Worldwide, there is a critical need for systems thinking to advance a culture of health (Alliance for Health Policy and Systems Research, 2016). For several decades, the World Health Organization (2010) has promoted a global health agenda. However, leading causes of death across the globe can be described as preventable (i.e., heart and lung diseases, infections) or human induced (i.e., medical errors, road injuries), marginalizing vulnerable people through poor allocation of funds or goods and services such as education and health care (United Nations, 2015). The integration of systems thinking for global health requires discerning how to effectively strengthen systems to prevent disease and to improve health and achieve equitable access for care among people of all cultures and countries.
The basis for systems thinking to advance global health is that all humans are interconnected, regardless of geopolitical boundaries. This premise assumes that human health outcomes are a result of interconnectivity, inferring that human actions affected health across system components. Human actions can improve, sustain, or even diminish health across the global health system.
Focus on a Culture of Health for Nurse Educators
For nursing to deliver on its universal mission to provide a culture of health, nurse educators must recognize ways of integrating systems thinking education for global health. Incorporating systems thinking into nursing education programs in academic, professional development, and continuing education programs provides an opportunity for nurses to increase awareness of how their actions affected health outcomes, shifting health ideology from individual responsibilities toward a consequence of a collective effort. That is, an international culture of health is dependent on nurse educators and their learners to be competent systems thinkers, recognizing that the whole global health system is greater than the sum of its components.
The System Awareness Model (SAM), which includes the progressions of seven phases for teaching systems thinking (Phillips & Stalter, 2016; Phillips, Stalter, Dolansky, & Lopez, 2016), is a guiding framework that nurse educators can use for beginner, intermediate, and advanced systems thinkers. Phases one to three designate beginning-level nurses who need to seek approval to take action and understand the consequences of behavior within the health care system. Phases four and five exemplify intermediate-level nurses who have confidence in understanding how quality and safety affects organizations as a whole. Phases six and seven are represented by nurses who function independently and take leadership roles for quality and safety in health care systems.
Tips on How to Begin to Teach Systems Thinking for Global Health
Systems thinking in nursing education and practice can allow nurses to address the complexity of health systems while improving patient care and outcomes for global health. The Table exhibits teaching tips on how to begin to teach global health using systems thinking, including curricular content and activities. The tips are aligned with the Alliance for Continuing Education in the Health Professions (2013) National Learning Competencies and support goals for professional nursing organizations in academic and service settings (Phillips, & Riner, 2018).
Tips for Using the System Awareness Model (SAM) for Global Health
The use of the SAM for global health provides a strategic approach for nurse educators to infuse systems thinking for global awareness and engagement in nursing or interprofessional education programs and practice (Phillips & Stalter, 2016; Phillips et al., 2016). The model can be used in combination with the Alliance for Continuing Education in the Health Professionals Learning Competencies (2013), global health content, and community-based activities to engage learners in setting the stage for critically needed leadership in health systems worldwide. The next article in this series will offer strategies and tips for integrating global awareness and engagement into clinical practice.
- Alliance for Continuing Education in Health Professions. (2013). National learning competencies: Alliance national learning competencies released by board of directors for interprofessional participation. Retrieved from http://www.acehp.org/p/cm/ld/fid=15
- Alliance for Health Policy and Systems Research. (2016). About us: Bridging the worlds of research and policy. Retrieved from http://www.who.int/alliance-hpsr/about/en/
- Phillips, J.M. & Riner, M.E. (2018). Global health engagement: At home and abroad. The Journal of Continuing Education in Nursing, 49, 109–110. doi:10.3928/00220124-20180219-04 [CrossRef]
- Phillips, J.M. & Stalter, A.M. (2016). Integrating systems thinking into nursing education. The Journal of Continuing Education in Nursing, 47, 395–397. doi:10.3928/00220124-20160817-05 [CrossRef]
- Phillips, J.M., Stalter, A.M., Dolansky, M.A. & Lopez, G.M. (2016). Fostering future leadership in quality and safety in health care through systems thinking. Journal of Professional Nursing, 32, 15–24. doi:10.1016/j.profnurs.2015.06.003 [CrossRef]
- United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development. Retrieved from https://sustainabledevelopment.un.org/post2015/transformingourworld
- World Health Organization. (2010). Framework for interprofessional education and collaborative practice. Retrieved from http://www.who.int/hrh/resources/framework_action/en/
Tips for Using the System Awareness Model (SAM) for Global Health
|SAM Phase||Global Health Content||Learning Activities||Continuing Education in the Health Professions NLC and Other Related Competencies for Academic and Professional Development Programs|
|Phase one: Basic nursing care||Local and global health issues||Invite a guest lecturer with expertise on both local and global trends with international experience or a patient from a culture commonly served by the health care agency: Learners identify and discuss global issues and potential partnerships for global health both at home and abroad.||NLC 4.2: Collaborate with external stakeholder groups and key partners that can help maximize the impact of CEhp activities and interventions.|
|Phase two: System-based awareness||Different national historical, political, and cultural perspectives||A virtual field trip to offices of organizations engaged in global health: Learners work in small groups to identify personal knowledge deficits about global health and report on various cultural perspectives of health issues within and across health care delivery systems.||NLC 7: Engage in self-assessment and lifelong learning by continually assessing individual and CEhp program performance. NLC 8: Engage in systems thinking in CEhp by recognizing that a team of health care professionals are a part of a complex system.|
|Phase three: Clinical reasoning||Challenges for developing countries||Local events or web-based video events about global health challenges: Learners write a reflective paper on clinical reasoning for the global health challenges presented at the events.||NLC 2: Design educational interventions that produce expected results for learners and the organization.|
|Phase four: System-level synthesis||Intercultural issues in professional practice||Role-play: Learners prepare scripts for role-play and debate for intercultural issues related to global challenges for interprofessional practice, as appropriate for understanding the health needs of the global population served by the clinical agency.||NLC 2.1: Implement CEhp activities and interventions to close health care professionals' practice gaps and address underlying learning needs through team-based learning and interprofessional education.|
|Phase five: System-level analysis||International and national laws, and standards professional practice||Media reports: Learners use interactive visual learning adult learning principles to analyze various global laws and standards of practice reported in the media, linking global trends to local practice.||NLC 1: Use evidence-based adult learning principles to improve the performance of health care professionals, the health care team, and the organizations in which they work, to improve patient outcomes.|
|Phase six: Application of system-level awareness||International and national customs to professional practice||Presentations: Learners conduct presentations about individual countries' customs related to global health and apply professional standards of practice to determine effectiveness.||NLC 3.1: Use data to assess and determine the effectiveness of CEhp activities, interventions, and the impact of the overall CEhp program.|
|Phase seven: Leadership in complex health care system||Leadership in systems thinking for global health systems||Data analysis: Learners collect data about disease-specific challenges within nations, then propose leadership interventions to address care within the health system.||NLC 3.2: Use data to evaluate the effectiveness of CEhp activities, interventions, and the influence of the overall CEhp program.|