Essential global health competencies for baccalaureate nursing students in the United States: A mixed methods Delphi study.

AIMS: To reach consensus among experts on global health competencies for baccalaureate nursing students in the USA. DESIGN: A three-round modified Delphi study using a mixed methods research approach. METHODS: In the first round, the original list of competencies (Wilson et al., 2012, Journal of Professional Nursing, 28, 213-222) was revised based on prior research, a review of literature and the Nursing Global Health Competencies Framework developed by the fist author. Nine global health domains and 52 competencies were identified in Round One. In Round Two, two surveys were conducted for validation of the revised list of global health competencies using a group of six nurses with expertise in global health and baccalaureate nursing education, which produced modifications in the competencies used for the third phase of the study. In Round Three, 41 participants completed a survey to rate the extent to which they thought the competencies obtained in Round Two were essential for baccalaureate nursing education in the United States. Data collection took place from May 2017 - January 2018. RESULTS: A group of experts in global health and baccalaureate nursing education from the United States achieved consensus that 40 global health competencies were essential for baccalaureate nursing education in the United States. CONCLUSION AND IMPACT: The domains and competencies derived in this study can be used to guide undergraduate nursing curriculum development in global health and provide a framework for both clinical instruction and evaluation of global health student experiences.

Nursing and midwifery advocacy to lead the United Nations Sustainable Development Agenda.

The United Nations 2030 Agenda for Sustainable Development was implemented on January 1, 2016 and is composed of 17 Sustainable Development Goals (SDGs) and further delineated by 169 targets. This article offers background information on the 2030 Agenda as it relates to nursing and midwifery, professional organizational initiatives currently advancing the SDGs, the ethos of global citizenship, the urgency to respond to dwindling planetary health, the salience of nursing and midwifery advocacy in SDG attainment, and the myriad opportunities for nurses to lead and collaborate toward realizing these Global Goals. A US-based perspective is employed to underscore the Agenda's relevance to the US nursing workforce and healthcare system. The SDGs, with their holistic bio-psycho-social-environmental approach to health, present enormous opportunities for nurses and midwives. The SDG framework is naturally aligned with the foundational philosophy and purpose of our professions.

'Global health' and 'global nursing': proposed definitions from The Global Advisory Panel on the Future of Nursing.

AIMS: To propose definitions of global health and global nursing that reflect the new paradigm that integrates domestic and international health. BACKGROUND: Increased globalization has led to expanded awareness of the importance of global health and global nursing among students and faculty in the health professions and among policymakers and practitioners. DESIGN: Discussion paper that includes a discussion and review of the literature related to global health and global nursing. DATA SOURCES: A task force searched for and reviewed articles published in English, Spanish or Portuguese between 2005-2015, developed summaries, listed key elements, identified prevalent themes and developed consensus definitions. IMPLICATIONS FOR NURSING: The definitions will be used by the Global Advisory Panel on the Future of Nursing to guide promoting a voice and vision for nursing that will contribute to the advancement of the profession's contribution to global health. CONCLUSIONS: Definitions of global health and global nursing were developed based on main themes and concepts identified in the literature review to guide contributions of nursing to global health.

Perspectives of nursing faculty in Africa on global health nursing competencies.

BACKGROUND: It is important to define global health competencies for health professionals. To date, we know little about perspectives of nurses in Africa where environments are particularly challenging. PURPOSE: The purpose was to describe perceptions of nursing faculty in Africa about global health competencies and compare those to faculty from the Americas. METHODS: A 32-item online survey with a convenience sample of nursing faculty. RESULTS: Data from 63 nurses in 21 African countries and 618 in the Americas were analyzed. Competencies related to Social and Environmental Determinants of Health were awarded relatively higher scores. Competencies related to globalization of health and health care were ranked relatively lower. This was similar across regions. DISCUSSION: Nursing education should address the social implications for health. CONCLUSION: Participants in all three regions considered Social and Environmental Determinants of Health as a priority. These data help set educational priorities in a setting where educational and training resources are limited.

Research nurse manager perceptions about research activities performed by non-nurse clinical research coordinators.

OBJECTIVES: There has been limited research to document differences in roles between nurses and non-nurses who assume clinical research coordination and management roles. Several authors have suggested that there is no acknowledged guidance for the licensure requirements for research study coordinators and that some non-nurse research coordinators may be assuming roles that are outside of their legal scopes of practice. There is a need for further research on issues related to the delegation of clinical research activities to non-nurses. METHODS: This study used nominal group process focus groups to identify perceptions of experienced research nurse managers at an academic health science center in the Southern United States about the clinical research activities that are being performed by non-nurse clinical research coordinators without supervision that they believed should only be performed by a nurse or under the supervision of a nurse. RESULTS: A total of 13 research nurse managers volunteered to be contacted about the study. Of those, 8 participated in two separate nominal group process focus group sessions. The group members initially identified 22 activities that they felt should only be performed by a nurse or under the direct supervision of a nurse. CONCLUSIONS: After discussion and clarification of results, activities were combined into 12 categories of clinical research activities that participants believed should only be performed by a nurse or under the direct supervision of a nurse.

Enhancing global health and education in Malawi, Zambia, and the United States through an interprofessional global health exchange program.

AIM: This article describes participant outcomes of an interprofessional collaboration between health professionals and faculty in Malawi, Zambia, and the United States (US). BACKGROUND: One strategy critical for improving global health and addressing Millennium Development goals is promotion of interprofessional education and collaboration. METHODS: Program participants included 25 health professionals from Malawi and Zambia, and 19 faculty/health professionals from Alabama and California. African Fellows participated in a 2 week workshop on Interprofessional Education in Alabama followed by 2 weeks working on individual goals with faculty collaborators/mentors. The US Fellows also spent 2 weeks visiting their counterparts in Malawi and Zambia to develop plans for sustainable partnerships. RESULTS/CONCLUSIONS: Program evaluations demonstrated participants' satisfaction with the program and indicated that the program promoted interprofessional and cross-cultural understanding; fostered development of long-term sustainable partnerships between health professionals and educators in Zambia and the US; and created increased awareness and use of resources for global health education.

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

The increasing interconnectedness of the world and the factors that affect health lay the foundation for the evolving practice of global health diplomacy. There has been limited discussion in the nursing literature about the concept of global health diplomacy or the role of nurses in such initiatives. A discussion of this concept is presented here by the members of a Task Force on Global Health Diplomacy of the American Academy of Nursing Expert Panel on Global Nursing and Health (AAN EPGNH). The purpose of this article is to present an integrative review of literature on the concept of global health diplomacy and to identify implications of this emerging field for nursing education, practice, and research. The steps proposed by Whittemore and Knafl (2005) were adapted and applied to the integrative review of theoretical and descriptive articles about the concept of global health diplomacy. This review included an analysis of the historical background, definition, and challenges of global health diplomacy and suggestions about the preparation of global health diplomats. The article concludes with a discussion of implications for nursing practice, education, and research. The Task Force endorses the definition of global health diplomacy proposed by Adams, Novotny, and Leslie (2008) but recommends that further dialogue and research is necessary to identify opportunities and educational requirements for nurses to contribute to the emerging field of global health diplomacy.

Perioperative music and its effects on anxiety, hemodynamics, and pain in women undergoing mastectomy.

There is increasing interest in evaluating the use of nonpharmacologic interventions such as music to minimize potential adverse effects of anxiety-reducing medications. This study used a quasi-experimental design to evaluate the effects of a perioperative music intervention (provided continuously throughout the preoperative, intraoperative, and postoperative periods) on changes in mean arterial pressure (MAP), heart rate, anxiety, and pain in women with a diagnosis of breast cancer undergoing mastectomy. A total of 30 women were assigned randomly to a control group or to the music intervention group. Findings indicated that women in the intervention group had a greater decrease in MAP and anxiety with less pain from the preoperative period to the time of discharge from the recovery room compared with women in the control group. Music is a noninvasive and low-cost intervention that can be easily implemented in the perioperative setting, and these findings suggest that perioperative music can reduce MAP, anxiety, and pain among women undergoing mastectomy for breast cancer.

Faculty knowledge and skills needs in interprofessional education among faculty at the College of Medicine and Kamuzu College of Nursing, University of Malawi.

Background: Undergraduate health professionals' education in Malawi is mostly provided through a uniprofessional approach, even though the World Health Organization (WHO) recommends interprofessional education (IPE) in order to prepare health workers for collaborative practice. Because IPE is not widely practiced in Malawi, faculty may not have the knowledge and skills required for successful IPE implementation. Aim: To explore perceived needs for knowledge and skills related to IPE among faculty in undergraduate health professional programs at the University of Malawi - Kamuzu College of Nursing (KCN) and College of Medicine (COM). Design: A qualitative exploratory descriptive study capturing the perspectives of purposively selected participants was conducted at the University of Malawi KCN and COM. Data were collected through in-depth interviews (n = 16) and focus group interviews (n=20). Data analysis was done using qualitative content analysis. Findings: Faculty perceived the need for being knowledgeable in IPE and understanding its benefits. The need for training in IPE was perceived as key to increasing faculty members' confidence for IPE. Faculty also perceived the need for enhanced skills in interpersonal relationships, communication, and facilitation of learning, conflict resolution, and clinical teaching in order to successfully implement IPE. Conclusion: Faculty perceived the need to be knowledgeable about IPE, its benefits and the need for enhanced skills related to IPE. The need for formal training in IPE was perceived key for successful implementation of IPE. These findings provide information which can help to identify faculty training needs for IPE and to design faculty training activities.

Healthcare workers' perceptions on collaborative capacity at a Referral Hospital in Malawi.

BACKGROUND: Lack of collaborative capacity results in provision of fragmented health services that do not meet the needs of patients. Collaborative capacity refers to the extent to which providers have influence over other healthcare workers' decision-making, and can be assessed by measuring perceptions of task interdependence, quality of interaction and collaborative influence. However, each healthcare worker may present differing perceptions that can influence their ability to collaborate effectively during provision of care. No studies that specifically assessed healthcare workers' perception of collaborative capacity in Malawi were identified. AIM: To assess the perceptions of healthcare workers regarding collaborative capacity in Malawi. SETTING: The study was conducted at a tertiary public hospital in Blantyre city, Malawi. METHODS: The study employed a quantitative cross-sectional correlational design. The instrument used was a Care Coordination survey that had been used previously in similar studies in the United States of America. Descriptive statistics as well as univariate and multivariate analysis were computed using Statistical Package for Social Science (SPSS) program version 21.0 (IBM, Armonk, NY, USA). RESULTS: A total of 384 healthcare workers participated in the study, with a response rate of 100%. There were differences in perceptions of collaborative capacity based on the cadre of the respondent (p < 0.005). Medical staff reported higher mean scores on quality of interaction (2.94) and collaborative influence (2.65), whereas technical support staff reported the lowest mean scores across all three measures of collaborative capacity (≤ 2.4). CONCLUSION: Differences in perceptions about collaborative capacity suggest the need for interventions to enhance interprofessional collaboration. CONTRIBUTION: The study will inform strategies to promote interprofessional collaboration.

Teaching Chilean mothers to massage their full-term infants: effects on maternal breast-feeding and infant weight gain at age 2 and 4 months.

The purpose of this study was to evaluate the effects of massage on infant weight gain and exclusive maternal breast-feeding of an intervention that involved teaching mothers to massage their full-term infants. The sample included 100 healthy newborn infants who were receiving primary healthcare at 3 health centers in a low-income neighborhood of Santiago, Chile. The control group included 65 infants and the massage group included 35 infants. During their second well-child clinic visit, clinic nurses provided instruction to massage-group mothers about how to massage their infants, based on the methods of the Baby's First Massage program (http://www.babysfirstmassage.com/Scripts/default.asp). Mothers were encouraged to massage their infants for 10 to 15 minutes at least once a day, starting when their infants were 15 days old. There was no difference in the mean weights of the infants between the massage and control groups at baseline, but at age 2 months, massage group infants weighed significantly more than control-group infants. There were no weight differences between the 2 groups at age 4 months. There were no differences between the 2 groups on the incidence of exclusive maternal breast-feeding at age 2 or 4 months. The findings suggest that teaching mothers to massage their newborn infants may have a beneficial effect on the infant's early weight gain. There is a need for additional studies to evaluate the effect of maternal massage on other health and welfare outcomes for both mothers and infants.

Supporting and retaining preceptors for NNP programs: results from a survey of NNP preceptors and program directors.

Preceptors are vital resources for the clinical education of healthcare providers, especially neonatal nurse practitioners (NNPs). With the increasing number of NNP programs, including distance accessible programs, there is a need for research to identify effective strategies for recruiting, preparing, and supporting preceptors in their roles. This article presents a review of existing literature and describes findings from a survey of NNP program directors in the United States and from a survey of preceptors for a distance-based NNP program in an Academic Health Sciences Center in the southern United States. The survey focused on current practices in recruiting and supporting preceptors and on perceptions of strategies that would facilitate success and enhance preceptor satisfaction with their roles. The article concludes with presentation of a model based on survey findings and recommendations from the literature that can guide NNP faculty and researchers in identifying effective strategies for recruiting, preparing, and supporting clinical preceptors.

Outcomes of a massage intervention on teen mothers: a pilot study.

The difficulties that adolescent mothers encounter as a result of the combined stress of adolescence, parenthood, maintaining peer relationships, and establishing positive relationships with their infants have been identified in the literature, and these characteristics are often associated with poor infant outcomes. This study was designed to examine the effects of an infant massage intervention on adolescent mothers' attitudes and perceptions of their infants. Twenty-five African-American adolescent mothers (mean age 16.13 years), who were enrolled in a parent training program for high school students in a southern state, participated in the project. The mothers were assigned randomly to an intervention (9) or control group (16). After a brief training session, participants in the intervention group practiced massage with their infants for approximately 2 months. Data analysis was based on the 15 participants who completed both baseline and 2-month follow-up measures (8 in the control group and 7 in the intervention group). This study found some support for teaching infant massage to adolescent mothers as a way of enhancing maternal-infant physical contact and lowering depression, as well as positively influencing mothers' perceptions of infant temperament. Results indicate that infant massage training may lead to improvements beyond those achieved with a typical parent education curriculum and shows potential as a low-cost supplement to current teen mother education in high schools.

The situation of nursing education in Latin America and the Caribbean towards universal health.

OBJECTIVE:: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. METHOD:: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. RESULTS:: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. CONCLUSION:: there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care. OBJETIVO:: avaliar a situação da educação em enfermagem e analisar o quanto os programas de educação em enfermagem, no nível de Bacharelado na América Latina e no Caribe, estão preparando graduados a contribuir para o alcance da Saúde Universal. MÉTODO:: estudo quantitativo, descritivo/exploratório, transversal, realizado em 25 países. RESULTADOS:: um total de 246 escolas de enfermagem participaram do estudo. O corpo docente com nível de Doutorado totalizou 31,3%; sem o Brasil o número fica reduzido a 8,3%. A razão entre experiências clínicas nos serviços de atenção primária à saúde e nos serviços hospitalares foi de 0,63, indicando que os estudantes têm mais experiências clínicas nos cenários hospitalares. Os resultados sugeriram necessidade de aprimoramento relacionada ao acesso à Internet; tecnologia da informação; acesso para portadores de deficiências; avaliação do programa, do corpo docente e dos estudantes; e aos métodos de ensino/aprendizagem. CONCLUSÃO:: há heterogeneidade na educação em enfermagem na América Latina e no Caribe. Os currículos de enfermagem incluem, geralmente, os princípios e valores da Saúde Universal e da atenção primária à saúde, bem como aqueles princípios subjacentes às modalidades de educação transformativa, como o desenvolvimento de pensamento crítico e complexo, a solução de problemas, a tomada de decisão clínica baseada em evidências, e aprendizagem contínua. No entanto, é preciso promover uma mudança de paradigma na educação em enfermagem que inclua mais treinamento na atenção primária à saúde. OBJETIVO:: evaluar la situación de la educación en enfermería y analizar en qué grado los programas de educación de enfermería a nivel de grado en América Latina y el Caribe están preparando a los graduados para contribuir al logro de la Salud Universal. MÉTODO:: se llevó a cabo un estudio transversal, cuantitativo, descriptivo y exploratorio en 25 países. RESULTADOS:: participaron en el estudio 246 escuelas de enfermería. El porcentaje de profesores con títulos de doctorado fue de 31,3%; pero, si se excluye a Brasil esta cifra se reduce a 8,3%. La proporción de la experiencia clínica adquirida en los servicios de atención primaria de salud en relación con la adquirida en servicios hospitalarios fue de 0,63, lo que indica que los estudiantes adquieren la mayor parte de su experiencia clínica en entornos hospitalarios. Los resultados mostraron una necesidad de mejorar el acceso a internet; la tecnología de la información; la accesibilidad para las personas discapacitadas; la evaluación de los programas, de los profesores y de los estudiantes; y los métodos de enseñanza y aprendizaje. CONCLUSIONES:: hay heterogeneidad en la educación en enfermería en América Latina y el Caribe. En general, los programas de estudios de enfermería han adoptado los principios y los valores de la Salud Universal y la atención primaria de salud, así como los principios que sustentan las modalidades de educación transformadora, como son el desarrollo del pensamiento crítico y complejo, la solución de problemas, la toma de decisiones clínicas basadas en la evidencia y el aprendizaje a lo largo de toda la vida. Sin embargo, hay necesidad de promover un cambio en el paradigma de la educación en enfermería, a fin de que abarque más capacitación en la atención primaria de salud.

Process for Mapping Global Health Competencies in Undergraduate and Graduate Nursing Curricula.

Determining the extent to which existing nursing curricula prepare students to address global health issues is a critical step toward ensuring competence to practice in an increasingly globalized world. This article describes the process used by nursing faculty at a public university in the southern United States to assess the extent to which global health competencies for nurses were being addressed across nursing programs. Steps used and lessons learned throughout this process are discussed.

Qualitative Description of Global Health Nursing Competencies by Nursing Faculty in Africa and the Americas.

OBJECTIVE: to analyze qualitative comments from four surveys asking nursing faculty to rate the importance of 30 global health competencies for undergraduate nursing programs. METHOD: qualitative descriptive study that included 591 individuals who responded to the survey in English (49 from Africa and 542 from the Americas), 163 who responded to the survey in Spanish (all from Latin America), and 222 Brazilian faculty who responded to the survey in Portuguese. Qualitative comments were recorded at the end of the surveys by 175 respondents to the English survey, 75 to the Spanish survey, and 70 to the Portuguese survey. Qualitative description and a committee approach guided data analysis. RESULTS: ten new categories of global health competencies emerged from the analysis. Faculty also demonstrated concern about how and when these competencies could be integrated into nursing curricula. CONCLUSION: the additional categories should be considered for addition to the previously identified global health competencies. These, in addition to the guidance about integration into existing curricula, can be used to guide refinement of the original list of global health competencies. Further research is needed to seek consensus about these competencies and to develop recommendations and standards to guide nursing curriculum development.

A Path Analysis of Latino Parental, Teenager and Cultural Variables in Teenagers' Sexual Attitudes, Norms, Self-Efficacy, and Sexual Intentions.

OBJECTIVE: to test a theoretical model based on the Parent-Based Expansion of the Theory of Planned Behavior examining relation between selected parental, teenager and cultural variables and Latino teenagers' intentions to engage in sexual behavior. METHOD: a cross-sectional correlational design based on a secondary data analysis of 130 Latino parent and teenager dyads. RESULTS: regression and path analysis procedures were used to test seven hypotheses and the results demonstrated partial support for the model. Parent familism and knowledge about sex were significantly associated with parents' attitudes toward sexual communication with their teenagers. Parent Latino acculturation was negatively associated with parents' self-efficacy toward sexual communication with their teenagers and positevely associated with parents' subjective norms toward sexual communication with their teenagers. Teenager knowledge about sex was significantly associated with higher levels of teenagers' attitudes and subjective norms about sexual communication with parents. Only the predictor of teenagers' attitudes toward having sex in the next 3 months was significantly associated with teenagers' intentions to have sex in the next 3 months. CONCLUSION: the results of this study provide important information to guide future research that can inform development of interventions to prevent risky teenager sexual behavior among Latinos.

Identifying interprofessional global health competencies for 21st-century health professionals.

BACKGROUND: At the 2008 inaugural meeting of the Consortium of Universities for Global Health (CUGH), participants discussed the rapid expansion of global health programs and the lack of standardized competencies and curricula to guide these programs. In 2013, CUGH appointed a Global Health Competency Subcommittee and charged this subcommittee with identifying broad global health core competencies applicable across disciplines. OBJECTIVES: The purpose of this paper is to describe the Subcommittee's work and proposed list of interprofessional global health competencies. METHODS: After agreeing on a definition of global health to guide the Subcommittee's work, members conducted an extensive literature review to identify existing competencies in all fields relevant to global health. Subcommittee members initially identified 82 competencies in 12 separate domains, and proposed four different competency levels. The proposed competencies and domains were discussed during multiple conference calls, and subcommittee members voted to determine the final competencies to be included in two of the four proposed competency levels (global citizen and basic operational level - program oriented). FINDINGS: The final proposed list included a total of 13 competencies across 8 domains for the Global Citizen Level and 39 competencies across 11 domains for the Basic Operational Program-Oriented Level. CONCLUSIONS: There is a need for continued debate and dialog to validate the proposed set of competencies, and a need for further research to identify best strategies for incorporating these competencies into global health educational programs. Future research should focus on implementation and evaluation of these competencies across a range of educational programs, and further delineating the competencies needed across all four proposed competency levels.