Global nursing leadership: a professional imperative.

Globalization is an inevitable trend in the modern world, as our communities become both closer and more diverse. Globalization is examined in this report as a key factor in recognizing the intersection of health and development. Nurse leaders face the crucial need to understand and take initiatives in responding to this radically changing world. The transformation of nursing requires active participation and leadership in practice, education, research, and policy arenas. To participate in shaping the public understanding of health and development, nurse leaders must be included in the multinational and multidisciplinary decision processes that shape health care at home and abroad.

Primary health care.

Primary Health Care (PHC) has been promulgated for over two decades as a global strategy for ensuring basic health care for all people. PHC is characterized by equity, accessibility, availability of resources, social participation, intersectoral community action, and cultural sensitivity. While PHC can be discussed as philosophy or a process, it is critical that PHC be understood as a community focus in health care that differs from a primary care focus on individuals. Capturing PHC components in community-based interventions in order to advance the development of a rigorous research base requires a shift in thinking about what constitutes acceptable methods and evidence for evaluating changes in health care. To this end, the authors of this review discuss perspectives and available research that inform practice within multidisciplinary teams, highlight the importance of social discourse, and review participatory evaluation issues for achieving a working relationship with communities. Particular attention is focused on education for nurses' roles in PHC activities within implementation models fostering community mobilization and development. An action plan is suggested as a means for situating discrete research activity within a PHC framework.

The Chicago Health Corps: strengthening communities through structured volunteer service.

The Chicago Health Corps is an AmeriCorps*USA program, established in 1994 by the Corporation for National Service in partnership with the Health Resources and Services Administration (HRSA) of the U.S. Public Health Service. The Chicago Health Corps deploys 20 full-time equivalent corps members in selected community sites that offer primary health care services to Chicago's underserved families. Chicago Health Corps members provide a combination of outreach, home visit, and case management services to address unmet health needs identified by community members, including both laypersons and professionals. Providing meaningful opportunities for participants to assist their communities with health care helps corps members develop an awareness of their fellow community members and an ethic of service.

AIDS awareness and knowledge among Botswana women: implications for prevention programs.

In-depth interviews with 56 urban women in Botswana revealed high levels of AIDS awareness and high reliance on mass media information. Many of the women expressed confusion about AIDS as an illness, that is, its symptoms and the latent period. Nearly all of the women were aware that the virus that leads to AIDS is sexually transmitted and believed that condoms are effective for prevention. However, one third had incorrect knowledge about transmission, lacking a full understanding of sexual transmission and believing that transmission can occur through casual contact. Two thirds believed they were at risk for getting AIDS, usually because they did not trust their partners and lacked control over their partners' behaviors. More than half of the women said they had changed their behaviours to prevent AIDS. Thirty-six said they had only one partner, but only 11 said they used condoms or would do so with a future partner. The women's responses provide important information on gaps in AIDS knowledge that need to be addressed in AIDS prevention.

Graduate nursing concentration in women's health at the University of Illinois at Chicago.

The Graduate Nursing Concentration in Women's Health was formalized in the 1980s as a program of study that emphasizes nursing theory, research, and practice related to women's health. We describe the purposes of the program and the assumptions underlying the care of women as well as the curriculum and characteristics desired of graduates. In this program, the goal of advancing women's health is balanced by the desire to create a productive, educational environment that facilitates the personal construction of knowledge by learners.

Measuring quality of life in Thai and US communities.

Assuring that the quality of life is continually improved for community residents is an important outcome of primary health care (PHC) programmes. Yet, how can it be measured. Below, the authors describe a tool developed to elicit client perceptions of PHC conditions in two communities in two different cultures: one in Thailand, the other in the USA. Such a tool can help communities prioritize their concerns and monitor the effect of PHC interventions.

AIDS prevention for women: a community-based approach.

PIP: There were approximately 3 million HIV-positive women in the world, most of them in reproductive age according to the WHO's 1991 estimates. One third of the world's HIV-positive individuals are women; by the year 2000, women will account for half of the HIV-positive population. There are at least 200,000 HIV-positive women in Asia, mainly in Thailand, India, and China. The community-based Botswana project approach to AIDS prevention for women was based on a community-based model project at the University of Illinois to promote health in 2 low-income communities in Chicago by teams of trained residents and a nurse. Program elements included: women as health promoters; acceptance of primary health care; and emphasis on self-care in basic health. In Botswana the fertility rate is 5%, and approximately 40% of the women use contraceptives. The overall mortality rate is 37 per 1000. The 1st case of AIDS in Botswana was identified in 1985. As of January 1991, there were 180 cases and 59 AIDS-related deaths. There are 20,000 to 47,000 HIV-positive individuals in Botswana. There have been more women than men among reported AIDS cases in Botswana. Most women in their childbearing years are at moderate risk of HIV infection because of weak partner ties and occasional multiple partners. A 2-stage study of the effectiveness of nurse-managed peer education and support groups for AIDS prevention for women has been in operation for the 2nd year. In the 1st phase, interviews with more than 50 urban women explored their current risk of HIV infection and the risk-reduction strategies. The strategy for change used peer education and support groups led by trained community women to achieve lasting behavioral changes that promote health. The target group approach will include all women in the community. Heterosexual transmission of HIV is the predominant route of infection for women, hence promotion of safer sex is central in the Botswana intervention. The same AIDS preventive practices also protect against other sexually transmitted diseases including gonorrhea, syphilis, and chlamydiosis, which have high prevalence rates in Botswana.^ieng

Self-care and menopause: critical review of research.

Existing literature on self-care as it relates to menopause is examined to determine whether the knowledge base in this area reflects important tenets in women's health. One such tenet is that understanding the lived experience of women is critical in developing effective health care interventions. Few investigators acknowledge the lived experience of women in their studies of self-care and menopause.

Community health advocacy: primary health care nurse-advocate teams in urban communities.

In summary, our health advocacy program uses PHC teams in urban, underserved communities to deal with the interaction of social and health factors in solving problems related to access to appropriate (as perceived by residents) and affordable health care. This approach encourages grass-roots participation in problem identification and solution, a fundamental ingredient of community empowerment. Further, this program facilitates community identification of nurses as resource persons who encourage collaboration to improve the community's health status and as health providers who enhance the authority and autonomy of community participation in the resolution of health issues.

Ethical concerns in caring for older women in the community.

Given the preceding discussion, what can be summarized at this point about the ethical concerns we face in the care of older women? Overall, we have presented a perspective that combines our understanding of women's health and nursing ethics. The essence of much of our concern about caring for older women is that we have views about their care that reflect our understanding of what it means to be professionals who have a social contract with our clients. We have discussed nursing ethics as a process that occurs within a social context that emphasizes working to maximize self-determination and informed choices for older women. We have emphasized autonomy and a perspective that places the nurse in an advocacy position with the patient in a relationship of partners. Arriving at reasoned positions on the ethical issues in the care of older women leads to agreement with Gloria Steinem that women may be the one group that grows more radical with age.