The scientific contribution of ES/CICAD/SMS/OAS^* project with schools of nursing in Latin America

Abstracts

The objective of the study was to determine the contribution of the Project of Executive Secretariat of the Interamerican Drug Control Commission of the Secretariat of Multidimensional Security of the Organization of American States with the Schools of Nursing through the analysis of the scientific evidence generated by nursing faculty in Latin America. The exploratory study analyzed 263 research prepared by participants, published in scientific journals, the thesis and the dissertations. 31,18% studies were from Brazil, 21,67% from Mexico and 9.89% from Peru. The School of Nursing from the Autonomous University of Nuevo León, Mexico; the School of Nursing of Ribeirao Preto, Brazil; and the Faculty of Nursing of the Peruvian University Cayetano Heredia, Peru had the highest scientific production on drugs. 191 studies had quantitative design, 62 qualitative design and 10 qualitative-quantitative designs. The findings indicated the Project had an important role in the development of scientific evidence on drugs developed by schools of nursing in America Latina.

Nursing; Drugs; Research

El objetivo del estudio fue determinar el aporte del Proyecto de la Secretaría Ejecutiva/Comisión Interamericana para el Control del Abuso de Drogas/Secretaría de Seguridad Multidimensional/Organización de los Estados Americanos con las Escuelas de Enfermería a través del análisis de la evidencia científica generada en América Latina. El estudio es del tipo exploratorio. Se analizaron 263 estudios realizados por docentes participantes del proyecto, publicados en revistas científicas, las tesis, y las disertaciones. Se rastreó la producción en bases de datos bibliográficas. Los resultados indicaran que los estudios publicados fueron en Brasil (31,18%), 21,67% en México y 9,89% en Perú. La Escuela de Enfermería de la Universidad Autónoma de Nuevo León, México, e la Escuela de Enfermería de Ribeirão Preto, Brasil y la Facultad de Enfermería de la Universidad Peruana Cayetano Heredia, Perú, tuvieron la mayor producción científica en drogas. 191 estudios tuvieron diseños cuantitativos, 62 cualitativos y 10 cuali-cuantitativos. Los datos indicaran que el Proyecto tuve un papel importante en el desarrollo de las evidencias científicas en drogas producidos por las escuelas de enfermería en América Latina.

Enfermería; Drogas; Investigación

O objetivo deste estudo foi determinar a contribuição do Projeto da Secretaria Executiva da Comissão Interamericana para o Controle das Drogas da Secretaria para a Segurança Multidimensional da Organização dos Estados Americanos com as Escolas de Enfermagem da América Latina. O estudo foi do tipo exploratório, que analisou 263 estudos realizados por participantes do projeto em revistas científicas, teses e dissertações. A busca da produção científica foi feita em diferentes bases de dados. 31,18% dos estudos publicados foram no Brasil, 21,67% no México e 9,89% no Peru. A Escola de Enfermagem da Universidade Autônoma de Nuevo León/México, a Escola de Enfermagem de Ribeirão Preto/Brasil e a Faculdade de Enfermagem da Universidad Peruana Cayetano Heredia/Perú tiveram a maior produção científica em drogas. 191 foram estudos quantitativos, 62 qualitativos e 10 qualitativos e quantitativos. Os dados indicaram que o Projeto teve um papel importante no desenvolvimento do conhecimento científico em droga produzido pelas escolas de enfermagem na América Latina.

Enfermagem; Drogas; Pesquisa

INTRODUCTION

Scientific knowledge is built by following a series of methodological, systematic, and orderly steps. It starts by questioning a certain reality in order to understand it better. Scientific knowledge is created by thinking beings who are rational and sensitive to what takes place in their surroundings.¹ Universities promote the development of knowledge and science and, because of this, scientific research is a key part of this function. Nowadays, no one doubts that the success of economies depends, to a certain extent, on the ability to generate and harness new knowledge, and university education constitutes an opportunity for individual development and international competitiveness.² Over the years, drug use has been a social problem with serious³ and even fatal consequences for humanity.^{4 - 5}

At the beginning of this century, scientific nursing knowledge on the subject of drugs was insufficient. The few studies conducted focused on the study of legal drugs, which had very little impact on the creation of public policies and the advancement of science and technology.⁶ Some other studies were mainly based on accounts of experiences or descriptive studies.⁷

The Project of the Executive Secretariat/Inter-American Drug Abuse Control Commission/Secretariat for Multidimensional Security/Organization of American States (ES/CICAD/SMS/OAS) was launched in 1997 with faculties and schools of nursing in Latin America and received funding from the governments of Japan, the United States, and Canada.⁸ The main purpose of the project was to train nurses on the subject of drugs. This was carried out in two stages. The first stage entailed inclusion of the subject of drugs in the nursing curriculum of undergraduate programs, and the second stage focused on including the subject of drugs in the curricula of graduate studies (specialization courses, master's degree and Ph.D.) and training nurses in the area of research. In the nurse training stage in the field of drug research, the objective was to promote research on drug use trends and the factors associated with substance use, utilizing standardized questionnaires and methodologies and observing the compatibility of the data in time and between countries.^{9 - 10}

From 1998 to 2010, this has involved more than 80 nursing schools and faculties from over 12 countries in the region.¹¹ For more than 10 years, teams of nurses participating in the ES/CICAD/SMS/OAS project have continuously striven to understand the phenomenon of drugs based on their particular realities, generating local and national multicentric studies^{12 - 14} on a par with international standards. The objective of this study was to determine the scientific contribution of the ES/CICAD/SMS/OAS Project with Schools of Nursing through an analysis of the scientific evidence generated by these schools in Latin America.

METHOD

This was an exploratory, cross-sectional study whose scope was the region of Latin America, where the ES/CICAD/SMS/OAS project was carried out. The study population consisted of all of those surveyed by the studies conducted by nursing professors from schools and faculties of nursing in the region who participated in the ES/CICAD/SMS/OAS project, and whose studies were published in scientific journals, theses, and dissertations. Only published research or theses/dissertations generated or supervised by professors trained by the CICAD project on the subject of drugs were included. Studies on the subject of drugs by authors who were not nurses or that were generated before the start of the ES/CICAD/SMS/OAS project (prior to 1998) were excluded. A total of 390 studies were collected, of which only 263 met the above criteria.

To identify the study population, the list of institutions participating in the ES/CICAD/SMS/OAS project was used, as well as the names of the trained research professors registered on the project's website. The studies identified as a starting point were those published as part of their training by the ES/CICAD/SMS/OAS project in special issues of Revista Latinoamericana de Enfermagem ("Latin American Journal of Nursing") of the School of Nursing of Ribeirão Preto-USP/Brazil. From there, the scientific production of each nursing researcher on the subject of drugs was tracked, either as first author, co-author, thesis author, or supervisor. The tracking was initially performed in bibliographic databases such as Scielo and PubMed, among others, and then in the form of an open search on the Internet. The open search included the surnames and names of each researcher, plus the words drugs, CICAD+drug intervention+use.

To register the information, an ad-hoc file was created that enabled the information obtained from the articles to be controlled, taking into account the names of the author or authors, country, institution, type of study, study design, level of evidence (if appropriate), theory used, level of prevention examined, published journal, objective of the study, results, and conclusions. Methodological quality was not assessed.

The data were tabulated on a properly coded Excel sheet, and an information quality control was performed prior to analysis in order to correct errors, eliminate double entries, complete missing data, etc.

Descriptive statistics was used to classify and break down the information as per each variable collected, after which the respective analysis was performed. An analysis of the content of each article was also done in order to systematize the contribution of each study. All of the studies were duly cited upon identifying their contribution.

In addition to analyzing identified studies according to the journal in which they were published, the journal was also tracked to identify its QUALIS/CAPES classification.15-16 This classification identifies scientific journals according to Impact Factor-ISI (J) and H Index- SCImago (H) as quality indicators for all areas of scientific knowledge. The categories used were17:

A1 classification: nursing journals indexed in the SCOPUS/SJR database, with H-index >15, or in the ISI/JCR database, with J impact factor >0.8 and related journals indexed in the ISI/JCR database, with JCR impact factor >2.4; A2 classification: journals indexed in the SCOPUS/SJR database, with H-index from 3 to 14, or in the ISI/JCR database, with J impact factor between 0.3 and 0.7, and those belonging to other areas with H>18 or J between 0.6 and 2.3; B1 classification: nursing journals indexed in the SCOPUS/SJR database, with H-index up to 2, or in the ISI/JCR database, with J impact factor up to 0.2, and others with H-index up to 9 or J up to 0.5 or, also indexed in CUIDEN with RIC index >0.6; B2 classification: Medline SciELO, CINAHL or CUIDEN indexed journals with RIC index between 0.2 and 0.5; B3 classification: journals indexed in the Lilacs or CUIDEN database, with RIC index up to 0.2; B4 classification: journals indexed in the BDENF database or "Portal de Revistas" (Journal Portal) of BVS-Enfermería or SPORTDiscus or Latindex; B5 classification: journals indexed in the following databases: Embase, Eric, PsycINFO, Cuidatge, Cab Health, Cabstracts, Physical Education Index, Periódica, Open Journal Systems, Cambridge Scientific Abstracts, or in another indexer, or, also, pertaining to the scientific or academic community in the area; and C classification: journals with ISSN and no reference sources (indexing databases or lists). Inappropriate journal

This study, with Code No. 60827, was approved by the Institutional Ethics Committee of Cayetano Heredia University

RESULTS

In Table 1, it can be seen that the nursing schools that participated in the Brazil ES/CICAD/SMS/OAS project reported the largest number of drug studies, followed by nursing schools in Mexico and Peru. It can also be noted that the number of nursing schools that participated in Brazil and Mexico was higher than in Peru, where only one institution was registered that generated all of the production. The average number of items produced by the nursing schools in these three countries indicates, that in the case of Brazil, there is a production of five studies per nursing school, while in Mexico it was 11 and in Peru 26.

Table 1
Distribution of original articles on the phenomenon of drugs by researchers from the ES/ CICAD/SMS/OAS Project, according to origin of the first author. 2004 - 2014

Continent		Country (number of institutions)	Original articles	%	Subtotal of originals	%
América	South America	Argentina (3)	13	4,94	179	68,06
		Bolivia (1)	7	2,66
		Brasil (16)	82	31,18
		Chile (3)	16	6,08
		Colombia (7)	20	7,60
		Ecuador (1)	9	3,42
		Peru (1)	26	9,89
		Venezuela (1)	6	2,28
	Central America	Guatemala (1)	2	0,76	23	8,75
		El Salvador (1)	1	0,38
		Costa Rica (2)	9	3,42
		Nicaragua (1)	3	1,14
		Panamá (1)	1	0,38
		Honduras (2)	7	2,66
	North America	Mexico (5)	57	21,67	59	22,43
		USA (1)	2	0,76
Europe		Portugal (1)	1	1	0,38	1
Africa		Mozambique (1)	1	1	0,38	1
Total			263	100	263	100

Table 2 shows the nursing schools that produced more studies. We found that the top ranked was the School of Nursing of the Autonomous University of Nuevo Leon in Mexico, followed by the School of Nursing of Ribeirão Preto-USP in Brazil and the School of Nursing of Cayetano Heredia University in Peru.

Table 2
Distribution of the 10 Universities that participated in the ES/CICAD/SMS/OAS project, with the highest production of original articles by lead author. 2004 - 2014

Ranking	Country	Institution	Number of originals
1	Mexico	Universidad Autónoma de Nuevo León	41
2	Brasil	Escola de Enfermagem de Ribeirão Preto - USP	40
3	Peru	Universidad Peruana Cayetano Heredia	26
4	Colombia	Universidad Nacional de Colombia	12
5	Brasil	Universidade Federal de Rio de Janeiro	12
6	Argentina	Universidad Nacional de Córdova	11
7	Brasil	Universidade Estadual de Rio de Janeiro	10
8	Ecuador	Universidad de Guayaquil	9
9	Chile	Universidad de Concepción	9
10	Costa Rica	Universidad de Costa Rica	8

Table 3 indicates that more than two-thirds of the studies published by nurses trained in the ES/CICAD/SMS/OAS project used quantitative methodology, while the remainder used qualitative or qualitative-quantitative methodologies.

Table 3
Distribution of original papers on the phenomenon of drugs according to type of study conducted by researchers in the ES/CICAD/SMS/OAS. 2004 - 2014

Research Design	n	%
Qualitative	62	23,57
Quantitative
Observational	187	71,10
Experimental	4	1,52
Qualitative Quantitative	10	3,80
Total	263	100

In Table 4, it was found that only 209 studies were published in indexed journals whose QUALIS/CAPES classification are in the "A" and "B" categories. Five indexed journals had the largest number of published articles, all from Brazil, followed by one journal each from Colombia and Peru, with five published articles.

Table 4
Distribution of Journals that published original articles from the ES/CICAD/SMS/OAS Project, and their CAPES Classification

	Name of Journal	Country	CAPES Classification	Number of Originals
1	Revista Latinoamericana de Enfermagem	Brasil	A1	146
2	Escola Anna Nery Revista de Enfermagem	Brasil	B1	15
3	Revista Texto y Contexto Enfermagem	Brasil	A2	12
4	Acta Paulista de Enfermería	Brasil	A2	6
5	Revista da Escola da Enfermagem da USP	Brasil	A2	5
6	Investigación y Educación en Enfermería	Colombia	B1	5
7	Revista Enfermería Herediana	Peru	B3	5
8	Revista Brasilera de Enfermería	Brasil	A2	4
9	Aquichan	Colombia	B1	3
10	Ciencia y Enfermería	Chile	B1	2
11	Cuidarte	Colombia	B5	2
12	Enfermería Global	Spain	B2	1
13	Avances en Enfermería	Colombia	B1	1
14	Revista de Salud Pública	Colombia	B1	1
15	Revista Enfermagem UERJ	Brasil	B1	1
16	Journal of Addiction Nursing	USA	B1	1
17	International Nursing Review	Switzerland	A1	1
	Total			211

Table 5 shows that the studies mostly focused (77%) on universal prevention, seeking to investigate the prevalence of use in the general population and to understand the protective and risk factors of use. In the case of selective prevention (13.79%), the contributions focused on understanding risk behaviors and, in the case of recommended prevention (8.43%), the contribution was focused on understanding the user population, their consumption patterns, the problems associated with their use of drugs, and the characteristics of their rehabilitation and social reintegration.

Table 5
CPrevention categories and topics where the studies published by researchers trained by the ES/CICAD/SMS/OAS Project made scientific contributions

Prevention categories*	Frequency	Percentage	Topics of scientific contribution
Universal Prevention	205	77,95	Prevalence of drug use and polydrug use, risk and protective factors, consequences of use.
Selective Prevention	36	13,69	Risk behaviors, exposure to drug use, those affected by the use of drugs
Recommended Prevention	22	8,37	Use patterns, first experiences of users, problems associated with use, recovery, rehabilitation and reintegration process,
Total	263	100

• * Prevention Classification - IOM/NIH (17-18).

In terms of the use of theories in the studies, it was found that there is still no strong inclination to use scientific nursing theories. Approximately 80% (206/261) of the studies addressed the issue using an epidemiological approach to drug use at a local or national level, while 4% (11/261) addressed the problem based on the theory of social norms. The remainder of the studies independently used a variety of theories, such as social, anthropological, psychological theories, as well as a few from nursing, to explain the phenomenon of drugs.

DISCUSSION

The ES/CICAD/SMS/OAS project with nursing schools in Latin America puts the subject of drugs on the table for discussion and as a reality to be investigated from the perspective of the nursing field on this side of the continent.^{18 - 19}

The main interest of the ES/CICAD/SMS/OAS project was to insert the subject of drugs into the undergraduate curriculum to ensure the training of new human resources with an emphasis on the issue of drugs. The strategy to train teachers as basic critical mass to generate new knowledge on the subject of drugs was important in that it prepared leaders and thereby ensured the continuity of the task.^{20 - 21}

This strategy succeeded in securing the production of scientific research on the subject of drugs, and it is very likely that many research professors found the opportunity for professional growth through the definition of a line of scientific work.^{22 - 23}

In total, the schools of nursing in the region produced 263 published studies on the subject of drugs following the implementation of the ES/CICAD/SMS/OAS project. Nurses trained on the subject of drugs are either first authors of each of those studies or are listed as co-authors or supervisors.

The training given through the project was carried out in Brazil and Canada, and each research professor who participated received the title of Specialist in the Study of the Drug Phenomenon upon presentation of an article published in Revista Latinoamericana de Enfermagem (Latin American Journal of Nursing). After the completion of their training, each professor was tracked on the Internet to identify his or her scientific production on the subject of drugs.

Each author's production was different, but a significant number have conducted more than one study on the subject. Some have even used the topic of drugs as the subject for their thesis to obtain advanced academic degrees, or have been supervisors for their undergraduate and graduate students. That is the reason why the number of studies produced as first author is different in each country, and why there were also few institutions per nation that participated.

The case of the School of Nursing of Ribeirão Preto is important, because although it was not the only institution in Brazil that participated, it was the one that had a key performance in the project. The School of Nursing of Ribeirão Preto carried out one of the International Researcher Training Programs in the region and hosted most of the professors who participated in the project to receive training. A large number of professors from the School of Nursing of Ribeirão Preto acted as supervisors for each project prepared by the research professors and appear as co-authors of the publications submitted for the purpose of obtaining the title. However, in order to avoid generating duplicate entries, only the first author was considered in this study, as well as his or her place of origin and institution, as the generator of the study. Currently, Revista Texto & Contexto Enfermagem (a nursing journal) of the Department of Nursing of the Federal University of Santa Catarina, Brazil is playing an important role in the publication and dissemination of scientific information on drugs produced by nursing professors in Latin American.

It was also found that research work groups have been consolidated within institutions, countries, and even between various countries. An additional result of the ES/CICAD/SMS/OAS project has been the generation of scientific networks of nursing researchers on the subject of drugs. As is known, the generation of synergies produces successive waves of related authors and a higher generation of future knowledge on a specific topic.

The contribution of nurses on the subject of drugs, through the use of extensive research methodology, has been important in the last decade, but the same is true in other specialties of the discipline. More and more experts agree on the importance of exploring other paradigms and ways of understanding this reality to achieve a more complete and comprehensive view.²⁴ However, nursing delves into the subjectivity of people to discover their needs, and qualitative research provides the appropriate method to understand their experiences, grasp their reality, and draw closer to them.²⁵

A good indicator of the impact of the ES/CICAD/SMS/OAS project is not only the number of studies conducted, but the number of original articles generated and published in indexed journals. Of the 263 documents published by the trained research professors, 211 were published in prestigious indexed journals, six of which are found in the "A" category of the QUALIS/CAPES classification. This may indicate not only that nurses in Latin America have a greater capacity to be increasingly included in publications from the scientific community, but that there are more ways to disseminate quality scientific nursing production. Many of these studies have been published in indexed journals at the regional and international level, permitting a wider propagation of nursing knowledge. The greatest number of these journals are from Brazil, a country that for many years has stood out for its high scientific production in this speciality^{26 - 27} and that has had years of experience in this area. Peru, Colombia, and Chile are making significant efforts on the subject of drugs, but their journals are still in the "B" category, according to QUALIS/CAPES (Table 4).

Insofar as the contributions made by the studies, they are abundant. The classification addressed in this article is organized according to the level of prevention. The studies published by trained professors in Latin America are diverse. Most are quantitative, descriptive, and cross-sectional and have sought to explore the general population in order to identify the level of prevalence of use and existing factors that either increase people's risk or protect them from drug use. Some other studies have explored the knowledge and attitudes of people toward the consequences of drug use.

An important group of nursing professors has approached the population at risk and drug users to investigate the phenomenon of drugs. Their studies not only examined the risk behaviors associated with the use of different types of drugs, but the social problems associated with drug use, as well as the recovery, rehabilitation, and social reintegration processes that users have undergone. It is worth noting, however, that regardless of the level of prevention (Table 5), studies that involve experimentation with an intervention-based approach on the part of nursing are still scarce. Only four studies were found that examined the effectiveness of a nursing intervention related to the subject of drugs.

It is important to mention in this study that nurses still do not orient their research from the perspective of a reference framework or specific theory of nursing knowledge. It seems that although they start their research on the basis of a perceived reality, most studies fail to explain the phenomenon from the angle of nursing care. Some nursing researchers manage to provide an explanation based on the field of drug use itself or using social or cultural approaches, but much work needs to be done to expand and strengthen the contribution of nursing care theories to the problem of drugs. It is important to note that the theoretical and philosophical frameworks entail a socio-humanistic approach, which is beneficial for philosophers, anthropologists, sociologists, educators, historians, and nurses.²⁸

CONCLUSIONS

It can be concluded that the ES/CICAD/SMS/OAS project has significantly contributed to the development of scientific evidence regarding drugs in Latin America, as demonstrated by the over 200 studies conducted and published in the scientific community.

While most of the published studies are quantitative and descriptive, the conducting of studies with qualitative methodologies is also considerable.

Lastly, the contribution of the project can be clearly seen in the number of professors trained in research on the subject of drugs, as well as new human resources in terms of students. The strength of this contribution refers not only to the number of publications but to how it has resulted in a better understanding of the phenomenon of drugs through the use of the scientific method. It would be advisable to continue or to generate initiatives such as this one in other nursing specialties or to continue strengthening support networks not only with universities but with other countries such as Brazil and Mexico in order to achieve synergies that enable the overall growth of the discipline in the region.

Furthermore, policies can be created to strengthen research in educational institutions, ranging from the management of groups of researchers to the training of new human resources who will continue with or generate new lines of research for "excellence in nursing".

Limitations

Although the study endeavors to understand the contribution of the ES/CICAD/SMS/OAS project, we acknowledge that there were weaknesses in the design, because it would be recommended not only to determine the scientific production of the nurses after the project, but to compare these results with the production of nurses on the subject of drugs before the start of the ES/CICAD/SMS/OAS project in Latin America. However, such a comparison is typical of an experimental or ex-post facto design, which was not possible for various reasons. It is very likely that many of the professors trained were not working as professors before the project began, but were students or had only recently started teaching. The study also lacked reliable and comprehensive databases to track these same researchers at the end of the last century.

In addition to this, it is possible that the tracking performed may have inadvertently omitted certain published studies, but this is estimated to be less than 10% of those registered in this study. This may have happened due to the way the researchers registered the professors' names and surnames which, due to the style of each journal, database, or country, may vary in terms of order or punctuation marks, not recognizing all of the algorithms at the time of tracking with the usual form of writing.

AKNOWLEDGMENTS

To the Government of the United States, to ES/CICAD/SMS/OAS and Cayetano Heredia University (UPCH) for having funded this study through the Integrated and Cross Faculty Project on the Phenomenon of Drugs of UPCH-ES/CICAD/SMS/OAS, and to everyone who was directly or indirectly involved in this study.

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• *
  Secretaría Ejecutiva, Comisión Interamericana para el Control del Abuso de Drogas, Secretaría de Seguridad Multidimensional, Organización de los Estados Americano

Publication Dates

• Publication in this collection
  2015