Leadership Institute VI: Legacy of Leadership

Developing & Implementing Global Initiatives in the Curriculum

Dorothy L. Powell , EdD, RN, FAAN

Associate Dean, Global & Community Health Initiatives

Duke University School of Nursing

June 14, 2013

Objectives

• Discuss the importance of global health to society and nursing;

• Differentiate among types of international experiences;• Analyze mission, philosophy, purpose and goals of

nursing programs in relation to global health;• Describe cardinal principles of global engagement;• Analyze elements for planning and implementing global

health experiences for nursing students; and • Examine an international experience for BSN students in

a rural clinical setting.

Importance of a Global Focus in Education and Health

• Global economy• Global society• Global policy• Advanced technology/instant communication• Ease of knowledge transfer• Frequency of international travel• Rates of migration

Migration to the USA(40.4 million in 2011)

• 29% Mexico • 9% Caribbean (Cuba, Dominican Republic,

Jamaica, Haiti, T&T) [2009]• 5% China • 5% India • 4% Philippines • 3% El Salvador, Vietnam, Cuba, & Korea (each) • 4% Africa (Nigeria, Ethiopia, Egypt, Ghana, Kenya)• 2% Dominican Republic, Guatemala (both)

Global Health Problems

Millennium Development Goals

1. Eradicate extreme hunger

2. Achieve universal primary education

3. Promote gender equity

4. Reduce child & infant mortality

5. Improve maternal health

6. Combat HIV/AIDS, malaria, and other diseases

7. Ensure environmental sustainability

8. Global partnerships for development

(UN Partners on MDGs)

World Map

Courtesy of worldmapper.org

Global Disparity for HIV Prevalence

Courtesy of worldmapper.org

Global Disparity for Malaria Deaths

Courtesy of worldmapper.org

Global Disparity for Nurses Working

Courtesy of worldmapper.org

Global Disparity for Physicians Working

Courtesy of worldmapper.org

Common Forms of International Deployment

• Tourism is travel for recreational, leisure, or business purposes.

• Mission Trips are usually sponsored by a faith-based organization with specific plans to benefit people or groups outside of one’s culture.

• Cultural Immersion Experiences refer to more than just being there; it is living the culture every day – not as a tourist, but more like a local, truly taking part in the life of another country. It is gaining a greater understanding of the culture and language, and gaining a deeper understanding of the world.

DUSON Global Health Experiences

Short Term Engagement

• Increasing Prevalence – 45% vs 6% “Year Abroad” (Hoffa, 2007)

• Longitudinal study on Nursing students – long-term positive – sustained qualitative transformation, but not quantitative(Bosworth, 2006; Haloburdo & Thompson, 1998; Webb, 2008)

Critical Global Principles

• Value of a gatekeeper• Mutually beneficial experience• Respect for counterparts• Clarity of roles and responsibilities• Shared Learning• Sufficient financial and human resources• Potential for dissimilar exchange• Cultural adaptation• Ethnocentrism

Definition & Dangers of Ethnocentrism

• Habitual disposition to judge foreign people or groups by the standards and practices of one’s own culture and ethnic group. (Merriam-Webster, 1993)

• Potential for:– resentment– derailed plans – unsatisfactory experience – failure to learn about another culture– potential inability to return

Is Global Health Part of Your Mission?

• Mission• Philosophy• Goals and Objectives• Curriculum

Planning and Implementing Global Health Experiences

• Type and purpose of experience sought?– Humanitarian– Enrichment– Part of curriculum for credit

• Level of student targeted?• Selection of students?

– Criteria– Requirements– Payment

• Role & Responsibilities of faculty; preceptors?• Legal implications of international experiences for credit?

Planning and Implementing Global Health Experiences (continued)

• Housing• Food & Safe Consumption• Clothing• Language• Local Transportation• Cultural Etiquette• Money• Safety• Health Care

Planning and Implementing Global Health Experiences (continued)

• Objectives to be accomplished? – Degree of latitude acceptable– Addressing different standards of care– Unique vs. standard skills– Resource availability vs. adaptation

• Guidance and supervision– Role of own faculty– Role of nursing staff– Role of faculty from partnering institution

• Evaluation– Undergraduates– Graduates

Enabling Mechanisms for Global Experiences• Prior Visitation• MOU or Contract• Partner or Representative In-Country• Orientation

– Pre-departure– Arrival

• Cost and Covering Cost• Visa/Immigration Considerations• State Department Registration• Immunizations• Insurance and Health Care• Rules and Policies

EXAMPLE:2011 Cultural Immersion Experience

Teamwork City of Hope (TCOH)

August 15-26, 2011

Duke University School of Nursing

Nursing 231

Specific Community Health Objectives at TCOH

• Conduct environmental assessments at TCOH, identify health risks, and recommend remediation within the context of setting, resources, and culture.

• Identify potential environmental health risks through participation in a riding/walking windshield survey of the broader Ntagatcha community, from TCOH to Tarime, around Tarime, and the district hospital.

• Assess general health status of the children, compare with 2010 data, and report findings to officials at TCOH. Include growth & development health status, compared with norms.

• Based on previously assessed needs, develop and deliver health promotion classes and activities for the children, and the staff (as relates to their responsibilities) that can be incorporated and sustained over time.

• Create a product that can be provided to staff as a resource for reinforcing and sustaining positive health practices.

Resources Needed

• Summary of 2010 health assessment• Environmental health assessment tool• Template for windshield survey• Key informant interview on health issues, available

health resources, and cultural norms

Community Health Activities

• Conduct environmental assessments of:– Children’s Home – Health Center– The grounds– The near-by community

• Riding/walking tour from TCOH to Tarime; around Tarime; and the district hospital

• Repeat health assessment of 2010

Community Health Activities (continued)

• Health Promotion Classes for children and staff– Hygiene and hand-washing (not just what to do, but why

important)– Malaria prevention and control – TB, Typhoid, Yellow Fever, Pneumonia– Diarrheal conditions; why it occurs, prevention, and management– How do diseases spread (respiratory, GI, communicable

diseases); Prevention• Skin conditions (ringworms, lice, tropical ulcers)• Nutrition Projects (attention to common and available foods)• Managing child health emergencies• Creating a comprehensive health guide/resource for TCOH

Questions & Answers

Bibliography

• Bosworth, T.L., Haloburdo, E.P., Hetrick, C., Patchett, K., Thompson, M.A., Welch, M. (2006). International partnerships to promote quality care: Faculty groundwork, student projects, and outcomes. Journal of Continuing Education in Nursing, 37(1), 32-38.

• Haloburdo, E.P., & Thompson, M.A. (1998). A comparison of international learning experiences for baccalaureate nursing students: Developed and developing countries. Journal of Nursing Education, 37(1), 13-21.

• Hoffa, B. (n.d.) Point:Counterpoint. The global job market: Why today’s study abroad programs are often inadequate. Retrieved Dec. 22, 2008 from http://www.transitionsabroad.com/publications/magazine/9511

/study_abroad_and_the_global_job_market_.shtml. • Merriam-Webster’s Collegiate Dictionary (10th ed.) (1993). Springfield, MA: Merriam-Webster.• Webb, A.K. (2008). Background report on short-term missions: In consideration of the development of a Catholic

Relief Services U.S.-Mexico border program. Final Report, March 14, 2008. San Antonio, TX: Catholic Relief Services Southwest Regional Office. Webb, A.K. (2008). Retrieved Dec. 19, 2008 from http://crscollege.org/wpcontent/uploads/2008/11/shortterm_missions_background_report_crs_31408a142.pdf

• Worldmapper.org. Maps retrieved June 3, 2013.