Reflecting on nursing contributions to global health

ABSTRACT

Objectives

Discuss possibilities of nursing contribution for global health approaching knowledge bases and the potential for global health, reflecting upon nursing education and their skills and abilities to perform into global health.

Results

Nurses contribute to global health in areas related to the health system policies, social determinants of health/disease, global issues related to culture, epidemics, communicable and non-communicable diseases, epidemiology, humanitarian actions and emergencies. Universities play an important role for this contribution.

Conclusions

Nurses are professionals who actively contribute to global health, whether in political, social, economic or cultural situations, and universities play an important role for the training of these professionals.

Nursing education; Global health; Millennium Development Goals

RESUMO

Objetivos

Discutir as possibilidades de contribuição da enfermagem para a saúde global por meio de uma abordagem das bases do conhecimento e do potencial da enfermagem e refletir sobre a formação do enfermeiro e suas competências e habilidades para atuar na saúde global.

Resultados

Verificou-se que o enfermeiro contribui para a saúde global em áreas relacionadas à política dos sistemas de saúde, determinantes sociais de saúde/doença, questões globais relacionadas à cultura, epidemias, doenças transmissíveis e não transmissíveis, epidemiologia, ações humanitárias e situações emergenciais. Observou-se que as universidades desempenham um papel fundamental nesta contribuição.

Conclusões

Concluiu-se que o enfermeiro é um profissional que contribui ativamente para a saúde global, seja em situações políticas, sociais, econômicas ou culturais, tendo as universidades um importante papel para a formação desse profissional que atua na saúde global.

Educação em enfermagem; Saúde global; Objetivos de Desenvolvimento do Milênio

RESUMEN

Objetivos

Discutir contribución de la enfermería de posibilidades para la salud mundial, abordando los conocimientos básicos y el potencial para la salud mundial reflexionar sobre la educación de enfermería para la salud general y sus habilidades y capacidades para trabajar en la salud mundial.

Resultados

Se encontró que la enfermera contribuye a la salud en general en áreas relacionadas con los sistemas de salud políticos, los determinantes sociales de la salud/enfermedad, los problemas mundiales relacionados con la cultura, las epidemias, transmisibles y las enfermedades no transmisibles, epidemiología, acciones humanitarias y situaciones emergencia. Observado que las universidades juegan un papel clave para este impuesto.

Conclusiones

Se concluye que la enfermera es un profesional que contribuye activamente a la salud en general, ya sean situaciones políticas, sociales, económicas o culturales, y las universidades un papel importante en la formación de un comerciante que actúa sobre la salud mundial.

Educación en enfermería; Salud Global; Objetivos de Desarrollo del Milenio

INTRODUCTION

The economic, political, cultural, informational and communicative globalization provide new opportunities and challenges, which involve several dimensions of human relations(¹). In this respect, during the 20th century, important economic, social and technical/scientific advances were observed, which led to improvement in quality of life and health conditions. However, the same process also increased major economic and social disparities, resulting in a context of social exclusion in health for some population groups(²).

In view of this, discussions on health are relevant in the globalization scenario, since health problems may not be considered individually and demand coordination of efforts among the different agents of the international community: states, international organizations, transnational companies and society(³). Therefore, the concept of global health describes health issues that transcend national boundaries and demand interventions in global flows that determine people’s health, while requiring new forms of governance at a national and international level(⁴), especially by means of international cooperation initiatives.

Regarding the increase of international cooperation actions, guidelines and development indicators were established for the United Nations (UN) member states, by means of approval of the UN Millennium Development Goals (MDGs). Amongst the eight MDGs, three are directly related to health problems: child mortality, maternal health and specific communicable diseases, such as HIV/aids, malaria and tuberculosis, and the other five are indirectly connected to health, since they focus on social determinants, such as poverty, starvation, basic education, environmental sustainability and international cooperation(²).

In this scenario of global assertion on the importance of health for economic, social and human development, it is worth mentioning the relevance of healthcare professionals in general, and nurses in specific, since they represent the largest contingent among human resources in health.

In 2009, the World Health Organization (WHO) published a document proposing global standards for the initial training of nurses and emphasized that, although almost 35 million nurses and midwives represent the largest healthcare professionals staff worldwide, they rarely take part in high level decision making and development of policies(⁵).

Regarding this growing discussion involving nursing professionals and their training specificities, this study emphasizes the importance of a more comprehensive analysis on their performance within the global health context. Brazilian schools organize curriculum frameworks according to the curricular guidelines for the undergraduate nursing education and determine that the graduated professional has the ability to know and intervene on the most prevailing health/disease problems/situations of the country’s epidemiological profile. The guidelines indicate that the training of nurses must enable the development of skills and general abilities of communication and continuous education that include knowledge in communication and information technologies. Consequently, besides encouraging continuous learning, universities must provide the development of academic/professional mobility by means of national and international networks(⁶), which may indirectly encourage the participation of Brazilian nursing graduates into global health actions. In this respect, from the remaining gaps in the definition of global health and the high potential for the performance of nurses in this area, the following question arises: which aspects pervade the possibilities of nursing contributions to global health?

Considering this question, the aim of this reflection study was to discuss possibilities of nursing contributions to global health, approaching knowledge bases and the potential for global health, reflecting upon nursing education and their skills and abilities to perform into global health.

To support this reflection, studies were researched in the databases of the Latin American and Caribbean Health Sciences Literature (LILACS), the Scientific Electronic Library Online (ScieLO) and PubMed, using the descriptors “Nursing”, “Global Health” and “Millennium Development Goals”, to provide theoretical bases and arguments for the development of this study.

NURSING AND GLOBAL HEALTH: KNOWLEDGE BASES AND PERFORMING POTENTIAL

The globalization process is characterized by several changes in political, social, economic and cultural relations among countries, that within other aspects, resulted in the liberalization of commercial relations, capital flows, as well as the increase of means of communication, introduction of new digital technologies, environmental changes and increasing migration of populations in search for better living and working conditions(¹).

Within a global scenario with fast changes, the transformation of health and disease standards, the understanding of social and economic health determinants and the diversity of institutional agents led to the redefinition of the global health concept. Global health is thus characterized by the emphasis on equity based on human rights and the right for health as a social right, in a dynamic view of development and the role to be performed by communities, healthcare professionals and each person individually in this process.

There is, therefore, a need to understand the broader health determinants and limitations from a governmental perspective(²), which also considers the different agents of the international community, based on acknowledgement and the search for understanding the relevant differences of power and interests that rule these relations. This comprehensive and complex view of global health, relating global and local contexts and their variables, results in a major challenge towards the training of healthcare professionals. In this view, two subjects are discussed in this study: nursing education and their skills and abilities to perform in global health.

NURSING EDUCATION IN GLOBAL HEALTH

Nursing education in global health requires connections, partnerships and many efforts beyond national boundaries(⁷). Therefore, there are still many challenges for strengthening this action. Mostly, the lack of knowledge on political, economic and social matters, associated to the scarcity of financial and technological resources, make the participation of these professionals in global matters difficult.

Traditionally, nursing education and practice are restricted to local realities. To be able to act globally, nurses must expand their performance conditions, understanding beyond their reality, which requires the involvement of nursing schools and their professors, as well as resource availability.

In this respect, the strengthening of nursing performance is of utmost importance for the education, research or care area, both at a local or global level(⁸). Additionally, most nursing curriculums are outdated, and nurses have not been prepared to perform globally(⁹), which requires changes on the paradigm of training of nurses, by means of structural adjustments of contents for proper education in global nursing(¹⁰).

In this view, education in global health in countries within North America have been strengthened in the last twenty years, focused on searching for answers to the needs for changes in the health area, which have been arisen as a globalization result. However, the insertion of global health into health courses curriculums, including nursing, has focused on the integration of eminently clinical subjects(¹¹).

Therefore, the main concern observed involves clinical subjects, focused on a curative conception of health care, such as absence of diseases. However, considering a broader conception of health, it is crucial that nursing professionals acquire theoretical and practical subsidies to understand their social determinants and limitations, and the economic, social, political and cultural aspects that influence health(¹²). It is worth mentioning again the role of universities in training these professionals, who must meet the challenge of breaking traditional models that only aim at clinical practice, and include in their curriculum framework the discussion of issues on citizenship, respect for differences, human rights and global health.

Consequently, this is a major challenge for nursing educators in the global health area. Although this discussion is still incipient in Brazil, it is important to outline the nursing curriculums for a performance that goes beyond the clinical aspect, enabling future nurses to reflect critically on their practice and to interact with other professions, based on a political understanding of their reality.

SKILLS AND ABILITIES OF NURSES TO PERFORM IN GLOBAL HEALTH

The increase of connectivity of relations resulting from globalization causes important implications for nursing and health care. The problems in health transcend national barriers and therefore, nurses must be prepared to deal with these challenges(¹³). Thus, nurses who perform in the global health area must be aware of their political responsibilities in a dynamic and complex movement called health diplomacy(¹⁴).

The practice performance is a major challenge, since it involves expansion of the innovative use of technologies, creative search for teaching/learning methods that deal with the complexity of the global environment, establishment of partnerships and development of networks involving students, different population groups and researchers, in order to enable future nurses to experience beyond their local boundaries and develop abilities to put their performance towards diversified cultural scenarios.

In order to act in global health, nurses must have knowledge on health system policies, their determinants and limitations, primary, secondary and tertiary care in health, besides global issues related to culture, epidemics, communicable and non-communicable diseases, epidemiology, humanitarian actions and emergencies(¹⁵), thus understanding the complexity of the health concept and not restricting it to the focus on diseases. Based on and strengthened by this knowledge, nurses have the potential to lead the development of politics and projects, as well as the establishment of internal and external partnerships that seek to deal with these issues.

In this respect, nursing is a professional category that interacts with several other subjects. In the globalization process, nurses may represent a significant figure, since they are part of an interdisciplinary healthcare team and cooperate with ideas and critical thoughts about several social, economic and health issues integrated into a global scenario.

Moreover, it is necessary to qualify professionals so they are able to deal with the information speed resulted from technological advances; professionals willing to face the difficult access to health observed in several countries; professionals performing within the perspective of healthy environment and sustainable development and with interpersonal abilities for the development of local and global partnerships.

CONCLUSION

Globalization caused changes that influenced global health issues. Within this context, nurses, as members of healthcare teams, must be able to deal with diplomatic, humanitarian, political, governmental and non-governmental issues. In this view, institutional curriculums must be prepared to approach aspects related to national and international policies and health diplomacy.

Therefore, the investment and expansion of studies, research and publications that seek to emphasize and encourage the potential participation of nurses in global health is needed. Universities represent a powerful tool for this end.

REFERÊNCIAS

• ¹
  Fortes PAC, Ribeiro H. Saúde global em tempos de globalização. Saúde Soc. 2014;23(2):366-75.
• ²
  Buss PM, Ferreira JR. Ensaio crítico sobre a cooperação internacional em saúde. Rev Eletr Comun Inf Inov Saúde. 2010;4(1):94-105.
• ³
  Kickbusch I, Berger C. Diplomacia da saúde global. Rev Eletr Comun Inf Inov Saúde. 2010;4(1):19-24.
• ⁴
  Kickbusch I, Lister G. European perspective on global health: a policy glossary. Brussels: European Foundation Centre. 2006 [citado 2015 jun 9]. Disponível em: http://apps.who.int/entity/km4ph/EFC_EPGH_GlobalHealthGlossary.pdf?ua=1
  » http://apps.who.int/entity/km4ph/EFC_EPGH_GlobalHealthGlossary.pdf?ua=1
• ⁵
  World Health Organization (CH). Global standards for the initial education of professional nurses and midwives [Internet]. Geneva (CH); 2009 [citado 2015 jun 9]. Disponível em: http://www.who.int/hrh/nursing_midwifery/hrh_global_standards_education.pdf
  » http://www.who.int/hrh/nursing_midwifery/hrh_global_standards_education.pdf
• ⁶
  Ventura CAA, Mendes IAC, Wilson LL, Godoy S, Tamí-Maury I, Zárate-Grajales R, et al. Competências em saúde global na visão de docentes de enfermagem de instituições de ensino superior brasileiras. Rev Latino-Am Enfermagem. 2014;22(2):179-86.
• ⁷
  Hanson, L. Global citizenship, global health, and the inter nationali-zation of curriculum a study of transformative potential. J Studies Int Educ. 2010;14(1):70-88.
• ⁸
  Silva AL. A Enfermagem na era da globalização: desafios para o século XXI. Rev Latino-Am Enfermagem. 2008;16(4):787-90.
• ⁹
  Turale, S. Technology and its impact on nursing education. J Nurs Science [Internet]. 2011 [citado 2015 out 20];29(1):9-17. Disponível em: http://www.ns.mahidol.ac.th/english/journal_NS/pdf/vol29/issue1/Sue.pdf
  » http://www.ns.mahidol.ac.th/english/journal_NS/pdf/vol29/issue1/Sue.pdf
• ¹⁰
  Turale S. Nursing and health policy perspectives: educating future nurses for global health. Int Nurs Rev [Internet]. 2015 [citado 2015 out 20];62(2):143. Disponível em: http://onlinelibrary.wiley.com/doi/10.1111/inr.12198/pdf
  » http://onlinelibrary.wiley.com/doi/10.1111/inr.12198/pdf
• ¹¹
  Bradbury JC. Globalization and its implications for health care and nursing practice. Nurs Stand. 2009;23(25):43-7.
• ¹²
  Breda KL. Qual o papel da enfermagem na saúde internacional e global? Texto Contexto Enferm. 2012;21(3):489-90.
• ¹³
  Labonté R, Gagnon ML. Framing health and foreign policy: lessons for global health diplomacy. Global Health. 2010;6(14):2-19.
• ¹⁴
  Hunter A, Wilson L, Stanhope M, Hatcher B, Hattar M, Hilfinger Messias DK, et al. Global health diplomacy: an integrative review of the literature and implications for nursing. Nurs Outlook.2013;61(2):85-92.
• ¹⁵
  Archambault N. Incorporating global health into 609 undergraduate nursing education. Vancouver: University of British Columbia; 2010.

Publication Dates

• Publication in this collection
  2015

History

• Received
  23 June 2015
• Accepted
  12 Nov 2015