Global learning: A post-COVID-19 approach to advance health equity.

The COVID-19 pandemic has accelerated acceptance of learning from other countries, especially for high-income countries to learn from low- and middle-income countries, a practice known as global learning. COVID-19's rapid disease transmission underscored how connected the globe is as well as revealed stark health inequities which facilitated looking outside of one's borders for solutions. The Global Learning for Health Equity (GL4HE) Network, supported by Robert Wood Johnson Foundation, held a 3-part webinar series in December 2021 to understand the current state of global learning and explore how global learning can advance health equity in the post-COVID-19 era. This paper reflects on these cutting-edge discussions about the current state of global learning, drawing upon the highlights, perspectives, and conclusions that emerged from these webinars. The paper also comments on best practices for global learning, including adapting for context, addressing biases, funding considerations, ensuring bidirectional partnerships, community engagement, and adopting a multidisciplinary approach.

Global Learning for Health Equity: A Survey of Five Global Learning Sites in the United States.

Global learning is the practice of adopting and adapting global ideas to local challenges. To advance the field of global learning, we performed a case study of five communities that had implemented global health models to advance health equity in a U.S. setting. Surveys were developed using a Consolidated Framework for Implementation Research (CFIR) framework, and each site completed surveys to characterize their global learning experience with respect to community context, the learning and implementation process, implementation science considerations, and health equity. The immense diversity of sites and their experiences underscored the heterogenous nature of global learning. Nonetheless, all cases highlighted core themes of addressing social determinants of health through strong community engagement. Cross-sector participation and implementation science evaluation were strategies applied by many but not all sites. We advocate for continued global learning that advances health equity and fosters equitable partnerships with mutual benefits to origination and destination sites.

Cross-Sectional Study of the Frequency and Severity of Traumatic Childbirth Events and How They Affect Maternity Care Clinicians.

OBJECTIVE: To describe the frequency and severity of traumatic childbirth events (TCEs) and how they affected the professional practice and personal lives of maternity care clinicians, including registered nurses (RNs), certified nurse-midwives, attending physicians, and resident physicians. DESIGN: Descriptive cross-sectional study. SETTING: Maternity units across five hospitals in the Baltimore metropolitan area. PARTICIPANTS: Maternity care clinicians (N = 160) including RNs (n = 104), certified nurse-midwives (n = 17), attending physicians (n = 28), and resident physicians (n = 11). METHODS: Participants completed an online survey to measure the frequency and severity of TCEs and how they affect participants' professional practice and personal lives. We used descriptive statistics to characterize maternity care clinicians and bivariate analysis and linear regression to examine relationships. RESULTS: Most participants were women (92.5%), White (62.5%), between the ages of 21 and 54 years (89.4%), RNs (65.0%), and employed full-time (79.2%). Shoulder dystocia was the most frequently observed TCE (90.6%), and maternal death was the most severe TCE (M = 4.82, SD = 0.54). Attending physicians (50.0%) reported a significantly greater frequency of exposure to TCEs than the other participants, χ2(6) = 23.8 (n = 159), p <. 001. The frequency of TCEs had a significant medium correlation with perceived effect on professional practice, r(154) = 0.415, p < .001, and personal life, r(155) = 0.386, p < .001. Perception of severity was strongly associated with professional practice, ß = 0.52, p < .001, and personal life, ß = 0.46, p < .001. CONCLUSION: If severe, TCE exposure can affect the professional practice and personal life of maternity care clinicians.

Global Learning for Health Equity: A Literature Review.

Background: In high income countries struggling with escalating health care costs and persistent lack of equity, there is growing interest in searching for innovative solutions developed outside national borders, particularly in low- and middle-income countries (LMICs). Engaging with global ideas to apply them to local health equity challenges is becoming increasingly recognized as an approach to shift the health equity landscape in the United States (US) in a significant way. No single name or set of practices yet defines the process of identifying LMIC interventions for adaptation; implementing interventions in high-income countries (HIC) settings; or evaluating the implementation of such projects. Objectives: This paper presents a review of the literature describing the practice of adapting global ideas for use in the US, particularly in the area of health equity. Specifically, the authors sought to examine; (i) the literature that advocates for, or describes, adaption of health-related innovations from LMICs to HICs, both generally and for health equity specifically, and (ii) implementation practices, strategies, and evidence-based outcomes in this field, generally and in the area of health equity specifically. The authors also propose terminology and a definition to describe the practice. Methods: The literature search included two main concepts: global learning and health equity (using these and related terms). The search consisted of text-words and database-specific terminology (e.g., MeSH, Emtree) using PubMed, Embase (Elsevier), CINAHL (Ebsco), and Scopus in March 2021. The authors also contacted relevant experts to identify grey literature. Identified sources were categorized according to theme to facilitate analysis. In addition, five key interviews with experts engaged with global ideas to promote health equity in the United States were conducted to develop additional data. Results: The literature review yielded over ninety (n = 92) sources relating to the adaptation of global ideas from low resource to higher resource settings to promote health equity (and related concepts). Identified sources range from those providing general commentaries about the value of seeking health-related innovations outside the US border to sources describing global projects implemented in the US, most without implementation or outcome measures. Other identified sources provide frameworks or guidance to help identify and/or implement global ideas in the US, and some describe the role of the World Health Organization and other international consortia in promoting a global approach to solving domestic health equity and related challenges. Conclusions: The literature review demonstrates that there are resources and commentary describing potential benefits of identifying and adapting novel global ideas to address health equity in the US, but there is a dearth of implementation and evaluation data. Terminology is required to define and frame the field. Additional research, particularly in the area of implementation science and evidence-based frameworks to support the practice of what we define as 'global learning' for health equity, is necessary to advance the practice.

Reliability and Validity of a Perinatal Shared Decision-Making Measure: The Childbirth Options, Information, and Person-Centered Explanation.

OBJECTIVE: To develop and test the psychometric properties of a shared decision-making tool: Childbirth Options, Information, and Person-Centered Explanation (CHOICEs). DESIGN: Multiphase instrument development study beginning with item development through a cross-sectional postpartum survey. SETTING: The cross-sectional postpartum survey was distributed online through convenience and snowball sampling methods. METHODS: We developed instrument items through an iterative process with key stakeholders. We evaluated reliability based on internal consistency and differential item functioning analysis. We evaluated validity on evidence of construct validity. We used criterion-related item mapping to evaluate whether the measure addressed the full spectrum of shared decision making related to maternity care. RESULTS: Surveys were completed by 1,171 participants. A Cronbach's α coefficient of .99 supported internal consistency reliability. Infit and outfit statistics that ranged from 0.92 to 1.55 supported item fit. Differential item functioning analysis showed that CHOICEs scores were invariant between different demographic groups. Significant positive correlations between scores on CHOICEs and the Mothers on Respect index (r = 0.75, p = .01) and the Mothers Autonomy in Decision-Making scale (r = 0.75, p = .01) supported criterion-related validity. Item mapping suggested more items were needed to capture the full spectrum of shared decision making. CONCLUSION: We recommend using CHOICEs to evaluate shared decision making in maternity care for research and quality improvement projects.

Nurses' Role in Addressing Social Determinants of Health: A Case Study on the Social Determinants of Health Taskforce of Baltimore City.

ABSTRACT: In recent years there has been increased interest in the social determinants of health (SDoH) by nurses and other healthcare professionals. Numerous seminars and discussions among nurses and other health professionals have focused on addressing social, economic, and environmental factors that impact the health and wellbeing of individuals and communities. Although these conversations are important and represent a movement towards health and social justice, they may be insufficient to address health inequities. There is an urgent need to move beyond community surveillance to implementing health equity programs and policies, especially in marginalized communities. Such is the case in Baltimore City, Maryland, where a nurse-led, community-based network of stakeholders transformed a grassroots health equity model to a state-mandated SDoH Taskforce focusing on a local community. The purpose of this column is to present a short case study that helps nurses understand their potential role in advancing health equity through policy.

Changing the Narrative for Nursing Globally.

Worldwide celebration of the Year of the Nurse and the Midwife boosts innovative efforts by academic nursing schools to change the narrative for the nursing profession globally. These innovations have the potential to disrupt narratives that perpetuate negative perspectives and to replace them with counter-narratives that elevate, motivate and empower the professions to the benefit of health service delivery and health systems globally.

Nurses on the move: Robert Wood Johnson Foundation nurse faculty scholars and their action on the social determinants of health.

OBJECTIVE: Medical care alone cannot adequately improve population health or eliminate inequities; social determinants of health (SDH) must be addressed. This study's purpose was to describe the research, teaching, service, and clinical practice activities implemented by RWJF Nurse Faculty Scholars to act on the SDH. DESIGN: A cross-sectional survey design was used with a sample of RWJF Nurse Faculty Scholars, chosen because they were provided specialized mentoring, grants, and other support that allowed them to explore SDH. RESULTS: Respondents (n = 57) addressed SDH in their research (86.0%), teaching (68.4%), service (66.7%), and clinical practice (33.3%). Leading research foci were quality of health care (56.1%), social and physical environmental stressors (54.4%), and access to health care services (49.1%). Leading SDH areas in teaching were discrimination in society against vulnerable populations (54.4%), quality of health care received by vulnerable populations (50.9%), and vulnerable populations' access to health care services (50.9%). Service activities included addressing discrimination against diverse populations. Leading SDH areas in clinical practice were quality of health care received by vulnerable populations (28.1%), vulnerable populations' access to health care services (22.8%), and discrimination in society against vulnerable populations (19.3%). Respondents also addressed SDH through personal mentoring (71.9%); efforts to recruit and/or retain underrepresented faculty (59.6%); developing a diverse pipeline of nurses (59.6%); and participation on a diversity committee (40.4%). CONCLUSION: The RWJF Nurse Faculty Scholars were able to leverage their awards to address SDH; however, further research is needed to assess the impact of the SDH work conducted. Knowledge from this study can be used as a road map for SDH elements and areas of professional work that nurses and other health professionals could address SDH in research, teaching, service, and practice.

Examining the Health Belief Model Risk Factors on PrEP Use Among African-American Women Ages 20-44.

Truvada, also referred to as Pre-Exposure Prophylaxis (PrEP), is the first medication approved for the purpose of preventing HIV infection. This study examined the odds of PrEP use solely among African-American women by comparing, by demographic profile, the relationship between risk taking behaviors of the Health Belief Model and the likelihood of PrEP use. A secondary data analysis from the 2013 National Survey on the potential adoption of PrEP was analyzed in this study. The sample for this study was 791 African-American women aged 20-44. The Health Belief Model constructs served as predictor risk factors for PrEP use. Results indicated that younger women of lower socioeconomic status (SES), higher levels of barriers, and higher levels of perceived susceptibility were more willing to take PrEP. This has significant implications for public health practice, policy, and opportunities for further research to establish interventions that incorporate increasing self-efficacy in PrEP use.

Does Parental Control Work With Smartphone Addiction?: A Cross-Sectional Study of Children in South Korea.

The purposes of this study were to (a) examine the relationship between personal characteristics (age, gender), psychological factors (depression), and physical factors (sleep time) on smartphone addiction in children and (b) determine whether parental control is associated with a lower incidence of smartphone addiction. Data were collected from children aged 10-12 years (N = 208) by a self-report questionnaire in two elementary schools and were analyzed using t test, one-way analysis of variance, correlation, and multiple linear regression. Most of the participants (73.3%) owned a smartphone, and the percentage of risky smartphone users was 12%. The multiple linear regression model explained 25.4% (adjusted R = .239) of the variance in the smartphone addiction score (SAS). Three variables were significantly associated with the SAS (age, depression, and parental control), and three variables were excluded (gender, geographic region, and parental control software). Teens, aged 10-12 years, with higher depression scores had higher SASs. The more parental control perceived by the student, the higher the SAS. There was no significant relationship between parental control software and smartphone addiction. This is one of the first studies to examine smartphone addiction in teens. Control-oriented managing by parents of children's smartphone use is not very effective and may exacerbate smartphone addiction. Future research should identify additional strategies, beyond parental control software, that have the potential to prevent, reduce, and eliminate smartphone addiction.

Gauging the Effects of Self-efficacy, Social Support, and Coping Style on Self-management Behaviors in Chinese Cancer Survivors.

BACKGROUND: Better self-management control in cancer survivors would benefit their functional status, quality of life, and health service utilization. Factors such as self-efficacy, social support, and coping style are important predictors of self-management behaviors of cancer survivors; however, the impact of these factors on self-management behaviors has not yet been empirically tested in Chinese cancer survivors. OBJECTIVES: The aim of this study was to examine how self-efficacy, social support, and coping style affect specific self-management behaviors. METHODS: A secondary data analysis was completed from a cross-sectional study. A total of 764 cancer survivors were recruited in the study. Validated instruments were used to assess patients' self-efficacy, social support, and coping style. Structural equation modeling (SEM) was used to test the hypothesis. RESULTS: The SEM model fits the data very well, with root mean square error of approximation (RMSEA) of 0.034; close-fit test cannot reject the hypothesis of root mean square error of approximation of 0.05 or less, comparative fit index of 0.91, Tucker-Lewis index of 0.90, and weighted root mean square residual of 0.82. For the measurement models in the SEM, all items loaded highly on their underlying first-order factors, and the first-order factors loaded highly on their underlying second-order factors (self-efficacy and social support, respectively). The model demonstrated that self-efficacy and social support directly and indirectly, via coping style, affect 3 self-management behaviors (ie, communication, exercise, and information seeking). CONCLUSION: Our results provide evidence that self-efficacy and social support impose significant direct effects, as well as indirect effects via copying style, on the self-management of cancer survivors. IMPLICATIONS FOR PRACTICE: Our findings may help nurses to further improve their care of cancer survivors in terms of their self-management behaviors, specifically communication, exercise, and information seeking.

Barriers and facilitators of care for diverse patients: Nurse leader perspectives and nurse manager implications.

OBJECTIVE: To examine chief nurse executives' perspectives on: (1) the provision of culturally and linguistically appropriate services in hospitals and (2) to identify barriers and facilitators associated with the implementation of culturally and linguistically appropriate services. BACKGROUND: Hospitals continue to face challenges providing care to diverse patients. The uptake of standards related to culturally and linguistically appropriate services into clinical practice is sluggish, despite potential benefits, including reducing health disparities, patient errors, readmissions and improving patient experiences. METHOD: A qualitative study with chief nurse executives from one eastern United States (US). Data were analysed using content analysis. RESULTS: Seven themes emerged: (1) lack of awareness of resources for health care organisations; (2) constrained cultural competency training; (3) suboptimal resources (cost and time); (4) mutual understanding; (5) limited workplace diversity; (6) community outreach programmes; and (7) the management of unvoiced patient expectations. CONCLUSIONS: As the American population diversifies, providing culturally and linguistically appropriate services remains a priority for nurse leaders. Being aware and utilizing the resources, policies and best practices available for the implementation of culturally and linguistically appropriate services can assist nursing managers in reaching their goals of providing high quality care to diverse populations. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers are key in aligning the unit's resources with organisational goals related to the provision of culturally and linguistically appropriate services by providing the operational leadership to eliminate barriers and to enhance the uptake of best practices related to culturally and linguistically appropriate services.

Leading Organizational Cultural Competency: Nurse Leader Rounds and Care for Diverse Patients.

Chief nurse executives (CNEs) face challenges in providing high-quality, patient-centered care for diverse populations. Although the implementation of culturally and linguistically appropriate services (CLAS) may improve patient satisfaction, the cost of initiatives and education coupled with shortened episodes of care pose obstacles. The article describes themes from a qualitative study with CNEs, describes resources and best practices, and highlights nurse leader rounds as a vehicle for implementing CLAS.

Nurse reported patient safety in low-resource settings: a cross-sectional study of MNCH nurses in Nigeria.

PURPOSE: Repeated international studies demonstrate the critical role of nursing and the associations between patient safety and nurse staffing and the nurse practice environment in high resource countries, yet nurse reported patient safety studies are sparse in Sub-Saharan Africa. This study explored nurse reported patient safety in Nigeria and examined the extent that patient safety is associated with nurse staffing levels and the nurse practice environment. METHODS: A cross-sectional study of 27 public health facilities in Nigeria used anonymous nurse surveys (N=222) to examine associations between nurse staffing, the nurse practice environment and nurse reported safety. Descriptive statistics and generalized linear mixed models (GLMM) were used to account for clustering of nurses within facilities. RESULTS: Of the 222 nurse participants, 26% reported patient safety as poor/fair. Nurses who cared for greater than 20 patients had higher percentages of poor/fair patient safety. With the GLMM models adjusted for type of facility and nurse staffing, the nurse practice environments had the strongest association with patient safety. As the nurse practice environment score increased, nurses were nearly three times more likely to rank patient safety as excellent/good OR=2.9 (1.5, 5.7). CONCLUSIONS: The taxonomy used globally with nurse safety research was comparable in Nigeria. Enhancing the nurse practice environment could offer opportunities to improve nurse reported patient safety in public health facilities in Nigeria. Further research is needed to better understand nurse reports of worse patient safety in secondary level health facilities and facilities with worse nurse staffing.

Advancing Organizational Cultural Competency With Dissemination and Implementation Frameworks: Towards Translating Standards into Clinical Practice.

Substantial public health efforts have been activated to reduce health disparities and ensure health equity for patients through the provision of culturally and linguistically appropriate services; yet associated policies and standards are sluggishly translating into practice. Little attention and resources have been dedicated to translation of public health policies into practice settings. Dissemination and implementation is presented as an active, strategic approach to enhance uptake of public health standards; reviews dissemination and implementation concepts; poses a systematic model to adoption, implementation, and dissemination; and concludes with recommendations for hospital-based implementation teams and complementary interprofessional collaboration.

Knowledge and willingness of prenatal women in Enugu Southeastern Nigeria to use in labour non-pharmacological pain reliefs.

BACKGROUND: Nigerian parturients desire, but experience unsatisfactory pain relief as labour analgesia is underutilised and unpopular among skilled-birth attendants. OBJECTIVES: To assess pregnant women's knowledge and willingness to use non-pharmacological labour pain reliefs. METHODS: Using a descriptive cross-sectional design, a pre-tested, structured questionnaire was interviewer administered to a convenient sample of 245 prenatal women at a specialist maternity hospital in Enugu. RESULTS: Majority (68.6%) of the women knew, but 31.4% were unaware that non-pharmacological labour pain reliefs exist in the study facility. Only 34.7% were able to identify at least four such methods, 21.2% could elicit two (each) advantages and disadvantages, and 0% to 28.3% had perceived self-efficacy of how to use each method. The leading four methods identified were breathing exercises (51.8%), massage (36.7), position changes (32.2%), and relaxation techniques (26.5%). Majority (59.6%) of the women expressed willingness to use non-pharmacological pain strategies in future labour, which is associated with increased knowledge of the methods, and parity (p<0.001). CONCLUSION: Pregnant women had limited knowledge of, but majority expressed willingness to use in labour non-pharmacological pain reliefs. Nurses/midwives should give adequate childbirth information and preparation on labour pain reliefs to antenatal women to inform their choices and effective use during labour.

Organizational learning and the development of global health educational capabilities: critical reflections on a decade of practice.

This paper describes the process of organizational global health capability development at the University of Maryland Baltimore over the past decade. Theories of organizational learning and of organizational capabilities are applied in this retrospective analysis of organizational innovations in global health education within UMB as well as in the University of Maryland School of Nursing.