Nursing Science Has No Boundaries

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• Dr. Barbara Resnick

This summer the Israel Society for Nursing Research in partnership with the Global Network of World Health Organization (WHO) Collaborating Centres for Nursing and Midwifery Development hosted an International Nursing Research conference entitled Facing the Challenge of Health Care Systems in Transition. The meeting was held in the most appropriate melting pot of all cultures and religions, Jerusalem. The local organizing committee included Orly Toren, RN, PhD, the Assistant Director of Nursing for Research and Development at Hadassah Medical Organization, Jerusalem, Israel; Freda Dekeizer, RN, PhD, Head of Masters Program, Henreitta Szold Hadassah Hebrew University School of Nursing, Israel; Michal Granot, RN, PhD, Head, Department of Nursing, Faculty of Social Welfare and Health Studies, University of Haifa, Israel; Hana Kertzman, RN, PhD, Nursing Research Unit, Nursing Division, Sheba Medical Center, Israel; and Ilana Margalith, RN, PhD, MHA, Director, Dina Academic School of Nursing, Clalit Health Services & Tel Aviv University, Department of Nursing, Recanati School for Community Health Professions, Ben-Gurion University of the Negev, Israel. In addition, there was an international advisory group including nurse researchers from the United States, Canada, Switzerland, Korea, Taiwan, Japan, Denmark, and the United Kingdom. The attendees, 400 in number, came from 38 countries and covered a wide span of clinical and nursing research expertise. Moreover, attendees included well-recognized leaders in nursing from the United States, including Drs. Barbara Heller, Barbara Medoff-Cooper, Afaf Meleis, Joyce Fitzpatrick, and Nancy Falchuk, the current president of the National Hadassah Woman's Organization. I had the opportunity to participate in this meeting and wanted to share my experience and what I learned as it relates to aging. Having had the opportunity to develop the master's program in advanced practice nursing, the gerontology track, for Hadassah Hebrew University I was familiar with some of the issues around aging in Israel because I had visited many sites of care for older adults on previous trips. The biggest differences that I perceive between the United States and some other countries include attitudes about institutionalization and aging, end-of-life care, cultural sensitivity, and coverage of services and National Health Insurance. I may be a bit optimistic and bizarre in that I have spent most of life in nursing homes and believe they can be wonderful, cozy places! Nursing homes, I believe, are places full of wonderful historians and tidbits of lives saved in the most special of pictures and tchotske (the Yiddish word for generally useless but lovely things we place around us!). Overall, I believe we are a little more positive about institutional living in the United States than other countries tend to be. This is even more so with our ever-growing assisted living industry. In some other countries, it is assumed that care is not optimal and bad things happen in these facilities.

End-of-life issues in other countries were also quite different in terms of rights of the patient versus the decision of the providers. No need to tell you which country is most driven, at least on paper, by patient rights and self-determination! In Israel, for example, although you can state that you do not want a feeding tube inserted, once this treatment has been initiated, you cannot have it removed. Along with end-of-life issues is the increased expertise in cultural sensitivity that has always impressed me in the Middle East and was likewise noted in what I heard from other participating countries. Given the boundaries and borders among some of these countries there are often mixed cultures, tribal differences, and needs and requests of visitors and families that are in conflict with facility rules and regulations. The nurses in these countries seem to be acutely aware and accepting of these differences and adjust their care as appropriate. We have much to learn in terms of true culture competence and acceptance. Moreover, this is all done in the face of political differences.

The issue of coverage and who pays for what is also quite different across nations. We do not have National Health Insurance, and thus our systems of care vary. Certainly we heard discussions about the advantages and disadvantages of National Health Insurance, and yet again we have much to learn from other countries. If we can listen and learn from them, we have an opportunity to benefit from the mistakes of other countries. In so doing, we will learn how to address and manage some of the issues that come up in a National Health Care system such as allocation of services.

Although the majority of the presentations were not focused on older adults, I am glad to say that several symposiums were particularly dedicated to research with older individuals across a variety of settings. Examples of some of these are shown in Table 1. In addition, there were presentations that addressed problems common to us all: falls, incontinence, dementia, delirium, urinary track infections, methicillin-resistant Staphylococcus aureus. Moreover, our approaches to these problems were generally consistent at least per site of service.

Table 1. Examples of Aging Presentations

The key notes likewise were not aging-specific but often at least addressed or alluded to aging issues. Dr. Meleis, for example, in her wonderful presentation on women's issues, identified the economic challenges some older women encounter and the plight of these women in their role as caregivers.

So, join me in acknowledging this work and saying thanks to the Israel Society for Nursing Research in partnership with the Global Network of WHO Collaborating Centres for Nursing and Midwifery Development for taking this on and making it happen. The success of the program has stimulated them to begin planning for future meetings and continue their agenda of bringing together the world in the name of nursing research. I encourage you all to participate in these future meetings for the experience of learning and seeing how older adults are cared for in other nations. I will keep you posted on future plans!