Developing an International Community of Research

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Grady" "autores" => array:1 [ 0 => array:4 [ "preGrado" => "PhD" "nombre" => "Patricia A." "apellidos" => "Grady" "email" => array:1 [ 0 => "gladstonee@mail.nih.gov" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Director, National Institute of Nursing Research, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desarrollo de una comunidad internacional de investigación<a class="elsevierStyleCrossRef" href="#fnzstar">☆</a>☆Una versión de este artículo se presentó como Conferencia Inaugural en XII Encuentro Internacional de investigación en enfermería y 6º Congreso Bienal del Instituto Joanna Briggs1. El Equipo Editorial de la revista agradece la disposición de la Dra Grady aceptando su difusión en este espacio." ] ] "textoCompleto" => "In this paper, I have the opportunity to share with you the international research efforts of the National Institute of Nursing Research in the United States and my vision for ‘Developing an International Community of Research’ to further both our science and our practice in dealing with the many global health issues that face us today. I am pleased that we meet at this conference as a ‘global workforce’ and as a ‘community of science’. Together, we share the vision to improve evidence-based health care throughout the world and recognize that “… the health of all nations, and of our world, is dependent upon the health of its individuals.”<a class="elsevierStyleCrossRef" href="#bib1">1</a> As scientists and practitioners, we meet to discuss the opportunities and the challenges we face as we embrace global communities of practice and ‘borderless’ partnerships.<a class="elsevierStyleCrossRef" href="#bib1">1</a> We recognize that globalization is reshaping the world, its people, and its health care priorities. With these changes, we must reinforce every occasion to share the gains in knowledge that have come from collaborative international research partnerships. But as we gain this knowledge, it is also important that we consider how we will disseminate and implement evidence-based discoveries into our communities of practice throughout the world. Today, I share with you examples of international research collaborations that have forged new pathways in transcultural, translational research and have created opportunities to advance global communities of nursing science—from informal research partnerships within local communities to large, multi-institutional, research ventures. I will also reflect on opportunities for global collaborations that will foster the development of the next generation of culturally diverse leaders of evidence-based, translational research.<a class="elsevierStyleCrossRef" href="#bib2">2</a> Using the maxim from McFarlane et al. (2008), we must “Think Globally, Act Locally, and Collaborate Internationally” to engage and facilitate unified communities of nursing science.<a class="elsevierStyleCrossRef" href="#bib3">3</a>Nursing Research: Global Visions, Global VoicesWorking collaboratively through global networks of research, we can strengthen the impact of our scientific discoveries as we strive to enact research that will improve the quality of life for the global community. From the clinic to the laboratory, nurses are leaders in improving the health of the world. Across all nations, nurses advocate for safer water supplies, provide disaster relief, vaccinate against infectious diseases, educate mothers on nutrition and safety, and develop relevant research questions that will drive tomorrow's discoveries and improve health care worldwide.<a class="elsevierStyleCrossRef" href="#bib4">4</a> Nurse scientists and practitioners across the globe are discovering new ways to manage the effects of poverty and prevent the spread of disease in vulnerable populations while educators are preparing the nurse scientists and the clinicians who will provide tomorrow's global leadership.Through a commitment to promote healthier communities and evidence-based care, the interventions emanating from nursing science will frame the solutions to the complex health issues confronting nations throughout the world.<a class="elsevierStyleCrossRef" href="#bib4">4</a> This world-wide attention on ever increasing global health priorities mandates that our profession expand our research beyond borders through collaborative communities of science. But what are the challenges we face as we become a global research community? How might we create the international partnerships necessary to enhance global research activities? How can we build collaborations that will address the pressing health issues of tomorrow's communities? Let us consider a number of factors that are shaping how we develop and implement international research.The Globalization of Scientific KnowledgeYears ago, our understanding of the world was based on the experiences of the global explorers of the time. However, today our ‘map’ of world knowledge extends beyond physical borders into a global world of information. New research discoveries occur on an almost daily basis, enhancing not only our world of scientific knowledge, but our local understanding of clinical solutions to solve the important health issues within our communities. With each new discovery, we witness how the globalization of nursing science unites and enhances our awareness of the similarities and challenges of health issues. But as global leaders, we must continue to expand our knowledge through scientific research and, as Kim et al state, “… provide the vision and the direction for delivery of health care…” for a rapidly changing world, and not just “… individual countries”(p. 29).<a class="elsevierStyleCrossRef" href="#bib5">5</a>The Global Expansion of Nursing ScholarshipA second issue to consider in creating international communities of research is that global communication and scholarship represent the “… extension of collaboration across cultures and countries” on a world-wide-scale (p. 69, Fitzpatrick, 2005).<a class="elsevierStyleCrossRef" href="#bib6">6</a> We travel to each other's countries to improve our understanding of the complexity of health threats to local communities. We connect with our global colleagues to understand and solve health care challenges. We experience cross-cultural exchanges through international journal publications, the World Wide Web, and conferences such as this. Together, we create the global linkages that will strengthen international collaborative relationships among investigators, practitioners, governments, and organizations. Such collaborations are essential for increasing global health care knowledge and are vital for the promotion of diversified, scientifically-based clinical practices.<a class="elsevierStyleCrossRef" href="#bib6">6</a>Organizations such as the World Health Organization (WHO) acknowledge the importance of international research collaborations through the designation of Nursing Collaborating Centers, which have as their mandate to conduct collaborative research of regional or global significance (Sigma Theta Tau International Conditions for International Collaborative Research).<a class="elsevierStyleCrossRef" href="#bib7">7</a> Other organizations, such as the International Council of Nurses (ICN) and Sigma Theta Tau International, have created ‘electronic neighborhoods’ that serve as global networks to exchange information related to nursing research. These programs, and others, demonstrate how international networks bring together the global nursing community to identify areas in need of research development, disseminate new scientific findings, and foster international relationships among investigators.<a class="elsevierStyleCrossRef" href="#bib7">7</a>‘Implementation Science’In the 2007 journal Science, Madon, Hofman, Kupfer, and Glass urged investigators to develop quantitative, scientific frameworks to guide health-care ‘scale-up’ in developing countries (p. 1728).<a class="elsevierStyleCrossRef" href="#bib8">8</a> Unlike traditional research paradigms, which identify and address barriers related to performance of specific projects, Madon et al stress ‘implementation science’ that creates generalizable knowledge that can be applied across settings and contexts and addresses those questions that will translate research into local communities of practice.<a class="elsevierStyleCrossRef" href="#bib8">8</a> But despite formidable gaps between innovations in health care and the delivery of findings to the communities of the world, ‘action-based’, ‘community-based’, ‘participatory’ research lies at the very core of nursing science.<a class="elsevierStyleCrossRef" href="#bib9">9</a> Rosenkoetter and Nardi (2006) in an American Academy of Nursing brief eloquently reiterate this point stating, “International researchers need to demonstrate how their products increase the research capacity so desperately needed in developing countries, and develop models to facilitate international research participation and exchanges.” (p. 114)<a class="elsevierStyleCrossRef" href="#bib10">10</a> It is clear, that as we look to build international communities of research, we must go beyond traditional methods of the conduct of science and become advocates for participatory, action-oriented initiatives that link neighborhoods with effective, evidence-based health care research.<a class="elsevierStyleCrossRef" href="#bib11">11</a> These efforts will bring science into transcultural, evidence-based programs that will engage the participation and acceptance of communities of practice.Prioritizing Globally Relevant Nursing ResearchFinally, by working together we can prioritize our science to focus on globally relevant research. The global research community faces an imbalance between research investment and disease burden—the so-called ‘10/90 Gap’ described in the 2000 Global Forum for Health Research.<a class="elsevierStyleCrossRef" href="#bib12">12</a> This gap emphasizes that less than 10% of worldwide research is devoted to diseases that account for 90% of the global burden of disease (p. iii).<a class="elsevierStyleCrossRef" href="#bib12">12</a> Nursing science must lead by addressing those ‘gap’ issues that will initiate and find solutions to relevant health problems. Our vision of evidence-based translational research must thus have global applications to the world nursing community and, through innovative collaborative partnerships, address the real health care issues facing the world's populations.<a class="elsevierStyleCrossRef" href="#bib13">13</a>The National Institute of Nursing Research: Partnerships and Programs in International ResearchThe National Institute of Health (NIH) is committed to supporting innovative, collaborative research communities devoted to evidence-based research. NIH is the primary Federal agency in the United States for the conduct and support of biomedical research. Its scientists conduct basic science research to understand the origins and causes of both common and rare diseases, as well as clinical research that develops preventive strategies, treatments and cures. Composed of 27 Institutes and Centers, the NIH provides leadership and financial support to researchers in all 50 States and throughout the world. The National Institute of Nursing Research (NINR) is the principal US Federal agency responsible for the support of nursing research. The work of the NINR improves the health and well-being of millions of Americans and world citizens through the advancement of nursing science. NINR supports clinical and basic research to establish a scientific basis for the care of individuals across the life span. Our research encompasses managing symptoms, promoting healthy lifestyles; maximizing quality of life; eliminating health disparities; and addressing end-of-life issues. Improved research methods and new technologies will be central to solving the difficult health care problems, and developing the researchers of tomorrow. I would like to highlight the research findings of several of our partnerships that serve to stimulate global communities of research.Building International Research Capacity in Health Promotion and Disease PreventionHealth promotion and disease prevention are core areas of the research supported by NINR. Nurses play a vital role in health promotion and disease prevention whether focusing on infectious disease, maternal-infant health, HIV/AIDS, or health services access. We are proud at the NINR to have several international collaborative studies addressing issues of health promotion and disease prevention. In particular, we have made concerted efforts to address HIV/AIDS prevention in the world's youth. As you know, HIV prevention is a global priority. The 1990–2007 UNAIDS Report on Children Living With HIV Globally demonstrated the escalating need for research to address health promotion and disease prevention in children.<a class="elsevierStyleCrossRef" href="#bib14">14</a> One research effort confronting the HIV/AIDS epidemic is occurring through a team of international collaborators from the Universidad Autónoma de Nuevo León and the School of Nursing at the University of Michigan in the United States. This team—of both scientists and practitioners– has taken steps to develop an HIV/AIDS behavioral intervention that will reduce adolescent sexual risk behaviors in a local community in Mexico.<a class="elsevierStyleCrossRef" href="#bib15">15</a>Working collaboratively, the investigators conducted a randomized control trial collecting data from 829 adolescents. Through their combined efforts, and the participation of the local community, the researchers identified key factors that influenced adolescents’ beliefs regarding safe sexual practices. Developing an intervention whose contents reflected the cultural relevance of the Northern Mexican community was a decisive factor for acceptance of the program in the adolescents, their parents, and the local facilitators of the intervention program.Across the globe is another example of an international research partnership between the College of Nursing at the University of Illinois at Chicago and the Kamuzu College of Nursing at the University of Malawi. This team has also focused on behavioral interventions aimed at preventing HIV in adolescent youth.<a class="elsevierStyleCrossRef" href="#bib16">16</a> According to the investigators, 14% of all people aged 15 years or more in this region are HIV positive; however nearly all children under 15 are HIV-free.<a class="elsevierStyleCrossRef" href="#bib17">17</a> In a program called ‘Friend to Friend Guiding Youth’, this diversified international team realized the importance of developing an early prevention program for young children prior to adolescence. In keeping with a trans-cultural, translational research approach, the team focused on a program that would be evidence-based as well as acceptable by the local community e.g., experts from the Malawi Kamuzu College of Nursing ensured that the HIV interventions used local terminology and were consistent with parental practices within the community. Their approach underscores the importance of developing trusting and collaborative relationships among investigators, the use of contextual features of the community, and the engagement of its participants in the research program. In doing so, this community-based participatory research program has the potential for effective implementation and acceptance within the entire community.Building International Research Capacity in Vulnerable PopulationsIn addition to an emphasis on health promotion and disease prevention, these studies also demonstrate the importance of advocacy in the promotion of health care to vulnerable populations and marginalized communities. The need for quality, effective health care impacts all countries, great and small, whose citizens experience poverty, live in rural communities, are aging, have poor infant health or may be socially marginalized. In an NINR-supported HIV/AIDS project, nurse scientists from the University of Illinois at Chicago focused efforts on developing a culturally relevant HIV risk-reduction program for Thai adolescent females. According to a 2005 report by Thailand's Ministry of Public Health, young women in Thailand are infected with HIV at twice the rate of males in the same age group.<a class="elsevierStyleCrossRef" href="#bib18">18</a> Recognizing the need to create a targeted intervention/prevention program specific to the adolescent female population, an international team of investigators recruited the support and effort of two public middle schools in Bangkok.<a class="elsevierStyleCrossRef" href="#bib19">19</a> Using input from local students and parents, the investigators developed an educational program geared to the cultural ideas and beliefs of this targeted population. Their efforts may ensure local access to an evidence-based intervention with the potential for effective health outcomes.Building International Research Capacity in Chronic Disease and Health Service AccessMany of the world's leading academic centers have designed programs to broaden the scope of nursing research and further the opportunities available for nurse researchers globally. The Johns Hopkins Center for Global Health at the School of Nursing has worked in South Africa examining the psychosocial and behavioral determinants of continuous hypertension and blood pressure control among Black South Africans.<a class="elsevierStyleCrossRef" href="#bib20">20</a> Hypertension has a 59% prevalence rate and is the most common cardiovascular disease among Black South Africans. Barriers to care exist at all levels of intervention. Working collaboratively with colleagues from the Medical Research Council in Tygerberg, South Africa and the University of Cape Town, South Africa Faculty of Medicine, this research team identified barriers to hypertension control and the need for comprehensive, multilevel interventions to care for this high risk population. Their work exemplifies evidence-based research that involves the integration of not only patient values, but the clinical expertise of the community in which research can become part of the local health practice.Building International Research Capacity: Global Shortages, Workforce Capacity, Mentorship and TrainingThe National Institute of Nursing Research recognizes the challenges of all countries in sustaining a global workforce. Dr. Linda Aiken from the University of Pennsylvania School of Nursing is the director of the Research Center for Nursing Outcomes and Policy Research. The Center operates as a unique community within the School of Nursing drawing together faculty from nursing, sociology, medicine, management, economics, and other related disciplines. We are proud of the Center's research collaborations around the world that have examined health system reorganization and policy changes. Their work has produced research evidence that will improve the quality of health care around the globe.NINR also collaborates with other NIH Institutes and Centers in many areas of mutual international interest through joint funding of research grants with agencies within the US Department of Health and Human Service. I would like to share with you several examples of how other agencies work with NINR to discover health care solutions through international research.Challenges in Chronic, Non-Communicable DiseasePoor diet and smoking are two factors that contribute to the millions of preventable deaths that occur each year and in people of all ages, nationalities and classes. These chronic, non-communicable diseases are reaching epidemic proportions worldwide.<a class="elsevierStyleCrossRef" href="#bib21">21</a> Tobacco-related illnesses alone will claim ten million lives annually by 2030.<a class="elsevierStyleCrossRef" href="#bib22">22</a> If current trends persist, these deaths will surpass the combined death toll from AIDS, tuberculosis, automobile accidents, maternal mortality, homicide and suicide according to the World Health Organization.<a class="elsevierStyleCrossRef" href="#bib23">23</a> As researchers and practitioners, these chronic diseases present what Daar et al. (2007) describe as ‘grand challenge’ exercises for developing and implementing participatory intervention and prevention programs.<a class="elsevierStyleCrossRef" href="#bib21">21</a> To meet this challenge, the NIH Fogarty International Center's International Tobacco and Health Research and Capacity Building Program generates data, trains the next generation of tobacco control scientists, and shares world-wide state-of-the art research findings related to best practices, obstacles, and opportunities.<a class="elsevierStyleCrossRef" href="#bib23">23</a> This program has awarded nearly $17 million in funds for projects focusing on capacity building and reducing tobacco-related deaths in developing nations throughout the world.Training tomorrow's Research Leaders“Relationships provide the single biggest contribution to the improvement of global health” – Comment by US Assistant Secretary of Health John Agwunobi, 2007 in an address to the NIH/Fogarty International Clinical Research Scholars.It is critical that opportunities are available to build the research skills of nurses and to teach others about the science of nursing.<a class="elsevierStyleCrossRef" href="#bib4">4</a> The NIH, Fogarty International Center, and the US Health Resources and Services Administration (HRSA) support the International Clinical Research Training Scholars and Fellows Program.<a class="elsevierStyleCrossRef" href="#bib24">24</a> In one funded program, a team of nurse researchers from seven universities in South Africa formed a collaborative partnership with Dr. William L. Holzemer of the University of California, San Francisco.<a class="elsevierStyleCrossRef" href="#bib25">25</a> In this five-year study on HIV/AIDS stigma in South Africa, the team has focused on why stigma has emerged as a major barrier to primary and secondary HIV/AIDS prevention and care.<a class="elsevierStyleCrossRef" href="#bib25">25</a> As you may know, stigma interferes with voluntary testing and counseling, as well as access to care treatments.<a class="elsevierStyleCrossRef" href="#bib26">26</a> This leads to increased suffering and a shortened lifespan.<a class="elsevierStyleCrossRef" href="#bib25">25</a> Thus, the goal of this team is to increase knowledge about AIDS stigma and discrimination, with the hope to ultimately reduce it. This program exemplifies how researchers in collaboration with community leaders can build programs that address not only local, but globally relevant health issues.It is also important that all nations work together to develop a cadre of young scientists who understand global health research from a trans-cultural perspective. NINR seeks to enhance the development of nurse researchers through collaborative training and career development opportunities. The Fogarty International Center has awarded Sarah Iribarren, a PhD candidate from the University of Utah College of Nursing, the NIH/Fogarty International Clinical Research Scholar Award. Ms. Iribarren is the second nurse to be awarded this honor in the scholarship program's history. Paired with foreign counterparts, these students conduct clinical research in a way that permits all involved to gain new insights into global health issues and instill mentorship skills for tomorrow's clinical leaders.Another example of training programs that foster the development of tomorrow's global leaders is the National Institutes of Health Minority Health and Health Disparities International Research Training Program (MHIRT). This program is a component of a long term strategy to establish biomedical, behavioral, and social science researchers that will work to reduce the disparate health burdens among underserved populations. The MHIRT awards support US academic institutions to offer short-term international training opportunities in health disparities research for undergraduate and graduate students in the health professions who are from health disparity populations and/or are underrepresented in basic science, biomedical, clinical, or behavioral health research career fields. Since its inception, the MHIRT has supported the conduct of research in countries throughout the world.Looking to the Future: Opportunities in International ResearchThe MHIRT, Fogarty International Center, and its collaborative research programs are just some of the many international research partnerships facilitated by national institutions and organizations. However, there is still much that can be done by all of us at the local level to foster global outreach. Each and every one of us has the opportunity to build new research skills, share with others the latest innovations in practice, further our global education, and become familiar with new discoveries from world-wide nursing research. What are some of the things to consider for the future, and what opportunities are available now to advance international collaborations throughout the global community? What are some of the critical research questions that need to be addressed by nurse scientists to fill gaps in nursing knowledge and how will these directly contribute to improving global health?<a class="elsevierStyleCrossRefs" href="#bib27">27,28</a> The World Wide Web has made the world a smaller place where access to information is only a ‘mouse-click’ away. Using these and other educational tools, we must all become informed consumers of research successes and implementers of these findings in our local health care communities. As Goethe reminds us, “Knowing is not enough, we must apply. Willing is not enough, we must do.”Rosenkoetter and Nardi (2006) presented a brief on the White Paper on Global Nursing and Heath developed by the Expert Panel on Global Health and Nursing of the American Academy of Nursing.<a class="elsevierStyleCrossRefs" href="#bib4">4,10</a> In this brief, as well as in the White Paper, are concrete suggestions for creating global partnerships at the national, local, and individual level.<a class="elsevierStyleCrossRefs" href="#bib4">4,11,12</a> I would like to share with you some of these ideas:<ul class="elsevierStyleList"><li class="elsevierStyleListItem">•First, recognize that at all levels, the world is seeking solutions for building stronger, effective international research partnerships. I encourage you, as you attend this conference, to take advantage of opportunities in forums that will promote nursing research around the globe.</li><li class="elsevierStyleListItem">•Learn from each other. Listen for ideas where we must fill gaps in knowledge. Use your local expertise to develop collaborative relationships with local practitioners to ensure that the research that may be conducted will be useable within the cultural contexts of your community.</li><li class="elsevierStyleListItem">•Seek local input to understand how research will affect the health care practices of your community. Identify ways to develop innovative practice techniques that will adapt or translate new interventions in a locally sustainable manner. Invest in developing stakeholder relationships to support and provide leverage to research projects in your community.</li><li class="elsevierStyleListItem">•Encourage curriculums that include global health and international learning experiences.</li><li class="elsevierStyleListItem">•Support the use of technologies for distance learning initiatives that are affordable and usable<a class="elsevierStyleCrossRef" href="#bib29">29</a> and promote cultural competence in research by establishing inter-university/inter-agency partnerships.</li><li class="elsevierStyleListItem">•Think global, link global. Become connected with nursing research through the many internet venues that are now available, whether list serves, websites, or on-line, long-distance tools for learning.</li><li class="elsevierStyleListItem">•Speak in shared terminology. Publish where it globally matters through international peer reviewed journals that have world-wide capacities for disseminating research information to the global community.</li><li class="elsevierStyleListItem">•Finally, share information about new research discoveries with the local community, area agencies, the press, or professional organizations.</li></ul>Caveats to International Research PartnershipsMcElmurray et al. (2003) point out that since the end of the cold war, “… we have moved from a world in which health care delivery, commerce, and education were limited to the boundaries of countries, to a world where these concepts are perceived as part of a global community” (p. 22).<a class="elsevierStyleCrossRef" href="#bib28">28</a> Developing collaborative relations with scholars in other countries is an important step in creating international research partnerships.<a class="elsevierStyleCrossRefs" href="#bib29">29–31</a> Many countries, such as the European Union, have research funds that are accessible if multiple countries collaborate in the endeavor.<a class="elsevierStyleCrossRefs" href="#bib29">29–31</a> But collaborative partnerships also bear some caveats. Research becomes more complex and the opportunities more challenging as we unite to study relevant issues across international boundaries.<a class="elsevierStyleCrossRef" href="#bib30">30</a> As we develop international collaborations in scientific research, whether on a small or large scale, we need to be aware of the uniqueness of how science is done in different nations.<a class="elsevierStyleCrossRef" href="#bib31">31</a> Differences in funding mechanisms, cultural perspectives, the training of students and research personnel and legal systems are issues that we must mitigate to forge effective, global communities of science. Funding mechanisms need to be agreed upon; researchers should develop integrated links where research responsibilities are shared amongst investigators. In focusing on research relevant to local populations, it is paramount that all researchers ensure the ethical conduct of international research by acknowledging the research governance of the country in which research is conducted.<a class="elsevierStyleCrossRef" href="#bib32">32</a> The International Centre for Nursing Ethics (ICNE) is a wonderful resource for issues surrounding professional ethics, law, and cultural accountability in nursing research.<a class="elsevierStyleCrossRef" href="#bib33">33</a>Looking to the Future: Nursing the Planet Through Evidence-Based Research PartnershipsBefore I conclude, I would like to take a moment to re-emphasize that building ‘International Research Partnerships’ is an effort that must be grounded in evidence-based research practices that occur both locally—and globally. In an article in the April, 2008 HealthBeat blog, a story is recounted at the World Health Care Conference in 2008 where Professor Ajit Lalavani, head of the Infectious Disease Department at the Imperial College of Health Care in London provided a perspective into the “Long and Tough Journey” of translating evidence into practice.<a class="elsevierStyleCrossRef" href="#bib34">34</a> Dr. Lalavanii recalled that the first controlled medical trial in world history was not of this modern era, but staged in 1601 by a British sea captain named James Lancaster.<a class="elsevierStyleCrossRef" href="#bib34">34</a> As his four ships were sailing from England to India around the Cape of Africa, Lancaster decided to give the sailors on one of his ships three teaspoons of lemon juice every morning. He did this after reading a report 8 years earlier by Sir Richard Hawkins. In this report, Hawkins observed that the most effective protection against scurvy appeared to be “sour oranges and lemons”. This careful observation and hypothesis testing resulted in 40% of the sailors on the ships where no one received the lemon juice developing scurvy and eventually perishing. However, on the ship receiving the lemon juice, none died of the disease. The medical evidence was compelling, and the entire British Navy put it to good use beginning in 1795—unfortunately this translation of evidence into clinical practice did not occur until 194 years after Lancaster's voyage!<a class="elsevierStyleCrossRef" href="#bib34">34</a> The important lesson for those who are neither researchers nor policy makers is that simple observations of health effects in your local community, and the practical use of tested knowledge, are the vehicles for making real health care differences. To all, I encourage you to take advantage at this conference and others to learn about evidence-based research and become translators of research knowledge at all levels of our profession.ConclusionIn the American Nursing Association publication, Florence Nightingale Today: Healing, Leadership, Global Action, the authors remind us that like Florence Nightingale, we are ‘inter-disciplinarians’ who collaborate with others to promote health in a variety of ways and in numerous arenas.<a class="elsevierStyleCrossRef" href="#bib35">35</a> These collaborations improve our patient's lives and within our local communities, promote transcultural understanding of globally relevant health issues. As we come together at this, the 12th International Nursing Research Conference and the 6th Biennial Joanna Briggs Colloquium, let us all be international partners in nursing science, communicating with and connecting to our global colleagues in health throughout the world. Let us engage in an international exchange of knowledge without borders and confirm our commitment to support globally relevant, evidence-based research on the real health issues affecting us all. Together, we will ‘Eliminate Borders of Knowledge’ and ‘Build International Communities of Research’." 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Articulo especial

Developing an International Community of Research

Desarrollo de una comunidad internacional de investigación☆☆

Una versión de este artículo se presentó como Conferencia Inaugural en XII Encuentro Internacional de investigación en enfermería y 6º Congreso Bienal del Instituto Joanna Briggs1. El Equipo Editorial de la revista agradece la disposición de la Dra Grady aceptando su difusión en este espacio.

Patricia A. Grady

Director, National Institute of Nursing Research, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA

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    "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">In this paper&#44; I have the opportunity to share with you the international research efforts of the National Institute of Nursing Research in the United States and my vision for &#8216;Developing an International Community of Research&#8217; to further both our science and our practice in dealing with the many global health issues that face us today&#46; I am pleased that we meet at this conference as a &#8216;global workforce&#8217; and as a &#8216;community of science&#8217;&#46; Together&#44; we share the vision to improve evidence-based health care throughout the world and recognize that &#8220;&#8230; the health of all nations&#44; and of our world&#44; is dependent upon the health of its individuals&#46;&#8221;<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> As scientists and practitioners&#44; we meet to discuss the opportunities and the challenges we face as we embrace global communities of practice and &#8216;borderless&#8217; partnerships&#46;<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a> We recognize that globalization is reshaping the world&#44; its people&#44; and its health care priorities&#46; With these changes&#44; we must reinforce every occasion to share the gains in knowledge that have come from collaborative international research partnerships&#46; But as we gain this knowledge&#44; it is also important that we consider how we will disseminate and implement evidence-based discoveries into our communities of practice throughout the world&#46; Today&#44; I share with you examples of international research collaborations that have forged new pathways in transcultural&#44; translational research and have created opportunities to advance global communities of nursing science&#8212;from informal research partnerships within local communities to large&#44; multi-institutional&#44; research ventures&#46; I will also reflect on opportunities for global collaborations that will foster the development of the next generation of culturally diverse leaders of evidence-based&#44; translational research&#46;<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a> Using the maxim from McFarlane et al&#46; &#40;2008&#41;&#44; we must &#8220;Think Globally&#44; Act Locally&#44; and Collaborate Internationally&#8221; to engage and facilitate unified communities of nursing science&#46;<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a></p><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Nursing Research&#58; Global Visions&#44; Global Voices</span><p class="elsevierStylePara elsevierViewall">Working collaboratively through global networks of research&#44; we can strengthen the impact of our scientific discoveries as we strive to enact research that will improve the quality of life for the global community&#46; From the clinic to the laboratory&#44; nurses are leaders in improving the health of the world&#46; Across all nations&#44; nurses advocate for safer water supplies&#44; provide disaster relief&#44; vaccinate against infectious diseases&#44; educate mothers on nutrition and safety&#44; and develop relevant research questions that will drive tomorrow&#39;s discoveries and improve health care worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> Nurse scientists and practitioners across the globe are discovering new ways to manage the effects of poverty and prevent the spread of disease in vulnerable populations while educators are preparing the nurse scientists and the clinicians who will provide tomorrow&#39;s global leadership&#46;</p><p class="elsevierStylePara elsevierViewall">Through a commitment to promote healthier communities and evidence-based care&#44; the interventions emanating from nursing science will frame the solutions to the complex health issues confronting nations throughout the world&#46;<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> This world-wide attention on ever increasing global health priorities mandates that our profession expand our research beyond borders through collaborative communities of science&#46; But what are the challenges we face as we become a global research community&#63; How might we create the international partnerships necessary to enhance global research activities&#63; How can we build collaborations that will address the pressing health issues of tomorrow&#39;s communities&#63; Let us consider a number of factors that are shaping how we develop and implement international research&#46;</p><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">The Globalization of Scientific Knowledge</span><p class="elsevierStylePara elsevierViewall">Years ago&#44; our understanding of the world was based on the experiences of the global explorers of the time&#46; However&#44; today our &#8216;map&#8217; of world knowledge extends beyond physical borders into a global world of information&#46; New research discoveries occur on an almost daily basis&#44; enhancing not only our world of scientific knowledge&#44; but our local understanding of clinical solutions to solve the important health issues within our communities&#46; With each new discovery&#44; we witness how the globalization of nursing science unites and enhances our awareness of the similarities and challenges of health issues&#46; But as global leaders&#44; we must continue to expand our knowledge through scientific research and&#44; as Kim et al state&#44; &#8220;&#8230; provide the vision and the direction for delivery of health care&#8230;&#8221; for a rapidly changing world&#44; and not just &#8220;&#8230; individual countries&#8221;&#40;p&#46; 29&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a></p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">The Global Expansion of Nursing Scholarship</span><p class="elsevierStylePara elsevierViewall">A second issue to consider in creating international communities of research is that global communication and scholarship represent the &#8220;&#8230; extension of collaboration across cultures and countries&#8221; on a world-wide-scale &#40;p&#46; 69&#44; Fitzpatrick&#44; 2005&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a> We travel to each other&#39;s countries to improve our understanding of the complexity of health threats to local communities&#46; We connect with our global colleagues to understand and solve health care challenges&#46; We experience cross-cultural exchanges through international journal publications&#44; the World Wide Web&#44; and conferences such as this&#46; Together&#44; we create the global linkages that will strengthen international collaborative relationships among investigators&#44; practitioners&#44; governments&#44; and organizations&#46; Such collaborations are essential for increasing global health care knowledge and are vital for the promotion of diversified&#44; scientifically-based clinical practices&#46;<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a></p><p class="elsevierStylePara elsevierViewall">Organizations such as the World Health Organization &#40;WHO&#41; acknowledge the importance of international research collaborations through the designation of Nursing Collaborating Centers&#44; which have as their mandate to conduct collaborative research of regional or global significance &#40;Sigma Theta Tau International Conditions for International Collaborative Research&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a> Other organizations&#44; such as the International Council of Nurses &#40;ICN&#41; and Sigma Theta Tau International&#44; have created &#8216;electronic neighborhoods&#8217; that serve as global networks to exchange information related to nursing research&#46; These programs&#44; and others&#44; demonstrate how international networks bring together the global nursing community to identify areas in need of research development&#44; disseminate new scientific findings&#44; and foster international relationships among investigators&#46;<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a></p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">&#8216;Implementation Science&#8217;</span><p class="elsevierStylePara elsevierViewall">In the 2007 journal Science&#44; Madon&#44; Hofman&#44; Kupfer&#44; and Glass urged investigators to develop quantitative&#44; scientific frameworks to guide health-care &#8216;scale-up&#8217; in developing countries &#40;p&#46; 1728&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib8"><span class="elsevierStyleSup">8</span></a> Unlike traditional research paradigms&#44; which identify and address barriers related to performance of specific projects&#44; Madon et al stress &#8216;implementation science&#8217; that creates generalizable knowledge that can be applied across settings and contexts and addresses those questions that will translate research into local communities of practice&#46;<a class="elsevierStyleCrossRef" href="#bib8"><span class="elsevierStyleSup">8</span></a> But despite formidable gaps between innovations in health care and the delivery of findings to the communities of the world&#44; &#8216;action-based&#8217;&#44; &#8216;community-based&#8217;&#44; &#8216;participatory&#8217; research lies at the very core of nursing science&#46;<a class="elsevierStyleCrossRef" href="#bib9"><span class="elsevierStyleSup">9</span></a> Rosenkoetter and Nardi &#40;2006&#41; in an American Academy of Nursing brief eloquently reiterate this point stating&#44; &#8220;International researchers need to demonstrate how their products increase the research capacity so desperately needed in developing countries&#44; and develop models to facilitate international research participation and exchanges&#46;&#8221; &#40;p&#46; 114&#41;<a class="elsevierStyleCrossRef" href="#bib10"><span class="elsevierStyleSup">10</span></a> It is clear&#44; that as we look to build international communities of research&#44; we must go beyond traditional methods of the conduct of science and become advocates for participatory&#44; action-oriented initiatives that link neighborhoods with effective&#44; evidence-based health care research&#46;<a class="elsevierStyleCrossRef" href="#bib11"><span class="elsevierStyleSup">11</span></a> These efforts will bring science into transcultural&#44; evidence-based programs that will engage the participation and acceptance of communities of practice&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Prioritizing Globally Relevant Nursing Research</span><p class="elsevierStylePara elsevierViewall">Finally&#44; by working together we can prioritize our science to focus on globally relevant research&#46; The global research community faces an imbalance between research investment and disease burden&#8212;the so-called &#8216;10&#47;90 Gap&#8217; described in the 2000 Global Forum for Health Research&#46;<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a> This gap emphasizes that less than 10&#37; of worldwide research is devoted to diseases that account for 90&#37; of the global burden of disease &#40;p&#46; iii&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib12"><span class="elsevierStyleSup">12</span></a> Nursing science must lead by addressing those &#8216;gap&#8217; issues that will initiate and find solutions to relevant health problems&#46; Our vision of evidence-based translational research must thus have global applications to the world nursing community and&#44; through innovative collaborative partnerships&#44; address the real health care issues facing the world&#39;s populations&#46;<a class="elsevierStyleCrossRef" href="#bib13"><span class="elsevierStyleSup">13</span></a></p></span></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">The National Institute of Nursing Research&#58; Partnerships and Programs in International Research</span><p class="elsevierStylePara elsevierViewall">The National Institute of Health &#40;NIH&#41; is committed to supporting innovative&#44; collaborative research communities devoted to evidence-based research&#46; NIH is the primary Federal agency in the United States for the conduct and support of biomedical research&#46; Its scientists conduct basic science research to understand the origins and causes of both common and rare diseases&#44; as well as clinical research that develops preventive strategies&#44; treatments and cures&#46; Composed of 27 Institutes and Centers&#44; the NIH provides leadership and financial support to researchers in all 50 States and throughout the world&#46; The National Institute of Nursing Research &#40;NINR&#41; is the principal US Federal agency responsible for the support of nursing research&#46; The work of the NINR improves the health and well-being of millions of Americans and world citizens through the advancement of nursing science&#46; NINR supports clinical and basic research to establish a scientific basis for the care of individuals across the life span&#46; Our research encompasses managing symptoms&#44; promoting healthy lifestyles&#59; maximizing quality of life&#59; eliminating health disparities&#59; and addressing end-of-life issues&#46; Improved research methods and new technologies will be central to solving the difficult health care problems&#44; and developing the researchers of tomorrow&#46; I would like to highlight the research findings of several of our partnerships that serve to stimulate global communities of research&#46;</p><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Building International Research Capacity in Health Promotion and Disease Prevention</span><p class="elsevierStylePara elsevierViewall">Health promotion and disease prevention are core areas of the research supported by NINR&#46; Nurses play a vital role in health promotion and disease prevention whether focusing on infectious disease&#44; maternal-infant health&#44; HIV&#47;AIDS&#44; or health services access&#46; We are proud at the NINR to have several international collaborative studies addressing issues of health promotion and disease prevention&#46; In particular&#44; we have made concerted efforts to address HIV&#47;AIDS prevention in the world&#39;s youth&#46; As you know&#44; HIV prevention is a global priority&#46; The 1990&#8211;2007 UNAIDS Report on Children Living With HIV Globally demonstrated the escalating need for research to address health promotion and disease prevention in children&#46;<a class="elsevierStyleCrossRef" href="#bib14"><span class="elsevierStyleSup">14</span></a> One research effort confronting the HIV&#47;AIDS epidemic is occurring through a team of international collaborators from the Universidad Aut&#243;noma de Nuevo Le&#243;n and the School of Nursing at the University of Michigan in the United States&#46; This team&#8212;of both scientists and practitioners&#8211; has taken steps to develop an HIV&#47;AIDS behavioral intervention that will reduce adolescent sexual risk behaviors in a local community in Mexico&#46;<a class="elsevierStyleCrossRef" href="#bib15"><span class="elsevierStyleSup">15</span></a></p><p class="elsevierStylePara elsevierViewall">Working collaboratively&#44; the investigators conducted a randomized control trial collecting data from 829 adolescents&#46; Through their combined efforts&#44; and the participation of the local community&#44; the researchers identified key factors that influenced adolescents&#8217; beliefs regarding safe sexual practices&#46; Developing an intervention whose contents reflected the cultural relevance of the Northern Mexican community was a decisive factor for acceptance of the program in the adolescents&#44; their parents&#44; and the local facilitators of the intervention program&#46;</p><p class="elsevierStylePara elsevierViewall">Across the globe is another example of an international research partnership between the College of Nursing at the University of Illinois at Chicago and the Kamuzu College of Nursing at the University of Malawi&#46; This team has also focused on behavioral interventions aimed at preventing HIV in adolescent youth&#46;<a class="elsevierStyleCrossRef" href="#bib16"><span class="elsevierStyleSup">16</span></a> According to the investigators&#44; 14&#37; of all people aged 15 years or more in this region are HIV positive&#59; however nearly all children under 15 are HIV-free&#46;<a class="elsevierStyleCrossRef" href="#bib17"><span class="elsevierStyleSup">17</span></a> In a program called &#8216;Friend to Friend Guiding Youth&#8217;&#44; this diversified international team realized the importance of developing an early prevention program for young children prior to adolescence&#46; In keeping with a trans-cultural&#44; translational research approach&#44; the team focused on a program that would be evidence-based as well as acceptable by the local community e&#46;g&#46;&#44; experts from the Malawi Kamuzu College of Nursing ensured that the HIV interventions used local terminology and were consistent with parental practices within the community&#46; Their approach underscores the importance of developing trusting and collaborative relationships among investigators&#44; the use of contextual features of the community&#44; and the engagement of its participants in the research program&#46; In doing so&#44; this community-based participatory research program has the potential for effective implementation and acceptance within the entire community&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Building International Research Capacity in Vulnerable Populations</span><p class="elsevierStylePara elsevierViewall">In addition to an emphasis on health promotion and disease prevention&#44; these studies also demonstrate the importance of advocacy in the promotion of health care to vulnerable populations and marginalized communities&#46; The need for quality&#44; effective health care impacts all countries&#44; great and small&#44; whose citizens experience poverty&#44; live in rural communities&#44; are aging&#44; have poor infant health or may be socially marginalized&#46; In an NINR-supported HIV&#47;AIDS project&#44; nurse scientists from the University of Illinois at Chicago focused efforts on developing a culturally relevant HIV risk-reduction program for Thai adolescent females&#46; According to a 2005 report by Thailand&#39;s Ministry of Public Health&#44; young women in Thailand are infected with HIV at twice the rate of males in the same age group&#46;<a class="elsevierStyleCrossRef" href="#bib18"><span class="elsevierStyleSup">18</span></a> Recognizing the need to create a targeted intervention&#47;prevention program specific to the adolescent female population&#44; an international team of investigators recruited the support and effort of two public middle schools in Bangkok&#46;<a class="elsevierStyleCrossRef" href="#bib19"><span class="elsevierStyleSup">19</span></a> Using input from local students and parents&#44; the investigators developed an educational program geared to the cultural ideas and beliefs of this targeted population&#46; Their efforts may ensure local access to an evidence-based intervention with the potential for effective health outcomes&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Building International Research Capacity in Chronic Disease and Health Service Access</span><p class="elsevierStylePara elsevierViewall">Many of the world&#39;s leading academic centers have designed programs to broaden the scope of nursing research and further the opportunities available for nurse researchers globally&#46; The Johns Hopkins Center for Global Health at the School of Nursing has worked in South Africa examining the psychosocial and behavioral determinants of continuous hypertension and blood pressure control among Black South Africans&#46;<a class="elsevierStyleCrossRef" href="#bib20"><span class="elsevierStyleSup">20</span></a> Hypertension has a 59&#37; prevalence rate and is the most common cardiovascular disease among Black South Africans&#46; Barriers to care exist at all levels of intervention&#46; Working collaboratively with colleagues from the Medical Research Council in Tygerberg&#44; South Africa and the University of Cape Town&#44; South Africa Faculty of Medicine&#44; this research team identified barriers to hypertension control and the need for comprehensive&#44; multilevel interventions to care for this high risk population&#46; Their work exemplifies evidence-based research that involves the integration of not only patient values&#44; but the clinical expertise of the community in which research can become part of the local health practice&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Building International Research Capacity&#58; Global Shortages&#44; Workforce Capacity&#44; Mentorship and Training</span><p class="elsevierStylePara elsevierViewall">The National Institute of Nursing Research recognizes the challenges of all countries in sustaining a global workforce&#46; Dr&#46; Linda Aiken from the University of Pennsylvania School of Nursing is the director of the Research Center for Nursing Outcomes and Policy Research&#46; The Center operates as a unique community within the School of Nursing drawing together faculty from nursing&#44; sociology&#44; medicine&#44; management&#44; economics&#44; and other related disciplines&#46; We are proud of the Center&#39;s research collaborations around the world that have examined health system reorganization and policy changes&#46; Their work has produced research evidence that will improve the quality of health care around the globe&#46;</p><p class="elsevierStylePara elsevierViewall">NINR also collaborates with other NIH Institutes and Centers in many areas of mutual international interest through joint funding of research grants with agencies within the US Department of Health and Human Service&#46; I would like to share with you several examples of how other agencies work with NINR to discover health care solutions through international research&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Challenges in Chronic&#44; Non-Communicable Disease</span><p class="elsevierStylePara elsevierViewall">Poor diet and smoking are two factors that contribute to the millions of preventable deaths that occur each year and in people of all ages&#44; nationalities and classes&#46; These chronic&#44; non-communicable diseases are reaching epidemic proportions worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib21"><span class="elsevierStyleSup">21</span></a> Tobacco-related illnesses alone will claim ten million lives annually by 2030&#46;<a class="elsevierStyleCrossRef" href="#bib22"><span class="elsevierStyleSup">22</span></a> If current trends persist&#44; these deaths will surpass the combined death toll from AIDS&#44; tuberculosis&#44; automobile accidents&#44; maternal mortality&#44; homicide and suicide according to the World Health Organization&#46;<a class="elsevierStyleCrossRef" href="#bib23"><span class="elsevierStyleSup">23</span></a> As researchers and practitioners&#44; these chronic diseases present what Daar et al&#46; &#40;2007&#41; describe as &#8216;grand challenge&#8217; exercises for developing and implementing participatory intervention and prevention programs&#46;<a class="elsevierStyleCrossRef" href="#bib21"><span class="elsevierStyleSup">21</span></a> To meet this challenge&#44; the NIH Fogarty International Center&#39;s International Tobacco and Health Research and Capacity Building Program generates data&#44; trains the next generation of tobacco control scientists&#44; and shares world-wide state-of-the art research findings related to best practices&#44; obstacles&#44; and opportunities&#46;<a class="elsevierStyleCrossRef" href="#bib23"><span class="elsevierStyleSup">23</span></a> This program has awarded nearly &#36;17 million in funds for projects focusing on capacity building and reducing tobacco-related deaths in developing nations throughout the world&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Training tomorrow&#39;s Research Leaders</span><p class="elsevierStylePara elsevierViewall">&#8220;Relationships provide the single biggest contribution to the improvement of global health&#8221; &#8211; Comment by US Assistant Secretary of Health John Agwunobi&#44; 2007 in an address to the NIH&#47;Fogarty International Clinical Research Scholars&#46;</p><p class="elsevierStylePara elsevierViewall">It is critical that opportunities are available to build the research skills of nurses and to teach others about the science of nursing&#46;<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a> The NIH&#44; Fogarty International Center&#44; and the US Health Resources and Services Administration &#40;HRSA&#41; support the International Clinical Research Training Scholars and Fellows Program&#46;<a class="elsevierStyleCrossRef" href="#bib24"><span class="elsevierStyleSup">24</span></a> In one funded program&#44; a team of nurse researchers from seven universities in South Africa formed a collaborative partnership with Dr&#46; William L&#46; Holzemer of the University of California&#44; San Francisco&#46;<a class="elsevierStyleCrossRef" href="#bib25"><span class="elsevierStyleSup">25</span></a> In this five-year study on HIV&#47;AIDS stigma in South Africa&#44; the team has focused on why stigma has emerged as a major barrier to primary and secondary HIV&#47;AIDS prevention and care&#46;<a class="elsevierStyleCrossRef" href="#bib25"><span class="elsevierStyleSup">25</span></a> As you may know&#44; stigma interferes with voluntary testing and counseling&#44; as well as access to care treatments&#46;<a class="elsevierStyleCrossRef" href="#bib26"><span class="elsevierStyleSup">26</span></a> This leads to increased suffering and a shortened lifespan&#46;<a class="elsevierStyleCrossRef" href="#bib25"><span class="elsevierStyleSup">25</span></a> Thus&#44; the goal of this team is to increase knowledge about AIDS stigma and discrimination&#44; with the hope to ultimately reduce it&#46; This program exemplifies how researchers in collaboration with community leaders can build programs that address not only local&#44; but globally relevant health issues&#46;</p><p class="elsevierStylePara elsevierViewall">It is also important that all nations work together to develop a cadre of young scientists who understand global health research from a trans-cultural perspective&#46; NINR seeks to enhance the development of nurse researchers through collaborative training and career development opportunities&#46; The Fogarty International Center has awarded Sarah Iribarren&#44; a PhD candidate from the University of Utah College of Nursing&#44; the NIH&#47;Fogarty International Clinical Research Scholar Award&#46; Ms&#46; Iribarren is the second nurse to be awarded this honor in the scholarship program&#39;s history&#46; Paired with foreign counterparts&#44; these students conduct clinical research in a way that permits all involved to gain new insights into global health issues and instill mentorship skills for tomorrow&#39;s clinical leaders&#46;</p><p class="elsevierStylePara elsevierViewall">Another example of training programs that foster the development of tomorrow&#39;s global leaders is the National Institutes of Health Minority Health and Health Disparities International Research Training Program &#40;MHIRT&#41;&#46; This program is a component of a long term strategy to establish biomedical&#44; behavioral&#44; and social science researchers that will work to reduce the disparate health burdens among underserved populations&#46; The MHIRT awards support US academic institutions to offer short-term international training opportunities in health disparities research for undergraduate and graduate students in the health professions who are from health disparity populations and&#47;or are underrepresented in basic science&#44; biomedical&#44; clinical&#44; or behavioral health research career fields&#46; Since its inception&#44; the MHIRT has supported the conduct of research in countries throughout the world&#46;</p></span></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Looking to the Future&#58; Opportunities in International Research</span><p class="elsevierStylePara elsevierViewall">The MHIRT&#44; Fogarty International Center&#44; and its collaborative research programs are just some of the many international research partnerships facilitated by national institutions and organizations&#46; However&#44; there is still much that can be done by all of us at the local level to foster global outreach&#46; Each and every one of us has the opportunity to build new research skills&#44; share with others the latest innovations in practice&#44; further our global education&#44; and become familiar with new discoveries from world-wide nursing research&#46; What are some of the things to consider for the future&#44; and what opportunities are available now to advance international collaborations throughout the global community&#63; What are some of the critical research questions that need to be addressed by nurse scientists to fill gaps in nursing knowledge and how will these directly contribute to improving global health&#63;<a class="elsevierStyleCrossRefs" href="#bib27"><span class="elsevierStyleSup">27&#44;28</span></a> The World Wide Web has made the world a smaller place where access to information is only a &#8216;mouse-click&#8217; away&#46; Using these and other educational tools&#44; we must all become informed consumers of research successes and implementers of these findings in our local health care communities&#46; As Goethe reminds us&#44; &#8220;Knowing is not enough&#44; we must apply&#46; Willing is not enough&#44; we must do&#46;&#8221;</p><p class="elsevierStylePara elsevierViewall">Rosenkoetter and Nardi &#40;2006&#41; presented a brief on the White Paper on Global Nursing and Heath developed by the Expert Panel on Global Health and Nursing of the American Academy of Nursing&#46;<a class="elsevierStyleCrossRefs" href="#bib4"><span class="elsevierStyleSup">4&#44;10</span></a> In this brief&#44; as well as in the White Paper&#44; are concrete suggestions for creating global partnerships at the national&#44; local&#44; and individual level&#46;<a class="elsevierStyleCrossRefs" href="#bib4"><span class="elsevierStyleSup">4&#44;11&#44;12</span></a> I would like to share with you some of these ideas&#58;<ul class="elsevierStyleList"><li class="elsevierStyleListItem"><span class="elsevierStyleLabel">&#8226;</span><p class="elsevierStylePara elsevierViewall">First&#44; recognize that at all levels&#44; the world is seeking solutions for building stronger&#44; effective international research partnerships&#46; I encourage you&#44; as you attend this conference&#44; to take advantage of opportunities in forums that will promote nursing research around the globe&#46;</p></li><li class="elsevierStyleListItem"><span class="elsevierStyleLabel">&#8226;</span><p class="elsevierStylePara elsevierViewall">Learn from each other&#46; Listen for ideas where we must fill gaps in knowledge&#46; Use your local expertise to develop collaborative relationships with local practitioners to ensure that the research that may be conducted will be useable within the cultural contexts of your community&#46;</p></li><li class="elsevierStyleListItem"><span class="elsevierStyleLabel">&#8226;</span><p class="elsevierStylePara elsevierViewall">Seek local input to understand how research will affect the health care practices of your community&#46; Identify ways to develop innovative practice techniques that will adapt or translate new interventions in a locally sustainable manner&#46; Invest in developing stakeholder relationships to support and provide leverage to research projects in your community&#46;</p></li><li class="elsevierStyleListItem"><span class="elsevierStyleLabel">&#8226;</span><p class="elsevierStylePara elsevierViewall">Encourage curriculums that include global health and international learning experiences&#46;</p></li><li class="elsevierStyleListItem"><span class="elsevierStyleLabel">&#8226;</span><p class="elsevierStylePara elsevierViewall">Support the use of technologies for distance learning initiatives that are affordable and usable<a class="elsevierStyleCrossRef" href="#bib29"><span class="elsevierStyleSup">29</span></a> and promote cultural competence in research by establishing inter-university&#47;inter-agency partnerships&#46;</p></li><li class="elsevierStyleListItem"><span class="elsevierStyleLabel">&#8226;</span><p class="elsevierStylePara elsevierViewall">Think global&#44; link global&#46; Become connected with nursing research through the many internet venues that are now available&#44; whether list serves&#44; websites&#44; or on-line&#44; long-distance tools for learning&#46;</p></li><li class="elsevierStyleListItem"><span class="elsevierStyleLabel">&#8226;</span><p class="elsevierStylePara elsevierViewall">Speak in shared terminology&#46; Publish where it globally matters through international peer reviewed journals that have world-wide capacities for disseminating research information to the global community&#46;</p></li><li class="elsevierStyleListItem"><span class="elsevierStyleLabel">&#8226;</span><p class="elsevierStylePara elsevierViewall">Finally&#44; share information about new research discoveries with the local community&#44; area agencies&#44; the press&#44; or professional organizations&#46;</p></li></ul></p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Caveats to International Research Partnerships</span><p class="elsevierStylePara elsevierViewall">McElmurray et al&#46; &#40;2003&#41; point out that since the end of the cold war&#44; &#8220;&#8230; we have moved from a world in which health care delivery&#44; commerce&#44; and education were limited to the boundaries of countries&#44; to a world where these concepts are perceived as part of a global community&#8221; &#40;p&#46; 22&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib28"><span class="elsevierStyleSup">28</span></a> Developing collaborative relations with scholars in other countries is an important step in creating international research partnerships&#46;<a class="elsevierStyleCrossRefs" href="#bib29"><span class="elsevierStyleSup">29&#8211;31</span></a> Many countries&#44; such as the European Union&#44; have research funds that are accessible if multiple countries collaborate in the endeavor&#46;<a class="elsevierStyleCrossRefs" href="#bib29"><span class="elsevierStyleSup">29&#8211;31</span></a> But collaborative partnerships also bear some caveats&#46; Research becomes more complex and the opportunities more challenging as we unite to study relevant issues across international boundaries&#46;<a class="elsevierStyleCrossRef" href="#bib30"><span class="elsevierStyleSup">30</span></a> As we develop international collaborations in scientific research&#44; whether on a small or large scale&#44; we need to be aware of the uniqueness of how science is done in different nations&#46;<a class="elsevierStyleCrossRef" href="#bib31"><span class="elsevierStyleSup">31</span></a> Differences in funding mechanisms&#44; cultural perspectives&#44; the training of students and research personnel and legal systems are issues that we must mitigate to forge effective&#44; global communities of science&#46; Funding mechanisms need to be agreed upon&#59; researchers should develop integrated links where research responsibilities are shared amongst investigators&#46; In focusing on research relevant to local populations&#44; it is paramount that all researchers ensure the ethical conduct of international research by acknowledging the research governance of the country in which research is conducted&#46;<a class="elsevierStyleCrossRef" href="#bib32"><span class="elsevierStyleSup">32</span></a> The International Centre for Nursing Ethics &#40;ICNE&#41; is a wonderful resource for issues surrounding professional ethics&#44; law&#44; and cultural accountability in nursing research&#46;<a class="elsevierStyleCrossRef" href="#bib33"><span class="elsevierStyleSup">33</span></a></p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Looking to the Future&#58; Nursing the Planet Through Evidence-Based Research Partnerships</span><p class="elsevierStylePara elsevierViewall">Before I conclude&#44; I would like to take a moment to re-emphasize that building &#8216;International Research Partnerships&#8217; is an effort that must be grounded in evidence-based research practices that occur both locally&#8212;and globally&#46; In an article in the April&#44; 2008 HealthBeat blog&#44; a story is recounted at the World Health Care Conference in 2008 where Professor Ajit Lalavani&#44; head of the Infectious Disease Department at the Imperial College of Health Care in London provided a perspective into the &#8220;Long and Tough Journey&#8221; of translating evidence into practice&#46;<a class="elsevierStyleCrossRef" href="#bib34"><span class="elsevierStyleSup">34</span></a> Dr&#46; Lalavanii recalled that the first controlled medical trial in world history was not of this modern era&#44; but staged in 1601 by a British sea captain named James Lancaster&#46;<a class="elsevierStyleCrossRef" href="#bib34"><span class="elsevierStyleSup">34</span></a> As his four ships were sailing from England to India around the Cape of Africa&#44; Lancaster decided to give the sailors on one of his ships three teaspoons of lemon juice every morning&#46; He did this after reading a report 8 years earlier by Sir Richard Hawkins&#46; In this report&#44; Hawkins observed that the most effective protection against scurvy appeared to be &#8220;sour oranges and lemons&#8221;&#46; This careful observation and hypothesis testing resulted in 40&#37; of the sailors on the ships where no one received the lemon juice developing scurvy and eventually perishing&#46; However&#44; on the ship receiving the lemon juice&#44; none died of the disease&#46; The medical evidence was compelling&#44; and the entire British Navy put it to good use beginning in 1795&#8212;unfortunately this translation of evidence into clinical practice did not occur until 194 years after Lancaster&#39;s voyage&#33;<a class="elsevierStyleCrossRef" href="#bib34"><span class="elsevierStyleSup">34</span></a> The important lesson for those who are neither researchers nor policy makers is that simple observations of health effects in your local community&#44; and the practical use of tested knowledge&#44; are the vehicles for making real health care differences&#46; To all&#44; I encourage you to take advantage at this conference and others to learn about evidence-based research and become translators of research knowledge at all levels of our profession&#46;</p></span><span class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p class="elsevierStylePara elsevierViewall">In the American Nursing Association publication&#44; Florence Nightingale Today&#58; Healing&#44; Leadership&#44; Global Action&#44; the authors remind us that like Florence Nightingale&#44; we are &#8216;inter-disciplinarians&#8217; who collaborate with others to promote health in a variety of ways and in numerous arenas&#46;<a class="elsevierStyleCrossRef" href="#bib35"><span class="elsevierStyleSup">35</span></a> These collaborations improve our patient&#39;s lives and within our local communities&#44; promote transcultural understanding of globally relevant health issues&#46; As we come together at this&#44; the 12th International Nursing Research Conference and the 6th Biennial Joanna Briggs Colloquium&#44; let us all be international partners in nursing science&#44; communicating with and connecting to our global colleagues in health throughout the world&#46; Let us engage in an international exchange of knowledge without borders and confirm our commitment to support globally relevant&#44; evidence-based research on the real health issues affecting us all&#46; Together&#44; we will &#8216;Eliminate Borders of Knowledge&#8217; and &#8216;Build International Communities of Research&#8217;&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:7 [
        0 => array:2 [
          "titulo" => "Nursing Research&#58; Global Visions&#44; Global Voices"
          "secciones" => array:4 [
            0 => array:1 [
              "titulo" => "The Globalization of Scientific Knowledge"
            ]
            1 => array:1 [
              "titulo" => "The Global Expansion of Nursing Scholarship"
            ]
            2 => array:1 [
              "titulo" => "&#8216;Implementation Science&#8217;"
            ]
            3 => array:1 [
              "titulo" => "Prioritizing Globally Relevant Nursing Research"
            ]
          ]
        ]
        1 => array:2 [
          "titulo" => "The National Institute of Nursing Research&#58; Partnerships and Programs in International Research"
          "secciones" => array:6 [
            0 => array:1 [
              "titulo" => "Building International Research Capacity in Health Promotion and Disease Prevention"
            ]
            1 => array:1 [
              "titulo" => "Building International Research Capacity in Vulnerable Populations"
            ]
            2 => array:1 [
              "titulo" => "Building International Research Capacity in Chronic Disease and Health Service Access"
            ]
            3 => array:1 [
              "titulo" => "Building International Research Capacity&#58; Global Shortages&#44; Workforce Capacity&#44; Mentorship and Training"
            ]
            4 => array:1 [
              "titulo" => "Challenges in Chronic&#44; Non-Communicable Disease"
            ]
            5 => array:1 [
              "titulo" => "Training tomorrow&#39;s Research Leaders"
            ]
          ]
        ]
        2 => array:1 [
          "titulo" => "Looking to the Future&#58; Opportunities in International Research"
        ]
        3 => array:1 [
          "titulo" => "Caveats to International Research Partnerships"
        ]
        4 => array:1 [
          "titulo" => "Looking to the Future&#58; Nursing the Planet Through Evidence-Based Research Partnerships"
        ]
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          "titulo" => "Conclusion"
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Información del artículo

ISSN: 11308621
Idioma original: Español

DOI:10.1016/j.enfcli.2009.02.002

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