Nursing Faculty's Perceptions of Climate Change and Sustainability.

AIM: The aim of this research study was to investigate the perceptions of climate change and sustainability of faculty teaching in associate and baccalaureate degree nursing programs in South Carolina and their attitudes toward inclusion of relevant content into the nursing curriculum. BACKGROUND: Climate change is a topic that receives limited discussion in most nursing education curricula. METHOD: This cross-sectional, descriptive study gathered data from 21 schools of nursing via an online survey consisting of demographic questions, the New Ecological Paradigm Scale, and the Sustainability Attitudes in Nursing Survey 2 and two questions regarding the current inclusion of content. RESULTS: Eighty-one percent of respondents did not include health implications of climate change in their teaching content; 67% did not include health implications of sustainability. CONCLUSION: Results provide preliminary evidence of gaps and areas of need for curricular content related to climate change and sustainability.

Nursing Education Amid a Pandemic: Mental Health in a Time of Virtual Learning.

BACKGROUND: The unprecedented pandemic presented new stresses and challenges in nursing education impacting the mental health of nursing students. PURPOSE: The purpose of this study was to evaluate the relationship between virtual learning and the mental health of nursing students. METHOD: This study used a descriptive, cross-sectional design with a convenience sample of 256 nursing students enrolled in a baccalaureate program. Data were collected through an online survey using 2 screening tools for stress, anxiety, and depression. RESULTS: Mean sum Patient Health Questionnaire-4 scores and subscale scores suggest that more than 40% of students experienced mild to moderate levels of psychological distress. Mean sum Perceived Stress Scale-10 scores indicate 84% of students experienced moderate levels of stress, and 14% experienced high levels of stress. CONCLUSIONS: During periods of societal crisis, faculty must be hypervigilant to the mental health needs of students.

Striving to Meet Global Health Competencies Without Study Abroad.

INTRODUCTION: The COVID-19 (coronavirus disease 2019) pandemic has radically changed the future of study abroad, yet students require the knowledge, skills, and attitudes to provide care for diverse cultures across geographical boundaries. The purpose of this article is to facilitate innovative learning opportunities in order to meet global health competencies in the physical or virtual classroom when study abroad is not feasible. APPROACH: Based on a review of published literature related to global health competencies and nursing over the last decade, a description of suggested global learning activities is provided. RESULTS: Few research publications exist to describe activities for meeting global health competencies when travel abroad is restricted. The proposed activities provide a foundation to address the gap in literature and to establish a trajectory for future research. DISCUSSION: The challenge is to demonstrate evidence of global health competency attainment when students are confined to their local community.

Preparing Undergraduates for the Global Future of Health Care.

BACKGROUND: Health professionals must be academically and experientially prepared regarding the social determinants of health to reduce health disparities at the global level. The emerging literature reflects a trend for incorporating global health competencies for health care. Specifically, recommendations from the Consortium of Universities for Global Health, National Academy of Medicine, and multiple nursing organizations encourage the inclusion of a global health curriculum. OBJECTIVES: To describe the development of an undergraduate global health certificate program and provide recommendations for the development of future global health programs. FINDINGS: At the completion of the certificate program, students felt better prepared to apply course content to culturally diverse populations in low resource settings. RECOMMENDATIONS: Before developing a global health program, preconceived ideas about study abroad experiences and faculty concerns associated with course overload should be dispelled through evidence-based, educational sessions. Curricular time constraints in content-laden programs should be mitigated through an appropriate mix of e-learning formats. Last, a strong value must be placed on interprofessional education to facilitate capacity building through a bi-directional flow of knowledge and resources between the educational institution and the host country.

Culture and Birth Outcomes in Sub-Saharan Africa: A Review of Literature.

INTRODUCTION: Almost 830 women die daily in childbirth with 550 of those deaths occurring in sub-Saharan Africa. This region has the highest maternal mortality rates in the world with 546 deaths per 100,000 live births. Research must focus on understanding cultural beliefs and practices to improve maternal health outcomes. The purpose of this review is to provide evidence of relevant cultural beliefs and the impact on birth outcomes for women in sub-Saharan Africa. METHOD: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the literature focused on 25 articles that defined, directly or indirectly, associations of cultural values, beliefs, and lifeways to pregnancy and birth from the perspective of women of childbearing age. RESULTS: Three relevant categories emerged from the literature: birth outcomes, maternal care-seeking, and maternal culture care. DISCUSSION: Women's voices and an understanding of cultural constructs of care are required to encourage the use of biomedical health system along with the use of indigenous practices.

From guidelines to local realities: evaluation of oral rehydration therapy and zinc supplementation in Guatemala.

OBJECTIVE: Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-income countries throughout the Americas. The World Health Organization (WHO) has developed guidelines on incorporating zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were: (1) to co-design an ORT/ZS training program for community members with local health promoters that is appropriate to the local context and (2) to understand how attitudes and behaviors of community members changed after receiving training from the study promoters. METHODS: In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to implement in their community. Community-based surveys, interviews, and focus group discussions were used to assess acceptability, accessibility, and availability of oral rehydration therapy and zinc supplementation. RESULTS: Use of ORT increased from 63% to 95% among community members following training by local health promoters. Satisfaction with the service offered by health promoters increased from 63% to 90% amongst community members trained by the study promoters. However, knowledge and use of zinc supplementation remained low, which was attributable to unavailability of zinc in the study community. CONCLUSIONS: Use of trained community health promoters is an effective way to translate WHO guidelines to local contexts and overcome sociocultural barriers to care. However, the health system's structure must support availability of essential medicines in order to effectively implement those guidelines.

From guidelines to local realities: evaluation of oral rehydration therapy and zinc supplementation in Guatemala / De las directrices a las realidades locales: evaluación del tratamiento de rehidratación oral y la administración de suplementos de cinc en Guatemala

Objective. Diarrhea remains a leading cause of morbidity and mortality for children in lowand middle-income countries throughout the Americas. The World Health Organization (WHO) has developed guidelines on incorporating zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were: (1) to co-design an ORT/ZS training program for community members with local health promoters that is appropriate to the local context and (2) to understand how attitudes and behaviors of community members changed after receiving training from the study promoters. Methods. In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to implement in their community. Community-based surveys, interviews, and focus group discussions were used to assess acceptability, accessibility, and availability of oral rehydration therapy and zinc supplementation. Results. Use of ORT increased from 63% to 95% among community members following training by local health promoters. Satisfaction with the service offered by health promoters increased from 63% to 90% amongst community members trained by the study promoters. However, knowledge and use of zinc supplementation remained low, which was attributable to unavailability of zinc in the study community. Conclusions. Use of trained community health promoters is an effective way to translate WHO guidelines to local contexts and overcome sociocultural barriers to care. However, the health system’s structure must support availability of essential medicines in order to effectively implement those guidelines.

Objetivo. La diarrea sigue siendo una de las causas principales de morbilidad y mortalidad en los niños de países de ingresos bajos y medianos en toda la Región de las Américas. La Organización Mundial de la Salud (OMS) ha formulado directrices relativas a la incorporación de los suplementos de cinc al tratamiento tradicional de rehidratación oral (TRO) para acortar la duración de los episodios diarreicos y disminuir los resultados deficientes en materia de salud. Guatemala adoptó estas directrices en el 2011, pero todavía no se las aplica plenamente a nivel de la comunidad. Los objetivos de este estudio fueron: 1) codiseñar un programa de capacitación sobre el TRO y los suplementos de cinc dirigido a los miembros de la comunidad por intermedio de promotores locales de salud que sea apropiado para el contexto local y 2) comprender cómo las actitudes y los comportamientos de los miembros de la comunidad cambiaron después de recibir la capacitación de los promotores que formaban parte del estudio. Métodos. Como parte de un estudio de observación, se capacitó a un grupo de promotores comunitarios de salud en zonas rurales de Guatemala sobre las directrices de la OMS, quienes trabajaron conjuntamente con el equipo del estudio para elaborar un programa de capacitación que se ejecutaría en su comunidad. Se usaron encuestas, entrevistas y debates con grupos de sondeo en las comunidades para evaluar la aceptabilidad, accesibilidad y disponibilidad del tratamiento de rehidratación oral y la administración de suplementos de cinc. Resultados. El uso de la TRO aumentó de 63% a 95% entre los miembros de la comunidad después de la capacitación a cargo de los promotores locales de salud. La satisfacción con el servicio ofrecido por los promotores de salud aumentó de 63% a 90% entre los miembros de la comunidad capacitados por los promotores del estudio. Sin embargo, el conocimiento y uso de los suplementos de cinc siguieron siendo bajos, lo que se atribuyó a la falta de disponibilidad de cinc en la comunidad del estudio. Conclusiones. El uso de promotores comunitarios de salud capacitados es una manera eficaz de traducir las directrices de la OMS a los contextos locales y superar los obstáculos socioculturales a la atención. Sin embargo, la estructura del sistema de salud debe apoyar la disponibilidad de los medicamentos esenciales para aplicar eficazmente estas directrices.

From guidelines to local realities: evaluation of oral rehydration therapy and zinc supplementation in Guatemala / De las directrices a las realidades locales: evaluación del tratamiento de rehidratación oral y la administración de suplementos de cinc en Guatemala

ABSTRACT Objective Diarrhea remains a leading cause of morbidity and mortality for children in low- and middle-income countries throughout the Americas. The World Health Organization (WHO) has developed guidelines on incorporating zinc supplementation (ZS) with traditional oral rehydration therapy (ORT) in order to shorten the duration of diarrheal episodes and to reduce poor health outcomes. Guatemala adopted these guidelines in 2011, but they have not yet been fully implemented at the community level. The objectives of this study were: (1) to co-design an ORT/ZS training program for community members with local health promoters that is appropriate to the local context and (2) to understand how attitudes and behaviors of community members changed after receiving training from the study promoters. Methods In an observational study, community health promoters in rural Guatemala were trained according to WHO guidelines, and they worked collaboratively with the study team to develop a training curriculum to implement in their community. Community-based surveys, interviews, and focus group discussions were used to assess acceptability, accessibility, and availability of oral rehydration therapy and zinc supplementation. Results Use of ORT increased from 63% to 95% among community members following training by local health promoters. Satisfaction with the service offered by health promoters increased from 63% to 90% amongst community members trained by the study promoters. However, knowledge and use of zinc supplementation remained low, which was attributable to unavailability of zinc in the study community. Conclusions Use of trained community health promoters is an effective way to translate WHO guidelines to local contexts and overcome sociocultural barriers to care. However, the health system’s structure must support availability of essential medicines in order to effectively implement those guidelines.

RESUMEN Objetivo La diarrea sigue siendo una de las causas principales de morbilidad y mortalidad en los niños de países de ingresos bajos y medianos en toda la Región de las Américas. La Organización Mundial de la Salud (OMS) ha formulado directrices relativas a la incorporación de los suplementos de cinc al tratamiento tradicional de rehidratación oral (TRO) para acortar la duración de los episodios diarreicos y disminuir los resultados deficientes en materia de salud. Guatemala adoptó estas directrices en el 2011, pero todavía no se las aplica plenamente a nivel de la comunidad. Los objetivos de este estudio fueron: 1) codiseñar un programa de capacitación sobre el TRO y los suplementos de cinc dirigido a los miembros de la comunidad por intermedio de promotores locales de salud que sea apropiado para el contexto local y 2) comprender cómo las actitudes y los comportamientos de los miembros de la comunidad cambiaron después de recibir la capacitación de los promotores que formaban parte del estudio. Métodos Como parte de un estudio de observación, se capacitó a un grupo de promotores comunitarios de salud en zonas rurales de Guatemala sobre las directrices de la OMS, quienes trabajaron conjuntamente con el equipo del estudio para elaborar un programa de capacitación que se ejecutaría en su comunidad. Se usaron encuestas, entrevistas y debates con grupos de sondeo en las comunidades para evaluar la aceptabilidad, accesibilidad y disponibilidad del tratamiento de rehidratación oral y la administración de suplementos de cinc. Resultados El uso de la TRO aumentó de 63% a 95% entre los miembros de la comunidad después de la capacitación a cargo de los promotores locales de salud. La satisfacción con el servicio ofrecido por los promotores de salud aumentó de 63% a 90% entre los miembros de la comunidad capacitados por los promotores del estudio. Sin embargo, el conocimiento y uso de los suplementos de cinc siguieron siendo bajos, lo que se atribuyó a la falta de disponibilidad de cinc en la comunidad del estudio. Conclusiones El uso de promotores comunitarios de salud capacitados es una manera eficaz de traducir las directrices de la OMS a los contextos locales y superar los obstáculos socioculturales a la atención. Sin embargo, la estructura del sistema de salud debe apoyar la disponibilidad de los medicamentos esenciales para aplicar eficazmente estas directrices.

Volunteer Service and Service Learning: Opportunities, Partnerships, and United Nations Millennium Development Goals.

PURPOSE: This article explores approaches to service involvement and provides direction to nurse leaders and others who wish to begin or further develop global (local and international) service or service learning projects. APPROACH: We review types of service involvement, analyze service-related data from a recent survey of nearly 500 chapters of the Honor Society of Nursing, Sigma Theta Tau International (STTI), make recommendations to guide collaborative partnerships and to model engagement in global and local service and service learning. FINDINGS: This article offers a literature review and describes results of a survey conducted by the STTI International Service Learning Task Force. Results describe the types of service currently conducted by STTI nursing members and chapters, including disaster response, service learning, and service-related responses relative to the Millennium Development Goals (MDGs). The needs of chapter members for information about international service are explored and recommendations for promoting global service and sustainability goals for STTI chapters are examined. CONCLUSIONS: Before engaging in service, volunteers should consider the types of service engagement, as well as the design of projects to include collaboration, bidirectionality, sustainability, equitable partnerships, and inclusion of the United Nations Sustainable Development Goals. CLINICAL RELEVANCE: STTI supports the learning, knowledge, and professional development of nurses worldwide. International service and collaboration are key to the advancement of the nursing profession. Culturally relevant approaches to international service and service learning are essential to our global organization, as it aims to impact the health status of people globally.

Addressing the Challenges of Conducting Research in Developing Countries.

PURPOSE: To explore the unique challenges that occur when conducting research in developing countries so the reader can consider approaches for providing ethically and culturally appropriate research strategies applicable for the context of the host country. ORGANIZING CONSTRUCT: This article presents an overview of the challenges, which are organized based on the phases of the research period: pre-enrollment, enrollment, and post-enrollment. At each stage, examples of adaptation to meet the challenges are presented and recommendations are posited. CONCLUSIONS: Strategies for research should protect the rights of the most vulnerable and disadvantaged populations while balancing the needs of society at large, provide culturally relevant ethical informed consent while balancing institutional review board requirements, and conduct research in a culturally appropriate manner for the host country while balancing the principles of ethical research established by developed countries. CLINICAL RELEVANCE: Researchers are implored to focus on the ethical and cultural appropriateness of each aspect of the study process to afford the highest level of research credibility and validity.

Submitting for Dollars: Playing the Funding Game to Promote Transcultural Nursing.

Research requires funding! Every researcher understands the crucial role that money plays in implementing a research study. Research for nursing is no different. In the current economic environment, funding sources have become limited. Therefore, researchers need to be prepared to submit grant proposals which will give them a competitive edge over other proposals. This paper will: (1) describe the development of a grant proposal for National Institutes of Health funding, and (2) provide suggestions to novice researchers about how to write a proposal that has the potential to receive a fundable score. This team of early stage investigators submitted a proposal which received a fundable score, but was not selected for funding. The proposal was revised, re-submitted, and received a highly competitive score that did result in funding. The lessons learned from this process can be useful for other nurses seeking to secure funding for their research projects.

Implementation of a training program for low-literacy promotoras in oral rehydration therapy.

OBJECTIVE: The purpose of this study was to ascertain the effectiveness of a culturally appropriate promotora training program related to oral rehydration therapy and diarrheal management. Factors that influenced the development, implementation, and evaluation of the program provided to low-literacy women in Guatemala are explored. DESIGN AND SAMPLE: Promotora training was conducted with 15 Mayan women from a rural community in the highlands of Guatemala. Women were selected by leaders of the community to participate in the program. MEASURES: Quantitative data were collected and analyzed to determine descriptive statistics and reliability coefficients for the pretests and posttests. A nonparametric Wilcoxon test for paired-samples was conducted. The qualitative data from the program evaluations were analyzed for themes. RESULTS: Mean scores increased from 41.73 (SD = 9.65) to 70.33 (SD = 21.29) on the pretest and posttest. The Cronbach's alpha was 0.54 on the pretest with 0.65 on the posttest. The Wilcoxon test demonstrated a significant difference between the pretest and posttest scores (Z = 3.040, p < .05). CONCLUSIONS: Extremely low-literacy levels played a major role in the ability of the women to successfully complete the requirements of the training program. The curriculum demonstrated effectiveness, but will benefit from replication with a larger sample.

Research-based recommendations for implementing international service-learning.

An increasing number of schools of nursing are incorporating international service-learning and/or immersion experiences into their curriculum to promote cultural competence. The purpose of this paper is to identify research-based recommendations for implementing an international service-learning program. A review of literature was conducted in the Cumulative Index of Nursing and Allied Health Literature database using the keywords international, immersion, cultural competence, nursing, and international service-learning. Additional references were located from the reference lists of related articles. Planning of international or immersion experiences requires consideration of the type of country, the length of time, and design of the program; the use of a service-learning framework; opportunities that require the student to live and work in the community, provide hands-on care, participate in unstructured activities, and make home visits; and a method of reflection. Increasing cultural competence does not require foreign travel, but it does necessitate that students are challenged to move outside their comfort zone and work directly with diverse populations. These research-based recommendations may be used either internationally or locally to promote the most effective service-learning opportunities for nursing students.

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.