Allison Squires,1 Angela Amico2 1College of Nursing, 2Global Institute of Public Health, New York University, New York, NY, USA Abstract: This review seeks to understand the role of remittances in international nurse migration within the context of three theories of international migration: equilibrium approaches, social networks, and globalization. To analyze the phenomenon, an integrative review of the literature was conducted. Search terms sought articles discussing, either directly or indirectly, remittances and international nurse migration. The initial search returned 369 articles, and further screening decreased the total to 65. Full text screening reduced the final number for the analysis to 48. A directed content analysis structured the analytic approach by examining how authors discussed remittances in the content and context of the paper. The final analysis showed the majority of papers were policy analyses (five); opinion papers, reviews, or editorials that indirectly discussed remittances (27); or were qualitative and quantitative studies (16), either with primary data collection (14) or secondary data analyses (two). Overall, a nurse's individual motivation for sending remittances home stemmed from familial factors but was never a primary driver of migration. Domestic labor market factors were more likely to drive nurses to migrate. The nurse's country of origin also was a factor in the remittance dynamic. The identity of the author of the paper played a role in how they discussed remittances in the context of international nurse migration. The three theories of migration helped explain various aspects of the role of remittances in international nursing migration. While the phenomenon has changed since the 2008 global economic crisis and the passing of the World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel in 2010, future research around the role of remittances needs to consider the confluence of gender, social, political, labor market, and economic dynamics, and not just view the phenomenon from an individual lens. Keywords: nursing, health care worker, remittance
The nurse-to-population ratio (NPOP) is a standard indicator used to indicate a country's health care human resources capacity for responding to its disease burden. This study sought to explore if socioeconomic development indicators could predict the NPOP in a country. Mexico served as the case example for this exploratory study, with the final five variables selected based on findings from a qualitative study analyzing the development of nursing human resources in the country. Multiple linear regression showed that two variables proved significant predictors of the NPOP and the model itself explained 70% of the variance (r2 = .7; p = .0000). The findings have multiple implications for nursing human resources policy in Mexico and at a global level as governments attempt to build human capital to respond to population health needs.
OBJECTIVE: Global migration and linguistic diversity are at record highs, making healthcare language barriers more prevalent. Nurses, often the first contact with patients in the healthcare system, can improve outcomes including safety and satisfaction through how they manage language barriers. This review aimed to explore how research has examined the nursing workforce with respect to language barriers. METHODS: A systematic scoping review of the literature was conducted using four databases. An iterative coding approach was used for data analysis. Study quality was appraised using the CASP checklists. RESULTS: 48 studies representing 16 countries were included. Diverse healthcare settings were represented, with the inpatient setting most commonly studied. The majority of studies were qualitative. Coding produced 4 themes: (1) Interpreter Use/Misuse, (2) Barriers to and Facilitators of Quality Care, (3) Cultural Competence, and (4) Interventions. CONCLUSION: Generally, nurses noted like experiences and applied similar strategies regardless of setting, country, or language. Language barriers complicated care delivery while increasing stress and workload. PRACTICE IMPLICATIONS: This review identified gaps which future research can investigate to better support nurses working through language barriers. Similarly, healthcare and government leaders have opportunities to enact policies which address bilingual proficiency, workload, and interpreter use.
The formation of health professionals is critical for the health system to function and achieve its universal health coverage (UHC) goals. This is well recognized by the majority of governments that plan for the training and regulations necessary to ensure quality. But the importance of market forces is often overlooked, resulting in interventions and regulations that often fail to achieve their intended effects. The Economics of Health Professional Education and Careers aims to inform the design of health professionals' education policies to better manage health labor market forces toward UHC. It documents what is known about the influence of market forces on the health professional formation process. The contexts of the market for health professional training have been subject to important changes in recent decades, in particular: the growing extent of employment of mid-level cadres of health professionals; changes in technology and the associated growth of high-skilled occupations; the increasing interconnectedness of national health systems through globalization, with its implications for international health professional mobility; and the greater complexity of the public-private mix in employment options. There is a need to ensure that market forces align with the intentions of planning and regulation and the UHC goals. This study provides recommendations to support the design of policies that help to achieve these goals.
BackgroundA key component to achieving good patient outcomes is having the right type and number of healthcare professionals with the right resources. Lack of investment in infrastructure required for producing and retaining adequate numbers of health professionals is one reason, and contextual factors related to socioeconomic development may further explain the trend. Therefore, this study sought to explore the relationships between country-level contextual factors and healthcare human resource production (defined as worker-to-population ratio) across 184 countries.MethodsThis exploratory observational study is grounded in complexity theory as a guiding framework. Variables were selected through a process that attempted to choose macro-level indicators identified by the interdisciplinary literature as known or likely to affect the number of healthcare workers in a country. The combination of these variables attempts to account for the gender- and class-sensitive identities of physicians and nurses. The analysis consisted of 1 year of publicly available data, using the most recently available year for each country where multiple regressions assessed how context may influence health worker production. Missing data were imputed using the ICE technique in STATA and the analyses rerun in R as an additional validity and rigor check.ResultsThe models explained 63 % of the nurse/midwife-to-population ratio (pseudo R (2) = 0.627, p = 0.0000) and 73 % of the physician-to-population ratio (pseudo R (2) = 0.729, p = 0.0000). Average years of school in a country's population, emigration rates, beds-per-1000 population, and low-income country statuses were consistently statistically significant predictors of production, with percentage of public and private sector financing of healthcare showing mixed effects.ConclusionsOur study demonstrates that the strength of political, social, and economic institutions does impact human resources for health production and lays a foundation for studying how macro-level contextual factors influence physician and nurse workforce supply. In particular, the results suggest that public and private investments in the education sector would provide the greatest rate of return to countries. The study offers a foundation from which longitudinal analyses can be conducted and identifies additional data that may help enhance the robustness of the models.
State and international entities can have profound effects on the development of a country's nursing profession. Through a global health governance lens, this paper explores the development of nursing in Brazil during the early twentieth century, and its intersections with national and international interests. Accordingly, we will show how state policies established an environment that fostered the institutionalization of nursing as a profession in Brazil and supported it as a means to increase the presence of females in nation building processes. The State focused on recruiting elite women for nursing, in part due to the Rockefeller Foundation's involvement in the country. Nurses who worked for Rockefeller came from well-educated classes within US society with specific ideas about who should be a nurse and the roles of nurses in a healthcare system. These women served as the primary vehicles for interacting with Brazilian health authorities responsible for health system development. Their early efforts did not, however, ensure a system capable of producing nursing human resources at a rate that, in present day Brazil, could meet the health needs of the country. Findings from this paper offer new avenues for historians to explore the early roots of professional nursing through a global health governance lens, improve the understanding of the intersection between international politics and professionalization, and highlight how these factors may impact nursing human resources production in the long term. ; Entidades estatais e internacionais podem ter efeitos profundos sobre o desenvolvimento da profissão de enfermagem de um país. Através de uma lente global de governança de saúde, este documento analisa o desenvolvimento da enfermagem no Brasil durante o início do século XX, e suas interseções com os interesses nacionais e internacionais. Desta forma, vamos mostrar como políticas de Estado estabeleceram um ambiente que promoveu a institucionalização da enfermagem como profissão no Brasil, apoiando-se na ideia de aumentar a presença das mulheres nos processos de construção da nação. O Estado focou em recrutar mulheres de elite para a enfermagem, em parte devido ao envolvimento da Fundação Rockefeller no país. As enfermeiras que trabalharam para a Fundação Rockefeller, provenientes de uma classe social americana bem-educada, tinham ideias específicas sobre quem deveria ser enfermeira e os papéis das mesmas em um sistema de saúde. Estas mulheres atuaram como os principais veículos para a interação com as autoridades brasileiras, responsáveis pelo desenvolvimento do sistema de saúde. Seus esforços iniciais não conseguiram, no entanto, assegurar um sistema capaz de producir recursos humanos de enfermagem a uma taxa que, nos dias de hoje, poderia satisfazer as necessidades de saúde do Brasil. Os resultados do presente estudo oferecem pistas sobre novos caminhos para historiadores explorarem as raízes da enfermagem profissional, utilizando uma perspectiva global de governança de saúde, a fim de melhorar a compreensão da interseção entre políticas internacionais e profissionalização, destacando como esses fatores podem impactar a produção de recursos humanos de enfermagem a longo prazo. ; Organizaciones estatales e internacionales pueden tener efectos profundos sobre el desarrollo de la profesión de enfermería de un país. A través de la óptica de la gobernación global de la salud, este documento analiza el desarrollo de la enfermería en Brasil en el inicio del siglo XX, y sus intersecciones con los intereses nacionales e internacionales. Por consecuencia, vamos enseñar como las políticas del Estado establecieron un ambiente que promocionó la institucionalización de la enfermería como profesión en Brasil, y la apoyó como medio para aumentar la presencia de las mujeres en los procesos de construcción de la nación. El Estado ha focalizado en el reclutamiento de mujeres de élite para la enfermería, en parte debido al envolvimiento de la Fundación Rockefeller en el país. Enfermeras que trabajaban para Rockefeller, también provenían de clases bien-educadas de la sociedad de los Estados Unidos, imbuidas de ideas específicas sobre quién debería ser una enfermera y su papel en un sistema de salud. Esas mujeres actuaron como vehículos primordiales en la interacción con autoridades brasileñas, responsables por el desarrollo del sistema de salud. Entretanto, sus esfuerzos iniciales no fueron suficientes para garantizar un sistema capaz de producir recursos humanos de enfermería con una tasa que, en los días de hoy, el Brasil podría satisfacer las necesidades de salud del país. Los hallados de este estudio ofrecen pistas sobre nuevos caminos para historiadores explotaren las primeras raíces de la enfermería profesional valiéndose de la lente de gobernanza global de la salud; mejoraren la comprensión de la intersección entre políticas internacionales y profesionalización; y aún destacaren, como eses factores pueden impactar la producción de recursos humanos de enfermería a largo plazo.
Abstract Background Obesity affects 37 % of patients at Veterans Health Administration (VHA) medical centers. The VHA offers an intensive weight management program (MOVE!) but less than 10 % of eligible patients ever attend. However, VHA patients see their primary care provider about 3.6 times per year, supporting the development of primary care-based weight management interventions. To address gaps in the literature regarding Veterans' experiences with weight management and determine whether and how to develop a primary care-based weight management intervention to both improve obesity counseling and increase attendance to MOVE!, we conducted a qualitative study to assess: 1) Veterans' personal experiences with healthy weight-related behavior change (including barriers and facilitators to behavior change and experiences with primary care providers, staff, and the MOVE! program), and 2) potential new approaches to improve weight management within primary care at the VHA including goal setting and technology. Methods Overweight/obese VHA patients (aged 18–75, BMI greater than 30 or greater than 25 with at least 1 co-morbidity) were recruited for focus group sessions stratified by gender, MOVE! referral, and attendance. Each session was facilitated by a trained moderator, audio-recorded, and professionally transcribed. Using an iterative coding approach, two coders separately reviewed and coded transcripts, and met frequently to negotiate codes and synthesize emerging themes. Results Of 161 eligible patients, 54 attended one of 6 focus groups (2 female, 4 male, 9–11 participants per session): 63 % were male, 46 % identified as African-American, 32 % White/Caucasian, 74 % were college-educated or higher, and 61 % reported having attended MOVE!. We identified two major themes: Impact of Military Service and Promotion and Sustainability of Healthy Behaviors. After service in a highly structured military environment, Veterans had difficulty maintaining weight on their own. They perceived physical activity as having more impact than diet, but chronic pain was a barrier. We identified individual/interpersonal-, community/environment-, and healthcare system-related factors affecting healthy behaviors. We also received input about Veteran's preferences and experiences with technology and setting health goals. Conclusions Unique factors influence weight management in Veterans. Findings will inform .
A primary service provided by home care is medication management. Issues with medication management at home place older adults at high risk for hospital admission, readmission, and adverse events. This study sought to understand medication management challenges from the home care provider perspective. A qualitative secondary data analysis approach was used to analyze program evaluation interview data from an interprofessional educational intervention study designed to decrease medication complexity in older urban adults receiving home care. Directed and summative content analysis approaches were used to analyze data from 90 clinician and student participants. Medication safety issues along with provider–provider communication problems were central themes with medication complexity. Fragmented care coordination contributed to medication management complexity. Patient-, provider-, and system-level factors influencing medication complexity and management were identified as contributing to both communication and coordination challenges.
State and international entities can have profound effects on the development of a country's nursing profession. Through a global health governance lens, this paper explores the development of nursing in Brazil during the early twentieth century, and its intersections with national and international interests. Accordingly, we will show how state policies established an environment that fostered the institutionalization of nursing as a profession in Brazil and supported it as a means to increase the presence of females in nation building processes. The State focused on recruiting elite women for nursing, in part due to the Rockefeller Foundation's involvement in the country. Nurses who worked for Rockefeller came from well-educated classes within US society with specific ideas about who should be a nurse and the roles of nurses in a healthcare system. These women served as the primary vehicles for interacting with Brazilian health authorities responsible for health system development. Their early efforts did not, however, ensure a system capable of producing nursing human resources at a rate that, in present day Brazil, could meet the health needs of the country. Findings from this paper offer new avenues for historians to explore the early roots of professional nursing through a global health governance lens, improve the understanding of the intersection between international politics and professionalization, and highlight how these factors may impact nursing human resources production in the long term. ; Organizaciones estatales e internacionales pueden tener efectos profundos sobre el desarrollo de la profesión de enfermería de un país. A través de la óptica de la gobernación global de la salud, este documento analiza el desarrollo de la enfermería en Brasil en el inicio del siglo XX, y sus intersecciones con los intereses nacionales e internacionales. Por consecuencia, vamos enseñar como las políticas del Estado establecieron un ambiente que promocionó la institucionalización de la enfermería como profesión ...
It is often said that modern-day nursing and midwifery was founded on the spirit of activism. Yet, historically, the link between nursing and activism has been inconsistent. Nursing Now USA was created in response to a global campaign launched in 2020 by the World Health Organization to mark the Year of the Nurse and Midwife. A goal of this initiative is education about how contemporary nurses serve as leaders in healthcare in the United States. This article describes the methods and results of a scoping review that sought to explore the current state of the science, key concepts, and operationalization of activism in nursing. The general consensus in the literature is that the profession of nursing has deep roots in activism, but a lack of a clear definition of activism and operationalization in policy, practice, research, and academic settings likely limits active engagement by many nurses. The current state of nurse activism is more subtle, often unseen, and non-confrontational compared to the participation and contribution of nurses from the 1900s to the 1980s. We identified barriers and facilitators to activism in nursing and our discussion includes implications for nursing practice, education, and leadership.
No study has systematically examined how researchers address cross-cultural adaptation of burnout. We conducted an integrative review to examine how researchers had adapted the instruments to the different contexts. We reviewed the Content Validity Indexing scores for the Maslach Burnout Inventory-Human Services Survey from the 12-country comparative nursing workforce study, RN4CAST. In the integrative review, multiple issues related to translation were found in existing studies. In the cross-cultural instrument analysis, 7 out of 22 items on the instrument received an extremely low kappa score. Investigators may need to employ more rigorous cross-cultural adaptation methods when attempting to measure burnout. ; This research is funded by the European Union's Seventh Framework Programme FP7/2007-2013 under grantagreement n° 223468 (W. Sermeus, PI), the National Institute of Nursing Research, National Institutes of Health(P30NR05043 L. Aiken), and by the Spanish Agency Fondo de Investigación Sanitaria under grant agreementPI08/0599 (C. Fuentelsaz-Gallego, PI). ; Sí
The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. On behalf of the Academy, these evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. Through improved palliative nursing education, nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative care nurses worldwide, nurses can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations. Part II herein provides a summary of international responses and policy options that have sought to enhance universal palliative care and palliative nursing access to date. Additionally, we provide ten policy, education, research, and clinical practice recommendations based on the rationale and background information found in Part I. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter.
The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.
