Member Spotlight: Sheila Davis on Raising the Nurse’s Voice in Global Health

By Sarah Arnquist | 05 May, 2011

“Member Spotlight” is a new series in which GHDonline highlights work by members engaged in the communities. Nursing Community Moderator Sheila Davis agreed to start it off. Sheila is a nurse practitioner and an Assistant Clinical Professor at the MGH Institute of Health Professions. In October 2010, she became the Global Nursing Coordinator at Partners in Health in Boston, Mass.

Sheila answered a few questions below and is pleased to answer further questions from the community so ask away! If you are interested in participating in a future spotlight, please email .

1. What does your role as Global Nursing Coordinator for Partners in Health entail?

Being a new position for PIH, this is an evolving role that is both exciting and challenging. Currently, in collaboration with my PIH colleagues, I am developing and coordinating programs to increase nursing capacity at PIH sites. Nursing is an integral part of our clinical programs, and PIH is committed to supporting nursing by focusing on improving education and specialty training to enable our nursing colleagues to deliver good care. Highlighting the critical role of nursing in quality care delivery and identifying nursing leaders at all of our sites are two of my main priorities.

2. Can you describe a couple of projects you’re working on?

PIH works in partnership with Ministry of Health (MOH) leaders at all of our sites to support and strengthen the public health sector. In Haiti, I am very excited to be working with MOH nursing leaders in advancing their comprehensive strategy for nursing. PIH hosted a meeting in March in Boston to encourage collaboration between Haitian nursing leaders and nursing leaders from the Boston academic and medical center communities. We were honored to have Irma Bois, Director of Nursing for the MSPP (MOH), present the Haitian delegation’s vision for nursing in Haiti. We will be moving forward on goals within the overall strategy in areas of Practice, Education, and Leadership, and the group committed to working within the public sector under the leadership of Irma Bois as a priority.

The Clinical Nurse Educator model began at one site in Rwanda and will be starting in Haiti this year. It is critical that we enhance in-country nursing expertise and support the development of local nurse experts. I have been working to develop partnerships with academic medical centers to provide PIH with ongoing access to nursing experts for clinical mentorship and advanced education in specialty areas. PIH has successful physician models of academic medical center collaboration; the challenge is to adapt that model for nursing.

3. What philosophy(ies) ground your work in global health?

The nursing profession has strong historical roots in social justice and a commitment to the underserved. As a nursing student in Boston in the mid- 1980s, I became involved in the HIV/AIDS field after witnessing the horrors of HIV and the stigma that fueled unjust and inhumane treatment of patients by the medical community. The HIV/AIDS community was a rich place to learn that health care cannot be separated from societal factors and social determinants, including poverty, education, and access to basic needs. I was very fortunate to be part of the inaugural class of Carl Wilkens Fellows at the Genocide Intervention Network in 2009. Carl Wilkens, one of the only US citizens to remain in Rwanda during the genocide, articulates the danger of viewing people as “other.” Not viewing ourselves as the same as other people is what allows atrocities to occur. Viewing this concept via a global health lens makes the current state of sub-standard health care for so many in the world intolerable. Health as a basic human right is critical and needs to be the basis for all of our work globally.

4. You often make a distinction between “task shifting” and “task sharing.” What do you mean by that?
 
I make this distinction because ‘sharing” implies accountability with the health provider team as a whole. As we look to provide health care to more people globally and embrace a more inclusive health care team, it is critical that quality remain at the core. PIH has a rich history of Community Health Workers providing excellent care in Haiti, Peru, and Boston — incorporated into the success of this model is ongoing involvement of nurses, doctors, and other health professionals to support the community health workers. I think this is important to view both ways, nurses and doctors are often not the experts on the community, and it would be inappropriate for me to go into a village to provide nursing care without input and oversight from the local community health worker. We can “shift” tasks from one member of the team to another, but we all “share” the responsibility that a person receives quality care.

5. Can you describe ways that GHDonline could be a useful tool to foster knowledge sharing and improve global health delivery?

GHDonline is an invaluable tool for the sharing of expertise among health care providers globally. The value and respect for all health care provider’s expertise regardless of whether they are from resource-limited or resource-rich settings, fosters an exchange of knowledge that benefits all. The multi-directional nature of the discussions in the communities is rich, and members contribute from their lived experiences, representing very different viewpoints. In addition to continuing to learn from many global nursing colleagues, I have found the GHDonline community to be a very good resource on topics in global health that are not necessarily my area of expertise. It has become a “go to” place to quickly get an overview of topics from a diverse group of providers.

6. Are there any roadblocks or questions you’ve faced recently in your work that this community of 760 people from 81 countries could help you answer or overcome?

I love this question as it really gets to the heart of the how a community like GHDonline is invaluable. One of the major challenges I continue to struggle with is how to give nursing more of a voice in global health. Nurses are an integral part of health care in villages, health centers, hospitals, governments, NGOs, academia, the for-profit sector, and faith based communities — but often we are not seen as global health leaders. There are exceptions and amazing, effective nurse leaders who are positively impacting global health care, but often these leaders are not visible. When we think of global leaders in other disciplines, many names come to mind, but nurse champions in global health are invisible. Identifying, highlighting, and promoting global nursing leaders are shared responsibilities for all of the global community. It is time that we find our voice.

Replies

 

Sheila Davis Moderator Emeritus Replied at 8:28 PM, 5 May 2011

Great timing as Nursing week is May 6-12, hopefully we can raise nursing's profile a bit!

Christopher Shaw Moderator Emeritus Replied at 12:03 PM, 6 May 2011

The issues highlighted here are very relevant to nursing. The themes of quality care, task sharing, and the example of viewing anyone as "other" that can result in terrible consequences are excellent reminders to nurses that we have a great responsibility to ensure human respect and dignity are maintained in all of our interactions. In reading this spotlight I am reminded that we are always called to use our voice and raise our voice whenever we witness an injustice, how to this collectively takes true leadership. Sheila and others have certainly provided that to many.

Inge Corless Moderator Replied at 9:52 AM, 7 May 2011

We have such phenomenal nurse leaders among us- Sheila and Chris being two outstanding representatatives of this group. Sheila's statements and Chris's response exemplify what we should pin to our mirrors to remind us each day what our responsibilities and opportunities are.
Advocacy is a core responsibility for all of us- to speak for those whose voices are not heard- to speak for those whose voices have been stilled- to speak with our unique nursing perspective; and to share with colleagues and learn from them with humility to improve our own knowledge and practice and theirs. In doing so we will strengthen the collective voice of nursing and be stronger for the effort and with a far greater impact in improving health care for all.

Jennifer Foster Replied at 4:22 PM, 8 May 2011

Sheila, I am so excited that you have the role of Global Nursing Coordinator at PIH. Congratulations! It is a groundbreaking and critical role. For those of us who are interested in increasing capacity of nurses and midwives and various areas around the world, what do you think are the essential elements for success for persons in roles such as yours, given that contexts vary so much from country to country? PIH has long standing commitments to Haiti and Rwanda and Peru. I believe a long standing commitment to a specific place is one of the essential elements. Would you agree?

Sheila Davis Moderator Emeritus Replied at 3:13 AM, 10 May 2011

Dear Jennifer,
thanks for the posting! I am in Rwanda right now so will keep my answer brief.
I definitely agree that a long term committment to a country is critical to enable a true partnership and relationship with our in country nursing colleagues. What I have found is that the wonderful nurses that I work with at all of our sites, are intelligent, hard-working nurses who know what they need and want, and need some assistance in helping their visions for their countries become a reality for nurses.
I am with a great group of Rwandan nurses who are working very hard to revitalize and structure the entire nursing education system, what an inspiring group of people!

Here in Rwanda, medical students are taught a nursing skills module BY A NURSE who is on the medical school faculty member as part of their medical school--- how so much more advanced than the US!

Hello to all from my Rwandan nurse colleagues,
Sheila

Brittney Sullivan Replied at 10:28 AM, 13 May 2011

Sheila,
Thank you for such an interesting Spotlight! I am curious to learn more about where nurse practitioners can best be utilized in the global arena. The role of the nurse and nurse-midwife seem relatively well established internationally (though still evolving), whereas NP's struggle to have one voice, whether due to barriers in policy or opportunities for higher education, lack of system support, or other reasons. Granted all nurses take on numerous roles providing patient care, advocacy, research, academia, etc. - do you find NP's are an understood role internationally and in positions similar to that in the US?
The Clinical Nurse Educator model in Rwanda you highlighted sounds like a wonderful opportunity to advance nursing education and mentoring. It seems vital to have local nurses at the forefront of continuing education with support from both national and international governments and NGO's.

Sheila Davis Moderator Emeritus Replied at 7:43 AM, 16 May 2011

Brittney,
Thanks for your posting. Your question was timely, I was in Rwanda all last week and had some very interesting discussions with Rwandan and US Academic Nursing school leaders about the NP role. According to my Rwandan nursing colleagues, the NP role has not been really explored on a national level, although many are interested in the concept as there are many ways where NP's would be an important contribution to the rural shortage of providers.

The International NP role has been one that I agree has been less established and could play such a critical role. I did find online a proposal by Grace Madubuko, Coordinator of Nursing Affairs , West African College of Nursing that was for an Advanced Practice Role/NP role in West Africa-- I am not sure where that stands but there is an International Nurse Practitioner/Advanced Practice Network at ICN that is interesting to look at as well-- see link below.

http://66.219.50.180/INP%20APN%20Network/About%20INPAPNN/Network%20History.asp

There have been specialty NP roles, HIV NP role for example in Haiti and other places, and in South Africa Primary Care nurses function in the rural areas as NP's with prescriptive authority on a limited formulary. In Haiti, I know that the MOH Nursing Director Irma Bois has expressed an interest in moving the NP agenda.

This is an area that I agree should be further developed, and would benefit from advocacy from NP's in the developed world. Taking your lead on this, I will look into the ICN group outlined above and see where we could help move this agenda along!
Thanks,

Sheila

Janet A DEWAN PhD CRNA Replied at 6:28 AM, 17 May 2011

Dear Colleagues

I am a Nurse Anesthetist, faculty at Northeastern University, and I have been working in Africa since the 1970's . Most recently the group I amam involved with travels to rwanda a few times a year where we perform mainly obstetric fistula repair surgery . I teach anesthesia students , who are well educated through a nursing and non nursing model.
I am also active with the International Federation of Nurse Anesthetists, which has acted as a global anesthetists organization for several decades, , where professionals , both nurses and non nursing anesthesia professionals ,meet and discuss anestetists' education and roles globally. We hold an international Congress every 2 years, next is in Slovenia, June 2012. The International Federation of Nurse ANesthetist (IFNA) model might be one that could guide or join with NPs as you organize globally. we have educational standards for accreditation at various levels and a formalized membership structure.

Most of my international experience is in West ( now East) Africa and if there is one resource i feel could improve global access to health as a right it would be expansion of the number of health workers at all levels, and access to professional colleagues and satisfying careers for those who are working in developing health systems. NPs ( and other APRNs ) could be key ingredients in securing the right to health. Establishing the role of NP at District hospitals and health centers would provide for consistent standards there and improve care, as medical coverage varies tremendously and can be inconsistent when it comes to policies and quality.

Let me know if you would like any more information about our international organization for Nurse anesthetists or have collaborative ideas about education.

I also just got back from 3 weeks in Rwanda, where I worked with both US and Rwanda anesthetist students. I will be teaching in Boston all summer.

Janet

Stacie Stender Replied at 1:54 AM, 18 May 2011

Dear colleagues,

Please note that there is an Advanced Practice Nursing Network within the ICN which address the role of advanced practice nursing globally. I encourage you to join. Go to: http://66.219.50.180/INP+APN+Network/INPAPNNHome.asp

Sheila Davis Moderator Emeritus Replied at 1:50 PM, 3 Jun 2011

Dear Colleagues,
Please see link to article by my colleague at the MGH Institute of Health Professions Dr. Lynda Tyer-Viola. Excellent piece on nursing and society.
In solidarity,
Sheila

http://www.theindependentbd.com/paper-edition/oped/52845-the-relationship-bet...

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