of partnership."
Through her studies in the United States, Li has found that families report substantial benefits to patients when nurses and families work together. Families report that the patients' stays in the hospital are shorter; they're less confused by the unfamiliar hustle and bustle of the busy environment; and they eat and drink more, maintaining their strength and preventing dehydration. Li and Associate Professor Bernadette Melnyk, R.N., Ph.D., are launching a pilot study, CARE, or Creating Access for Relatives' Empowerment, to confirm these findings.
She hopes to discover whether the issues surrounding care for the elderly in U.S. hospitals are similar in China, where there are more than 130 million people over the age of 60. "This research is grounded in this country, but now we want to help Chinese nurses and family caregivers who provide care to Chinese patients."