Comparing Approaches to Research in Global and International Health: An Exploratory Study.

Background: Global health is a term often used interchangeably with international health due to overlapping similarities and unclear distinctions. While some international health supporters argue that global health as a field is unnecessary as it is simply a duplicate of international health, global health supporters argue that global health is unique; for instance, it actively includes elements of empowerment and promotes cross-border collaboration. Objective: To investigate differences and similarities in research representing the fields of global and international health. Methods: We analyzed all the articles published in 2017 in two comparable academic journals representing the fields of global health (Annals of Global Health, AGH) and international health (International Health Journal, IHJ). Abstracted data included: research design and methods, income status of country of study, empowerment recommendations for practice, participation and research collaboration. Findings: Most studies in both AGH and IHJ used quantitative research methods but were significantly more common in IHJ (70%) compared to AGH (48%), whereas mores studies in AGH (17%) than IHJ (9%) used mixed methods. The majority of studies in both journals focused on low- or lower-middle income countries whereas more AGH studies (16%) focused on high-income countries compared to the IHJ studies (4%). It was more common in the AGH studies to make empowerment recommendations (90%) and to include stakeholders/users in the study (40%) compared to the IHJ studies (75% empowerment recommendations and 18% stakeholder/user participation). No difference was observed regarding cross-border research collaboration. Conclusions: This study does not show great differences between global health and international health research; however, there are still some differences indicating that global health emphasises different aspects of research compared to international health. More research is necessary to understand whether and how the distinctions between the definitions of global and international health are applied in real life, in research and beyond.

First Year's Work Experiences of Foreign Educated Nurses Coming to Norway From Other European Countries.

INTRODUCTION: Nurses educated in the European Union and European Economic Area are automatically given professional authorization to work in all member states, facilitating workforce mobility between countries. Along with many other European countries, Norway faces nursing shortages in healthcare. European Foreign Educated Nurses are often recruited to work in Norway by agencies or apply for work themselves. AIMS: To explore the experiences Foreign Educated Nurses from European Union and European Economic Area had with their preparation and orientation programs and their first year of work in Norwegian elderly care institutions. METHODS: The study followed a qualitative explorative design. Nine open, dialogue-based, semi-structured interviews were conducted with Foreign Educated Nurses from Poland, Lithuania, Latvia, Iceland, and Spain. Data were analyzed using qualitative content analysis. FINDINGS: One main theme, struggling to adjust to professional competence standards, and four subthemes emerged from our data (1) deficiencies in preparation and orientation by recruitment agencies and institutions, (2) language skills and communication challenges at work, (3) cultural differences in the nursing role in clinical practice, and (4) social interactions at work. CONCLUSION: More comprehensive preparation and orientation programs regarding language skills and local healthcare systems are needed. Foreign Educated Nurses make important contributions to the Norwegian healthcare work force, but the challenges brought to light in this study negatively affected their work conditions and can possibly threaten patient safety. More research is suggested to address the lack of collaboration between agencies, healthcare institutions, and other stakeholders in establishing professional standards and appropriate support for Foreign Educated Nurses from European Union and European Economic Area.

Foreign educated nurses' work experiences and patient safety-A systematic review of qualitative studies.

AIM: The aim of this systematic review was to identify the evidence contributed by qualitative research studies of foreign educated nurses' work experiences in a new country and to link the results to patient safety competencies. DESIGN: A systematic literature review of qualitative studies. METHODS: Electronic searches in the Ovid MEDLINE, Embase, PsycINFO, Cochrane Library and Cinahl databases and additional manual searches in five scientific journals. A content analysis of 17 qualitative articles was conducted. RESULTS: The analysis revealed one main theme: "Being an outsider at work" and two themes: "Cultural dissonance and Unfamiliar nursing practice. Two sub-themes emerged from the first theme; Loneliness and discrimination" and "Communication barriers". The second theme was based on the following two sub-themes: "Handling work-related stress" and "Role uncertainty and difficulties in decision-making". A better prepared and longer orientation period with continual clinical supervision including systematic reflection on practice experiences is needed to support foreign educated nurses in the transition period and strengthen their Patient Safety Competencies. Nurse Managers have an important role in ensuring the inclusion of foreign educated nurses and providing desirable working conditions.

Enhancing students' moral competence in practice: Challenges experienced by Malawian nurse teachers.

BACKGROUND: Nurses and student nurses in Malawi often encounter challenges in taking a moral course of action. Several studies have demonstrated a need for increased awareness of ethical issues in the nursing education. OBJECTIVE: To explore the challenges experienced by nurse teachers in Malawi in their efforts to enhance students' moral competence in clinical practice. RESEARCH DESIGN: A qualitative hermeneutic approach was employed to interpret the teachers' experiences. PARTICIPANTS AND RESEARCH CONTEXT: Individual interviews (N = 8) and a focus group interview with teachers (N = 9) from different nursing colleges were conducted. ETHICAL CONSIDERATIONS: Ethical approval was granted and all participants signed their informed consent. FINDINGS: Two overall themes emerged: (1) authoritarian learning climate, with three subthemes: (a) fear of making critical comments about clinical practice, (b) fear of disclosing mistakes and lack of knowledge and (c) lack of a culture of critical discussion and reflection that promotes moral competence; and (2) discrepancy between expectations on learning outcome from nursing college and the learning opportunities in practice comprising three subthemes: (a) gap between the theory taught in class and learning opportunities in clinical practice, (b) lack of good role models and (c) lack of resources. DISCUSSION: Our findings indicated that showing respect was a central objective when the students were assessed in practice. A number of previous studies have enlightened the need for critical reflection in nursing education. Few studies have linked this to challenges experienced by teachers for development of moral competence in practice. This is one of the first such studies done in an African setting. CONCLUSION: There is a clear relationship between the two themes. A less authoritarian learning climate may enhance critical reflection and discussion between students, teachers and nurses. This can narrow the gap between the theory taught in college and what is demonstrated in clinical practice. Moral competence must be enhanced in order to ensure patients' rights and safety.

Ethical problems in practice as experienced by Malawian student nurses.

Student nurses are confronted by many ethical challenges in clinical practice. The aim of the study was to explore Malawian students' experiences of ethical problems during their clinical placement. A phenomenological hermeneutic design comprising interviews and qualitative content analysis was used. Ten students were interviewed. Three main themes emerged: 1) Conflict between patient rights and the guardians' presence in the hospital; 2) Conflict between violation of professional values and patient rights caused by unethical behaviour; and 3) Conflict between moral awareness and the ideal course of action. The students had difficulties ensuring patient rights and acting in accordance with western norms and values which are not always appropriate in the Malawian context. The students require role models who demonstrate professional attitudes towards patients' rights and values. There is a need to create pedagogical strategies in which a caring attitude and ethical reflection can be learned and cultivated in clinical practice.

Prevention of unethical actions in nursing homes.

Ethical problems regularly arise during daily care in nursing homes. These include violation of patients' right to autonomy and to be treated with respect. The aim of this study was to investigate how caregivers emphasize daily dialogue and mutual reflection to reach moral alternatives in daily care. The data were collected by participant observation and interviews with seven caregivers in a Norwegian nursing home. A number of ethical problems linked to 10 patients were disclosed. Moral problems were revealed as the caregivers acted in ways that they knew were against patients' interest. We used a theoretical interpretation according to Habermas' discourse ethics on the importance of dialogue when deciding moral courses of action for patients. This theory has four basic requirements: communicative competence, equality, self-determination, and openness about motives.