Toward Global Core Competencies in Nursing, Research Paper Example

Summary

Review of Torsvik and Hedlund (2008), Cultural encounters in reflective dialogue about nursing care: a qualitative study, examines a comparative study of two groups of nursing students from Norway and Tanzania. Hypothesis to the ethnographic query looks to the development of reflective nursing practice and its potential for translation in the global healthcare context. If current practice setting theories find departure in communicative praxis, studies dedicated to analysis of  globalization nursing, and particularly recommended nurse-to-nurse and nurse-to-patient approaches is of import. The foregoing outlines the comparatives study’s impetus as a programme of action, and as a platform for development of global core competencies in the field of nursing.

Premise to the study relies upon grounded socio-cultural theory as a basis for primary investigation into the human dimension of international healthcare infrastructure. Methodologies to the study substantiate phases of implementation in the tri-partite research design. Selection of the ethnographic methodologies is constructed around the concept of a ‘narrative pedagogy.’ Participants to the investigation were actively involved in iteration of the research, as data was collected by the researchers. Dataset collection was informed by respondent input through: group interviews, student log’ samples and foreknowledge of participatory observation by the researchers. Independent variable to the research – the international practice setting – served to constitute site selection of a convenience sample, based on existing nursing students whom are already participating in such a context.

Unlike experimental research, qualitative studies utilize ‘grounded theory’ approaches as they are not interested in maintaining controlled measures of quantification as evidentiary basis of a hypothesis. Rather, qualitative queries of this sort look to importation of findings into an ongoing knowledge structure that is reinterpreted as data is collected. In Torsvik and Hedlund’s study, the model of research is based on methods developed by Severinsson and Hallberg (1996). The nursing students were supervised during a pedagogical process; allowing questions and systematized experiences from shared clinical care activities in a professional context to be called forth contiguous to the research. Following Schön’s theoretical approach, (1995), the study’s grounded theory distinguishes between ‘reflection-on’ action and ‘reflection-in’ action as the delineation between conscious and unconscious practices embedded into professional performance.

Other theoretical consideration to the project addresses the value systems of nursing students assessed in previous research on the topic, and with parallel intent toward development of a culturally inclusive and universal approach to core competencies in patient care. Rather than focus on a top-down approach to knowledge exchange and attendant practices in nursing, these new research strategies seek to reflect the general trend of horizontal work relationships critical to the phenomenon of traveling nurses, and formative organizational management and leadership models respective to those changes in the healthcare institutional environment.

Significant to prior studies, is the insight that nurses from “visiting developing countries matured personally and intellectually more than those who experienced encounters between developed countries” (Torsvik and Hedlund, 2008, 389). Consistent to the current investigation, those encounters were characterized with an open attitude; facilitating a natural ‘learner-centered’ situation for equitable exchange between the students. From the two groups, distinct patterns of cultural conduct were recorded: 1) Norwegian students emphasized nurse–patient relationships, which included individualized care, direct communication and emotional involvement; while 2) Tanzanian nursing students demonstrated a collectivist approach in nursing characterized by nurse–relative–patient relationships, and emphasis on curing attributes with skilful deployment of procedures.

Analysis

In consideration of qualitative investigations on nursing practice in hospital organization and other clinical institutional settings, the following criterion enables nurse administrators and practitioners to develop better models of comprehensive care, and this includes synergy approaches to intra-unit training recommended by certification boards, such as the American Nurses Credentialing Center (ANCC) and related accreditation on progressive care certification (PCCN).  To this end, query to the import of Torsvik and Hedlund’s (2008) study of Norwegian and Tanzanian nursing interns to the certification process, and other standardization protocols is sought for determination of: 1) accuracy of the completeness of the study; 2) results plausible/believable; 3) results applicable to the patients; 4) results useful in practice; and 5) patient and family values considered.

The qualitative nature of ethnographic methodologies offers unique insights into cultures of practice that would otherwise remain opaque. Outcomes to the study reveal a thorough going investigation into the praxis or even ‘habitus’ within nursing student’ responses to various situations, and disseminates information on common response patterns persistent to the two national cultural groups. Patient and family values were put into dialogue throughout the process, and the study did indeed reveal consistency in style of mindfulness toward patient care, and the interpretation of both clinical and emotional needs.

The results are entirely believable, yet how they might be useful to a practice setting is not of direct value outside of the context of the convenience sample, without more extensive study in this direction.  Recommendations from the findings must inevitably be interfaced with existing rules and regulations already present within international nursing protocol, and will of course be refined according to national credentialing standards. Still the study offers a new window onto the types of curriculum that might be employed in individual institutions where there are a dense number of participants from various ethnic or national nursing cultures working together in practice. Grounded insights from those scenarios promises to be fruitful as nurses reflect on personal experiences, and inform professional knowledge sharing networks of their perspectives.

Globalization in healthcare has instigated much attention to comparative studies in healthcare and nursing practice, as circulation of human resources is common in the field, and absence of ‘universal’ protocol means that gaps between expectation and adherence to stated protocols, and general procedures may increase in high change contexts. While ‘change’ is considered a ‘good’ from an organizational theory perspective, and presents challenges that might be turned into opportunities, and this includes knowledge sharing, the impact of rapid flux in certain fields such as healthcare is also potential catastrophic in that risk to patients intensifies with each shift. If costs to healthcare institutions are to be mitigated responses to priority areas where risk reduction may proceed relatively quickly and cheaply is everyone’s first response. Designated best practice recommendations and institutional protocol stand to benefit from continuity in organizational culture(s), with ‘a duty to a standard of care’ the preeminent concern as a core competencies are reconfigured in regard to international nursing exchanges.

Conclusion

If healthcare institutions and their patients are to reap the benefit of international nursing exchanges in the face of nursing shortages, the acknowledgement that those cultural distinctions in healthcare practice exist, and inform how professionals in the field will assume provisions to  institutional guidelines, even when stipulated as rule. What Torsvik and Hedlund’s study perhaps shows best is that lessons learnt early at the nursing intern stage of clinical training enable medical practitioners to feel comfortable with distinctions, and form flexible conclusions about how patient care might be standardized. As the researchers point out, “both curing and caring are components of nursing practice,” but the efficacy revealed in the data offers deeper interpretation, in that “cure and care traditions may differ across countries and cultures as a result of the different value systems” embedded in the actual processes of nursing education pedagogy (Torsvik and Hedlund, 393).

Works Cited

Schön, D. (1995) Think in Action. Aldershot: Arena.

Severinsson E.I. & Hallberg I.R. (1996) Clinical supervisors’ views of their leadership role in the clinical supervision process within nursing care. Journal of Advanced Nursing 24(1), 151–161.

Torsvik, M. & Hedlund, M. (2008). Cultural encounters in reflective dialogue about nursing care: a qualitative study. Journal of Advanced Nursing 63(4), 389–396. doi: 10.1111/j.1365-2648.2008.04723.x