In response to a growing emphasis on transcultural nursing and global health, nursing education is challenged to provide international experiences to enhance cultural competence and the global awareness of students and faculty. The American Association of Colleges of Nursing (2006) document, Preparing a Culturally Competent Workforce, outlined cultural competencies and provided a framework for implementation and evaluation in baccalaureate nursing education. While current curricula may incorporate piecemeal information or elective courses, such approaches have been recognized as inadequate in preparing nurses for increased population diversity and the global scope of nursing (Calvillo et al., 2009).
The University of Tennessee College of Nursing has embraced the integration of multiple curricular strategies to promote knowledge and understanding of diverse cultures, including a defined course in transcultural nursing practice and several opportunities for international immersion experiences. With university-level support through the Ready for the World program, faculty develops innovative partnerships and opportunities for international experiences in nursing and health care. Participation in the Ghana Health Mission is a recent example of these efforts.
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Founded in 1994, the goal of the Ghana Health Mission is to provide community-based primary health care services to a population in need. The initial collaboration between Dr. Leda McKenry from the University of Massachusetts School of Nursing and Reverend Robert Andoh, pastor of the Assemblies of God Church in Sekondi, has continued to sustain and expand the mission for many years. Each health care team consists of volunteer students and faculty from various academic programs. The University of Massachusetts, the University of New England (UNE) Portland, and the University of Tennessee Knoxville College of Nursing (UTK CON) have partnered consistently to provide services for a two-week time period during March and/or August. In August 2009, a total of 23 health care providers made the trip, including two University of Tennessee nursing faculty, Maureen Nalle, PhD, RN, and Karen Lasater, DNP, RN, APN.
The makeup of the team varies, depending on availability of undergraduate and graduate (advanced practice) nursing students, as well as faculty resources to support the clinical learning activities. In recent years, the UTK CON team is primarily composed of nursing students and faculty, while UNE has provided a multidisciplinary team including nurses, physician's assistants, physical therapists, and occupational therapists. Faculty and students are allocated to the diverse tasks of the clinic, including triage, pharmacy, primary care, and wound care. Sharing of talents and resources amongst the team members creates a rich learning environment for all participants; for many students, this is their first opportunity for interdisciplinary care. Experienced community health care workers are invaluable for interpretation and facilitating clinic operations.
The August 2009 health care team provided care to more than 600 patients in a 10-day period, challenging the skills and knowledge of every provider. The health care needs of the Sekondi community reflect both the poverty and lack of resources of its residents. Malaria, malnutrition, and infectious diseases are the most common reasons to seek treatment, with greatest effects on young children and the elderly. Frequently, patients have not seen a health care provider for many months or even longer, which exacerbates their symptoms and the severity of their illness. Skin infections and diabetic ulcers of the legs and feet are common examples of inadequate preventive care, poor sanitary conditions, and lack of treatment for chronic illness. Hypertension is very common among the adults and even some of the young adults seen in the clinic. The majority of patients seen have high blood pressure and are referred to a community health nurse for follow-up. While the health care demands far exceed the capacities of a two-week clinic, some critical needs for antibiotics, anti-malarial drugs and hypertension treatment clearly ensure some measure of health care that would otherwise be lacking in this population.
Both Nalle and Lasater have made previous trips to Ghana, although this time they were not accompanied by students. 'In past years, we have accompanied one of the other academic groups and wanted to explore the potential for an additional yearly trip by our students and faculty for a separate health mission,' Nalle said. 'The more consistently health care services are available, the greater the impact on overall community health and disease prevention. Ideally, a health mission team would be present at least twice a year if faculty and student resources were available.' This exploratory trip was supported by faculty grants from the University of Tennessee Center for International Education and the UT Ready for the World Initiative, two university initiatives to promote global competence.
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Beyond the important health care provided, nursing faculty took advantage of the opportunity to meet with Matilda Bansah, the Director of the Sekondi Nursing and Midwifery Training School. Reporting that faculty resources and educational materials are areas of serious need, Bansah also discussed prospects for shared educational experiences between GHM students and the nursing students in the Sekondi program. Such collaboration would be mutually beneficial to U.S. students and local public health nursing students, creating an opportunity to exchange ideas, develop cultural competence, and to role model international nursing. Faculty exchange of research ideas and teaching strategies is also a priority for supporting growth of this nursing program.
The next Ghana Health Mission is scheduled for August 2010 under the leadership of Jennifer Morton, DNP, MPH, nursing faculty at UNE. Interested students and faculty may contact Dr. Maureen Nalle at 865-974-7598 or mnalle@utk.edu to request more information, or visit the Ghana Health Mission website at www.ghanahealthmission.org.
by Maureen Nalle, PhD, RN, and Karen Lasater, DNP, RN, APN
