Havana, August 29, 2001

 

 

Preliminary Scientific Project

 

 

Strengthening General Nursing as a Science and Some General Nurses as Scientists to Face the Health Research Prioritized Problems in the Less Healthy Countries and Areas

 

Rodolfo Stusser, MD, Clinical Research Centre, Havana
Marie Farrell, RN, PhD & Vicki George, RN, PhD, Nursing Research Centre, CO sponsored with University of Wisconsin Milwaukee campus Milwaukee, WI

 

Introduction

 

Taking only infant mortality rate and life expectancy at birth as the main indexes of health, of the 210 countries in the world, there are still 172, or 82% of them, with an infant mortality rate of greater than 10 x 1000 life born, and a life expectancy of less than 75 years of age.

 

However, even in the other 38 countries with the best health indexes, there are 12 where great inequalities produce bad indexes in some rural and suburban areas populated by minorities, and there are only 26 countries, with the most equitable and homogeneous health states.

 

The idea of this project has been a result of the friendly scientific exchanges with more than 500 of the best U.S. physicians, nurses, public administrators, natural and political scientists, who represent 21 Initiatives of the People to People Ambassadors Program held in Havana since November, 2000. This project idea arose in our discussions of the Development, Results & New Scenarios of the Health Research System in Cuba.

 

 

Problem

 

There has been great progress in the biomedical and bio-health sciences in the last 150 years. Over the past 50 years, there has been even greater progress in the area of technology.

 

However, in that same half-century, general medicine and epidemiology as sciences have greatly advanced, and in the last 30 years, there has been major development in the behavioural health sciences and in nursing as a science.

 

In the U.S., less than 4% of the clinical physicians do real scientific research at a clinical level -- although 14% report their scientific work. It could be estimated that less than 1% of nurses do their own research in nursing science or participate as scientists with clinical medicine teams. These figures are much smaller in the less healthy countries and areas.

 

However, clinical nurses are three, four, five or more times frequent than the clinical physicians in the health care settings of the poor rural and suburban areas of the less healthy countries. The same occurs in some areas populated by minorities in more healthy countries. 

 

Hypothesis

 

As any other health professional in any health system of the world, the general or family nurses practising alone or with a physician, are health-care professionals with great, untapped scientific research potential.

 

The promotion of general nursing as a science and the provision of scientific research training for the most motivated general nurses would ensure that competent and qualified nurse researchers are prepared to contribute to investigations of urgent health problems in less healthy areas and countries of the world. These contributions would include clinical empirical research and clinical hermeneutical, epidemiological and behavioural research, fields not well approached by the general physicians yet.

 

Objective

 

To strengthen the scientific basis of general nursing as a science and of scientific research training to prepare more general nurse scientists to conduct research investigations in the less healthy countries and areas.

 

Design

 

This project could begin in 2002, with a partnership between Cuban and U.S. centres, with other centres located in Africa and Asia. The project is estimated to conclude in 2005.

 

The operational base would be established firstly at the Clinical Research Centre in Havana, Cuba, and the conceptual head and main partner would initially be based at the Centre for Nursing Research in Milwaukee, WI, USA, and then possibly at other U.S. centres.

 

An International Centre for General Nursing Science and Research could immediately be created in Havana, which will be the normative level for higher studies and investigations, and at the same time two other International Centres created, one in an African country and one in Asia.

 

The International Centre in Havana could function as a reference centre for the Latin American and Caribbean region, and at the same time could co-ordinate the efforts with the centres in Africa and Asia, which could be reference centres for the rest of the countries in their regions.

 

All of the centres could provide appropriate educational courses in nursing research in methodological and logical, clinical empirical, hermeneutical, epidemiological and behavioural sciences, and could create research plans to strengthen general nursing as a science in collaboration with the centres in the U.S. At the same time, these centres could provide nursing research training in the same five areas of research and award Masters and Doctorate degrees in general nursing science.

 

In Cuba, these general nurse scientists would go progressively to the 5 big health provinces to organise the health research plans for the community polyclinics and medical posts of the country and to focus their efforts in their areas of clinical expertise. They would also contribute to the general medicine and public health research with the physicians and other professionals in those areas.

 

In the other countries of the Third World or of the South (Latin America, Asia & Africa), these general nurse scientists could go to the poor rural and suburban areas or to other countries of the region to improve the scientific level of the health community centre teams, many of which do not have physicians yet. In addition, the nurses could implement scientific research studies to increase the level of health of their patient populations.

 

In other developed countries, such as Australia, Italy, Portugal, Spain, U.S., and others, these experiences could be exchanged with the health and nursing departments of the poor rural and suburban health areas.

 

Expected Results

 

This research project would expand the role of nurses, important professionals who have historically been dedicated to health care and education, as scientists in the planning and implementation of scientific investigations of urgent health problems in less healthy countries and areas.

 

In Cuba, this research project would prepare 4% of almost 40,000 general nurses in primary health care to conduct scientific research to improve the quality of patient care and to promote optimal health policy within an optimal health system.

 

In other poor Southern countries, where the nurses are infrequently accompanied by general physicians, this research project would prepare them to scientifically face the great health challenges in their practice.

 

In the countries with a higher quality of health, the research results obtained with this project, conducted in the poorest countries, would help to find an equilibrium between the richest and poorest rural and suburban areas of those countries.

 

Financial Support 

 

This project will be presented to the Forum 5 Market Place of the Global Forum for Health Research on October 9-12, in Geneva, by one of its authors. There will be present around 30 of the major donors of the health research of the world for the southern countries to help reduce the gap 10/90 in health research in the world. We hope to receive the support of some of them. Within them:

 

The Global Forum for Health Research Foundation is supported by the:

Rockefeller Foundation: [email protected]; [email protected],

World Bank: [email protected]; [email protected],

International Development Research Center of Canada: [email protected]; 

Canadian International Development Agency: [email protected]

And the governmental agencies of:

Holland: [email protected]

Norway: [email protected]; [email protected],

Sweden: [email protected]; [email protected]; [email protected]; [email protected]

Switzerland: [email protected]; [email protected]

and by the WHO: [email protected]; [email protected].  

 

Other institutions that could support my project at Forum 5:

USAID: [email protected]

UNAIDS: [email protected]; [email protected]; [email protected]

DANIDA, Denmark: [email protected]

German Foundation for International Development: [email protected]

Deutche Gesellschaft for Technische Zusammenarbeit: [email protected]; [email protected]

 

References

 

COHRED. The ENHR Handbook. The Council for Health Research for Development. Geneva, 2000.

 

GFHR. The 10/90 Reports on Health Research 1999-2000. Global Forum for Health Research, Geneva, 2000.

 

Prochaska JO. Disease management needs new paradigms. J Gen Intern Med 1995;10:472-3.

 

Prochaska JO. Prochasca JM. Helping cure health care systems via changing minds and behaviours. Disease Manag & Health Outcomes 2000;6: In press.

 

Rodríguez F. The Political Economy of Latin American Economic Growth. World Bank’s Global Development Network Research Project. The World Bank, Washington, D.C., 2001.

 

Sen AK. "Health in Development". In Development as Freedom. Alfred Knopf Pub., 1999.

 

Stusser RJ. The Creation of New Family Medicine Research Spaces Project. Plaza Community Polyclinic-Clinical Research Centre, Havana, 1995. (Sent since 1995 to the WHO ACHR & RPS)

www.fortunecity.com/skyscraper/systems/1000/artfam2.html

 

Stusser RJ. A Unified Approach to Medical and Health Scientific Methodologies. Clinical Research Centre-Plaza Community Polyclinic, Havana, 1997. (Contracted by the WHO HQ ACHR & RPS)

www.fortunecity.com/skyscraper/systems/1000/artwho9.html

 

Stusser RJ. Contribution to the World Consultative Process for the World Forecast, Policy & Action Plan in Health Research 2001-2010. Havana, 2000. www.fortunecity.com/skyscraper/systems/1000/contribution.html

 

Stusser RJ. The Unity of Human Being Health Needs a Program of Human Health, Development, Medicine, and Behaviour Projects, to Integrate with the Human Genome Project. Havana 2000. (Presented before the International Conference health research for Development at Bangkok on October 2000)

www.fortunecity.com/skyscraper/systems/1000/integration2.html

 

The Editors. Editorial. Looking Back on the Millennium in Medicine. NEJM 2000;342:42-49.

 

The World Business Council for Sustainable Development. www.wbcsd.ch/aboutus.htm

 

WHO. Investing in Health Research and Development. Report of the AD Hoc Committee on Health Research Relating to Future Intervention Options. World Health Organisation, Geneva, 1996.

 

WHO. A Research Policy Agenda for Science and Technology to Support Global Health Development. Document of the Advisory Committee on Health Research. World Health Organisation, Geneva, 1997.

 

WHO. The World Health Reports from 1995 to 2000. World Health Organization,Geneva, 1995-2000.

 

World Bank. World Development Report 1993. To Invest in Health. World Bank, Washington, D.C., 1993.

 

World Bank. World Development Indicators 2001. Washington DC: International Bank for Reconstruction & Development & The World Bank, Washington, D.C., 2001.