Looking Back, Looking Forward

Barbara Peterson Sinclair, MN, RNC, OGNP, FAAN,

is editor of AWHONN Lifelines and the director

of the Institute of Nursing, as well as a professor of

rrursing at California State University, Los Angeles, CA.

ecently, I had the opportunity to attend a meeting on nursing leadership in Latin Ainerica and the Caribbean. It was most interesting to hear about educational R programs described within the context of a country’s existing health care deliv-

ery infrastructure, as well as the social and scientific underpinnings of nursing itself. The descriptions varied greatly-from university baccalaureate programs to poorly function- ing, hospital-dominated diploma programs. All were reminiscent of nursing’s education- al history in the U.S. Some countries required the baccalaureate for entry level as a nurse clinician while others had no licensure or standardization. The health care described also varied greatly. I was greatly impressed with what I heard, and with the dedication of the leaders who gave presentations.

The conference brought back many memories. Years ago, I served as a director of training programs for volunteers serving with the Peace Corps. Several of those pro- grams involved nursing activities or had nurses within the training group. As a result of my work with the Peace Corps, I had an overview of health care in Latin America. As I listened to the speakers at the conference, those memories rushed back to me, as well as the realization that, thankfully, much had changed. Now, as then, it seems appropriate that the focus was centered on raising nursing consciousness in an ever-shrinking world.

From country to country, there remained great divergences in terms of economic, political, and organizational infrastructure. Differences within health care delivery, and nursing itself, also were evident. Even so, the commonalities among the nursing leaders in attendance at this conference were striking. Each one was concerned about the health of hidher people and how nursing could contribute. They wanted the best possible sys- tems for educating nurses, including scientific underpinnings, standardized content, and quality outcome measures. They were aware that nurses had to be recognized as profes- sionals and peers to those in other health disciplines-especially physicians-and able to exert influence in policy at all levels. They showed interest in using technology to enhance learning and service. They recognized the need for all countries within Latin America and the Caribbean to have licensure requirements for entry into practice. They cried out for collaboration with nurses in neighboring countries and in the U.S.

Although 1 heard many philosophical similarities, there were also vast differences in the ways in which nursing was practiced. Lydia Zamora, director of the School of Nursing in Polytechnical University Nicaragua, lamented the problems faced by health care in her relatively poor country. She stressed the need for a method to provide infor- mation, especially in the sciences and technology, and recommended using media as a basis for an information center. She was instrumental in recently initiating the only nursing journal in Nicaragua.

ing requires a bachelor’s degree. Ute Lange, director of the School of Nursing at Catholic University of Chile, spoke of the need for nursing to strengthen its research base, increase management skills, expand programs for graduate degrees, support an influential professional association, and maintain a permanent and visible presence in the mass media.

Two leaders from Mexico spoke of the variation of nursing expertise and available health care in their country. Ester Gallegos, University of Nuevo Leon, Monterey, overviewed a cogent curriculum with strong clinical application of evidence-based infor- mation. Susanna Salas, director of the National University School of Nursing and Obstetrics in Mexico City, whose presence was apparent throughout the conference, spoke of nurses needing to initiate standardized education and licensing, to increase salary and status, to encourage willingness to provide care outside of the hospital (most nurses are interested in working only in acute care to the detriment of community set- tings), to instill concepts of health promotion and disease prevention, to provide health information for the lay public, and to upgrade quality and standardization of education-

At the other end of the spectrum was Chile, where entry level requirements for nurs-

February/March 1999 A W H O N N L i f e l i n e s 9