key: cord-0945595-4arfuzn7
authors: Yatsu, Hiroko; Saeki, Akari
title: Current trends in global nursing: A scoping review
date: 2021-05-22
journal: Nurs Open
DOI: 10.1002/nop2.938
sha: cfc735b508584d2162ac5e0aa09d634dd80381c6
doc_id: 945595
cord_uid: 4arfuzn7

AIM: This review aimed to elucidate research trends in global nursing in international literature. DESIGN: A scoping literature review of the PRISMA was used to guide the review. METHODS: PubMed was used to search for English articles published in academic journals between 2016–2018. The search keywords were “global/international/world nursing.” We used thematic synthesis to analyse and interpret the data and generated topics for global nursing literature. RESULTS: In total, 133 articles were analysed. Six topics emerged: (a) conceptualization of global nursing, (b) environmental health, (c) infectious diseases, (d) security efforts, (e) global shortage of nursing personnel and (f) diversification of study abroad programmes. The results of this review reflect today's serious international health, labour and global environmental issues. Based on these latest global nursing topics, it is necessary to develop new strategies, nursing models and environment‐related theories to create and maintain a healthy environment.

Since the latter half of the 1970s, capital flow, people's movement and technology transfer based on free trade have accelerated drastically. This secondary globalization has negatively impacted the natural and social environment worldwide, such as atmospheric pollution, global warming, water and food shortages, increases in the frequency and severity of natural disasters, epidemics of infectious diseases and increasing financial disparity. Simultaneously, it has severely impacted individuals' health and well-being globally (Edmonson et al., 2017; Goodman, 2016; Koplan et al., 2009 ).

The concept of global health has been established under these circumstances. The concept refers to tackling healthcare disparities to solve issues associated with regional health care, which requires collaboration beyond national and regional borders to identify health problems and plan and intervene (Edmonson et al., 2017) . The concept of global nursing practice was proposed in 2000 when nursing experts began to participate in global health. Global nursing education was initiated as undergraduate and graduate programmes, mainly in Europe and North America (Wong et al., 2015) .

Examples of problems that require cross-border and crossregional cooperation include large-scale storm and flood damage and fires associated with climate change and adverse effects on human health and safe living due to rising sea levels and reduced freshwater (Nicholas & Breakey, 2017) . Recently, the spread of zoonotic diseases, such as coronavirus disease 2019 (COVID-19) (Aggarwal et al., 2000; Mackenzie & Smith, 2020) , has also become severe. Under these circumstances, future global nursing needs support and care from an international perspective, as well as efforts to address healthy environmental problems from a global perspective (Kleffel, 1996) .

In Japan, the new curriculum implemented by the Ordinance of the Ministry of Health and the Ministry of Education amended the ordinance of 1997, which clearly stated that "in an international society, nurses [should] consider collaboration with various countries based on a wide perspective" (Hiraoka & Yoshino, 2002, p. 3) .

In 2006, 40% of nursing universities offered courses on global nursing practices and health care (Yoshino, 2006, p. 20) . However, many Japanese research articles in global nursing practice were on "healthcare cooperation," focusing on medical support for developing countries. There have not been many research articles based on global nursing practices (Hiraoka & Yoshino, 2002) . Is the lack of research from a global perspective unique to Japan, or is it a universal problem? A review is needed to clarify research pieces conducted worldwide regarding global nursing to answer this question.

Based on the definition of Edmonson et al. (2017) , this study defined global nursing as nursing in which the nursing profession participates in the extraction, planning and intervention of global health problems. Clarifying trends in the global nursing literature through this study was considered to provide a source of information for guiding nursing education, research and theory towards resolving global health problems.

The number of articles on global nursing has increased rapidly since 2000. Searching for articles in the PubMed database using the search term "global nursing" on 13 December 2020, the number of papers published since 2000 has been more than three times that of the previous 40 years. Specifically Consequently, they found that progress in the number of countries guaranteeing breastfeeding breaks was still modest, noting the need for global efforts to promote working mothers' breastfeeding capacity. Ryan and Dogbey (2015) reported that as of 2012, 15 million preterm births were registered, many of which occurred in resource-poor countries that lacked nursing care-India, Nigeria, Pakistan and Congo-which can be avoided. They pointed out that global action by sharing knowledge and technology needed for the millennium development goals was essential to end premature birth. Yan et al. (2015) surveyed Chinese nurses on the skills, knowledge and attitudes of disaster nursing required for earthquake relief. Consequently, all nurses believed there was a significant gap between knowledge and skills and supported the need for future disaster nursing courses. Wong et al. (2015) analysed reports published in six WHO areas between 2007-2012. The results indicated that the global level's key nursing issues were the workforce, the impact of nursing in health care, professional status and nurses' education.

These treatises have a global perspective on local issues. Many papers have pointed out that nursing problems, which initially seem to be a problem-specific to that country or region, are a global concern that other countries or regions also have. The causes of health problems at various health levels and life stages were analysed as global problems that transcended national and regional areas. Improvement measures were considered from a global perspective.

In September 2015, the United Nations announced the sustainable development goals (SDGs). Globally, nurses and midwives provide 80% of healthcare services (WHO, 2016) , and their work is critical to achieving universal health and the SDGs (Gresh et al., 2017) . Although the SDGs are thought to impact nursing science significantly, few studies have revealed global nursing papers' topics based on the SDGs' focus. Therefore, in this research, we focused on articles published between 2016-2018 and attempted to clarify their characteristics.

This study aimed to elucidate the trends in global nursing in international literature. The review question was as follows: What are the focus topics on global nursing papers?

A scoping review was selected to review the literature because it maps relevant published literature in a defined area-in this review, global nursing. Scoping studies have been designed to address a broader range of topics than systematic reviews. This is because they do not typically focus on a well-defined question in which an appropriate study design can be identified in advance (Arksey & O'Malley, 2005) . Scoping research aims to map the key concepts that rapidly underpin a research area and the primary sources and types of evidence available (Mays et al., 2001) . Arksey and O'Malley described four motives to complete a scoping review: "To examine the extent, range, and nature of research activity"; "To determine the value of undertaking a full systematic review"; "To summarise and disseminate research findings"; and "To identify research gaps in the existing literature. (p. 21) ." This study was motivated by all these possibilities, especially the first and third reasons; therefore, it was considered that there were sufficient reasons to adopt a scoping review. Critical appraisal of the literature was not undertaken in this scoping review. This is because scoping reviews do not assess the quality of evidence. Consequently, it is impossible to determine whether the reviewed papers provide robust or generalizable findings (Arksey & O'Malley, 2005, p. 27 ). Therefore, we decided to use one database, PubMed (MEDLINE and PreMEDLINE). Consequently, there was enough time to review the extracted literature; however, the provided information's completeness may be limited.

Literature was included if it met all of the following criteria: (a) extracted with the search term "global nursing," (b) published in English between 2016-2018, and (c) the title or abstract contained one or more words of "global," "international" or "world." Articles were excluded if the authors did not mention global awareness and/or research objectives in the research methods and discussions section.

For example, if the author set childhood obesity as a global problem, but the data were collected and analysed in only one region and the results were interpreted without comparison to global data, then the treatise was excluded from this review. No particular study design was excluded, including both qualitative and quantitative studies.

Grey literature, such as government publications, non-academic treatises and white papers, were also not excluded to understand global nursing trends better.

One of the two reviewers searched for literature that met criteria (a) and (b), after which the two reviewers independently screened the title and summary of the literature for (c). Next, the abstracts of the screened articles were read by two reviewers using the exclusion criteria. If one or more of the reviewers could not discern whether the document met the exclusion criteria, the two reviewers read the document's full text. There were five documents in which the two reviewers disagreed on inclusion in the analysis; thus, those documents were excluded. The two reviewers subsequently agreed to include all relevant articles (N = 133).

The information of the 133 target documents was converted into data using the following procedure: one reviewer extracted the data for each study using a structured form developed by the researcher;

another reviewer confirmed the extracted data. The extracted data included the author name of the selected document, author affiliation information (country of affiliation, occupation, position), year of publication, volume page of the journal, article title, background and research purpose, study design, sample size, participant characteristics, data collection/analysis methods, results and discussion.

We conducted thematic synthesis based on Thomas and Harden (2008) to answer this scoping review's research question. There are three stages in the synthesis: the free line-by-line coding of the findings of primary literature; the organization of these "free codes" into related areas to construct "descriptive" themes; and the development of "analytical" themes. The first and second stages remain "close" to the primary study. Conversely, the third stage is an interpretation stage in which the reviewers "beyond" the primary research to generate new interpretive constructs, explanations or hypotheses (pp. 4-7).

In developing the theme of this research, each reviewer first performed line-by-line coding and descriptive theme generation. Next, two reviewers discussed, inferred and integrated the patterns that appear in those themes to generate six categories as themes as interpretations beyond the original literature's content. Furthermore, we derived concepts that more clearly show each theme and identified them as six topics representing recent trends in the global nursing literature.

This study was conducted without ethical approval because a literature review did not require ethical approval according to the institution's research guidelines to which the first author belongs.

There were 562 articles published on 21 June 2019, which were published in international academic journals on nursing or global nursing over the last three years. Among these, 192 articles did not contain "global, international," or "world" in the title or abstract. We read the abstracts of 370 articles and found that 232 articles did not reflect an awareness of a global problem or research objective in the sampling, data collection or analytical methods. Moreover, five documents did not match the results of the exclusion scrutiny by the two authors. Once these five articles were excluded, 133 articles remained as the final analytical subjects of this study 

The papers and designs were classified into 20 sub-categories and then grouped into six categories (essays, practice reports, literature review, quantitative research, qualitative research and mixed method). There were 38 essays (28%), 27 qualitative studies (20%), 25 literature reviews (18%), 24 quantitative studies (18%), 20 practice reports (15%) and one report that used a mixed method (1%).

Two out of 133 articles were analytical reports classified under two sub-categories: a case study and discourse analysis in one case (Evans-Agnew et al., 2016) and systematic review and meta-analysis (Tung et al., 2018) .

The reviewed articles were classified into 18 categories. The most commonly mentioned area was "global health issues and nursing" (79 articles, 33.7%), which was followed by "nursing education"

(68 articles, 29.1%) and "nursing management" (26 articles, 11.1%) ( Figure 3 ).

The topics that the literature on global nursing focused on were divided into the following six concepts:

Most articles that attempted to clarify concepts associated with global nursing, such as global health, sustainability and cultural competence (e.g. Cesario, 2017; Goodman, 2016; Milton, 2016; Wilson, Moran, et al., 2016) , derived more comprehensive and essential definitions through the comparison of results from previous articles. 

Many articles have identified global infections and pandemic problems, which have increased in number since the late 1990s. These articles included discussions on nursing practices associated with prevention and response to infections, prevention methods and patient satisfaction. The diseases discussed in these articles included Ebola haemorrhagic fever (Ferranti et al., 2016; Lori et al., 2017; McGillis Hall & Kashin, 2016) , Zika fever (Forman et al., 2017; Phillips & Neyland, 2016; Visovsky et al., 2016) and tetanus (Carter & Viveash, 2017) . 

Anxiety about international affairs has a significant effect on global nursing practices. There have been several studies and reports on issues such as safety and health issues for immigrants in conflict zones and racism against immigrants (Moyce et al., 2016; Ogunsiji, 2016) , human trafficking and organ trade among the poor (Corfee, 2016; Stevens & Berishaj, 2016; Twigg, 2017) , The author also stresses the importance of dealing with the gap in knowledge about the socio-cultural factors surrounding armed conflicts in the twenty-first century. Further, the author points out that more focus is needed on the Geneva Convention that stipulates the protection of nursing staff, adherence to international humanitarian laws and global healthcare workers' safety.

With the global labour shortage and increasing need for health care, Some articles have practised and evaluated an attempt to experience foreign cultures by entering a domestic region with diverse cultural backgrounds for a certain period (Lane et al., 2017; Tanaka et al., 2018) . Other programmes have sought to involve students with service learning by engaging them in volunteer work (Brown, 2017; Ryan-Krause, 2016; Underwood et al., 2016; Wade et al., 2017 ).

An article entitled "Going Domestic" by Lane et al. (2017) discussed the importance of "studying abroad" in a domestic setting in cities with diverse cultures, based on the active learning strategy pursued by Appalachian State University in New York City.

According to Lane et al., because students' cost of studying abroad in developing countries is generally high, only wealthy students may participate. This resulted in a lack of diversity and increased disparity among the students. Because studying abroad takes time, it requires time off, which is difficult for students. It also tends to implant a tourist mindset in students, making it challenging to nurture serviceminded attitudes in the performance of community-based activities.

"Studying abroad" in a domestic setting solves all of these problems and allows students to acquire an open-minded perspective on culture that transcends their geographic and ethnic experiences (pp. 198-199) . Tanaka et al. (2018) However, the scope of international nursing research and education in Japan is narrow. Takatsuka and Tanaka (2017) surveyed 24 universities belonging to the Association of Private Nursing Colleges in Japan. They pointed out that the main themes covered in class subjects for international nursing education in Japan were focused on support and care from an international perspective, such as "culture," "health issues," "international cooperation," "developing countries" and "primary care." In the future, it will be necessary to carry out research and education to tackle healthy environmental problems from a global perspective based on global nursing definitions that address changes over time.

As shown in global nursing conceptualization, many articles that tried to elucidate concepts surrounding global nursing practices derived a comprehensive and essential definition based on integrative methods of results from previous studies. This suggests that research in global health and nursing is evolving to a more academically mature stage, from writing researchers' personal views and borrowing definitions from disciplines other than nursing (Meleis, 2018) . Wilson, Moran, et al. (2016) defined global nursing as an evidencebased nursing process that promotes sustainable global-scale health and equality for all-this is a new definition of nursing in the global era. This suggests that, importantly, nurses provide more practical, research, educational and policy leadership on global health issues and play an influential role in respecting human rights and diversity.

The present study revealed that environmental health was the central theme in practice, education and global nursing research.

This demonstrates the seriousness of environmental problems that impact human health and the importance of nursing roles. To achieve a sustainable environment today and in the future, nurses need to warn about how humans live with heavy environmental loads and find improvements. Although global warming is a severe threat to human health, healthcare staff and organizations have been relatively slow to dedicate themselves to sustainable healthcare practices. Griggs et al. (2017) found that "inaction" from "endemic blindness to global issues" and "environmental numbness" is widespread in healthcare organizations. They pointed out that there are many social, cultural and psychological barriers to this issue.

It will be necessary to research and clarify measures to overcome these barriers and further educate and raise awareness that creating a sustainable environment is also an essential task of the nursing profession.

Nursing efforts to combat the health hazards of infectious dis- countries. This experience is integrated with service learning for practical skills. As Lane et al. (2017) discussed, studying abroad usually incurs a high cost, limiting the participating students to affluent backgrounds and creating a disparity between students. Therefore, the Internet's use is necessary to "study abroad" in a domestic setting and facilitate educational efforts that integrate service learning.

Today, significant changes in the environment change ecosystem balance and affect people's lifestyles and working styles. Nursing professionals in the 21st century will need new strategies and models to create and maintain a healthy environment (Meleis, 2018) and

health care for individuals and groups. The development of some types of environment-related theories that guide the development of a healthy environment and behaviour for environmental changes and healthcare policies (Salazar & Primomo, 1994 ) through many existing research findings will be required in the future.

The results of this review should be considered with some limitations. The most significant limitation was that the search databases used in this review were limited to PubMed. Furthermore, the articles reviewed in this study were limited to those published between 2016-2018. Therefore, it was impossible to show the research results, including trends in research on COVID-19. Since COVID-19

is considered to significantly impact nursing practice, research and education, examining research trends after 2020 is a fundamental challenge for the future.

Global nursing's latest trends reflect today's severe international health problems, labour issues and global environmental affairs.

Based on these global nursing topics, it is necessary to develop new strategies, nursing models and environment-related theories to create and maintain a healthy environment.

We would like to thank Editage (www.edita ge.com) for English language editing.

There are no conflicts of interest relating to this article.

Each author of this study has substantially contributed to conducting the underlying research and drafting the manuscript. The first author, Yatsu, contributed to the conception and design of this study, data collection, data analysis and interpretation, manuscript writing and final approval of the version to be submitted. The second author, Saeki, performed the data collection, data analysis and interpretation, revising the manuscript critically and approval of the final version.

The data that support the findings of this study are openly avail- (2017) (2017) Health damage caused by atmospheric pollution Nicholas and Breakey (2017) Spread of infectious diseases via water and food Nicholas and Breakey (2017) , Veenema et al. (2017) Exposure to ultraviolet rays Nicholas and Breakey (2017) Complex humanitarian emergencies (CHEs) and natural disasters

Williams and Downes (2017) Infection diseases

There are many articles on nursing interventions associated with the prevention, treatment and 

A PPE N D I X 3

The number and ratio of papers by design (N = 135 a ) 

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