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Moving the Agenda Forward for Nursing and Midwifery Clinical Research in the Eastern Mediterranean Region: Summit Report

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"Providing healthcare to the large number of people in the midst of war and political upheaval in the Eastern Mediterranean region is especially urgent. This summit is timely in light of the Syrian refugee crisis, one of the worst humanitarian emergencies in decades. Nursing and midwifery leaders will meet to map out how to improve people’s health throughout the region, "Jennifer Dohrn.

Executive Summary

In conjunction with Columbia University School of Nursing and its Office of Global Initiatives, the School of Nursing at the University of Jordan, Faculty of Nursing at Jordan University of Science and Technology, Jordanian Nursing Council, Nursing Department, Faculty of Nursing at Badr University in Cairo, Rafic Hariri School of Nursing, American University of Beirut, King Abdulaziz University College of Nursing, World Health Organization (WHO) Eastern Mediterranean Regional Office (EMRO), Columbia Global Centers | Amman hosted the Research Summit meeting “Moving the Agenda Forward for Nursing and Midwifery Clinical Research in the Eastern Mediterranean Region” on July 18th – 19th, 2016 in Amman, Jordan.

The aim of the Research Summit was to foster regional and international relationships for collaboration and sharing of human resources in order to increase clinical research capacity and to shift the regional agenda to critical research priorities as established by regional clinical nursing and midwifery research experts.

In attendance were 37 participants from 13 of 22 Eastern Mediterranean Regional (EMR) countries and the USA. Other participants included the Executive Vice President for Global Centers and Global Development, Columbia University, Safwan Masri; Dean of the School of Nursing at Columbia University, Bobbie Berkowitz; His Excellency Dr. Mahmoud Al-Sheyyab, Minister of Health, Jordan; and Her Royal Highness Princess Muna Al Hussein, Jordan.

Background

Globally, efforts to strengthen the nursing and midwifery workforce have intensified to improve quality and access to healthcare to achieve Universal Health Coverage.  In order to meet this need, nursing and midwifery research must also increase to provide the solid evidence base essential to providing regionally and culturally appropriate interventions and best care practices.

Columbia University School of Nursing’s Office of Global Initiatives received a three year grant from Columbia University’s Presidential Global Innovation fund, the first year of which was dedicated to establishing a network of clinical nursing and midwifery researchers in Southern and Eastern Africa (August 2014-July 2015).  The template that was developed from this process was introduced in the Eastern Mediterranean Region (EMR) in year two (August 2015-July 2016). The objectives for each year were to: build a network of midwifery and nurse scientists, identify regional gaps in knowledge and priorities for nursing and midwifery research, develop strategies that address these gaps, and initiate a plan to implement these strategies.

To achieve these objectives, Columbia University School of Nursing collaborated with nursing leaders from the Faculty of Nursing at The School of Nursing at the University of Jordan, Faculty of Nursing at Jordan University of Science and Technology, Jordanian Nursing Council, Nursing Department, Faculty of Nursing at Badr University in Cairo, Rafic Hariri School of Nursing, American University of Beirut, King Abdulaziz University College of Nursing, WHO EMRO and Columbia Global Centers | Amman to conduct a scoping review and Delphi survey of regional clinical nursing and midwifery research and priorities, and to convene a research summit in Amman, Jordan.

Research Summit Proceedings

 

Scoping Review and Delphi Survey Results: Clinical nursing and midwifery research priorities for the Eastern Mediterranean Region

The Columbia University School of Nursing team Carolyn Sun conducted a scoping literature review and Delphi survey in which representatives participated prior to the Research Summit.

  • A Scoping Review – a review of the peer-reviewed published literature – revealed 210 indexed publications from 10 countries in the EMR, most frequently focusing on Midwifery/Maternal Child health, Women’s Health, Mental Health and Patient Experience/Patient Satisfaction.
  • A Delphi Survey was conducted among 42 clinical nursing or midwifery research experts. Critical priorities included Chronic Illness, Emergency Preparedness for Disasters, Infection Prevention/Infection control and were well aligned with gaps in the literature identified in the scoping review. Among critical research priorities, there were statistically significant differences between low child low adult mortality and high child/high adult mortality countries for self-management of disease/patient participation in care

 

Identifying Common Regional Gaps in Knowledge and Priorities for Nursing and Midwifery Research and Mentorship at the Clinical Level

Summit participants broke into groups to identify achievable regional clinical research projects to address identified regional research priorities.  Some examples of essential elements to address the regional gaps include:

  • Perspectives of communities in the midst of complex humanitarian crises on quality of healthcare
  • Universal Health Coverage
  • Impact of primary health nurses training on patient outcomes with chronic illnesses
  • Midwifery-led care to reduce maternal mortality
  • Emergency preparedness/disaster management
  • Environmental/infection control
  • International health regulations
  • Tobacco Use
  • Community-based nursing education interventions
  • Role of nursing to prevent and treat communicable and non-communicable diseases
  • Impact and cost of chronic disease in the social, economic and health care system
  • Capacity building to translate research into practice

Regional Barriers and Specific Actions to Address Research Priorities

Each group discussed regional barriers and specific actions to be taken to accomplishing these research priorities in terms of: research skillset and interface with clinicians; support (e.g., funding); political stakeholder buy-in, etc.

 

Some examples of regional barriers are:

  • Lack of joint positions (practice/academia gap - “Pracademia” lacking)
  • Lack of importance of research culture in clinical institution
  • Lack of research competencies
  • Lack of funding for nursing research priorities
  • Shortage of nurses
  • Time - Nurses are already working beyond their scope, not enough time for research
  • Research is not a priority not in countries agenda (National agenda)
  • Lack of mentorship
  • Problems in relation to dissemination of research and lack of venues for publication
  • Attitude of nurses toward clinical research
  • Expectation to do research while working in clinical areas
  • Lack of policies that support clinical research
  • Role and limitation of nurses in clinical research
  • Lack of interest by hospital management in clinical research
  • Political situation and instability
  • Lack of authority (to do or to change practice based on results)

The group discussed and developed action plans to address these barriers.  Some examples are:

  • Build research competencies in all levels of curricula (even in Masters, PhD)
  • Have a research position in clinical settings
  • Create a research culture; within institutions establish rewards to promote nursing research
  • Practice according to evidence
  • Coaching and Mentoring (Culture of research where senior researchers mentor junior researchers; likewise with publications)
  • Develop collaborative networks (Need a national and regional network)
    • Collaborative research on common problem among countries
  • Evaluation and dissemination (Regional journals--peer reviewed)
  • Assessing resources and developing a database
  • Joint appointment between research and clinical work
  • Develop mechanisms for academic and service collaboration
    • Joint appointment between research and clinical work
    • Develop method of incentive or promotion

During the summit, barriers and challenges specific to areas of conflict and migration were also identified across the region.  Participants also presented success stories of how they had pushed a clinical research agenda for nursing and midwifery at policy, regulatory, educational and clinical levels.  The sharing of these models and claiming the victories offered inspiration and concrete ways that could be adapted in other countries and across the region. 

 

Participants in groups also developed and agreed on actionable projects on clinical nursing and midwifery research priorities aligned with the WHO strategic direction and priority that would be achievable in the next year:  (1) a publication to discuss regional success stories, (2) a regional database of clinical research, (3) a study to identify topics that clinicians feel are critical clinical regional research priorities, and (4) a scoping review related to the current regional humanitarian crises. 

Conclusion

Developing a regional action plan for clinical nursing and midwifery research is an essential step in building a solid evidence base for practice and strengthening the profession, a core component of the World Health Organization (WHO) Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020.  The purpose of the “Moving the Agenda Forward for Nursing and Midwifery Clinical Research in the Eastern Mediterranean” Research Summit was to gather influential nurse and midwife scientists and leaders from within the region, develop a nursing and midwifery network to foster research collaboration, solidify clinical nursing and midwifery research priorities, and move the agenda forward by developing a plan for action and strategies to overcome barriers to implementing clinical research in established priority areas.  The Research Summit successfully completed each of these objectives with representation from the majority of countries in the region, with representatives from 13 countries. Regional priorities were developed through the Delphi survey and were confirmed through participation and feedback of attendees as well as the evaluation survey. 

This Research Summit elucidated the importance of considering regional political and social turmoil when producing action plans. Tactics to overcome potential barriers and use existing resources were successfully identified, as well as a strategy going forward with achievable first steps.  For critical research priorities to be successfully implemented into the research agenda will require the continued efforts of each of the participants and well as key collaborators. Through the united efforts of each of the collaborators and participants, nursing and midwifery research in Eastern Mediterranean countries will see increased output, as well as a shift in direction to focus on critical clinical research priorities.