Global Health Nursing & Midwifery

During early visits, nurses at the frontline can make assessments, educate, monitor, do surveillance and evaluate. Their input is invaluable

I agree that nurses are and will continue to have a large role in effecting improvement in global health. But do you think that the opportunities in training and education in global health are there for nurses? Are nurses included at the table when it comes to the planning and implementation of global health programs?

Thanks for raising this important topic. We know from the US that nurses play a critical role in the delivery of care for all NCD's. Oncology is a great example that depends on excellent nursing care for symptom management, pain assessment and treatment, and the management of family and psychosocial needs. Absent in most discussions of global health in these areas is the role that nurses do, can, and should play.

Thanks for bringing up this sensitive issue. Nurses are never deemed
important in the planning phase, yet they are expected to front the care
activities when it comes to care. I come from Uganda, I have taught in
Nursing institutions since my residency in 2007 up to today where I teach
Midwifery at the University (*www.must.ac.ug)* and there are a few
observations I have made.

Unlike the western world, the Nursing profession in the developing world
claims much *dependency* on its sister profession 'Medicine'. Coupled with
the Education level of entry into the profession and the
trainers' educational background.
More to that, Nursing has for centuries been known to be a *female
profession* all of which determine the level of involvement of Nursing in
planning and participation in global health.

If we are to appreciate the role of nurses in global health, the concept
needs to be inculcated into nurses from the *training institutions*,
encourage nurses' autonomous practice, and do research to enhance exposure.
Gender bias should be eliminated to reduce dependence and promote autonomy.

thank you.

Byaruhanga B. Emmanuel

Midwifery Part-time Lecturer
Mbarara University of Science and Techniligy

Nurses are the largest group of skilled workers in any health system and serve as the foundation for health delivery. Most developing countries have so few skilled health workers that it is impossible to meet basic health needs of citizens. For example in Niger, West Africa, there are fewer nurses for a population of 15,000,000 than are employed at just one of our major Boston teaching hospitals. Increasing the training capability for nursing in poor countries would help but more long range there is a need to increase the number of students who successfully complete pre nursing education, which would widen the pool of qualified candidates for nursing education. The issue has many facets that need addressing from education , work conditions that foster retention, to foreign recruitment and development . It seems to me there is a solidarity among nurses to support each other so let's make that happen globally.

Practice, education and research mean nothing if we cannot apply what we do the current structure of healthcare delivery.

The truth is, we ARE medicine as much as any other health professional regarding delivery of services by the healthcare team. We all need to understand each other, and our value as conduits to "the greater good" in our delivery of care. To be effective leaders, we need to also understand and value the roles of all persons around us on the healthcare delivery team, as well as an understanding of funding resources and how they work. All of us need to be proponents of working together, not separately.

This is such an important discussion and really mirrors what all nurses have experienced historically but of course in the extreme given the many health needs pointed out in the discussion. Nurses are such important members of the health care team and should be leading efforts internationally. We all know that they provide the care anyway.

Thanks for bringing such an important topic for discussion. It is becoming
more obvious that nurses are playing an important role at the primary care
level in combating NCDs. However, we nurses are still not doing a good job
at articulating and sharing what we know and do. It seems that the
discourse within the nursing community is always "nurses are not included
in ABCD", "nurses are not recognized in XYZ", etc. We [nurses] need to move
from this and begin asking our selves how can we create the nursing
visibility? How can we share what we know and do with the broader health,
public health community-- beyond the nursing community? Who do we expect to
do it for us? Thanks.

Monica Onyango

--
https://voicesofmidwives.wordpress.com/

What a topic. I strongly believe that the success of managing NCDs lies with the Primary Health Care Nurses. And this will even be made more realized with the support of Primary Care Physicians.
Munyadziwa Kwinda
Dr Kwinda M.A, B.Sc.(Univen); MBChB(Natal); AHMP(FPD/YALE); Cert in Travel Medicine(Wits); M.Med -Fam Med(UL); Family Physician - Tshilidzini Hospital
Tel: 015 9641061
Fax: 0867677024
Cell: 0820523580

A good deal of problem also lies with the doctors in some areas who treat the nurses as being subservient,rather than partners in patient management.

Working with the Ministries of Health regarding their country's definition of what nursing standards for registration and/or regulation are, will help us immensely as we attempt to assist other areas of the world regarding our profession, and in the communities served re: NCD's.

Just back from Nepal a few months ago, our group noticed that there is no formal science education for nursing, and that training starts at the 10th grade level for those interested in nursing as a profession. We have been asked to assist in the process of formation for a school of nursing and midwifery, and we are at a loss for words. The challenge of this magnitude would require a great deal of time, effort and resources that we are not sure we could accumulate, never mind organize and execute within a reasonable time frame.

Large numbers of ER patients streaming in constantly could easily be softened if there were a more effective triage system in place. NCD's could be screened, priortized and treated.

There is presently a medical school model in place for free or low cost education in lieu of working in outlying areas after graduation for a predetermined number ...

Working with the Ministries of Health regarding their country's definition of what nursing standards for registration and/or regulation are, will help us immensely as we attempt to assist other areas of the world regarding our profession, and in the communities served re: NCD's.

Just back from Nepal a few months ago, our group noticed that there is no formal science education for nursing, and that training starts at the 10th grade level for those interested in nursing as a profession. We have been asked to assist in the process of formation for a school of nursing and midwifery, and we are at a loss for words. The challenge of this magnitude would require a great deal of time, effort and resources that we are not sure we could accumulate, never mind organize and execute within a reasonable time frame.

Large numbers of ER patients streaming in constantly could easily be softened if there were a more effective triage system in place. NCD's could be screened, priortized and treated.

There is presently a medical school model in place for free or low cost education in lieu of working in outlying areas after graduation for a predetermined number of years.
http://www.pahs.edu.np/

This may work for a nursing school model as well, but will require many "feet on the ground", as well as a mission statement, standards that meet or exceed those of the MOH, financing, faculty, physical space and administrative support.

If the value of this is paid forward, the resulting ability to work in the field re: NCD's will be remarkable.

Maggie, I do agree with you that we are missing the Nursing Voice in the dicussion to identify and address challenges related to global health and NCDs. We are at the forefront of implementation and care delivery but not in the dicussion. Much has to be learned from the fields and need to be translated to the table for policy and process development.

Lessons learned are great benchmark for care delivery templates, hence no need to reinvent the wheel.

As the largest group of health professionals in the world and in many countries the only health professional that some populations have contact with, nurses have a terrific opportunity to contribute to the prevention and management of NCDs. They do not have to wait for anyone's permission or agreement! In terms of prevention, nurses are often limited by their lack of knowledge about the extent of the problem and the fact that a high proportion of NCDs such as type 2 diabtes and cardio-vascular disease can be prevented by promoting smoking cessation, healthy diets and physical activity. As well as improving their knowledge and skills in prevention nurses can ensure that they make every patient contact count by by promoting and encouraging healthy behaviours. By improving their own health and lifestyles nurses are more likely to take the initiative to educate patients. Research has shown that doctors who are overweight or obese are less likely is to initiate weight management discussions with patients than those who are of normal weight. The same is likely to be true for nurses. C3 Collaborating for Health has worked to raise awareness of the challenge with nurses in different countries www.c3health.org