The Sustainable Development Goals (SDGs), adapted by the United Nations in September 2015, provided a blueprint for the advancement of social and economic issues across the world to end poverty and reduce health inequalities by 2030. SDG 3 focuses on increasing universal health coverage for all, prioritizing increased financing of health systems and improvement in the recruitment and training of the human resources for health workforce (“Goal 3: Sustainable Development Knowledge Platform,” 2016). Nurses are the largest healthcare workforce in the world and are a fundamental component in the achievement of universal health coverage and access to health care for the poor. However, their contribution is often underestimated. Globally, the nursing profession faces critical shortages in staff and tangible resources, as well as inconsistent and limited education and training. In addition, nurses are not given adequate opportunities for leadership within health care systems (“Triple Impact of Nursing,” 2016.).
The World Health Organization (WHO) has focused on strengthening the global community of nurses through the establishment of universal education standards to improve both patient outcomes and access to care. In 2017, WHO appointed registered nurse, Elizabeth Iro, as the organization’s first Chief-Nursing Officer, a critical acknowledgement to the importance of nurses in achieving improved well-being of all persons and a significant step toward advancing nursing leadership. Additionally, this year WHO and the International Council of Nursing, launched the "Nursing Now" global campaign led by the Bill & Melinda Gates Foundation, the United Kingdom’s All Parliamentary Group on Global Health, and the Lancet. Nursing Now focuses specifically on underscoring the overall importance of nursing and on enhancing the general nursing profile (“Nursing Now,” 2018). Paralleling this global recognition of nurses by the health care community, leading nursing scholar organizations, like Sigma Theta Tau International (STTI), have prioritized increased engagement of and collaboration between nursing colleagues globally. STTI is supporting nurses worldwide to set a global agenda, establish a unified voice and vision to strengthen the role of nurses worldwide (“STTI’s Global Action supports its mission to improve world health,”2018).
Methods:
To establish an effective and equitable global collaboration and to support the strengthening of the skills of the global nursing community, a team of nursing faculty and students at Emory University conducted a systematic review of literature on university-university educational partnerships. The aim of the literature review was to establish best practices in global nursing partnerships and to define the strengths and the lessons learned from health educational exchanges over the past two decades (WHO, 2009).
In conjunction with this analysis, Emory School of Nursing conducted baseline evaluations to identify the needs and goals of partner organizations in Rwanda, Haiti, and Indian Health Services in Northern California related to these partnerships. These assessments allowed Emory and its partners to jointly and intentionally define gaps in clinical, research, scholarship, and leadership needs that would mutually benefit both Emory and partner sites.
Results:
A literature review on global nursing partnerships found that there has been a surge in the number of global health education exchanges in the past decade. These opportunities have grown out of programs offered at universities in the United States and Europe, which are designed to strengthen the health education curricula, training opportunities, and capacity of health systems and the healthcare workforce in the Global South. These early programs aim to strengthen the capacity of universities’, primarily in low-income areas, to train physicians, nurses, and researchers in specific clinical expertise by engaging with host countries’ Ministries of Health and Education to jointly identify gaps in health care education (Stringer et al., 2016). A strength of many of these programs are the successful inclusion of interprofessional partners, including physicians, nurses, and public health practitioners (Hakim et al., 2018; Mugore, Mwanja, Mmari, & Kalula, 2018). Several case studies from various countries link interprofessional communication and collaboration in the health care settings to improved patient outcomes (Levett‐Jones et al., 2018).
These partnerships, however, often lack nurse directorship and are housed outside the Schools of Nursing. These efforts also are widely one directional, failing to establish effective and equitable collaboration between nursing students and universities (Arora, 2017). More recent research has proven that educational exchanges between universities in low and high-income countries are stronger when there is greater parity between learners and when programs offer bi-directional exchange, providing an opportunity for both partners to engage in mutual teaching and learning (Arora, 2017; Russ, 2017).
Follow these recommendations found in the literature review, Emory School of Nursing worked with each partner to identify needs from the partnership for both parties. Table 1 outlines preliminary partnership collaborative needs and goals from the partnership.
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Table 1: Identified needs for global partnerships |
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Partner |
Partner identified needs |
Emory identified needs |
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Hôpital Universitaire de Mirebalais (Haiti) |
- Training related to reducing sepsis and respiratory infections among neonates; training on complex wound care - Research/scholarly writing - Access to library resources |
- Global health education related to effective and high-quality health programs in low-resource settings - Developing skills for faculty and students related to working in low-resource settings |
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University of Rwanda |
- Developing curricula related to nurses’ research skills - Nursing leadership development - Research support, including use of library services |
- Global health site for interdisciplinary student research - Understanding culturally appropriate care within the context of Rwanda |
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Chapa-De Indian Health Services (California) |
- Training a future generation of culturally humble health care providers related to care of people with addictions - Research support |
- Global health site for nursing students to learn about Native American health and evidence-based care and treatment of addiction/substance use - Research collaboration - Content experts in addiction/substance use nursing care |
Based on these findings and initial site visits, Emory School of Nursing and global nursing institutions have formed more effective and equitable bi-directional global partnerships spearheaded by nurse leaders at each institution. These educational exchanges will ensure opportunities for site visits for nurses and nursing students from around the world, strengthen the clinical, teaching, and research skills of Emory’s Global partners, while simultaneously allowing Emory University students, researchers, and clinicians the opportunity to not only build clinical skills, but critical thinking skills in global health competencies and develop creative solutions that can be applied in resource limited settings.
Conclusion:
As we implement these activities we plan to collect quantitative and qualitative data, including participant evaluations and in-depth student and faculty interviews to assess progress and achievement of the following program objectives:
- Identify effective methods of global nursing exchanges and training that increase nursing students and nurses’ access to global health opportunities and knowledge.
- Establish sustainable bi-directional exchange programs between Emory University’s School of Nursing and global nursing partners.
- Increase Emory nursing students and global partners’ knowledge of sustainable bi-directional global exchanges.
- Promote equity and knowledge exchange between global nurse colleagues.
- Develop leadership competencies of nurses and nursing students that will allow Emory and global partner nurses to more effectively engage in future policy and decision-making that expand nursing training and support the nursing workforce to practice to their full extent of their competencies.
These global bi-directional educational partnerships are generated from systematic research and partnership building, including a review of best practices, joint prioritization of training gaps, and the establishment of interprofessional partnerships. They have prioritized student leadership throughout the process, including identifying sustainable funding and program planning. This work is cemented in the Nursing Now movement, aiming to increase and ensure leadership, research, clinical skills, and scholarship by nurses and nursing students with the ultimate goal to increase access to high quality, culturally humble health services for people around the world.