Strategies for Strengthening the Resilience of Public Health Systems for Pandemics, Disasters, and Other Emergencies.

OBJECTIVE: The aim of this study was to identify and prioritize strategies for strengthening public health system resilience for pandemics, disasters, and other emergencies using a scorecard approach. METHODS: The United Nations Public Health System Resilience Scorecard (Scorecard) was applied across 5 workshops in Slovenia, Turkey, and the United States of America. The workshops focused on participants reviewing and discussing 23 questions/indicators. A Likert type scale was used for scoring with zero being the lowest and 5 the highest. The workshop scores were analyzed and discussed by participants to prioritize areas of need and develop resilience strategies. Data from all workshops were aggregated, analyzed, and interpreted to develop priorities representative of participating locations. RESULTS: Eight themes emerged representing the need for better integration of public health and disaster management systems. These include: assessing community disease burden; embedding long-term recovery groups in emergency systems; exploring mental health care needs; examining ecosystem risks; evaluating reserve funds; identifying what crisis communication strategies worked well; providing non-medical services; and reviewing resilience of existing facilities, alternate care sites, and institutions. CONCLUSIONS: The Scorecard is an effective tool for establishing baseline resilience and prioritizing actions. The strategies identified reflect areas in most need for investment to improve public health system resilience.

Effectiveness of a Culturally Responsive mHealth Gaming Application to Improve Diabetes Health Literacy in India: A Randomized Controlled Trial.

The purpose of this study was to determine the effectiveness of a culturally responsive interactive gaming mHealth educational application designed to improve diabetes health literacy among an underserved urban population in India when compared with a traditional approach of verbal education. In addition, relationships between participant sociodemographic variables and participant knowledge were assessed. A randomized controlled trial was conducted using a two-arm parallel, single-blinded intervention and control group design. The parallel groups were the mHealth Education group serving as the intervention group and the Verbal Education group serving as the control group. The mHealth application was as effective in improving diabetes health literacy as verbal education. Results for the difference in posttest and pretest score between the two groups indicated there was no statistically significant difference between groups ( P = .9306). However, there was a significant improvement in the difference in posttest and pretest scores for each group ( P < .0001), indicating that the culturally responsive type 2 diabetes educational content was effective in improving type 2 diabetes health literacy among both groups. This study answers a call by the World Health Organization that advocates for evidence-based mHealth interventions that offer unique opportunities for cost-effective informatics service delivery in low- and middle-income countries.

Building Nurse Upstanders for Health Equity.

BACKGROUND: Health inequities are prevalent in the United States and globally; however, racism as a root cause for health inequities is not explicitly addressed in most nursing or health science curricula. METHOD: Nursing students enrolled in an undergraduate Bachelor of Science in Nursing research course were immersed in a trip to a Holocaust and Human Rights Museum as a nontraditional experiential approach to building upstanders for health equity. RESULTS: Students used their experiences to inspire research to advocate for health equity for vulnerable populations and disseminated their research at local, national, and international conferences. CONCLUSION: Nurse educators are responsible for ensuring nursing curricula are current and inclusive to address the health needs of patients and communities and to improve patient and population health outcomes. Embedding an immersive experience and related assignments is one strategy toward dismantling structural racism in health care. [J Nurs Educ. 2022;61(7):417-420.].

Nursing as a Calling: Using the Pedagogy of Reflection While on Mission.

ABSTRACT: This qualitative research study used the pedagogy of reflection as faculty guided undergraduate nursing students in self-reflection and critique while on a mission trip to South India. Working through a dichotomy of emotions, students began to view nursing as a calling and themselves as global citizens embracing cultural diversity.

Cross Cultural Team Collaboration: Integrating Cultural Humility in mHealth Development and Research.

The World Health Organization called for mobile health initiatives to improve population health outcomes, particularly in limited-resource settings. The aim of our study was to reflect upon approaches embedded in cultural humility and recognize areas where improvement was needed in the social innovation collaborative development of an mHealth app to improve hypertension health literacy in India. A qualitative descriptive case study approach was employed to elicit concepts of cultural humility and areas for improvement derived from communications between project stakeholders. Overarching themes included fostering coalescence and strengthening partnerships in addition to multiple subthemes. Enveloping cultural humility in multidisciplinary, interprofessional and cross-cultural healthcare projects and processes is imperative for the development and implementation of successful culturally congruent health initiatives. Team fostering of coalescence and recognizing challenges and adapting to mitigate challenges can strengthen partnerships, a desired consequence of cultural humility.

Mobile Health to Improve Hypertension and Diabetes Health Literacy Among Asian Indian Migrants to Hong Kong.

The use of mobile technologies to improve health outcomes or mobile health is rapidly evolving, and culturally relevant resources are needed to address health disparities among vulnerable populations. Noncommunicable disease health disparities among Asian Indian migrants to Hong Kong are prevalent. A mobile health application designed to improve hypertension and type 2 diabetes mellitus health literacy was tested using a mixed-methods design to determine its impact on improving health literacy among this subpopulation. Quantitative findings indicated the mobile health application was effective in improving health literacy. Qualitative findings revealed participant perceptions about the application explored its informative nature, usability and likability of application components, and its ability to initiate intentionality for a healthier lifestyle among users. This feedback was valuable to ensure future modifications that will promote the application's scalability and sustainability.

Improving Neonatal Outcomes Through Global Professional Development.

BACKGROUND: Globally, stillbirths account for 2.7 million infant deaths each year, with the vast majority occurring in sub-Saharan Africa and South Asia. Approximately 900,000 infants die due to birth asphyxia. The focus of the Helping Babies Breathe (HBB) program is to help the nonbreathing infant to breathe within the first minute of life, termed the "Golden Minute." PURPOSE: To present a multinational interprofessional development program utilizing the train-the-trainer methodology for HBB to address neonatal morbidity and mortality. Involving nursing students in collaboration with established global partners provided an innovative method of professional development. Lessons learned and challenges will be shared to enhance success of future efforts. PROJECT IMPLEMENTATION: HBB train-the-trainer workshops were held to provide professional development for nurses and nursing students in 5 locations in 4 countries including Ethiopia, India, Vietnam, and Zambia. Workshop participants and the trainers participated in discussions and informal conversation to assess impact on professional development. RESULTS: HBB training and train-the-trainer workshops were implemented in 4 counties. Equipment and supplies were provided in these countries through several internal university grants. All 145 participants demonstrated increased knowledge and skills at the end of the workshops through the HBB check off. Collaborative teaching and cross-cultural professional skills were enhanced in student and faculty trainers. IMPLICATIONS FOR PRACTICE: Nurses, midwives, and advance practice nurses can engage globally and contribute to closing this gap in knowledge and skills by providing train-the-trainer workshops. IMPLICATIONS FOR RESEARCH: Developing systems to integrate the HBB program within each country's existing healthcare infrastructure promotes in-country ownership. Joining the global effort to save the lives of neonates can be a meaningful opportunity for innovative professional development projects. While HBB education has been shown to save lives, a 1-time training is insufficient. Determining how often HBB updates or refreshers are required to maintain skills is an important next step. Another direction for research is to implement this project within prelicensure nursing programs.

Effectiveness of Peripheral Intravenous Skill Continuing Education Using Low-Fidelity Simulation Among Nurses in India.

BACKGROUND: Many nurses have limited opportunities to practice peripheral intravenous (IV) skill access until they begin their nursing career, particularly in limited resource settings. Continuing nursing education is needed for practicing nurses to build nurse capacity and skill accuracy in IV access globally. METHOD: A pretest-posttest design was used to measure effectiveness of peripheral IV continuing education among 180 nurses in India. A skills checklist was used to observe for skill accuracy using low-fidelity simulation. RESULTS: A statistically significant improvement in knowledge regarding peripheral IV skill access and care was found (p < .001), and 95% of nurse participants successfully simulated IV access accuracy after the continuing education intervention. CONCLUSION: Findings support the need for continuing nursing education to improve peripheral IV access and care knowledge and skill among nurses, particularly in low- and middle-income countries or other settings where hands-on experience is limited during undergraduate nursing education programs. J Contin Educ Nurs. 2018;49(6):255-261.

Smart phone accessibility and mHealth use in a limited resource setting.

AIM: To determine smartphone access and use including future opportunities for mHealth and potential ethical implications among health care professionals practicing at a health care facility in Bengaluru, India. BACKGROUND: The evolution of smart phones can provide convenient, portable, and rapid access to resources for health care professionals. While mobile phone accessibility has improved in recent years in many low and middle-income countries, the use of smart phones to address health priorities remains limited in some limited resource settings. DESIGN: A quantitative descriptive design was used. METHODS: A survey was administered in November of 2016 to nurses and physicians at a tertiary care hospital in India. RESULTS/FINDINGS: All respondents had a mobile phone, and the majority owned a smart phone that was used for text messaging, email, accessing internet, and downloading apps. Participants recommended smart phone use to improve health care provider access to continuing education and to improve patient knowledge about health. Physicians had better access to mHealth resources compared with nurses. CONCLUSION: Credible, evidence-based, affordable mobile applications are needed to provide a platform for continuing health education to health professionals and patients in India and limited resource settings. Nurses need equitable access to mHealth resources to build successful mHealth initiatives.

The Pad Project: A Global Initiative Uniting Women.

The Pad Project is a women's health program used to educate women on their monthly menstrual cycles. Through this ministry, women who do not have access to menstrual hygiene products are given sustainable hygienic kits to promote menstrual health. This unique health education program also integrates stories from the gospel to illustrate Christ's love and caring commitment toward women and women's health.

Partnering to Establish and Study Simulation in International Nursing Education.

The purpose of this article was to describe an international partnership to establish and study simulation in India. A pilot study was performed to determine interrater reliability among faculty new to simulation when evaluating nursing student competency performance. Interrater reliability was below the ideal agreement level. Findings in this study underscore the need to obtain baseline interrater reliability data before integrating competency evaluation into a simulation program.

Patient Storytelling in the Classroom: A Memorable Way to Teach Spiritual Care.

Storytelling is an evidence-based teaching and learning strategy that engages students and promotes critical thinking. Although most nursing textbooks incorporate spiritual nursing care, the texts lack examples of how to tie evidence-based spiritual interventions to specific medical-suigical content. Stories told from the patient's perspective can communicate insights that nurses and students can use when planning spiritual carefor patients. Stories shared by patients with undergraduate nursing students were effective in promoting learning and offered concrete examples of supportive spiritual resources for patients.

Travel as a Transformational Spiritual Event.

There is a philosophical connection between elements of travel and elements of spirituality. Nurses can develop spiritual intelligence, hone transcultural skills, and develop cultural humility through travel. Concepts of spiritual intelligence are incorporated to distinguish spirituality from religion. This discussion is to describe the spiritual attributes of travel through exploration of unique cultural sameness and differences, stepping out of one's routine, experiences of solitude, and the application to nursing. Venues such as study abroad, mission trips, cultural exchange opportunities, and service learning projects all can provide meaningful times of transformation, spiritual growth, learning new ways of doing things, and of being in the world. Nurses who integrate these practices into the care they provide daily will be enriched personally and rewarded with improved outcomes.

Multi-institutional Collaboration to Promote Undergraduate Clinical Research Nursing.

Clinical research nursing is distinct from nursing research and includes the coordination and delivery of care for patients enrolled in clinical research trials. An innovative elective in clinical research nursing was developed collaboratively by stakeholders at a university, research institute, and national organization to provide experiential learning for undergraduate nursing students. The multi-institutional collaborative process, course overview, and precepted experience are described.

A method comparison of photovoice and content analysis: research examining challenges and supports of family caregivers.

PURPOSE: The purpose of this manuscript is to compare methods and thematic representations of the challenges and supports of family caregivers identified with photovoice methodology contrasted with content analysis, a more traditional qualitative approach. METHODS: Results from a photovoice study utilizing a participatory action research framework was compared to an analysis of the audio-transcripts from that study utilizing content analysis methodology. RESULTS: Major similarities between the results are identified with some notable differences. Content analysis provides a more in-depth and abstract elucidation of the nature of the challenges and supports of the family caregiver. CONCLUSIONS: The comparison provides evidence to support the trustworthiness of photovoice methodology with limitations identified. The enhanced elaboration of theme and categories with content analysis may have some advantages relevant to the utilization of this knowledge by health care professionals.

Nurse migration from India: a literature review.

BACKGROUND: A profound nursing shortage exists in India where nurses are increasingly outmigrating to practice nursing in surrounding countries and abroad. This is important globally because countries with the lowest nursing and healthcare workforce capacities have the poorest health outcomes. OBJECTIVE: This review sought to synthesize and unify the evidence about nurse migration from India and includes a look at nurse retention within India. DESIGN: A comprehensive literature review was performed to synthesize and unify both qualitative and quantitative research. DATA SOURCES: Bibliographic databases searched included CINAHL, MEDLINE, PsycINFO, and EconLit using associated keywords for empirical and descriptive literature published between January 2004 and May 2014. Hand searches of the Nursing Journal of India from 2004 to February 2014 and the Journal of Nursing Research Society of India from its inception in 2007-February 2014 were also completed. REVIEW PROCESS: 29 studies were selected and analyzed for the review. Data were appraised for quality; reduced through sub-categorization; extracted; and coded into a framework. Thematic interpretation occurred through comparing and contrasting performed by multiple reviewers. RESULTS: Findings included an exponential growth in nurse recruitment efforts, nurse migration, and a concomitant growth in educational institutions within India with regional variations in nurse migration patterns. Decision-making factors for migration were based on working conditions, salience of family, and the desire for knowledge, skill, technology, adventure and personal enrichment. Challenges associated with migration included questionable recruiting practices, differing scopes of practice encountered after migration and experiences of racism and cultural differences. A shift toward a positive transformation of nursing status in India has resulted in an increased respect for individual nurses and the profession of nursing. This was attributed to the increased globalization of nursing. CONCLUSIONS: Results from this review can be used to shape health policy and advocate for nursing reform in India. As India's healthcare infrastructure continues to evolve, effective programs to improve conditions for nurses and retain them in India are needed. Additionally, as the globalization of nurses increases, more research is needed to develop effective programs to aid in a smooth transition for nurses who migrate from India.

Perceived Rewards of Nursing Among Christian Nursing Students in Bangalore, India.

Nurses in India face significant challenges and often migrate to practice nursing abroad. Few studies have focused on the rewards of nursing in India. The aim of this study was to illuminate perceived rewards of nursing among Christian student nurses in Bangalore, India. Photovoice, a participatory action methodology was used, and 14 Christian student nurses participated in the study. Thematic interpretation of photographs, journals, critical group dialog sessions, and observational field notes resulted in the identification of two main themes. These themes included intrinsic rewards and lifelong benefits of nursing in India.

Perceived challenges and supports experienced by the family caregiver of the older adult: a photovoice study.

As the older adult population in the United States grows in number, the need for family caregivers will also rise. Results from quantitative studies mostly provide evidence of caregiver burden, not caregiver support, and qualitative studies are needed. This study used a community-based participatory action research methodology called photovoice to explore challenges and supports experienced by family caregivers of the older adult. Photovoice incorporates the use of photographs to facilitate the elucidation of an experience by populations or groups. Using photovoice, study participants self-identified 5 challenges and 5 supports experienced in the caregiver role.