Gloria J. Willingham-Toure PhD, RN, BSN, MNSc

1. Gloria J. Willingham-Toure PhD, RN, BSN, MNSc Fulbright Specialist, Public/Global Health Fulbright Scholars Program Council for The International Exchange of Scholars Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 1

2. Committed and Empowered to Provide Community Service in a Global Society Community Health in a Changing World! Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 2

3. Objectives • Identify at least three characteristics of the 21st Global Society • Identify at least three implications for nursing community service in the local community Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 3

4. Community Service • Committed • Empowered • Global Society • Nursing • You! Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 4

5. The Republic of Malta Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 5

6. Describing the Community • North of North Africa • South of France • 122 square miles • Approximately 430,000 residents • 93% literacy rate • Life expectancy: Males – 77, Females-82.2 Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 6

7. Describing the Community: Employment • 162,000 Employed • Agriculture, hunting, forestry – less than 2% • Manufacturing – 15% • Electricity, gas, water supply – 2.2 • Construction – 7.2% • Wholesale/retail trades/repairs – 15.5 Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 7

8. Describing the Community: Education • Compulsory – until age 16 • 92.7% population educated at the high school level • 93% literacy Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 8

9. Describing the Community: Economy • National Resources: Limestone, Salt, Land • Services: 60% GNP • Industry: 17% GNP Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 9

10. Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 10

11. People • 3400 people per square mile. • Note: The US has approximately 55 people per square mile • Colonized multiple times: Phoenicians, Romans, Arabs, Normans, Knights Hospitaliers of St. John of Jersalusem of Rhodes and of Malta • British Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 11

12. Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 12

13. Demographics: Recent Immigrants • Sub Saharan Africa • North Africa • Eastern Europe Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 13

14. History • History Pre-cedes Christianity • 400 BC – Was Cultic center for earth-mother worship • Was part of the Roman Empire – 218 B.C • Saint Paul was shipwrecked on Malta in A.D. 60 • Malta has been bought and sold to various feudal lords for 440 years Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 14

15. History • 1522: The Knights of St John driven out of Jerusalem and Rhodes were given sovereignty over the Maltese Islands. • The history of Nursing on the Maltese Islands dates back to the 1500s. • Knights of St. John ended in 1798 when they surrendered to Napoleon Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 15

16. Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 16

17. Enter Nursing 2007 • Sick Care • Free to All • One hospital • One university • One nursing school • Local Clinics – primarily physician ran Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 17

18. Planning for the Future! Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 18

19. Enter Nursing 2007 • New immigrants arriving • Various levels of acceptance by existing population • Call for a re-evaluation of health care system and nursing roles • Health promotion and disease prevention sought Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 19

20. Nursing 2007 • Medicines dispensed in community-based clinics • Nurses in handmaiden roles to Physicians • Physicians primarily males • Nurses seeking leadership in healthcare • Chancellor support for the initiation of a Community Health Nursing Program Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 20

21. Nursing 2007: Challenges • Insufficient faculty to open desired school • No established community health curriculum • Unfamiliar concepts • Family resistance to possible nursing roles in Community health • Physician resistance • Community uncertainty • History of “sick care” Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 21

22. Nursing 2007: Opportunities • Fully paid education for nurses • Cadre of Nurses willing to be the “first” • Committed Director • Ministry of Health/Education Support • Capacity issues in hospitals • New Hospital in progress • Supportive US Embassy Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 22

23. Nursing 2007: Opportunities • Supported Change strategies • Development of New Curriculum • Faculty development program for inaugural group • Building support in communities/homes • Opportunity to develop a culturally sensitive model. • Historical moments Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 23

24. Reflections/Outcomes - 2010 • Inaugural students graduated • Community Health and Midwifery Program • University of Malta • New Hospital • Acceptance by community/homes • International Council of Nurses convention to be hosted in Malta - 2011 Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 24

25. Characteristics of 21st Century Global Society • Population Mobility • Multiple languages and cultures • Cultural and historical differences • Disparities in access to healthcare • Differences in health belief systems • Shifts in power and control • Learning outside your comfort zone Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 25

26. Implications for Nursing Community Services • Opportunity to re-think the boundaries of nursing and nursing care • Opportunity to make a measureable difference in the health status of the community • Requires closer relationships and knowledge of community • Changes in nursing curriculum Funded by Fulbright Specialist Program, Fulbright Scholar, US Dept of State 26

27. Community Health Graduates 2010: University of Malta 27