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Training of International Nurse Scholars: Leadership Development

Shaké Ketefian, EdD, RN, FAAN
Director of International Affairs
University of Michigan School of Nursing
ketefian@umich.edu

A compelling reality in the current climate is the globalization of all enterprises and international cooperation in all domains of activity; the interdependence of nations and economies is dramatically brought home to us by news reports heard on our airwaves every day.

The need for international cooperation is no less true in the arena of education. Many U.S. institutions have campuses in other countries, and many more have developed distance education programs or courses that are available to people residing anywhere. In the area of nursing education there is perceptible evidence of movement in this direction. Many institutions offer study abroad opportunities and accommodate exchange students from overseas. While these developments are salutary, such experiences occur in undergraduate education mostly. At the graduate level, many nursing programs within the U.S. host students from other countries who are enrolled in masters or doctoral programs. To a limited extent, faculty exchange opportunities have been provided through the Fulbright Scholar program, and there is evidence that this type of exchange has been mutually beneficial to the visiting faculty and the host institutions alike. However, there is an expressed need to provide short-term, non-degree scholarly experiences for individuals at the post-master's or postdoctoral levels who are at the beginning or middle of their careers. This paper describes the elements of such a program developed at the University of Michigan School of Nursing to respond to this felt need.

Modes of Doctoral Education Worldwide

Many countries have developed doctoral education opportunities for nurses. There are over 100 doctoral programs within the United States, and approximately 350 worldwide, offered by over 30 countries. Determining the exact number of such programs in other countries has been challenging, and no exact number is available. This is due to the different ways in which doctoral education is organized and delivered from the system in place within the U.S.

In many countries doctoral education occurs through the individual advisement and tutoring process between an identified supervisor and student, and it is not necessary to have a "doctoral program" in place, nor is it necessary that there be a "department of nursing" with a group of nursing faculty in place. In some instances one nurse faculty may be a member of a science department and would be supervising doctoral nursing students individually. Alternatively, nurses in many countries receive supervision from faculty in other departments and obtain their degrees through these non-nursing schools/departments. In most of these instances the student is not exposed to any coursework, and thus, the degree of exposure to advanced nursing concepts, theories and methodologies is limited. Further, the scholarly socialization within the discipline of nursing and the interaction with peers and a community of scholars may not be present. The extent to which these are crucial elements for the future scholar in nursing, many nurses who have received postmasters or doctoral education in various countries may feel the need for exposure to advanced nursing research, and a period of immersion in an environment that is imbued with nursing research activity, and values such activity. These environments typically can be found in research intensive universities where the faculty is actively engaged in research, and where postdoctoral training is a well-established tradition.

This paper describes the experience of one such nursing program in providing advanced research training to scholars from other countries, and in helping them to begin a program of research upon return to home institution. Thus, this paper will describe the nature of the institutional program and its impact.

Elements of Doctoral and Postdoctoral Education

The University of Michigan offers degree programs in nursing for a range of undergraduate and graduate studies, as well as postdoctoral training in selected areas of nursing. In this section we will briefly describe the doctoral and postdoctoral research training structure and opportunities.

Unlike the system of graduate education in many countries, within the United States doctoral education is achieved through a combination of coursework and individually supervised research experiences. The goals are generally to prepare individuals who can contribute to the development of nursing science through research and who will function in leadership capacities in various domains of health care, education, or policy. Coursework varies across programs, but generally, they are organized around requirements in [a] research methodology and theory development, [b] advanced content in substantive areas of nursing, and [c] courses taken in other fields for their relevance to the students' area of research investigation. Non-course requirements include supervised research and scholarly experiences and internships, various examinations taken following coursework, research projects such as master's level thesis and an independently conducted dissertation. Within the area of [a] above, the majority of the coursework is similar for all students regardless of area of research interest. In the cognate area, [c] above, the decisions as to courses are highly individualized, and students choose courses from other colleges and schools on campus in a manner that will assist them in conducting their dissertation research. The component of the curriculum that comprises the concentrations, [b] above, is described below.

Advanced content in substantive areas of nursing. There is great variation within the United States doctoral programs in the manner in which this component of the curriculum is planned and taught. At the University of Michigan the nursing faculty have developed four concentrations, based in part on research priorities developed by the nursing profession nationally, and in part, based on the particular research expertise of its faculty.

The four concentrations and examples of particular faculty research are as follows:
 

1. Health promotion and risk reduction nursing; faculty research in this concentration pertain to: exercise adherence, substance use and abuse, health in pregnancy, family health, socio-behavioral strategies to manage health.
2. Biobehavior; faculty research pertain to alterations in cognitive structure and function, sleep disruptions, agitation, disorientation, wandering behavior, affective dysfunctions.
3. Nursing and health care systems; faculty research pertain to public policy and analysis, micro-level organization phenomena, delivery systems, resource allocation issues, nursing ethics, cost of health care.
4. Women's health; faculty research pertain to reproductive health, menstrual cycle disorders, early sexual behavior, healthy sexual practices, substance abuse and smoking cessation in young females, urinary incontinence, breast-feeding issues, prenatal care, global women's health issues.

Doctoral students decide which one of the four concentrations to focus on and select at least three courses from that area, and develop their dissertations in a topic within the area. Thus, they are able to develop both substantive and methodologic expertise in the chosen field of study.

Postdoctoral training. The purpose of postdoctoral training is to enable individuals to develop a program of research under the direction of a faculty mentor, and begin a line of investigation as an independent researcher. The School of Nursing offers postdoctoral training opportunities in a number of the substantive areas of research delineated above. This type of training is provided by senior faculty who are experienced mentors and who are actively engaged in funded research of their own. This is a new trend in nursing, and graduates of doctoral programs are being urged to engage in this type of training for a year or more. Many universities now indicate preference in hiring new faculty who have had postdoctoral training.

Short-term Training for International Scholars

The University of Michigan School of Nursing receives requests to provide different kinds of training opportunities for international colleagues. Some of these requests come from governmental or international agencies such as the World Health Organization, others come from institutions to accommodate their faculties, some come from senior faculty mentors to locate appropriate experiences for their doctoral students, and some come from individuals designing meaningful ways to spend their sabbatical and study leave periods. Against the background of graduate education and training provided earlier, the School of Nursing has begun responding systematically to such requests as a way of providing an important service to the international community. We describe below the steps and process involved in planning and providing scholarly preparation.

Upon receipt of requests we ask that the potential visitor provide us with objectives for the study period. Occasionally, it becomes necessary to provide the individual with information on the research of our faculty so that the applicant can develop a focused set of goals. The goals are then examined for consistency with the ongoing faculty research and academic programs. When the determination is made that there is a match between the scholar's goals and school offerings, a potential faculty mentor is located and asked about willingness to supervise the experience of the fellow. This is an important step, as it is a voluntary activity and is not part of the formally assigned workload of faculty members. We are fortunate however, in that the majority of our senior faculty are very active and interested in international work and greatly enjoy working with international fellows. Following the determination of intellectual congruence and faculty assignment, pragmatic matters have to be taken care of. The International Center at the University of Michigan is a resource and its staff greatly facilitates the technical matters involved in arranging visas, determining compliance with government regulations, assisting with health insurance, housing, and the like. Some scholars are accompanied by family members, including children, spouses and parents. The School of Nursing works closely with relevant campus resources to accommodate the needs of the family so scholars can be productive during their stay on campus.

The nature of scholarly experiences. Upon arrival of the visiting scholar a meeting is held to develop a specific plan for the period of study. Goals of fellows vary greatly. Some fellows would like to focus on advanced concepts in patient care in a given specialty. For these, we involve colleagues from the University of Michigan Medical Center, who will plan and provide the needed training. Other fellows are interested in observing the teaching-learning process in undergraduate or graduate education; in these cases, a wide range of opportunities and exposure are provided. These might include class attendance, curriculum committee meetings to observe the manner in which ongoing curriculum issues are addressed within the faculty, audio-visual and technology facilities used in instruction, meetings with School staff with technical knowledge of these methods, discussions regarding program review and evaluation concepts and techniques, and the like.

In many cases scholars’ goals are focused on research and scholarly activities; in these instances the scholar becomes part of the ongoing research team of the faculty mentor and works as a member of the research team. This gives them exposure to activities in different phases of the research. Some fellows have focused on data collection and management, others have worked during the conceptualization, design and instrumentation phase of research and participate in proposal preparation, others have worked in data analysis and writing. Typically, the scholars are interested in activities in which they have limited experience, and this becomes a way of expanding their understanding of research and scholarship. Class attendance is arranged on an individual basis if indicated. Faculty mentors are developing innovative strategies in their research as different nursing problems demand creative solutions. Further, some of the research teams are interdisciplinary, and afford the scholar an opportunity to observe teams in action and observe ways in which different members contribute to the achievement of project goals. As the scholar becomes more adept and expresses the desire for greater involvement, increasing responsibilities are given. Those who stay for more than one year sometimes develop their own independent projects or pilot studies, which they then conduct under their mentor's supervision.

An important learning activity relates to scientific integrity issues. These are issues related to ethical considerations in research, such as protection of human and animal subjects, how to allocate authorship credit fairly, managing data in such a way as to avoid distortions in results, collaboration in team research, how to avoid conflicts of interest, and the like. These issues have become very important in scientific circles within the United States; given the need expressed by the scientific community, nursing has developed its own guidelines regarding these issues to assist investigators and students in resolving any issues that might arise. We have found that most international scholars are not familiar with the area of scientific integrity and they greatly value the opportunity to learn about these newer trends and issues.

Opportunities for collegial learning. Postdoctoral fellows and visiting scholars meet from time to time in a seminar format to discuss a topic of choice. Fellows present their research, with topics chosen for their general relevance to all the members. Methodological topics appear to be of great interest as these enable group members to learn from the experience of others, and thus expand their understanding of different research approaches. Special analytic techniques being used in a research project might be presented by a member so that others can be exposed to it and learn the circumstances and research problems for which the technique has proven useful. These monthly sessions also enable the development of team spirit and shared fellowship that provide important support to members as they deal with difficult issues. The fellows are highly supportive of one another; this is facilitated by the office arrangement that the School provides; instead of separate offices, fellows share a large space with several computers available for their use; thus they are able to communicate and share with one another with ease, and assist one another in various ways.

In some instances visiting scholars are doctoral students in other countries who wish to obtain supervised experience in their area of research during the formative stage of their doctoral study, or in some cases, to conduct their dissertation research on our campus with one of our faculty members.

Depending on the degree of involvement of these scholars, many faculty mentors offer co-authorship opportunities to them for scientific articles and/or presentations; this affords the scholars the opportunity to build their scholarly portfolio during the study leave, and in most cases, they are able to continue in the same line of research begun here, or to continue collaboration with their mentors upon their return home.

Contribution to International Cooperation

Conducted over a number of years, these experiences with international visiting scholars have shown us the mutuality of benefits that can be attained to both the visitors, their institutions and countries, as well as our School of Nursing and its faculty. The kind of excitement generated when creative minds come together can lead to new directions of research. Most importantly, ideas have been generated for cross-cultural research and ways in which approaches used within the U.S. may be modified and adapted to be useful in other countries and cultures. The collaboration begun in this manner have continued over the years. In some cases we have been able to utilize funding opportunities on the University of Michigan campus to obtain funding for faculty/visiting scholar teams to continue their research in the scholar's country, or have been able to provide modest funding to enable scholars to conduct pilot projects that they feel they need to do to maximize the usefulness of their work in their home settings.

Nursing science needs to develop global properties so that people everywhere can draw from it and benefit. In this vein, the presence of these scholars has enabled our faculty to become more aware of how specific aspects of their research might be modified to respond to needs of particular populations and cultural features in other countries. It has also enabled our faculty to publish in scholarly journals in other countries, which in turn might stimulate the reciprocal publication of other scholars publishing in U.S. journals. These positive benefits are both exciting and lasting, and are bound to have long term effects on those involved in these endeavors as well as on the development of nursing science in the participating countries.

Application material is submitted to:

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