The "global village" term has become a perspective used by many individuals and organizations concerned with the survival of human society and its institutions. Clearly, traditional concerns, centered on community and nation, have given way to more comprehensive, holistic views of systemic balance. Global responsibilities become more pressing in a world that is highly mobile, has mass communication capability, sees jobs disappear (robotics), and lives with a deemphasis on traditional family structures (increasing single parent homes headed by men or women). Health care professionals must learn to identify and cope with these varying needs. This article describes an alternative to studying communities that takes into account the cultural pluralism inherent in a shrinking global village.
Leininger (1986, p. 11) states". . . nurses are interacting more than ever before with people from many cultures in the world and need to understand care practices." Thus nursing educators have responsibility to identify, plan, integrate, and make more visible cultural components of caring in nursing curricula at all educational levels. This charge is consistent with Gosnell's (1985, p. 108) assertion that "wellprepared nurses educated in the international area with knowledge and skill in the use of the nursing process as the framework for designing and implementing primary health care represents possibly the greatest resource for accomplishing health care for all by the year 2000."
Community health nursing faculty decided to provide an opportunity to acknowledge the importance of sensitizing students to a pluralistic society requiring culture-based nursing care. Additionally, we hoped to challenge them to think of their own "community" as a relatively small microcosm of the global village and view their professional discipline as having potential significant impact on the world's health.
During their community health rotation, students were offered the option of studying a country rather that the usual suburb or social planning area. Since collecting demographic data, reporting vital statistics, interviewing health care professionals, and studying cultural influences on health were still possible and expected, no change in the basic guidelines and learning objectives of the resulting paper were needed. Students moved in easily and collected sufficient information to demonstrate understanding of a country's health status and how community health nurses care for their people.
Two students studying Japan contacted a faculty member from a nearby university who had published articles on nursing care in their' country. The daughter of a student's community health family was pursuing her doctorate in anthropology by studying Iceland - and the student had chosen to study Iceland, too. Other countries studied were England, Nicaragua, New Zealand, Australia, Transkei (the largest tribal homeland in the Republic of South Africa), Bhopal, Uganda, and Tobago.
The study on Nicaragua vividly exemplified how war influenced a country's basic human rights. Many Nicaraguans became amputees from land mines. Students faced having to reconcile their feelings of anger about the political situation and acknowledge its reality, while devising nursing interventions aimed at dealing with the results. This type of political/ethical dilemma was Usted as one of seven major areas of concerns found by Forni (1986) while studying international nursing consultants.
Students studying Japan discovered how climate or terrain can affect mortality rates. For example, Japan has limited land available for cattle grazing; consequently, their diet relies heavily on smoked seafood, which contains cancercausing agents. Japan has the highest gastric cancer rate in the world (Luckman & Sorensen, 1980). Furthermore, the students noted that as Japanese emigrate to the United States, their cancer mortality rate declines and heart disease mortality rate increases with change in diet.
Methods of health care delivery were found to be different in various countries. Some countries were organized into smaller states each with its own delivery system. Countries consisting of many islands (e.g., the Philippines and Japan), precluded availability of comparable health care on each island. Still, island countries existing on one land area whose population lived primarily on the coast, presented similar problems. For example, availability of comparable care was absent because only one or two large cities had the "best" hospitals.
In terms of actual delivery of community health nursing services, students found that nurses in Nicaragua often relied upon teaching basic first aid to residents of outlying areas and only visiting periodically while being located elsewhere. Also, women's status in some countries considerably affected the role of nurses. For example, cultural aspects often influenced how much education women were permitted to receive, and even if educated in nursing, what responsibilities could be assumed in terms of health care. Thus, Japanese nurses were limited in terms of how much time could be spent away from their families during the day. Therefore, visiting patients far away from their own homes became a significant barrier to providing nursing care. In Bhopal and Uganda, students found an overwhelming percentage of people living in poverty who did not have access to even basic kinds of health care such as immunizations.
Our pilot project yielded considerable acclaim from not only faculty but students as well. To observe their enthusiasm and joy when they researched and found what they were looking for was especially rewarding to faculty. Those students who chose countries appeared eager to examine nursing from a new perspective. Some had visited the country they chose; others indicated that they would like to visit the country having completed the study. Our experience suggests keeping the country as an alternative option for community studies.
This alternative does what the General Conference of UNESCO recommended on November 19, 1974:
Post-secondary education establishments should carry out programmes of international education as part of their broadened function in lifelong education and. . . enable students to understand their role and the role of their professions in developing their society, furthering international cooperation, maintaining and developing peace, and assume their role actively as early as possible (Graves, Dunlop, TorneyPurta, 1984, p. 240).
It would appear that educators should become responsible for planning learning activities designed to increase understanding and cooperation as related to human rights and fundamental freedoms from a global perspective. The nursing profession must be proactive and continue to meet the needs of cosmopolitan communities within which it exists.
- Forni, P. (1986). Health care delivery in Sweden and Finland: A challenge to the American. Journal of Professional Nursing, 2, 234-245.
- Gosnell, D. (1985). The international implica' tions of nursing education and practice. International Nursing Review, 32(4), 105-108.
- Graves, J., Dunlop, 0., & Torney-Purta, J. (Eds. I (1989). Teaching for international understanding, peace, and human rights. New York, NY: UNESCO.
- Leininger, M. (1986). Transcultural nursing: Quo vadie (where goeth the field)? In M. Leininger (Ed.), Selected papers from the Eleventh Annual Transcultural Nursing Society (pp. 1-15). Memphis, TN: Transcultural Nursing Society.
- Luckman, J. & Sorensen, K. (1980). Medicalsurgical nursing. Philadelphia: W.B. Saunders.