Culture, context and community: ethical considerations for global nursing research

Combatting neo-Colonialism in Health Research: What can Aboriginal Health Research Ethics and Global Health Research Ethics Teach Each Other?

The ethics of research involving Aboriginal populations and low and middle-income country populations each developed out of a long history of exploitative research projects and partnerships. Commonalities and differences between the two fields have not yet been examined. This study undertook two independent literature searches for Aboriginal health research ethics and global health research ethics. Content analysis identified shared and differently emphasised ethical principles and concepts between the two fields. Shared ethical concepts like "benefit" and "capacity development" have been developed to guide collaborations in both Aboriginal health research and global health research. However, Aboriginal health research ethics gives much greater prominence to ethical principles that assist in decolonising research practice such as "self-determination", "community-control", and "community ownership". The paper argues that global health research ethics would benefit from giving greater emphasis to these principles to guide research practice, while justice as approached in global health research ethics may inform Aboriginal health research practice. With increasing attention being drawn to the need to decolonise global health research, the lessons Aboriginal health research ethics can offer may be especially timely.

Un modelo para favorecer la ética y las buenas prácticas en investigación global e intercultural: aplicaciones en México y Chile

La investigación intercultural plantea desafíos éticos complejos. Por ello, en el año 2019 se desarrolló un modelo de análisis de conflictos éticos en colaboración con más de 200 investigadores de más de 30 países. Este modelo parece pertinente para América Latina. El modelo propone que los desafíos éticos (y sus soluciones) dependen de cuatro factores presentes durante todo el proceso de investigación: el lugar donde se realiza la investigación, las personas involucradas, los principios éticos relevantes y los precedentes de investigaciones pasadas. En este artículo hacemos un análisis de la aplicabilidad de dicho modelo mediante dos análisis de casos referidos a la investigación con pueblos originarios en Chile y al trabajo con latinos migrantes en la frontera México-Estados Unidos.

Participatory Action Research and Photovoice: Applicability, Relevance, and Process in Nursing Education Research

Participatory action research (PAR) is a philosophy and approach to qualitative research. The purpose of this article is to generate a clearer understanding of PAR and its relevance to the discipline and profession of nursing. The authors provide a description of the principles and process of implementing PAR methodology, using photovoice as an innovative, participant-directed data collection method in rural nursing preceptorship. Participants were undergraduate nursing students and faculty advisors assigned to rural communities during the final clinical preceptorship. Participants described opportunities and challenges experienced during the preceptorship and how these experiences influenced their learning and overall preceptorship experience.

Duty versus distributive justice during the COVID-19 pandemic

The COVID-19 pandemic exposed vulnerabilities in inadequately prioritized healthcare systems in low- and middle-income countries such as Kenya. In this prolonged pandemic, nurses and midwives working at the frontline face multiple ethical problems, including their obligation to care for their patients and the risk for infection with severe acute respiratory syndrome coronavirus 2. Despite the frequency of emergencies in Africa, there is a paucity of literature on ethical issues during epidemics. Furthermore, nursing regulatory bodies in African countries such as Kenya have primarily adopted a Western code of ethics that may not reflect the realities of the healthcare systems and cultural context in which nurses and midwives care for patients. In this article, we discuss the tension between nurses' and midwives' duty of care and resource allocation in the context of the COVID-19 pandemic. There is an urgent need to clarify nurses' and midwives' rights and responsibilities, especially in the current political setting, limited resources, and ambiguous professional codes of ethics that guide their practice.

Ethics in global research: Creating a toolkit to support integrity and ethical action throughout the research journey

Global challenge-led research seeks to contribute to solution-generation for complex problems. Multicultural, multidisciplinary, and multisectoral teams must be capable of operating in highly demanding contexts. This brings with it a swathe of ethical conflicts that require quick and effective solutions that respect both international conventions and cultural diversity. The objective of this article is to describe the process of creating a toolkit designed to support global researchers in navigating these ethical challenges. The process of creating the toolkit embodied the model of ethical research practice that it advocates. Specifically, at the heart of ethical decision-making is consideration of the following: Place, solutions must be relevant to the context in which they are to be used; People, those impacted by the outcomes must be partners in co-creation; Principles, ethical projects must be guided by clear values; and Precedent, the existing evidence-base should guide the project and, in turn, the project should extend the evidence-base. It is the thesis underlying the toolkit that consideration of these 4Ps provides a strong basis for understanding ethical conflicts and allows for the generation of potential solutions. This toolkit has been designed in two phases of collaborative work. More than 200 researchers participated from more than 30 countries and more than 60 different disciplines. This allowed us to develop a model for contextual, dynamic analysis of ethical conflicts in global research that is complementary to traditional codes of ethics. It emphasizes the need to consider ethical analysis as an iterative, reflective, process relevant at all stages of the research journey, including, ultimately, in evaluating the legacy of a project. The toolkit is presented as an open access website to promote universal access. A downloadable “pocket guide” version is also now available in 11 languages.

Unpacking the hidden curriculum in nursing education: clinical placements abroad

Many Canadian nursing programs endorse clinical placements abroad. We critically examined the hidden curriculum embedded in clinical placements seeking to provide a 'global' experience. Using purposeful sampling, we interviewed a total of 18 participants, including eight faculty, eight students and two placement coordinators. Data were analyzed using initial and focused coding, supported by NVivo. After generating themes from the coded data, we adapted Hafferty's (1998) framework to further analyze the theme of the hidden curriculum. The findings illuminate how policies sustained international experience as a privileged endeavour, with restricted access based on grades. Placements incorporated little evaluation of benefits for local communities. Few resources were allocated to students for such placements, as many students paid for their placement. The institutional terms 'international and global experience' denoted interactions with cultural "Others". We recommend that nursing programs attend to hidden practices that sustain clinical placements abroad as prestigious, commodified experiences.

Conducting nursing research in low- and middle-income countries: experiences, challenges and solutions

BACKGROUND

Conducting nursing research in low- and middle-income countries (LMICs) balances challenges and opportunities. Understanding the shared experiences of researchers who have completed studies in diverse cultural contexts using various methodologies is important, to advance global nursing research and to build health research capacity and sustainability strategies.

AIM

To provide a reflexive account using a case-study methodology of transactions and processes conducted during a study in a LMIC.

DISCUSSION

Lessons learned from the study include the importance of preplanning, being flexible and creative, engaging local collaborators early in planning, establishing good rapport and respectful relationships with gatekeepers and collaborators, having a backup plan, appreciating cultural differences, and sharing findings.

CONCLUSION

Conducting research in LMICs is complex, especially negotiating access and obtaining ethical approval. Understanding the issues will benefit future research and prepare nurse researchers who take on the challenges and rewards of conducting international research in LMICs.

IMPLICATIONS FOR PRACTICE

This paper provides a roadmap to help novice researchers conduct research in LMICs.

Global nursing as visualised on the internet: a netnographic analysis of the emerging global paradigm in nursing

BACKGROUND

Positioned to face increasing issues relating to the growing and aging population, ill health, climate change, natural disasters, and humanitarian crises, nurses play a crucial role in responding to the challenges of globalisation. With nurses rising to meet these challenges, the term 'global nursing' has been coined. Given the ongoing proliferation of the term, it seems relevant to explore the key relationship of the concepts of 'global' and 'nursing' within the milieus provided through the internet.

AIM

To describe how global nursing as a concept is visualised in images on the internet.

METHOD

A cross-sectional observational design based on netnographic methodology was conducted. By searching the term 'global nursing' in the Google search engine, a total of 973 images illustrating 'global nursing' were collected and stored on one specific search occasion. The inclusion of data covered all regions but no other search limits.

RESULTS

The results show that global nursing, first and foremost, is visualised as an academic discourse, as a nursing activity, and as an approach to target sustainability. Further, the results also highlight that global nursing has manifested as a Western discourse, targeting students with access to resources and a humanitarian interest.

CONCLUSION

By paying attention to global nursing as it is presented in this study, it has been possible to provide valuable insights about colonial boundaries in the nursing discourse relating to globality. Based on these results, we stress that the nursing paradigm would benefit from a greater postcolonial awareness and some reflexivity connected with the global issues that nurses are facing. Impact statement: Global nursing is paradoxically visualised as something distant, connected to ideas of 'otherness', and of not belonging to the Western nursing community.

Mock Institutional Review Board: Promoting Analytical and Reasoning Skills in Research Ethics

Although it is critical that nurses possess ethical reasoning skills for research, there is limited information on effective strategies to develop these skills in graduate health care students. A research study analyzing educational interventions including the effect of online human subjects training followed by a mock institutional review board simulation demonstrated that knowledge acquisition is not enough to acquire the ethical reasoning skills needed to implement health care research. Situational context is also needed to envision the application of ethical principles.

Developing nursing research in the United Arab Emirates: a narrative review

AIM

This article identified, critically analysed and synthesized the literature on international nursing and midwifery research capacity building and standards.

BACKGROUND

The United Arab Emirates is heavily dependent up on expatriate nurses. Only 4% of nurses working within the country are Emirati. The nation is therefore committed to developing nurses and nursing as a profession.

INTRODUCTION

The United Arab Emirates' Nursing and Midwifery Council was formed in 2009 and initially focused on regulation, education and specialization. This review was undertaken to inform the work of the Council's newly established Scientific Research Sub-Committee.

METHODS

A rapid narrative review was conducted using the Cumulative Index of Nursing and Allied Health Literature database, key words, Boolean operators, parameters and a journal-specific search. An inclusion/exclusion criterion was identified.

RESULTS

The search provided 332 articles with 45 included in the final review. The literature on nursing research 'standards' and 'capacity building' is diverse and inconsistent across continents and in approaches.

DISCUSSION

Nursing research has evolved to varying degrees across the globe. Nevertheless, irrespective of the locale, there are similar problems encountered in growing research, for example nursing faculty shortage, lack of collaborative research, funding. There are also specific challenges in the Middle East and North Africa region.

LIMITATIONS

The review was constrained by time and access.

CONCLUSION AND IMPLICATIONS FOR NURSING POLICY

There are specific challenges for the United Arab Emirates. However, the country is well placed to learn from the experiences of colleagues elsewhere. Time and commitment is required to build the solid foundations necessary to ensure robust, sustained growth. Identifying research capacity as both a process and outcome at the outset may also assist. Further, it may be prudent to consider initiating a Gulf Coast Countries' collaborative approach to building research capacity to harness scare resources and create a larger critical mass.

Global Nursing-a literature review in the field of education and practice

Aim

To describe key findings of Global Nursing in empirical nursing studies.

Design

A literature review using descriptive data synthesis of peer‐reviewed articles in the field of nursing education and practice.

Methods

This review of Cinahl Complete, PubMed, PsycINFO and Scopus was undertaken using the search strategy “global nursing”. Independent title/abstract and full‐text screening was undertaken, identifying original articles written in English.

Results

A total of 472 titles and 170 abstracts were read through. Seventy‐three articles were included for full‐text review. Twenty published studies of Global Nursing with multiple research methodologies fulfilled the inclusion criteria. Findings were described with five categories. Global Nursing Arena, Global Nursing Working Environments, Global Nursing Workforce Management, Global Nursing Competencies and Global Nursing Networking were shown to be crucial when Global Nursing was addressed in the literature.

Developing a model of health behavior change to reduce parasitic disease in Vietnam

Worldwide more deaths occur due to conditions that can be ameliorated by behavior change. Changing health behaviors using models popularized in non-western countries has not proven particularly successful. The purpose of this study was to test variables elicited during qualitative interviews and cultural conversations to develop a model of health behavior change from the ground up in Vietnam. Village leaders and women representatives from the Women's Committee were trained as health advocates to facilitate changes in health practices that led to parasitic and infectious diseases. The health advocates visited 156 families to assess household conditions and assist women head-of-households in applying new behaviors to water treatment, personal hygiene, proper latrining and proximity of animals to humans. Predictors that were tested were self-efficacy, social desirability, internal and external control, and outcome expectations. The correlational and regression design resulted in self-efficacy alone predicting both home hygiene and family health with a large effect size. Social desirability appears to play a different role than in western culture studies. Outcome expectations and control were not predictive. A cultural analysis of the results is included.

Exploring Cultural Influences of Self-Management of Diabetes in Coastal Kenya: An Ethnography

In spite of increasing prevalence of diabetes among Kenyans and evidence suggesting Kenyans with diabetes maintain poor glycemic control, no one has examined the role of cultural attitudes, beliefs, and practices in their self-management of diabetes. The purpose of this ethnographic study was to describe diabetes self-management among the Swahili of coastal Kenya, and explore factors that affect diabetes self-management within the context of Swahili culture. Thirty men and women with type 2 diabetes from Lamu town, Kenya, participated in this study. Diabetes self-management was insufficiently practiced, and participants had limited understanding of diabetes. Economic factors such as poverty and the high cost of biomedical care appear to have more influence in self-management behavior than socio-cultural and educational factors do. Economic and socio-cultural influences on diabetes self-management should not be underestimated, especially in a limited resource environment like coastal Kenya, where biomedical care is not accessible or affordable to all.

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.

Novel and emerging strategies for longitudinal data collection

PURPOSE

To describe novel and emerging strategies practiced globally in research to improve longitudinal data collection.

ORGANIZING CONSTRUCT

In research studies, numerous strategies such as telephone interviews, postal mailing, online questionnaires, and electronic mail are traditionally utilized in longitudinal data collection. However, due to technological advances, novel and emerging strategies have been applied to longitudinal data collection, such as two-way short message service, smartphone applications (or "apps"), retrieval capabilities applied to the electronic medical record, and an adapted cloud interface. In this review, traditional longitudinal data collection strategies are briefly described, emerging and novel strategies are detailed and explored, and information regarding the impact of novel methods on participant response rates, the timeliness of participant responses, and cost is provided. We further discuss how these novel and emerging strategies affect longitudinal data collection and advance research, specifically nursing research.

CONCLUSIONS

Evidence suggests that the novel and emerging longitudinal data collection strategies discussed in this review are valuable approaches to consider. These strategies facilitate collecting longitudinal research data to better understand a variety of health-related conditions. Future studies, including nursing research, should consider using novel and emerging strategies to advance longitudinal data collection.

CLINICAL RELEVANCE

A better understanding of novel and emerging longitudinal data collection strategies will ultimately improve longitudinal data collection as well as foster research efforts. Nurse researchers, along with all researchers, must be aware of and consider implementing novel and emerging strategies to ensure future healthcare research success.

Eyes wide open: an essay on developing an engaged awareness in global medicine and public health

BACKGROUND

There is a growing understanding of the role social determinants such as poverty, gender discrimination, racial prejudice, and economic inequality play on health and illness. While these determinants and effects may be challenging to identify in parts of high-income countries, they are patently obvious in many other areas of the world. How we react to these determinants and effects depends on what historical, cultural, ideological, and psychological characteristics we bring to our encounters with inequity, as well as how our feelings and thoughts inform our values and actions.

DISCUSSION

To address these issues, we share a series of questions we have asked ourselves-United States' citizens with experience living and working in Central America-in relation to our encounters with inequity. We offer a conceptual framework for contemplating responses in hopes of promoting among educators and practitioners in medicine and public health an engaged awareness of how our every day work either perpetuates or breaks down barriers of social difference. We review key moments in our own experiences as global health practitioners to provide context for these questions. Introspective reflection can help professionals in global medicine and public health recognize the dynamic roles that they play in the world. Such reflection can bring us closer to appreciating the forces that have worked both for and in opposition to global health, human rights, and well-being. It can help us recognize how place, time, environment, and context form the social determination of health. It is from this holistic perspective of social relations that we can work to effect fair, equitable, and protective environments as they relate to global medicine and public health.

Mind the gaps in ethical regulations of nursing research

The introduction of and the commitment to evidence-based nursing in all care settings have led to a rapid increase of intervention and outcome-based research programs. Yet, the topics of nursing research are not only affected by interventions and outcomes but also affected by the concept of caring derived from humanistic philosophy. Considering this twofold orientation of nursing science, nuanced ethical regulations for nursing research programs are called for. In addition to the different research approaches, further arguments for ethical regulations are as follows: first, the different degrees of contextualization and the variety of participation models regarding the target groups; second, the capacities and opportunities of participants; and third, the caring relationship between nurses and research subjects. To capture these special features of nursing science, four approaches to fill the gaps in existing ethical regulations for nursing research are proposed: (a) process orientation, (b) community orientation, (c) context orientation, and (d) relation orientation.

Descriptive survey of the contextual support for nursing research in 15 countries

Background: Global research productivity depends on the presence of contextual factors, such as a doctorally prepared faculty, graduate programmes, publication options, that enablethe conduct and publication of studies to generate knowledge to inform nursing practice.Objectives: The current study aimed to develop and test an instrument that measures the level of contextual support for nursing research within a specific country, allowing comparisons between countries.Method: After development of a 20-item survey with seven factors and 11 criteria based on aliterature review, a quantitative descriptive e-mail survey design was used.Results: Nurse researchers (N = 100) from 22 countries were invited to participate. Theresponse rate was 39% from 15 countries. Ethics approval was obtained by investigators in their country of origin. Results showed wide variation in the level of contextual support. The average total level of support across all countries was 26.8% (standard deviation [SD] = 14.97). The greatest variability was in the area of availability of publishing opportunities (ranging between no suitable journals in a country to over 100). The least variability was in the area of availability of local enabling support (SD = 7.22). This research showed wide differences in the level of contextual support for nursing research.Conclusion: The survey instrument can be utilised as a country assessment that can be used tostrategically plan the building of infrastructure needed to support nursing research. Contextual support for nursing research is an antecedent of strong science. Building infrastructure for nursing science is a priority for global health.

International nursing exchange and collaboration with China: a perspective from the South and the East

BACKGROUND

There are an imbalanced world power relationships and international knowledge system, as well as cultural differences across nations.

RESULTS

Based on the author's international experiences, this article describes the needs and motivations of international exchange and collaboration in nursing from the perspective of both China and Western countries, examines the ethical and cultural issues involved, and suggests winning strategies.

CONCLUSIONS

Western educators and scholars must keep these issues and strategies in mind in order to build a productive, mutually beneficial, and sustainable international exchanges and collaboration.

A review of current ethical concerns and challenges in substance use disorder research

PURPOSE OF REVIEW

To consider and summarize provocative and important publications from 2009 and 2010 related to the ethics of international substance use disorder research.

RECENT FINDINGS

This review highlights publications related to the interconnected areas of responsible conduct of research, human participant protections and the increasingly important area of community concerns in research, all within the larger realm of ethical concerns. Ongoing concerns highlighted include standards for conflict of interest, recruitment and remuneration practices. Other literature discussed expands the ethical dialogue to consider the community perspective on research, stigmatization of drug users from research and the absence of the 'moral voice' of drug users in ethical decision-making.

SUMMARY

Ethical dilemmas are inherent in the pursuit of any research; in substance use disorder research, often situated in a community with at-risk populations, questions such as who sets the research agenda and what norms are followed are critically important. Responsible research that protects participants and their communities internationally requires ongoing vigilance.

Global and cultural perinatal nursing research: improving clinical practice

High-quality perinatal nursing care should be based on the best evidence including research findings, clinical expertise, and the preferences of women and their families. Principles of perinatal research initiatives are defined, with suggested research priorities designed to close current gaps in the micro and macro environments of perinatal nursing throughout the world. Nearly a decade ago, the following question was asked, "Where is the 'E' (evidence) in maternal child health?" Improving the quality and safety of perinatal nursing care for culturally diverse women globally is the primary goal of nurse researchers leading the future of perinatal healthcare.