Application of a partnership model for transformative and sustainable international development

A professional virtues-based ethical framework for medical missions

BACKGROUND

More than 1.6 million physicians participate in medical missions each year. This effort is part of a long history of volunteerism and service to those in need in the form of medical missions to low-income countries. The Children's Health International Medical Project of Seattle has provided the following 7 guiding principles of sustainable short-term international medical missions: "mission, collaboration, education, service, teamwork, sustainability, and evaluation." The role of professional virtues in grounding these principles and thus guiding medical missions is underappreciated.

OBJECTIVE

To provide a professional virtues-based ethical framework for medical missions, this article addressed the question, "How should physicians design and implement a medical mission in a professionally responsible way?" Reference is made to one of the authors' experiences as a point of reference.

STUDY DESIGN

The authors addressed the questions on how to design and implement a medical mission based on 5 professional virtues: compassion, integrity, humility, self-effacement, and self-sacrifice. A concise, historically based explanation of each virtue was provided, and the implications of the aforementioned principles for medical missions were identified.

RESULTS

Compassion motivates the mission and its team members, whereas integrity, humility, self-effacement, and self-sacrifice guide team members as they act on the professional virtue of compassion.

CONCLUSION

These 5 professional virtues can be used to provide a practical framework for the professionally responsible design and implementation of medical missions.

Global partnerships in nursing - A qualitative study in lessons for success

Global nursing partnerships can develop cultural competence and standardisation across international nurse education programmes. Issues of context, cultural awareness and modes of engagement can influence the success of international collaboration. The 'Supporting Internationalisation of Traineeships in the Healthcare Sector' project, funded from 2017, brought together nine international partners from Finland, Poland, Spain and the UK to develop a pan-European quality audit process for clinical learning environments. As part of the evaluation, eight project partners were interviewed about the project and their criteria for a successful global partnership. The interviews allowed insight into previously hidden aspects of implementation. The importance of a scoping period for nursing global partnerships was highlighted that built on cultural diversity to explore common understandings. Attention to the use of prior expertise in internationalisation, or project objectives, could accelerate a global partnership to achieve a greater potential in its outcomes and cultural sensitivity. Framed in a clear structure, it is possible for global partnerships to embed ownership, autonomy and individual voice in partner organisations. The research concludes that only by growing international champions through funded and well constituted projects, that a genuine impact on the global health and educational needs in nursing can be met.

The impact of learning abroad programs in developing countries: A scoping review

OBJECTIVES

An increasing number of higher education healthcare students from developed countries are undertaking short-term learning abroad programs in developing countries. However, sociocultural differences between the students and the communities could lead to unintended, possibly negative consequences for the community. The objective of this review was to explore what is known about the impact of learning abroad programs undertaken by healthcare students on the communities in the developing countries who host them.

DESIGN

The six-step scoping review developed by Arksey and O'Malley (2005) provided a methodological framework for searching the literature and identifying records meeting the inclusion criteria.

DATA SOURCES

A comprehensive range of databases were used to facilitate the literature search (including CINHAHL, EBSCO, ERIC, Google Scholar, MEDLINE, PsycINFO, Scopus and Web of Science).

REVIEW METHODS

A two-stage review process was undertaken. Stage 1 reviewed articles on learning abroad undertaken in developing countries by higher education healthcare students. Stage 2 identified articles that reported the impact on the host community. Articles meeting the stage 2 criteria were further assessed for methodological quality using the Critical Review Form for Qualitative Studies.

RESULTS

The stage 2 review revealed less than one quarter of the included articles (n = 36) reported on the impact of the learning abroad program on the host community and across these eight articles, there was a significant diversity in the methodological rigour and outcomes presented.

CONCLUSIONS

This review identified that most of the published research on learning abroad in developing countries focusses almost exclusively on the impact the programs have on the students, with a paucity of research considering how they impact host communities. Our findings suggest the need to further extend and strengthen the research on the host communities in order to understand the impact higher education healthcare students have on the international communities who host them.

Building an International Partnership to Develop Advanced Practice Nurses in Anesthesia Settings: Using a Theory-Driven Approach

The International Federation of Nurse Anesthetists is calling for international collaboration to develop advanced nursing practice in anesthesia settings globally. However, international collaboration is challenging. Limited information is available about what process and factors specifically lead to a successful international collaboration partnership. This article aimed to describe a theoretical and empirical base that can be used to build and maintain long-term international partnerships. The Theoretical Framework of Developing International Partnerships was developed, which comprises seven interrelated concepts including partnerships, collaborations, environment, structure, process for collaborating, outcomes, and sustainability. It was used to guide an equitable horizontal collaboration partnership to develop anesthesia nursing care in local culture and context. Five major challenges were identified during the collaboration process. Sixty-six strategies were developed to facilitate collaboration using the theoretical framework. This work can inform others in establishing an international collaboration and partnership in advancing nursing knowledge and culturally congruent health care delivery.

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.

Nursing Partnership Activities, Components, and Outcomes: Health Volunteers Overseas in Uganda 2001-2016

Nurses increasingly form global health partnerships through academic and voluntary organizations that are designed to improve health outcomes. Many such partnerships are funded for specific time periods and have short- or long-term goals to achieve during the partnership. Other partnerships are sustained for longer periods of time through the efforts of partners committed to their joint work. The case example of the Health Volunteers Overseas Nursing Education partnership in Kampala, Uganda, demonstrates key components of partnerships that promote sustainability of programs. This case example is analyzed using literature that reports partnership models to identify those factors that have led to sustainability. Additionally, both objective and subjective program outcomes are reported. Recommendations for further evaluation are included.

Nicaraguan and US nursing collaborative evaluation study: Identifying similarities and differences between US and Nicaraguan curricula and teaching modalities using the community engagement model

BACKGROUND

Curricula evaluation is an essential phase of curriculum development. Study describes the implementation of a formative evaluation used by faculty members between Universidad Nacional Autonóma de Nicaragua (UNAN-Leon) Escuela de Enfermeriá, Nicaragua and East Carolina University College of Nursing (ECU CON) in North Carolina, US.

OBJECTIVES

Program evaluation study to conduct an assessment, comparison of a medical-surgical adult curriculum and teaching modalities. Also, explore the Community Engagement (CE) Model to build a Central American-US faculty partnership.

DESIGN

Methodological evaluation study utilizing a newly developed International Nursing Education Curriculum Evaluation Tool related to adult medical and surgical nursing standards. Also, the CE Model was tested as a facilitation tool in building partnerships between nurse educators.

DATA

Nicaragua and US nursing faculty teams constructed the curriculum evaluation by utilizing the International Nursing Education Curriculum Evaluation Tool (INECET) by reviewing 57 elements covering 6 Domains related to adult medical and surgical nursing standards.

METHODS

Developed, explored the utilization of the INECET based on a standard of practice framework. The Community Engagement Model, a fivephase cycle, Inform, Consult, Involve, Collaborate, and Empower was utilized to facilitate the collaborative process.

RESULTS

Similarities between the US and Nicaraguan curricula and teaching modalities were reflective based on the 57 elements covering 6 Domain assessment tool. Case studies, lecture, and clinical hospital rotations were utilized as teaching modalities. Both schools lacked sufficient time for clinical practicum time. The differences, included UNAN-Leon had a lack of simulation skill lab, equipment, and space, whereas ECU CON had sufficient resources. The ECU school lacked applied case studies from a rural health medical-surgical adult nursing perspective and less time in rural health clinics. The UNAN-Leon nursing standards generalized based on the Ministry of Health (MINSA) and the US program was specific based on the American Nurses Association and various sub-specialties of nursing practice requirements. The CE Model was a useful framework to facilitate a collaborative partnership.

CONCLUSION

Collaborative evaluation study using the International Nursing Education Curriculum Evaluation Tool can be an effective method to evaluate medical and surgical curricula similarities and differences within international nursing schools. The Community Engagement Model fostered a faculty partnership.

Building International Sustainable Partnerships in Occupational Therapy: A Case Study

Occupational therapy practitioners frequently identify opportunities for international practice. The World Health Organization and the World Federation of Occupational Therapists have encouraged occupational therapists to address transnational issues, social inclusion, and equal access to opportunities grounded in meaningful occupation (WFOT, 2012). This case study describes a partnership between two U.S. schools of occupational therapy and a Cuban community based pediatric clinic. It examines the dynamics that have sustained the partnership despite political, economic, and logistical barriers. The literature is scrutinized to show how this case study fits into other accounts of collaborative international partnerships. Particularly, it investigates structural and institutional conditions that shape international sustainable partnerships. In doing so, we answer the following questions: (1) Under which circumstances do international partnerships emerge and flourish? (2) What structural and institutional conditions shape international sustainable partnerships? And (3) How do partners perceive and experience the bilateral international partnership? It also discusses and illustrates the foundations and development of international partnerships that succeed. Through the use of a case study we illustrate the development of this partnership. Finally, we consider the next steps of this particular sustainable and collaborative international partnership.

Bridging nursing practice and education through a strategic global partnership

To forge strong relationships among nurse scholars from the University of Pennsylvania School of Nursing, Philadelphia, PA (USA); University of Botswana School of Nursing, Gaborone, Botswana; the Hospital of the University of Pennsylvania, Philadelphia; Princess Marina Hospital (PMH), Gaborone; and the Ministry of Health of Botswana, a strategic global partnership was created to bridge nursing practice and education. This partnership focused on changing practice at PMH through the translation of new knowledge and evidence-based practice. Guided by the National Institutes of Health team science field guide, the conceptual implementation of this highly successful practice change initiative is described in detail, highlighting our strategies, challenges and continued collaboration for nurses to be leaders in improving health in Botswana.

Development and evaluation of an international service learning program for nursing students

OBJECTIVES

(1) Using Riner's framework, the development of an international service learning program in the Dominican Republic (DR) for Baccalaureate nursing students will be described, and (2) an initial impact of the students' experiences will be examined.

DESIGN AND SAMPLE

A qualitative descriptive research design was used to examine its impact. The international service learning program included (1) didactic (five, 2 hr and one full day educational sessions) prior to (2) immersion (2 weeks in country), and (3) posttrip debriefing session. Ten females, senior nursing students participated in the program. Students' daily journals were examined using thematic analysis.

RESULTS

Five major themes that emerged were as follows adapting physically, encountering frustration in their inability to fully meet patients' needs, increasing confidence in speaking Spanish and assessing health problems, and increasing cultural awareness. Students were descriptive regarding their daily activities, and did some, but limited, critical reflection.

CONCLUSIONS

Models of reflection need to be explored to select the most appropriate technique to facilitate students' critical reflection in meeting the goals and objectives of the experience. Curriculum integration of global learning, social consciousness, and global cultural competence development is needed.

A framework for sustainable implementation of e-medicine in transitioning countries

Organizations in developed countries such as the United States of America and Canada face difficulties and challenges in technology transfer from one organization to another; the complexity of problems easily compounds when such transfers are attempted from developed to developing countries due to differing socioeconomic and cultural environments. There is a gap in the formation of research and education programs to address technology transfer issues that go beyond just transferring the technologies to sustaining such transfers for longer periods. This study examined telemedicine transfer challenges in three Sub-Sahara African countries and developed a framework for sustainable implementation of e-medicine. Both quantitative and qualitative research methods were used. The study findings indicate that e-medicine sustainability in Sub-Saharan Africa is affected by institutional factors such as institutional environment and knowledge management practices; technical factors such as the technological environment and technology transfer project environment; social environmental factors such as social environment and donor involvement. These factors were used to model the proposed framework.

Assessing global partnerships in graduate nursing

North-South partnerships in graduate nursing education can prepare students to address global healthcare issues, increase cultural competence, and build research capacity. However, the current literature does not include a critical and systematic assessment of partnerships using established guidelines. This paper has two objectives: 1) Find and refine a suitable measure to assess a North-South inter-institutional research and clinical partnership in nursing; 2) Pilot test an assessment measure and describe the results of a systematic institutional self-evaluation of a developing North-South research and clinical partnership within a graduate nursing program. The first objective was addressed by searching for, examining and selecting an assessment measure. The second objective was obtained by applying the assessment measure to a developing graduate-level research and clinical partnership between a Canadian School of Nursing and a Malawian College of Nursing; qualitative data collected included information from a document review and subjective experiences of partners. Results showed that when appropriate revisions are made to an existing guideline, it is applicable to use as an assessment measure for North-South inter-institutional research and clinical partnerships. Recommendations for improvement were made, allowing the guideline to be more specific for research and clinical partnerships. Results demonstrated that the existing Canadian-Malawian partnership was strongest in the guideline category of "shaping the purpose and scope of the partnership," and weakest in "partnership implementation and context." This paper implies that: 1) evaluation can strengthen partnerships and enhance educational experience for nursing students; 2) research comparing and contrasting different genres of partnerships could help determine which type is the most appropriate for an institutions' particular outcome goals; and 3) effective establishment and maintenance of North-South partnership occurs through an on-going process of evaluation.

Pillars for the care of older persons in the Caribbean

Pillars for the Care of Older Persons in the Caribbean: A Comprehensive Community-Based Framework (Pillars) is a hybrid of multiple public health frameworks developed through community-based participatory research processes. Health and social service professionals, governmental organizations, elderly persons, and others from across the English-speaking Caribbean countries developed the Pillars framework to address the growing elderly population and with an aim to increase the number of healthy and active years of life. The Pillars framework consists of four interrelated pillars organized across multiple sectors of society: primary care with care management; integrated services coordination; population-based health promotion and disease prevention; and planning and accountability. Pillars is enabled by an envisioned integrated system of information technology that will increase community-based services delivery, interprofessional communication and coordination, and will aggregate data with all identifiers removed for surveillance, planning, forecasting, policy making, evaluation, and research.

Managing the demand for global health education

Vanessa Kerry and colleagues discuss how to manage the unprecedented growth in and demand for global health programs in the United States, Europe and other high-income countries.

Enhancing nursing knowledge through democratic cross-national collaboration

Enhancing nursing knowledge requires the exchange of ideas worldwide through the collaboration of nurse scientists. Healthy partnerships abide by the values of collaboration, mutual trust, respect and dignity. However, a lack of information exists regarding the nature of cross-national academic partnerships in nursing. The purpose of this article is twofold: to explore democratic cross-national collaborations in nursing and to pose theoretically-based interventions to enhance future democratic collaborations cross-nationally in nursing. While a review of the literature revealed some model nursing partnerships, nursing can benefit from having a better evidence based understanding of the topic. Theoretical formulations from education, philosophy and critical anthropology offer complementary lenses to aid in the analysis. The process can help nursing academics to think more critically about the issues and to delineate theory driven protocols for democratic cross-national collaboration with the ultimate aim of enhancing nursing knowledge.

How ethical is your clinical trial?

Is Institutional Review Board (IRB) approval and a rigorous informed consent process enough? It is our view that this is no longer the case. Conventional research ethics emphasise the importance of weighing the risks and benefits for prospective participants as one of the key determinants of deeming a clinical trial ethical. We support the notion that ethical obligations of research should include considerations not only at the individual level, but also at the community level (1 ,2 ).