Global Health Nursing & Midwifery

Sheila,

This is a fascinating topic! It made me think of NP residency programs I've
been reading about recently which train new NP grads or NPs switching
specialties for 1-2 years in acute/critical care skills through an academic
model similar to MD residency. I am wondering if similar approaches have
been or could be implemented in low-resource settings?

-Naira Arellano

Naira,
Great comment--- do you have any articles on NP residency that you could post for us?
Sheila

One interesting model we at Partners In Health are piloting is a collaboration with the Nurses at Dana Farber Cancer Institute in Boston. The hospital has supported four nurses going to Rwanda to work on setting up our Oncology program at Butaro Hospital . Each nurse will be going over for 3 months each with a one week overlap so for one year we will have expert oncology clinical mentorship. The nurses are working closely with our Rwandan nurses and our Clinical Nurse Educator in Butaro on educating about safe administration of Chemotherapy, symptom management, wound care and basic nursing skills. Our goal is to build in country nurse expertise in oncology for Rwanda. This is a great example of true partnership with a US based Academic medical center, PIH and the Rwandan MOH.

I work with the catholic archdiocese of Lagos health department,the mentorship programme will highly benefit us if we can be enlightened on how to go about it.we have in all about 42 clinics located in Lagos(1 was built to be a tertiary health care facility,5 provides secondary care,the rest provide primary health care services)

Thanks for our comment, I would be interested to hear about your efforts thus far.
I think it is difficult to find funding for these inpatient nurse capacity building efforts unfortunately. Most funding is still disease specific therefore difficult to apply to primary care and acute care settings. Our program I was talking about in Rwanda was funded by the US hospital, DFCI by a private donor. Trying to leverage vertical funding for horizontal health system strengthening has been used by PIH for decades but this continues to be very challenging. Does anyone have ideas on funding or structure for good inpatient nurse mentorship programs to share?

Although the number of acute care NP residency/fellowship programs in the US is small, I was surprised to find such sparse amount of articles on this topic. The most thorough article I could locate describes a residency program for primary care NPs. I am pasting the link to this article below as I was not able to access a PDF version.

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/...

In terms of training programs in acute care settings, the two articles I found (attached) describe 1) an NP fellowship program in a pediatric emergency department and a 2) postgraduate training curriculum for pediatric critical care NPs.

When looking for this literature, I was disappointed to read that articles talking about NP training and NP roles in general are focused around filling the gaps left by medical resident work hour restrictions in the hospital and lack of physicians interested in primary care. It is unfortunate that the motivations for providing NPs with academic and training opportunities seem to be more related to physician needs than the interests and needs of RNs & NPs.

thanks so much for posting these resources!

Sheila, this is a great question. When I was in Haiti after the earthquake, one of the few acute care roles I've been in, there was a sudden influx of US nurses working with Haitian nurses. This was not a classic mentorship scenario and, in fact, there was plenty of underlying friction. Differences in training, language, expectations for documentation, how to pass meds and how to interact with patients all seemed to provide some grist. This can be difficult in any clinical situation, but especially in acute care or disaster relief. It makes me wonder if other organizations prepare nurses from one country to work effectively with nurses from another country, before traveling. It also raises questions for me about the differences in the practice of mentorship between nurses from the same country versus nurses from different countries. And not only how medical/nursing training differs between countries, but how race, class, gender and political history affects the quality of mentorship. Even if other folks don't have relevant resources to share on the topic (but it would be fantastic if you do), I'd be curious to learn about your mentorship experiences in global nursing.

Maggie, the many dimensions of intercultural nursing is very interesting to me as well. I think that it is very important for all different types of medical staff to be educated in anthropology. The study of the other culture can be a great way to prevent some of the friction that is bound to arise. Speaking of practicing in other countries, I was also wondering what the legality of international NP's compared to MD's working abroad. Do you know if it is more difficult for NP's to get clearance from other countries considering that this role in the medical field is not currently recognized all over the world, whereas the role of a doctor is fairly universal?

Great question! I don't know the answer. I do know as nurses we need to be very scrupulous in what we do in other countries. I have had nurses invite my students to engage in "nursing" practice i.e. drawing bloods, and have had to say my students couldn't do that. This was in a country other than the U.S. There are strict guidelines for nursing practice by foreign i.e. U.S. nurses and I would check with the nursing council in the particular country as to what is acceptable to them.
As to your suggestion about anthroplogy, if that is not feasible then having seminars about the particular country from history to politics to health care to customs, culture, etc. will provide some preparation. Also a large dose of cultural humility! The nurses in a particular country are the experts. Hopefully we provide support to them in whatever we do and make their lives a little easier.

Great points Inge-- I totally agree with you. If nurses are in a clinical mentorship role in some countries they can work in conjunction with the in country nurses but this is all dependant on the nursing council and the MOH's rules and standards.

Sheila Davis, DNP, ANP, FAAN
Director of Global Nursing

Partners In Health
888 Commonwealth Ave
3rd Floor
Boston, MA 02215

617-998-6517 (o)
617-584-7751 (c)

Hello all. I would like to add the importance of learning to speak the
local language and seeking the wisdom of colleagues from the local nursing
community. Great discussion!

*I live in a very small house but my windows look out on a very large world
---Confucius*

I was part of a volunteer group in Kathmandu, Nepal doing ICU based teaching for nurses. What we found was that nurses there had no formal science training! We worked on best practices, trauma assessment, quality control and ABG interpretation. We were well received and respected for what we were doing by the local nurses and hospital leadership.

To really make an impact, one would really need to spend more time on the ground to make a difference from classroom to bedside practice to policy.

It would be great to work with MOH"s in other countries to determine and follow guidelines related to how they define nursing practice. We can work to broaden knowledge bases that can then be applied to the beside. Clinical mentorship, as well as working with nursing leadership to establish safe practices is where "it" is at.

I genuinely appreciate reading everyone's comments here.

Ed, where do you begin to start when there's been no formal science training? Did you end up providing basic science training to nurses? Did you learn specifics about their nursing curriculum? How long do you think one would need to be in country in order to make a difference from classroom to bedside practice? Do others have suggestions for how to fill in the educational gaps? I don't mean to rapid-fire questions, but this is a glaring area I've come up against as well.

We email meet, and met personally as a group discussing prior experiences. The concept we applied was built upon that knowledge. What is their baseline training? What clinical work infrastructure they have? What training was given or do they receive regularly or from other expats? As the four of us have various expertise, we agreed on critical care, pain mgt, trauma, leadership and quality. Helping build on prior knowledge. Behind these topics we also equipped ourselves with knowledge on any potential training request they may have or areas we have assessed during rounds and validated with nurses, that needs education and training.

For my area on leadership and quality I use my observation during unit rounds as scenario to stimulate critical thinking that will then lead me to discuss leadership roles and quality/ safety. I use the evocative technique capitalizing on what the audience see, live by, and have to work on day to day.

Follow through is always a challenge, Kenya, Nepal, Philippines - web groups were developed (with consent from the groups) so there will be an open forum for support and discussion but the challenge of 'stale-mate' occurred. Other things I have tried is to continue sending research ...

We email meet, and met personally as a group discussing prior experiences. The concept we applied was built upon that knowledge. What is their baseline training? What clinical work infrastructure they have? What training was given or do they receive regularly or from other expats? As the four of us have various expertise, we agreed on critical care, pain mgt, trauma, leadership and quality. Helping build on prior knowledge. Behind these topics we also equipped ourselves with knowledge on any potential training request they may have or areas we have assessed during rounds and validated with nurses, that needs education and training.

For my area on leadership and quality I use my observation during unit rounds as scenario to stimulate critical thinking that will then lead me to discuss leadership roles and quality/ safety. I use the evocative technique capitalizing on what the audience see, live by, and have to work on day to day.

Follow through is always a challenge, Kenya, Nepal, Philippines - web groups were developed (with consent from the groups) so there will be an open forum for support and discussion but the challenge of 'stale-mate' occurred. Other things I have tried is to continue sending research abstracts or clinical informations and opportunities as I come across them to a group of health professionals I maintained in another international group. I do receive appreciative acknowledgement from some and wanted me to continue it. One MD sends me updates from India.

We remain ready to be mentors across continent!

Tess

Sent from my iPhone, sorry for misspelled words.

We were fortunate enough to work with Tess in our group. Tess played a large role in quality and leadership, and I learned so much from her. We all brought our particular areas of expertise to the table, and our nurses were intellectually hungry for as much information we could provide.

Continuity and sustainability continue to be huge obstacles when our hearts and minds are all in the right place, trying to do the right thing.

Online resources are wonderful. Sharing links to articles and powerpoint presentations is both necessary and important. Nursing informatics can play an important role in education, practice, and policy development.

Access, however is another challenge. From hospital/clinic staffing issues to power to hardware to internet connections, how our peers from across the globe can access, print and use the information is a whole new level of challenge, especially in areas with limited access to electricity, like in Kathmandu.

Intercontinental mentorship is an option worthy of our efforts.

Another option for certain situations, is obviously "nursing shoes" on the ground regarding the ability to affect positive change. If I were independently wealthy enough to begin this process without home, family and children responsibilities, I know ...

We were fortunate enough to work with Tess in our group. Tess played a large role in quality and leadership, and I learned so much from her. We all brought our particular areas of expertise to the table, and our nurses were intellectually hungry for as much information we could provide.

Continuity and sustainability continue to be huge obstacles when our hearts and minds are all in the right place, trying to do the right thing.

Online resources are wonderful. Sharing links to articles and powerpoint presentations is both necessary and important. Nursing informatics can play an important role in education, practice, and policy development.

Access, however is another challenge. From hospital/clinic staffing issues to power to hardware to internet connections, how our peers from across the globe can access, print and use the information is a whole new level of challenge, especially in areas with limited access to electricity, like in Kathmandu.

Intercontinental mentorship is an option worthy of our efforts.

Another option for certain situations, is obviously "nursing shoes" on the ground regarding the ability to affect positive change. If I were independently wealthy enough to begin this process without home, family and children responsibilities, I know where I would be right now.

Thank you everyone! This is a great thread.

Very much enjoying the discussion on mentorship. I've found that with
long-term intercultural work there can be so many benefits and sharing of
knowledge. I have learned as much from my Kenyan colleagues as I have
shared with them. One of the discussions that really impacted me was that
of evidence based practice. We always talk about the importance of using
evidence to make sure we are doing the best thing possible for our
patients. But the fact is that in the third world evidence is often
lacking. Just because the evidence from the west says that a practice is
best does not guarantee that it will be the best practice in a third world
setting. For instance, use of antibiotics in chicken pox. I would have
NEVER done it in the west, and shuddered when I saw colleagues in Kenya
doing so. However I've found that there are times when I will now
prescribe antibiotics prophylactively because of the secondary infections
that are so commonly developed with chicken pox in our community.

--
Michelle Kiprop, RN MSN
Family Nurse Practitioner
Empowering Lives International
P.O. Box 6367
Eldoret, 30100 KENYA
+254.711.174720

Thanks, Michelle. I remember the early days in my pediatric career when we
were certain that IV fluid was essential in treating dehydration. When I
found WHO rehydration solution in our medication refrigerator for the first
time, I realized that 'clinical mentorship' is a two-way street. I'm happy
to share this as we celebrate nursing this week.
Jan Holzhauer, RN, MS
Whitefish Bay, Wisconsin USA

--
*
*
*I live in a very small house but my windows look out on a very large world
---Confucius*