Creating and maintaining healthy communities around the world are demanding tasks for healthcare providers, governmental agencies, and individual populations. Health is challenged by the presence of disease, environmental conditions, urbanization, violence, socioeconomic disparities, and ever-changing health care delivery systems. More than a decade ago, the Institute of Medicine (IOM) created a paradigm shift in our view of worldwide "health." Rather than the concept of international health (health-related relationships between and among nations), we were asked to define global health as "health problems, issues and concerns that transcend national boundaries, may be influenced by circumstances or experiences in other countries, and are best addressed by cooperative actions and solutions" (IOM, 1997).
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At about the same time, the Sigma Theta Tau International Honor Society of Nursing tried to envision the global contributions of nurses to healthy communities through their Arista series of multinational, multidisciplinary conferences (Dickenson-Hazard, 2004). Arista1 focused on the nursing shortage in the United States and its effects on professional nurse migration; Arista2 and Arista3 focused on nurses and their impact on health worldwide. The Arista conferences identified the following challenges for nursing: (1) differing cultures, values, and beliefs that require us to balance Western medicine and nursing with more traditional approaches; (2) differing, although often surprisingly similar, population-related health needs that reflect changing disease patterns and shifting priorities; and (3) research-related issues. Arista conferences also outlined strategic action areas that encompass (1) creating research models and partnerships, (2) creating opportunities for collaboration and partnerships related to care, (3) identifying mechanisms to increase the availability of human and material resources, (4) enhancing the image of nursing by communicating the value of what we do and the outcomes we achieve, and (5) addressing workforce-related issues such as shortages and imbalance of nurses and migration of nurses from less developed nations to those with education and opportunities perceived as "better."
In this issue of JNN, we feature a number of articles that reflect our commitment to the dissemination of neuroscience nursing knowledge that supports healthy communities worldwide. DiIorio and colleagues publish a timely, and closely related, report of the research priorities facing neuroscience nurses. As part of the work of the Neuroscience Nursing Foundation, these authors outline areas of potential research that address gaps in our current knowledge base; these include disease prevention, health disparities, the development of measurement tools, and collaboration between hospitals and academia as well as symptom management and/or the prevention of secondary conditions. The gaps reflect to a fair degree the action areas identified by the Sigma Theta Tau International Honor Society of Nursing. The authors also consider culture, ethnicity, financial constraints, and the value of nursing care outcomes in this new set of priorities.
Three groups of authors from Canada write about supportive care after stroke (MacIsaac et al.), rehabilitation of women after a traumatic brain injury (Colantonio et al.), and the body of literature that examines qualitative research related to chronic neuromuscular disorders (LaDonna). Each article has explored an area that reflects the new Neuroscience Nursing Foundation priorities and/or the IOM/Arista areas of focus. Braine, a practitioner in the United Kingdom, examines the experience of survivors of brain injuries and those who care for them. Saburi, a nurse researcher from Zimbabwe, examines the stressors faced by those caring for school-age children with epilepsy; she also explores the role of community support in providing this care because "formal" support from the professional healthcare community is often limited. Finally, Okubo describes a Japanese intervention program being used for patients who have prolonged disturbances of conciousness.
The two articles by American authors explore differences in perceived knowledge in civilian and military nurses (Watts et al.)-a potentially growing concern for U.S. healthcare providers in light of the number of returning veterans who have sustained neurologic injuries in recent wars-and a preintervention and postintervention study (Frey & Ramsberger) that examines nurses' implementation of a dysphagia protocol. Again, both of these articles have added to our understanding of symptom management, prevention of secondary complications, and possible health disparities.
The world is a small place today. We care for patients here in the United States who face many of the same health issues as their global counterparts. The authors who publish with us this month are examples of the ways in which nurses and nursing research can advance global healthcare. Kudos.