The impact of international placements on nurses' personal and professional lives: literature review

AIM: This paper presents a critical review of research literature on the impact of international placements on the lives and practice of nurses. BACKGROUND: Health care institutions are progressively more aware of the need to respond to diverse patient populations and cultivate leaders to enrich the nursing profession, both locally and globally. One response has been to establish international exchange programmes for nursing students to give them experience of different cultures and health care systems. METHODS: A search of the literature from 1980 to 2003 using electronic databases was undertaken using the databases CINAHL, ERIC, British Nursing Index, Web of Science, the BIDS Social Science Citation Index and Medline. The keywords used were 'international exchange experience', 'international studies', 'international education', 'international placement(s)', 'exchange programme(s)', combined with 'nurses/nursing', combined with 'evaluation', 'practice', 'education' and/or 'policy'. The papers retrieved used both qualitative and quantitative approaches and were scrutinized for recurring themes. FINDINGS: Nurses reported significant changes in their personal development, perspectives on nursing practice and critical appraisal of health care systems. They also indicated an increased appreciation and sensitivity towards cultural issues and cross-cultural care. Moreover, differences in placement programmes, such as duration, preparation and debriefing were found to have affected the reported overall international placement experience. However, the primary effects of international placements were identified as personal development and transcultural adaptation. CONCLUSION: Students should be exposed to a variety of nursing experiences within the host country. This would give them a broad spectrum for comparisons between cultures, nursing practice and health care delivery in those cultures. Therefore, educational institutions are strongly encouraged to provide opportunities for students to participate in nursing care and education in another country.     

Developments in nursing practice in primary health care in Hong Kong: opportunities and challenges

The significance of primary health care to the health of individuals and communities has been well established but the development of primary health care and nursing practice within the context of primary health care remains varied in different countries and settings. This paper focuses on developments in nursing practice in primary health care in Hong Kong, using three community-based research projects to identify the opportunities and challenges created for nurses working in these settings. The projects were established in response to identified health needs and to target cancer education, HIV/AIDS and chronic health problems. Opportunities include the development of professional autonomy, innovative approaches to clinical practice, and developing skills in working with a diverse range of professionals and communities. Challenges include managing uncertainty and the development of evaluation systems to demonstrate health gains from nursing interventions.     

Opportunities in preparing global leaders in nursing.

During the past decade, there has been a large increase in the number of international nurses pursuing doctoral education in the United States. The influx of these nurses has ramifications for the institutional systems providing education as well as on international and American nursing students. To begin understanding the issues presented by international doctoral nursing education, a survey of U.S. schools of nursing as well as a focus group of currently enrolled international doctoral students was conducted. The survey revealed that both international students and nursing programs experience challenges with regard to language, communication, financing, and support systems. More specifically, information gathered from the focus group identified issues regarding (1) lack of familiarity with the U.S. health care system, (2) lack of previous experience with the seminar format used in doctoral programs, (3) restricted opportunities to participate in faculty research, and (4) stress from a heavy course load to finish the program within a very short time period. Universally, the surveys and focus group lauded the positive global perspective imbued on all students and faculties via the international connection. Nonetheless, schools of nursing need to identify more effective strategies to aid international students in their development as successful global leaders. Meleis's framework for culturally competent scholarship is offered as a guide for schools of nursing.     

International rural health needs and services research: a nursing and midwifery response.

As the importance of evidence-based practice in global health care increases, the need for constant, accurate feedback from those in practice is critical, yet the requirement to rapidly obtain and disseminate data on a global basis is a challenge for all health professionals. The Internet allows for global participation in data collection that dramatically streamlines the traditional survey process. This new paradigm applies to surveys that are short, issue focused, and time sensitive. The Global Network of World Health Organization (WHO) Collaborating Centres for Nursing and Midwifery Development used a sample of international nurses in 70 countries to identify the worldwide rural health issues of WHO priority health needs, treatment modalities, health care interventions, and providers, as well as the current state of rural health research on a global level. This article presents the results of the survey regarding rural health needs and nursing and midwifery's response to them internationally, demonstrates Internet data collection, and shows how this research paradigm can help establish an evidence base for nursing practice.     

Setting a new course for advanced practice community/public health nursing.

In recent years the changes in the organization and delivery of health care have created an environment that places great demands on nursing education at all levels. Determining a sound, responsive course of study in advanced practice community/public health nursing (C/PHN) is dependent on clear educational outcomes and competencies. Outcomes and competencies for C/PHN practice need to continue to be derived from the rich knowledge, experience, and research tradition with populations living in the community. However, in today's health care environment, these outcomes and competencies also must be integrated within the context of a very different health care system perspective. This article describes the outcomes and competency indicators developed to guide a curriculum designed to integrate traditional C/PHN and a health systems perspective for students seeking advanced practice education in C/PHN at the College of Nursing, University of Nebraska Medical Center.     

Creating an international nursing practice and education workplace

In today's global workplace, both nursing practice and education need to promote international health. Nurses from a comprehensive 373-patient-bed hospital at Cincinnati Children's Hospital Medical Center and faculty from the College of Nursing, University of Cincinnati, in southwest Ohio have successfully collaborated to develop several unique international nursing exchange programs. The goals of these programs are to increase cultural sensitivity and nursing knowledge relevant to a global community. The essential components used in creating and implementing the programs with Scotland, Honduras, and Korea will serve as an international workplace model for others, especially for those settings focused on children and family health care.     

End-of-life: An urgent update in nursing terminology

Although nursing terminologies and classifications represent nursing knowledge across diverse clinical areas, end-of-life care seems under represented in many aspects of these instruments. NANDA- I is an international nursing diagnostic classification widely used in nursing education and research. This taxonomy is based on seven axes, including the axis of time. In this commentary we bring discussion to the need to update nursing terminology by including the term end-of-life in the time axis of NANDA-I. After describing the epidemiologic aspects of end-of-life care and discussing the relevant nursing role, we discuss patients' and family's human responses towards the end-of-life time and circumstance, which are central to defining nursing diagnoses. End-of-life care is one priority in health care, and nursing diagnoses should represent that situation as well. This paper focuses on a specific and international nursing diagnosis classification, NANDA-I, which lacks an end-of-life component to its time axis for defining labels of nursing diagnoses. Attending to the importance of classifications in clinical reasoning, nursing diagnoses could better represent responses towards this health condition, opening new opportunities for increasing nursing roles in clinical practice, and also for new studies aiming to validate nursing diagnoses, and promoting an evidence-based practice by including end-of-life in the axis time.     

Global collaboration in primary health care

The role of nurses in global collaboration in primary health care is explored in this address. The concept of primary care differs in various countries depending on needs, so re-education of nurses parallels these needs. Nursing practice is adapting to shortages of physicians in some areas, but reacting to excess of physicians in Spain for example. Only the United States makes a distinction between primary health care and community health nursing: most other countries emphasize team approach to a greater extent, integrating nutrition, agriculture, social work, education and other fields into nursing practice. One great challenge to international collaboration by nurses is their failure to be more assertive in initiating local and regional health programs. Another obstacle is communication, not only language but also unfamiliarity with professional development in terms of advanced academic education and professional journals. International nursing collaboration can begin by developing strategies for solving the problems of refugees, agricultural migrants, homeless, and marginal people of all kinds. International collaboration could improve primary care, for example the infant low birth weight and mortality in the Black U.S. population, 34th among all nations. The primary health care movement challenges nurses to break through barriers that maintain professional isolation.     

Preparing the nursing workforce for the next era: Re-classifying and reframing enrolled nursing knowledge

Health systems are being transformed and redesigned in Australia to better respond to changing health needs, technological advances, and new capabilities needed for safe and quality care. A capable and responsive nursing workforce, at both enrolled and registered nurse levels, is one of the mechanisms required for achieving effective health care reform.This paper situates a critical discussion of enrolled nurse education within a symbiotic relationship model to consider how nursing knowledge can enhance workforce performance and contribute to improved function of health systems. Discussion focusses on classification, or what constitutes nursing knowledge, and how that knowledge can be presented, or framed, in nursing education.It is contended that different nurse education systems in Australia mean the construction of professional enrolled nurse knowledge differs in form and structure from registered nurse professional knowledge. While different courses are needed for enrolled and registered nurses to reflect their different scope of nursing practice, it is important enrolled nurse education classified and frames nursing knowledge in ways that prepare graduates for complex nursing practice to safeguard the public.     

Nursing Leaders as Visionaries and Enablers of Action

ObjectivesThe engagement of nursing leaders is critical for the future of the cancer nursing profession, quality cancer care, and the overall health care system. The field of cancer care is facing enormous challenges, requiring strong nursing leadership. Cancer nursing leadership is needed to overcome the challenges caused by workforce shortages, restricted resources, historic and ongoing under-recognition of nursing, unsafe working conditions, and unequal access to education. The aim of this article is to contribute to the discussion about how cancer nursing leaders can act as visionaries and support transformation of cancer nursing for the future.Data SourcesAuthor experience, journal articles and organizational position papers were used.ConclusionTo improve the state of cancer nursing and the working conditions of the cancer nursing workforce, nursing leadership practices need to be embraced on all governance levels in clinical practice and academia. When effective and high-quality nursing leadership is enacted, positive outcomes for people affected by cancer, nursing, and health care systems can be achieved. Cancer nursing leadership needs to be supported through nursing scholarship, influencing national and global policies and strategies and by active involvement in national and international health care management.Implications for Nursing PracticeNursing leadership and governance is critical to strengthening the cancer nursing workforce. Strong nursing leadership is required to realize the vision for transforming the health care systems and cancer care. Therefore, collaboration among multidisciplinary leadership, health care organizations, academic institutions, professional organizations, and policy-making structures is warranted.     

Changing foci in American nursing education: primary and transcultural nursing care.

Two major movements in the USA–transcultural nursing and primary care nursing–are discussed. They are considered to be exciting, challenging and promising developments to advance nursing education and practice. These movements are placing new and heavy responsibilities on nurse educators. The author argues that both transcultural nursing and primary care nursing movements need to be part of local, national and international health education and care systems.     

Issues and challenges in international doctoral education in nursing

Education is a driving force in improving the health and welfare of communities globally. Doctoral education of nurses has been identified as a critical factor for provision of leadership in practice, scholarship, research, policy and education. Since the genesis of doctoral education in nursing in the USA in the 1930s, this movement has burgeoned to over 273 doctoral programs in over 30 countries globally. The present article seeks to identify the issues and challenges in nursing doctoral education globally, and those encountered by doctoral program graduates in meeting the challenges of contemporary health care systems. Information was derived from a comprehensive literature review. Electronic databases and the Internet, using the Google search engine, were searched using the key words "doctoral education"; "nursing"; "International Network for Doctoral Education in Nursing"; "global health"; "international research collaboration". Doctoral education has been a critical force in developing nurse leaders in education, management, policy and research domains. An absence of consensus in terminology and of accurate minimum data sets precludes comparison and debate across programs. The complexity and dynamism of contemporary globalized communities render significant challenges in the conduct of doctoral programs. Addressing funding issues and faculty shortages are key issues for doctoral programs, especially those in developing countries, to achieve an identity uniquely their own. These challenges can also afford considerable opportunities for discussion, debate and the formulation of innovative and collaborative solutions to advance nursing knowledge and scholarship. In spite of discrete differences between countries and regions, the similarities in the issues facing the development of doctoral programs internationally are more striking than the differences. The harnessing of a global collective to address these issues will likely serve to not only forge the future viability of doctoral education of nurses but to improve the health and well-being of communities. This paper proposes international collaborative strategies to address a number of the challenges identified.     

International consensus-based policy recommendations to advance universal palliative care access from the American Academy of Nursing Expert Panels

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.     

Integration of international and transcultural content in nursing curricula: a process for change

A brief review of education and nursing literature indicates that it is essential to help students develop a global perspective as they prepare to practice nursing in a world of increasingly interdependent nations and people. The process currently being implemented to integrate international and transcultural content in the undergraduate nursing curriculum at a Midwestern state university is described in this article. Assessment of the school indicated that the student population and faculty are characterized by a high degree of radical-ethnic homogeneity. Assessment also included the mapping of content in all required courses in the undergraduate curriculum in the following areas: cultural differences, health care delivery systems in other countries, nursing in other countries, and international health organizations and issues. Recommendations were then made regarding content in required courses, continuation of elective courses, and informal educational strategies. Examples of these are described, as well as the resultant changes. Some of the changes described include content added and educational strategies used to integrate transcultural and international health content in required courses. Elective courses, taught both on-campus and abroad, are briefly described. Evaluation is an ongoing part of overall program evaluation. Highest priority for future planning is currently being placed on development of a semester study-abroad program and increasing cultural diversity in all students' educational experiences.     

Cultural Competence in the Undergraduate Nursing Curriculum

Although health care providers and health care systems have increasingly acknowledged the need for culture-specific care in a global society, its implementation has remained daunting. Thus, integrating cultural competence into nursing education is no longer a choice but a requirement that builds on the values of the racially and culturally diverse population of the United States for optimal health care. The need has never been greater for nurses who understand the health implications of the demographic shifts that are shaping an American society whose African American, Hispanic, Asian, and Native American constituents compose a significantly growing portion of the population and whose health care needs will need to be served in health care settings that range from their homes to health care institutions. This article provides a blueprint on how our undergraduate program integrated cultural competence education throughout the curriculum.     

Addressing the need for education: curriculum development for nurses about intellectual and developmental disabilities

People with disabilities and national and international agencies are voicing their views, forcing health care providers to look at how people with disabilities are treated in the health care system and to find ways to help them achieve equal access to quality care. Education about nursing care of patients with I/DD is limited in basic nursing education programs and for nurses who are in practice. A number of developmental disabilities nursing projects are addressing this need with curriculum development that has validated the need for education and has begun testing the various methods of instruction. As the curriculum is disseminated in written or Internet-accessible formats, nurses in education and practice will be able to find resources that target a specific topic area or a set of comprehensive instructions to acquire a better understanding of the comprehensive needs of people with I/DD and better ways to provide care. There is a need for a greater integration of curriculum about nursing care of people with developmental disabilities into basic nursing education at all levels and further evaluation of the impact of this curriculum on nursing care for people with I/DD. The hope is that these efforts can improve the education of nurses and other health care providers for the direct benefit of individuals with intellectual disabilities.     

American Academy of Nursing Expert Panel consensus statement on nursing's roles in ensuring universal palliative care access

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.     

The Albrecht Nursing Model for Home Health Care: Implications for Research, Practice, and Education

Home health care has become increasingly popular with consumers. Despite this movement of care away from the hospital, the literature does not contain a comprehensive nursing model of home health care. The need for a model to guide nursing research and ultimately, nursing practice and education is apparent. Four health service delivery models are available to be applied to home health care nursing; however, analysis of all four demonstrates a need for one specific to home care nursing.     

Meeting tomorrow's health care needs through local and global involvement

Strengthened efforts to achieve the United Nations Millennium Development Goals by 2015 are urgently needed. A fundamental step toward achieving these goals is strengthening global partnerships for development. This article describes critical challenges and opportunities in global health and the social responsibility of the nursing profession in this area. Examples and suggestions for nursing action are provided for consideration by those interested in influencing global health. Engaging in global health activities such as study abroad programs, interprofessional exchanges, continuing education workshops, and seminars with a global health focus can have significant implications for nursing education, research, policy, and practice. Equipping nurses with the leadership skills, knowledge, and attitudes needed to advance global health is integral in the delivery of effective, culturally relevant health care.     

Nursing knowledge for the 21st century: an international commitment.

This article sets forth some assumptions about 21st century trends in science, communication systems, and lifestyle patterns. Further, it offers speculations about the relationship of these trends to future health care. Nursing knowledge in light of the assumptions and speculations is addressed and a nursing science curriculum proposed. A complex of centers to replace today's health care system is described in an effort to make explicit the contribution of the professional nurse to the health care of individuals and families in the 21st century. The author calls for an international commitment from nurses of all nations to use extant nursing theories and frameworks, rather than the biomedical model, as guides to research and practice in order to expand the base of nursing knowledge while specifying the uniqueness of the discipline.