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Global nursing: the Dance between Health and Development


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Global Nursing and Healthcare Considerations
Chronic Noncommunicable disease
Global Health Bodies
Humanitarian, grassroots global organizations
International organizations

Published in: Health & Medicine, Education
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Global nursing: the Dance between Health and Development

  1. 1. from the Bush to the BoardroomGlobal Healthcare2013NURS 483Issues in ProfessionalNursingMary Ellen Ciptak RN PsyDMUSIC by ZAHARA
  2. 2. NURS 482MALSOW’S HEIRARCHY OF NEEDSIndividual, Economic and Societal• sub-Saharan Africa- maternal death: 1 in 39 births• sub-Saharan Africa- child deaths: 1 in 9 (under 5 years)• 800 preventable pregnacy and childbirth deaths dailyDepression: leading cause of years lost due to disability• the burden is 50% higher for females than for malesLife Expectancy:• Zambia 37, Malawi 47, Lesotho 48, Afghanistan 48• Mozambique 49, Sierra Leone 49, Zimbabwe 49, Chad 47• India 65, Iraq 66, Oman 74, United States 79, Norway 81• Singapore 82, Israel 82, San Marino 83THE DANCE BETWEEN HEALTH AND DEVELOPMENT
  3. 3. NCDs cause 63% of global deaths, and are largely preventableNURS 482Cautionary ChronicChronic, noncommunicable disease (NCD): A GlobalCrisis• Low and middle income countries have 80% of deaths.• By 2015 ~ 2.3 billion adults will be overweight.• 700 million will be obese.• Diabetes increased 70% in last 10 years.• By 2020, estimated 10% of all deaths will be from smoking.• Elimination of risk factors can prevent 75% of all heart disease, strokeand type 2 diabetes, with a cancer decrease of 40%.Health.ion 2011 Reprinted 2011
  4. 4. Global Health IndicatorsNURS 482Millennium DevelopmentGoals.Built on IMHE’s DAH and GHE.To achieve by 2015.• Eradicate extreme povertyand hunger• Achieve universal primaryeducation• Promote gender equality• Reduce child mortality• Combat HIV/AIDS, malariaand other communicable andnon communicable diseases• Ensure environmentalsustainability• Develop global partnership fordevelopment.MDG 8IMHEWHO. Disability-adjusted lifeyears (DALYs). How manyyear of life lost through deathand disability.• Valid, impartial andconsistent estimates ofdisease occurrence andinjury for all 21 regions of theworld• Cause-specific mortality byregion: estimating globalmortality• Calculate the health stateseverity weight (who ishealthier: a blind person or achronic pain person?)• Estimate years lived withdisability (YLD), years of lifelost (YLL)Burden of DiseaseInstitute for Health Metricsand EvaluationUniversity of Washington. Seattle,USAFocus:• Major world health problems anddisease• Is society addressing theseissues?• How best to commit healthresourses to maximize healthimprovement?IMHE: tracks >$200 billion ofprivate and public contributionsannuallyOnly 12 of top 20 countries with highest disease burden receive the mostdevelopment assistance for health (DAH) and government healthexpenditure (GHE). Remaining 8 countries are middle income.Health Metrics and Evaluation. 2010. IMHE.Financing Global Health 2012: End of a Golden Age? IMHE.Millennium Development goals. MDGs. IMHE.
  5. 5. Your LogoGlobal Health Indicators• Direct phenomena - death and disease– Developing countries maintain poor records• Indirect measures - poverty, education, social cohesionand stability• Water and sanitation• Behavior and lifestyle-alcohol, smoking, diet, exerciseCharacteristics for high, medium and low burden of disease
  6. 6. NURS 482Global Health BodiesDonor governmentsNational governmentsBilateral development agenciesMultinational governmentsFoundationsNon-governmental agenciesCorporationsAcademic institutions
  7. 7. NURS 482Continent with majority of poor counties. This regionaccounts for 67%-71% deaths in the world.DAH per US dollar- varies from $1 a day to $75.00 a day,depending on country, not the disease.Research and DevelopmentVaccinesPublic Project, Public GoodsMiddle East disbursements decreased by 8.1%($519 million total allocation)Improved from a loss of 70.8% in 1990. Moretransparency, improved reporting andallocation.1999-2012Development Assistance for Health (DAH)SubUnallocatedfunds36.4% annuallyGlobal$3.5 BillionSub-SaharanAfrica 24% DAH$8.1 Billion.
  8. 8. • Zimbabwe, 2009. Most nursing and medical schools suspended programs due to lackof adequate facilities, support, supplies.Only dental technician school closed their doors. Little improvement today.• South African-Cuban Health Cooperation AgreementCuba trains S.A. MD’s for rural sector. One in 5 MD’s within 5 years of graduation migrates out ofthe country.• Aid is allocated to specific illnesses rather than general healthcare.• Two to three healthcare workers/1000Africa has 24% of global disease burden, and has only 1% of total global health funding.• Brain drain: RN’s leave for a living wage, better working conditions, better equipment,and better education.• Medical Education Partnership Initiative (MEPI). Training and retention.Healthcare conditions in Africa
  9. 9. Interpersonal, educational and societal growth potentialsWhy volunteer globally?Understanding that nurses have the power to changeGreater understanding of vulnerable populationsLearned cultural sensititvies and perspectivesRenewed passion in nursing professionExposure to ethics, policy, social justice and politicsCognitive developmentPositive global and local influence on colleaguesNURS 482
  10. 10. Chronic, noncommunicable diseases (NCDs):A nursing perspective• Representative survey of 1600 nurses in 8 countries.• 95% said they wanted to use time and knowledge towardsprevention and education of NCDs.• 98% said that to work load and time pressures prevent them fromdevoting more time.• Work and environment issues need to be addressed so that first linehealthcare providers can maximize their potential.Decola, P., Benton, D., Peterson, C. & Matebeni, D. (2012) International Nursing ReviewNURS 482
  11. 11. NURS 482International OrganizationsNursing, applied research, educationGLOBAL HEALTH COUNCILEvidence based approach to global health. Excellent publications and monthly magazine. Funded by Department ofState international Affairs and the Department of Health and Human ServicesFOGARTY INTERNATIONAL CENTER (NIH)• Supports applied research, clinical training through grants and fellowships.INTERNATIONAL COUNCIL OF NURSES (ICN)• > 130 national nurses associations worldwide. Largest international healthcare organization.• 13 million members – seek to advance nursing and positively impact health policyINTERNATIONAL NETWORK FOR DOCTORAL EDUCATION IN NURSING (INDEN)• Curriculum development, program evaluation, collaborative research, innovation in doctoral education.GLOBAL RESEARCH NURSES. Part of Global Health Network.• Open to all RN’s interested international research.• Great resources and guidelines on prevention and management of diseaseAFRICAN HEALTH OER NETWORK (open educational resources)• South African Institute for Distance Learning (SAIDE)• Share video lectures, health information exchange, networking, e-learning, health IT workforce curriculum.
  12. 12. NURS 482Humanitarian, Grassroots OrganizationsVolunteer, Immersion and Educational Programs Johns Hopkins Centre for Global Health Johns Hopkins Center for Clinical Global Health Education Medecins Sans Frontieres / Doctors without Borders Global Health Immersion Programs. RN’s and MD’s. Excellent resource. World association of Non-governmental Organizations Peace Corps (Volunteer for 2 years, than eligible for any qualified Federal Job). PATH. Global healthcare advocacy, collaboration and education Global Volunteer Network-GVN. Charitable trust Cross Cultural Solutions International Volunteer HQ (IVHQ) Child Family Health International (CFHI) M.E.D.I.C.O. – Central America Mission of Mercy
  13. 13. INTERNATIONALHEALTHCARE INTERNET RESOURCESPitt.eduDuke.eduGlobalhealthlibrary.netFundisaforum.orgNURS 482FUNDISAForum of University Nursing Deans in SouthAfricaProvides excellence in nursing practice,research and education.AFRICAN HEALTH OER NETWORK(open educational resources)• South African Institute for DistanceLearning (SAIDE)• Share video lectures, health informationexchange, networking, e-learning, healthIT workforceGlobal Health LibrarySupercourse:Epidemiology, the Internet andGlobal HealthLectures, videos, publications. Over56,000 professionals in 174 countries.Library >5000 lectures in 31 languages.Exhaustive resource on global health,disease management, education andprevention.Call for a nursing Supercourse. Currentlyhas small dedicated nursing section.WHO-NIH-PITT.EDU SUPERCOURSE
  14. 14. NURS 482Global nursing ethical considerations• Affordable and sustainable• Culturally bound: Informed consent is moral and social collective, not an individual• African Autonomy? UBUNTU. I am because we are.• Be aware of any “colony” mentality: intimidation, paternalism, exploitation and power imbalance• Altruism and self interest balance• Psychological and spiritual distress awareness• Scarcity of resources: should the poor receive more allocation because of need?• Cannot ignore political influence and social impact• Researching on children-special considerations• Resources:– Council for International Organizations of Medical Ethics– World Medical Association– Integrated Regional Information Networks (IRIN)Autonomy, non-maleficence, beneficence and distributive justice
  15. 15. ConclusionNursing in a global economyGlobal healthcare is anethical, societal, economic, political andhumanitarian force.Nurses are the greatest number of healthcareprofessionals in the world.Involvement in global theoretical, research-based and applied clinical health issues adds amultifaceted prowess and aptitude whichotherwise would be difficult to attain.The weight and influence in one’s personal andprofessional life is potentially boundless.
  16. 16. ReferencesA comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factorclusters in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study, 2010.Beaglehole, R. et al. (2011). The Lancet. 377(9775) 1438-1447. WHO International: Global status report onnoncommunicable disease.Carter, B. (2009). International Journal of Nursing Studies. 46(6), 858-864. Tick box for child? The ethicalposition of children as vulnerable, researchers as barbarians and reviewers as overly cautious.Decola, P., Benton, D., Peterson, C. & Matebeni, D. (2012) International Nursing Review 59, 321–330. Nursespotential to lead in non-communicable disease global crisis.Harrowing J.N., Mill J., Spiers J., Kulig J. & Kipp W. (2010). International Nursing Review 57, 70-77.Cultural, context and community: Ethical considerations for global nursing research.Health care: an African solution. The Lancet. 26 March 2011. doi:10.1016/S0140-6736(11)60417-0Human Resources for Health (2009). Zimbabwe Health Workforce Observatory. Country Profile: ZIMBABWE.Retrieved from, K., Chou, D. P., Schneider, M. T., Tardif, A., Dieleman, J. L., Brooks, B. P. C . . . Murray, C. J. L.(2012). Health Affairs,31(1), 228-35. The global financial crisis has led to a slowdown in growth of funding toimprove health in many developing countries. Retrieved from S.S., Vos T., Flaxman A.D., Danaei G., Shibuya K., Adair-Rohani H., Amann M., ... Ezzati M. (2012). TheLancet, 380(9859), 2224-2260.
  17. 17. ReferencesReferences continuedMurray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. (2012). The Lancet. 380(9859):2197–2223.Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis forthe Global Burden of DiseaseStudy 2010. Retrieved from, J. (2011). Global development opportunities for nursing practice. Journal of Advanced Nursing, 67(4), 689.doi: Lancet. (2012). 380(9859) 2197-2222. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21regions, 1990—2010: a systematic analysis for the Global Burden of Disease Study 2010.World Health Organization. 2009. Global Health RisksMortality and burden of disease attributable to selected major risks. Retrieved from Health Organization. 2012. Mortality and Burden of DiseaseWHO International. 2012. Global Health Indicators.World Health Organization. UNICEF. 2012. Child Mortality EstimatesWorld Health Organization. 2013. Maternal Mortality