Global nurse/midwife workforce and reproductive health through social ecology lens.

OBJECTIVE: To explore how community social ecology factors may be associated with country registered nurse/registered midwife (RN/RM) workforce supply and reproductive health globally. DESIGN: A cross-sectional design using a social ecology framework was employed. SAMPLE: Data were retrieved from publicly available websites for 107 countries. MEASUREMENTS: Dependent variables included RN/RM density, maternal mortality ratios (MMR), and adolescent birth rates (ABR). Independent variables included gender inequality, region, country income classification, education, gross domestic product per capita, government expenditure of spending on education and health, life expectancy, percent of female seats in legislature, and labor force participation factors. RESULTS: The best fit multivariable model of RN/RM density showed that after adjustment for region, country income and the GII, the percent of females with some secondary education explained most of variation in RN/RM density. The best fit models of MMR and ABR showed that gender inequality explained most of the variation. Other factors in the models were the percent of female seats in legislatures, region, country income class, and mean years of schooling. CONCLUSIONS: Employing a social ecology model can useful in RN/RM workforce planning and development as countries seek multisectoral strategies for increasing the RN/RM supply and improving reproductive health outcomes.

Leading and Participating in International Medical Service Trips.

In communities around the world, health professionals and students preparing for health careers are increasingly responding to global health needs stemming from natural disasters, infectious disease outbreaks, and inadequate resources. This has resulted in a wide range of faith-based and nonfaith-based health care organizations establishing international medical service programs. This article provides guidance for nursing professional development educators and faculty on leading and participating in these programs. The emphasis is on using best practice guidelines while engaging with the community and providing culturally appropriate and sustainable health care services within an international context. J Contin Educ Nurs. 2018;49(6):251-253.

Global Health Engagement: At Home and Abroad.

Nurses and nurse educators need to be prepared to accelerate progress toward the United Nations' Sustainable Development Goals to improve local and global health in the face of continued poverty, hunger, and disease. This four-part Teaching Tips series will focus on developing nurse educators to prepare nurses for global engagement on the following topics: introduction to global health, systems thinking for global health, strategies for integrating global awareness and engagement into clinical practice, and leading and participating in service trips. The authors offer tips for increasing global awareness and using frameworks, strategies, and resources for both students and nurses to use in their own settings and practice. J Contin Educ Nurs. 2018;49(3):109-110.

Using implementation science as the core of the doctor of nursing practice inquiry project.

New knowledge in health care needs to be implemented for continuous practice improvement. Doctor of nursing practice (DNP) programs are designed to increase clinical practice knowledge and leadership skills of graduates. This article describes an implementation science course developed in a DNP program focused on advancing graduates' capacity for health systems leadership. Curriculum and course development are presented, and the course is mapped to depict how the course objectives and assignments were aligned with DNP Essentials. Course modules with rational are described, and examples of how students implemented assignments are provided. The challenges of integrating this course into the life of the school are discussed as well as steps taken to develop faculty for this capstone learning experience. This article describes a model of using implementation science to provide DNP students an experience in designing and managing an evidence-based practice change project.

The Impact of Cultural Competence Education on Short-Term Medical Mission Groups: A Pilot Study.

BACKGROUND: There are large numbers of short-term medical mission (STMM) groups traveling yearly from the United States to underdeveloped countries. Medical professionals educated in the Western biomedical model of treatment have an ethnocentric view of how to treat illness. PURPOSE: The purpose of this pilot study was to demonstrate that a 2-hour culturally sensitive educational program administered to medical professionals travelling to Haiti on a STMM could raise their cultural competency as measured by a specific tool. METHOD: The participants were invited to a short educational program designed to help them understand their own biases and make better treatment decisions for their patients based on the five constructs of Dr. Campinha-Bacote's cultural competence model. FINDINGS: Following an evidence-based educational program, the members of the STMM groups demonstrated improved levels of cultural competency. IMPLICATIONS: This program could provide an appropriate way to raise the cultural competency of medical mission health care providers.

The global perspective of nursing students in relation to college peers.

OBJECTIVE: The purpose of the present study was to assess the nursing students' global perspectives and compare it to a nationally normed reference group. BACKGROUND: An individual's global perspective impacts the extent to which the person perceives and knows the people and cultures within the world. Nursing care is expected to take a holistic perspective in providing care and respond in culturally appropriate ways to a diverse population through understanding the impact of cultural influences. METHODS: Participant nursing students completed the Global Perspective Inventory survey and information about their current global perspective taking and their perceptions of curricular and co-curricular experiences was collected and analyzed. RESULTS: Compared to the nationally normed reference group, nursing students expressed statistically significant lower intrapersonal affect average score.  Although higher average scores were detected in most of the other scales, differences were not statistically significant. CONCLUSION: A global perspective approach to intercultural nursing education is an area that needs to be further developed and different options are to be examined.

Scholarly publication practices of Doctor of Nursing Practice-prepared nurses.

Doctor of Nursing Practice (DNP) graduates are expected to contribute to nursing knowledge through empirically based studies testing the effectiveness of practice approaches that ultimately benefit patients and health care systems. This article describes publication practices of DNP graduates in the scholarly literature. Published studies (2005 to 2012) with at least one author with a DNP degree were identified. The search yielded 300 articles in 59 journals; 175 met the inclusion criteria and were included in this study. A codebook, consisting of 15 major categories, was used to extract relevant information. Original clinical investigations were the most frequent, followed by practice-focused patient and provider studies. The number of studies published in peer-reviewed journals with DNP-prepared authors increased over time. We recommend greater integration of translational science models into DNP curricula to achieve the goal of publishing scholarly products that use evidence to improve either practice or patient outcomes.

Globally engaged nursing education with local immigrant populations.

This case study describes how a community health nursing practicum course was redesigned to increase undergraduate students' knowledge of and interactions with local immigrant populations. The goal of this tailored practicum is to develop students' sense of global engagement while remaining in the local community. The GENE framework is applied to course planning, delivery, and evaluation of the experience. The key components of the GENE framework are organizational mission/course goals, global health core content, program characteristics, learner characteristics, reflection, and transformational learning. The practicum design, learning objectives, and community partnership development served to create a co-learning environment. Use of an experiential education philosophy allowed the practicum to evolve as students, faculty, agency staff, and community residents learned together over the practicum. Students developed a more complex understanding of health and social conditions of immigrant populations. They moved from a primarily mono- to an increasingly multicultural orientation. The GENE model was useful in offering a globally focused learning experience within a local community.

Globally engaged nursing education: an academic program framework.

OBJECTIVE: This paper presents a model for designing, providing, and evaluating global experiential education, both local and internationally. METHODS: A literature review was conducted to identify studies and models of global nursing education experiences in the scientific indexed literature and the gray literature on the Internet published by professional associations. RESULTS: Key elements of the model developed include institutional and program mission and goals, global health core content, program characteristics, student characteristics, reflection, and perspective transformation. These factors combine to address the range of interweaving factors that need to be considered in providing well-designed global health offerings. CONCLUSIONS: The framework is offered for use in developing global experiences and in conducting studies to advance our understanding of what and how students learn and are transformed from participation in global education.

An international, multidisciplinary, service-learning program: an option in the dental school curriculum.

INTRODUCTION: Many health professions students who treat Spanish-speaking patients in the United States have little concept of their culture and health related traditions. The lack of understanding of these concepts may constitute major barriers to healthcare for these patients. International service-learning experiences allow students to work directly in communities from which patients immigrate and, as a result, students gain a better understanding of these barriers. OBJECTIVE: This article describes the implementation of an international, multidisciplinary, service-learning program in a dental school in the United States. PROGRAM DESCRIPTION: The Indiana University International Service-Learning program in Hidalgo, Mexico began in 1999 as an alternative spring break travel and clinical experience for medical students, focusing on the treatment of acute health problems. Travel-related preparatory sessions were offered, and no learning or service objectives had been developed. The program has evolved to include a multidisciplinary team of dental, medical, nursing, public health and social work students and faculty. The experience is now integrated into a curriculum based on the service-learning model that allows students to use their clinical skills in real-life situations and provides structured time for reflection. The program aims to enhance teaching and foster civic responsibility in explicit partnership with the community. Preparatory sessions have evolved into a multidisciplinary graduate level course with defined learning and service objectives. PROGRAM EVALUATION METHODS: In order to assess the program's operation as perceived by students and faculty and to evaluate student's perceptions of learning outcomes, evaluation tools were developed. These tools included student and faculty evaluation questionnaires, experiential learning journals, and a strengths, weaknesses, opportunities and threats analysis. FINDINGS: Evaluation data show that after program participation, students perceived an increase in their cultural awareness, cross-cultural communication skills and understanding of barriers and disparities faced by Latinos in the United States. Faculty evaluations offer insights into the lessons learned through the implementation process. CONCLUSION: The development of a service-learning based curriculum has posed challenges but has enriched international service experiences.

A social ecological approach of community efforts to promote physical activity and weight management.

Obesity and physical inactivity are major public health problems in the United States. Campus-Community partnerships have the potential to address the community health and quality of life issues at the local level. The purposes of this study were: (a) to identify groups who are at risk for being overweight and physically inactive; (b) to identify a relationship between broad social ecological layers and weight and exercise levels; and (c) to identify community features that are associated with weight and exercise levels. Interventions for physical activity and weight reduction should consider the social ecological framework, including environmental and social influences.

Individual and neighborhood-level factors in predicting asthma.

OBJECTIVE: To identify the neighborhood socioeconomic and housing factors at the census-block level and the sociodemographic factors at the individual level that are associated with the risk of asthma. DESIGN: Cross-sectional study of children aged between 5 and 18 years seen in a network of urban primary care clinics. SETTING: A network of urban primary care clinics (Indiana University Medical Group) in Marion County, Indiana, in the calendar year 2000. PARTICIPANTS: A total of 2544 subjects with 1541 black children (947 girls, 594 boys) and 1003 white children (568 girls, 435 boys). MAIN OUTCOME MEASURE: Whether a subject ever had asthma. RESULTS: The prevalence rate of ever having asthma was 21% with the lowest (14.6%) in white girls and the highest (27.4%) in black boys. None of the census-block characteristics were significant in predicting ever having asthma. The significant predictors for childhood asthma were age, race, sex, and body mass index. Boys who were overweight had 3.1 times higher odds and girls who were overweight had 1.8 times higher odds of having asthma than girls who were normal weight. There was a stronger association between asthma and being overweight in female subjects than in male subjects. Black children had 1.3-fold higher odds of ever having asthma than white children. The highest likelihood of having asthma is among boys who were young, black, and overweight and the lowest among girls who were older, white, and normal weight. CONCLUSION: Increased efforts at prevention, screening, and treatment may need to be directed at certain subpopulations such as children living in socially and physically at-risk families and neighborhoods.

Public health education and practice using geographic information system technology.

The use of geographic information system (GIS) technology allows public health practitioners to explore disparities in health, analyze disease outbreaks, and prioritize the use of limited resources for improving population health. Nursing students benefit from use of World Wide Web GIS resources as they develop knowledge and skill in assessing population health and planning interventions. This article identifies the benefits of GIS for public health practitioners, presents a communicable disease control application of GIS, and discusses a GIS module used in an undergraduate nursing education course. Uniform standards for making health data available for public use with GIS are discussed.

Development of the social ecology model of adolescent interpersonal violence prevention (SEMAIVP).

The Social Ecology Model of Adolescent Interpersonal Violence Prevention (SEMAIVP) was used to examine adolescent beliefs and behaviors about interpersonal violence. Cross-sectional data were collected from middle school students using the Youth Conflict Mediation Survey. Regression models were developed for the total sample, by gender and by race. Factors explaining 48% of the variance in violence avoidance responses include more frequent positive recognition for violence avoidance, possessing a higher sense of nonviolence self-efficacy, and more frequent involvement in violence engagement behaviors. Factors explaining 53% of the variance in violence engagement responses include more exposure to neighborhood fighting, fewer prosocial anger control beliefs, fewer prosocial anger control strategies, more skill development opportunities, and more frequent involvement in violence avoidance behaviors. Findings suggest that prevention approaches need to use a comprehensive social ecology approach that includes intrapersonal, personal, school, and neighborhood environmental components and that provides recognition to adolescents for using violence avoidance skills.