O trabalho do enfermeiro na saúde indígena: desenvolvendo competências para a atuação no contexto intercultural / The work of nurses in Indigenous Health: developing competencies for action in the intercultural context

Introdução: O trabalho em saúde indígena tem como característica marcante a interculturalidade. O locus da prática dos profissionais é o contexto intercultural. A atuação nesse espaço de trabalho exige conhecimentos e competências que, muitas vezes, não são abordados durante a formação acadêmica. É também escassa a oferta de cursos após a graduação. O foco deste estudo foi a compreensão e a análise das possibilidades de aprendizagem do enfermeiro a partir da vivência do trabalho no interior das áreas indígenas. Para isso, considerou-se a realidade concreta do trabalho como um potencial espaço de aprendizado, fortemente marcado pela interculturalidade. Objetivo: Analisar a vivência do trabalho de saúde dentro do território indígena como um espaço potencial de aprendizagem para que o enfermeiro qualifique a sua prática profissional voltada para a atuação neste contexto intercultural. Método: Trata-se de um estudo descritivo de abordagem qualitativa do tipo estudo de caso. O campo do estudo foi o Distrito Sanitário Especial Indígena (DSEI) Xingu e os sujeitos da pesquisa foram os enfermeiros que nele atuam. Os dados primários foram obtidos por meio de entrevistas semiestruturadas que abordaram a prática profissional e o processo de aprendizagem tendo como referência o trabalho no interior da terra indígena. A análise do material empírico foi realizada através da técnica de análise de conteúdo e com o apoio de conceitos do campo da antropologia e da educação tais como: competência profissional, aprendizagem significativa e interculturalidade. Resultados: A partir da inserção no serviço, os enfermeiros iniciam um processo de aprendizado que segue impulsionado cotidianamente pelas situações vivenciadas no trabalho e que tem os indígenas como principais mediadores. Aos poucos, os profissionais aprendem a identificar e mobilizar os recursos necessários para uma atuação profissional mais competente que atenda às demandas do contexto. A reprodução de práticas e atitudes é a principal estratégia utilizada pelos profissionais para lidar com as dificuldades. Dentre os elementos que compõem a competência para o trabalho nesse campo, se destacam as atitudes na relação com os indígenas e suas práticas. As representações e concepções trazidas pelos profissionais interferem na atuação profissional. A interculturalidade se mostra como fator inerente que caracteriza o contexto e as demandas que são colocadas aos profissionais que nele atuam. O distanciamento da gestão do DSEI faz com que tanto o processo de aprendizado quanto o desenvolvimento de competências ocorram de maneira autodirigida. Conclusões: O perfil da atuação profissional do enfermeiro ganha forma, quase que exclusivamente, a partir de referências encontradas dentro da área indígena contribuindo para a consolidação de um modelo de atenção distante do proposto nas diretrizes políticas

Introduction: The work in Indigenous Health is characterized by interculturality. The locus of practitioners\' practice is the intercultural context. Acting in this workspace requires knowledge and skills that are often not addressed during academic education. The offer of courses after graduation is also scarce. The focus of this study was the understanding and analysis of nurses\' learning possibilities based on the experience of work within indigenous areas. For this, the concrete reality of work was considered as a potential learning space, strongly marked by interculturality. Objective: To analyze the experience of health work within indigenous lands as a potential learning space for nurses to qualify their professional practice geared towards acting in this intercultural context. Method: This is a descriptive study of a qualitative approach of the case study type. The field of study was the Indigenous Special Sanitary District (DSEI) Xingu and the research subjects were the nurses who work in it. The primary data were obtained through a semi structured interview that approached the professional practice and the learning process having as reference the work in indigenous land. The analysis of the empirical material was carried out through the technique of content analysis and with the support of concepts of the field of anthropology and education, such as: professional competence, meaningful learning and interculturality. Results: As from the insertion in the service, the nurses begin a learning process that continues driven daily by the situations experienced in the work and that has the indigenous people as main mediators. Professionals are gradually learning to identify and mobilize the resources needed for more competent professional action that meets the demands of the context. Reproduction of practices and attitudes is the main strategy used by practitioners to deal with difficulties. Among the elements that compose the competence for the work in this field, the attitudes in relation with the natives and their practices stand out. The representations and conceptions brought by the professionals interfere in the professional performance. Interculturality shows itself as an inherent factor that characterizes the context and the demands that are presented to the professionals who work in it. The distance from the DSEI management makes both the learning process and the development of competencies occur in a selfdirected way. Conclusions: The profile of nurses\' professional performance is shaped, almost exclusively, from references found within the indigenous area, contributing to the consolidation of a model of attention that is far from that proposed in the political guidelines

Reflexive photography: an alternative method for documenting the learning process of cultural competence.

PURPOSE: This qualitative descriptive study used reflexive photography to evaluate the learning process of cultural competence during an international service-learning project in Guatemala. Reflexive photography is an innovative qualitative research technique that examines participants' interactions with their environment through their personal reflections on images that they captured during their experience. DESIGN: A purposive sample of 10 baccalaureate nursing students traveled to Guatemala, where they conducted family and community assessments, engaged in home visits, and provided health education. Data collection involved over 100 photographs and a personal interview with each student. FINDINGS: The themes developed from the photographs and interviews provided insight into the activities of an international experience that influence the cognitive, practical, and affective learning of cultural competence. CONCLUSIONS: Making home visits and teaching others from a different culture increased students' transcultural self-efficacy. IMPLICATIONS: Reflexive photography is a more robust method of self-reflection, especially for visual learners.

FOCUS on excellence: making a difference through global initiatives.

The Center of Excellence (COE) designation in the category of"student learning and professional development" has hallmarked Regis College as having nursing programs that create environments for students to excel academically, professionally, and personally. As a designated COE nursing program, our efforts have focused on creating and sustaining a curriculum that has a strong enculturation of diversity, with numerous local, regional, national, and international learning experiences. Examples of learning opportunities through global outreach health initiatives are included, demonstrating how the COE designation has provided recognition and led to further opportunities for faculty and students to become involved in health-related activities.

Nursing student voices: reflections on an international service learning experience.

For the past decade participation in service and experiential learning in higher education has increased. The purpose of this study was to explore the lived experience of BSN and MSN students participating in a multidisciplinary service-learning course in a rural, underserved village in Belize. Researchers analyzed student journals utilizing qualitative data analysis techniques. There were eight consistent themes found in the student journals. The findings indicate that international service learning opportunities increase students' awareness of their place in a global society and the potential contribution they can make in society. For the past decade, service and experiential learning in higher education, including nursing education, has become increasingly important. Simply put, service and experiential learning combine community service activities with a student's academic study for the sole purpose of enriching the academic experience. As faculty, we feel the goal of baccalaureate and graduate nursing education is to produce an educated professional who will become a responsible citizen.

Service-learning abroad: a life-changing experience for nursing students.

Incorporating service-learning experiences into nursing education is one way to help prepare students for practice in a global, culturally diverse society. Partnering with a church with a long-term mission program in El Salvador offers the nursing school at Old Dominion University opportunity to develop a service-learning program and support healthcare missions.

Global health competencies for nurses in the Americas.

This article reports the findings from an online survey of nursing faculty from the United States, Canada, Latin America, and Caribbean countries to identify their perceptions about global health competencies for undergraduate nursing students. A list of global health competencies for medical students developed by the Association of Faculties of Medicine of Canada Resource Group on Global Health and the Global Health Education Consortium was adapted for nurses and translated from English to Spanish and Portuguese. The competencies were divided into six subscales, and respondents rated each competency on a 4-point Likert scale, with high scores reflecting strong agreement that the competency was essential for undergraduate nursing students. E-mail invitations and links to the online survey were distributed using a nonprobability convenience sampling strategy. This article reports findings only from the respondents to the English and Spanish surveys. The final sample included 542 responses to the English survey and 51 responses to the Spanish survey. Cronbach's alpha reliability coefficients for the subscales ranged from .78 to .96. The mean values for all 6 subscales and for each of the 30 items were greater than 3.0 for the respondents to the Spanish survey, and the mean values for 27 of the items were greater than 3.0 for the respondents to the English survey. These findings suggest that respondents perceived the competencies as essential global health competencies for undergraduate nursing students in the Americas. Narrative comments written by respondents indicate additional competencies and specific concerns about adding additional content to an already full curricula. Results of this study can be used to guide faculty deliberations about global health competencies that should be incorporated in the nursing curricula.

Short of transformation: American ADN students' thoughts, feelings, and experiences of studying abroad in a low-income country.

ADN students are a large yet distinct subgroup of nursing students who require research and understanding. The purpose of this study was to describe the thoughts, feelings, and experiences of American associate degree nursing (ADN) students who participated in a short study abroad course in a low-income country. A qualitative, narrative method was used. Three categories emerged from the analysis. Participants revealed thoughts of "constant comparisons", feelings of an "emotional journey", and they experienced "learning". Participants did not demonstrate perspective transformation as defined by Mezirow as participants signified no intent for social action. Several potential blocks to perspective transformation were identified: egocentrism/emotional disconnect, perceived powerlessness/being overwhelmed, and a vacation mindset. The findings provide insight into the student experience of studying abroad. Transformative learning is not a guaranteed result. Nurse educators must consider strategies to foster transformation including discussing global systemic oppressors, international relations, coping, connecting, and social action.

Back to school: what I learned teaching cross-culturally.

The need for nurse educators around the globe is prompting some to do short-term teaching internationally. Prompted by God's call and the great need at the Faculty of Nursing Science of the Episcopal University of Haiti (FSIL), the author taught in Léogâne, Haiti, for 18 days. This article shares practical insights from her experience and important revelations about teaching cross-culturally.

International cultural immersion: en vivo reflections in cultural competence.

A baccalaureate nursing program developed and implemented an international cultural immersion course in Guatemala to explore the impact of cultural immersion on student nurses' cultural competence. This qualitative descriptive study generated data through in-depth interviews and en vivo reflective journals. The three themes: Navigating daily life, Broadening the lens, and Making a difference, revealed an expanded context and worldview of culture. International service learning seemed to pervade all aspects of the students' experience. Exercises in participant-observation and reflective writing could enhance student self-awareness and their ability to benefit from a cultural immersion course.

The impact of service-learning on cultural competence.

Service-learning provides an excellent pedagogy for introducing students to clients of different cultural backgrounds, helping students become aware of the issues these clients face related to culture and health care, and teaching culturally appropriate care. The Transcultural Self-Efficacy Tool was used to evaluate self-perceived cultural competence in a convenience sample of 60 baccalaureate nursing students enrolled in a community health nursing course following the completion of service-learning projects with local and international communities. Pre- and posttests were analyzed based on total scores and subscale (cognitive, practical, and affective) scores. A paired-samples t test compared the mean pretest total score to the mean posttest total score, which demonstrated a significant increase. In addition, paired-samples t tests demonstrated a significant increase in each subscale.

"Leaving the comfort of the familiar": fostering workplace cultural awareness through short-term global experiences.

PROBLEM: Facilitating the development of student nurses' cultural competence and translating these experiences into the clinical setting. METHODS: Qualitative methods. FINDINGS: A short-term global immersion experience informs student nurses' cultural awareness, education, and future clinical practice. CONCLUSIONS: Participation in a short-term global health experience contributes to students' personal growth and broadens their insight into multicultural care.

Bring me to Belize: a timeless journey.

Time is a concept that varies from culture to culture. This article describes differences in time perception of patients in Belize compared to those in the United States. A medical mission team's approach to care with regard to time perception is also provided.

Ready for the World: preparing nursing students for tomorrow.

In 2004, a 5-year plan of international and intercultural education was developed by the University of Tennessee, Knoxville (UTK) to help students become ready for the changing world in which they will live. This program is called "Ready for the World." The University of Tennessee College of Nursing in Knoxville has integrated many of the suggestions from this program into the undergraduate nursing curriculum to prepare students for the world by making the world their classroom. Intercultural learning includes both a solid base of knowledge obtained in the classroom and multiple experiences that involve cultural interaction. Experiences begin on UTK's diverse campus and expand to the surrounding city of Knoxville, including interactions with vulnerable populations such as the homeless or elderly persons, then to nearby Appalachian communities, and on to Central America. Many of these experiences are offered for credit in the Community Health Nursing or the Transcultural Nursing courses. The knowledge nursing students acquire and their varied experiences will help them gain cultural competence for their future nursing practice.

Nursing in diverse cultures: an international experience.

The global service learning experience often has long-lasting influences. Students improve their communication and listening skills, develop better skills of patient assessment, learn to rely on their clinical judgments in consultation with faculty, and increase their knowledge of diseases prevalent in the developing world with limited resources. Anyone interested in developing or participating in an international service learning program can find an organized group for almost any country and length of stay. The best plan is to first go on a trip as a participant. Realize that working conditions may be primitive; even with the best steps in planning, supplies will still be limited. Participants will likely face health and social problems they cannot change in a short-term project. Look for organizations with sustainable programs as this allows for coordination and ongoing service to the communities. Finally, remember who nurses are and what nurses can do. Think frequently about nursing as both an art and a science. The international service learning experience embraces this fundamental characteristic of nursing that can often be difficult to articulate.

Community health nursing student experience in Nicaragua.

International clinical experiences can provide excellent opportunities for nursing students to practice community health nursing, enhance their global perspective, and increase their cultural awareness of vulnerable populations. Selected students from the Georgetown University nursing program spent part of their winter intercession in Nicaragua, working with a vulnerable population in an impoverished community. Students cared for families, worked in clinics, conducted health teaching sessions to large groups in the community, and held a health fair. A community assessment provided an experience in learning about the resources and demographics of the community. The program was feasible through the collaboration with the local Nicaraguan university nursing program.