International Programming

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International Engagement of School of Nursing Faculty

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World Health Organization Collaborating Center

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International Resources

Faculty Leadership in Achieving the Goals of the Collaborating Center

Many faculty members in the School of Nursing are actively engaged in international work. The following faculty members are specifically doing research and training that help meet the Terms of Reference of the WHO Collaborating Center. They are listed alphabetically, with a sample project, provided illustratively.

Jody Lori, MS, CNM
Lecturer
jrlori@umich.edu

Title: Participation in NIH-funded research to improve mother-infant care
Responsible person: Jody Lori, MS, CNM, Lecturer
Description: During the past year Ms. Lori has worked with consultants on a NIH-funded randomized controlled trial designed to test a complex series of interventions to improve the continuum of quality care provide to mothers and their neonates by the formal and informal health care systems in the study clusters. This trial is being conducted by the Global Network for Women’s and Children’s Health Research, a consortium of universities with the common goal to expand scientific knowledge relevant to improving health outcomes for women and children in developing countries with funding from the NIH. One of key interventions in the package is Home-Based Life Saving Skills (HBLSS), a community based intervention aimed at early recognition and referral of obstetric and newborn complications. The objective of the Global Network Emergency Obstetric and Newborn Care (EmONC) trial is to reduce maternal and neonatal mortality by increasing access to and improving the quality of obstetric and neonatal care for pregnant women in study clusters. The study is being conducted in six counties, Guatemala, India, Pakistan, Zambia, Kenya and Argentina.
Ms. Lori traveled to Guatemala from July 9 -16, 2008 to participate in the scale-up of community mobilization and training for the EmONC community based interventions. The Senior Foreign Investigators (SFI) for the Guatemala site are Dr. Ana Lucia Garces, Director of IMSalud, San Carlos University, Guatemala City and Dr. Manolo Mazariegos, CESSIAM, Guatemala City. The Ministry of Health has been briefed on the study and is supportive. She worked in Zambia for the project in the same capacity in November 2008. While in Guatemala, she met with Dr. Daniel Frade, the Director of Maternal and Infant health for PAHO in Guatemala to discuss the NIH trial as well as the potential of expanding HBLSS to other parts of Guatemala. He is interested in this possibility and we discussed possible funding sources including funding from PAHO-Guatemala.
Next steps include keeping him apprised of results from the study as it unfolds as well as identifying additional communities where HBLSS could be implemented without contaminating the study. She is in communication with faculty from the WHO Collaborating Center at UCSF to expand our work together in Guatemala.
Dissemination of activities: American College of Nurse-Midwives Annual Meeting, Boston, MA “Home Based Life Saving Skills: From Design to Reality, Full-day workshop, May 23-29, 2008. The study is ongoing.

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Lisa Kane Low, PhD, RN
Assistant Professor
kanelow@umich.edu

Title: Transitions in Reproductive Health in Northern Rural Honduras: Exploration of the models of care within a low resource community in Honduras.
Responsible person: Lisa Kane Low, PhD, RN, Assistant Professor
Updates and time frame: Over the last year we were able to make four trips to Morazan, Honduras during which time we were able to scale up our program to implement use of Active Management of Third Stage Labor. We had initially focused on one birth center in the Department of Yoro and we have now spread out to six other birth centers throughout the Department. We initiated the scaling up in October 2007 by meeting with the varied officials of the Ministry of Public Health to seek final approval for the project in each site. In February, 2008 we then visited each of the sites and conducted training on estimation of blood loss. At the Morazan site that was already familiar with this procedure and was completing a research project related to active management of third stage labor, we instead conducted neonatal resuscitation.
In June 2008, we repeated the neonatal training for the staff of each of the birth centers when we conducted a full day training for all the birth center nursing administrative staff. The staff from each of the birth centers and all of the Morazan staff attended this training. The day conference was sponsored by the University of Michigan School of Nursing in collaboration with the Centro Materno Infantil Nursing Administration. The day included a review of the results of the post partum hemorrhage management at CMI in Morazan that noted a 10% reduction of the incidence of PPH with active management of labor. This was followed by training for the implementation of the research protocol at each birth center site in the scale up phase. The afternoon session involved training for neonatal resuscitation and discussion of potential barriers to the implementation of evidence based measures of care. The second day of the conference focused on the role of traditional birth attendants in the local area. Thirty three midwives attended the programs where we discussed prevention of post partum hemorrhage and care of the newborn, including resuscitation.
February, 2009 will focus on evaluation of the results of the scaling up project and also follow up on the implementation of care practices by the TBA.
Expected outcomes: Upgrade midwifery skills of traditional birth attendants and nurses to reduce maternal and child mortality in Northern Rural Honduras.
Links with WHO activities: Addresses MDGs #4 and #5, and educating and training health workers.
Funding: University of Michigan Collaborating Center and other internal University sources.
Dissemination of results: Presentations to relevant individuals in the Ministry of Health of Honduras and nursing organizations; presentations at regional conferences; publication of articles in scientific journals.

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Joanne Pohl, PhD, RN, FAAN
Professor
jpohl@umich.edu

Title: The Institute for Nursing Centers (INC)
Responsible Person: Joanne M. Pohl, PhD, APRN, BC, FAAN, Professor
Description: The Institute for Nursing Centers is a network of organizations that focuses on the advancement of nurse managed health centers (NMHCs). The intent of the Institute is to create a strong network to facilitate the development and promotion of NMHCs to address primary health care needs of communities and increase access to quality primary health care. INC also developed the only national database and data warehouse for NMHCs that tracks demographic, clinical and outcomes data. INC informs policy that promotes NMHCs and advanced practice nursing as a means to address access to care and quality care. INC has partnered with a network of Federally Qualified Health Centers (FQHCs) who serve underserved populations and together we have been funded by the Agency for Healthcare Research and Quality (AHRQ) to implement electronic health records in both FQHCs and NMHCs. The goal of this latest funding is to examine how health information technology impacts patient safety and health outcomes.
Expected outcome: National data warehouse with standardized data from NMHCs across the US provides the only such data base; this data base has the potential to document a different model of care, document quality care and inform policy. Such a data base could be expanded to include international NMHCs, and could serve as a model for other countries. Expected outcomes from the AHRQ funding are to inform how technology impacts quality and patient safety in health services that serve the underserved.
Link with WHO Activities: Primary health care worldwide is a WHO priority; the INC also contributes to health system reform. Health technology is also a worldwide priority.
Funding: W.K. Kellogg Foundation has funded this for five years. Future funding is currently being sought.
Dissemination of Results: Results have been presented already to more than 15 different conferences (including S. Africa at the ICN/APN conference) and will continue to be presented at major conferences including the ICN/APN conference in Toronto, September, 2008. Manuscripts are also in process and will be another major commitment for dissemination. Dissemination will continue for the next two years.
Time Frame: This project could be ongoing as long a there are funds to support it; it will be enhanced to provide consultation services for those who wish to establish such centers and provide them with needed skills, such as managing a business.

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Antonia Villarruel, PhD, RN, FAAN
Professor
avillarr@umich.edu

Title: HIV Prevention for Mexican Youth
Responsible person: Antonia M. Villarruel, PhD, RN, FAAN, Professor; Esther C. Gallegos (Mexico), PhD, RN, Professor at UANL. Description: The broad objective of this project is to test the efficacy of a theory-based HIV risk-reduction intervention, which includes both an adolescent component and parental component, designed to reduce the adolescents’ risk of sexually transmitted HIV. The communities chosen represent low income families in Mexico.
Expected outcome: The outcome is an evidence based curriculum that can be used in practice settings; once implemented, it can transform the health of communities, families, and youth.
Links with WHO activities: Addresses Millennium Development Goal [MDG] #6.
Funding: National Institute for Nursing Research; CDC; CENSIDA, CONACYT
Dissemination of results: Several articles (6) have already been published in US and Latin American journals. Further, we have presented at relevant scientific meetings, including the International AIDS Congress in Mexico City. Our collaborators at the UANL have received a grant from CENSIDA to facilitate the dissemination and implementation of this evidenced based program community settings.
Time frame: 2008-2009, completion of research and relevant publications; 2008-2009, continue with plans for training and replication of the intervention throughout Mexico and Latin America. 2009-2010, ongoing training and evaluation of dissemination efforts.

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International Scholars Program: This program meets both the goals of the Office of International Affairs as well of those of the WHO Collaborating Center.

University of Michigan School of Nursing
Office of International Affairs
SNB, Room 3216
400 North Ingalls
Ann Arbor, MI 48109-5482
Contact: Shaké Ketefian, EdD, RN, FAAN,
Professor and Director of OIA
Tel: 734-763-6669
Fax: 734-615-3798
Email: ketefian@umich.edu