Global health diplomacy: an integrative review of the literature and implications for nursing

Diplomatic response to global health challenges in recognizing patient needs: A qualitative interview study

Background

Global health diplomacy is the applied practice of foreign affairs to further national goals that focus on health issues requiring international cooperation and collective action. We aimed to determine how international diplomats and health policy-related professionals in the EU understand the concept of health diplomacy, which impacts both diplomatic relations as well as patients' rights.

Methods

In a qualitative interview study, we used a heterogeneous stratified purposeful sampling to reach participants from different countries and different practitioners from the Pyramid of Health Diplomacy: core, multi-stakeholder, and informal. Reflexive thematic analysis was used to identify the main themes.

Findings

We contacted 131 practitioners of GHD, of which 37 responded, and nine agreed to be interviewed. From 11 interview questions, four main themes emerged from the analysis of the individual interview. The participants reported limited knowledge about the definition of GHD but also that they engaged in daily activities and decisions of inter-governmental bodies. They were not aware of existing special education and training for health attachés and made suggestions for improving the field and practice of GHD. They were not fully familiar with the European Charter of Patients' Rights. There was a consensus from all participants that patient rights need to improve as a fundamental right. They stressed the fact that the hospital lockdown and the right access to healthcare were impaired during the COVID pandemic.

Interpretation

The role of health diplomacy in linking public health and foreign affairs is key to respecting patients' rights. Health over other interests is becoming an increasingly critical element in foreign policy. Establishing a clear career path for health attachés is necessary to foster effective global health agreements and coordination across countries.

Global Health Diplomacy and Governance: Mapping and Future Trends

This study evaluates global health diplomacy and governance by performing bibliometric analysis to investigate the current publication trends, authors and keywords-based clusters, research trends, author's productivity, and future research areas. The analysis results suggest that global health diplomacy has garnered attention only in developed countries and has been researched negligibly in developing countries. The research in this field increases after the onset of pandemics such as Swine Flu and COVID-19. Authors kickbush and lee are the most influential authors based on their h index. The identified future research areas are "International laws" and "Social Determinants of Health."

Defining global health: findings from a systematic review and thematic analysis of the literature

INTRODUCTION

Debate around a common definition of global health has seen extensive scholarly interest within the last two decades; however, consensus around a precise definition remains elusive. The objective of this study was to systematically review definitions of global health in the literature and offer grounded theoretical insights into what might be seen as relevant for establishing a common definition of global health.

METHOD

A systematic review was conducted with qualitative synthesis of findings using peer-reviewed literature from key databases. Publications were identified by the keywords of 'global health' and 'define' or 'definition' or 'defining'. Coding methods were used for qualitative analysis to identify recurring themes in definitions of global health published between 2009 and 2019.

RESULTS

The search resulted in 1363 publications, of which 78 were included. Qualitative analysis of the data generated four theoretical categories and associated subthemes delineating key aspects of global health. These included: (1) global health is a multiplex approach to worldwide health improvement taught and pursued at research institutions; (2) global health is an ethically oriented initiative that is guided by justice principles; (3) global health is a mode of governance that yields influence through problem identification, political decision-making, as well as the allocation and exchange of resources across borders and (4) global health is a vague yet versatile concept with multiple meanings, historical antecedents and an emergent future.

CONCLUSION

Extant definitions of global health can be categorised thematically to designate areas of importance for stakeholders and to organise future debates on its definition. Future contributions to this debate may consider shifting from questioning the abstract 'what' of global health towards more pragmatic and reflexive questions about 'who' defines global health and towards what ends.

Factors affecting the emergence of diplomacy in Iranian nurse managers: a qualitative study

AIM

To explore the factors affecting the emergence of diplomacy in Iranian nurse managers.

BACKGROUND

Today, with the development of complex health systems, diplomacy in health care can take place at organizational, national and international levels.

INTRODUCTION

Diplomacy's role is to convince others peacefully to achieve goals. Diplomacy in nursing can facilitate professional development and direct policy and decision-making process towards the development of a healthcare system.

METHODS

The study used a qualitative descriptive approach. The sampling method was purposeful, and data were collected via in-depth, unstructured and face-to-face interviews with 16 participants. The interviews were digitally recorded, transcribed verbatim and analysed through conventional content analysis based on Graneheim and Lundman's work.

RESULTS

In total, 212 codes were generated, which were grouped into three main categories, namely paradigmatic socio-political changes (two subcategories), nurses' dissatisfaction with their status in healthcare system (two subcategories) and multidimensional development of the nursing profession (four subcategories).

DISCUSSION/CONCLUSIONS

Socio-political changes, development of the nursing profession and nurses' dissatisfaction with the health system have led to the emergence of diplomacy roles in nurse managers, the recognition and development of which can improve the effectiveness of nurse managers in policymaking.

IMPLICATIONS FOR NURSING & HEALTH POLICY

The recent COVID-19 pandemic outbreak has demonstrated the urgent need to use diplomacy to solve health problems and adjust or develop policymaking at the national and international levels. Strengthening their role in diplomacy, nurse managers can play an important role as diplomats at various levels of policymaking and in health crisis management.

Developing and validating learning domains, competencies, and evaluation items for global health clinical immersion practicums for graduate-level nursing programs

AIM

To develop and validate learning domains, competencies, and evaluation tool for graduate-level experiential nursing global health programs.

BACKGROUND

Standard competencies have not been synthesized and delineated nor have evaluation tools been developed for global health programs at the graduate level.

DESIGN

A combination of a documentary literature review and expert consensus panel to validate results was used as a design for this study.

METHODS

The NLM and CINAHL databases were searched for articles published between 2007 - 2017 relevant to graduate-level global health nursing programs. Data were extracted and coded, from which themes regarding learning domains, competencies and evaluation items were derived. We then used a three-step expert panel to refine and form a statistical representation (>0.78 agreement on importance, relevance and clarity) of the learning domains, competencies, and evaluation items.

RESULTS

Relevant articles (N = 26) were included for the documentary review, 18 concerning learning domains of global health immersion programs and eight concerning interdisciplinary global health competencies specific to nursing. These learning relationships were then formatted into a table subdivided between learning categories for expert panel consensus. After expert panel review, a compendium of learning domains, competencies, and evaluation items resulted.

CONCLUSION

Global health clinical learning practicums are essential for graduate-level preparation of nurses. Learning domains, competencies, and evaluation tools need to be adopted and empirically tested by international and national nursing associations. The results of this study need further testing to aid these associations.

How American Nurses Association Code of Ethics informs genetic/genomic nursing

Members of the Ethics and Public Policy Committee of the International Society of Nurses in Genetics prepared this article to assist nurses in interpreting the American Nurses Association (2015) Code of Ethics for Nurses with Interpretive Statements (Code) within the context of genetics/genomics. The Code explicates the nursing profession's norms and responsibilities in managing ethical issues. The nearly ubiquitous application of genetic/genomic technologies in healthcare poses unique ethical challenges for nursing. Therefore, authors conducted literature searches that drew from various professional resources to elucidate implications of the code in genetic/genomic nursing practice, education, research, and public policy. We contend that the revised Code coupled with the application of genomic technologies to healthcare creates moral obligations for nurses to continually refresh their knowledge and capacities to translate genetic/genomic research into evidence-based practice, assure the ethical conduct of scientific inquiry, and continually develop or revise national/international guidelines that protect the rights of individuals and populations within the context of genetics/genomics. Thus, nurses have an ethical responsibility to remain knowledgeable about advances in genetics/genomics and incorporate emergent evidence into their work.

Applied global health diplomacy: profile of health diplomats accredited to the UNITED STATES and foreign governments

BACKGROUND

Global health diplomacy (GHD) is a burgeoning field bridging the priorities of global health and foreign affairs. Given the increasing need to mobilize disparate global health stakeholders coupled with the need to design complex public health partnerships to tackle issues of international concern, effective and timely cooperation among state actors is critical. Health Attachés represent this coordination focal point and are key diplomatic professionals at the forefront of GHD. Despite their unique mandate, little is published about this profession and the perspectives of those who work in the field.

METHODS

Through purposive sampling, we performed in-depth qualitative interviews with seven Health Attachés: three foreign Health Attachés accredited to the United States and four U.S. Health Attachés accredited to foreign governments. Our interviews explored four key topics: the role and mission of Health Attachés, skills needed to perform GHD, examples of successes and challenges in accomplishing their respective missions, and suggestions for the future development of the diplomatic profession.

RESULTS

We identified several lessons to apply to the growing field of GHD. First, GHD actors need to receive appropriate training to successfully negotiate the intersection of global health and foreign affairs. Participants suggested several areas of training that would benefit GHD actors: diplomacy and negotiation, applied science, and cross-cultural competency. Second, participants articulated the need for a career path for GHD practitioners, increased opportunities for on-the-job training and mentored experiences, and GHD competencies with defined levels of mastery that can be used in occupational evaluation and career development.

CONCLUSIONS

Our findings indicate that skills in diplomacy and negotiation, applied science, and cross cultural competency are essential for the statecraft of Health Attachés. Additionally, establishing a clear career pathway for Health Attachés is critical for future maturation of the profession and for fostering effective global health action that aligns public health and foreign diplomacy outcomes. Achieving these goals would ensure that this special cadre of diplomats could effectively practice GHD and would also better position Health Attachés to take the lead in advancing shared global health goals among nation states in a new era of twenty-first century diplomacy.

Health-related quality of life of Palestinian refugees inside and outside camps in Jordan

BACKGROUND

Jordan hosts more Palestinian refugees than any country in the world. Conditions under which people in a community live influence their health-related quality of life (HRQOL).

PURPOSE

The purpose of this descriptive comparative cross-sectional study was to compare HRQOL of Palestinian refugees in Jordan who live inside camps with those who live outside camps.

METHODS

Participants, recruited from inside the Baqa'a camp (n = 86) and the surrounding Abu Nsair community (n = 91), completed the World Health Organization Quality of Life Brief questionnaire.

FINDINGS

There were disparities in education and social relations and environment HRQOL related to income and residency, but not gender, among refugees.

CONCLUSION

Refugees living inside camps, particularly if poorer, fared worse than refugees living outside camps. Enhanced programs and policies may be needed to improve HRQOL, education, and socioeconomics for camp refugees. Nursing's perspective on refugee health could make an important contribution to humanitarian efforts and health diplomacy.

Understanding how domestic health policy is integrated into foreign policy in South Africa: a case for accelerating access to antiretroviral medicines

BACKGROUND

South Africa, as an emerging middle-income country, is becoming increasingly influential in global health diplomacy (GHD). However, little empirical research has been conducted to inform arguments for the integration of domestic health into foreign policy by state and non-state actors. This study seeks to address this knowledge gap. It takes the form of an empirical case study which analyses how South Africa integrates domestic health into its foreign policy, using the lens of access to antiretroviral (ARV) medicines.

OBJECTIVE

To explore state and non-state actors' perceptions regarding how domestic health policy is integrated into foreign policy. The ultimate goal of this study was to achieve better insights into the health and foreign policy processes at the national level.

METHODS

Employing qualitative approaches, we examined changes in the South African and global AIDS policy environment. Purposive sampling was used to select key informants, a sample of state and non-state actors who participated in in-depth interviews. Secondary data were collected through a systematic literature review of documents retrieved from five electronic databases, including review of key policy documents. Qualitative data were analysed for content. This content was coded, and the codes were collated into tentative categories and sub-categories using Atlas.ti v.7 software.

RESULTS

The findings of this work illustrate the interplay among social, political, economic and institutional conditions in determining the success of this integration process. Our study shows that a series of national and external developments, stakeholders, and advocacy efforts and collaboration created these integrative processes. South Africa's domestic HIV/AIDS constituencies, in partnership with the global advocacy movement, catalysed the mobilization of support for universal access to ARV treatment nationally and globally, and the promotion of access to healthcare as a human right.

CONCLUSIONS

Transnational networks may influence government's decision making by providing information and moving issues up the agenda.

Global health education in Chinese universities and potential for collaboration with schools of nursing: A qualitative study

Background

The Chinese Consortium of Universities for Global Health (CCUGH) was established within schools of public health in 2013 with the goal of enhancing global health in China. Expanding nursing students' exposure to global health curricula is important as nurses are essential actors in the health care system. However, information related to existing global health education within CCUGH-affiliated universities and the current engagement of Chinese schools of nursing in global health remains extremely limited.

Objective

To identify and describe the current definitions and conceptualizations of global health education in Chinese universities, with a focus on schools of nursing, in order to explore potential opportunities for strengthened collaboration between global health initiative and schools of nursing in China.

Methods

Purposive sampling with snowballing was used to recruit 19 key informants who were critical stakeholders in global health and nursing in China. Key informant interviews were conducted from July 2014 to February 2015, and data were updated in June 2016. Content analysis was used to analyze data via Atlas.ti 7.

Results

There was a rapid growth in global health education within and beyond CCUGH-affiliated universities with nine universities establishing global health institutes. Translation and definition of global health lacked consistency in Chinese language. Though no course directly related to global health was offered, schools of nursing were gradually participating in global health education and research. Nursing was a critical component of global health, and global health and nursing mutually advanced each other. Nursing education should include global health contents, but at present independent global health curriculum in schools of nursing was not appropriate.

Conclusion

Increasingly Chinese universities are promoting global health education through the platform of CCUGH. It is an ideal moment to promote and expand work across the fields of global health and nursing, specifically to highlight opportunities for collaboration across education, research and practice.

[Reflecting on nursing contributions to global health]

OBJECTIVES

Discuss possibilities of nursing contribution for global health approaching knowledge bases and the potential for global health, reflecting upon nursing education and their skills and abilities to perform into global health.

RESULTS

Nurses contribute to global health in areas related to the health system policies, social determinants of health/disease, global issues related to culture, epidemics, communicable and non-communicable diseases, epidemiology, humanitarian actions and emergencies. Universities play an important role for this contribution.

CONCLUSIONS

Nurses are professionals who actively contribute to global health, whether in political, social, economic or cultural situations, and universities play an important role for the training of these professionals.

A practical field guide to conducting nursing research in low- and middle-income countries

OBJECTIVES

The purpose of this report is to offer practical guidance to nurse investigators interested in international research in low- and middle-income countries (LMICs). Lessons learned and strategies for planning and implementing an international research project are addressed.

METHODS

Four nurse researchers who conducted studies in diverse international settings (Argentina, India, South Africa, and Tanzania) describe their collective experiences regarding study planning and implementation; data collection using a variety of methods; and cultural, contextual and ethical considerations.

RESULTS

Nurses who undertake international health research projects, particularly in LMICs, can face unique challenges and opportunities. Recommendations for success include advance planning, remaining flexible, having a backup plan, cultivating an attitude of curiosity and cultural humility, establishing collaborative and respectful partnerships, and budgeting adequate time.

CONCLUSIONS

Nurse scientists often receive little training and support to conduct international research. Guidance to undertake research projects in LMICs can build capacity for nurses to make significant contributions to global health.

Establishing a program of global initiatives for nursing education

In the global nursing community, schools of nursing are increasingly developing initiatives and networks across national boundaries. This article describes the process undertaken at a school of nursing to determine its global health priorities and develop a program of global initiatives for nursing education. A series of meetings were held to determine faculty global activities and gauge interest in designing a 5-year strategic plan for the program. A volunteer Strategic Planning Work-group was convened to formalize a mission, vision, and strategic plan for the program, which were presented to, refined by, and vetted by an advisory board and the faculty at large. We recommend this process to schools committed to developing or expanding a program dedicated to global initiatives and a global perspective in educational planning. Involving stakeholders, building on current strengths, and aligning with mission and vision are essential elements for developing a meaningful program of global initiatives for nursing education.