Nurse Education Today 35 (2015) 653–656
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Contemporary Issue
Building global nurse capacity through relationships, education, and collaboration
Collaborating internationally, if done well, can be mutually beneficial to nursing faculty both at home and abroad. Global partnerships between faculty can address the nursing research gap (Amieva and Ferguson, 2012) and help to ease the global shortage of nurse faculty (Nardi and Gyurko, 2013). Partnerships have also been shown to develop global leaders (Blaney, 2012) and build international health workforce capacity (Lasater et al., 2012). How best can nurse educators collaborate with international partners for the benefit of the nursing profession and the people in their care? Carefully orchestrated global endeavors cultivate in students and faculty an attitude of cultural humility and global engagement while contributing to the international nursing community. Baylor University Louise Herrington School of Nursing (LHSON) has a long history of global engagement. A multifaceted investment of LHSON resources in nurses, researchers, faculty, and students in diverse global venues reveals an operationalized priority. India is an exemplar of an intentionally developed and expanding partnership. The partnership between the Rebekah Ann Naylor School of Nursing (RANSON) in Bengaluru, India and LHSON involves developing strengths in students and faculty from both countries in the areas of teaching, scholarship, and clinical care. Our purpose in this manuscript is to describe the process of developing an authentic and rich global partnership to build capacity in nurse faculty.
collaborative faculty development between RANSON and LHSON foundered, in part, due to lack of vision for how global engagement would build capacity for all involved. After several meetings between potential stakeholders it was recognized that it was time to build on the deep interconnection between the two schools. RANSON, in 2010, had been approved for a Bachelor of Science (BSc) degree in nursing and a new computer lab with internet access was available for the first time. An LHSON delegation was formed and the inaugural faculty trip in 2011 provided a perfect aligning of opportunity for the development and subsequent expansion of a meaningful partnership in a significant and well-timed way. Instrumental faculty members at LHSON and a medical librarian from Georgetown University had attended an International Network for Online Resources and Materials (INFORM) workshop to learn about health care related resources available in low and middle income countries (LMICs). It is precisely through carefully planned collaboration, building relationships, investing in common goals and creating infrastructure that faculty capacity can be built (Gillespie et al., 2010; Segrott et al., 2006). Providing education about relevant online resources was a foundational step in developing an equitable and collaborative relationship. Access to quality information enabled Indian students and faculty to move forward with their goals. In addition to online resource education a comprehensive five year plan was jointly created that included multifaceted faculty development workshops.
Background Theoretical Underpinnings The partnership between RANSON and LHSON has evolved over several decades. The first director of nursing in the 1970s of the RANSON affiliated Bangalore Baptist Hospital was Dr. Linda Garner, current Faculty Emeritus at Baylor University. In 2010, Dr. Lyn Prater was the Baylor University Sigma Theta Tau International representative who spoke at the graduation in India. During that visit personal and professional partnerships began to develop between Dr. Prater, Dr. Naylor, the medical director, and Leena Raj, Principal of RANSON. In global collaboration, not only finding but being the right partner at the right time is the key. In an overview on partnerships to build research capacity, Boland et al. (2010) explained that implementation is best achieved through relationships. A variety of components were identified over the years and a sustainable global partnership evolved between LHSON and RANSON. These components are listed in Table 1 to provide useful and pragmatic tips for faculty interested in seeking an international collaboration. These key recommendations may help faculty avoid cultural pitfalls, misunderstanding, and faux pas. Initial efforts for increasing
http://dx.doi.org/10.1016/j.nedt.2015.01.014 0260-6917/© 2015 Elsevier Ltd. All rights reserved.
Our collaborative work was guided by the middle-range nursing intellectual capital (NIC) theory. Covell (2008) the developer of this theory postulates that it is nursing human capital, defined as the nurses' knowledge, skills, experience, and expertise that significantly influences patient and institutional outcomes. The NIC theory was selected because it provides a framework that can be used to consider the added value of intangible components. Relevant exemplars would include Reidinger's (2010) use of the NIC theory in her dissertation research on mentoring or Davidson's (2007) application in her research on positive practice environments. Covell's theory provides a way to consider the intrinsic benefits in global collaboration to enrich practice and enhance teaching that would be difficult to empirically measure. Nursing human capital can be strengthened by investments such as continuing professional development (Covell, 2009). The improved outcomes that occur with capacity building activities such as better quality of patient care and fewer adverse events are products of investments in nurses (Covell, 2008;
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Contemporary Issue
Table 1 Components of global capacity building. • Establish mutual priorities early in cooperative effort • Collaborate and set goals that address needs in a bilateral and balanced manner (George and Meadows-Oliver, 2013) • Consider the distribution of power and strive for egalitarian efforts and intentional encouragement of all involved to contribute ideas (Bender et al., 2011) Commit to strategic investments • Identify critical resources i.e. time, knowledge, and experience • Determine the best use of resources to build capacity • Prioritize sustainability by investments in nursing human capital (Covell, 2008; Ogilvie et al., 2003) Promote cultural humility • Commit to an ongoing process of self-reflection and self-critique • Be willing to accurately assess oneself and one's limitations • Acknowledge gaps in one's knowledge • Have an openness to new ideas (Tangney, 2000) • Use partner centered interview techniques • Explore each other's values, priorities and goals (Tervalon and Murry-Garcia, 1998) Maintain flexibility and • Explore low cost alternatives such as drop adaptability boxes and email or video conferencing, when face-to-face communication is not possible • Be cognizant of international time difference • Understand disparities in workloads, particularly for faculty practicing in LMICs (Muula, 2010) • Adapt graciously to needed changes in workshop schedules or research timelines, particularly when on-site at a host facility Reflective practice and revision • Develop or choose a framework for reflective practice such as Ash and Clayton (2009) • Provide orientation on the framework and distribute materials for reflection such as journals, templates, photographs, or audio recorders • Incorporate reflection from planning to implementation • Set up a drop box for team members to share reflections and provide a confidential way for reflections to be sent to the team leader if the team member wishes • Hold post-trip debriefing to critically review reflections and revise future trips for improvement Develop relationships & establish mutually beneficial goals
Building Teaching Capacity The majority of the Indian faculty did not have experience using technology to augment lectures nor were many of them comfortable with internet searches. The hands-on computer segment proved especially helpful in building confidence and increasing skills for utilizing information and preparing interactive presentations. Evidence on how to move didactic content from lectures to a more critical pedagogy was presented (Mikol, 2005). The librarian facilitated access to the Health InterNetwork Access to Research Initiative (HINARI). This is a program designed by the World Health Organization as a source for LMICs to obtain biomedical information (WHO, 2014). Participatory teaching and learning approaches were used in the workshops to build teaching capacity. For example, RANSON faculty chose a teaching topic and enhanced it using internet search applications and new teaching modalities. This assignment was announced on the first day of the workshop so that faculty would have time to prepare and work with the librarian. The objectives created by the RANSON faculty were well written, teaching methodologies were diverse, and the participants clearly succeeded in applying topics from the workshop. Another interactive workshop focused on developing unfolding problem based case studies. Each year the workshop ended with a time of feedback and debriefing where participants discussed their interests for future workshops. Additional objective are outlined in Table 2.
Building Research Capacity In 2012, during an educational capacity building workshop, the RANSON faculty requested an impromptu class on systematic reviews. Their genuine interest in research was palpable during the spontaneous session where RANSON faculty used the HINARI library link in search of systematic reviews. This exchange led to a dialogue on the possibility of a future collaborative research study between the two schools. Later that day, the Principal at RANSON gave a presentation to the LHSON visiting faculty on the contemporary issues that nurses face in India. She cited the nursing shortage as an ongoing challenge that contributes to health disparities in India. This presentation was the impetus for a research partnership between LHSON and RANSON to explore issues related to nurse migration from India to wealthier nations.
Table 2 Workshop objectives.
Covell and Sidani, 2013). The LHSON investment in nurse faculty and students at RANSON aims to increase nursing human capital, student learning, and patient care. The RANSON's reciprocal investment was foundational for the success of this project.
Faculty Development The faculty role consists of three major areas: teaching, research, and service. With a goal to build teacher capacity for the newly instituted BSc in nursing, topics for the workshops to enhance the role of the teacher were mutually chosen. Gillespie et al. (2010) highlight meeting local needs rather than pressing a USA based agenda. The workshops were formatted so that in addition to providing information, presenters intentionally role modeled teaching strategies. The Indian faculty enthusiastically participated in all discussion and activities.
2011 1. Apply course development strategies including teaching methods for baccalaureate nursing students. 2. Synthesize principles of critical thinking. 3. Assess counseling needs of nursing students. 4. Utilize internet resources for teaching baccalaureate students. 2012 1. Apply concepts of evidence-based practice to the educational preparation of baccalaureate nursing students. 2. Utilize problem case based learning as a teaching strategy for baccalaureate nursing students. 3. Learn to evaluate an evidence based practice or nursing research journal article using a journal of the month club format. 4. Synthesize principles related to change theory as it relates to nursing practice. 5. Develop critical thinking test items for use in the baccalaureate nursing program. 6. Examine the components of evidence based spiritual nursing care. 7. Identify current trends in national healthcare. 2013 1. Apply concepts related to promoting servant leadership among faculty and students. 2. Utilize the concept of stress reduction among nursing students and nurses. 3. Incorporate strategies for giving feedback to students. 4. Synthesize principles related to communication in nursing education.
Contemporary Issue
The trusting relationship between the faculty contributed to an open exchange of ideas. According to Muula (2010), limited resources, lack of time, and a heavy teaching load contribute to a scarcity of research in LMICs. Despite these challenges, faculty at RANSON were interested in a partnership to pursue a program of scholarship. An electronic drop box was used to exchange articles as a literature review was compiled on nurse out migration and the contemporary issues faced by nurses in India. The team planned a participatory action research study to assess the perceived challenges and rewards of nursing by nursing students in Bengaluru, India. This became a foundational step for our collaborative research. Students from LHSON were recruited as research assistants and were included in our third trip to India. After 18 months of collaborative planning, training, implementation, and data analysis, the study culminated with two manuscripts accepted for publication, co-authored by the RANSON and LHSON faculty. The subjective and objective viewpoints of the international research team strengthened the research study. Although the implementation of the research took place in India, much of the discussion related to qualitative content analysis of focus group transcripts and field notes took place via email communications. This was at times challenging due to the time differences and limitations of working by email. Hierarchal charts containing condensed meaningful text, coded data, and thematic interpretation were exchanged. In addition to the journal publications, two abstracts related to this study were also accepted for oral presentations at international conferences to disseminate the study findings. One conference offered a scholarship to individuals from LMICs that will help fund a trip for one of the RANSON researchers to visit the United States to present at the conference and further our international research efforts.
Building Service Capacity Although we sought to build faculty capacity in service by presenting a workshop session on servant leadership, we quickly realized that the RANSON faculty were already embedded in service to their students, community, and nursing profession. The hospitality that they displayed and their eagerness to implement their teaching and research skills were living examples of their commitment to service for others. Through their service, they gave our faculty and students an opportunity for global engagement and taught us lessons in cultural humility. Cultural humility has been described as a lifelong process of self-reflection and self-critique which does not have an end point but is on a continuum (Tervalon and Murry-Garcia, 1998; Tangney, 2000). Humility is a necessary part of the dynamics required to build mutually respectful and fluid partnerships (Tervalon and Murry-Garcia, 1998). Rather than focusing on a partner's belief system, reflection should focus on the individual's assumptions and beliefs (California Health Advocates, 2007). Prior to traveling to India meetings were held between LHSON faculty and participating students, not only to explore the Indian culture but for lessons in self-reflection and journaling. The Ash and Clayton (2009) model for reflective journaling was used for this preparation. Time was spent reading Indian journals, books on India written by Indians, and internet sites for cultural norms. Special attention was paid to appropriate dress, safe travel and food, and interactions with Indian professionals. We learned how important it was both culturally and socially to incorporate tea breaks both in the morning and afternoon. Even with this preparation we did not get it all right. While we chose modest attire, our blouses were not tunic style, which is an important element of their dress (Viharini, 2012). Lessons learned were incorporated into future trips and used to improve our cultural humility.
655
Conclusion Our primary purpose in developing this manuscript was to bring clarity to building capacity through global partnership. Freshwater et al. (2006) emphasize the importance of international collaborations in unifying organizations with the common goal of promoting health related activities and research across international boundaries. These activities can aid in bridging the gap between theory and practice and result in effective change in nursing practice to improve global health outcomes. Our partnership has developed over the last several years into one of mutual respect and friendship. The faculty at RANSON have been excited to show us how they have incorporated evidencebased teaching and learning strategies into their curriculum. We meet as colleagues and share lived experience with each other. Student issues seem universal. It is not uncommon for us to talk over tea and share similar stories. Being humble and earnestly wanting to learn from each other provided a platform to begin building our partnership. These opportunities allow us to grow as faculty members and provide us with a better understanding of our diverse student populations. Including students on these trips has provided opportunities for them to look at the world through a different lens and to potentially become leaders in a global society. Educating the mind without educating the heart is no education at all. [Aristotle]
References Amieva, S., Ferguson, S., 2012. Moving forward: nurses are key to achieving the United Nations Development Program's Millennium Development Goals. Int. Nurs. Rev. 59 (1), 55–58. http://dx.doi.org/10.1111/j.1466-7657.2011.00944.x. Ash, S.L., Clayton, P.H., 2009. Generating, deepening, and documenting learning: the power of critical reflection in applied learning. J. Appl. Learn. High. Educ. 1, 25–48 (Retrieved from http://webii.eckerd.edu/qep/faculty/files/Ash_Clayton_Generating_ Deepening_and_Documenting_Learning.pdf). Bender, A., Guruge, S., Aga, F., Hailemariam, D., Hyman, I., Tamiru, M., 2011. International research collaboration as social relation: an Ethiopian–Canadian example. Can. J. Nurs. Res. 43 (2), 62–75 (Retrieved from http://www.ingentaconnect.com/ content/mcgill/cjnr/2011/00000043/00000002/art00006). Blaney, P., 2012. Senior nursing leadership—capacity building at the global level. Int. Nurs. Rev. 59 (1), 40–47. http://dx.doi.org/10.1111/j.1466-7657.2011.00953.x. Boland, M.G., Kamikawa, C., Inouye, J., Latimer, R.W., Marshall, S., 2010. Partnership to build research capacity. Nurs. Econ. 28, 314–336. California Health Advocates, 2007. Are You Practicing Cultural Humility? — The Key to Success in Cultural Competence. (Retrieved from https://www.cahealthadvocates. org/news/disparities/2007/are-you.html). Covell, C.L., 2008. The middle-range theory of nursing intellectual capital. J. Adv. Nurs. 63, 94–103. http://dx.doi.org/10.1111/j.1365-2648.2008.04626.x. Covell, C.L., 2009. Outcomes achieved from organizational investment in nursing continuing professional development. J. Nurs. Adm. 39 (10), 438–443. http://dx.doi.org/10. 1097/NNA.0b013e3181b92279. Covell, C.L., Sidani, S., 2013. Nursing intellectual capital theory: implications for research and practice. Online J. Issues Nurs. 18 (2) (Retrieved from http://www. nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/ TableofContents/Vol-18-2013/No2-May-2013/Nursing-Intellectual-CapitalTheory.html). Davidson, D., 2007. Strength in nursing leadership: the key to the evolution of intellectual capital in nursing. Nurs. Adm. Q. 31 (1), 36–42. Freshwater, D., Sherwood, G., Drury, V., 2006. International research collaboration: issues, benefits and challenges of the global network. J. Res. Nurs. 11, 295–303. http://dx.doi. org/10.1177/1744987106066304. George, E., Meadows-Oliver, M., 2013. Searching for collaboration in international nursing partnerships: a literature review. Int. Nurs. Rev. 60 (1), 31–36. http://dx.doi.org/10. 1111/j.1466-7657.2012.01034.x. Gillespie, K.H., Robertson, D.L., Bergquist, W.H., 2010. A Guide to Faculty Development. Jossey-Bass, San Francisco, CA. Lasater, K., Upvall, M., Nielsen, A., Prak, M., Ptachcinski, R., 2012. Global partnerships for professional development: a Cambodian exemplar. J. Prof. Nurs. 28 (1), 62–68. http://dx.doi.org/10.1016/j.profnurs.2011.10.002. Mikol, C., 2005. Teaching nursing without lecturing: critical pedagogy as communicative dialogue. Nurs. Educ. Perspect. 26, 86–89. Muula, A.S., 2010. Goodbye collaboration, welcome partnerships in international research. Croat. Med. J. 51, 359–360. http://dx.doi.org/10.3325/cmj.2010.51. 359.
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Nardi, D.A., Gyurko, C.C., 2013. The global nursing faculty shortage: status and solutions for change. J. Nurs. Scholarsh. 45 (3), 317–326. http://dx.doi.org/10. 1111/jnu.12030. Ogilvie, L., Allen, M., Laryea, J., Opare, M., 2003. Building capacity through a collaborative international nursing project. J. Nurs. Scholarsh. 35 (2), 113–118. http://dx.doi.org/ 10.1111/j.1547-5069.2003.00113.x. Reidinger, G., 2010. The Preservation of Intellectual Capital of Nurses Working in the Community Hospital. (Doctoral dissertation), (Retrieved from Digital commons @ Olivet. http://digitalcommons.olivet.edu/cgi/viewcontent.cgi? article=1010&context=edd_diss). Segrott, J., McIvor, M., Green, B., 2006. Challenges and strategies in developing nursing research capacity: a review of the literature. Int. J. Nurs. Stud. 43, 637–651. http://dx. doi.org/10.1016/j.ijnurstu.2005.07.011. Tangney, J.P., 2000. Humility: theoretical perspectives, empirical findings and directions for future research. J. Soc. Clin. Psychol. 19, 70–82. http://dx.doi.org/10.1521/jscp. 2000.19.1.70. Tervalon, M., Murry-Garcia, J., 1998. Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. J. Health Care Poor Underserved 9, 117–125. Viharini, J.D., 2012. Enjoying India: The Essential Handbook. Tara Satara Press, Fairfield, Iowa. World Health Organization, 2014. HINARI Access to Research in Health Programme. Retrieved from. http://www.who.int/hinari/en/.
Lori A. Spies* Lori A. Spies1 Shelby L. Garner2 Lyn Prater3 Baylor University, Louise Herrington School of Nursing, 3700 Worth Street, Dallas, TX 75246, USA ⁎Corresponding author. Tel.: +1 469 964 8355 (cell); fax: +1 214 820 3361. E-mail addresses: [email protected]. [email protected]. [email protected]. [email protected].
1 2 3
Tel.: +1 214 820 4179 (work); fax: +1 214 820 3375. Tel.: +1 469 585 8823 (cell); fax: +1 214 820 3375. Tel.: +1 214 326 8864 (cell); fax: +1 214 820 3375.
Contents lists available at ScienceDirect
Nurse Education Today journal homepage: www.elsevier.com/nedt
Contemporary Issue
Building global nurse capacity through relationships, education, and collaboration
Collaborating internationally, if done well, can be mutually beneficial to nursing faculty both at home and abroad. Global partnerships between faculty can address the nursing research gap (Amieva and Ferguson, 2012) and help to ease the global shortage of nurse faculty (Nardi and Gyurko, 2013). Partnerships have also been shown to develop global leaders (Blaney, 2012) and build international health workforce capacity (Lasater et al., 2012). How best can nurse educators collaborate with international partners for the benefit of the nursing profession and the people in their care? Carefully orchestrated global endeavors cultivate in students and faculty an attitude of cultural humility and global engagement while contributing to the international nursing community. Baylor University Louise Herrington School of Nursing (LHSON) has a long history of global engagement. A multifaceted investment of LHSON resources in nurses, researchers, faculty, and students in diverse global venues reveals an operationalized priority. India is an exemplar of an intentionally developed and expanding partnership. The partnership between the Rebekah Ann Naylor School of Nursing (RANSON) in Bengaluru, India and LHSON involves developing strengths in students and faculty from both countries in the areas of teaching, scholarship, and clinical care. Our purpose in this manuscript is to describe the process of developing an authentic and rich global partnership to build capacity in nurse faculty.
collaborative faculty development between RANSON and LHSON foundered, in part, due to lack of vision for how global engagement would build capacity for all involved. After several meetings between potential stakeholders it was recognized that it was time to build on the deep interconnection between the two schools. RANSON, in 2010, had been approved for a Bachelor of Science (BSc) degree in nursing and a new computer lab with internet access was available for the first time. An LHSON delegation was formed and the inaugural faculty trip in 2011 provided a perfect aligning of opportunity for the development and subsequent expansion of a meaningful partnership in a significant and well-timed way. Instrumental faculty members at LHSON and a medical librarian from Georgetown University had attended an International Network for Online Resources and Materials (INFORM) workshop to learn about health care related resources available in low and middle income countries (LMICs). It is precisely through carefully planned collaboration, building relationships, investing in common goals and creating infrastructure that faculty capacity can be built (Gillespie et al., 2010; Segrott et al., 2006). Providing education about relevant online resources was a foundational step in developing an equitable and collaborative relationship. Access to quality information enabled Indian students and faculty to move forward with their goals. In addition to online resource education a comprehensive five year plan was jointly created that included multifaceted faculty development workshops.
Background Theoretical Underpinnings The partnership between RANSON and LHSON has evolved over several decades. The first director of nursing in the 1970s of the RANSON affiliated Bangalore Baptist Hospital was Dr. Linda Garner, current Faculty Emeritus at Baylor University. In 2010, Dr. Lyn Prater was the Baylor University Sigma Theta Tau International representative who spoke at the graduation in India. During that visit personal and professional partnerships began to develop between Dr. Prater, Dr. Naylor, the medical director, and Leena Raj, Principal of RANSON. In global collaboration, not only finding but being the right partner at the right time is the key. In an overview on partnerships to build research capacity, Boland et al. (2010) explained that implementation is best achieved through relationships. A variety of components were identified over the years and a sustainable global partnership evolved between LHSON and RANSON. These components are listed in Table 1 to provide useful and pragmatic tips for faculty interested in seeking an international collaboration. These key recommendations may help faculty avoid cultural pitfalls, misunderstanding, and faux pas. Initial efforts for increasing
http://dx.doi.org/10.1016/j.nedt.2015.01.014 0260-6917/© 2015 Elsevier Ltd. All rights reserved.
Our collaborative work was guided by the middle-range nursing intellectual capital (NIC) theory. Covell (2008) the developer of this theory postulates that it is nursing human capital, defined as the nurses' knowledge, skills, experience, and expertise that significantly influences patient and institutional outcomes. The NIC theory was selected because it provides a framework that can be used to consider the added value of intangible components. Relevant exemplars would include Reidinger's (2010) use of the NIC theory in her dissertation research on mentoring or Davidson's (2007) application in her research on positive practice environments. Covell's theory provides a way to consider the intrinsic benefits in global collaboration to enrich practice and enhance teaching that would be difficult to empirically measure. Nursing human capital can be strengthened by investments such as continuing professional development (Covell, 2009). The improved outcomes that occur with capacity building activities such as better quality of patient care and fewer adverse events are products of investments in nurses (Covell, 2008;
654
Contemporary Issue
Table 1 Components of global capacity building. • Establish mutual priorities early in cooperative effort • Collaborate and set goals that address needs in a bilateral and balanced manner (George and Meadows-Oliver, 2013) • Consider the distribution of power and strive for egalitarian efforts and intentional encouragement of all involved to contribute ideas (Bender et al., 2011) Commit to strategic investments • Identify critical resources i.e. time, knowledge, and experience • Determine the best use of resources to build capacity • Prioritize sustainability by investments in nursing human capital (Covell, 2008; Ogilvie et al., 2003) Promote cultural humility • Commit to an ongoing process of self-reflection and self-critique • Be willing to accurately assess oneself and one's limitations • Acknowledge gaps in one's knowledge • Have an openness to new ideas (Tangney, 2000) • Use partner centered interview techniques • Explore each other's values, priorities and goals (Tervalon and Murry-Garcia, 1998) Maintain flexibility and • Explore low cost alternatives such as drop adaptability boxes and email or video conferencing, when face-to-face communication is not possible • Be cognizant of international time difference • Understand disparities in workloads, particularly for faculty practicing in LMICs (Muula, 2010) • Adapt graciously to needed changes in workshop schedules or research timelines, particularly when on-site at a host facility Reflective practice and revision • Develop or choose a framework for reflective practice such as Ash and Clayton (2009) • Provide orientation on the framework and distribute materials for reflection such as journals, templates, photographs, or audio recorders • Incorporate reflection from planning to implementation • Set up a drop box for team members to share reflections and provide a confidential way for reflections to be sent to the team leader if the team member wishes • Hold post-trip debriefing to critically review reflections and revise future trips for improvement Develop relationships & establish mutually beneficial goals
Building Teaching Capacity The majority of the Indian faculty did not have experience using technology to augment lectures nor were many of them comfortable with internet searches. The hands-on computer segment proved especially helpful in building confidence and increasing skills for utilizing information and preparing interactive presentations. Evidence on how to move didactic content from lectures to a more critical pedagogy was presented (Mikol, 2005). The librarian facilitated access to the Health InterNetwork Access to Research Initiative (HINARI). This is a program designed by the World Health Organization as a source for LMICs to obtain biomedical information (WHO, 2014). Participatory teaching and learning approaches were used in the workshops to build teaching capacity. For example, RANSON faculty chose a teaching topic and enhanced it using internet search applications and new teaching modalities. This assignment was announced on the first day of the workshop so that faculty would have time to prepare and work with the librarian. The objectives created by the RANSON faculty were well written, teaching methodologies were diverse, and the participants clearly succeeded in applying topics from the workshop. Another interactive workshop focused on developing unfolding problem based case studies. Each year the workshop ended with a time of feedback and debriefing where participants discussed their interests for future workshops. Additional objective are outlined in Table 2.
Building Research Capacity In 2012, during an educational capacity building workshop, the RANSON faculty requested an impromptu class on systematic reviews. Their genuine interest in research was palpable during the spontaneous session where RANSON faculty used the HINARI library link in search of systematic reviews. This exchange led to a dialogue on the possibility of a future collaborative research study between the two schools. Later that day, the Principal at RANSON gave a presentation to the LHSON visiting faculty on the contemporary issues that nurses face in India. She cited the nursing shortage as an ongoing challenge that contributes to health disparities in India. This presentation was the impetus for a research partnership between LHSON and RANSON to explore issues related to nurse migration from India to wealthier nations.
Table 2 Workshop objectives.
Covell and Sidani, 2013). The LHSON investment in nurse faculty and students at RANSON aims to increase nursing human capital, student learning, and patient care. The RANSON's reciprocal investment was foundational for the success of this project.
Faculty Development The faculty role consists of three major areas: teaching, research, and service. With a goal to build teacher capacity for the newly instituted BSc in nursing, topics for the workshops to enhance the role of the teacher were mutually chosen. Gillespie et al. (2010) highlight meeting local needs rather than pressing a USA based agenda. The workshops were formatted so that in addition to providing information, presenters intentionally role modeled teaching strategies. The Indian faculty enthusiastically participated in all discussion and activities.
2011 1. Apply course development strategies including teaching methods for baccalaureate nursing students. 2. Synthesize principles of critical thinking. 3. Assess counseling needs of nursing students. 4. Utilize internet resources for teaching baccalaureate students. 2012 1. Apply concepts of evidence-based practice to the educational preparation of baccalaureate nursing students. 2. Utilize problem case based learning as a teaching strategy for baccalaureate nursing students. 3. Learn to evaluate an evidence based practice or nursing research journal article using a journal of the month club format. 4. Synthesize principles related to change theory as it relates to nursing practice. 5. Develop critical thinking test items for use in the baccalaureate nursing program. 6. Examine the components of evidence based spiritual nursing care. 7. Identify current trends in national healthcare. 2013 1. Apply concepts related to promoting servant leadership among faculty and students. 2. Utilize the concept of stress reduction among nursing students and nurses. 3. Incorporate strategies for giving feedback to students. 4. Synthesize principles related to communication in nursing education.
Contemporary Issue
The trusting relationship between the faculty contributed to an open exchange of ideas. According to Muula (2010), limited resources, lack of time, and a heavy teaching load contribute to a scarcity of research in LMICs. Despite these challenges, faculty at RANSON were interested in a partnership to pursue a program of scholarship. An electronic drop box was used to exchange articles as a literature review was compiled on nurse out migration and the contemporary issues faced by nurses in India. The team planned a participatory action research study to assess the perceived challenges and rewards of nursing by nursing students in Bengaluru, India. This became a foundational step for our collaborative research. Students from LHSON were recruited as research assistants and were included in our third trip to India. After 18 months of collaborative planning, training, implementation, and data analysis, the study culminated with two manuscripts accepted for publication, co-authored by the RANSON and LHSON faculty. The subjective and objective viewpoints of the international research team strengthened the research study. Although the implementation of the research took place in India, much of the discussion related to qualitative content analysis of focus group transcripts and field notes took place via email communications. This was at times challenging due to the time differences and limitations of working by email. Hierarchal charts containing condensed meaningful text, coded data, and thematic interpretation were exchanged. In addition to the journal publications, two abstracts related to this study were also accepted for oral presentations at international conferences to disseminate the study findings. One conference offered a scholarship to individuals from LMICs that will help fund a trip for one of the RANSON researchers to visit the United States to present at the conference and further our international research efforts.
Building Service Capacity Although we sought to build faculty capacity in service by presenting a workshop session on servant leadership, we quickly realized that the RANSON faculty were already embedded in service to their students, community, and nursing profession. The hospitality that they displayed and their eagerness to implement their teaching and research skills were living examples of their commitment to service for others. Through their service, they gave our faculty and students an opportunity for global engagement and taught us lessons in cultural humility. Cultural humility has been described as a lifelong process of self-reflection and self-critique which does not have an end point but is on a continuum (Tervalon and Murry-Garcia, 1998; Tangney, 2000). Humility is a necessary part of the dynamics required to build mutually respectful and fluid partnerships (Tervalon and Murry-Garcia, 1998). Rather than focusing on a partner's belief system, reflection should focus on the individual's assumptions and beliefs (California Health Advocates, 2007). Prior to traveling to India meetings were held between LHSON faculty and participating students, not only to explore the Indian culture but for lessons in self-reflection and journaling. The Ash and Clayton (2009) model for reflective journaling was used for this preparation. Time was spent reading Indian journals, books on India written by Indians, and internet sites for cultural norms. Special attention was paid to appropriate dress, safe travel and food, and interactions with Indian professionals. We learned how important it was both culturally and socially to incorporate tea breaks both in the morning and afternoon. Even with this preparation we did not get it all right. While we chose modest attire, our blouses were not tunic style, which is an important element of their dress (Viharini, 2012). Lessons learned were incorporated into future trips and used to improve our cultural humility.
655
Conclusion Our primary purpose in developing this manuscript was to bring clarity to building capacity through global partnership. Freshwater et al. (2006) emphasize the importance of international collaborations in unifying organizations with the common goal of promoting health related activities and research across international boundaries. These activities can aid in bridging the gap between theory and practice and result in effective change in nursing practice to improve global health outcomes. Our partnership has developed over the last several years into one of mutual respect and friendship. The faculty at RANSON have been excited to show us how they have incorporated evidencebased teaching and learning strategies into their curriculum. We meet as colleagues and share lived experience with each other. Student issues seem universal. It is not uncommon for us to talk over tea and share similar stories. Being humble and earnestly wanting to learn from each other provided a platform to begin building our partnership. These opportunities allow us to grow as faculty members and provide us with a better understanding of our diverse student populations. Including students on these trips has provided opportunities for them to look at the world through a different lens and to potentially become leaders in a global society. Educating the mind without educating the heart is no education at all. [Aristotle]
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Lori A. Spies* Lori A. Spies1 Shelby L. Garner2 Lyn Prater3 Baylor University, Louise Herrington School of Nursing, 3700 Worth Street, Dallas, TX 75246, USA ⁎Corresponding author. Tel.: +1 469 964 8355 (cell); fax: +1 214 820 3361. E-mail addresses: [email protected]. [email protected]. [email protected]. [email protected].
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Tel.: +1 214 820 4179 (work); fax: +1 214 820 3375. Tel.: +1 469 585 8823 (cell); fax: +1 214 820 3375. Tel.: +1 214 326 8864 (cell); fax: +1 214 820 3375.
