Whitney R. Bunker (BS ’15) listened attentively as a white-haired patient fumbled over the words to a song he had learned from American soldiers long ago. He quietly began to sing “My Bonnie Lies over the Ocean” with a thick Czech accent, and Bunker pieced the puzzle together: he was sad because his wife, his “bonnie,” had died. Bunker held his hand, glad to have made a small but powerful connection with her patient.
Last year BYU College of Nursing students studied in the Czech Republic for the first time as part of a clinical practicum. Bunker, among 10 nursing students, paired up with Czech nursing students from the College of Nursing in Plzeň and traveled to several different cities throughout the country, where they had both cultural and clinical experiences that provided perspective and enhanced the way they nurse. “We got to see firsthand what makes the Czech Republic such a special place, and learned what it takes to connect with someone from a different culture,” says Bunker.
“The key thing our students pick up on is that there are other ways of communicating with the patients,” says associate teaching professor James Kohl. “It does not always have to be audible; it can be in smiles, frowns, or gestures. We do not have to rely just on spoken communication to know what the patient needs.”
Formerly a part of communist Czechoslovakia (a satellite state of the Soviet Union), the Czech Republic and its healthcare system have undergone dramatic changes since the country became independent in 1993. “In less-developed countries, the students are out of their comfort zones with regards to food, beds, and environmental conditions,” says teaching professor Dr. Sheri P. Palmer (AS ’81, BS ’84). But in the Czech Republic, where the healthcare system is advanced, “the students had to get out of their comfort zones to build relationships with people they did not fully understand at first.”
One of the first things Bunker noticed as she got off the airplane was the many people smoking cigarettes. “It was hard for some of us to get used to—to understand why everyone smokes,” says Bunker, a Utah native. “In the U.S., and especially in Provo, antismoking has been pushed so much that there are not nearly as many people who smoke as in the Czech.”
In addition to smoking, Czechs love their beer. The students found this to be all too true at their first stop in the city of Plzeň, the beer capital of the world. Bunker recalls that a bottle of beer was cheaper than a bottle of water. These differences in standards turned out to be a great learning opportunity for the students.
“The students were able to see that people, even those who have different values, are still good people,” Palmer says. “I think that is so important to realize as a nurse. It helps you treat each patient with the best care possible.”
Students identified some key differences in the healthcare system as well. “The biggest difference we saw was a lack of nurses,” Bunker says. “And the nurses who were there had huge workloads and appeared to be underpaid.” Bunker gave a presentation on nursing and healthcare in America to a group of doctors and nurses in a hospital in Jablonec. When she showed the slide about the salary for American nurses, the room filled with the loudest collective gasp she had ever heard.
Czech nurses also have a lot of restrictions on patient care. “Nurses [in the United States] can move patients around, put them on different diets, or even stop oxygen because they are saturating well enough,” Palmer says. Nurses in the Czech have to get a doctor’s order before they can do anything, so they usually end up doing paperwork or dispensing medications. “They still have a super important job and a lot of responsibility,” she says, “but it is a little bit different than in the U.S.”
Despite the difficulties these Czech nurses face, big cities in the Czech have developed medical care that rivals healthcare in the United States. Students were amazed that a system still recovering from communist rule could give such great care to its patients.
“In Jablonec one of the nurses stuck out to me,” Bunker says. “She had an amazing amount of work to do, but she was very dedicated to her job. She had fewer resources, such as people and supplies than a U.S. nurse would have, but she was still optimistic. I think I learned the most from her and from other nurses we got to meet. I learned what dedication to your job means and how important it is to have good team relationships among all the nurses.”
Getting to know a different culture helped the students not only to gain perspective on different countries’ healthcare systems but also to appreciate its citizens, customs, and historical events.
The BYU students arrived in Plzeň during the 70th anniversary celebration of when American troops liberated the city from Nazi occupation during WWII. During a community event, old Sherman tanks rolled down the narrow cobblestone streets as hundreds of Czechs, dressed in American uniforms from WWII, marched into town. Crowds lined the streets and American marching music accompanied the cheers of the crowd and the rumble of the heavy vehicles.
“We had never seen such a patriotic display anywhere—within or outside the U.S.,” Kohl says. “Fourth of July celebrations pale in comparison to what the Czech people did to celebrate their liberation. A couple of the students told me that they had never felt more proud to be an American.”
Students realized that learning more about the country, the people, and their hardships brings an understanding that is essential to nursing with the Healer’s art. “We could spend time with catheters, IVs, or nasogastric tubes anywhere,” Kohl says. “We do not go abroad for that experience; we go abroad to meet the people and to interact with and understand them.”