Indian Nurses Research Articles

“WE ARE THE INTERNATIONAL NURSES”: AN EXPLORATION OF INTERNATIONALLY QUALIFIED NURSES’ EXPERIENCES OF TRANSITIONING TO NEW ZEALAND AND WORKING IN AGED CARE

IntroductionWorldwide, a critical nursing shortage is predicted to occur within the next five years. Workforce projections from India, the European Union (EU), and the United States (US) collectively demonstrate approximately four million additional nurses will be required to care for increasingly aged populations (American Nurses Association, 2014; Royal College of Nursing, 2015; Senior, 2010). Traditionally, Western nursing shortages have been managed by recruiting Internationally Qualified Nurses (IQNs), who remain a significant source of labour in Australia, New Zealand (NZ), the United Kingdom (UK), and the US (Aiken, 2007; Brush, Sochalski, & Berger, 2004; Buchan, 2006; Li, Nie, & Lie, 2014). Many of these nurses are employed from India and the Philippines; a competitive process subject to influence from countries such as the US, where small changes in supply, demand, and policy have a substantial impact on the global nursing resource (Aiken, 2007; Aiken, Buchan, Sochalski, Nichols, & Powell, 2004; Aitken, 2006; Ball, 2004; Brush & Sochalski, 2007; Lorenzo, Galvez-Tan, Icamina, & Javier, 2007). Despite this market existing for over 60 years, experiences of IQNs working abroad are not always positive (Bland & Woodbridge, 2011; Daniel, Chamberlain, & Gordon, 2001; DiCicco-Bloom, 2004; Lorenzo et al., 2007). These experiences require consideration, as demand for international nurse labour is expected to continue - especially in smaller countries, such as NZ, where domestic capacity for workforce growth is limited (Nana, Stokes, Molano, & Dixon, 2013).BackgroundInternationally qualified nurses, or nurses who gained their first nursing qualification abroad (Nursing Council of New Zealand, 2013a), are a significant and important section of New Zealand's Registered Nurse (RN) workforce. Since 2010, IQNs have represented approximately 25 percent of this workforce, and in the 2014 to 2015 registration period, 40 percent of newly registered RNs were internationally qualified (Nana et al., 2013; Nursing Council of New Zealand, 2011; 2015). Over time, local IQN profiles have grown to include mostly nurses from India and the Philippines (Nana et al., 2013; Nursing Council of New Zealand, 2013b; 2015), and IQNs have become vital to aged care; comprising about 40 percent of RNs in this setting (Grant Thornton New Zealand Ltd., 2010; Nursing Council of New Zealand, 2013c). This contribution is expected to remain important as New Zealand's ability to increase domestically trained nurses remains constrained while a projected workforce shortage looms (Nana et al., 2013).Internationally, substantial literature explores experiences of IQNs from a range of countries that gain employment abroad (Alexis & Shillingford, 2012; Nichols & Campbell, 2010; Okougha & Tilki, 2010; Smith, Fisher, & Mercer, 2011; Wheeler, Foster, & Hepburn, 2013). Most of this research originates from Australia, Canada, the UK, and the US, and is rarely exclusive to Filipino and Indian nurses, yet often includes participants from these countries. The findings from the literature would likely indicate IQNs overcome a series of challenges as they enter nursing positions overseas. Common issues cited relate to: language and communication (Brunero, Smith, & Bates, 2008; Hawthorne, 2001; Konno, 2006; Magnusdottir, 2005; Takeno, 2010); cultural displacement and/or socio-cultural differences, including discrimination from patients, colleagues, and employers (Alexis, Vydelingum, & Robbins, 2007; Kawi & Xu, 2009; Tregunno, Peters, Campbell, & Gordon, 2009); credentialling (Allan & Larsen, 2003; Sochan & Singh, 2007); and adjusting to new health contexts (Xu, 2007). Despite this plethora of studies, no international publications exclusively investigate experiences in aged care, and very few exclusively explore experiences of Filipino and Indian IQNs. While limited, the few international publications regarding the specific experiences of Filipino and Indian IQNs report that: Filipino and Indian nurses migrate for social and professional reasons - not just economic incentive (Alonso-Garbayo & Maben, 2009; Daniel et al. …

Nursing & Empire: Gendered Labor and Migration from India to the United States by Sujani Reddy

Reviewed by: Nursing & Empire: Gendered Labor and Migration from India to the United States by Sujani Reddy Asha Nadkarni (bio) Nursing & Empire: Gendered Labor and Migration from India to the United States, by Sujani Reddy. Chapel Hill: University of North Carolina Press, 2015. 290 pp. $32.95 paper. ISBN: 978-1-4696-2507-2. If “Indian physicians were perhaps the consummate representatives of both brain drain and model minority discourse” (14), what do Indian nurses represent? Sujani Reddy’s masterful new monograph, Nursing & Empire, answers this question through eight rich chapters that chart the global field of nursing, nursing migration, and its imbrication in the shifting terrain of Anglo-American imperialism. Examining how Indian nurses have been viewed as “women on the loose” (associated with low morals and impurity) and “women in the lead” (due to female-led migration patterns), Reddy explodes many of the classed and gendered assumptions we have about South Asian migration to the United States. One of Nursing & Empire’s most notable aspects is how it consistently challenges an American exceptionalist frame. By carefully charting Indian [End Page 433] nurse migration in relation to U.S. imperial incursions into the subcontinent, the history of the professionalization (and according racialization) of nursing, the global division of nursing labor, and the larger historical and economic factors that act upon migrants, Reddy tells a story that necessarily exceeds U.S. boundaries. She furthermore rejects U.S. exceptionalism by resisting what Chandra Mohanty calls “third world difference” as an explanatory model. That is, by tracing the concurrent and linked development of nursing in the United States and India, Reddy questions “cultural” explanations for the stigmatization of nursing labor in either site. In sketching these larger contexts, moreover, Reddy contests what she calls a “model minority exceptionalism” that figures the United States as “the ultimate horizon for decolonization and desegregation” (14). Instead, she theorizes Indian migration in relation to the United States as an “imperial nation,” a formulation she uses to reference U.S. settler colonial projects at home and imperial adventures abroad. Indeed, the care with which Reddy outlines the contours of U.S. empire as it developed in relation to British imperialism and Indian nationalism is one of this book’s many strengths. Another strength is Nursing & Empire’s methodology, as Reddy tells the story of Indian nursing migration in a variety of different ways. Not only does she excavate historical archives, she interjects nurses’ own stories and voices throughout, particularly in the last two chapters. These stories serve to both animate and complicate the historical and theoretical perspectives elaborated elsewhere. But equally striking is the careful way that Reddy registers various silences; silences of the archive, silences of nurses who for whatever reason did not or could not speak to her. In this sense, Reddy follows a subalternist reading practice in which, as she beautifully states in her epilogue, she recognizes “silence as a chosen strategy, one not always reducible to the act of being silenced” (211). The eight body chapters are arranged according to focus, with the first two concentrating on Protestant medical missionaries in India. Chapter 1 charts how women’s medical missionary work dovetailed with Indian nationalist grapplings with the “woman’s question” and issues of social reform. The second chapter creatively mines archives to investigate the precarious place of Indian nurses within the development of the global division of nursing labor. Its wonderful readings show us how, in India as well as in the United States, the stigmatization of one kind of nursing labor enabled the rise of another. Chapters 3, 4, and 5 look at the ways the Rockefeller Foundation takes over the work of medical missionaries. Chapter 3 draws important connections between the development of Jim and Jane Crow in the U.S. South and the global professionalization of nursing, charting how the Rockefeller Foundation was a part of a U.S. strategy of “open door imperialism.” Chapter 4 traces [End Page 434] the development of what Reddy calls “open door nursing,” namely, a system of Rockefeller Foundation fellowships that produced a global coterie of nurses trained in U.S. methods. This then became a means of creating the United States as...

Musculoskeletal Disorders and Perceived Work Demands among Female Nurses at a Tertiary Care Hospital in India.

Introduction. Musculoskeletal disorders (MSD) are common among nurses and can affect patient outcomes. There is a dearth of literature on MSD among Indian nurses. The study objective was to measure prevalence of MSD and their association with perceived work demands and sociodemographic variables among female nurses at a tertiary care hospital in rural India. Methods. A cross-sectional study was undertaken in 2013 through interviewer administered questionnaires which comprised three parts: sociodemographic data, modified Nordic questionnaire, and perceived physical and psychological work demands. Results. 296 nurses with a mean age of 30.4 years participated. Prevalence of any MSD in the last seven days was 60.5% with low back pain being the most common and elbow pain the least common. Occurrence of any MSD was associated with age, number of children, working hours at home, BMI, and total work experience. High perceived physical demands score was associated with lower back (OR: 3.06) and knee pain (OR: 7.73). Conclusion. Prevalence of MSD was high and occurrence of lower back and knee MSD was associated with perceived physical demands. This information should be used as a benchmark and guiding tool for designing work place interventions to improve working conditions and health of nurses.

Indian nurses' perceptions of and attitudes towards organ donation

Nurses play a significant role in identifying and securing potential organ donors in the clinical environment. Research among Indian nurses related to organ donation is sparse. The present study aimed to investigate nurses' attitudes towards organ donation. A cross-sectional descriptive survey was carried out among nurses (n=184) at a tertiary care centre. Data were collected through a self-report questionnaire. A majority (81%) of the respondents were ‘willing to sign the card’ for organ donation; however, only 3.8% (n=7) of them actually ‘signed the organ donation card’. There were significant associations found between intentions to sign the organ donation card and gender (x2=5.852; p<0.054), religion (x2=40.175; p<0.000), and experience caring for brain-dead patients (x2=22.790; p<0.001). The researchers strongly suggest continuing education for nurses to enhance skills and knowledge, as well as sensitivity to cultural, ethical, social, and religious issues, and advocacy in the area of organ donation. Furthermore, nurse administrators must take the initiative to develop guidelines clarifying the role of nurses in the organ donation and transplantation process to promote organ donation and improve rates.

Indian ICU nurses' perceptions of and attitudes towards organ donation.

Nurses play a significant role in identifying and securing potential organ donors in the clinical environment. Research among Indian nurses related to organ donation is sparse. The present study aimed to investigate nurses' attitudes towards organ donation. A cross-sectional descriptive survey was carried out among nurses (n=184) at a tertiary care centre. Data were collected through self-report questionnaire. A majority (81%) of the respondents were 'willing to sign the card' for organ donation; however, only 3.8% (n=7) of them actually 'signed the organ donation card'. There were significant associations found between intentions to sign the organ donation card and gender (x2=5.852; p<0.054), religion (x2=40.175; p<0.000), and experience caring for brain-dead patients (x2=22.790; p<0.001). The researchers strongly suggest continuing education for nurses to enhance skills and knowledge, as well as sensitivity to cultural, ethical, social, and religious issues, and advocacy in the area of organ donation. Furthermore, nurse administrators must take the initiative to develop guidelines clarifying the role of nurses in the organ donation and transplantation process to promote organ donation and improve rates.

Role of Burnout in the Relationship between Job Demands and Job Outcomes among Indian Nurses

Burnout is a severe psychological strain that occurs in response to prolonged exposure to stress at work and has adverse individual and organizational consequences. It has reached a critical stage among today's workforce with a high occurrence among human service professionals. Although avid studies on burnout have been made worldwide, the same among the nursing profession still needs more attention. The goals of this study are to understand how various nursing specific job demands have impact on nurses� burnout and to see if burnout has a role in their job commitment and intentions to turnover. Through a structured questionnaire, data were collected from 862 nurses working in 24 private and public hospitals across six cities in India. Descriptive statistics, confirmatory factor analyses, path analyses, and mediator analyses tested the hypotheses. The results reveal the following: Workplace demands such as role conflict, role ambiguity, work load, work-home conflict, shift work attitudes, job complexity, physical environment, and organizational politics are positively associated with emotional exhaustion. While role ambiguity, organizational politics, and job complexity are important predictors of depersonalization, role ambiguity and organizational politics have lowered personal accomplishment. While perception of organizational politics is found to be the most important predictor of emotional exhaustion and depersonalization, role ambiguity is the most important predictor of reduced personal accomplishment. While emotional exhaustion and reduced personal accomplishment are responsible for decreased commitment, emotional exhaustion and depersonalization initiate the intentions to turnover. Finding of the study provided empirical evidence that tri-components of burnout mediate the relationships between job demand and outcome variables. Emotional exhaustion is the most important mediator between job demand and outcome variables. In the context of the nursing profession, the above-mentioned job demands can be minimized. Also, early screening for burnout components can help in mitigating their adverse impacts on commitment and turnover of nurses through targeted strategies.

PO-0648 Norwegian – Indian Collaboration Project To Improve Newborn Care

Background Norway India Partnership Initiative (NIPI) is cooperation between the Governments of Norway and India, and has a particular focus on improving newborn health by training health personnel. A former exchange program in Kolkata (2011–2013) reports reduction in neonatal mortality rate and improved newborn care. Aim This project aims to improve the care of sick and premature newborns, in line with international standards, in Rajasthan, India. The exchange of health personnel in north-south collaboration can reduce neonatal morbidity and mortality by improving basic neonatal nursing. Focus areas are KMC, nutrition and breastfeeding, developmental care, hygiene and pain management. The project intends to increase multicultural understanding within newborn health care. Method Exchange of 4 indian and 2 norwegian nurses/year for a 3 year period. Norwegian nurses will stay in JK Lone Hospital, Jaipur for 12 months and indian nurses in Oslo university hospital for 6 months. Focus for Norwegian nurses in Jaipur will be teaching doctors and nurses in evidence based newborn care through bedside training in the NICU. Interact with the indian team of doctors, nurses,and family of the sick newborn, in order to develop an understanding of the culture and society they are working in. Focus for Indian nurses in Oslo will be hands on bedside training in the NICU under surveillance of experienced personell. In depth knowledge of the focus areas. All participants are to convey their experience to their home partners after homecoming through teaching, demonstrations and reports. The goal is sustainable practice change according to evidence based care.

Risk Factors for Coronary Heart Disease Among Asian Indians Living in Australia

The aim of this study was to assess the coronary heart disease risk factors in the Asian Indian community living in a large city in Australia. A cross-sectional survey was conducted at the Australia India Friendship Fair in 2010. All people of Asian Indian descent who attended the Fair and visited the health promotion stall were eligible to participate in the study if they self-identified as of Asian Indian origin, were aged between 18 and 80 years, and were able to speak English. Blood pressure, blood glucose, waist circumference, height, and weight were measured by a health professional. Smoking, cholesterol levels, and physical activity status were obtained through self-reports. Data were analyzed for 169 participants. More than a third of the participants under the age of 65 years had high blood pressure. Prevalence of diabetes (16%) and obesity (61%) was significantly higher compared with the national average. Ten women identified themselves as smokers. Physical activity patterns were similar to that of the wider Australian population. The study has provided a platform for raising awareness among nurses and promoting advocacy on the cardiovascular risk among Asian Indians. Strategies involving Asian Indian nurses and other Asian Indian health professionals as well as support from the private and public sectors can assist in the reduction of the coronary heart disease risk factors among this extremely susceptible population.

Work-related Musculoskeletal Disorders in Indian Nurses: A Cross-sectional Study

It is established that nurses suffer from varying degrees of musculoskeletal disorders (MSD) in different regions of the body which results in frequent loss of work days. There are about 1.5 million registered nurses employed in health sector in India. Out of these, a majority are taking care of the health of 1.2 million strong Indian military personnel. However the prevalence of MSD in these nurses has not yet been explored till date. A detailed study of the MSD occurring in Indian nurses (n=627) working in Indian Army was carried out using standard Nordic Musculoskeletal Questionnaire and Borg’s scale of Rating of Perceived Exertion. The participants completed the Questionnaires in presence of the authors without disclosing their identity. The data collected was tabulated and analyzed for aspects like frequencies of MSD, body parts affected, normal activities prevented, duration of pain in various regions of the body, doctor visited, duty changed, etc. One year prevalence of low back (LB) pain was found to be maximum (67.0%) followed by pain in neck (47.4%) and ankles/feet (36.0%). Musculoskeletal disorders were found to be more widespread among the nurses in middle age group (31-40 years) closely followed by youngest group (21-25 years). Among the subjects studied, married subjects were found to face more problems due to upper body MSD and single nurses suffered more from lower body MSD. The study concluded that nurses in India were suffering from high level of MSD which could be comparable with international studies with younger age group being at higher risk. This study has highlighted the health status of care givers in Indian Armed Forces and indicates the need to develop preventive strategies to minimise the health risk of these personnel. This would enhance the performance of our nurses and improve the quality of health care services.

Un métier pour partir : la migration des infirmières kéralaises (Inde du Sud)

Depuis la fin des ann&#233;es&#160;1970, un grand nombre d&#8217;infirmi&#232;res indiennes travaillent dans les pays du Golfe. La plupart d&#8217;entre elles viennent du K&#233;rala, un petit &#201;tat du Sud. Apr&#232;s avoir explicit&#233; les strat&#233;gies &#233;labor&#233;es peu &#224; peu par ces migrantes et leurs familles, cet article s&#8217;attache &#224; analyser les particularit&#233;s d&#8217;une migration dans le Golfe, par rapport une migration dans les pays occidentaux, autre opportunit&#233; migratoire pour les infirmi&#232;res indiennes. Il aborde enfin la question de l&#8217;&#233;volution du statut de ces migrantes dans leur pays, en tant que professionnelles et en tant que femmes.

A suitable job?: A qualitative study of becoming a nurse in the context of a globalizing profession in India

BackgroundResearch on Indian nurses has focused on their participation as global migrant workers for whom opportunities abroad act as an incentive for many to migrate overseas. However, little is known about the careers of Indian nurses, or the impact of a globalized health care market on nurses who remain and on the profession itself in India. ObjectivesTo explore nurses’ accounts of entry into nursing in the context of the globalisation of the nursing profession in India, and the salience of ‘migration’ for nurses’ individual careers. DesignQualitative interview study (n=56). Settings and participantsThe study drew on interviews with 56 nurses from six sites in Bangalore, India. These included two government hospitals, two private hospitals, a Christian mission hospital, a private outpatient clinic and two private nursing colleges. Participants were selected purposively to include nurses from Christian and Hindu backgrounds, a range of home States, ages and seniority and to deliberately over-recruit (rare) male nurses. MethodsInterviews covered how and why nurses entered nursing, their training and career paths to date, plans for the future, their experiences of providing nursing care and attitudes towards migration. Data analysis drew on grounded theory methods. ResultsNursing is traditionally seen as a viable career particularly for women from Christian communities in India, where it has created inter-generational ‘nurse families’. In a globalizing India, nursing is becoming a job ‘with prospects’ transcending traditional caste, class and gender boundaries. Almost all nurses interviewed who intended seeking overseas employment envisaged migration as a short term option to satisfy career objectives – increased knowledge, skills and economic rewards – that could result in long-term professional and social status gains ‘back home’ in India. For others, migration was not part of their career plan: yet the increases in status that migration possibilities had brought were crucial to framing nursing as a ‘suitable job’ for a growing number of entrants. ConclusionsThe possibility of migration has facilitated collective social mobility for Indian nurses. Migration possibilities were important not only for those who migrate, but for improving the status of nursing in general in India, making it a more attractive career option for a growing range of recruits.

Knowledge and awareness of dental trauma among Indian nurses

AimThe aim of the study was to assess the knowledge and awareness regarding the emergency management of dental traumatic injuries among the present and prospective nurses of KLE Institute of Nursing Sciences and Hospital, Belgaum, India. MethodologyA 15-item questionnaire regarding the clinical situation of tooth avulsion inquiring nurses’ knowledge was administered to 308 nursing professionals, includes nursing interns and staff nurses. ResultsOut of 300 respondents, only 2.2% knew about the storage medium used for storing avulsed tooth. Majority of the participants accepted that they had no knowledge regarding the emergency management of dental traumatic injuries and also that no training had been given to them about this. ConclusionAs nurses stand on the front lines of responding to emergency, it is essential that they also possess adequate knowledge about dental traumatic injuries and its emergency management. As the findings of our study revealed poor knowledge about emergency management of dental trauma, it is concluded that there is a need for mass educational campaign to broaden the nurses’ knowledge about this.

Low back pain among female nurses in Yemen

This study aimed to investigate the prevalence of Low Back Pain (LBP) among female nursing staff and explore the potential risk factors associated with LBP. An analytical cross-sectional study was conducted on randomly selected female nurses using payroll as a sampling frame in all public hospitals in Sana'a City, Yemen. Data was collected through face-to-face interview using a structured, pre-coded questionnaire that was available in Arabic and English. Weight and height of the nurses were measured using weight and height scales and body mass index was calculated. Multiple logistic regression was used to identify the factors associated with LBP. Out of 696 female nurses selected, 687 (98.7%) responded. The life-time, the 12-month and one-week prevalence rates of LBP among female nurses were 512 (74.5%; 95% CI: 71.1-77.7%), 411 (59.8%; 95% CI: 56.0-63.5%) and 249 (36.2%; 95% CI: 32.6-39.9%), respectively. The prevalence was significantly lower in Indian nurses compared to other nurses. Three out of every 10 nurses with LBP had sick leave because of LBP in the last 12 months. Factors that showed significant association with LBP among nursing staff in the multivariate analysis were age, nationality, menstrual disorders and stress level at work. LBP is common among female nurses in Yemen. The role of menstrual disorders in developing LBP among female nurses seems to be important. Although sharing the same working conditions, Indian nurses were less likely to report LBP, which highlight the importance of cultural differences in willingness to report LBP.

Transnational masculinity: Indian nurses’ husbands in Ireland

&lt;p class="resume"&gt;&lt;span xml:lang="en" lang="en"&gt;I have met many young Christian men in Kerala whose ambition, like Philip’s, was to migrate by marrying a nurse. If the matrimonial market used to be harsh on nurses a few decades ago, the picture has changed and nurses are now on high demand. The stigma attached to this profession in India has certainly not completely vanished, but in Kerala, nursing has become a real chance to enhance one’s career opportunities. While visiting matrimonial websites (See for instance keralamatrimonials.com, keralamatrimony.com or shaadi.com), it is easy to check how much they are looked after by prospective grooms. However despised may the commonly named USA nurses be by the highest class/casts (George, 2005), they tend to represent the key to the Western dream for loads of young men belonging to the Christian Malayali middle class who don’t envisage the possibility of a bright future in their own country.&lt;/span&gt;&lt;/p&gt;

(A47) Disaster Nurses in Developing Countries: Strengthening Disaster Nurses' Competencies through Training and Disaster Drills

IntroductionIn many developing countries nurses are the front-line of care, yet do not receive appropriate theoretical or clinical skills related to disaster and emergency medicine. The ICN/WHO have outlined disaster nursing competencies for improving disaster nursing globally. These can serve as a basis for strengthening nursing through increased participation in training programs. In Mumbai, India during December 2010, MEMEX II occurred: a 7 day training in disaster preparedness and humanitarian response. This was the first time nurses were included in a separate disaster nursing track to improve skills and knowledge.MethodsThrough Cornell and Columbia Universities; faculty, Indian nurses clinical competencies and disaster theory were strengthened through training in clinical trauma management, CPR, disaster preparedness and drills, public health evaluation, and the disaster cycle. 700 participants from medical, education, government and private/public entities collaborated in the training program, culminating in a large scale disaster drill and needs assessment workshop for high-level stakeholders.ResultsNurses improved emergency clinical skills and gained theoretical disaster knowledge for the first time. Nurses located at the disaster event site gained important insight into the role of Emergency Medical Services, police, fire, and civilian defense during disaster response. Triage skills were improved and an evaluation component enabled vital information to be collected for hospital preparedness. A video was made for future training and for evaluation purposes. Nurses planned to establish coordination networks amongst the 9 hospitals present to regularly review disaster preparedness plans.ConclusionsStrengthening nursing competencies in disaster planning and emergency response is vital to advancing nursing in developing countries and building capacity through global networking. Through a multi-disciplinary approach, professional networks can be formed, disaster plans reviewed and clinical skills improved. Nursing input is vital to hospital and community preparedness and nurses must be included in training programs and needs assessments.

Establishing a Center for Behavioral Research

Background: Northern plains American Indians, the rural elderly poor, Latino migrant farmworkers, women, and children suffer disproportionate rates of suicide and mental disorders, and physical disorders such as diabetes or obesity that respond to behavioral treatment. There are also shortages of behavioral health researchers serving these vulnerable groups. Purpose: The goal of this project was to obtain funding, plan and create the Northern Plains Center for Behavioral Research - an interdisciplinary, integrated center for behavioral research and research training. The work was driven by the health needs of our region's rural populations. Methodology: With NIH funding, a 27,883 square foot behavioral research facility was constructed to house research and research training focusing on mental disorders and behaviorally mediated diseases central to improving the health status of these groups. Interdisciplinary research training within this center was planned to address critically unmet national public health needs. The facility includes a metabolic kitchen, dining area, a psychological and physiological clinic and data labs. The resulting behaviorally-focused research has relevance for the rural, underserved study populations – a priority for the center. Findings: Funded studies in the center have focused on interventions for severe and persistent mental illness, effects of pesticide exposure on children, nutrition's role in mitigating diabetes and enhancing cognition, and cholelithiasis among American Indian women. Vulnerable groups could not be assisted and our research portfolio could not be expanded without the specialized facilities. Action was urgent since the region is rapidly aging and significantly older than the Nation as a whole The behavioral research center has a 20-year plan that builds upon our leadership in training research-competent American Indian nurses and clinical psychologists. Summary Concluding Statement: Our newly constructed Northern Plains Center for Behavioral Research will enable multidisciplinary investigators to conduct behavioral research and translate results to nurses and clinical practitioners within rural communities.

Supporting Indian nurses migrating to New Zealand: a literature review

New Zealand, like many other Western countries, is struggling to cope with increasing demands for nursing services. Registered nurses are being actively recruited internationally and New Zealand has become a popular destination for nurses who wish to emigrate, including those from India. These nurses have unique cultural, professional and educational needs yet it is unclear how to best support them as they move to their destination countries. The issues around nursing migration and its effects have been discussed in many forums, but there is evidence of a gap in understanding the issues around acculturation and socialization. This selected literature review sought to identify the significant factors that impact on migrating nurses becoming competent and confident registered nurses in the New Zealand practice environment. A bibliographical database search was undertaken (Web of Knowledge, Web of Science, CINAHL, Medline, Academic Search Elite, and Ebscohost EJS) along with national and international nursing websites for the period 2002-2009. Search terms included Indian nurse, international nurse, migration, experience, cultural safety, globalization, nurse migration, nurse recruitment, New Zealand and research. The search was limited to texts published in English, with preference given to peer-reviewed research-based articles. A significant volume of literature was located. The key themes that arose were migration, education, language, nursing skills, competence, cultural safety and reflection on practice. Literature considered to best reflect these main themes, and of most relevance to New Zealand, was selected for this review, with preference given to research reports and official nursing publications. Strategies such as providing ongoing professional education, ensuring cultural safety and offering mentoring in practice environments will contribute to a safe passage for migrating nurses. Further research is required into the acculturation and socialization of Indian nurses, especially those moving to New Zealand.

Nursing brain drain from India

In response to recent findings regarding migration of health workers out of Africa, we provide data from a survey of Indian nurses suggesting that up to one fifth of the nursing labour force may be lost to wealthier countries through circular migration.

Demands of Immigration Among Indian Nurses Who Immigrated to the United States

To describe the demands of immigration of Indian nurses who immigrated to the United States, and to compare the demands of immigration of Indian nurses who immigrated less than 3 years ago to those who immigrated 3 or more years ago. A comparative descriptive design was used to examine the Demands of Immigration (DI) total and subscale scores of Indian nurses (n = 105) who immigrated to the United States between 1985 and 2005, who were categorized into two groups: those who immigrated less than 3 years ago (n = 44) and those who immigrated 3 or more years ago (n = 61). The DI total score and subscale scores (loss, novelty, occupation, discrimination, language and not feeling at home) are reported. Study findings are related to previous research on immigration of women and nurses. Recommendations for future research are included. There was a significant difference between groups in total DI scores and language and novelty subscale scores. Additional research in these areas could help to assess the demands of immigration of Indian nurses and immigrant nurses from other countries.

Seeds That May Have Been Planted May Take Root: International Aid Nurses and Projects of Professionalism in Postindependence India, 1947–65

Upon the creation of an independent India in 1947, a cadre of international nurse advisors was dispatched to the new state, bringing with them ambitious plans for remaking the local profession.1 These women, among the most highly qualified nurses in the world, were backed by the considerable wealth of international governmental organizations and nongovernmental organizations (NGOs), including the Rockefeller Foundation, United States Agency for International Development (USAID), and World Health Organization (WHO). Their nursing programs attempted to institutionalize the values and infrastructure of the nurse professionalism that had evolved in early-twentieth-century North America. They pursued these aims in three main ways-support for university-based nursing programs, encouragement of a strong public health role for nurses, and education of Indian nurses overseas. This article draws on Rockefeller and USAID records, as well as secondary literature on other organizations, to examine their influence on Indian nursing from 1947 to 1965. I argue that, although they made some significant contributions-the institutionalization of degree education for the elite, a better infrastructure for the preparation of teachers and administrators, a broader awareness of the importance of public health-their projects were ultimately flawed by a passionate commitment to American educational models that was insufficiently tempered by awareness of the sociocultural context in which they intervened. International nurses encountered a local profession that was numerically small, almost without leadership, subject to dire working conditions, and stigmatized in wider Indian society. It was felt that the answer to these problems lay in the preparation of a small elite who would be broadly educated and skilled as leaders. This would produce a trickle-down effect, raising teaching standards, elevating the profession in the public eye, and eventually producing large numbers of more empowered nurses. The attempt to achieve this solution, however, was beset by a range of difficulties. With overcrowded wards, underequipped hospitals, a frequently hostile medical profession, and unsupportive governments, degree programs struggled to function at all. The view that high-level projects of professionalism were the best way to use the considerable resources and expertise invested in nursing is ultimately questionable. Breaking with the Past? Nursing under Colonial Rule When international nurses arrived to plan postindependence Indian projects, they found a small and struggling local profession. This underdevelopment in nursing was to some extent a consequence of a more general underdevelopment in public health and hospital care under colonial rule. During the eighteenth and early nineteenth centuries, there had been a general absence of state-provided health care for the Indian population, with allopathic medicine chiefly confined to European military and civil enclaves. Throughout the period of British rule, the vast bulk of the population, living in rural areas, had minimal access to allopathic medicine; village India continued to rely on indigenous systems of medicine such as ayurveda and unani. For the majority of women, the main contact with medical practitioners of any kind was with the dai, or village midwife.2 The late nineteenth century saw some expansion in health services, mainly focused on urban areas. David Arnold suggests that from this period onward there was an attempt to provide a public health and hospital system that catered to Indian as well as European health needs, although Radhika Ramasubban has asserted the ongoing lack of state interest in Indian needs.3 Mridula Ramanna's account of medicine in mid- to late-nineteenth-century Bombay highlights the strong role of the increasingly numerous and assertive Indian medical profession there, and its philanthropic role in funding hospitals and dispensaries.4 The Dufferin Fund, a privately supported philanthropic organization established in 1885 by the vicereine, Lady Dufferin, was designed to provide hospitals for women and children and to train Indian women doctors and nurses. …