EXPERT PANEL: Nurse leaders - shaping the future of global health 9/9/13-9/13/13

By Maggie Sullivan Moderator | 05 Sep, 2013

We at GHDonline are excited to announce an upcoming virtual expert panel titled Nurse leaders - shaping the future of global health. It will begin Monday 9/9/13 and continue through Friday 9/13/13. Panelists will be Elizabeth Glaser, Dr Naomi Seboni, Gini Williams and Professor Nthabiseng Phaladze. More information on each of the panelists will be posted on the first day of the panel. Please plan on joining us next week with your questions and comments!

EXPERT PANEL: Nurse leaders - shaping the future of global health

SUMMARY:
While nurses are very active in the delivery of care around the globe, their roles in policy making, program directing, publishing/research, among others, is sparse. A recent discussion within our own online nursing community revealed, at the time, there was no nurse on the inter-disciplinary advisory board for the Lancet's new global health series. As a result of online community advocacy, a highly experienced nurse was ultimately invited to the Lancet's new series. Using this recent experience as an example, this expert panel will discuss how nurses can do more to be leaders in a field within which they've always worked.

Initial Questions:
 - Getting beyond the question of why this is our current situation, how can nurses be better prepared to fill leadership roles in the field of global health? And how can we best support this among our nurse-colleagues in low-and middle-income countries?
 
- Taking a broad view of what "leadership role" means, in what types of positions would you like to see nurses?

 - In what ways can the nursing community come together to increase the number of nurses leading the field of global health?

 - How do you envision yourself to be a nurse leader in the field of global health?

 - What are the best ways to bring this topic, and change, to light without creating divisions within the field?

 - Is there a role for exclusive fields of global health medicine and global health nursing, versus a mixed inter-disciplinary field?

Replies

 

Elizabeth Glaser Moderator Emeritus Replied at 10:05 AM, 9 Sep 2013

Hello and good morning,

Many thanks to Maggie and the GHDonline team for suggesting this subject and bringing together this panel. I am very honored to be present with Gini Williams, Dr Phaladze and Dr. Seboni.
My name is Elizabeth Glaser, I have more than 20 years of experience working with underserved populations in domestic and international settings, particularly with homeless adults, and those living with HIV/AIDS, TB, malaria, and substance abuse. My education includes a BS in Nursing from University of Massachusetts-Boston, an MA in Social Policy and MSc. in International Health Policy from the Heller School, Brandeis University, and the Zinberg Fellowship in Psychiatry at Harvard Medical School. At present I am a doctoral candidate focusing on Global Health and Development at the Heller School, Brandeis University, on a team which is performing an economic evaluation of new malaria prevention technologies in East Africa.

First thing, I don't think that this will be an easy road. Having personally seen the conditions that nurses work under in South Africa, Kenya, Tanzania, and even the US and having been told of conditions elsewhere, I understand the challenges each one of us may make in just getting through a day of work.

But we have to start somewhere, so I start from a place of hope.

There are a lot of ways of approaching the question "how can nurses be better prepared to fill leadership roles in the field of global health", but one way is to understand the perceptions of those outside of nursing to this question. An informal poll of my non-nursing colleagues provided some interesting answers.
1. Nurses, in general, do not have adequate education to take on broader leadership.
2. Even if nurses do have education we still may not be allowed to participate because of the existing hierarchy.
3. The respondents I polled, however, typically report that they use interdisciplinary approaches to their work.

Frustrating , isnt it?

So part of my answer to question #1 is that even those many of us may not have adequate education to be come leaders, many of us do. We are already prepared to fill leadership roles in the field of global health, but we have to demonstrate our capacity and let our voices be heard in different ways. One way is to for nursing scholars and researchers to publish in more interdisciplinary journals, such as Health Policy and Planning, The Lancet, and open access journals such as Malaria Journal, Human Resources for Health, or Lancet Global Health. When other researchers read good work , they begin to appreciate you in another way and want to include you in initiatives.

Without nursing leadership, decent health care just can't happen. Think of policies and programs that we have had to work under , programs that were perhaps well funded but a failure because there was a lack of understanding of what went on in clinics and hospitals every day. A lack of understanding of what yo do and of your patients' needs. Those policies might have worked if there had been more involvement of nurses in the research which informed it and in the policy, planning and implementation process. We need to understand that we not only should become leaders in global health, but that we must do so in order to improve the health of those we serve.

What roles? Advisory boards on journals, reviewers. Any panel or board claiming to have an interdisciplinary or public health approach to health care should have a nurse in a major role. If they do not, then I believe that those groups should be asked to explain their logic in not having a nursing presence.

For example, I know of a group that is seeking to address cancer care in low and middle income countries, and yet excludes nurses at the highest level. We should not have to justify our presence in these groups; As we comprise a the majority of workers in health care what could be the logic in not including us ? It is a matter of breaking old bad habits of hierarchy and class on both sides and opening up the doors.

I look forward to hearing your viewpoints on this in the coming days.

Elizabeth

Patricia Abbott Replied at 12:41 PM, 9 Sep 2013

I read your posting with interest Elizabeth - particularly in relation to this snippet "One way is to for nursing scholars and researchers to publish in more interdisciplinary journals, such as Health Policy and Planning, The Lancet, and open access journals such as Malaria Journal, Human Resources for Health, or Lancet Global Health. When other researchers read good work , they begin to appreciate you in another way and want to include you in initiatives."

You are right and this is very important. "Getting the word out" lets people know what you are doing, where you are doing it, and what lessons you have learned from the experience. Much of the challenge however is the intimidation factor - or how to get the experience and the lessons learned from our heads into press. Many of the greatest "learnings" I have had come from global colleagues who either have a poor grasp of English, or are unable to get the material into a publishable form.

What I have suggested to several colleagues is to listen to those voices, collect the wisdom, and serve as their "voice". That is part of the beauty of forums such as this - we are sharing things that might otherwise go unknown.

With that said - I think one way to move forward to exert some pressure on the environment is to collect the stories and then publish those stories. OK - so it may not get published in JAMA or some high impact factor journal - but starting somewhere is better than never starting at all. Frankly - when I think about the meaning of the word "impact" (such as in "impact factor") it means that you work has some measure of an impact. I see many journals, where the bar for publishing is lower (such as Open Source articles as Elizabeth mentioned), and the articles are widely read because access to the literature is possible. Isn't that a great interpretation of impact?

Thinking about Open Source publications, being the voice for the voiceless, and sharing the stories of real-world care could be a start. Good points Elizabeth.

Thanks to all for the forum!
Patti

Elizabeth Glaser Moderator Emeritus Replied at 1:11 PM, 9 Sep 2013

Dear Patti,

Using other fora to practice one's voice is a very good idea. The Global Nursing Caucus, a group that Maggie and I are both in , wants to mentor nurses in their writing. We are in the process of developing a blog where we could post written pieces by nurses in the field. The content would be similar to the Malawi blog here but the focus would be on having a Malawian nurse post about her interests or a Kenyan nurse post about his work as well as a US nurse. Volunteers would assist with writing but not direct the content beyond that of a copy editor.

Newspaper op-ed pages can be a venue to exercise one's voice, too.
Key points in writing an opinion piece : Be clear, be concise, and know both sides of the issue as this allows you to articulate a coherent argument.

However to lead we need to get into journals with wider focus. We don't have to get into JAMA, for a journal such as AJPH is truly interdisciplinary and is worth trying for. I want to be clear that this is not about there being a problem with nursing journals, it is about publishing inside nursing for some cases and outside for others.
If we limit ourselves to writing in nursing journals and few outside of nursing read them , then how can we expect others to know of the work we are doing ?

Elizabeth

Lisa Kennedy Sheldon Replied at 4:27 PM, 9 Sep 2013

GLOBAL NURSING CAUCUS

"Advancing the role of nursing in global health practice, education and policy through advocacy, collaboration, engagement and research."

The Global Nursing Caucus (GNC) was formally created in 2011 in response to a global need for improved collaboration and information dissemination in the quickly evolving field of global health nursing. Through dissemination of information about nurses and nursing around the world, the GNC is working to advance the role of nurses through practice, education and policy in countries around the globe.

Year of Advocacy

Nurses are providing 80% of the health care worldwide. The voice and experience of nurses is crucial for creating effective global health programs. In order to support this, the GNC has decided to make this the “Year of Advocacy”. All of the programs, newsletters, and blogs will explore the issue of "advocacy" culminating at the Third GNC conference in the Fall 2014 in Boston.

The GNC welcomes everyone who is interested to join us. Together we can raise the voice of nursing around the world!

The GNC has two main working groups to focus activities:

Research, Policy and Advocacy
The GNC understands the importance of research and policy in understanding the challenges of improving health in diverse settings. Research provides data to inform the design of interventions to address health and policy in resource-constrained settings. There continue to be challenges, including oversight, informed consent processes, and the integration of local/global partnerships in design, analyses and interventions, in global health research. However, the role of nurses in global health research requires increased:
• Advocacy
• Training
• Collaboration
• Visibility

All four aspects are needed to foster nursing’s presence as investigators on research studies and advocates for policies that improve the health and well being of all people. The GNC seeks to foster collaboration and sharing of ideas about experiences and lessons learned to direct future initiatives.

During the Year of Advocacy, the GNC celebrates the work of nurses around the globe and gratefully acknowledges the work of colleagues at GHD online in promoting these discussions.

We need your ideas!

The GNC is seeking input about the needs of nurses working around the world. The Board and Advisory Panel seek ideas on how the GNC can advocate for nurses in practice and policy, bring the necessary education and training to empower nurses in all settings, and increase the connections between nurses practicing in different countries. Our first newsletter will be released this month as we launch the Year of Advocacy.

We welcome your ideas to develop a network for advocacy and growth!

Attached resource:

Patrick Palmieri Replied at 1:01 AM, 10 Sep 2013

Hola Elizabeth,

As an acute care nurse practitioner with 6 years experience living in Peru and actively working in the Peruvian health sector, I would like to address a couple of points specific to your questions: 1) How can nurses be better prepared to fill leadership roles in the field of global health? and 2) How can we best support this among our nurse-colleagues in low- and middle-income countries?

From my perspective, our professional nursing organizations and educational institutions are simply missing in action in developing economies. Since the bulk of the global health agenda is tightly coupled to developing economies, minimal nursing involvement is a root cause for the limited leadership role. Yes, there are many educational programs involved in research in developing economies and bring students for experiences but this is remarkably different than establishing boots on the ground to develop capacity which solves problems. Where are the nursing focused centers and institutes in developing economies?

Also, I believe too many professional nursing organizations are increasingly more economically and less mission driven. And, this is more problematic when many nursing organizations have stated international interests. Again, this is my personal experience from countless contacts with professional organizations. In fact, most professional organization membership dues are simply not affordable in developing economies (with the exception of STTI and AONE). Where are the professional organizations in developing economies?

The long story short is nursing is not involved at the same level in developing economies as other healthcare professions. Unfortunately, this has been my personal experience in Peru. Thank you for this forum and the opportunity to learn more about my colleagues working in developing economies.

Saludos, Patrick

Gini Williams Replied at 5:54 AM, 10 Sep 2013

Good morning everybody. My name is Gini Williams and I am delighted to have the opportunity to be part of this panel. I would firstly like to thank the organisers and secondly apologise for my tardy start although this has given me the chance to see what is on people's minds.

This year is my 20th anniversary as a nurse specialising in the field of tuberculosis (TB). I had my first post as a TB Nurse Specialist in West London and have had various roles since then including UK and international consultancy, project co-ordination in Russia, pre- and in-service training and education. I have been working internationally for the last 15 years and currently run a capacity building project for the International Council of Nurses with National Nursing Associations and Organisations in 18 different low- and middle-income countries.

Like Elizabeth, I believe that good quality nursing care is paramount to the success of all health programmes and that this cannot be achieved without effective nurse leadership. One of the major challenges lies in defining exactly what we mean by 'good quality nursing care' and the fact that nurses themselves often do not own the definition. Our ability to participate for instance, in an advisory capacity at a policy-making level, is often governed by the perceptions of others who do not necessarily understand that nurses work at different levels within their profession and have developed valuable expertise and skills.

Why does this matter? So often health programmes are organised around managing the condition itself - how it needs to be identified and treated. The nursing role is then arranged around these technical aspects and that is where it often stays in a purely clinical context.Only after the technical aspects are taken care of do we think about the people affected by the condition and how we can reach them to make the diagnosis and prescribe treatment. A good nurse will try to ensure that diagnosis and treatment are arranged sensitively and according to the needs and circumstances of the people affected. This will be an enormous struggle as investment in training and service delivery is usually focused on clinical needs and does not take into account the wider social, psychological and economic impacts on the people affected.

Essential conditions for good quality nursing such as space for confidential conversations, time for counselling, individual assessment to identify vital support which a person may need in order to complete the diagnostic process let alone stick to a course of treatment, are too often regarded as luxuries. Nurses have to be in leadership positions to ensure that the circumstances are in place to deliver the best possible care and improve outcomes.

These issues, although known to be true in the clinical setting, need to be supported by solid evidence and this is where research and publication is so important. Here lies another important challenge as much of the research done around patient care strategies is necessarily qualitative which is undervalued within the hierarchy of evidence, where quantitative studies are the gold standard. That said, we need to lobby for research funding to illuminate what happens in the clinical setting to strengthen the case about what is required in terms of training and investment to ensure that person-centred care can be delivered.

Leadership roles need to be cross-cutting. Strong nurse leadership is required within the nursing profession to ensure we maintain our identity and define our own ethos and standards of care. Wherever I visit I see amazing nurses delivering excellent care in the most difficult circumstances but these nurses are in a minority and much of the nursing care I see is very poor. This is by no means the fault of the nurses who are working in impossible conditions, which are often unsafe for both patients and themselves, with enormous workloads and no support. They feel neglected and demoralised. It is up to the nursing profession to address this though better management and education as well as advocacy at a local, national and international level.

Nurses need to be represented on hospital boards, government committees, research committees and international strategic bodies especially those advising donors about priorities for investment. They also need to become researchers, educators, politicians, consultants as well as nurse leaders. Patients and communities are getting much better organised to demand better care and a seat at the table and we, in our professional capacity, need to do the same.

I am looking forward to our on-going discussion
Gini

Gini Williams Replied at 6:59 AM, 10 Sep 2013

I think the issue regarding mentorship for new writers is a very important one. I would never have started writing if I had not had support to do so - in fact, my boss at the time (1998) a public health doctor, helped me with my first article in a peer-reviewed journal. I have just finished working with Stacie Stender from Jhjiego, on a supplement for the International Journal of TB and Lung Disease. The topic of the supplement is patient-centred care for people affected by tuberculosis and all 10 peer-reviewed articles have been written by nurses. It should be coming out on-line this week and will be available in print in October. It took 2 years and we had to pay for the editorial services but was worth it.Your comments about impact are very pertinent and it will be interesting to see what the impact of this supplement will be.
As for the comment professional nursing associations, I would say that in spite of their limitations with regard to capacity, particularly in some low-income countries, they can be a good place to start as they tend to have good links with academic institutions, regulators and government health departments. Partnership between professional associations in high-income countries and those from low and middle-income countries can be very effective and productive for both organisations. Running the TB Project with ICN means that I am obliged to work with National Nursing Associations and Organisations and it is a great way of tapping into a national network of nurses and ensuring that our activities are relevant and appropriate to the local priorities, challenges and capabilities. It also boosts their leadership role and visibility as they manage all aspects of the project at a national level.

suzanne willard Replied at 6:59 AM, 10 Sep 2013

Hi Patrick and the audience

Patrick, you bring very good points. As incoming president of the association of nurses in aids care, i am committed to supporting nurses throughout the world. We have experts and materials to support efforts related to nursing and treatment of HIV/aids. We offer a no cost membership electronically to nurses who are working in developing countries. And we have been doing this for many years. It is challenging to run a professional organization but it is important to stay with the mission. We have been supportive of nurses who wish to start chapters and there have been some initiatives in Nigeria and in Uganda. We look forward to expanding our support.
Please let us know how we can support.
Sue

Lynda Wilson Replied at 7:18 AM, 10 Sep 2013

I have been following this discussion with keen interest - and thank you for initiating it! I wanted to reply to the last question posed: Is there a role for exclusive fields of global health medicine and global health nursing, versus a mixed inter-disciplinary field? I am currently serving as a member of the Education Committee for the Consortium of Universities for Global Health (CUGH), and chair a sub-committee charged with identifying interprofessional and discipline-specific global health competencies that can be used to prepare future health professionals for global health leadership roles. We are reviewing the literature for all related health disciplines and on October 25 I will participate in a round table that is being convened at the University of Maryland to identify interprofessional global health competencies. Our sub-committee and the participants in this round table will be trying to identify both discipline-specific and interprofessional global health competencies. I would welcome suggestions, comments, or links to resources that may help us with our task! Lynda Wilson, RN, PhD, FAAN, University of Alabama at Birmingham School of Nursing

dian marandola Replied at 8:59 AM, 10 Sep 2013

Dear Linda

I am reminded of the core competencies for emergency preparedness and public health professionals that may be useful as your sub-committee will be trying to identify both discipline-specific and interprofessional global health competencies.

The Core Competencies are designed to serve as a starting point for academic and practice organizations to understand, assess, and meet training and workforce needs. They are being used by hundreds of health departments and public health professionals across the country and abroad.

Have participants in this weeks discussion been using the core competency framework for public health, to date? If so, what are your thoughts about practically in using the framework in your specific workplace?:


1. The Council on Linkages Between Academia and Public Health Practice's Core Competencies for Public Health Professionals (Core Competencies) were designed for public health professionals at three different levels: Tier 1 (entry level), Tier 2 (supervisors and managers), and Tier 3 (senior managers and CEOs). The Core Competencies are a set of skills desirable for the broad practice of public health, reflecting the characteristics that staff of public health organizations may want to possess as they work to protect and promote health in the community (i.e., deliver the Essential Public Health Services).


http://www.phf.org/resourcestools/Pages/Core_Public_Health_Competencies.aspx

http://www.phf.org/resourcestools/Documents/Core_Competencies_for_Public_Heal...

2. For a description of a competency project between CDC and Schools of Public Health
Gebbie, Kristine & colleagues, Implications of Preparedness and Response Core Competencies for Public Health, see page 225 for competency map

http://www.naccho.org/topics/workforce/upload/Preparedness-Competencies-Artic...

http://www.asph.org/userfiles/PreparednessCompetencyModelWorkforce-Version1.0...

3. For a brochure
The Core Emergency Preparedness Competencies for All Public Health Workers described in this brochure are based upon the essential services of public health and provide a foundation for personal and agency development. A
competent workforce is one component of a strong public health infrastructure.
These competencies are a basis for improving preparedness for all public health emergencies, including a bioterrorism event. The Public Health Practice Program Office is pleased to support projects which achieve our vision of “every health department fully prepared; every community better protected.”
Edward L. Baker MD, MPH “ http://www.soph.uab.edu/isoph/SCCPHP/documents/compbroch.pdf

I appreciate the opportunity to participate in this important discussion. Dian Marandola (APRN, MSN, MPH - peds nurse practitioner)

Jumatil Fajar Replied at 10:15 AM, 10 Sep 2013

Regarding leadership, nurses in our district and province have the capacity on that issue. Our big problem is regarding language. Little of nurses in our province that fluent in English. This is become a great obstacle to interact with the world. Support that we can provide is giving opportunities for them to have motivation in learning English. I had experienced with Health Professional Project, this project made our nursing school got supervision from Nursing School in Melbourne, Australia. At that time there was a great motivation from them to learn English. But after the project came to end, the motivation also disappeared.

Elizabeth Glaser Moderator Emeritus Replied at 11:40 AM, 10 Sep 2013

Gini, welcome. A pleasure to read these really good comments.
Patrick, I agree that there are economic barriers to nurse participation in low and middle income countries.
In some countries, a national nursing board may provide support , but it sounds as if that is not the case in your experience. although examples are noted below, my first question would be to ask , based on your experience there?
what are the unmet needs of the local nurses ?
who are the actors in nursing ?
where are they based ?
How can nurses within the country provide support for one another?

As Suzanne noted, some groups, such as ANAC ( Association of Nurses in HIV/AIDS Care) have substantial discounts or free use for electronic access, however the absence of our colleagues Dr Seboni and Phaladze illustrate that the internet is still not reliable enough in some areas to provide a consistent source of support.
One way to foster long term support and professional development within countries is by strengthening educational systems. This has been talked about before in this community, but twinning and other initiatives can give the process a kick start.

Lynda may be able to talk about twinning as I believe the University of Alabama has participated in this. Twinning supports long term relationships between schools of nursing in the US, UK, and Canada, with schools in low and middle income countries. Nursing faculty can mutually support one another in curriculum and professional development.

Similarly, Nancy Street at Regis College is working with Haitian nurses and the MOH there to build a sustainable educational system for nursing. One aspect of this initiative includes working with local universities to allow Haitian students to study at Regis in the summer and Haiti during the rest of the year, with the graduates receiving joint degrees from each school. A program such as this help create future leaders.

Both twinning and the work in Haiti depend to some degree on external support, although the ultimate goal of the ten year Haitian initiative is to have a sustainable system; However, as external fiscal support is not always feasible, do people know of sustainable internal initiatives to support nursing and create an environment for leaders to emerge?

Lynda Wilson Replied at 12:28 PM, 10 Sep 2013

Dear Dian - thank you VERY much for the great suggestion about looking at the core competencies in emergency preparedness. This is helpful information!

Elizabeth noted that we have done some work with "twinning." Although we did not have specific "twinning" funding, we have had numerous partnerships with other nursing schools on a variety of levels, through our work as a Pan American Health Organization/World Health Organization Collaborating Center on International Nursing. Gina - I'd be happy to chat with you further about this if you email me at ! Lynda Wilson

Elizabeth Glaser Moderator Emeritus Replied at 12:48 PM, 10 Sep 2013

I haven’t said much about my background, but would like to give some context now. One of the many reasons that I sought advanced training was because of the support I received during the first decade my career.

I worked at Pine Street Inn, which at the time (1993-2003) was the largest homeless shelter in New England ( an area of 6 US states). The nursing clinics there provided care using an innovative nursing, rather than medical, model which promoted self-care while also attending to homeless men and women’s acute and chronic health and emotional needs.

We mostly succeeded to treat each guest as a person worthy of respect, to advocate for them, and to encourage ,via outreach and education, the highest possible level of functioning and self-determination that each individual could reach. We were not paid well, the conditions could be harsh, as could our clients, but somehow we took on each challenge as it came and the clinic remained a nurse run entity for over 31 years.

Ultimately we closed because an agency came in with extensive experience caring for the homeless and the financial support that would allow the shelter to relinquish responsibility for staffing and funding the clinics. We tried to show that our work could be supported with a federal block grant but those in charge had already made up their minds. So we closed. The new agency is still there, they are very good, but use is a medical model which is different; I know from having worked for them before going to Pine Street Inn.

If at that time, I had the training that I have now, perhaps we could have demonstrated that our program was cost-effective and worth sustaining.

The positive part of this is that our closing created a diaspora of women and men who know the value of the nursing model and could teach it to others.

I do not know what it is like to work on a daily basis in a low – middle income country. But I try to understand the challenges our colleagues face every day, by recalling my work in the shelter and on the street outreach team.
I know what it is like to live in one of the wealthiest countries on the planet yet have to tell men and women living on the street that our outreach van was out of blankets and hot soup on a cold winter night, or that there are no more beds in the shelter.
I know what it is like to work in the shadow of Harvard teaching hospitals and yet have try to heal an infected wound without the benefit of antibiotics because of a person’s extreme paranoia and substance abuse, or because at that time there was no coverage for those who cannot afford medications. I know what active TB looks like, and have cared for those living and dying with HIV before the availability of HAART.
I know what it is like to have little help but my own education and that of my colleagues to find solutions to a problem. We found answers by sharing information and teaching one another how to provide good care despite low resources.
I know what nursing bring to health care, our strengths and our many weaknesses, too. And these lessons were learned while working in a shelter. So I also know that while nursing leaders can be fostered in universities and schools, we also can do so in the work place, we just have to take a small part of the positive energy we give to our patients and spend a part of it on supporting ourselves and our colleagues.

Gini Williams Replied at 2:26 PM, 10 Sep 2013

Thank you Elizabeth for that very heartfelt and personal account of your background. Your passion to deliver the best possible care to patients, whatever their circumstances, shines through. I agree that we need to develop leadership in the workplace and this is what I also wanted to highlight when thinking about today's question regarding how we can increase the number of nurses leading the field of global health. We need to recognise and support the development of nurses with the type of experience you describe.
One of the greatest strengths of the ICN TB project is the potential it provides to identify nurses who are leading their field and give them the opportunity to develop their training, research and writing skills. Fellow nurses, as well as educators and ministries of health can then find out about the work they do and start seeing them as a resource for their health programmes. In both China and Russia leading TB nurses are now participating in national conferences which nurses rarely have attended in the past let alone spoken at. The supplement I mentioned earlier includes articles by at least four nurses from Russia, Swaziland, Ethiopia and Kenya who have never published before.
One of the things that those of us who work internationally can do is assist exceptional nurses in writing abstracts to participate in conferences, mentor them with writing and put them forward as important representatives for the profession at a national as well as international levels. I have heard it said too often that one committee or another would have welcomed a nurse representative but could not find one. This is absurd when you think of the talent out there. The best nurses do not often push themselves forward nor are they always encouraged to do so by their nursing colleagues, and sadly their managers. Nurses who are prepared to go the extra mile, to try new and innovative approaches who challenge the status quo, need to be identified and supported so they can reach their potential and communities, health services and even global programmes can benefit from their leadership .

Maatasesa Samuelu-Matthes Replied at 4:09 PM, 10 Sep 2013

Hi Patrick and the audience



I am a RN in Samoa, a small pacific island in the South Pacific region, and
a developing country. I am interested in the discussion about writing
journals and chapters in nursing and apparently you have supported the other
areas. What is the possibility of assisting interested nurses in Samoa?

Maatasesa Samuelu-Matthes Replied at 4:11 PM, 10 Sep 2013

My apologies as this email should ask Suzanne instead.



Suzanne



I am a RN in Samoa, a small pacific island in the South Pacific region, and
a developing country. I am interested in the discussion about writing
journals and chapters in nursing and apparently you have supported the other
areas. What is the possibility of assisting interested nurses in Samoa?

Elizabeth Glaser Moderator Emeritus Replied at 4:42 PM, 10 Sep 2013

Dear Maatasesa,

What would you like to write about - is it about your practice in direct care is it to do investigation on an aspect of current care care or how well a program works in your facility or health system?

Elizabeth

Lorna Owens Replied at 6:25 PM, 10 Sep 2013

Love the conversation.I am a former nurse and midwife and I head up my own NGO.I intend to be a major player in global health. Sometimes you just have to start your own.I welcome all nurses and midwife to join our global faculty. If you love research and scholarship we have a place for you.www.footprints-foundation.org

Lorna Owens

Jeanne Leffers Replied at 6:28 AM, 11 Sep 2013

Greetings. I learn so much from those who participate in this discussion!
In response to Lynda Wilson's comment about the competency project for the Education Committee for the Consortium of Universities for Global Health (CUGH) to identify both interdisciplinary competencies as well as discipline specific ones for nursing, I have some thoughts to add to this work. Having read the article, Global Health Competencies for Nurses in the Americas, Journal of Professional Nursing, 2012 authored by Lynda and colleagues, and reflection upon what Elizabeth Glazer shared above and my own experience in nursing in the US with underserved populations and in global settings, I would like to add some of my thoughts here.
Certainly, there are many competencies for global health that are shared by many disciplines, but I urge Lynda's sub-committee for nursing to consider the unique role of nurses across the globe. Elizabeth speaks to her work in a nurse-run clinic and a model of care that differed from a medical model. The inclusion of social determinants of health as a framework and a response to the MDGs should serve as a guide from which competencies for all health professionals can be developed. Elizabeth in her passionate story about the work at the shelter noted that the nurses did "treat each guest as a person worthy of respect, to advocate for them, and to encourage ,via outreach and education, the highest possible level of functioning and self-determination that each individual could reach." This addresses some competencies for nursing that reach across global health roles as clinician, educator, consultant or researcher that I believe are critically important.
In addition to inclusion of health and human rights, social determinants of health, cultural humility, and ethics that were mentioned in Lynda Wilson et al publication, I would like to add the following:
1. ability to build relationships with global colleagues based upon mutual respect
2. competency to develop partnerships to achieve mutual goals
3. respect for cultural differences in the implementation of health programs
4. ability to collaborate effectively with other health professionals including community health workers
5. capacity building skills to help partners become empowered to "own" their programs and to sustain the work (as Elizabeth notes "self-determination")
6. employ strategies to build sustainability for evidence based global health interventions that work
7. conduct research that involves community members and is participatory in nature (in addition to the code of ethics for research noted in Lynda's article)
8. Ensure that nurses who are guests in a country reach out to nursing organizations in the host country to build relationships for the discipline
9. Consider issues of appropriateness, accessibility and sustainability of material resources such as EKG machines or equipment that cannot be maintained across borders

I am sure I have neglected some here but as nurses we have a unique role as advocates for patients and in our global health practice we must ensure that our skills to collaborate, partner and empower others should be paramount in our work. Further, as noted in the competencies published in Lynda's et al article, all participants (and especially students) should have extensive preparation about the country's history, politics, social system, health system, nursing profession, culture and religions prior to participation as a nurse in global health settings.
Thank you for the opportunity to share my thoughts--

Elizabeth Glaser Moderator Emeritus Replied at 9:47 AM, 11 Sep 2013

Jeanne,
Thank you for a wonderful comprehensive response to Lynda. Your framework really covers most aspects of what we need to be aware of as practitioners from upper income settings when we visit lower-middle income settings. I say settings , not countries, because we have districts in the US with health outcomes worse than that of some middle income countries.

Elizabeth

Maggie Sullivan Moderator Replied at 10:54 AM, 11 Sep 2013

Despite having some technical difficulties with loging on from Botswana- I am most excited to introduce our panelist Dr Naomi Seboni and to present her bio and responses on her behalf.

Bio:
Naomi Mmapelo Seboni is Head, School of Nursing, at the University of Botswana, Director, WHO Collaborating Centre for Nursing and Midwifery Development. Dr Seboni is also the current President-elect of the International Planned Parenthood Foundation (IPPF). Most recently, she has been appointed to the advisory council of the Lancet's new series on global health. Dr. Seboni obtained her Bachelors Degree in Nursing at the University of Botswana and Swaziland, Masters Degree at Teachers College, Colombia University, New York and her PhD at University of California in San Francisco (UCSF).

Her areas of research and publications are adolescent sexuality and risk-taking behaviors, Adolescents living with HIV/AIDS, family and self care symptom management strategies for people living with HIV/AIDS and Home Based Care.

Dr Seboni is actively involved in professional service. She is the former President of the Nurses Association of Botswana, former member of ICN Council of National Representatives; member of STTI, where she served in ARISTA 3, Leadership Advisory Council and Service Advisory Council. She is a founder member of STTI African Chapter –Tau Lambda at large Chapter, and is its immediate past President. She also serves as a volunteer for International Planned Parenthood Federation (IPPF) at national, regional and international levels, currently she is a member of IPPF international governing council. Dr. Seboni served as a consultant and technical support for several international organization, namely UNICEF, UNFPA, PATH and WHO. At WHO she was part of the team that developed the strategic plan for nursing and Midwifery development in Africa, and also participated in WHO Regional workshops that addressed the issue of migration of nurses and the plans for scaling up nurses and midwives training in the WHO African Region.

Maggie Sullivan Moderator Replied at 10:55 AM, 11 Sep 2013

Dr Naomi Seboni on the question of how nurses can be better prepared to fill leadership roles in the field of global health; and how can we best support this among our nurse-colleagues in low-and middle-income countries?

"Nurses can best be prepared to fill the leadership role through inter-professional education at graduate level. Currently the Faculty of Health Sciences (School of Nursing and School of Medicine) are a member of the consortium of 8 universities, 4 in Africa and 4 in the USA offering a program on global leadership in Health. The candidates are exposed to broader and in-depth analysis of global health issues from various professional and cultural perspectives. This partnership has provided the nurses in developing economies to develop curricula and co-teach with nurses and other professionals from the developed countries. Such partnerships will expose nurses to not only concern themselves with local or national health issues, but also to use the global health approach. The low and middle income countries, especially in my region-sub-Saharan Africa are rich in mineral resources, nurse leaders need to advocate for these riches to be used on human investment, and discourage exploitation of their populations by those in power and their counterparts in the developed world. Through our global Organisations such as ICN and STTI , we can embark on global projects which will empower nurses for global health leadership."

Maggie Sullivan Moderator Replied at 10:58 AM, 11 Sep 2013

Dr Naomi Seboni on the question of what "leadership role" means and in what types of positions would you like to see nurses?

"Nurses need to be equipped with knowledge and skills which will enable them to compete with other professionals in top national , regional and global positions of power. They should be actively involved in regional and global initiatives that promote global health. They should not shy away from active politics at all levels of the society, but be advocates for access to quality health care services especially for the disadvantaged population groups globally. Nurses have to be leaders in global health policy nationally, regionally and globally."

Maggie Sullivan Moderator Replied at 10:59 AM, 11 Sep 2013

Dr Naomi Seboni on the question of, in what ways can the nursing community come together to increase the number of nurses leading the field of global health?

"I believe that nursing education has often concentrated on the countries health needs. Nurse educators need to see the need to not only educate for their countries, but for the global community. Science and Technology has made the world smaller, and people are more mobile than in the past, thus we need to respond effectively to the demands of the global village. It is essential to pursue partnerships in nursing education , research and practice: Partnerships that will bring about insight on matters of global health. Twinning of universities in low and advanced economy could be our starting point, where the partnership will enjoy equal responsibility and autonomy."

Elizabeth Glaser Moderator Emeritus Replied at 11:14 AM, 11 Sep 2013

Good morning!

I want to thank everyone for their participation and thoughtful questions and responses. I have asked Maggie to clarify if we can find an alternate way to contact Dr Seboni and Prof Phalandze so they can add their considerable experience and expertise to the conversation.
The question for today is :
How do you envision yourself to be a nurse leader in the field of global health?

I do not envision myself to be a leader. At present, I am a nurse who is struggling through a doctoral program who is trying to envision graduation.

For leaders, I think of Sheila Davis at PIH and Anne Sliney at Clinton Health Access Initiative , at Manzi Analtole with the MESH initiative in Rwanda, Dr. Seboni leading IFPPP and others.

I supposed to lead in nursing one has to consider at least two areas:
1. The direct care setting
What can be done to improve the work environment of those in the front lines of nursing? When staff have adequate education, supplies,and support, it improves our ability to provide care in the moment and our capacity as humans to continue to give of ourselves day after day. When one is daily confronted by inhumane conditions, we risk burnout and a dehumanized or even frankly cruel approach to care.
Working to improve all the inputs to the care environment, supply chains, financing, etc, can be overwhelming. If we focus on training the next generation of nurses, to enbolden nurses to expect more resources and better conditions for themselves and their patients, then we will be fostering an environment for change.

2. Beyond the direct care setting. Are there nurses in the major management of WHO, the Global Fund for AIDS , TB and Malaria? If not why?
We need to see that change, such as breaking down long entrenched hierarchies , is not just to elevate our profession, as an end to a means , but to help colleagues in other health professions by creating an interdisciplinary, interprofessional environment of shared work, values and goals.

The first step is to consider where we are and where we are not, to decide which venues can be approached, and then to seek meaningful inclusion of appropriate nurses in the setting. For example , if WHO is lacking , then what would be the role for a nurse, who could do the work and how do we approach the those within the organization to discussion this., or would a letter campaign be better, or can a nurse with experience from within act as a bridge to communicate our concerns?

But we can take the lead , each one of us, by expecting inclusion in multidisciplinary venues. As I noted on day 1, It is okay to to ask questions. How have nurses been included in the management team for a program? Why did you decide to exclude nurses from your program/policy/panel? If you ask, then others may learn to do so too and maybe over time we wont have to ask that particular question, because we will be there at the table contributing to solutions.

Elizabeth Glaser Moderator Emeritus Replied at 11:18 AM, 11 Sep 2013

Dear Maggie,
Thank you for facilitating this. I am very glad Dr Seboni can participate a d I look forward to reading more from her in the coming days.

Elizabeth

Lynda Wilson Replied at 2:00 PM, 11 Sep 2013

I want to thank Jeanne Leffers for her thoughtful comments and suggestions about discipline-specific global health competencies for nurses! I will bring those ideas to our sub-committee! Please feel free to email me directly if you'd like to discuss further! ()

dian marandola Replied at 2:35 PM, 11 Sep 2013

How would the quad council competencies for public health nursing meet a nursing only persoective?

Maatasesa Samuelu-Matthes Replied at 3:14 PM, 11 Sep 2013

Elizabeth.

Thank you for your prompt reply.



Writing for publications in nursing within Samoa is a weak area. Nursing
here usually conduct audits, surveys, situational analysis few researches
for clinical governance purposes and quality improvement. Some results of
these works are in written reports, but rarely for publications. I am
following the notion that publications and writing on journals can possibly
lift the profile of nursing and nurses and people that will be able to
access those publications /writings will come to know and understand the
capacity of nurses for leadership roles.



So to answer your question I believe it is writing for all that you have
mentioned. I kind of interest in writing on how well the program works in
nursing in Samoa to start with.

Sheila Davis Moderator Emeritus Replied at 4:18 PM, 11 Sep 2013

Great discussion thus far--- this is such an important dialogue and there have been very concrete ideas on how to move forward getting nursing voices amplified and I agree that is critical for global health and for the nursing profession overall.
In response to the question of a broader view of nursing leadership, I think it is important that nurses be seen as leaders/experts in clinical areas and global health delivery overall and how we do that best is our focus on patient ( family and community) centered care. In my role at PIH and in other roles in the US and globally, what I found is that if the focus of the conversation is related to nurses only—it is easy to marginalize and to be siloed as a nursing-centric issue. When the conversation is turned to patient quality and how we can provide that quality care—the conversation naturally turns to our nursing workforce and our value is obvious. I am definitely Pro-Nurse, I have spoken, written and been an advocate for raising the visibility for nurses for many years and definitely see that as a priority for all of us. But, I also want us to move to the next level where we as nurses keep the patient as our focus. Our advocacy focused on a world that truly values health as a human right and the provision of quality global health delivery will lead to the discussion of who is the best positioned and qualified to provide that care---nurses.

Elizabeth Glaser Moderator Emeritus Replied at 8:29 PM, 11 Sep 2013

Dear Sheila,
Very much agree with you. It is important to find a balance between disciplines so we can complement , not clash. When we create an interdisciplinary, interprofessional environment of shared work, values and goals then we are improving health delivery for the consumers and for those who work within the health system.
Jody Hoffer Gittell has a framework for this - Relational Coordination. (http://rcrc.brandeis.edu/) Much of it is focused on task integration in health care or other settings.
"RELATIONAL COORDINATION is communicating and relating for the purpose of task integration - a powerful driver of performance when work is interdependent, uncertain and time constrained...by building shared goals, shared knowledge and mutual respect across boundaries."

Have many of you heard about this and used it in your work to assess team performance?

Elizabeth

Attached resource:

Elizabeth Glaser Moderator Emeritus Replied at 11:49 PM, 11 Sep 2013

Dear Maatasesa ,

If you want to to begin to write I would be happy to help with copy editing and if it comes to fruition we could see if it could be posted on the blog of the nursing group that I am in .
In starting out it can be helpful to write a brief piece, perhaps one page or about
250-300 words. If you want to write it first and then sent it to me for editing and comments that would be fine, or if you wish to correspond before beginning to write that is fine as well. Think about it and feel free to email me, .
Thank you for giving this a try. I look forward to reading it and learning about the health system in Samoa.

Elizabeth

Gini Williams Replied at 7:57 AM, 12 Sep 2013

Regarding how I envision myself to be a nurse leader in the field of global health, I think it is more by default than design. Through my work in high-, middle- and low-income countries, I have come into contact with thousands of nurses, and beyond my own clinical experience, have visited hundreds of nurses in their clinical areas. In all these encounters I see good practice, poor practice and circumstances which support or obstruct nurses in providing good quality care. In my current role I have the opportunity to participate in strategic meetings with donors and international policy-makers and I feel duty-bound to speak up and share the information, frustrations and successes of my colleagues who are not there to speak for themselves. It brings me unwanted attention and brands me as a trouble-maker and so often it would be easier to stay quiet. But I have too many voices in my head and I have seen too much to let it lie.
I do as Sheila suggests and frame the need for nurse representation within the essential expertise that nurses bring to quality care delivery. The major challenge is that good quality, people-centred care is still seen as a luxury and there are not enough people (such as nurses) who know what it takes to deliver people-centred care, involved in designing health programmes which tend to be bio-medically driven. Nevertheless I carry on making the point - as Winston Churchill said, " Success is going from failure to failure without loss of enthusiasm".
Another leadership opportunity for me is the possibility I have to enable nurses to write, submit abstracts to national and international conferences and present their work. This is a great way of raising their profile and getting them in situations where they can be seen as leaders in their field by international NGOs, other specialists in the field, donors and government representatives. This is entirely based on their own merit.
In my opinion nurses often find it difficult to see themselves as leaders if they do not hold traditional leadership positions in management or the higher parts of the nursing hierarchy. Elizabeth is so right when she talks about leaders in clinical areas. These nurses do not necessarily hold a certain position of leadership but they display many leadership qualities in their ability to identify a problem and work with their colleagues and managers to solve it in spite of the many obstacles they face. These nurses need to be supported and nurtured into leadership positions in the future.

Elizabeth Glaser Moderator Emeritus Replied at 11:47 AM, 12 Sep 2013

Now I am was wondering what people think makes a leader - Gini described her situation well. Who do you see as a leader in nursing, especially global health?

Essi Havor Replied at 2:02 PM, 12 Sep 2013

Hello,
I have been following all discussions for a while, and it is very interesting to read all my colleagues' answers, giving us (i mean nurses considering global health) hope that we can use our education/experiences and skills to help other nurses around the globe.
In the global health field, i envision myself to be a leader, a role model for new nurses, and others professionals; and be the best and strong advocate for better care for women and children around the world. However my goals are not achievable if experts and leaders in the nursing profession express their desire to mentor us, and take us to the next level, but when it comes to put their words into actions they disappear. I have been to many conferences, and have received contact info of leaders that can be potential role models for me. When i called or e-mailed most of them, i have not received any response back.
I think it is very important that experts in the Global health field mentor/coach and prepare new nurses and other professionals how to acquire those leadership skills. It is about networking, and if we don't have seniors to look up for, we will not be visible. Leaders and experts in the leadership roles are too busy, and have little time to mentor.

Maggie Sullivan Moderator Replied at 2:46 PM, 12 Sep 2013

Dr Seboni on the question of being a nurse leader in the field of global health:

"Yes I do envision myself as a nurse leader in the field of global health because of my active involvement in health matters handled by global nursing organisations and multidisciplinary health oriented organisations. First through the presidency of my National Nurses Association I was a member of the Council of National representatives , a governing body of International Council of Nursing. I was a founder member of the East Central and Southern African College of Nursing, an affiliate of the Commonwealth Nurses Federation. I attended meetings and conferences of both organisations where we deliberated on nursing and midwifery development, as well as the role of nursing in Commonwealth countries. My Colleague (Leana UYS of KwaZulu-Natal in South Africa) and myself initiated the Africa at Large at chapter of STTI- thus providing the opportunity for African nurses to engage in discourse about health matters in their continent , and also to dialogue with nurses from the entire world during STTI biennial conventions where nurses discuss global health matters. I have been actively involved in IPPF member association in my country Botswana Family Welfare Association , and its presidency provided me an opportunity to engage in sexual and reproductive health and rights (SRH & R) at national , regional and global level. I am currently the global President of International Planned Parenthood Federation ( IPPF), an organisation that has 153 member associations (in 153 countries) and it serves in 170 countries. IPPF is an exciting multi-disciplinary organisation that serve the poor, marginalised, hard to reach population groups. It is a grassroots movement that is grounded in volunteerism. We have a program called SPRINT that serves the displaced persons either by man-made or natural disasters, during which women and girls are subjected to gender based violence including rape. Leadership at this level demands close following of the global events, and a swift response by our colleagues in the l country or region experiencing turmoil. Every day before I go to sleep I watch CNN and other global channels. Being a global leader connects you to the communities beyond your own, challenging , but fulfilling. I was mentored by nurse leaders in my country and in the United states who were my teachers. So I do concur with the panellist and respondents who emphasized mentorship as the best mode of nurturing global leadership in nursing."

Elizabeth Glaser Moderator Emeritus Replied at 4:26 PM, 12 Sep 2013

Dear Essi,
Your passion for your work is very clear. I have experienced a similar lack of responsiveness to emails, sometimes from my own advisor at school! Not to excuse their actions, but I have come to realize that the lack of response is usually because though they want to make time to respond, they are overwhelmed by many responsibilities.
However, if they did respond, what in particular would you seek to learn from them?
Is there anyone else near to you or more available by email who could provide similar mentoring?
Could you form a group with other like-minded nurses to support one another in achieving your goals?

Elizabeth

Maggie Sullivan Moderator Replied at 4:30 PM, 12 Sep 2013

Maggie (on behalf of herself :) - Dr Seboni, we had this recent eye-openning experience of online advocacy around the topic of the lack of nursing presence on the advisory council of the Lancet's new series on global health. There was a lot of conversation on our end about why that might be, the appropriate course of action to be taken and goals. Given that you are now on the advisory council, what was your perception of this experience?

Chinomnso Obi peter Replied at 4:54 AM, 13 Sep 2013

Great Panel, I have been following all useful comments here. Well from Nigeria where I come from much works is needed to create a good leadership in Nursing and midwifery . The people growing in the profession find a lot of things difficult from the leaders, things are not made easy for people. Most times I wonder if the leaders ever what to grow new leaders that will take over from them, people do not have the zeal to study higher because of the maltreatment they get from both tutors and leaders. Talking about how it goes in the hospitals, higher nurse leaders as well don't engage in nursing care , that work is only for junior nursing officers. I have been to some parts of the world and its a different practice.

we hope to grow in nursing leadership down here

Gini Williams Replied at 5:30 AM, 13 Sep 2013

Chinomnso Obi Peter, you bring up a very important issue. The problem is that some people in leadership positions do not demonstrate good leadership skills and have a negative impact on on the growth of the profession. It seems that the battles fought to gain a position can lead to that position being jealously guarded at the expense of others. We see it in all areas (one obvious one being politics) and nursing is no different.
I have heard shocking stories from Europe, North America, Russia, Asia and Africa where nurses with great commitment, ideas and skills being thwarted by managers and teachers as you suggest. Things such as nurses being denied permission to travel to present papers, being moved from an area where they are specialised and making great progress to an unrelated field of practice, refusal to grant study leave and the list goes on.
It is difficult to know how to address this but I think again it is something maybe a network or team of mentors could help with. It was interesting what Essi said about leaders promising mentorship and not delivering and as Elizabeth said this can often be down to capacity rather than will.
Maybe we need to use GHD-online, or some other network, as a place for nurses to air their challenges and ideas and get feedback from colleagues. Answering queries in a public arena may also inform more nurses who are dealing with similar situations - if there is something in particular someone can help with on a one-to-one basis it may be simply that the right mentor can be found through the forum. These are just suggestions off the top of my head - does anyone have any other ideas? It would be great if, as a result of this discussion we can end up with something concrete.

Maggie Sullivan Moderator Replied at 7:41 AM, 13 Sep 2013

Dr Seboni, on my question about her recent experience with the Lancet:

"My perception of being in the Advisory Council of Lancets new series on global health was to have an opportunity to interact with other health professionals on critical issues on global health, and to inject a nursing perspective in the discourse. I believed that this will enhance nursing’ visibility for being associated with works of the prestigious journal. Also that nursing will carefully listen to the ideas and perspectives generated by other disciplines, and that there will be no dominating voice, as the concern will be to focus on matters that benefit humanity. That this experience will consolidate the team spirit, and enhance respect for nursing’s contribution to global health."

Maggie Sullivan Moderator Replied at 7:45 AM, 13 Sep 2013

Dr Seboni on the question of best ways to bring this topic [of nurses as leaders within the field of global health], and change, to light without creating divisions within the field?

"Thanks a lot for posting my messages. Technology shrinks the world, but at times we in Africa do not enjoy the swiftness it creates to easily engage in discourse globally. Technical hitches prevented us from signing in. I want to thank Maggie by assisting me to share my thoughts by posting my deliberations for me. Fortunately I am able to read other participants comments.

Avoidance of divisions in any profession is essential. Change is slow. Nurses will have to come up with innovative strategies to promote unity in diversity, because at global level we are dealing with different situations which are embedded in our cultures. Whilst nursing phenomena of interest are the same globally , we must be sensitive to the fact that the response may be different, and strategies adopted to bring about change must take cognisance of the similarities and differences. We may create global nursing hubs through our global nursing organisation to expedite, but tread carefully to bring about the desired change."

Lynda Wilson Replied at 8:39 AM, 13 Sep 2013

I have been energized this week by this amazing discussion about global nursing leaders! I wanted to share with everyone the attached flyer about the Fourth International Interprofessional Health Care Leadership Program that will be held at the University of Alabama at Birmingham (UAB) School of Nursing (SON) on July 14-25, 2014. The program is open to 30 nurses and other health professionals from ANY country, and is sponsored by the UAB SON Pan American Health Organization (PAHO)/World Health Organization (WHO) Collaborating Center on International Nursing, and the UAB Sparkman Institute for Global Health. The program will include:
• an interactive class focused on application of leadership principles to common issues faced by nurses and other health professionals in clinical practice as well as in teaching and research settings;
• development of individual leadership development plans in collaboration with UAB faculty coaches and other institute participants; and
• the opportunity to participate in classes focused on English for health professionals offered by the UAB English Language and Culture Institute offered BEFORE the leadership program IF there are at least 10 registrations for this program (from July 7-11, 2014).

Participants will live in a UAB dormitory/residence for an estimated cost of $450 for 2 weeks. There will be a limited number of free home stays offered by volunteer host families. The estimated cost for the program, health insurance, and SEVIS fee is approximately $1,250. The cost may vary depending on the cost of health insurance. The additional cost for the English classes will be approximately $550 (including the classes, book, insurance and dormitory/residence). The cost of airfare, visa, housing, food, and ground transportation is NOT included in the above prices.
Deadline to register: March 1, 2014
For more information: http://www.uab.edu/nursing/home/international-affairs-home
Dr. Lynda Wilson (; 1-205-934-6787) OR
Lisa Theus (; 1-205 996 7621)

I am attaching a flyer and would appreciate your sharing it with your colleagues! Lynda Wilson

Attached resource:

Elizabeth Glaser Moderator Emeritus Replied at 10:34 AM, 13 Sep 2013

Lynda,
The program at UAB sounds great. Are there scholarships or subsidies available to cover costs for those accepted to the Interprofessional Health Care Leadership Program?

Elizabeth

Lynda Wilson Replied at 11:15 AM, 13 Sep 2013

Hi Elizabeth - I wish we did have scholarships from UAB..we are continuing to try to seek funding, but as of now the only help we can offer is volunteer host families who provide free lodging and breakfast and dinner...we will try to find enough host families for all 30 participants, but if we do not have enough volunteers, we have UAB dormitory space at a reasonable rate! Thank you! Lynda Wilson

Lynda Law Wilson, RN, PhD, FAAN
Professor, Assistant Dean for International Affairs and
Deputy Director, PAHO/WHO Collaborating Center on International Nursing
Family/Child Health and Caregiving Department
School of Nursing
UAB | The University of Alabama at Birmingham
NB 420 | 1720 2ND Avenue South | Birmingham, AL 35294-1210
P: 205.934.6787 | C: 205.306.1556 |F: 205.996.7813 | <mailto:>
Facebook<https://www.facebook.com/uabson> |Twitter<https://twitter.com/UABSON> | Linkedin<http://www.linkedin.com/groups/UAB-School-Nursing-4233185@@

uab.edu@@http://uab.edu/>/nursing
Knowledge that will change your world

Elizabeth Glaser Moderator Emeritus Replied at 11:31 AM, 13 Sep 2013

Dear Dr Seboni,
Maggie brought up Lancet Global Health, so I would like to say a bit about that process and also ask for your impressions on the future of global health nursing. I had been glad that Lancet was offering an open access journal on global health and so was disappointed that the advisory board had no nursing representation. It seemed to be one more lost opportunity for the nursing profession, but more importantly, a loss for the journal to comprehensively address issues in global health.

GHDonline was a great forum for discussing the lack of nursing presence at Lancet and then deciding on a course of action. With a bit of persuasion, Zoe Mullan was open to having a nurse on the board, actively seeking input from us on who might best serve, although she surely was checking with many other people when making her decision on who might best serve.

Lancet Global Health were quite receptive once we caught their attention, but prior to that, why do you think that they did not include a nurse from the start?

My impression from physicians and other non-nursing professionals was that they do not see nurses as doing this kind of high level work. They may think of individuals within nursing as having the capacity to do policy or higher program level work but not of the nursing profession as opposed to physicians, economists, epidemiologists or even entomologists who sit on interdisciplinary boards.

What do we do so that others at a high level understand that we have the capacity to be drivers of global health policy?

Sheila and Gini talked the of importance using a quality care focus vs a nurse-centric focus. I agree with that view.

But sometimes a little push helps, too. Having read the work of several of your colleagues on the Lancet board, I had noted that they had published articles in the The Lancet advocating a move towards non-hierarchical interprofessional environment in health care.Since they had advocated for this, it seemed a good time to remind the editor that having a qualified nurse scholar and clinician would be a move towards that end.

What do you see as ways to increase our visibility in this arena?

Thanks very much for your insights,

Elizabeth

Gini Williams Replied at 11:42 AM, 13 Sep 2013

Today's question asks whether there are roles for exclusive fields of global health medicine and global health nursing, versus a mixed inter-disciplinary field? I think it is essential to have both. We need strong leadership for the nursing profession and we need nurses to be seen as important contributors to inter-disciplinary fields at a local, national, regional and global level. It is only my working with other disciplines that we can hope to make the progress in health and health care to reduce suffering and prevent premature death.
We cannot make a strong contribution if we are not clear about our role and expertise. As nurses we need to take charge of our professional identity, standards and regulation - if we do not, others will. This is how we can fall prey to decisions such as the de-skilling of nurses to prevent migration; the maintenance of enrolled nursing as opposed to registered nursing posts to reduce training and salary costs; the lack of investment in nurses within health programmes where only medical personnel and politicians have been negotiating with donors about priorities for funding. There are so many more examples and each of those I mention are real, I just do not want to mention countries specifically.
There are so many great nurses out there who are striving to do the best for patients and communities often without support and recognition. My hope rests on these nurses and the ability of those of us in leadership positions to shine the light on them and show how valuable their contribution is. The most common complaint I hear from nurses on the ground is that they are not recognised for the work they do. We all have a duty to change this.

Gini Williams Replied at 11:45 AM, 13 Sep 2013

Correction - sorry, I posted in haste. The last line of the first paragraph of my latest post should read. "It is only by working with other disciplines that we can hope to make the progress in health and health care to reduce suffering and prevent premature death."

Elizabeth Glaser Moderator Emeritus Replied at 1:36 PM, 13 Sep 2013

Gini
These are great points. They highlight that as we gain more opportunities and raise our profile, our profession may also receive more outside examination and criticism of issues within nursing such as standards for education and licensure. That is to be expected and may be we should welcome examination and critiques as fresh perspective on nursing just was we seek to do the same in global health.

As an aside. I was rereading Gini's posts as it was helpful to me in writing a coherent piece, as I some times do not hold to my main idea. So Gini thank you for giving such good examples on how to write.

Elizabeth

Elizabeth Glaser Moderator Emeritus Replied at 2:01 PM, 13 Sep 2013

Re interdisciplinary work.
Here 's slightly different take on that - we can, ourselves .be interdisciplinary practitioners.
We bring our nursing background with us no matter what our eventual role may be.
A foundation in nursing does not exclude us from becoming managers or economists, or lawyers or politicians, it only enhances what we do when we lead.

In reference to Sheila and Gini's mention of being siloed:

It can strengthen our work, the way we train new nurses, and how we approach interprofessional/ interdisciplinary work by having nursing faculty with advanced degrees in other areas as well as in nursing.

it can strengthen our own research and raise our profile by publishing in interdisciplinary publications.

For nurses at the bedside and clinics, supporting the work of your non-nursing peers, such as pharmacists, physical and occupational therapists, can enhance your practice,and lighten the psychological load we carry as well as the physical work load.

There are many problems in health care, and within nursing, but I feel optimist about our prospects if we can embrace the uncertainty that comes with change and see it as a great opportunity to move forward.


Elizabeth

Barbara Waldorf Moderator Emeritus Replied at 2:11 PM, 13 Sep 2013

Thank you to everyone who has been responding and contributing to this fascinating and very important conversation. The expression of global nursing leadership that we see here has many lessons for us all to learn. One that has particular resonance is about mentorship as a crucial aspect of nurturing future leaders in global nursing. None of us would be where we are without our mentors and the support, encouragement, and practical “showing the way” that they have given us.

At the Global Nursing Caucus, part of our mission is to create a database of people, programs and resources that are well-suited to facilitating partnerships with mentors as well as highlighting talents of members in their various expertise. We at the GNC are discussing and working on creating structures that support mentoring and connecting those who are looking for mentorship in the various nursing fields. We are focusing on mentorship across borders and the facilitation of cross cultural learning and skills and are also in the midst of building a new website that will have space for these connections to occur. Currently, we have a newsletter and blog where all can discuss these and other issues.

We welcome anyone who has interest in mentoring to contact us and be part of this project.

Barbara Waldorf BSN, MPH
Executive Director
Global Nursing Caucus

http://globalnursingcaucusblog.wordpress.com/

Tess Panizales, DNP, MSN, RN Replied at 4:30 PM, 13 Sep 2013

Its a lovely conversation -

I believe in interdisciplinary collaboration. We are all sharing and
contributing each of our expertise for the benefit of those we serve. We
just have to define our roles and expectations, most importantly*
respect*each others areas of expertise. Respect within our own so
others may
respect us as well.

We may have to initiate the collaboration, and often be its promoter - for
others may not understand its importance. We have to live it to make it
happen. It is always very important to be clear in once action and once
communication.

Barbara Astle, RN, PhD Replied at 5:23 PM, 13 Sep 2013

I’ve been following the discussion on an off during this week. I particularly wanted to briefly comment on a “mentorship” initiative as it relates to global “leadership” that I am involved in. Barbara Waldorf’s wrote about a database being created for partnering and mentors for future leaders in global nursing which sounds very interesting. I wanted to share with you a program offered by the Canadian Society for International Health (CSIH) called “Mentornet”, which I’ve participated in for the past two years. The primary focus of this program is to support the next cohort of global health leaders in all disciplines. The way “MentorNet” works is that a student or a young professional is partnered with a Mentor (Leading professionals in Global Health) in a shared area of interest. Over the course of a year, the “student or young professional” have continued opportunities to discuss with their assigned “Mentor” current global health challenges either in person, email, phone or SKYPE. The initiative is well structured with modules (on various topics), as well there is the opportunity to request information on other topics that may be of particular interest to the “Mentee”, and the MentorNet Faculty will provide such materials. As I work in the field of Global Health in Nursing, I have been partnered with nurses who are recent graduates interested in global health. It is important to note that MentorNet is designed to include all disciplines. If you would like more information, you can look at their website http://www.csih.org/en/about/job-opportunities/mentornet/ or contact me at the information below.
I have been a member of the Canadian Society for International Health (CSIH) since 2006. During this time I was Chair and Co-Chair of the CSIH from 2009 - 2012 as a Nurse Leader of an interdisciplinary board of economists, physicians, and public health specialists.
BARBARA ASTLE, PhD, RN
Associate Professor | School of Nursing
Director | Centre for Equity & Global Engagement
Director | Master of Science in Nursing Program
Trinity Western University
Langley, BC Canada

Maggie Sullivan Moderator Replied at 5:29 PM, 13 Sep 2013

Dr Seboni on the question of, is there a role for exclusive fields of global health medicine and global health nursing, versus a mixed inter-disciplinary field?

"The nursing world view and that of medicine are different. However there can be shared ideologies on global health. I do believe that there are exclusive fields of global health nursing and medicine such as promotion of access to quality health services where medical doctors will focus on cure and nurses on care, and use of technology in interventions. Some activities will be best tackled through a mixed inter-disciplinary field such as in prevention of communicable diseases, health promotion through poverty eradication, Issues of gender inequality and inequity, advocacy for adequate resources for health services and development of evidence based policies just to mention a few."

Elizabeth Glaser Moderator Emeritus Replied at 5:32 PM, 13 Sep 2013

Barbara ,
Thank you for the information on MentorNet. Can you clarify, are the recent grads and mentors from North America or can they be from anywhere in the world?

Elizabeth

Maggie Sullivan Moderator Replied at 5:33 PM, 13 Sep 2013

Dr Seboni on my further questioning about her personal experience with the recent process with the Lancet:

Maggie: This is very helpful. I was perhaps probing a bit into your personal experience of what it was like to know that no nurse was initially on the advisory council, learning that there was a certain amount of online discussion/advocacy about this, and then your being invited to join the advisory council after the fact. Given that we are discussing how nurses can lead the field of global health, I am curious to know more about your perception of coming to this leadership role. I know that nurses are not always thought of first (when it comes to leading) and that there may be some politics/beaurocracy that must be crossed, but this process with the Lancet has been very interesting to me.

Dr Seboni: I am excited to be in the Advisory Council. We should receive such invitations with our two hands, irrespective of what happened before we got there. What is important is that someone applied pressure, fought and advocated for nursing representation, what I need to do is to seize the moment, work smarter, consult with nursing colleagues and make contributions that benefit nursing and humanity globally. I guess my experience as the President of IPPF and my membership to the Lancet Commission on Women and Health since December last year, both of which are multi-disciplinary in nature have sharpened my skill in working in such fora, without feeling intimidated. We need powerful nurses who continue to fight for the opportunity for nursing to be heard in leadership roles, and we should not hesitate to join.

Barbara Astle, RN, PhD Replied at 1:07 AM, 14 Sep 2013

Elizabeth,
At this point, the mentors and graduates have been from Canada, however, an international person could apply if they wished. MentorNet, however has only been functioning for the past two years so awareness of its existence has been relatively local, ie Canada.
Barb Astle

Maggie Sullivan Moderator Replied at 9:04 AM, 14 Sep 2013

Good morning everyone - we are reaching the official conclusion of our expert panel for this week. Thank you so much to each and every one of your for participating. This has been such a thorough and enlightening conversation. Please don't hesitate to continue to post your comments to this thread in the future. Though the panel is officially ending, the thread will remain open. I am also happy to forward any additional questions to our expert panelists. Elizabeth, Gini and Dr Seboni - special thanks to you for your time, thoughtfulness and flexibility. You model leadership to all of us. In the coming weeks, we will post a discussion brief summarizing the contents of this panel discussion for your reference. Thank you!

Gini Williams Replied at 5:34 AM, 17 Sep 2013

Following on from our discussion last week, I am delighted to inform you that The International Journal of Tuberculosis and Lung Disease has published a supplement entitled "Achieving patient-centred care for people affected by tuberculosis" along with its October issue. The supplement is open access and has been co-sponsored by Jhpiego and the International Council of Nurses (ICN) TB Project. It was guest edited by Stacie Stender, the Africal Regional Director for Jhpiego and myself as the Director of the ICN TB Project. All ten articles have been written by nurses from different parts of the world and present a variety of perspectives with regard to patient-centred care. We hope that this will give great encouragement to nurses everywhere who have so much to contribute in so many different fields.
If anyone is keen to write on any aspect of TB or public health in general, I am a guest editor for Public Health Action, the International Union Against Tuberculosis and Lung Disease's open access journal and they are trying to encourage more contributions from nurses.

Attached resource:

Barbara Waldorf Moderator Emeritus Replied at 7:35 AM, 20 Sep 2013

Dear Barbara,

Thank you so much for the information on "Mentornet". It is very helpful to see how this has been structured by the CSIH. How long has the program been functioning? What feedback have you gotten from the participants? Do you see long term relationships being created? With your experience, what challenges do you see in making this type of project work internationally?

Regards,
Barbara Waldorf
Global Nursing Caucus

Maggie Sullivan Moderator Replied at 10:28 PM, 25 Sep 2013

On this very topic of advancing nursing leadership in global health, there is a new opportunity for a nurse from a low/middle-income country (LMIC) to attend the International Nursing Research Conference in Glasgow, UK, April 2014. The opportunity exists in the form of a competition and to win, a nurse needs to compose an article on the role of the research nurse.

From the website Global Research Nurses:
"This competition presents an opportunity for a nurse who works in research to attend an international conference with expenses paid*. The winner will be able to network with nurse researchers and research nurses from across the globe and to share understanding of international nursing research. The prize winner has the opportunity to submit an abstract for presentation at the Conference, at the discretion of the committee.

There will be two additional prizes of one year online subscriptions to both the Journal of Advanced Nursing and the Journal of Clinical Nursing, published by Wiley.

* see Terms and Conditions

Entries are invited from nurses from low/middle income countries who fulfill the following criteria:
- Registered Nurse from a low/ middle income country
- Working in a low/ middle income country (as defined by World Bank)
- Working as as a research nurse or a nurse with clinical research responsibilities - i.e. 'a nurse who as part of her role, undertakes research within the clinical environment.'
- Member of Global Research Nurses’ network. To become a member, register NOW, on the Home page.

To enter the comptetition, you are required to write an article of a maxiumum of 1,000 words. The topic is: "with reference to a research study that you have worked on, describe how nurses contribute to clinical research and discuss what support is needed to enable greater involvement for nurses in clinical research."

CRITERIA TO BE USED IN JUDGING:
- An understanding of the research process
- A description of the role and responsibilities of the nurse in the research team
- Identification of and insight into challenges faced by research nurses
- A well-structured and thoughtful discussion presenting original ideas about how nurses can be more involved in clinical research

FIRST PRIZE:
- Attendance at the Royal College of Nursing (UK) International Nursing Research Conference, April 2nd – 4th 2014. The Conference provides an opportunity for the winner to network with nurse researchers from across the globe and to share understanding of international nursing research.

THE FIRST PRIZE WILL COVER:
- Registration for the Conference
- Attendance at Conference dinner
- A British Airways return flight from nearest airport to winner’s home served by British Airways to Glasgow, economy ticket, with specified BA luggage allowance. (Global Research Nurses' network cannot cover the cost of connecting flights to join the BA flight to Glasgow)
- Single accommodation in Glasgow, for 4 nights, as provided by Global Research Nurses’ network, 1st – 5th April 2014
- Expenses to cover i) visa, £80, ii) transfer to and from airport, approx. £40, iii) living expenses to a maximum of £25 per day for 5 days - refunded within 30 days on production of receipts

SECOND PRIZES:
There will be two additional prizes of one year online subscriptions to both the Journal of Advanced Nursing and The Journal of Clinical Nursing, published by Wiley.

TERMS AND CONDITIONS:
- The competition is open to Clincal Research Nurses, or nurses working on clinical research.
- Entrants must be from a low or middle income countries, working in low or middle income countries.
- Entrants must be members of the Global Health Network.
- Applicants will submit an article of a maximum of 1,000 words on the topic given on the competition advertisement: ‘‘With reference to a research study that you have worked on, describe how nurses contribute to clinical research and discuss what support is needed to enable greater involvement for nurses in clinical research.”
- Entries must be written in English.
- Entries are to be sent by 30th October 2013.
- All applications will be judged by the Global Health network using the criteria stated on this competition advertisement. A short-list will be taken forward to a judging panel of senior research nurses and the winners will be announced in early December 2013.
- Decisions made by the Judging team are final.
- Applications are to be sent following instructions shown on the competition advertisement.
- The winner may be invited to submit an abstract for consideration for presentation of a concurrent session if the winning article links to the themes of the conference. This decision rests with the RCN committee.
- GRN may use all material submitted to the competition in future research and for sharing with others on The Global Health Network.
- The winner of the competition will be responsible for obtaining a business visa for travel to the UK. Global Research Nurses network can send a letter of invitation but will take no further part in obtaining the visa. If the winner is refused a visa, the prize will be forfeit.

TO SEND YOUR ENTRY, PLEASE FOLLOW THESE INSTRUCTIONS:
- Register/ sign in to the Global Research Nurses’ network
- Click on ‘Articles’ at the top of the Home page
- Find the tab for ‘Submit an article,’ on the right hand side of the screen
- Click on ‘Upload now'
- In the ‘Title’ box, write ‘Competition’ and your name
- In the Abstract box, state i) what research project you are currently working on and ii) from which airport you would take your British Airways flight to Glasgow
- Go to ‘File upload’ box
- Add your entry to the competition as a pdf file.
- You will be notified through the network when your entry is received

Attached resource:

Maggie Sullivan Moderator Replied at 1:44 AM, 27 Sep 2013

An additional opportunity for leadership (and publication), shared by fellow GHDonline colleages:

The Challenge
Turning the World Upside Down – Mental Health Challenge is an open competition to celebrate projects, practices and ideas from low and middle income countries, which could be effectively applied to the major health challenges faced by high income countries.

Submit a case study to share your work and have the chance to pitch your idea to our high profile panel and win the Turning the World Upside Down - Mental Health Award. The goal of the challenge is to collect, promote and celebrate alternative approaches to mental health from low and middle income countries.

Turning the World Upside Down - Mental Health Award is a collaboration with the Centre for Global Mental Health, Institute for Healthcare Improvement, Maudsley International, Mind, and NYU's Program in Global Mental Health.

Why mental health?
Mental health conditions are the greatest contributor to years of life lost to disability worldwide. They worsen the course of most medical conditions and stand in the way of our key drivers for social improvement. As mental health seems to be finally taking its place on the global health agenda, attention is growing on the inability of mental health systems and policies to live up to this challenge. Services can be fragmented, policy siloed, access to care poor, preventive and population-level strategies underused, evidence-based interventions variably deployed, healthcare not culturally relevant, and investment limited.

Both high and low-income countries face these challenges. Countries with fewer resources, and without the baggage and vested interests found in high income countries, often cultivate their own unique climate for innovation and finding practical solutions.

By changing the flow of information we can turn the global mental health world upside down, driving new and needed change, and offering perspectives and solutions to these same challenges in high-income countries.

At this event, our dragon's den style panel of experts will be hearing the best ideas submitted throughout the challenge. Each presenter will have 5 minutes to share their idea, followed by feedback from the panel, the audience and across the world via the #TTWUDmh twitter hashtag. We will also be live video-streaming the event across the internet through YouTube. Sign up for an "online ticket" below to receive updates and instructions on how to access the video stream.

With opening remarks by Lord Nigel Crisp and a world class panel including Philip Campbell, Editor-in-Chief of Nature, and Paul Farmer, CEO of mental health charity Mind, this event is not to be missed! Agenda and speaker details to follow.

When:
Wednesday, 27 November 2013 from 17:30 to 19:30 (GMT)
Where:
John Snow Lecture Theatre, LSHTM, Keppel Street, London WC1E 7HT, United Kingdom

Attached resources: