COLUMBIA UNIVERSITY, SCHOOL OF NURSING

WHO Collaborating Centre for Advanced Practice Nursing

DIRECTORS

Jennifer Dohrn
Lorraine Frazier

STAFF

Tonda Hughes
Yu-hui Ferng

TERMS OF REFERENCE

Support PAHO/WHO to build capacity to strengthen the response of the health sector through the identification and application of core competencies for an advanced practice nursing (APN) model.

Support PAHO/WHO to strengthen the health sector in human resources through regional expertise development of nursing and midwifery research in Latin America and Caribbean Member States.

Support PAHO/WHO to build capacity of human resources for health development with expanded knowledge and application of e-learning/informatics in nursing and midwifery.

This institution is a member of the
WHOCC MIDWIFERY NETWORK

ANNUAL REPORT 2020

Drs. Tonda Hughes, Lorraine Frazier and Jennifer Dohrn at a United Nations meeting on nursing activities across the globe.

    • TOR 1 Support PAHO/WHO to build capacity to strengthen the response of the health sector through the identification and application of core competencies for an advanced practice nursing (APN) model.
      • APN Core Competency Survey (2019) was adapted for use in Brazil. It was translated into Portuguese and face and content validity between the English and Portuguese version. This assessment was conducted by 3 experts in instrument construction and 2 nurses who work in primary health care. The adaption of the instrument included the following modifications:
          • Instrument was translated into refined Portuguese and back translated
          • The ICN definition of APNs (2009) is included on the questionnaire
          • Explicit instructions on how to answer the questionnaire
          • Demographic items added
          • Place of employment
          • Position held
          • Date of graduation
          • Date of birth
          • Previous knowledge of APN
      • The project was authorized by the Municipal Health Department. The study was approved by University of Sao Paulo Escola De Enfremagem de Ribeiroa Preto. IRB Modification at Columbia University is in progress.
      • A crosswalk table of LAC Core APN and curricular content was created with the expectation to modify it to align with the Brazilian APN Core Competencies are identified by the above study.
      • The Domains of LAC Core APN Competencies was mapped to the extant courses in the Professional Masters Program at the University of São Paulo at Ribeirão Preto College of Nursing with the expectation to modify it to align with the Brazilian APN Core Competencies are identified by the above study. This macro view of the Brazilian Professional Master’s offered insight regarding overlapping areas of curriculum as well as large gaps in the Brazilian curriculum with respect to APN curricula.
    • TOR 2: Support PAHO/WHO to strengthen the health sector in human resources through regional expertise development of nursing and midwifery research in Latin America and Caribbean Member States.
      • We have developed a survey (in collaboration with Silvia Cassiani) that will be administered to nursing faculty and nursing leaders in Latin America to assess the extent to which nurses are familiar with and/or engaged in nursing research related to the priority areas identified by PAHO five years ago. (Cassiani, S, Bassalobre-Garcia, A., & Reveiz, (2015). Universal access to health and universal health coverage: Identification of nursing research priorities in Latin America. Rev. Latino-Am. Enfermagem, 23(6), 1195-208).
      • Drs. Tonda Hughes and Maureen George met with Silvia Cassiani and Lilian Ferrer, Director of Global Health Programs and the head of the nursing school at Pontificia Universidad Católica in October 2019 to plan the survey development. The survey has been formatted in Qualtrics and we are in the process of applying for IRB approval from Columbia University.
      • The English version survey will be reviewed. Once approved, we will translate the survey into Spanish PAHO will distribute the survey.
      • Dr. Tonda Hughes and Dean Lorraine Frazier (co-Director of CUSON’s PAHO/WHOCC travelled to Santiago January 24-27, 2020 to meet with Lilian Ferrer and other leaders of the School of Nursing at Pontificia Universidad Católica to begin planning the WINS workshop.
      • We decided that we will to hold the WINS workshop at Pontificia Universidad Católica and invite nurses from neighboring universities.
    • TOR 3 Support PAHO/WHO to build capacity of human resources for health development with expanded knowledge and application of e-learning/informatics in nursing and midwifery.
      • Activity 28123 Support PAHO/WHO to expand knowledge of eLearning/informatics in nursing and midwifery by identifying eLearning resources for use in LAC.
      • Data collection for eLearning usage survey for Midwives and Midwifery was administered and completed for Latin America and the Caribbean in September 2019.
      • Currently we are working with Professor Luciana Fonseca from University of São Paulo at Ribeirão Preto College of nursing to:
          • Translate the survey into Portuguese
          • Validate the survey
          • Obtain IRB approval to distribute in Brazil
      • Initial descriptive analysis of survey results has been completed for non-Brazilian countries in LAC. Currently, we are conducting qualitative thematic analysis.

We are working with nursing and midwifery leadership in Sierra Leone and Liberia. We collected 39 oral histories in August 2019 of nurses and midwives who participated in the Ebola Response, from clinical to policy level. May 2020 we are returning in collaboration with the Ministries of Health Chief Nursing and Midwifery Officers for a day of nurse/midwife recognition to the Ebola response. September 2020 we will hold a policy roundtable and workshop to develop recommendations for pandemic response based on the evidence collected from the oral histories.


We have a grant from the Columbia University President Global Innovation Fund to collaborate with Bel-Air School of Nursing in Panchgani, India to develop a simulation learning center to advance nursing curriculum. In December 2019 we conducted an assessment at three nursing schools and held a dissemination meeting in Mumbai of results for nursing colleges in western India on their use of simulation learning.

In October 2019 we held two dissemination meetings in Jordan from a study of over 500 Syrian refugee women living in Jordan views of their own reproductive meetings. One manuscript has been published and two more are in review.
In November 2019 we held the first National Nursing LGBTQ Health Summit focusing on advancing nursing’s progress in addressing LGBTQ health issues and drew deans and other leaders from top U.S. nursing schools, and representatives of nursing organizations, including the American Academy of Nursing and the American Association of Colleges of Nursing, as well as the National Institutes of Health. The summit ended with a call to action for nursing to prioritize LGBTQ health through innovations in education, research, and practice and to advance LGBTQ health policy. Outputs of the summit will include the following: publication of a white paper or individual papers that address LGBTQ health in education, research, and practice, with implications for policy; a national LGBTQ health action plan focused on the dynamic intersections among nursing education, research, and practice, with recommendations in each of these arenas and with wide dissemination of the plan through publications, conferences, and social media; and a forum through which participants can network and plan future collaborations.

We are also involved in collaborating with the University of Haiti to introduce palliative care into nursing curriculum. Two Haitian nurses have received training in the US and will lead this workshop with two CU nursing faculty members in June 2020 at the University of Haiti campus.

Over eighty students have participated during this reporting year in global clinical experiences in seventeen countries to transform our nursing curriculum to be responsive to global health equity.

ANNUAL REPORT 2019

Sending students off for global clinical experiences

TOR 1
Activity 1:
Title: Identify core competencies essential for advanced practice nursing (APN)

    1. A comprehensive review of established and published APN competencies was conducted and a set of essential APN competencies was derived and conceptualized into 4 domains. Two experts in APN practice and education independently categorized the competencies. This draft served as the foundation for a survey to better understand the relevance of each competency in the context of primary care in LACs and to establish consensus. The survey was conducted and the analysis completed.
    2. The preliminary and final results have been broadly disseminated. A manuscript, Moving towards universal health coverage: Advanced practice nursing competencies, was submitted to Revista Latino-Americana de Enfermagem – RLAE (Latin American Journal of Nursing) and has been accepted for publication.

Activity 2:
Title: Curriculum mapping for APN in Brazil to be expanded to other countries
Using the results of the survey conducted at CUSON, consensus Core APN Competencies in LAC were established. In collaboration with Carla Ventura and her colleagues at U of Sao Paula College of Nursing at Riberiro Preto, a plan was established toward the goal of mapping a competency-based APN curriculum in Brazil that can be used a prototype for other LACs. To accomplish, the collaboration outlined two specific aims: 1) further refine the APN competencies for relevancy in Brazil’s health system and 2) develop exemplar curriculum in coordination with the structure of Brazil’s graduate education.

    • To accomplish aim 1, a Delphi study will be conducted with nurse leaders and educators in Brazil. As the first step, Dr. Ventura and her team have already translated the competencies into Portuguese. Work is underway to obtain IRB approval at the respective schools.
    • To accomplish aim 2, suggested content will mapped that aligns with the refined competencies for curriculum development. The CUSON team has drafted a document that links content with the competencies. This document is under review by the Brazilian team to identify duplicative content that is already included in the graduate curriculum so that we can identify unique new content relevant to the APN. As the results of the Delphi study further refines the competencies, the content will undergo revisions. 

Activity 3:
Title: Promotion of APN in advancing universal health coverage and universal health access
Description: With PAHO develop document regarding the importance of the role of APN in primary health care to advance Universal Health Coverage and Universal Health Access with recommendations for policy, regulation, education, and practice changes.

CUSON faculty team and clinical expert, Dr. Judy Honig, has the manuscript, Moving towards universal health coverage: Advanced practice nursing competencies, to Revista Latino-Americana de Enfermagem – RLAE (Latin American Journal of Nursing) accepted for publication. Plans are underway to create a White Paper on Advancing Universal Access and APNs.

TOR 2
Activity 4:
Title: Assessment of clinical nursing and midwifery research in LAC
A scoping review of existing clinical nursing and midwifery research conducted in the past 10 years in LAC countries was published:

    • Iribarren S, Stonbraker S, Larsen B, Santos I, Faria R, Góes FSN, Binfa L, Larson E. (2018). Clinical Nursing and Midwifery Research in Latin American and Caribbean Countries: A Scoping Review. Int J Nurs Pract. 2018 Apr; 24(2):e12623. doi: 10.1111/ijn.12623
    • TOR 2 has been in collaboration with Escuela de Enfermería Pontificia Universidad Católica de Chile WHO CC and Escuela de Obstetricia Universidad de Chile WHO CC.

TOR 3
Activity 6:
Title: Expanding knowledge of informatics in nursing
CUSON PAHO/WHO CC continues to make progress on the assessment of the current use of e-learning in nursing and midwifery curriculum in LACs. From the review of the research literature in the LAC, CUSON learned that: 1) the PAHO eHealth initiative has developed robust regional and country level knowledge that covers physicians’ and nurses’ knowledge and use of e-learning at educational and clinical levels; and 2) Brazil is the only country in the region that has generated scholarly research about e-learning for nurses and midwives. Consequently, CUSON has refined the focus of this activity to assessing eLearning tools and capabilities for midwives in the region.

Activities are to be accomplished together with the Escuela de Obstetricia Universidad de Chile PAHO/WHO CC, University of the West Indies PAHO/WHO CC conduct an environmental scan to identify e-learning resources currently used for curriculum development in midwifery in LAC.

In addition to those mentioned above, the following activities have been accomplished:

    • Judy Honig, Professor of Nursing, is collaborating with Faculty of Nursing/ Jordan University of Science and Technology WHO CC: Using an adapted version of the APN Competency Survey developed by the PAHO Collaborating Center, Drs. Honig, Abu AL Rub and Al-Maaitah conducted a study to delineate APN practice and competencies in relation to Universal Health Care in Jordan as an initial step towards educating APNs and establishing the foundation for future work on building APN capacity in Jordan.
    • Dr. Honig is working with an international research group, Canadian Centre for Advanced Practice Nursing Research (CCAPNR), on two projects. Using a scoping review and a rapid review of the grey literature, we conducted a comparative analysis of pedagogical and evaluation methods used in graduate nurse practitioner education. An international research team conducted a scoping review of published and grey literature examining the core curriculum features of NP education programs. The results of the two studies were presented in 2018 in a symposium format at the 10th ICN NP/APN Conference, Rotterdam, Netherlands. A manuscript is in progress.
    • Dr. Honig has assumed the role of co-chair for the International Council of Nurses, APN Education Subgroup. The subgroup conducted a study of clinical education from the global perspective. The results of the study were presented in 2018 at 10th ICN NP/APN Conference, Rotterdam, Netherlands. A manuscript is in progress.
    • Tonda L. Hughes (Director of Global Health Research) and Lilian Ferrer (Director of International Affairs, School of Nursing, Pontificia Universidad Católica de Chile WHO CC) are working with Kenrick Cato, Assistant Professor of Nursing, and two postdoctoral fellows at Columbia School of Nursing on literature reviews of research focusing on sexual minority (e.g., lesbian, bisexual) women’s health and on transgender health in Latin America and the Caribbean. The first review was recently submitted to the International Journal of Nursing Scholarship and the other is in progress (Caceres, B.A., Ferrer, L., Jackman, K., Kenrick, C.D., & Hughes, T.L. Sexual minority women’s health in Latin America and the Caribbean: A scoping review. Under Review).
    • Kenrick Cato, Assistant Professor of Nursing, has been working with the University of West Indies School of Nursing (UWISON) WHO CC to develop a virtual library that will be entirely online.
    • Maureen George, Associate Professor of Nursing, visited University of West Indies School of Nursing and its WHO CC 6/11/18 – 6/13/18. The purpose of the visit was to determine the feasibility of a Columbia Nursing and University of West Indies School of Nursing research collaboration. The visit had two specific aims: (1) to begin to build research capacity among UWISON faculty members and graduate students; and (2) to explore the possibility of implementing adult clinic-based and pediatric school-based asthma research interventional studies.
    • Drs. Jennifer Dohrn and Tonda Hughes attended the 12th Biennial Conference of the Global Network of WHO Collaborating Centres for Nursing and Midwifery in Cairns, Queensland, Australia, July 17th – 19th, 2018 to discuss Sustainable Development Goals are Everyone’s Business. Dr. Dohrn also made an oral presentation Transforming Nursing Education to be Relevant for a Global Community.

In addition to the activities mentioned above, CUSON PAHO/WHO CC actively continues to engage and support the goals of the WHO CCs:

    • Jennifer Dohrn has been active in the creation of the Global Network of WHO Collaborating Centers Midwifery Network, established at the 12th Biennial Conference of the Global Network of WHO Collaborating Centres for Nursing and Midwifery in Cairns, Queensland, Australia, July 17th – 19th, 2018.

Columbia University SON has developed a global clinical practicum program for final clinical experiences for graduating master’s students. Spring 2019 – 78 students are spending six weeks doing clinical work sites in countries.