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Print version ISSN 0104-1169On-line version ISSN 1518-8345
Rev. Latino-Am. Enfermagem vol.13 no.spe2 Ribeirão Preto Nov./Dec. 2005
International nursing leadership related to the drugs phenomenon: a case study of the partnership experience between the Inter-American Drug Abuse Control Commission (CICAD) and the University of Alberta - Faculty of Nursing1
Maria da Gloria Miotto WrightI; Catherine CaufieldII; Genevieve GrayIII; Joanne OlsonII; Alicia del Carmen LuduenaIV; Flor Yesenia Musayon OblitasV; Julia Huaiquian SilvaVI; Helena Maria Scherlowski DavidVII; Ketty Aracely Piedra ChavezVIII; Maria Carmen Bernal RoldanIX; Maria do Horto Fontoura CartanaX; Maria Magdalena Allonso CastilloXI; Sandra PillonXII; Sueli Aparecida Frari GaleraXII; Vera RanduzX
IPhD, Inter-American Drug Abuse Control Commission/CICAD - Organization of American States/OAS/US
IIRN, PhD, University of Alberta/Faculty of Nursing/Canada
IIIRN, RM, M.Sc, University of Alberta/Faculty of Nursing/Canada
IVRN, M.Nurs, National University of Cordoba/Argentina
VRN, MEd.&Res., Peruvian University Cayetano Heredia/Peru
VIRN, M.Nurs, University of Concepción/Chile
VIIRN, PhD, State University of Rio de Janeiro/Brazil
VIIIRN, MCH, University of Guayaquil/Ecuador
IXRN, MEd, National University of Colômbia/Colômbia
XRN, PhD, Federal University of Santa Catarina/Brazil
XIRN, MPH, National University of Nuevo Leon/México
XIIRN, PhD, University of São Paulo/Brazil
In this article, the authors discuss the value of international health in advancing the nursing profession through the development of strong leadership in the area of drug demand reduction. Paradigms for nursing leadership are briefly reviewed and linked to the development of the "International Nursing Leadership Institutes" organized by the Inter-American Commission for the Control of Drug Abuse (CICAD). The "International Nursing Leadership Institutes" have facilitated the implementation of Phase III of the CICAD Schools of Nursing Project: a) planning and implementing the first "International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in Latin America", b) development of Regional and National Strategic Plans for Nursing Professionals in the Area of Demand Reduction in Latin America, and c) preparation of a document that provides guidelines on how to include drug content into undergraduate and graduate nursing curricula. The article also brings reflections directly from several of the participants in the first International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in the Americas, offered in collaboration with the Faculty of Nursing at the University of Alberta in Edmonton, Canada. These reflections demonstrate the multiplicity of ways in which this capacity-building program has made it easier for these members of Latin American Schools of Nursing to show leadership in the area of drug demand reduction.
Descriptors: leadership; capacity-building; research; nursing
With the beginning of the 21st Century, it is already evident that the nursing profession will face new challenges. Among the macro determinants and conditioning factors influencing nursing profession, the exercise of leadership, and the conduct of research within the profession are also the political and economic stability of the countries; international and national security; health and environmental conditions; and scientific and technological advances.
These new realities will influence the direction the nursing profession will take to work together to solve problems using scientific evidence, and to demonstrate new models of leadership to deal with the consequences of the globalization process, as well as with issues related to the drug phenomenon, violence, increase in refugees, degradation of the environment, health care reform, information and technology, terrorism and bio-terrorism acts; the aging of our populations, new demands in the job market, and new models of partnerships(1-3).
The development of new models of leadership based not only on individual characteristics, but also on the ability to use scientific and technological evidence for the solution of problems and conflicts, requires a combination of efforts from individuals and what the nursing profession offers collectively as resources, strategies and environment for development(4).
The advancement of the nursing profession in Latin America requires the development of international and national efforts and partnerships. A good example of such effort is the role of the Inter-American Drug Control Commission (CICAD) in the advancement of nursing education, practice (extension activities) and research in the field of demand reduction in Latin America. Educating nurses to work in the field of demand reduction requires a combination of international and national commitment and efforts with continued financial support to see results over the short, medium, and long term.
In 1997, CICAD, with financial support from the Government of Japan initially, and later from the United States and Canada, initiated a unique experience with selected schools of nursing in Latin America. The goal was to prepare faculty and, through them, future nursing graduates to work in the field of demand reduction with activities related to health promotion, prevention of drug use and abuse, and social integration. This experience was divided into four phases: Phase I - pilot experiment with a few schools of nursing; Phase II - expanding the experiences to other schools of nursing; Phase III- development of regional and international partnerships to provide research capacity-building programs for nursing faculty; and Phase IV - implementation of new models of nursing intervention in the field of demand reduction.
This paper presents a new scholarly leadership model developed by CICAD with the collaboration of the University of Alberta-Faculty of Nursing, to prepare nursing faculty to study the drug phenomenon in Latin America. The faculty at the Latin American Schools of Nursing that participated in this unique and significant experience have been positioned to play a lead role in redefining nurses' roles in society, forming future nursing and health professionals in their countries through visionary and innovative curricula, with an emphasis on the drug phenomenon and international health. They will build science and technology in the field of drug demand reduction, and will transfer knowledge through technology to public policies that are more consistent with current societal demands.
Participants in the CICAD/University of Alberta project were strengthened by the program, which involved a nursing leadership model based on knowledge that transforms society. The program offered a life-lasting experience that will multiply in Latin America and influence the transformation of the knowledge society in the future.
NEW LEADERSHIP PARADIGMS AND MODELS
The advancement of globalization in the world has opened frontiers for new leadership paradigms and models. These need to meet the job market demands and, at the same time, offer theoretical and operational foundations for problem solving based on scientific evidence. Globalization is a dynamic process involving the flow of goods, capital, people, and ideas and the interconnection of activities in different sectors of society(5-6).
The development process involves four fundamental concepts: power, interest, knowledge and leadership for policy design and decision-making. The interrelationship among these four concepts makes the process of development dynamic and progressive(7). The new leadership paradigms and models that will advance the nursing profession in the XXIst century need to take these elements into consideration to create a cadre of new nursing leaders that will make education, practice, and research dynamic, integrative, and progressive processes to respond to the challenges of a global world. The leader in this paradigm becomes a transformational leader(8).
According to Selanders(9), Florence Nightingale's thoughts, values and activities provide elements of a trans-visionary leadership paradigm. The leader in this paradigm uses expert knowledge, position, and opportunity as a power base for decision making and for creating permanent social change.
Lucey(10) introduces the concept of "adventure" as part of a new paradigm, because of the complex environment we live in today. She emphasizes that, when nurses see leadership as an adventure, they will develop "adventure skills", such as assessment skills, interpersonal communication skills, and organizational skills. A leader who sees leadership as an adventure is dedicated to lifelong learning.
Lemire(11) emphasizes the importance of leadership development as part of nursing education responsibilities. She suggests that an innovative leadership education model is an important element for guiding the development of a progressive leadership curriculum that will contribute to the acquisition of new leadership behaviors within the profession. She proposes a "Leadership Educational Model" that is based on integration, progression and evolving processes. Within this model, a leader would become a visionary, as well as an expert, an achiever, a critical thinker, a communicator and a mentor.
Hemphill(12) indicates that there is an urgent need to integrate education, practice and research to meet the new demands of society and achieve a new profile of leadership. She addresses the need to substitute the old paradigm of structural isolation and cultural individualization with one that gives emphasis to collaboration, commitment and partnership. This model opens possibilities for the creation of a transformational leader.
Pesut(13) provides a vision for leadership based on the process of renewal. It involves aspects related to self, service, scholarship of reflective practice, science, society, and spirit, which all allow for more creative, thoughtful and inspiring leaders.
According to some Latin American authors, the new leadership paradigm and models should address social transformation, based on the use of science and technology to solve problems and decision making. The leader becomes an "agent of transformation" within the context s(he) is part of(14).
Taking into consideration the new paradigms and models of leadership, CICAD created a mechanism to strengthen nursing leadership in Latin American countries. Three "International Nursing Leadership Institutes" for Deans and Coordinators of Graduate Nursing Programs from eleven countries in Latin America were implemented with financial support from the U.S. Government.
The three Leadership Institutes that CICAD organized in 2003, 2004 and 2005 had the following objectives: (i) promote interaction, integration and sharing of experiences among Deans and Coordinators of Graduate Nursing Programs from eleven countries from Latin America with Deans from Canada and the United States; (ii) develop a regional and national strategic plans to advance nursing education, research and practice in Latin America in the field of demand reduction; (iii) develop curriculum guidelines to promote the inclusion of international health and drug phenomenon issues within undergraduate and graduate nursing programs; and (iv) develop leadership knowledge and skills to acquire political and scientific support at international, national and local levels.
CICAD has played an important role in promoting the creation of a new nursing leadership profile in Latin America and, at the same time, has opened opportunities for new partnership models among schools of nursing in countries from the North and the South of this hemisphere. Only with a clear knowledge and understanding of the forces that are shaping and leading the directions of the nursing profession in the XXI century will it be possible to create and sustain these new forms of nursing leadership in the Americas.
As important as the creation of a new leadership model is the provision for leadership succession, an idea that originated in the business world. According to Conger and Fulmer(15), it is important to create a succession management system that will build a steady, reliable pipeline of leadership talents. For them, succession planning and leadership development involves getting the right skills in the right place.
In some ways, with the development of "International Nursing Leadership Institutes," CICAD is promoting an alternative path to achieving the final goal of advancing the nursing profession in the field of demand reduction in Latin America.
The importance of the International Nursing Leadership Institutes is that they have allowed the participants to face the opportunities and historical challenges in this globalized world, using new leadership capacities and skills. These leaders are interested in contributing with professional knowledge, technology and interventions in the arena of the drug phenomenon-especially in the area of demand reduction, as they identify the many problems that derive from drugs and related problems: violence, terrorism, accidents, self-provoked injuries, and the appearance of social problems such as poverty, delinquency and marginality.
Leaders recognize that they should act from different perspectives, such as interdisciplinary education, social practice, public policy, research, technology and cultural diversity. Thus, they should use their capacities of future global vision, creative and strategic thinking, negotiation, and action oriented to decision making.
THE CICAD AND UNIVERSITY ALBERTA-FACULTY OF NURSING PARTNERSHIP EXPERIENCE
During 2000, CICAD entered into Phase III of the Nursing Schools Project in the area of Demand Reduction in Latin America. One of the activities of Phase III of this project was the development of a new Model of Technical Cooperation (TC), as a process to build partnerships with universities in Canada and the United States to carry out "International Research Capacity-Building Programs for Nurses to Study the Drug Phenomenon in Latin America."
Initially, CICAD sent invitations to one School of Nursing in Canada - Faculty of Nursing of University of Alberta/Canada; and two Schools of Nursing in the United States - the School of Nursing of the University of Michigan/Ann Arbor; and School of Nursing of the University of Maryland. They were invited to be part of a new Model of Technical Cooperation to prepare Latin American nursing faculty to further develop research methodologies to conduct studies on drug phenomenon issues in the areas of health promotion, prevention of drug use and abuse, and social integration.
The process of TC between CICAD and these three universities involved the following steps: CICAD (i) prepared a Memorandum of Understanding (MOU) and sent it to these Schools of Nursing; (ii) sent a representative from CICAD as an official visitor to the three Schools of Nursing; (iii) invited representatives of these Schools to participate in international meetings organized by CICAD in Mexico, Brazil and Peru during 2002-2005; (iv) prepared a schedule for the implementation of the "International Research Capacity-Building Programs for Nurses to Study the Drug Phenomenon in Latin America"; and (v) prepared a "Letter of Intent" to implement the "First International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in Latin America" at the University of Alberta-Faculty of Nursing/Edmonton/Alberta/Canada during the Summer of 2003, with financial support from the Government of Canada.
To facilitate the process of TC, the Faculty of Nursing of the University of Alberta/Canada invited the representative of CICAD to be Adjunct Faculty during 2002-2003 and, in the summer of 2002, the CICAD representative was responsible for teaching a graduate summer course entitled "International Health and Nursing Leadership". During 2002-2003, CICAD and the Faculty of Nursing planned and organized the program and the curriculum for the "First International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in Latin America". In the fall of 2002, CICAD, the Faculty of Nursing of the University of Alberta/Canada and the Deans of fifteen Schools of Nursing distributed in ten countries of Latin America, selected the eleven candidates who participated in this program. In February of 2003, CICAD received the financial support from the Government of Canada to implement the "First International Research Capacity-Building Program".
The 11 nurses participating in the program were educators and leaders at their universities. The most significant component of the program was its international vision, which mandated an analysis of study phenomena (reducing drug demand) from a holistic and critical perspective, using both quantitative and qualitative methodological approaches.
Important strategies used in the program included discussion among colleagues and professors from the University of Alberta Faculty, University of Alberta faculty mentorship on research projects and academic sessions with experts in drug phenomenon. The facilities, infrastructure, databases, bibliographies and communication technology offered by the University of Alberta were factors that allowed the 11 nurses to gain significant lifelong learning skills. Among the lessons learned, those that stand out include working in collaborative networks and learning about technical cooperation, academic mobility, the need for technology transfer, research outcomes, and different ways of creating new spaces and opportunities for nursing in reducing drug demand.
INTERNATIONAL RESEARCH CAPACITY-BUILDING PROGRAM
"The First International Research Capacity-Building Program for Nursing Faculty to Study the Drug Phenomenon in Latin America" was implemented with technical and financial support from CICAD-the Government of Canada, and the University of Alberta-Faculty of Nursing during the summer of 2003. The program took one year and was divided into three parts. Part I of the program was implemented onsite at the University of Alberta-Faculty of Nursing and was composed of three Modules, which emphasized the following aspects: (i) Module I - International Health and the Drug Phenomenon; (ii) Module II - The Drug Phenomenon in the Americas; (iii) Module III - Research Methodologies (Qualitative and Quantitative Methods). Part II involved distance mentoring when the participants returned to their countries to implement the multi-centric research studies. Part III involved the process of communication and dissemination of the results of research studies at national and international conferences, meetings, workshops and in peer reviewed publications.
For the process of publication, another letter of agreement between CICAD and University of Alberta-Faculty of Nursing was signed, detailing the nature and authorship of the manuscripts that would result from this unique experience.
The eleven nurses who participated in the program were enrolled as "Latin American Visiting Scholars" and came from Argentina (1); Brazil (5), Chile (1), Colombia (1), Ecuador (1), Mexico (1) and Peru (1). The Faculty of Nursing at the University of Alberta provided a "Specialization Certificate" for those who had a Masters Degree, and a "Post-Doctoral Certificate" for those with Doctoral Degrees.
This program was intended to develop Multi-Centric Research Proposals on drug issues in the areas of health promotion, prevention of use and abuse of drugs, and social integration. The main topic for the development of the multi-centric research studies was "Women, Drugs and Violence in Latin America". The participants were divided into four groups to develop the research proposals, using multi-centric research approaches. The composition of the groups and areas of concentration of the studies according to the main topic is presented below:
The multi-centric research groups had a total of three advisors from the University of Alberta-Faculty of Nursing and one representative from CICAD. The requirements for program completion were: (i) conclusion of research studies by each participant of the program within their own country; (ii) preparation and presentation to CICAD of a technical research report in their own language (Spanish or Portuguese); (iii) preparation and presentation of a "Poster" at the "First International Nursing Research Forum in the Field of Demand Reduction in Latin America", organized by CICAD in collaboration with the University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Brazil and the National University of Honduras in August of 2004; (iv) preparation and presentation to CICAD of a publishable manuscript (in their own language) about the research findings for submission to a peer reviewed journal. The publications involving comparative results of the studies between groups will be done in a follow-up phase of the program, and they will be published in English or another language.
LATIN AMERICAN NURSING FACULTY: SCHOLARLY LEADERSHIP EXPERIENCE
University: National University of Cordoba
Visiting Scholar: Alicia del Carmen Luduena, R.N.; M.Nurs.
This international course allowed me to enrich my personal experience with images, values, customs, knowledge and emotions from a heterogeneous group of persons who lived together in solidarity and exercised respect for differences on a daily basis. This experience reinforced my spirit and convictions to accept challenges, strengthen communication skills and reflect on how we use our small and daily spheres of freedom.
The program adopted a comprehensive approach, covering academic, professional and personal activities, which maintained an adequate rhythm to achieve the program goals. The academic program on International Health and the Drug Phenomenon, the Drug Phenomenon in the Americas and Research Methodologies discussed themes of central and paramount importance in the formation of nurses involved in the social and health reality of their respective countries and in the formation of new human resources. This was accompanied by enriching experiences, especially library use, contact with training institutions such as the Faculty of Nursing and the International Institute for Qualitative Methodology, and direct contact with Canadian colleagues involved in international programs. Within the program, the English language course which the teachers offered with great technical and human ability had a special meaning. This course provided a valuable tool and exerted significant influence on our possibilities for professional development.
The development of this course allowed me to carry out my research project without difficulties. The organization of the research supervision during this process has been extremely fruitful. Applying the qualitative methodologies has been highly useful to improve aspects in all spheres of my profession.
I continue interacting with people from different Latin American countries, who help me to evaluate my individual and collective projects, successful and failed experiences in a better way.
University: University Peruana Cayetano Heredia
Visiting Scholar: Flor Yesenia Musayon Oblitas, R.N.; Med.& Res.
This International Research Training Program about the Drugs Phenomenon has helped me to propose and lead new studies in this area and, moreover, provide technical advice to new researchers who want to formulate proposals for drugs research. Hence, as a result of this training program, I have been designated as a member of the first Research Coordination team at the Faculty of Nursing of the Universidad Peruana Cayetano Heredia, responsible for planning new strategies to stimulate and achieve leadership in health research in general and drugs research in particular. Now, due to the research skills I acquired, I represent the Faculty at the level of the university, as a member of the Teaching Research Committee, working with other faculty members on an innovative proposal that increases the university's current lead position as a result of its research activities. At the same time, my Faculty has asked me to represent the institution as a member of the scientific committee involved in the organization of the Pan-American Nursing Research Colloquium, chaired by our Faculty, which this year will call upon nurses from all over the American continent to discuss and propose strategies for strengthening nursing research in our countries. Finally, given the fact that, interinstitutionally speaking, the CICAD/OAS project has managed to turn our Faculty of Nursing into a national benchmark as a training institution that is working seriously to decrease the drugs use and abuse problem in the Peruvian population, it has become easier for me to apply for research funding from public agencies.
The opportunity to work with nurses from other countries during a long period gave me a wider vision of the Latin American situation, the common problems and the possible solutions to them by taking as an example the developed countries' approach, to have also a clear vision of the drug problem from the perspective of each one of them in its own reality and culture. Furthermore, I think that, eventually, in the near future, we will be able to interact in a better way day by day.
It is the first program of which I can give an accurate testimony because it included the analysis of problems and the discussion of opinions from different realities, cultures and experiences. In addition, investigations were made by those who participated in their own reality. In this way, we obtained a contribution to our own society and to our jobs.
We carried out an investigation throughout the program which enhanced our research abilities. To have an idea in mind and to develop it during 365 days of the year and to see the progress day by day, to discuss it with the advisor or other participants, to solve problems together - all that helped to improve all of the abilities that scientific research requires and which the researcher herself should develop.
When I was told about my participation in this program, the idea of being away from my family did not let me think about it clearly. To live away from home was very hard for me, although the sacrifice was worth it because I gained professional experience. All my family gave me the support and help I needed to survive those days without them. That demonstrates that love is stronger than distance and that the mutual support is a sign of family integration.
To identify the problems, to analyze and to investigate them has enriched my professional life in many ways. First of all, the research allowed me to analyze my reality as an employee and as a woman, as a person vulnerable to the influence of drugs, and that I and also many other women have to face difficult situations and be exposed to the risk of getting into drugs. Also, to analyze new things about nursing, new technology, new theories, new scientific tools to fight the problem successfully, as well as how research is possible, and how to develop successful programs. The teacher is much better teaching things that have already been investigated. By my own experience, I can say that it is possible to state that persons who do research can teach because they have the knowledge, since they themselves investigated and will be the ones who motivate the students to know the facts and investigate too. Finally, there is a great professional contribution to the Peruvian society because, as everybody knows, knowledge makes it possible to carry out prevention programs successfully with the only goal of reducing drug consumption that causes big damages to our people, countries and societies.
University: University of Concepción
Visiting Scholar: Julia Huaiquian Silva, R.N.; M.Nurs.
The program was very varied and covered a wide range of relevant information that helped me to obtain an international view of the drugs phenomenon. Moreover, it gave me the tools needed to approach this problem in my country and, thus, help to work towards a solution to this huge drugs problem on a national and international scale. After participating in the program, I have been invited in my country to be part of the group who leading the efforts to ratify a framework agreement to regulate tobacco consumption. I have also offered two workshops on anti-tobacco strategies in Buenos Aires and Santiago.
This experience has allowed me to get to know and develop, in a more detailed sense, a qualitative research methodology like Ethnography and to recognize my great affinity with quantitative research. After my stay in Canada, I have received greater recognition from my peers and have been invited to participate in a university research group, which has applied for and gained two research project contests.
Living far from home for three months was a tremendous challenge, which turned me into a stronger and better prepared woman to live in this world full of good and bad things. In a couple of hours, my life changed from being a woman - mother, wife, housewife and professional into a woman - foreign student who did not understand what the rest of the world was saying and who could not communicate what she was thinking to others. This required me to make my best effort to manage and communicate with the Canadians, whose English pronunciation was very different from what I had listened to at home.
My heart had to bear and overcome the feelings of bitterness, solitude and sadness caused by being away from my loved ones, my husband and daughters, but this distance served to strengthen the bonds that unite me with my beautiful family.
My participation in this experience allowed me to broaden my view of the world, its different cultures and international nursing. Living in such a cosmopolitan country for three months, together with ten nurses from different countries, exerted a professional impact that will be hard to forget because, after this trip, I have a much clearer view of what I want and what I have to do to reach the goals I am aiming for.
This experience increased my English language knowledge, which has opened new development opportunities, as I can get access to international knowledge in my area.
University: State University of Rio de Janeiro
Visiting Scholar: Helena Maria Scherlowski Leal David, R.N.; Ph.D.
I had a splendid time in Canada and it was, besides being academically strengthening, an opportunity for making new friends. The support provided by the teachers at the University of Alberta Faculty of Nursing made us feel "at home" and allowed us to face the distance from our families and culture. Canadian multiculturalism is the central issue that makes this country so friendly and rich.
The methodological approaches gave us the tools to develop our research, using the most adequate method to allow for the development of an accurate and reliable study. There were some gaps in the theoretical component of the Program, specifically about Health Promotion and Health Education concepts and applications.
So far, the research development has showed me that drug use and abuse is an issue that must be examined in several different ways and that we, as nurse-researchers, must be aware of the importance of this issue, keeping a political, social, biological and psychological critical view. Latin American countries must, therefore, invest in this kind of capacity-building program.
Personal and Professional Impact:
The achievement of a deeper understanding about the drug phenomenon and the opportunity to live in a completely different culture had an important and very positive impact in my personal and academic background.
University: University of Guayaquil
Visiting Scholar: Ketty Aracely Piedra Chavez, R.N.; M.C.H.
It could only have been a dream to close the breach that separates us from other countries that confront the process of globalization efficiently, if it were not for the initiative and cooperation of the CICAD Project of Nursing Schools for Latin America. The Modality applied breaks the old schemes of University Education, introducing us into a new paradigm of Andragogy, which is the art of educating adults.
It was a model of a cross-cultural and academic experience that should be copied by others involved in teaching to adults.
The humanistic and scientific knowledge has been tremendously significant in the application of the quantitative methodological patterns, which have been analyzed thoroughly through the installation of the Statistical Informatics Packages, showing more productivity and efficiency.
Due to the high responsibility of being indicated by the School of Nursing of the University of Guayaquil, I became committed to being a student and to training students who are perpetually autonomous and respond to the demands and social tasks, as demanded by the World declaration on Higher Education in the XXI century.
The recognition of the authorities of the University of Guayaquil and the indication of the School of Nursing in the context of the University Community has allowed me, as a Research Specialist who possesses the scientific rigor required in the research area:
a) To participate in proposals for Nursing Care Design, Planning and Evaluation. This project is required by the Hospital Education System of the University of Guayaquil, which is a complex and innovative context that has initiated a process of care excellence within the health system of Ecuador.
b) As the coordinator of the research and development unit, I will strengthen the tutoring at undergraduate and graduate level with innovative, integrative and expansionist actions required from this Unit, now and in future scenarios.
University: National University of Colombia
Visiting Scholar: Maria Carmen Bernal Roldán, R.N.; MEd.
Having the possibility of seeing the professional development of Nursing, in a country like Canada, when I visited Hospitals and Centers of Health, I felt motivated to create a research proposal and see in what forms I can contribute to produce beneficial changes, considering the social, political and economic conditions of my country.
I strengthened my ability to communicate and read in English. This has been beneficial to me as much scientific material is written in this language, and has helped me to make my nursing practice evidence-based.
It was a very valuable program. I benefited from hearing what other professionals are contributing to the area of drug demand reduction. All of the themes developed in the program are applicable to the construction of the nursing profession of the future. It was useful to attend this program in another country, as it allowed me to recognize the importance of cultural difference and to consider the cultural diversity of this global village when offering nursing care.
Participating in this course has allowed me to gain a practical understanding of the qualitative research process and to recognize that this type of research is very important for me as a nurse. It helps me to deepen aspects of the integrity of human beings and to bring together professional and popular knowledge. I recognized that the University of Alberta has a great strength in qualitative research, with its International Institute of Qualitative Methodology. I have already begun applying the knowledge gained in this program to my work in the undergraduate and post-degree programs at the National University of Colombia, specifically in the maternal - perinatal area. I participate in the CICAD/OAS committee of the Faculty, which is developing different activities in order to strengthen the personal development of the students and community.
The program has sensitized me to the drug phenomenon and helped me to recognize that there is a great influence of the environment that propitiates the use of drugs. For example, the great poverty associated with difficult situations of underemployment and informal employment, low educational level, malnutrition, family violence and alterations in social, emotional and psychological equilibriums.
This was an important program for me. It was my first exposure to International Health and I strengthened my knowledge in the area of the drug phenomenon in Latin America and in aspects of social integration. I recognized that nursing has a great potential that can be developed in the area of drugs consumption prevention, care for addicts and social integration. This potential can be especially developed to support adolescents and young people and to promote healthy behaviors in all human development cycles, in order to contribute to decrease this problem in our society. I have brought the knowledge gained from this program into my professional teaching practice in both undergraduate and graduate programs at the Faculty of Nursing and in extension programs. For example, I create awareness among couples in my maternity and paternity preparation course (taken by parents during the prenatal stage and with mothers during postpartum period) that there are diverse ways to be happy and to cope with problems in a healthy way. The visit to healthcare providers allowed me to recognize the nurse's importance in aspects like education. This motivates me to take maximum advantage of each contact that I have with the users of health care services and I transmit this to my students. By law, in our country consultation time is limited to 20 minutes, which is a very short time. Some day, I hope to be able to impact on policies to expand the contact time with users, in order to strengthen the integrity of care for human beings.
University: Federal University of Santa Catarina
Visiting Scholar: Maria do Horto Fontoura Cartana, R.N.; Ph.D.
The First International Capacity-Building Program for Nursing Faculty to Study the Drug Phenomenon in Latin America, implemented with the technical and financial support of CICAD/Government of Canada, in which I had the opportunity to participate in 2003, was a unique chance to join nursing leaders from 7 countries to advance their knowledge and construct collective strategies to cope with a problem their countries have in common: drugs abuse. The program included theoretical training, presenting contents directly related to the phenomenon of drugs abuse in the national and international contexts. It also covered operational contents on adequate research methodologies for different national realities. At the end of Part I of the Program, participants constructed multi-centric research projects, joining the students' and the advisors' efforts to construct research proposals that could be applied in the different national realities.
Participating in this program was at the same time enriching and challenging. Enriching experiences included the opportunity to live with nursing colleagues from other realities over an extended period of time. Living with a group of unknown persons allowed for bonding and friendship, discovering joint interests, values and hidden potentials. The same is true for the friendly welcoming by the Canadian faculty, who tried to understand and overcome the cultural differences between the countries, providing support in fragile times and celebrating individual and collective conquests. The challenging aspect involved overcoming differences in language and habits. This different reality required constant efforts to understand and be understood, to recognize and live in harmony with the peculiarities of the Canadian way of life, as well as that of other colleagues from Latin America.
The opportunity to deepen my knowledge about the theme was extremely positive. Through discussions and research, we understood that the drugs abuse phenomenon involves many factors and is highly complex. We also deepened our analyses of national and international contexts and their mutual relations in the genesis of the problem.
The construction of a multi-centric research project on health promotion related to drugs abuse was not easy. Various characteristics placed the 4 nurse researchers and 2 advisors in different positions as to possible methodological options, the selection of study contexts and theoretical reference frameworks, besides differences in daily professional activities. The construction of one single project required several moments of negotiation, translations back and forth between Spanish, Portuguese and English, besides a steady confidence in the possibility of constructing joint proposals among different realities. When the project became a reality and was approved by the Ethics Committee at the University of Alberta, this represented the completion of a joint effort, in which the similarities and the identity of Nursing overcame the difficulties and differences between people and nations.
One personal impact provided by this experience was the creation of bonds of comradeship and friendship with people from different origins. Both my colleagues from Latin America and from Canada became part of my personal and professional life, and I still keep contact with them. However, I believe that the main personal impact was the creation of a group identity. By taking distance from the context I was familiar with, I could perceive myself as a Latin-American nurse, with potentials to develop and limitations to overcome, with contributions to offer and to accept, a person who is part of this group.
The program's main impact was the understanding of the drugs phenomenon as multi-factorial, transnational and complex. Understanding and coping with this phenomenon requires investments from the whole society and, in this scenario, the presence of nursing stands out. Based on the program and the experience of realizing the research project, I constructed growing confidence to take a stand about the problem in various professional contexts and to look for partners with a view to the construction of alternative coping strategies.
University: Universidad Autónoma de Nuevo León
Visiting Scholar: María Magdalena Alonso Castillo, R.N.; MPH
Facing the challenge of participating in an international program for improving my research capacities about the drug phenomenon has perhaps been the most significant experience in my professional career. I acknowledge the nursing coordination leadership of CICAD and the Director and faculty who participated in this experience for their willingness to change and transform, to learn and unlearn, to accept and acknowledge the cultural diversity in our countries, and to take advantage of this in order to creatively think of innovative and cost-effective ways of intervening in health promotion, the prevention of drug use and abuse, and social integration.
The lessons learnt, in my case, include looking at the future with a global vision and appreciating that transitions and changes occurring in the world and in people allow for the construction of freer societies and happier, self-actualized persons. Another skill I developed was tolerance and an understanding that cultural diversity is a chance to learn human sharing and form interpersonal relationships; thus, through this program, life-long cooperation and effective links were built.
The modality of the on-site program, with a stay at the University of Alberta, allowed me to build a multi-centric research project, spanning Mexico, Peru and Brazil, on the topic of Women's Drug Consumption and Violence in the Work Environment. This topic was selected due to the theoretical and social importance of the problem of occupational violence and drug consumption in working women in societies that are increasingly poor and where drug consumption has alarmingly increased, especially in this group. The development of our research in our countries permitted the application of the knowledge gained in the program in research methodology, statistics, the drug phenomenon and international health. Our advisor's follow-up during ten months was effective. Sessions by means of academic chat via electronic channels fostered closeness and academic discussion for methodological and theoretical doubts. The opportunity to submit our projects for critique by experts in the University of Alberta, as well as the Universidad Autónoma de Nuevo León, my parent institution, enriched a project that will be disseminated and published.
The program strengthened my abilities in qualitative methodology, as my previous experience was only quantitative. The opportunity to discuss various qualitative approaches allowed the research project to look at qualitative interviews with key informants and content analysis. The knowledge obtained by means of this approach will complement the empirical findings obtained by a quantitative approach.
Personally, I improved some capacities, such as creative thinking, communication skills, understanding of different cultures, and the willingness to change. Being exposed to life and study conditions in the Canadian culture impacted my way of communicating with colleagues. I increased my respect for diversity. I relived the pressure of being a student. It let me understand my students, who come from different parts of Mexico, in a better way.
The program allowed me to globally envision the phenomenon of drugs, with its multiple factors, which are causes and consequences, and now I identify more clearly the multiple opportunities that nursing has to contribute to drug demand reduction. I substantially improved my abilities for research and now I work on advanced nursing research projects with greater social impact, with my graduate students and professors. Since September 2003, we have trained the Addiction Prevention Faculty, which was acknowledged by the Secretaría de Educación Pública (Public Education Secretariat) in Mexico. I hold a leading position in the Faculty, where scientific knowledge is generated, applied and spread; undergraduate and graduate education is realized; services are extended to society; and management is realized, which means that ways of financing projects are looked for - in our case for projects on drug demand reduction.
University: University of São Paulo
Visiting Scholar: Sandra Pillon, R.N.; Ph.D.
The Inter-American Drug Abuse Control Commission - CICAD considers that, on a global scale, the drugs phenomenon constitutes a social and health problem, whose roots involve determinant and conditioning factors of national and international origin. CICAD also recognizes that this social phenomenon has strong repercussions on the health of the populations (CICAD 2002). Thus, this commission seeks to incorporate the contribution of the nursing profession in Drugs Demand Reduction into a project between Latin-American Nursing Schools. This project aims to capacitate a group of nursing professionals with scientific knowledge and technical abilities in drugs research, teaching and care, in order to lead programs and projects at different levels of action. Nursing, as well as alcohol and drugs use, are considered to be social practices in constant movement. Knowledge about this reality influences the agents and is influenced by them, in a dialectic relation, due to the concrete conditions of society. Nursing actions are an essential resource in care for individuals, families and communities facing problems related to the use of psychoactive substances and, in order to realize these activities, they need to possess practical, cognitive and relational skills.
This project has contributed to the development of team work, favoring solidarity between the participants, in order to overcome the difficulties of living in a multicultural country like Canada.
My participation in the program provided me with transdisciplinary experience, which was concretized through communication, within the unique perspective of obtaining knowledge about drugs, at the level of health policies, prevention, treatment and qualitative or quantitative research. Integration and complementation occurred, overcoming the difficulties related to language and the insertion into the world of qualitative research, as each member possessed a particular training. It also allowed me to get to know nurses from different regions in Brazil, Latin America and Canada, with specific activities. Many of them are expanding their research, teaching and care practices in the area of drugs with different perspectives.
My participation in the international CICAD Program provided great contributions, at personal as well as professional level. The course was offered by highly qualified faculty members and its goals corroborate and are in line with my specialty in the field of chemical dependence. The Department of Psychiatric Nursing at the University of São Paulo at Ribeirão Preto College of Nursing, Brazil, WHO Collaborating Centre for Nursing Research Development, offers a research line on "Alcohol and Drugs", in which we develop quantitative and qualitative research at graduate level, using different approaches. Examples are studies about the attitudes of nurses related to drugs use and the prevalence of drugs use in work relations. This research is supported by care and research partnerships with services that offer programs for alcohol and drugs users in Ribeirão Preto, such as the Emergency Unity of the Hospital de Clínicas at the University of São Paulo at Ribeirão Preto Medical School, the Psychosocial Care Center - Drug dependence (NAPS-F), and the Integral Health Care Center (CAIS) in Santa Rita do Passa Quatro - SP. This experience has helped to strengthen programs where we work with drugs use prevention at the University, involving students as well as employees, in a Project called PROCURA - Rehabilitation and Care Program for Alcohol Users, supported by the University of São Paulo Culture and Extension Fund.
Getting to know the diversity of drugs-related problems in Latin-American countries and the educational difficulties of nurses to work with this context in their daily practice.
Alcohol-related teaching, research and care in the international context can contribute to nursing training in a new sphere of action. This is one of the areas that seek to expand the professional formation process, proposing to contribute to the quality of nursing teaching, research and care, as well as to transform these activities. The responsibility for nursing formation and the complexity of this theme point out the need to be both attentive and flexible towards new knowledge in this practice, establishing greater interaction between theory and practice. The relation between International Health and drugs use strongly contributed to my professional training, as I was consolidated in the traditional model, which guided my care practice. This experience generated reflections in order to change my paradigms and knowledge in this respect. Education about drugs as a function of nurses in care, teaching and research is needed, primarily with greater emphasis on nursing training, adopting a broad view of the drugs use phenomenon, including educational and health policy issues, and linking this knowledge with social, economic and cultural transformations in course in societies. Based on this premise, I got to know different ways of working in undergraduate and graduate level, as well as the relation between International Health and problems related to drugs use. This experience also allowed me to develop research with other faculty from Latin America, like from Brazil and Ecuador for example.
University: University of São Paulo
Visiting Scholar: Sueli Aparecida Frari Galera, R.N.; Ph.D.
I believe that developing leadership nowadays implies developing the capacity to propose national and international research projects that are connected with the general problems that affect the world population. It is not enough to develop research alone, as an individual researcher. Therefore, the role of a leader also incorporates the capacity to articulate research groups around projects and obtaining funding for their development. In Brazil, resources can come from agencies at national (National Council for Scientific and Technological Development - CNPq and Coordination for the Improvement of Higher Education Personnel - CAPES) and state level (São Paulo State Research Foundation - FAPESP for example). The University of São Paulo at Ribeirão Preto College of Nursing receives this kind of funding for several of its research groups, as a result of its international articulations with universities, institutions and organizations like the WHO, being a WHO Collaborating Centre for Nursing Research Development, CICAD and Sigma Theta Tau International Honor Society of Nursing. My experience with the International Research Capacity-Building Programs for Nurses to Study the Drug Phenomenon in Latin America was enriching, because it allowed me to learn more about the process of negotiating research projects with groups and institutions.
As a nurse at the University of São Paulo at Ribeirão Preto College of Nursing, with some experience in living abroad in an English-speaking or bilingual (English-French) country, and in receiving nurses from other states of Brazil, Latin-American countries and Mexico, I believed that this previous "experience" could help me, and it actually did. It helped me to face the different daily reality of being a student. But, at that time, I could not face it as a leader. Hence, my main experience relates to the stress involved in the experience, the solutions that came up and some considerations about how to solve problems that appeared. Leaving one's family and colleagues behind to study and do research in another country is an opportunity for professional and personal growth. It is also a stressing situation, as it involves: Understanding the language and communicating; understanding values, beliefs and behaviors and living with differences. Adopting the basic equation of the stress theory presented by Boss (19), I believe that, in this context, what occurs is a loss of cultural identity and a personal devaluation. At this moment, some factors are extremely important, as they influence each participant's coping process. These factors involve three levels - individual, group and institutional (receiving institution). I believe that, at the end of the process, which was permeated by diseases, small fights and worries, disputes and new organizations, the group of 11 nurses was successful. I learned that, although I understood a bit of Spanish, this group had its own Spanish-speaking leader who, in a way, had the same cultural origin - Hispanic. The Brazilian participants, on the other hand, all of whom had a doctoral degree, in a way alternated with the group of Canadian nurse participants in using abilities and inabilities to exercise group leadership.
My Program Experience clearly revealed the need for a better preparation in terms of English language. Brazilian research institutions that stimulate foreign experiences at doctoral and post-doctoral level should evaluate this knowledge through the TOEFL test, and the score needed is determined by the university and faculty member receiving the student. Another alternative would be offering more time for student with limited English language skills to adapt and get the necessary training. Having someone who mastered the language of the student's country of origin was very useful to alleviate tensions, clarify situations and balance proximity and distance so as to accommodate the different experiences in terms of friendship, collegiality and individuality. Respecting the other participants' culture and demonstrating curiosity about it was another relevant aspect, which I believe is related to the Canadian context of being a so-called multicultural country. As to the courses, I believe those related to the qualitative and quantitative methods and international health exerted the strongest impact on my experience. The course about the problem and interventions was the most tiresome, as not all participants were experienced in the subject of drugs use and abuse. Moreover, the problem has a different profile in our contexts. In Canada, there is a predominance of heroin and cocaine use, while the problem is more related to alcohol and marihuana in Brazil. The way of choosing the subject and the three basic levels of promotion, prevention and social inclusion of health research was also important, whether due to the maturity with which the proposal was presented and welcomed, whether to all participants' efforts to develop it. I believe this has been one of my main experiences in International Health.
The deeper knowledge I obtained on qualitative research was the most important research experience to me. This knowledge was related to the wide range of pedagogical resources that can be used in teaching the qualitative methods, and the diversity of bibliographic resources and possibilities to discuss the research problem with experienced researchers; writing a qualitative research project - developing the subject qualitatively, highlighting the articulation of the subject with one of the qualitative methods, developing the research design and submitting the project to the ethics committee.
The experience allowed me to deepen my knowledge on the phenomenon of alcohol and drugs use and abuse, affirming it as a theme area in psychiatric nursing, including family, social inclusion and long-term health problems. My contact with the subject of culture and its relation with health mobilized me to seek a better understanding about the subject on my return to Brazil.
I believe that the main professional impact has been the increase in my responsibilities towards the goal of strengthening the national and international research and teaching network at the University of São Paulo at Ribeirão Preto College of Nursing. At this moment, we are getting organized to elaborate projects involving colleagues from other states and countries, whom we have worked with in the context of CICAD. We are applying for funding from agencies in Brazil and other participant countries. I believe this represents leadership as it was discussed during the program.
University: Federal University of Santa Catarina
Visiting Scholar: Vera Radünz, R.N.; Ph.D.
Participating in the International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in the Americas was an unique opportunity to establish partnerships and friendships between the Latin America Nurse participants and the Canadian Nurses, leading us to build bridges for future interchanges. I acknowledge the International Coordinator Schools of Nursing and Drug Demand Reduction in Latin America of CICAD and the Dean and Faculty of Nursing from the University of Alberta, Canada, as pioneers in offering this historic program.
The experience of spending almost 3 months in a different country, living with participants of different backgrounds, different languages abilities, and adjusting to cultural diversity and differing expectations, was a major life experience for me, the effects of which will last forever. "I am not the same having seen the moon shine on the other side of the world". Maryanne Radmacher
The four interest areas, English as a Second Language (ESL), International Health, the Drug Phenomenon and Qualitative and Quantitative Research contributed to achieve the goals of the program.
Participating in a research program in which four countries are involved is complex and challenging. Professional development has certainly occurred with the challenging experience of developing multi-centric study.
Specifically the contents about International Health and the Drug Phenomenon helped me to look at the problem in a macro context. However, in a micro context, it also stressed my obligation as a health professional to keep a major focus on Health Promotion.
Since the Drug Phenomenon is a global problem, which respects no boundaries, it is clear to me that poor and rich countries, developed and underdeveloped countries and health professionals from all those countries need to exchange knowledge and add whatever resources they have to affect global drug demand reduction.
The first International Capacity-Building Program for Nurses to Study the Drug Phenomenon in the Americas provided the opportunity for both national (amongst the five Brazilian participants) and international collaboration for designing research in the area of drug demand reduction. It was exciting for all of the nurses to engage in dialogue about the profession of nursing in their respective countries and to exchange perspectives on the importance of nursing in international health policy-making.
The process of strengthening skills in both quantitative and qualitative research methods built confidence which enabled the participating faculty members of Latin American Schools of Nursing to work more strongly as leaders within their respective faculties of nursing. Each participant returned home with the task of implementing the proposal that had been developed while at the Faculty of Nursing at the University of Alberta.
Each proposal was developed by three or four nurses, each from a different country, which meant that the international collaboration continued information technologies such as fax and the internet. There were certainly challenges to this innovative project. It was difficult to work across three languages on each of the four multi-centric research projects. The level of language ability ranged widely among participants. English was to be the lingua franca, but there was insufficient time allowed at the beginning of the program for language preparation in English before participants were expected to undertake the theoretical part of the program.
This presented enormous challenges to some of the participants and made the beginning weeks extremely stressful. Nevertheless, regional and international partnerships were forged and each person who participated in the project was transformed in some way. There is a ripple effect from this initial model of technical cooperation for research capacity-building, as many of the nursing faculty who participated in this project have continued on to accept leadership roles in their faculties with respect to drug demand reduction and/or to develop related research into the drug phenomenon.
The phenomenon of the use and abuse of drugs highlights the interconnectedness of our global world. It is not only the difficult problem of addiction and related illnesses such as HIV, but also all of the troubling sequelae of the drug phenomenon, such as organized crime, violence, and family disintegration, which too have such a significant impact on health status. The first International Program for Research Capacity-Building for Nurses to Study the Drug Phenomenon in the Americas provided a new paradigm for approaching a significant problem in international health in an interdisciplinary way. Participants were enthusiastic about visioning a future for nursing that integrated education, practice and research into a dynamic and progressive process that could respond to the challenges of our global village. Participants have taken this experience back to their respective Schools of Nursing and continue to work collaboratively, both nationally and internationally, in the area of drug demand reduction.
Grateful acknowledgement is extended to the Department of Foreign Affairs of the Government of Canada for the funds provided for this project and to the Executive Secretariat of the Inter-American Commission for Drug Abuse Control/CICAD of the Organization of American States/OAS and the University of Alberta Faculty of Nursing for the partnership developed and all of the hard work in planning and implementing the project. We also wish to express our deep appreciation to all of the Directors of Schools of Nursing involved in the project, to all Canadian and Latin American faculty, and to any other person who directly or indirectly supported the process of planning, implementing, and evaluating the first International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in the Americas.
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Recebido em: 20.12.2004
Aprovado em: 31.3.2005
1 The opinions expressed in this article are the sole responsability of the authors and do not in any way represent the position of the organization they work at or its administration