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International
Programming
Office of International Affairs
WHO: Collaborating Center
International Scholars Program
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Office of International Affairs
International Scholars Program
INTERNATIONAL TRAINING OF 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 will
describe 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 85 doctoral programs within the United States. 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.
It is the purpose of this paper to describe the experiences 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:
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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.
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neurobehavior; faculty research pertain to alterations in cognitive structure
and function, sleep disruptions, agitation, disorientation, wandering behavior,
affective dysfunctions.
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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.
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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. While
this is a new trend in nursing, 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
and objectives are then examined for consistency with the ongoing 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 on the University of Michigan campus
is a resource and their staff greatly facilitate the technical matters
involved in arranging visas, determining compliance with government regulations,
assisting with health insurance, housing, and the like. typically,
most 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 members 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 the goals are focused on research and scholarly activities;
in these instances the scholar becomes part of the ongoing research team
of the faculty member 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. Each of the faculty mentors
are developing innovative strategies in their research as different nursing
problems demand creative solutions. Further, many 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. Once a month all
postdoctoral fellows and visiting scholars meet 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 professional nursing
in the participating countries.
The Office of International Affairs is home to the International Network for Doctoral Education in Nursing (INDEN). Information on INDEN and international doctoral education can be found at the INDEN website: http://www.umich.edu/~inden/
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
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