Utilizing nurses in global health delivery

Background: Despite growing interest in global health nursing in the United States, nurses are grossly under represented in the field of global health delivery. Finding solutions to the challenges of healthcare in resource poor settings requires a combination of clinical experience and knowledge about the local clinical environment. While nurses who contribute to this work are most commonly drawn from academia, those with significant clinical experience have valuable expertise and skills to share with colleagues facing clinical challenges in the developing world.

Description: A program was designed to promote global health nursing in collaboration between a US health institution and a non-governmental organization (NGO) working in a rural healthcare system in the developing world. During the 6-month fellowship conducted on a repeating basis, an experienced clinician works alongside locally trained nurses in a rural setting on training needs and patient management issues. An onsite nurse mentor provides direction and support. Following a 6-month field placement, the fellow returns to share the experience with colleagues at their home institution. For example, a nurse midwife participating in the fellowship worked with locally trained nurses on management of postpartum hemorrhage and manual vacuum aspiration techniques. Her extensive clinical experience enabled her to evaluate the clinical environment and find feasible and sustainable solutions.

Lessons learned: An experienced clinician with knowledge in and focus on a specific area provides maximal impact to the local trained healthcare providers. The NGO infrastructure and onsite mentor help the fellow navigate an unfamiliar system, thereby increasing the effectiveness of their time and efforts. These two characteristics of this program contribute significantly to the local health system and the program's success. Nurses and other medical staff at the fellow's home institution gain insight into working as a health professional in a resource poor area.

Recommendations: Resources are needed to allow nurses to directly contribute to global health delivery. A well-defined practice area or program, sustainable training and system improvement goals, and onsite facilitation by a clinician familiar with the setting characterize these mentorships.