Research and reports

Establishing Global Nursing Education Equity by Developing Open Access Resources

Keating, Stacen A. PhD, RN; Berland, Alex MSc, RN; Capone, Kathleen MS, RN, CNE; Chickering, Miriam J. BSN, RN

Nurses Called to Serve in Low-income Countries: The Development of Nurses International - Journal of Christian Nursing




Addressing community and population health needs in sub-Saharan East Africa was the impetus that sparked the creation of Nurses International. The World Health Organization estimates a current global shortage of 9 million nurses, with the shortage being most severe in developing countries where nurses are often the professionals charged, whether well-prepared or not, with meeting an estimated 80% of the health care needs of the population at large.

There is a tremendous need for well-educated healthcare providers who are prepared to meet the burgeoning health care needs that exist in low-resource countries. Mobilizing an international nurse faculty who are equipped to meet these needs through the provision of globally minded and locally relevant educational programs of excellence is a complex and challenging mission.

Nurses International has stepped forward to begin meeting this need, creating both a framework and educational methodology that, when applied, allows contextualization of program curriculum toward cultural relevance in any community. This multi-faceted framework and methodology have been specifically designed to foster the delivery of consistent, high quality and culturally relevant nursing education within low-resource countries.


Nurses International, a 501c3 organization, believes that removing barriers to learning and increasing access to education, when combined with the provision of adequate resources, enables nursing students to focus on learning. Empowering these students through barrier removal and resource allocation promotes the development and growth of a supply of nurses who are prepared to take 21st Century nursing care to the local level in low-resource countries. The alleviation of suffering by these nurses will be the initial fruit and the starting impact: the potential that exists for blossomed transformation in terms of health and wellbeing of individuals, families, and communities touched by these nurses who graduate and then move to act within their communities and beyond is exciting to consider.

Listen, Learn, Serve, Share Framework

The Listen, Learn, Serve, Share model was developed by Nurses International and is used to identify barriers to and provide solutions for learning and health in a culturally appropriate, locally relevant context.

Commonly encountered barriers identified by the model have been found to include, among others, the following:

– Lack of qualified faculty

– Inadequate educational resources

– Prohibitive program costs

– Need for optimization of nursing roles and scope of practice

– Inaccurate public perceptions of professional nursing practice

The Listen, Learn, Serve, Share framework provides structure to the process of identifying the partner, student, and community strengths and needs. The LLSS Framework is key to properly augmenting strengths and to addressing needs toward the development of successful and sustainable collaborative partnerships. Nurses International applies the Listen, Learn, Serve, Share framework internally and promotes its use in cooperative endeavors.

Components of the Framework:

Listen: Listen to the stories, thoughts, insights and dreams of those with whom you are interacting.

Learn: Learn through the practice of cultural humility. Seek opportunities to engage as a learner with an open mind. Listening well reveals knowledge gaps and opportunities for learning and growth.

Serve: Serve by helping with partner identified immediate needs. Show that you care. As understanding, listening, and active learning occurs relationships become increasingly reciprocal. Serving to achieve mutually identified goals strengthens collaborative efforts.

Share: Identifying and sharing solutions is most effective when undertaken with an understanding of context, cultural knowledge, and collaborative service with partners. Solutions are best when they are shared with the community and sustainable within the community.

Listen, Learn, Serve, Share Application Exemplars


Collaborative engagement is an undergirding premise in the Listen, Learn, Serve, Share framework. Nurses International collaborates with organizations that have an existing nursing program or the infrastructure capable of facilitating a nursing program. Criteria for partnership considered include academic administrators, classrooms, and transportation for students to clinical sites. Preferred partners have demonstrated an ability to successfully collaborate with many organizations to achieve sustainable academic programs and community development initiatives.

Nurses International and its partners share core values of resilience, integrity, and a common vision of holistic, transformational community development. Partners also provide guidance regarding government accreditation requirements.

Key partnership attributes:

– Resilience

– Communication

– Integrity

– Infrastructure

– Shared vision

– Shared ownership

– Networking

– Sustainability

Multinational Faculty – A Truly Global Effort

Nurses International volunteer faculty originate from many countries around the world. Exposure to nursing experts from different academic and practice settings provides students access to global expertise, diverse perspectives, and the breadth and depth of global nursing role models. Intentional professional socialization of nursing students occurs in the classroom with both on-site and off-site faculty as well as in face-to-face interactions with faculty during clinical experiences. Creating a community of learning and caring is a top priority, and achieved through timely response to student questions, planned intermittent synchronous teaching sessions, online forums, and discussions. Students receive individualized and holistic attention throughout their course of study. The curriculum incorporates planned interactions between faculty and students using methods such as the inclusion of caring questions and responses.


As the program continues to emerge, develop, and grow, it is anticipated that findings from subsequent work will serve to begin filling the gap that currently exists in terms of best practices around the development of sustainable educational initiatives in low-resource countries. Findings have the potential to inform future work by educational researchers and foster new interest in the area of developing sustainable educational initiatives in low-resource countries.

Curriculum Review of Source Materials for Nurses International's Open Access Project

Report on IUBAT's BScN program submitted by H. Ewing June 2013.docx