Shelby L. Garner

Nurse migration from India: A literature review

BACKGROUND A profound nursing shortage exists in India where nurses are increasingly outmigrating to practice nursing in surrounding countries and abroad. This is important globally because countries with the lowest nursing and healthcare workforce capacities have the poorest health outcomes. OBJECTIVE This review sought to synthesize and unify the evidence about nurse migration from India and includes a look at nurse retention within India. DESIGN A comprehensive literature review was performed to synthesize and unify both qualitative and quantitative research. DATA SOURCES Bibliographic databases searched included CINAHL, MEDLINE, PsycINFO, and EconLit using associated keywords for empirical and descriptive literature published between January 2004 and May 2014. Hand searches of the Nursing Journal of India from 2004 to February 2014 and the Journal of Nursing Research Society of India from its inception in 2007-February 2014 were also completed. REVIEW PROCESS 29 studies were selected and analyzed for the review. Data were appraised for quality; reduced through sub-categorization; extracted; and coded into a framework. Thematic interpretation occurred through comparing and contrasting performed by multiple reviewers. RESULTS Findings included an exponential growth in nurse recruitment efforts, nurse migration, and a concomitant growth in educational institutions within India with regional variations in nurse migration patterns. Decision-making factors for migration were based on working conditions, salience of family, and the desire for knowledge, skill, technology, adventure and personal enrichment. Challenges associated with migration included questionable recruiting practices, differing scopes of practice encountered after migration and experiences of racism and cultural differences. A shift toward a positive transformation of nursing status in India has resulted in an increased respect for individual nurses and the profession of nursing. This was attributed to the increased globalization of nursing. CONCLUSIONS Results from this review can be used to shape health policy and advocate for nursing reform in India. As Indias healthcare infrastructure continues to evolve, effective programs to improve conditions for nurses and retain them in India are needed. Additionally, as the globalization of nurses increases, more research is needed to develop effective programs to aid in a smooth transition for nurses who migrate from India.

A method comparison of photovoice and content analysis: research examining challenges and supports of family caregivers

PURPOSE The purpose of this manuscript is to compare methods and thematic representations of the challenges and supports of family caregivers identified with photovoice methodology contrasted with content analysis, a more traditional qualitative approach. METHODS Results from a photovoice study utilizing a participatory action research framework was compared to an analysis of the audio-transcripts from that study utilizing content analysis methodology. RESULTS Major similarities between the results are identified with some notable differences. Content analysis provides a more in-depth and abstract elucidation of the nature of the challenges and supports of the family caregiver. CONCLUSIONS The comparison provides evidence to support the trustworthiness of photovoice methodology with limitations identified. The enhanced elaboration of theme and categories with content analysis may have some advantages relevant to the utilization of this knowledge by health care professionals.

Partnering to Establish and Study Simulation in International Nursing Education.

The purpose of this article was to describe an international partnership to establish and study simulation in India. A pilot study was performed to determine interrater reliability among faculty new to simulation when evaluating nursing student competency performance. Interrater reliability was below the ideal agreement level. Findings in this study underscore the need to obtain baseline interrater reliability data before integrating competency evaluation into a simulation program.

A model for upscaling global partnerships and building nurse and midwifery capacity

AIM To provide a unique model for use in guiding global collaboration and policy to upscale nursing and midwifery partnerships. BACKGROUND AND INTRODUCTION Nurses and midwives across nations need skills reaching beyond the bedside and unit level in todays complex, global, multifaceted healthcare milieu. Thoughtful consideration, research and concomitant development of models to guide appropriate upscaling of nurse and midwifery capacity within and between nations are needed. DISCUSSION This article explores an integrated global approach to upscaling nurse and midwifery capacity using examples of partnerships between nursing and midwifery programmes across multiple continents. CONCLUSION AND IMPLICATIONS FOR NURSING Global nurse and midwifery capacity is effectively being developed using a myriad of approaches. A new model is presented to illustrate supports, strategies and activities to achieve intermediate and long-term goals for capacity building through strong and sustainable global partnerships. IMPLICATION FOR NURSING POLICY Development of global skills can focus the nurse and midwife to influence policy-level decisions. Human resource planning that can impact countrywide provision of health care begins in the preservice setting for both nurses and midwives. A global experience can be a value-added component to the well-rounded education of future nurses. Education during preparation for entry into practice is a strategic way to develop a worldview. Incorporating reflective practice can build skills and shape attitudes to prepare the new nurse to be comfortable as a global healthcare provider. An expanded world view is the springboard to more robust and informed involvement and inclusion in policy-level discussions.

Use of an evidence-based protocol to screen for sleep-disordered breathing in a heart failure disease management clinic.

Undiagnosed and untreated sleep-disordered breathing can lead to negative health outcomes and increased utilization of health resources among patients with heart failure. The purpose of this evidence-based practice project was to implement and evaluate a new multifaceted sleep-disordered breathing screening protocol in a heart failure disease management clinic. The combined use of a symptoms questionnaire, the Epworth Sleepiness Scale, and overnight pulse oximetry was significantly more effective in identifying patients with a positive diagnosis of sleep-disordered breathing than using the Epworth Sleepiness Scale alone (P < .05).

Health Behavior and Adherence to Treatment for Sleep Breathing Disorder in the Patient With Heart Failure

Background: Heart failure can be complicated by a variety of comorbidities including sleep breathing disorder (SBD). Treatment for SBD in the heart failure patient can improve quality of life and decrease mortality. Few studies have sought to examine the reasons why patients with heart failure who screen positive for SBD do not follow through with diagnostic testing and recommendations for evidence based treatments. Purpose: The purpose of this study was to describe and compare the characteristics of patients with heart failure who adhered to recommendations for evaluation and treatment of SBD with those who did not. Additionally, the study sought to examine reasons for nonadherence. Methods: A descriptive comparative design was used. Descriptive statistics were used to define and compare the study population in terms of demographic data, which included age, gender, ethnicity, New York Heart Association heart failure classification, and comorbidities. Additionally, patients were surveyed to determine reasons for nonadherence to recommended overnight sleep study evaluation and or treatment with positive airway pressure. Results: Demographics with higher percentages of adherence to evaluation and treatment included younger individuals and male gender. Prevalent reasons for nonadherence for evaluation and treatment included negative perceptions of an overnight sleep study evaluation and advanced age. Implications for practice: The community nurse educator can use the descriptive comparative findings in this study to tailor educational programs toward individuals with heart failure who have screened positive for SBD who are most at risk for nonadherence.

Perceived Challenges and Supports Experienced by the Family Caregiver of the Older Adult: A Photovoice Study

As the older adult population in the United States grows in number, the need for family caregivers will also rise. Results from quantitative studies mostly provide evidence of caregiver burden, not caregiver support, and qualitative studies are needed. This study used a community-based participatory action research methodology called photovoice to explore challenges and supports experienced by family caregivers of the older adult. Photovoice incorporates the use of photographs to facilitate the elucidation of an experience by populations or groups. Using photovoice, study participants self-identified 5 challenges and 5 supports experienced in the caregiver role.

Effectiveness of Peripheral Intravenous Skill Continuing Education Using Low-Fidelity Simulation Among Nurses in India

BACKGROUND Many nurses have limited opportunities to practice peripheral intravenous (IV) skill access until they begin their nursing career, particularly in limited resource settings. Continuing nursing education is needed for practicing nurses to build nurse capacity and skill accuracy in IV access globally. METHOD A pretest-posttest design was used to measure effectiveness of peripheral IV continuing education among 180 nurses in India. A skills checklist was used to observe for skill accuracy using low-fidelity simulation. RESULTS A statistically significant improvement in knowledge regarding peripheral IV skill access and care was found (p < .001), and 95% of nurse participants successfully simulated IV access accuracy after the continuing education intervention. CONCLUSION Findings support the need for continuing nursing education to improve peripheral IV access and care knowledge and skill among nurses, particularly in low- and middle-income countries or other settings where hands-on experience is limited during undergraduate nursing education programs. J Contin Educ Nurs. 2018;49(6):255-261.

Smart phone accessibility and mHealth use in a limited resource setting

AIM To determine smartphone access and use including future opportunities for mHealth and potential ethical implications among health care professionals practicing at a health care facility in Bengaluru, India. BACKGROUND The evolution of smart phones can provide convenient, portable, and rapid access to resources for health care professionals. While mobile phone accessibility has improved in recent years in many low and middle-income countries, the use of smart phones to address health priorities remains limited in some limited resource settings. DESIGN A quantitative descriptive design was used. METHODS A survey was administered in November of 2016 to nurses and physicians at a tertiary care hospital in India. RESULTS/FINDINGS All respondents had a mobile phone, and the majority owned a smart phone that was used for text messaging, email, accessing internet, and downloading apps. Participants recommended smart phone use to improve health care provider access to continuing education and to improve patient knowledge about health. Physicians had better access to mHealth resources compared with nurses. CONCLUSION Credible, evidence-based, affordable mobile applications are needed to provide a platform for continuing health education to health professionals and patients in India and limited resource settings. Nurses need equitable access to mHealth resources to build successful mHealth initiatives.

The Pad Project: A Global Initiative Uniting Women

The Pad Project is a womens health program used to educate women on their monthly menstrual cycles. Through this ministry, women who do not have access to menstrual hygiene products are given sustainable hygienic kits to promote menstrual health. This unique health education program also integrates stories from the gospel to illustrate Christs love and caring commitment toward women and womens health.