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The impact of globalization and environmental change on health: challenges for nurse education
NET 2002 Commentary The impact of globalization and environmental change on health: challenges for nurse education A response to Maggie Kirk Nurse Education Today (2002) 22(1): 60±71 The impact of globalization and environmental change on health: challenges for nurse education
Mary Birchenall Globalization is a theme current in health and social education and as such should feature as a strand of nurse education. It is an unfortunate reality that the demands of national and professional curricular requirements leave little scope for a definitive exploration of this topic. In turn, it is reasonable that pre-qualifying programmes ensure that this underpinning knowledge is established and post-qualifying education promotes awareness into understanding. There are many challenges set within this agenda for nurse education, and perhaps significantly the subtle demand that such a curricular inclusion should move educational content from parochial and national imperatives to those of international relevance. Such a challenging move would indeed bring nursing to the fore of health management and prepare individuals to work within the changing health services around the globe as proposed by Maggie Kirk in the article that prompts this commentary. Is the local world of nursing prepared to a sufficient extent to be able to rise to this challenge, as outlined in the paper titled above? In this special article, Kirk begins by alluding to the use of nursing models to promote a more universal approach to the delivery of nursing care, and the individual nurse's appreciation of the scoping required when accessing a worldwide social and health agenda. Sadly, this is pursued no further within the article but must, by its early inclusion, stimulate nurse educators to consider the significance of such tools for teaching the fundamentals of nursing care in relation to the local, national and international preparedness of the new nurse. The first half of this article provides a great if inadvertent service for nurse educators,
72 Nurse EducationToday (2002) 22, 72±73
delivering as it does an erudite pocket directory on the nature of globalization. This, alongside the splendid reference list, will prove a valuable resource for those seeking to promote this relatively new subject within a nursing curriculum. The next short section reviews the impact of the changing global environment on health, and again this is a valuable summary for the novice to this area of study. It is the build-up to the impact of global changes for health and nursing that must draw the reader to the concluding section for direction and relevant details on local to global demands and pressures on care. The challenges for nursing are outlined, but the strategies for confronting them are not truly there. Nursing is grounded in nationally approved curricula and responds to the economic and political demands of a specific context. Articles such as this seek to reflect nursing as an autonomous and proactive service. Although there is potential for individual action to contribute to the global culture and make an impact through numbers, a laudable minor goal in itself, it is insufficient when addressing the educational demands for nursing. The global community is driven by economic and political agendas. Major players from the core nations and international business conglomerates and their tenacious grasp on the big business of health must not be overlooked. Nursing, embedded in altruistic notions of caring and service, cannot compete with such ruthless economic enterprises. This is evident in UK drivers in relation to the nature of nursing as expressed through a curriculum for training that is set by a professional body, interpreted through collaboration with local service providers and delivered through a university system. Each of
& 2002 Harcourt Publishers Ltd doi:10.1054/nedt.2001.0743, available online at http: // www.idealibrary.com on
1
NET 2002 Commentary
these three players has a significant embedded personal agenda with the potential to fragment curricular development, leaving the inclusion of global aspects of care an additional burden that is easily lost in pre-qualifying programmes. Just as easily overlooked in post-qualifying education, global understandings can be overwhelmed by the immediate needs of key local players who require a responsive workforce focused on health agendas that are often both local and short term. A health agenda for nurses that is proactive, long term and external to the immediate needs of the local services is as yet alien to the pragmatically based nursing world. This despite the seemingly contradictory reality that for many the epitome of nursing education is based on the early conception of Florence Nightingale and generated within a worldwide context. Yet even here the battle with political agencies emerged, and the purpose of nursing was established as being managed by powerful and external agents. Such agents today have recognized the need for nursing to extend boundaries beyond the local, and there is a slowly emerging recognition of the need for a public health approach to be incorporated as part of nurse education. It is here, perhaps, that the most optimism can be expressed for the development of a global awareness for nursing to evolve into a practice-based reality. In turn, such an approach requires the inclusion of both awareness and understanding of national and international social and health policy. The consequent layering of educational needs to enable the complex learning evident in the global curriculum leads to a necessary review of the way in which nursing curricula develop. It is insufficient for writers such as Kirk to list the needs of nurses in promoting the globalization of nursing. Although this can be useful in itself as a means for extending the understanding of nurse educators in this area, it provides yet another series of demands on compressed timetables. The evolution of problem-based learning can help with the dense curriculum, but the implementation of ideas from concept to practice is yet another challenge. The use of a diagram to show the potential influence that each sector of the nursing population can impose is useful, but in
& 2002 Harcourt Publishers Ltd
truth seems to ignore the complexity of the impact and the actuality of the powerlessness of the individual. Within a social world that shows a willingness to set up dialogue between diverse nations, it is not surprising to read Kirk's proposal for an optimistic position for globally influential nursing. Although the use of Change Theory has succinctly shown that there is a need for change to be established through a `bottom-up' approach, it is evident that the perpetrators of such change are often the key players in the organization. It is no less surprising to find that in the `global village' there is activity to ensure that existing significant sectors retain a valid power base. The creation of a powerful nursing force that would seek to superimpose altruistic concerns for the care of others upon the economic and political agendas of the Core powers is a wonderful ideal, but a remote possibility even at the turn of this new century. The insularity of personal safety and need was manifested by the terrible happenings of September 11th 2001. It is through such events that the true level and extent of the ability of trans global cultures to communicate at a real level is shown to be woefully inadequate. Whilst major world players can be self-centered in the determination of world policy, it is unlikely that the influence that nurses have can transcend the purely personal. The powerful may seek to empower the powerless, but only to the extent that they influence the way in which that power is used. As Kirk suggests, the arena of public health gives nursing the opportunity to influence policy, but it is also essential to avoid the selfish approach so often evident in international politics. It is important that nursing as a profession retains the altruism of caring and avoids the trap of self-importance to the exclusion of weaker nations and groups of the world. As Kirk suggests, nurses must be able to think globally whilst acting locally. Set against this, her imperative that appropriate education is the key simplifies the complex context of nurse education. Mary Birchenall
Senior Nursing Lecturer, School of Healthcare Studies, University of Leeds, UK
Nurse EducationToday (2002) 22, 72±73 73
Mary Birchenall Globalization is a theme current in health and social education and as such should feature as a strand of nurse education. It is an unfortunate reality that the demands of national and professional curricular requirements leave little scope for a definitive exploration of this topic. In turn, it is reasonable that pre-qualifying programmes ensure that this underpinning knowledge is established and post-qualifying education promotes awareness into understanding. There are many challenges set within this agenda for nurse education, and perhaps significantly the subtle demand that such a curricular inclusion should move educational content from parochial and national imperatives to those of international relevance. Such a challenging move would indeed bring nursing to the fore of health management and prepare individuals to work within the changing health services around the globe as proposed by Maggie Kirk in the article that prompts this commentary. Is the local world of nursing prepared to a sufficient extent to be able to rise to this challenge, as outlined in the paper titled above? In this special article, Kirk begins by alluding to the use of nursing models to promote a more universal approach to the delivery of nursing care, and the individual nurse's appreciation of the scoping required when accessing a worldwide social and health agenda. Sadly, this is pursued no further within the article but must, by its early inclusion, stimulate nurse educators to consider the significance of such tools for teaching the fundamentals of nursing care in relation to the local, national and international preparedness of the new nurse. The first half of this article provides a great if inadvertent service for nurse educators,
72 Nurse EducationToday (2002) 22, 72±73
delivering as it does an erudite pocket directory on the nature of globalization. This, alongside the splendid reference list, will prove a valuable resource for those seeking to promote this relatively new subject within a nursing curriculum. The next short section reviews the impact of the changing global environment on health, and again this is a valuable summary for the novice to this area of study. It is the build-up to the impact of global changes for health and nursing that must draw the reader to the concluding section for direction and relevant details on local to global demands and pressures on care. The challenges for nursing are outlined, but the strategies for confronting them are not truly there. Nursing is grounded in nationally approved curricula and responds to the economic and political demands of a specific context. Articles such as this seek to reflect nursing as an autonomous and proactive service. Although there is potential for individual action to contribute to the global culture and make an impact through numbers, a laudable minor goal in itself, it is insufficient when addressing the educational demands for nursing. The global community is driven by economic and political agendas. Major players from the core nations and international business conglomerates and their tenacious grasp on the big business of health must not be overlooked. Nursing, embedded in altruistic notions of caring and service, cannot compete with such ruthless economic enterprises. This is evident in UK drivers in relation to the nature of nursing as expressed through a curriculum for training that is set by a professional body, interpreted through collaboration with local service providers and delivered through a university system. Each of
& 2002 Harcourt Publishers Ltd doi:10.1054/nedt.2001.0743, available online at http: // www.idealibrary.com on
1
NET 2002 Commentary
these three players has a significant embedded personal agenda with the potential to fragment curricular development, leaving the inclusion of global aspects of care an additional burden that is easily lost in pre-qualifying programmes. Just as easily overlooked in post-qualifying education, global understandings can be overwhelmed by the immediate needs of key local players who require a responsive workforce focused on health agendas that are often both local and short term. A health agenda for nurses that is proactive, long term and external to the immediate needs of the local services is as yet alien to the pragmatically based nursing world. This despite the seemingly contradictory reality that for many the epitome of nursing education is based on the early conception of Florence Nightingale and generated within a worldwide context. Yet even here the battle with political agencies emerged, and the purpose of nursing was established as being managed by powerful and external agents. Such agents today have recognized the need for nursing to extend boundaries beyond the local, and there is a slowly emerging recognition of the need for a public health approach to be incorporated as part of nurse education. It is here, perhaps, that the most optimism can be expressed for the development of a global awareness for nursing to evolve into a practice-based reality. In turn, such an approach requires the inclusion of both awareness and understanding of national and international social and health policy. The consequent layering of educational needs to enable the complex learning evident in the global curriculum leads to a necessary review of the way in which nursing curricula develop. It is insufficient for writers such as Kirk to list the needs of nurses in promoting the globalization of nursing. Although this can be useful in itself as a means for extending the understanding of nurse educators in this area, it provides yet another series of demands on compressed timetables. The evolution of problem-based learning can help with the dense curriculum, but the implementation of ideas from concept to practice is yet another challenge. The use of a diagram to show the potential influence that each sector of the nursing population can impose is useful, but in
& 2002 Harcourt Publishers Ltd
truth seems to ignore the complexity of the impact and the actuality of the powerlessness of the individual. Within a social world that shows a willingness to set up dialogue between diverse nations, it is not surprising to read Kirk's proposal for an optimistic position for globally influential nursing. Although the use of Change Theory has succinctly shown that there is a need for change to be established through a `bottom-up' approach, it is evident that the perpetrators of such change are often the key players in the organization. It is no less surprising to find that in the `global village' there is activity to ensure that existing significant sectors retain a valid power base. The creation of a powerful nursing force that would seek to superimpose altruistic concerns for the care of others upon the economic and political agendas of the Core powers is a wonderful ideal, but a remote possibility even at the turn of this new century. The insularity of personal safety and need was manifested by the terrible happenings of September 11th 2001. It is through such events that the true level and extent of the ability of trans global cultures to communicate at a real level is shown to be woefully inadequate. Whilst major world players can be self-centered in the determination of world policy, it is unlikely that the influence that nurses have can transcend the purely personal. The powerful may seek to empower the powerless, but only to the extent that they influence the way in which that power is used. As Kirk suggests, the arena of public health gives nursing the opportunity to influence policy, but it is also essential to avoid the selfish approach so often evident in international politics. It is important that nursing as a profession retains the altruism of caring and avoids the trap of self-importance to the exclusion of weaker nations and groups of the world. As Kirk suggests, nurses must be able to think globally whilst acting locally. Set against this, her imperative that appropriate education is the key simplifies the complex context of nurse education. Mary Birchenall
Senior Nursing Lecturer, School of Healthcare Studies, University of Leeds, UK
Nurse EducationToday (2002) 22, 72±73 73