Nurse Education in Practice (2009) 9, 102–108 Nurse Education in Practice
www.elsevier.com/nepr
International collaboration: A concept model to engage nursing leaders and promote global nursing education partnerships
Bonnie L. Garner a,*, Sharon E. Metcalfe a, Ann Hallyburton b a Nursing, Western Carolina University, 1459 Sand Hill Road, Suite G-33, A-B Tech Campus, Candler, NC 28715, United States b Hunter Library, Western Carolina University, Cullowhee, NC 28723, United States
Accepted 10 October 2008
KEYWORDS Summary This article describes a newly developed, internationally focused con- International; cept model, Engaging tomorrow’s international nursing leaders (ETINL). The primary Collaboration; tenets of the ETINL model encourage advocacy, activism, and professional account- Concept model; ability in preparing nursing leadership. The article presents the foundation and Nursing leadership application of the ETINL model in providing an on-going forum for student and fac- education ulty exploration of global nursing issues. The concept model has been applied in a collaborative partnership between a United States school of nursing and two United Kingdom schools of nursing to create a leadership development course ’blending web-based learning and mentored experiential travel. This pilot project illustrates the ways alliances between international schools of nursing build nursing leaders who can facilitate global health outcomes. c 2008 Elsevier Ltd. All rights reserved.
Introduction tion technology explosion (Elley et al., 2008), and the ever increasing healthcare needs of at-risk pop- The global nursing profession faces significant chal- ulations (McCauley, 2005) offer nurse educators a lenges that require the action of effective and aware myriad agenda for action in fostering tomorrow’s leaders. The complexities of moving the profession nurse leaders. International experience for nursing forward through issues such as worldwide nursing students presents a powerful and rewarding option shortages (Allen, 2008), an international informa- in addressing leadership development challenges, both global and domestic. Transcultural opportuni- ties provide students with a valuable perspective * Corresponding author. Tel.: +1 828 670 8810; fax: +1 828 670 8807. on global issues while supporting work experience E-mail address: [email protected] in diverse settings with often disparate resources.
1471-5953/$ - see front matter c 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.nepr.2008.10.011 International collaboration: A concept model to engage nursing leaders 103
Many nurse educators have international health- healthcare community. Many programs provide care experience. These educators often return to hands-on experience with a perspective on cultural teaching duties enriched, motivated, and inspired appreciation and unique team communication by what they witnessed. Many feel a responsibility methods (Lindahl et al., 2008; Kuehn et al., to mentor and pass this learning forward to stu- 2005). Professional accountability represents the dents in a way that will engage enthusiasm for synthesis of advocacy and activism experiences, learning and encourage them to become leaders and sets the learner on a quest for meaningful within the nursing profession. The authors are involvement in global nursing issues. Today’s nurs- nurse educators who have participated in interna- ing educators must engage and strengthen tomor- tional teaching and practice experiences that have row’s global nursing leaders. shaped their views on leadership development in Examples of international collaborations within nursing education. One author’s experience as a nursing education are widespread. For instance, consultant in pediatric nursing in South Africa students and instructors from San Francisco State sparked the desire to share other global experi- University’s nursing program have traveled to lo- ences with students in such a way that the students cales including the United Kingdom, Ghana, Thai- could envision themselves as participants. This land, Peru, and Italy to learn from practitioners experience led to the creation of the concept mod- in those areas about differences in maternity, pedi- el Engaging tomorrow’s international nursing lead- atric, and general care (Perry and Mander, 2005). ers (ETINL). The primary tenets of the ETINL In another example, nursing faculty from Johns concept model encourage advocacy, activism, Hopkins University together with the non-profit and professional accountability in preparing nurs- Haiti Medical Mission program formed a partnership ing leadership. These interlocking components to provide clinical services in Leon, Haiti. In the can be translated into practical and exciting learn- Haitian partnership, practitioners from the US ing pathways for students as entry level nurses. worked with and learned from Haitian practitio- International collaborative education provides ners; Haitian nurses educated the team on cultural the experiential link between advocacy issues, issues they would face and informed them of ill- nursing leadership actions, and ethical account- nesses and treatments common to the area but ability (Leppa and Terry, 2004). Drawing from pre- unfamiliar to the US team (Sloand and Groves, vious experiences with facilitating international 2005). Additionally, the Honor Society of Nursing, collaboration, the authors developed a learning Sigma Theta Tau International offers programs, opportunity involving nursing students from the institutes, and directives to promote mentoring United States (US) and the United Kingdom (UK). and international leadership skills. The ETINL con- The authors applied the tenets of the ETINL con- cept model embodies the purpose of these interna- cept model in working with these students to in- tional partnerships within the concept model’s crease their understanding of the interplay of combined focus on leadership growth and interna- advocacy, activism, and professional accountabil- tional nursing collaboration (Girot and Enders, ity in leadership development. 2004; Leh et al., 2004).
International perspective Components of the concept model
Diversity in healthcare populations and the nursing Advocacy – lessons in empowerment workforce offers opportunities for culturally sensi- tive leadership approaches (Gerrish, 2004; Bennet Advocacy is essential to nursing intervention and Holtz, 2008). Nursing education must be cul- (American Nurses Association, 2003). As nurses de- turally attuned in all levels of global leadership velop leadership skills, the intricacies of advocacy preparation (Schim et al., 2005). International may challenge their understanding; however, when nursing collaborations offer unparalleled opportu- offered the clinical opportunity to practice the nities for developing culturally aware global lead- advocacy role, many individuals are reminded of ership skills. These opportunities occur within a the reasons they chose nursing as a vocation (Ben- vast array of volunteer organizations such as Oper- ner, 1984). Nurses recognize the necessity of a par- ation SMILE, Project Hope, and UNICEF. Educa- ent learning to interpret signs of illness in their tional travel groups, such as Ambassador People newborn and the importance of a dying client’s to People International, offer professional ex- wishes to be heard (Wilkinson et al., 2008). What- changes and collaborative adventures in the global ever the circumstances, developing nursing leaders 104 B.L. Garner et al. must respond to the needs of at-risk clients and Effective mentoring is an integral part of culti- populations (Chinn, 2005). vating professional accountability. Nurse mentors The role of political advocate often falls to encourage professional accountability by demon- nurses. As Falk-Rafael argues, ‘‘nurses practice at strating an excellence in caring that extends be- the intersection of public policy and personal lives; yond their immediate circle of patients and they are, therefore, ideally situated and morally encompasses novice nurses (Carroll, 2004; Yonge obligated to include sociopolitical advocacy in et al., 2007). Effective mentoring requires the abil- their practice’’ (Falk-Rafael, 2005, p. 222). Advo- ity to maintain a balance between allowing the cating for excellence in nursing through political learner to experience risks while maintaining their action has direct benefits for client care outcomes scope of practice (Block et al., 2005). Mentorship and client satisfaction (Smith, 2004). By learning to occurs in all areas of nursing practice and reflects speak for individuals in need, nurses strengthen the communication and caring skills that expert their own voices in expressing professional dignity nurses bring to their clients (McCarthy, 2003; van and worth (O’Connor and McIntyre, 2005). Epps et al., 2006). Nursing leadership exemplifies social justice Professional accountability represents the syn- fundamentals inherent to advocacy. The Ameri- thesis of advocacy and activism experiences, and can Nurses Association publishes standards of sets the learner on a quest for meaningful involve- practice and social policy statements that affirm ment in global nursing issues. Today’s nursing edu- nursing’s deep roots in social justice on behalf cators must engage and strengthen tomorrow’s of clients, especially individuals who are econom- global nursing leaders. ically and educationally disadvantaged or are experiencing healthcare disparities (American A pilot project in nursing leadership Nurses Association, 2003; California Endowment, development – applying the theoretical 2003). framework
Activism – bridging, learning, and practice The challenges of global nursing have advanced the development of the ETINL concept model for build- The nursing profession has a legacy of activism, ing future nursing leaders. This concept model syn- particularly in working to remedy health disparities thesizes the interplay of role modeling and (Chinn, 2005). Individuals exposed to inequities can mentorship influences with service, scholarship, become energized leaders in healthcare activism and research to facilitate international nursing (Reimer Kirkham et al., 2005). Leadership develop- leadership opportunities. Leadership experiences ment based on the tenets of advocacy and activism are evident within a dynamic learning relationship supports not only improvements in client care, but that demonstrates the synergy between advocacy, also the evolution of the nursing profession (Phil- activism, and professional accountability. lips and Benner, 1994). Activism means working to- Using the ETINL concept model as a guide, ward the betterment of conditions for employees nursing faculty at a University in the southeastern within the nursing profession itself (O’Connor and US devised an experiential learning opportunity McIntyre, 2005) and testifying before governing called nursing: world class to promote global bodies on issues vital to nursing (Shirley, 2005). nursing leadership. Entry level nurses (licensed Activism provides transformational learning oppor- nurses who have not yet completed a Bachelor tunities that enrich nurse leadership development of Science in Nursing) enrolled in the elective (Grossman and Valiga, 2000). nursing: world class course. They developed cul- tural insight through learning to apply sound lead- Professional accountability – ership behaviors using web-enhanced learning responsibilities and rewards technologies, collaborative methods, and interna- tional travel. The pilot project’s goal was to Professional accountability enables nurse leaders create a continuing, collaborative relationship be- to be self-directed learners, self-disciplined practi- tween three Universities in the US and the UK in tioners, and self-reflective evaluators (Schon, the realms of practice, education, research, and 1983). Accountability extends beyond practice set- service. tings to prepare ‘‘world-citizen change agents’’ Employing web-based technologies, the US and willing and capable to effect global healthcare UK faculty collaborated on combined class improvements for the most needy clients (Leinin- discussions. The 15 US students (cohort I) in the ger, 1999). course were nurses working to satisfy requirements International collaboration: A concept model to engage nursing leaders 105 for a Bachelor of Science in Nursing (BSN). Having tional collaboration, advocacy, activism, and pro- previously completed their basic nursing prepara- fessional accountability are difficult to fully tion and successfully met requirements for licen- quantify, qualitative instruments provided the sure as a registered nurse (RN), these students means for pilot project measurement. Evaluation represented entry level, ‘‘non-traditional’’ learn- of student progress was measured through reflec- ers. Most students held professional positions of tive journals, group discussions, a post-travel responsibility in acute care, critical care, mater- survey, presentation of a continuing education pro- nal–child health, and community agencies. All stu- gram, and a final examination reflective essay dents were interested in global health issues, while detailing their progress in leadership development. approximately half had traveled internationally. Themes of cultural awareness, the impact of Participating students at the two UK Universities politics on healthcare provision, and similarities were a blend of urban, multi-cultural, 20- to 22- in nursing issues in the US and the UK appeared in year-old University students completing their basic students’ written and oral responses. Overall, re- nursing education program and a small cohort of sponses revealed growth in leadership competen- mature, rural, advanced study nurses experienced cies including improved communication skills and in specialized, autonomous practice. The UK stu- increased self-confidence. As evidence of partici- dents’ course focused on socio-cultural aspects of pants’ professional and personal growth during chronic illness. the course, several US students were inducted into Nursing: world class course objectives included the Honor Society of Nursing, Sigma Theta Tau discussing current, international nursing chal- International following the project’s completion. lenges; participating in active-learning communi- By promoting socio-cultural learning, program ties to develop collaborative and creative participants experienced a heightened sense of solutions; and comparing personal and professional professional and personal nursing community. They perspectives. Participants used reflective journal- recognized similarities between their academic ing to track their progress towards individual and and practice environments, and commented on course objectives in nursing leadership develop- the benefits gained from sharing nursing experi- ment. Strong collaborative threads were woven ences outside the formal classroom encounter. throughout the course as students communicated Exchanges of laughter and email addresses follow- online in study groups, designed presentations, ing the class gave evidence to the connectedness of and joined mutual course discussions during the nurses on both sides of the Atlantic. travel component. Participants became adept at teamwork across The service learning opportunity enabled the US boundaries of time and physical space. UK faculty participants to develop educational programs for and students expressed eagerness to continue this their domestic and international peers. The US learning experience through reciprocal visits to participants prepared presentations on relevant the US. In course evaluations, US participants’ nursing issues for their UK peers. Following the comments ranged from describing the course as international travel portion of the course, the US ‘‘an enlightening and enjoyable learning experi- students designed a continuing education (CE) ence’’ to statements calling the experience a program for community nurses in the US that high- ‘‘highlight’’ of their nursing education. In post-tra- lighted international learning experiences. vel surveys, the US students unanimously agreed Throughout the course, the components of the that the nursing: world class course had enriched ETINL concept model provided a basis for acquiring their leadership skills and broadened their perspec- effective leadership skills. Students gained aware- tives of global nursing issues. ness of global nursing issues (advocacy), presented research on topics of common interest (activism), and contributed a continuing education workshop Perspectives on teaching and learning: based on their experiences (professional accounta- nursing leadership development bility). The ETINL concept model demonstrates versa- tility in its application to learning modalities, Initial outcomes teaching strategies, and international leader- ship experiences. Using the ETINL concept In 2008, the authors shared preliminary project model, students bridge leadership theory to outcomes at US and international nursing education their nursing practice in a dynamic yet struc- conferences. While learning outcomes of interna- tured way. 106 B.L. Garner et al.
The concept model provides a framework for ness of the issue (professional accountability). designing individual student assignments and group The student reviewed relevant literature to find learning opportunities. Recent examples from the an assessment tool for primary care providers to US institution involved in the pilot project include use in pediatric healthcare settings. The student student-designed ‘‘teaching notebooks’’ that ad- then surveyed advanced practice nurse practi- dress health-related educational needs of parents tioner students on their impressions of the tool as of pediatric patients. Students chose current child an aid in routine client assessments. Following healthcare topics (advocacy), designed bi-lingual, the review process, the student presented her work culturally appropriate education materials (activ- at a national pediatric nursing conference. ism), and donated their work to community clinical Lessons in leadership development for this stu- sites for use by parents and agency staff (profes- dent were numerous throughout her year-long pro- sional accountability). Creative projects foster ject. At the project’s end the student remarked, leadership skills and enable students to gain knowl- ‘‘It was interesting to learn the process from begin- edge of, and experience in, developing educational ning to end, and most importantly, to feel I had a materials while supporting resource-scarce clinical successful impact on a subject I hope to continue agencies. The ability to produce culturally effec- to pursue as a graduate student.’’ For this student, tive, accurate, and economically feasible health the ETINL concept model provided a comprehen- educational materials is a welcome skill in many sive guide for moving from advocacy and activism community nursing settings. for a chosen topic to promoting professional The ETINL concept model likewise provides guid- accountability by sharing her findings with the nurs- ance in designing innovative group projects. An ing community at the conference. example of such an endeavor is a course project As a teaching tool, the ETINL concept model of- done by students in the US institution’s pre-licen- fers a visual method of explaining complex ideas. sure nursing program. Students explored topics on The triangular concept model (Fig. 1) provides a global child health. One student group chose the way to connect theory to practice for most visual topic of ‘‘child soldiers’’ and designed a world learners. Each side of the concept model repre- geography poster showing localities where children sents an equally important and interconnected part are currently used as soldiers and a resource guide of the whole. Together, the three sides illustrate providing further information on the issue. Stu- the dynamic nature of the central goal. dents presented the project at an annual under- Other elements can be substituted for the core graduate research symposium, an action that components to make both simple and complex con- embodied the three concepts of advocacy, activ- ceptual diagrams. In lecture classes, faculty may ism, and professional accountability. use this conceptual design to provide a map of con- During their investigation of children and vio- tent material and to encourage students to make lence, students commented on the success of the links in critical thinking during discussions. For active-learning, group project. One student stated, example, in the clinical setting, this design allows ‘‘This was a lot more work than doing our own students to document the interdependence of (individual) projects, but we learned so much more body–mind–spirit as demonstrated by the nursing and felt like we made a difference in educating the roles of provider of direct (physiologic) care, University community on this important pediatric educator (health promotion and maintenance), issue.’’ Leadership skills inherent in the project included fostering positive group dynamics, coordi- nating tasks, giving a presentation, and developing information resources. The ETINL concept model is applicable in non- traditional (outside the regular classroom struc- ture) teaching and learning environments. For example, nursing faculty used the ETINL concept model to guide the learning experience of an undergraduate US nursing student engaged in an independent study project. Following a challenging clinical placement in a medical office that special- ized in forensic nursing interventions (advocacy), the student wanted to learn more about child abuse prevention and to ‘‘do something’’ (activ- ism) to promote the nursing community’s aware- Figure 1 The ETINL concept model. International collaboration: A concept model to engage nursing leaders 107 and supporter of spiritual aspects (psychosocial– References cultural). Students may use the ETINL concept model to document their leadership development Allen, L., 2008. The nursing shortage continues as faculty by connecting successful learning activities to core shortage grows. Nursing Economic$ 26 (1), 35–40. concepts in the self-evaluation process. American Nurses Association, 2003. Nursing’s Social Policy Statement, second ed. ANA, Washington. Benner, P., 1984. From Novice to Expert: Excellence and Power Limitations, recommendations, and in Clinical Nursing Practice. Addison-Wesley, Menlo Park. 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