WHO/PAHO Collaborating Centre For International Nursing Development In Primary Health Care: Partnerships for International Nursing Development

Programs

Global Health Leadership at the UIC College of Nursing emphasizes collaboration, capacity building, and the fostering of an increasingly strong role for nursing in global healthcare. Partnerships with institutions and individuals are continually being developed and maintained. Programs and pilot studies center on needs, values and other factors that are relevant to the site countries, and they prioritize sustainability. Following are descriptions of current and recently concluded programs.

Mobilizing Health Workers for Community HIV Prevention in Chile

Funding Source: National Institute of Nursing Research

Program Director (UIC): Kathleen Norr, PhD

Participating Faculty (UIC): Kathleen Crittenden, PhD; Barbara Loyce Dancy, RN, PhD, FAAN; James Norr, PhD; Marie Talashek, RN, CS, EdD

Participating Faculty (Pontificia Universidad Católica de Chile): Rosina Cianelli, RN, PhD; Lilian Ferrer, EM, PhD  

Summary: The AIDS-Fogarty International Research Collaboration Award (FIRCA) project will adapt and pilot a peer group intervention to mobilize health workers as HIV/AIDS prevention leaders. Chile has an incipient AIDS epidemic, with a number of signs that the epidemic is now spreading to the general population. Much more remains to be done to contain the epidemic or to prepare health workers for their role in HIV prevention. The Malawi model (see above) of peer leader training for health worker mobilization is a low cost and sustainable model that is highly relevant for Chile and the Latin American region. The Chile research will be a partial replication of the Malawi study.  

In Phase 1, a formative evaluation using focus groups and interviews with health administrators and workers will tailor the intervention and evaluation instruments for health workers in Chile. The revised peer group intervention for HIV prevention will be piloted for health workers in five intervention clinics. Health services outcomes include consistent practice of universal precautions, sensitivity toward HIV-related concerns, and incorporation of HIV prevention messages. Health worker outcomes include increased HIV/AIDS knowledge, more positive attitudes toward persons living with HIV/AIDS and HIV prevention, and increased HIV prevention behaviors at work and in their personal lives. Results will be disseminated to health workers and policy makers. The intervention is a low-cost sustainable model for national mobilization of health workers for HIV prevention.  

International Leadership Project

Funding Source: Kellogg Foundation

Program Director: Hattie Bessent, RN, EdD, FAAN

UIC Participating Faculty: Beverly McElmurry, RN, EdD, FAAN  

Summary: The purpose of this program is to support the Leadership, Enhancement and Development (LEAD) of minority nurses through their participation in international nursing study. Minorities are underrepresented in nursing, a reality that affects not only the diversity of the workforce, but the ability of nursing as a whole to relate to the different values, customs and needs of various patient populations.  

Participants in the LEAD program explore real-life scenarios in which specific leadership skills made the difference in building strong cooperation and supportive relationships. Five key leadership elements fostered in this approach are: knowledge of self, integrity, vision, communication, and collaboration. Through their work, participating scholars identify specific aspects of leadership that are effective in managing highly diverse groups of individuals. Notable health leaders from agencies such as the World Health Organization (WHO), the International Congress for Nurses (ICN) and the Royal College of Nurses (RCN) meet with scholars and assist them in identifying aspects of leadership that are effective in managing highly diverse groups.    

China Nursing Leadership Initiative

Funding Source: Maryknoll China Service Project

Program Director (UIC): Carol Christiansen, RN, PhD

Participating Faculty: Beverly McElmurry, RN, EdD, FAAN  

Summary: The University of Illinois at Chicago College of Nursing, and the MaryKnoll China Service Project are collaborating in an effort to respond to the AIDS crisis in China by developing a culturally sensitive training program for Chinese nurses.    

Malawi Capacity: Pilot Testing a Women's Professional Assisted Peer Support Model 

Funding source: 1-R24-AT01573 NIH/National Center for Complementary and Alternative Medicine

Program Director (UIC): Judith Levy, RN, PhD, School of Public Health

Participating Faculty: Chrissie P.N. Kaponda, RN, PhD, University of Malawi Kamuzu College of Nursing; Lena Hatchett, PhD, UIC School of Public Health, Loyola University Chicago; Linda L. McCreary, RN, PhD, UIC College of Nursing  

Summary: Pilot Testing a Women's Professional Assisted Peer Support Model in Malawi was an exploratory study to assess the feasibility and acceptability of a professional-assisted women caregiver's information and skill-building support group. Women caregivers provide informal, home-based care to family members whose symptoms suggest AIDS, and the support groups were designed to assist in the development and sharing of HIV/AIDS prevention information and caregiving skills.  

One rural and one semi-rural (peri-urban) community were selected as sites for the pilot study, which was conducted in two phases: formation and implementation. In Phase 1, qualitative data regarding caregiving practices and challenges, and HIV knowledge and prevention practices, were collected from health professionals and women caregivers. Phase 2 consisted of pilot testing the intervention with two groups of 12 caregivers. The intervention combined information and skills training with a peer support component. Two community nurses at each site participated in training conducted by the research team. The groups, led by the trained nurse facilitators, were designed to help reduce some of the caregivers' problems and stresses by fostering mutual support. A quantitative questionnaire was used to evaluate the effectiveness of the interventions.  

The smaller numbers of concurrent caregivers in a rural village, combined with higher rates of nursing staff turnover in rural health centers, made implementation more challenging in the rural areas than in the peri-urban communities. Overall, however, providing a professional-assisted informational and emotional support group intervention was evaluated as feasible, desirable, and highly valued by participants. Indicators for sustainability include women caregivers who continued to share the knowledge they acquired during the study, as well as the continued use of the intervention manual and materials, and the caregivers' continued interactions with the nurse facilitators as ongoing resources. The pilot data support the planned development of a larger study to test the effectiveness of the intervention.  

Mobilizing Health Workers for HIV Prevention in Malawi

Funding Source: National Institute of Nursing Research

Program Director (UIC): Kathleen Norr, PhD

Participating Faculty (UIC): Kathleen Crittenden, PhD; Barbara Loyce Dancy, RN, PhD, FAAN; James Norr, PhD; Marie Talashek, RN, CS, EdD

Participating Faculty ( University of Malawi ): Chrissie Kaponda, RN, PhD; Siti Kachingwe, RN, MA; Diana Jere, RN, MSN; Mary Mbeba, RN, MSN  

Summary: Health workers are key potential leaders in the struggle to contain the HIV/AIDS pandemic. The Mzake ndi Mzake (Friend-to-Friend) intervention integrates the powerful social cognitive behavioral change model of peer groups with the primary health care model of health worker-community collaboration to improve health. Health workers are mobilized as rural community leaders who involve a community in a peer group intervention for HIV/AIDS prevention.

The intervention is implemented in four phases using a train-the-trainers model. In Phase I, health workers at a district hospital are trained as community leaders through participation in the peer group intervention. In Phase II, at a selected rural health clinic and the cluster of villages it serves, the trained district health workers train clinic health workers and interested local leaders as community peer group leaders. Training in Phase I and II enables the district and rural clinic workers to change their own HIV prevention behaviors and to modify health services to be more supportive of HIV prevention. In Phase III, the clinic workers train community members as peer group leaders who then offer peer group education and other activities to the entire community. In Phase IV, the program expands to provide the knowledge and skills parents need to protect their children, thus enhancing young people's safer sex behaviors.  

Effectiveness of each phase is being evaluated through comparison with a similar district. The final evaluation is nearly complete. The midterm evaluation found that both health workers and community adults had increased HIV prevention-related knowledge, more positive HIV prevention-related attitudes, safer sex behaviors, and more involvement in community HIV prevention activities. Health workers also showed some increase in their practice of universal precautions and HIV prevention education of clients. Results for the adolescent intervention, which had not begun at the midterm evaluation, will be released with the final evaluation.

The Mzake ndi Mzake HIV prevention intervention is now ready for wider dissemination to additional health facilities and communities. The program builds on the existing resources of the health care system and community leadership, making the program a relatively low cost approach for effective HIV prevention. In addition, the project will strengthen research capacities of the collaborating college of nursing and the district and rural clinic health workers. Scaling up the Mzake ndi Mzake program can make a major contribution to primary prevention of HIV transmission in Malawi.

Advancing Nursing Education in India - Bel-Air Hospital

Funding Source: Minu K. & Mehroo M. Patel Endowment Fund for Nursing Education in India

Supporting Faculty (UIC): Beverly McElmurry, RN, EdD, FAAN; Karen Solheim, APRN , BC, PhD; Janet Larson, RN, PhD, FAAN; Usha Menon, RN, PhD; Patrick Robinson, RN, ACRN, PhD

Participating Faculty (Bel-Air Hospital): Fr. Tomy Karyilakulam  

Summary: The UIC College of Nursing collaborated with Bel-Air Hospital, which is operated by the Maharashtra Red Cross Society and the Missionary Congregation of the Blessed Sacrament, in Panchgani, Maharashtra, India , to conduct a feasibility study of a nursing college at Bel-Air Hospital, a facility that provides affordable, non-discriminatory care to people with TB and/or HIV/AIDS. Bel-Air Hospital is one of the few hospitals in Satara district that provides care for people affected by HIV/AIDS. Goals of developing a nursing college are: 1) to offer high-quality nursing care; 2) to advance the role of nursing in health care in India; and 3) to improve recruitment and retention of nurses at Bel-Air Hospital at a time when many nurses are migrating out of India.  

The feasibility study showed that desirability and need for a nursing college were both present. Long-term viability was assessed as being largely dependent on leadership, linkages with other established nursing schools and hospitals in the region, and finances.  

Based on the dedication of the hospital's leadership and generous financial support from the Patel Endowment Fund at UIC, the college accepted its first class of students in the fall of 2006. Formal dedication of the college occured in 2007. The first BSN class graduated in March 2011. The college is associated with Maharashtra State University, from which a Bachelors of Science degree will be awarded to all successful students.

Advancing Nursing Education in India: Rubi Hall Clinic, Maharashtra State

Funding Source: Tehmi Grant Institute of Nursing Education

Participating Faculty (UIC): Beverly McElmurry, RN, EdD, FAAN; Karen Solheim, APRN , BC, PhD; Janet Larson, RN, PhD, FAAN; Usha Menon, RN, PhD; Patrick Robinson, RN, ACRN, PhD  

UIC faculty first met the faculty of Tehmi Grant Institute of Nursing Education (TGINE) in Pune, India during the Fall of 2004 while visiting Bel-Air Hospital in nearby Panchgani. TGINE is a well-reputed nursing college in India and is part of Ruby Hall Clinic (RH), a large (550-bed) health care facility with an excellent international reputation. TGINE started in 1999 and admits 30 new students per year. A Bachelor of Science degree from Maharashtra University of Health Sciences is awarded to students completing this program. TGINE principal, Mrs. Achiamma Singh, as well as hospital leaders have plans to develop a nursing masters and a nursing doctoral program.

The initial contact between TGINE and UIC CON led to ongoing collegial faculty connections through travel and internet for teaching and learning, collaborative grant-writing activity and future planning. For example, Mrs. Singh visited UIC in Fall 2005 and Dr. Usha Menon conducted a successful short course in research methods at TGINE in Spring 2006. The following objectives between UIC and TGINE have been established.

1. To continue conducting research methods short courses at TGINE. Dr. Usha Menon, UIC is the lead faculty member. The second course in this series is scheduled for May, 2007, with the third planned for 2007/2008. 
2. To launch an HIV prevention/attitudes study in collaboration with TGINE. Investigators include Dr. Usha Menon and Dr. Patrick Robinson at UIC and Mrs. Singh as Site PI in India .  
3. To collaborate with TGINE to develop master's of science degree in Community Health Nursing with Mrs. Achiamma Singh representing TGINE, and Dr. Karen Solheim and Dr. Beverly McElmurry representing UIC.

International Practice Program Development Initiative

Funding Source: Health Resources and Services Administration

Program Director: Kathleen Baldwin, RN, PhD

Participating Faculty: Patricia Lewis, RN, PhD; Martha Bergren, DNS, RN BC, NCSN ; Geraldine Gorman, RN, PhD; Cheryl Schraeder, RN, PhD, FAAN; Nancy DeVilder, PhD; Michele Issel, RN, MN, PhD; Beverly McElmurry, RN, EdD, FAAN

Summary: The International Practice Program Development Initiative is designed to facilitate international learning opportunities for faculty and students at the University of Illinois at Chicago (UIC) College of Nursing. Overall interest in collaboration and research in international settings continues to grow, and this initiative aims to ensure that such programs are of the greatest possible benefit to participants and to the communities with which they interact. Global Health Leadership at the College of Nursing supports numerous service learning opportunities on the UIC campus and in international settings around the globe. The International Practice Program Development Initiative will facilitate those opportunities and enhance planning and support services so that priorities of quality learning, safety, participatory engagement with local communities, sustainability, and cultural appropriateness are consistent program components of all global health activities.