Running head: INTERNATIONAL COLLABORATION

Advancing Nursing Practice in Vietnam: An International Collaboration to Improve Quality
Darlene Robles
Arizona State University

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Abstract

International partnerships offer opportunities for healthcare professionals to promote
evidence-based nursing in underdeveloped countries. When international collaboration is utilized
among nurses in developing countries the clinical outcomes may be improved. This project
focused on collaboration with nurse colleagues in Hanoi, Vietnam to support an internally
identified quality improvement process and leadership development. Collaboration occurred in a
large inpatient medical center between the author and nursing shared governance team members
representing the General Surgical, Neuro Surgical, and Intensive Care Units. The nursing
collaboration over 9 months concluded with an onsite visit by 5 members of a diverse group
from the United States. The shared governance team reported an overall increase in nursing
knowledge and skill regarding urinary catheter maintenance and care.
Keywords: international, collaboration, partnership, quality improvement

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Vietnam Nursing Collaborative: Building International Partnerships
The development of worldwide nursing partnerships among progressive health care and
developing countries is imperative to advancing nursing education and practice. The Doctor of
Nursing Practice (DNP) prepared nurse has an obligation to create organizational environments
that promote interprofessional collaboration (Zaccagnini & White, 2014). The DNP is prepared
at the highest level of nursing, has extensive preparation in evidence-based practice, nursing
process, leadership, and innovation (Chism, 2016). Nurses in the U.S. health care system are at
an advantage because nursing research is one of the foundations of baccalaureate study (Tingen,
Burnett, Murchison, & Zhu, 2009). Vietnam is a developing country; nurses in Vietnam have
identified education and clinical practice as areas for improvement. For this reason, it is
important for the DNP to reach out to mentor and collaborate with nurse colleagues in Vietnam
sharing their expertise on a global level.
Worldwide, healthcare organizations are challenged to increase the use of evidence-based
knowledge and subsequent evidence-based practice. Increased use of evidence-based practice
will improve processes and outcomes in health care (Wallin et al, 2011). Strategic goals of global
partnerships include creating a foundation for evidence-based practice and assisting nurses in
leadership skill development. (Stringer, et al., 2016).
Problem Statement
International partnerships can facilitate evidence-based nursing practice. Collaboration
which includes evidence-based practice skills can improve the quality of care, and impact patient
outcomes during hospitalization. Health disparities can be identified and addressed through health
promotion before they grow to become larger global concerns. (Anderson, et al.,2012). As in many
developing countries, Vietnamese nurses are unable to fully contribute to the development of their

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practice or the health care system due to reduced or missing resources (Crow & Ba Thuc, 2011).
Further attention is needed to advance evidence-based practice as a form of health care innovation
in Hanoi, Vietnam (Fleiszer, et al., 2015).
Purpose and Rationale
The purpose of this paper is to explore the effectiveness of a collaborative partnership
with nurses on a shared governance team in a large medical center in Hanoi, Vietnam. Shared
governance was introduced to Vietnamese nurses in 2007 (Crow, Nguyen, & DeBourgh, 2014).
The first hospital to design and implement a Nursing Practice Council was Than Nhan Hospital.
Their unit-based council was established to improve nursing knowledge and care provided using
evidence-based research. International partnerships have the potential to improve the quality of
patient care and support the education and evolving professional role of the nurse (Tremethick &
Smit, 2014). Currently, there are seven hospitals in Hanoi that have established nurse practice
councils. Nurses in Hanoi participate voluntarily in nurse practice councils to improve their
practice and positively impact patient outcomes.
Background & Significance
Overview
International nursing collaborations offer incomparable learning experiences and can lead
to widespread change in nursing education and practice (Garner, Metcalfe, & Hallyburton,
2009). There is a gap in the literature regarding international nursing partnerships in a clinical
setting, most publications focus on educational partnerships in a university or academic setting
(Stringer, et al., 2016).
Culture

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Vietnam is an underdeveloped country with a population of over 96 million. The country
is comprised of 54 different ethnic groups, and several diverse climate zones (CIA, 2017). The
capitol of this country is Hanoi also the second largest city followed by Ho Chi Minh City
(formerly Saigon). In the Vietnamese culture, etiquette and customs are of high importance and
follow the influence of Confucianism. Confucianism is “the system of ethics, education, and
statesmanship taught by Confucius and his disciples, stressing love for humanity, ancestor
worship, reverence for parents, and harmony in thought and conduct”
(http://www.dictionary.com/browse/confucianism).
Role of the family. Vietnamese families play a significant role in caring for a hospitalized
family member. The patient may come alone for a routine check-up, but if he or she is admitted
into the hospital, at least one family member is urged to stay to provide food and manage the
patient’s hygiene. Family members want to take care of the patient because they believe they are
more attentive to the patient’s needs than doctors or nurses (Harvey, Calleja, & Phan Thi, 2013).
Vietnam Health Care System: Health Spending and Health Concerns
The average wage per person in Vietnam is around 3.2 million VND ($150) a month
(https://www.vietnamonline.com/az/average-salary.html). There are many medical services that
are readily available, but most people are not able to afford them. In addition, Vietnam is
experiencing a severe shortage of health care providers (Pham, 2016). Although the gross
domestic product (GDP) of Vietnam has progressively climbed to reach its highest of 6.68% in
2015, health care costs have also increased. Health care spending makes up approximately 7.2%
of the GDP (Pham, 2016). Alternatively, the average life span in Vietnam is to 72.8 years, which
is higher than other countries with similar levels of GDP (Hinh & Minh, 2013). In Vietnam, there
are three elements in the Vietnamese social security system that employers are required to cover:

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social insurance (SI), unemployment insurance (UI) and health insurance (HI). Vietnamese
patients have national insurance only if their employer pays the monthly fees (Shira, 2017). Often,
it is not until they are ready to be admitted that they find their employer has was not paying the
fees and must forgo the care they require. For those who are admitted and receive the care needed,
the average length of stay can vary anywhere from one week to forty-five days if being treated in
the Intensive Care Unit (ICU).
Public health issues. Although there has been noticeable improvement in Vietnam health
care, the country faces many obstacles and problems (Hinh & Minh, 2013). Public health issues
impacting Vietnam include infectious diseases and chronic illnesses. The five most prevalent
infectious diseases in Vietnam are Hepatitis A, Hepatitis E, Typhoid Fever, Malaria, and Dengue
Fever. Hepatitis A is spread through consumption of food or water contaminated with fecal matter,
primarily in areas of poor sanitation. Hepatitis E is a water-borne viral disease that impedes with
liver functioning; most commonly spread through fecal contamination of drinking water. Typhoid
Fever is a bacterial disease spread through contact with food or water contaminated by fecal matter
or sewage. Malaria can be caused by single-cell parasitic protozoa Plasmodium which is
transmitted to humans via the bite of the female Anopheles mosquito. Lastly, Dengue Fever is a
mosquito-borne viral disease linked with urban environments. The three leading causes of death
are: Stroke, Ischemic Heart Disease, and Chronic Obstructive Pulmonary Disease (WHO, 2017).
Vietnamese Nursing Education, Professional Practice, and Gaps
Nursing education. In Vietnam, the title of “nurse” is earned upon completion of the
program requirements. Vietnamese nurses are not mandated to take a standardized exam to
practice nursing nor do they have a nurse practice act to abide by to guide their nursing practice
(Hill & Crow, 2013). An example of nursing curriculum from Bach Mai Nursing School (BMNS),

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consists of 4 semesters during which theory and clinical hours are almost evenly distributed. Most
clinical hours occur with direct patient care while the remainder are done in a simulated
environment (Crow & Ba Thuc, 2011). Similarly, physicians in Vietnam attend four years of
medical school, they may continue to do residency or an internship, however, this is not mandatory.
Once the physician completes four years of schooling they receive the title of “physician.” The
Ministry of Health (MoH) is the government entity responsible for the governance and guidance
of the health, healthcare and health industry of Vietnam. The MoH is currently working on
establishing national standards in which both nurses and physicians would have to oblige by.
Nursing culture. Nursing in Vietnam has not been viewed or practiced as an autonomous
profession. Nurses in this underdeveloped country have become accustomed to following orders
of the physician and not to question a physician’s directive. In 2010, the quality of clinical
education was identified as a significant barrier to developing the nursing profession in Vietnam.
The Vietnam Nursing Association (VNA) with the support of the Vietnam Ministry of Health
endorsed their national nursing competency standards. (Harvey, Calleja, & Phan Thi, 2013). This
represents advancement towards nursing empowerment in Vietnam. Despite the small surge in
health care spending, the disparity between income units and those living in small villages or
remote mountainous areas is also on the rise (Crow & Ba Thuc, 2011). For this reason, it is
imperative that nurses in Vietnam understand and practice evidence-based techniques to care for
their patients while hospitalized. In addition, they will need to learn the importance of
sustainability of care once they are discharged. Collaboration between Vietnam nurses and
nurses in the U.S. in the areas of nursing process and the understanding and utilization of
evidence-based practice has the potential to improve patient outcomes.

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Collaborative Partnerships
It is imperative to build a foundational relationship before taking on a challenge such as
international working partnerships. One example of this includes building a team. Identifying
experts across areas so that relevant concepts unique to the area can be integrated (Shepard &
Allen, 2014). One such collaborative partnership is the Vietnam Practice Improvement Project
(VPIP). This partnership began in 2007 as a continuing academic-service partnership between
the University of San Francisco School of Nursing & Health Professions and healthcare
collaborators in Vietnam. VPIP aimed to improve the health and well-being of the people of
Vietnam by enhancing the education, training, and practice of the nurses. Partnering with VPIP
allowed for collaborations to occur on a national level within the United States (U.S.) and on an
international level between nurses in the United States and in Vietnam (Crow & Ba Thuc, 2011).
Establishing an international collaborative could result in opportunities for leadership and
mentoring. A successful partnership requires consideration for cultural differences to include
language, lifestyle, economic capitals, and political schemes (Zheng, et al., 2001). Developing an
international partnership takes time while the process evolves to its unique shape (Mason &
Anderson, 2007). The complexity of the collaboration can lead to enhancement of nursing
education and practice between different countries (Robinson, et al., 2006).
The understanding of building a solid foundation is essential before beginning an
international partnership. Recognizing the circumstances in which international partnerships
emerge and flourish, comprehending the structural and institutional conditions for sustainable
partnerships is critical, and being aware of the perception and experience of the bilateral
international partnership are vital components (Tupe, Kern, Salvant, & Talero, 2015).

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Being able to communicate with the team in Vietnam could present a potential barrier.
There must be an agreement on a method for communication to best accomplish the goal.
Several innovative platforms for video communication are available including Skype and Zoom,
A translator is also a requirement when language barriers exist.
An effective partnership is globally recognized as an essential tool for constructing a
more effective health care delivery system. Principles found in successful partnerships include
shared goals, clear roles, mutual trust and respect, effective communication, and measurable
process and outcomes. (Babiker, et al, 2014).
Collaborative partners create a common and clearly defined purpose that includes
combined interests and demonstrates shared ownership. There are clear expectations for each
team member’s functions, responsibilities, and accountabilities, optimizing the team’s efficiency.
In successful partnerships members earn each other’s trust, creating strong bonds and greater
opportunities for shared achievement. They respect and appreciate the role of each other. They
also respect each other’s talents and beliefs, in addition to their professional contributions.
Effective partnerships accept and encourage a diversity of opinions among members. This is
crucial for the teamwork success.
The team prioritizes and continuously enhances its communication skills. It has
consistent and accessible channels for complete communication and are used by all team
members. Dependable and timely feedback on successes and failures should be agreed and
implemented by the partnership. These can be used to track and improve performance
immediately and implement strategies for the future.

Internal Evidence/Clinical Significance

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A history of established relationships between U.S. and Vietnam nurses has occurred
through VPIP. Nurses in Vietnam are eagerly poised to make significant and essential
contributions to the well-being of the Vietnamese society (Jones, et al., 2000). Currently, there
are active quality improvement projects underway in numerous hospitals in Hanoi, Vietnam.
However, Vietnamese nurses have difficulty accessing evidence-based practice because
of resource limitations. Many of these nurses do not have the skills to perform searches for
evidence-based information in databases and many experience a language barrier, resulting in the
inability to read and interpret research articles. (Hill & Crow, 2013).
Providing education and guidance in using evidence-based practice techniques can
contribute to positive patient outcomes via quality care (Black, et al., 2015). Outcomes from a
recent quality improvement project at one Vietnam hospital demonstrated a decrease in central
line associated blood stream infections from greater that 13% to <10% over a 9-month period.
The intervention was a change in clinical practice using innovative techniques and evidencebased practices shared by a nurse consultant from the U.S.
The author collaborated with the shared governance team, at a hospital in Hanoi. The
nursing team identified a goal of reducing catheter associated urinary tract infections in the
general surgical, neuro-surgical, and intensive care patient population. This request has led to the
following PICOT question, “In Vietnam Nurses working in a hospital in Hanoi, how does a
collaborative partnership versus no collaborative partnership affect the rate of catheter associated
urinary tract infections over 9 months?”
Search Sources and Process

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The search process was performed to answer the PICOT question. There were four
databases used for the inquiries. These included PubMed (Appendix A), CINAHL (Appendix B),
JStor (Appendix C), and ProQuest (Appendix D).
In the initial search with PubMed the keywords utilized included: Vietnam which found
over 17,000 results. The subsequent search included Vietnam AND collaboration which
narrowed it down to 177. Following that search included Vietnam AND nursing AND education,
bringing up 180 results. When searching only under title and abstract the results were minimal.
The search was broadened to Vietnam AND nursing AND quality improvement that brought the
results to 71. As the search was refined the keywords were changed to international AND
nursing AND collaborative AND quality improvement. This final search in PubMed gleaned 10
results. All publications were thoroughly reviewed for appropriateness related to the PICOT
question. Not all publications were kept for further research.
The second database used in the search was CINAHL. The initial keyword used was
Vietnam. The search was filtered by adding the inclusion of dates from 2000-2017 and full text
articles. The subsequent search added international nursing AND Vietnam where 334
publications were found. To refine the search international partnerships AND nursing was
included where 34 results were found. Quality improvement AND nursing AND Vietnam were
added next to glean 3 articles. The search was made larger by adding international nursing and
collaboration which found 248 texts. Some of these studies were kept being used for further
examination and used to support the PICOT question.
The third database used was JStor. The initial search here began with the words Vietnam
AND international partnership. This gleaned over 74,000 results. The search was further refined
by including only publications pertinent to health sciences with a publication date between 2000

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and 2017. The search was modified to include only full text, peer-reviewed articles. There were
several articles identified. The final number yielded here was 966. However, of the 966 results
only a couple were kept for utilization for the evidence table.
The fourth and final database used was ProQuest. The first search started with Vietnam
AND international collaboration which resulted in over 79,000 finds. The search was expanded
by adding full text, peer-reviewed articles. The search in this database was refined ultimately to
include the key phrases of international collaboration AND Vietnam AND nursing education
AND quality improvement. This final search yielded 109 results. These were carefully reviewed
and only a few kept for analysis and further appraisal.
Evidence Synthesis
Ten studies were evaluated for their relevancy with international partnerships (Appendix
E). Five of the studies focused on educational partnerships. The other five focused on clinical
settings versus the academic setting. All ten studies were published from 2008 to 2016. Further
synthesis included assessing their levels of evidence (Appendix F). Two of the articles were level
one evidence which is evidence from a systematic review. Four of the studies were level four
from a well-designed case control, three were level five from qualitative studies and one was a
level six from a single descriptive/qualitative study (Melnyk & Fineout-Overholt, 2015).
Variables in the studies reviewed included partnership, improvement of care, and process
development. Of these variables five were directly related to partnerships, one related to
improvement of care, and four related to process development.
Reliability varied from high to low. Seven of the ten studies were highly reliable while
the remaining three were low. The higher reliability studies are more likely to be used for project

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purposes to enforce common concepts and themes. All studies demonstrated use of a theory or
conceptual model associated with international partnerships.
Through critical appraisal of each of these studies the author was able to collect
information on collaborative partnerships, international collaboration. Gaps in literature were
identified. The author was unable to find research related to nurse to nurse collaboration to
improve specific clinical outcomes in a medical center in Vietnam. The author was able to
identify several articles related to international collaboration via the academia setting. This
appraisal did lead to an understanding of international partnerships and global nursing
collaboratives.
Application to Practice
Although there was much heterogeneity found within the evidence, there are some
common themes that surface to establish effective international partnerships. Aside from the
complexity of these affiliations, both parties must be flexible and understand their cultural
differences to include language, lifestyle, health and economic resources (Zheng, et al., 2001).
The collaborative relationship between the U.S. and Vietnam nurses is strengthened by
the desire and motivation to improve the quality of care for patients. This unique experience will
require trust, care, nurturing, and determination (Crow & Ba Thuc, 2011). Open communication
will cultivate brainstorming on practice techniques with limited resources. The international
experience could have encouraging effects on U.S. and Vietnamese participants, positively
affecting professional practice (Bosworth, et al., 2006).

Evidence Based Practice Model

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Implementation of a quality improvement project requires consideration and planning.
The Ottawa Model of Research Use (OMRU) was utilized. The Ottawa Model (Appendix G)
provided a framework with six steps for applying innovation and a change in practice. The
Ottawa Model of Research Use is a knowledge translation model that directs the course of
shifting research into practice (Graham & Logan, 2004).
There is a total of six key elements, including practice environment, potential adopters,
research-based innovation, transfer strategies, adoption, and outcomes (Hogan & Logan, 2004).
Under the section of assess barriers and supports, there are three components that should be
evaluated. These components are evidence-based innovation, potential adopters, and practice
environment. The second section of monitor intervention and degree of use there is
implementation intervention strategies and adoption. The last portion of evaluate outcomes
includes the outcomes section. The OMRU is an interactive model that is effective in allowing
change across multiple settings. OMRU allows for mindful planning and implementation across
each stage of progression (Graham & Logan, 2004).
Contribution of Theory
The Adult Learning Theory perhaps is the most applicable theory that relates to
international partnerships as it relates to quality improvement. The Adult Learning Theory was
created by Malcolm Shepard Knowles. Knowles had five assumptions as it connects to adult
learners. These assumptions were: self-concept, adult learner experience, readiness to learn,
orientation to learning, and motivation to learn (Pappas, 2013).
With self-concept Knowles points out that a person matures to be a self-directed
individual. The notion of an adult learner experience comes from the idea that as one progresses
through life their experiences serve as a reservoir for resources related to learning. An

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individual’s readiness to learn relates closely to their social role while orientation to learning is
enacted when their learning shifts from subject to problem centeredness. All the while one’s
motivation to learn comes from their internal being (Pappas, 2013).
The Adult Learning Theory fits in proportion to international collaboration in that
international learning and exchange of information can only be done if an individual is ready to
absorb the provided information. The ability or sentiment of needing to know and being selfdirected are key elements that will be conveyed during this project (Cox, 2015).
Project Methods
To begin work at the hospital in Hanoi a letter of consent approving the collaboration was
obtained (Appendix H). The project plan was submitted to Arizona State University Internal
Review Board (IRB) to insure protection for human subjects. The IRB determined that the
proposed activity is not research involving human subjects as defined by DHHS and FDA
regulations and was given an exempt status (Appendix I).
The objective at the hospital in Hanoi was to assess nursing knowledge regarding urinary
catheter care insertion and maintenance. Initial stages of the project included the completion of
the Institute for Healthcare Improvement (IHI) Roadmap (Institute for Healthcare Improvement,
2018). The IHI Roadmap was utilized to establish a working document to identify the specific
steps and outcomes for of urinary catheter care.
The VPIP collaboration for quality improvement occurred between March and November
2017. Monthly synchronous on-line video conferences were conducted with the Nurse Practice
Council to design and implement new evidence-based practice guidelines. Most Vietnamese
nurses spoke only their native language; therefore, a designated translator was utilized during

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each video conference. In most cases, the translator was a Nurse Practice Council nurse. Notes
outlining the process were taken by the author during the videoconferences. Several hours of email exchanges contributed to the exchange of evidence-based information. All written
communication was stored on a password protected laptop computer and deleted at completion
of the project. Participants were not identified by name.
Intervention. The first step in the intervention was to determine the gap in nursing practice
the Nurse Practice Council wanted to improve. The nurses wanted to enhance their knowledge
base for urinary catheter insertion and care. Once the gap was identified the author began to
research the topic in multiple databases. The collaboration included providing evidence-based
information on best practice techniques related to urinary catheter maintenance. The author
provided articles in which was explained as best practice in the U.S. The Hanoi participants
sent pictures of supplies used to insert and maintain urinary catheters. These pictures were used
to create alternatives to U.S. best practices as resources are limited in Vietnam. Videos were
developed by the nurses demonstrating urinary catheter insertion, care and cleansing of the
perineal area.
A checklist was created to identify steps the nurses were currently performing to care for
the urinary catheter. Added to this checklist was the best practice skills that are recommended
standard of practice in the U.S. The initial checklist was used to demonstrate areas the
Vietnamese performed adequately and those requiring improvement. These areas for
improvement served as a foundation to heighten awareness and fully implement evidence-based
practice techniques. Alternatives to cleansers were identified as the team collaboratively worked
to find a safe and efficient alternative to chlorohexidine which is used in the United Stated. The
Nurse Practice Council and the author determined the use of betadine was the best alternative

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cleansing agent. Breeches in sterility were also identified and immediate feedback was provided
on correct techniques.
A pre-test was designed by the author and Nurse Practice Council to assess the
knowledge of nurses regarding urinary catheter insertion, urinary catheter maintenance, and
cleansing of the perineum. Once the best practice techniques had been established, the Nurse
Practice Council began to educate their nurses on these best practices as demonstrated through
evidence-based guidelines. After education was completed, the nurses were given a post-test.
The post-test was also designed by the author and the Nurse Practice Council. The post-test
would assess the same items as identified on the pre-test. Administration of a pre and post test
allowed the Nurse Practice Council to evaluate how effective their teaching was.
The outcome measures performed by the Nurse Practice Council at the Hanoi hospital
consisted of pre and post surveys. These surveys asked questions related to the necessity of the
urinary catheter, how to maintain the urinary catheter, how to care for the perineal area, and
assessing for signs and symptoms of urinary catheter infection.
Several Zoom meetings, dropbox videos, and e-mails allowed the opportunity to problem
solve and share ideas. The collaboration was robust as there were several questions and
conversations between Vietnamese and U.S. participants. Trust was established quickly. Factors
in developing this trust were the prompt and active responses, and the intentional demonstration
of respect for the willingness of the nurses to learn and improve the care provided to their
patients. They knew if they posed a question they would receive a quick answer whether
multifaceted or simple.
Project Results

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The Nurse Practice Council utilized a sample of 41 nurses in the General Surgical, Neuro
Surgical, and Intensive Care Units. The hospital team assessed the nurse’s knowledge in relation
to these techniques using a pre and post survey. The pre-survey identified gaps in perineal care
post urinary catheter insertion. Based on the gap analysis the nurse practice council developed a
checklist that discussed important components that would be included in a catheter bundle. Such
items include: indication for use, proper way to perform perineal care, and proper sterile
technique upon insertion. Education after the survey was conducted to nursing staff reviewing
evidence-based guidelines relative to urinary catheter maintenance.
Knowledge of perineal care post urinary catheter insertion increased from 73.2% to
96.5%. Additionally, assessing practice skills of the nurse regarding catheter care increased from
27% to 85% post project intervention. Other components measured were cleansing the perineal
area which climbed from 18.2% to 67.1 % and utilizing the appropriate cleaning agents rose
from 20% to 70%.
Discussion
Building a strategic global partnership requires the partnering nurses to establish trust,
share cultural experiences, and establish a shared vision (Stringer, et al., 2016). To sincerely
have an international partnership each stakeholder must have a shared vision and values that are
understood and respected by both sides (Tremethick & Smit, 2014). Not practicing our
professional accountability can lead to deflection and misrepresentation. The challenge lies with
establishing collaborative methods to initiate and implement project goals (Garner, Metcalfe, &
Hallyburton, 2009).
A review of the literature suggests little is known between the outcomes of quality
improvement initiatives in relation to international partnerships. Most of the studies discuss how

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to create and sustain the partnership through comprehensive schemes such as creativity, context,
trust, and values (Buckner, et al., 2014). Cultural competence is another element discussed
amongst the studies. This includes a progressive process incorporating learned skills, which
fosters quality care among health care professionals (Long, 2016).
One barrier encountered was some recommended supplies were not available in Vietnam
and alternative products had to be identified. Another barrier included skeptical physicians.
Vietnamese physicians are accustomed to giving direction in every regard within this Hanoi
hospital. Nurses are accustomed to following orders. Implementing evidence-based guidelines in
this setting is a change in culture and has been a struggle to surpass.

Plan for Sustainability
The Nurse Practice Council members at the Hanoi hospital also developed a plan for
sustainability. They developed and integrated a standardized procedure and checklist to care for
patients after catheterization. The council has educated all nursing staff regarding care for
patients who require urinary catheters. The Nurse Practice Council will continue to train their
staff nurses annually to keep knowledge update to date with current evidence-based practice
guidelines.
Conclusion
The objective of this project is to identify whether international partnerships effect
quality improvement in a Hanoi hospital. The mixture of studies reviewed suggests little is
known between outcomes of quality improvement initiatives in relation to international
partnerships. Building global partnerships requires establishing trust and a shared vision.

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Utilizing innovation leadership skills to assist Vietnamese nurses in developing and sustaining
practice changes is needed to move practice forward.
It is important to continue to investigate this association to develop clinical resources
accessible to Hanoi nurses to aid in applying evidence-based practice (Stringer, et al., 2014). The
implementation and analysis of the project will serve as a model for further development of
international partnerships linked to quality improvement in underdeveloped patient care settings.

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INTERNATIONAL COLLABORATION

25

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INTERNATIONAL COLLABORATION

26
Appendix A

Database Search Strategy 1
PubMed

INTERNATIONAL COLLABORATION

27
Appendix B

Database Search Strategy 2
CINAHL

INTERNATIONAL COLLABORATION

28
Appendix C

Database Search Strategy 3
JStor

INTERNATIONAL COLLABORATION

29
Appendix D

Database Search Strategy 4
ProQuest

INTERNATIONAL COLLABORATION

30
Appendix E

Table 1
Evaluation Table
Citation

Conceptual
Framework

Design/Method

Citation:
Anderson, K.H.
(2012).
Immersion
research
education:
students as
catalysts in
international
collaboration
research.
International
Nursing Review,
59(1), 502-510.

Adult learning
theory

Design: Case control,
3-month Research
practicum

Country: United
States, Germany,
Italy, Columbia,
England, Austria,
and Thailand

Aim: To narrow the
health care gap for
disadvantaged families
in the US and partner
countries.

Sample/Setting

N= 7 Countries
US, Germany,
Italy, Colombia,
England, Austria
and Thailand
Skype conferences,
site visits, and
intellectual
interactions
3-month research
practicum

Major
Variables &
Definitions
IV: MHIRT
Program
DV 1: Student
research
outcomes
DV 2: Crosscultural
collaboration
research
outcomes

Measurement

Weekly journal reports,
papers, documentation of
achievements, faculty
evaluation and student
experience summation.

Data
Analysis

Outcomes
encompass
research
products,
personal
growth and
role
development.

Findings

Cross
fertilization of
research,
cultural
awareness and
ideas about
improving
family health
occur through
education

Decision for Use in
Practice/Application
to Practice
LOE: IV
Strengths: Students as
catalysts in research
efforts. International
collaboration.
Limitations: United
States semester and
international universities
don’t coincide and
accommodations must be
made. Group meeting
across time zones offer
challenges.

N= 70 Students
-52 H
-11 A/C
-4 A
-3 MR

Conclusions:
Collaborative efforts of
faculty and students
facilitate the growth of
international partner
research base.

Funding: Project
supported by
‘Training in
Feasibility: Hands on
Chronic Illness
training for students to
Research Group
serve as international
in Georgia and
researchers.
Abroad’ from the
National Institute
for Minority
Health and
Health
Disparities,
Table Key: A-Asian, AA-African American, A/C-African/Caribbean Black, C-Caucasian, CC- Cultural Competence, CINAHL-Cumulative Index to Nursing & Allied Health Literature, EBPEvidence Based Practice, ERIC-Educational Resources Information Center, F-Female GDP-Gross Domestic Product, H-Hispanic, HIC-High-Income Country, ICE-International Clinical Education,
ISL-International Service Learning, KAP- Knowledge, Attitude, Practice, L-Latino, LIC-Low-Income Country, M-Male, MHIRT- Minority Health International Research Training, MR-Mixed Races,
N-Native American, P-Pacific Islander, OECD-Organization for Economic Co-operation and Development, OT-Occupational Therapy, PsychINFO-Psychological Information Index, RADARResponsibility, Anticipation Discussion, Assessment, Response, RRI-Rapid Results Initiative, UB-University of Botswana, US-United States

INTERNATIONAL COLLABORATION

31

National
Institutes of
Health.
Bias: None
acknowledged.

Citation

Citation:
Black, A.T.
(2015).
Promoting
evidence-based
practice through
a research
training program
for point of care
clinicians. The
Journal of
Nursing
Administration,
45(1), 14-20.

Conceptual
Framework
Learning
Theory

Design/Method

Design: Mixed
methods design
Aim: Evaluate the
effect of research
training on clinician’s
attitude and knowledge
and practice related to
evidence based
practice.

Sample/Setting

Survey 1 (n=101)

Major
Variables &
Definitions
IV: Clinicians in
Canadian health
care

Survey 2 (n=68)
Survey 3 (n=34)

Participant
recruited from
organizational
employees who
applied to be part
of training
program.

DV1:
Baccalaureate
degree
DV 2: Practice
>10 years

Measurement

KAP survey.
KAP= 5 factors:
identifying clinical
problems, establishing
current best practice,
implementing research into
practice, administering
research implementation
and
conducting/communicating

DV 3: Gender
Survey administered in 3
waves

Country:
Canada

Data
Analysis

Findings

Results show
that a research
training
program can
successfully
increase
clinicians’
research
knowledge and
offer them a
sense of
confidence and
excitement
about their
clinical
practice

3 key themes:
benefit from
training
program,
impact of
training
program on
EBP,
challenges
faced by
beginner
researchers.

Decision for Use in
Practice/Application
to Practice
LOE: IV
Strengths: Quantitative
and qualitative research
Limitations: Restricted to
clinicians working at
Canadian health care
organization. Potential
clustering among research
team members.
Conclusions: Health care
organizations can no
longer afford for EBP to
remain abstract.
Feasibility: Promising
initiative highlighting the
importance of research.

Funding:
Received from
Michael Smith
Foundation for
Health Research
Bias: None
acknowledged.

Citation

Citation:
Buchan, J.
(2015). Policies
to sustain the
nursing
workforce: an
international

Conceptual
Framework

Design/Method

Inter
professional
education and
practice

Design: Quantitative
data analysis.
Workforce policy
content was explored.
Aim: Examine metrics
and policies regarding

Sample/Setting

N= 4 countries
Data from the
OECD were used
to compare
expenditure,

Major
Variables &
Definitions
DV 1:
Expenditure
DV 2:
Workforce
DV 3: Health

Measurement

Total health care
expenditure percent of
gross domestic product

Data
Analysis

Findings

OECD average
>70% in
United
Kingdom

Future supply
of nurses in
all four
countries is
vulnerable.

Decision for Use in
Practice/Application
to Practice
LOE: I
Strengths: Identified
problems are similar in all
four countries

Australia has
highest life

Table Key: A-Asian, AA-African American, A/C-African/Caribbean Black, C-Caucasian, CC- Cultural Competence, CINAHL-Cumulative Index to Nursing & Allied Health Literature, EBPEvidence Based Practice, ERIC-Educational Resources Information Center, F-Female GDP-Gross Domestic Product, H-Hispanic, HIC-High-Income Country, ICE-International Clinical Education,
ISL-International Service Learning, KAP- Knowledge, Attitude, Practice, L-Latino, LIC-Low-Income Country, M-Male, MHIRT- Minority Health International Research Training, MR-Mixed Races,
N-Native American, P-Pacific Islander, OECD-Organization for Economic Co-operation and Development, OT-Occupational Therapy, PsychINFO-Psychological Information Index, RADARResponsibility, Anticipation Discussion, Assessment, Response, RRI-Rapid Results Initiative, UB-University of Botswana, US-United States

INTERNATIONAL COLLABORATION
perspective.
International
Nursing Review,
62(1), 162-170.

nurse workforce across
four countries.

32
workforce, and
health

expectancy at
almost 82
years

-total expenditure
on health (% GDP)

Country:
Australia,
Portugal, United
Kingdom, United
States

Limitations: Variation in
overall impact of global
fiscal crisis in countries in
research.

United States
with lowest
life expectancy
of 78.7 years

-public expenditure
on health (% total
expenditure on
health)

Conclusions: Differences
in context and nursing
workforce policy
available in all four
countries.
Feasibility: Scope for
improved productivity
through advance practice
nurse roles evident in all
four countries.

Funding:
Partially
supported by the
Center for Health
Policy, Columbia
University
School of
Nursing
Bias: None
acknowledged.

Citation

Citation:
Buckner, E. B.
(2014).
Perspectives on
global nursing
leadership:
International
experiences from
the field.
International
Nursing Review,
61(4), 463-471.
Country: United
States, Pakistan,
The Netherlands,
Hong Kong,
Colombia,
Australia

Conceptual
Framework
Hofstede’s
culture
dimensions

Design/Method

Method: Personal
stories of global
leadership
Design: Dialogues
among
participants/conference
calls/videoconferences
Aim: Strengthen
individual and
collective capacity as
nursing leaders in a
global society.

Sample/Setting

Major
Variables &
Definitions

N= 6 countries

IV: Interviews

Year-long
discussion on
global leadership.

DV 1: Power
distance

Field experiences
in practice and
education were
shared.
Emerging
perspectives and
leadership themes
represented all
contexts of
practice, education,
research and
policy.

DV 2:
Individualism
DV 3:
Masculinity
(masculine or
feminine)
DV 4:
Uncertainty
avoidance

Measurement

Discussions/interviews

Data
Analysis

Findings

Data analysis
revealed
numerous
quality issues
in medication
dosing, timing
of lab,
standardization
of protocols,
and variations
of
consultations.

Final
resolutions
took 18
months;
outcomes
were achieved
Six
framework
elements
found:
creativity,
change,
collaboration,
community,
context, and
courage

Decision for Use in
Practice/Application
to Practice
LOE: I
Strengths: Six framework
elements found:
creativity, change,
collaboration, community,
context, and courage
Limitations: Definition
of framework
Conclusions: Strong basis
for furthering leadership
development has been
found.
Feasibility: Nurse leaders
from six countries were
engaged in the year long
discussion

Table Key: A-Asian, AA-African American, A/C-African/Caribbean Black, C-Caucasian, CC- Cultural Competence, CINAHL-Cumulative Index to Nursing & Allied Health Literature, EBPEvidence Based Practice, ERIC-Educational Resources Information Center, F-Female GDP-Gross Domestic Product, H-Hispanic, HIC-High-Income Country, ICE-International Clinical Education,
ISL-International Service Learning, KAP- Knowledge, Attitude, Practice, L-Latino, LIC-Low-Income Country, M-Male, MHIRT- Minority Health International Research Training, MR-Mixed Races,
N-Native American, P-Pacific Islander, OECD-Organization for Economic Co-operation and Development, OT-Occupational Therapy, PsychINFO-Psychological Information Index, RADARResponsibility, Anticipation Discussion, Assessment, Response, RRI-Rapid Results Initiative, UB-University of Botswana, US-United States

INTERNATIONAL COLLABORATION

33

Funding: This
research received
no specific grant
from any funding
agency in the
public,
commercial, or
not-for-profit
sectors.
Bias: None
acknowledged.

Citation

Citation:
Long, T. (2016).
Influence of
international
service learning
on nursing
students’ selfefficacy towards
cultural
competence.
Journal of
Cultural
Diversity. 23(1),
28-33.
Country: Belize,
Central America
Funding: None
identified.
Bias: None
noted.

Conceptual
Framework
Badura’s
Social
Cognitive
Theory
Leininger’s
theory of
transcultural
nursing

Design/Method

Sample/Setting

Design: Qualitative
and quantitative
analysis of influence
of a two-week service
learning medical
experience on a
student-nursing group
who traveled abroad to
Belize, Central
America.

N= 19
-Caucasian (C)=14
-Latino (L)=1
-Pacific Islander
(P)=1
-African American
(AA)=3
-Native American
(N)=1

Aim: To measure
cultural competence,
provide students with
formal training in
cultural competence,
to provide students
with real life
experiences working
with a population, to
allow students to gain
experience in a rural
clinic, to identify
qualitative themes of
learning,

-Male (M)=1
-Female (F)=18

Likert Scale of 1-5
used

Age: >50=3
40-49=2, 30-39=2,
20-29=12
Prior CC
Training:
Yes=14
No=4
Prior Travel
Abroad:
Yes= 13
No= 6

Major
Variables &
Definitions

Measurement

IV: Students

t-score=8.957

DV 1: Prior CC
Training

p-value=6.20x 10(-8),
x=121.94, Sx=56.3

DV 2: Prior
Travel Abroad
DV 3: Prior
Language
Training

Data
Analysis

Findings

Quantitative
data analyzed
with a one
sample
matched pair ttest

Assumption
1: participants
self- selected
randomly

Null
hypothesis was
Ho=o
Qualitative
data collected
from self reflection
journals
identified
common
themes such as
cultural shock,
gratitude and
self-awareness

Assumption
2: samples are
independent
Assumption
3: population
standard
deviation
sigma is
unknown
Assumption
4: 10N<N
Assumption
5: population
of differences
is normally
distributed, N
is > 30

Decision for Use in
Practice/Application
to Practice
LOE: IV
Strengths: Clinical
exposure to client
diversity
Limitations: Small
sample size. Data not
collected to measure
improvement in Spanish
speaking ability
Conclusions:
Significantly improved
self-efficacy, selfconfidence and selfawareness. Valuable
learning experience
Feasibility: Educators
need to be aware of
cultural competence

Prior Language
Training:
Spanish= 7
Table Key: A-Asian, AA-African American, A/C-African/Caribbean Black, C-Caucasian, CC- Cultural Competence, CINAHL-Cumulative Index to Nursing & Allied Health Literature, EBPEvidence Based Practice, ERIC-Educational Resources Information Center, F-Female GDP-Gross Domestic Product, H-Hispanic, HIC-High-Income Country, ICE-International Clinical Education,
ISL-International Service Learning, KAP- Knowledge, Attitude, Practice, L-Latino, LIC-Low-Income Country, M-Male, MHIRT- Minority Health International Research Training, MR-Mixed Races,
N-Native American, P-Pacific Islander, OECD-Organization for Economic Co-operation and Development, OT-Occupational Therapy, PsychINFO-Psychological Information Index, RADARResponsibility, Anticipation Discussion, Assessment, Response, RRI-Rapid Results Initiative, UB-University of Botswana, US-United States

INTERNATIONAL COLLABORATION

34
French= 4
German=
Italian= 1
None= 8
Qualitative Data
collected from selfreflection journals

Citation

Citation:
Pechak, C.M.
(2014).
Exploring
international
clinical
education in US
based programs:
identifying
common
practices and
modifying an
existing
conceptual
model of
international
service learning.
Physiotherapy
theory and
practice, 30(2),
94-104.

Conceptual
Framework
ICE
conceptual
model

Design/Method

Design: Qualitative
content analysis
Aim: Explore various
international clinical
education programs
and determine whether
the conceptual model
of Optimal
International ServiceLearning could be
applied or adapted to
represent ICE.

Sample/Setting

N= 15 participants
Sample included
14 faculty
employed at 13
physical therapist
education programs
offering ICE, 2
were from the same
institution. 5 were
directors of clinical
education
-ICE experiences
in different
countries

Major
Variables &
Definitions
IV: Interview
guide
DV 1:
Evaluation
phase

Measurement

Interview transcriptions
were systematically
analyzed by two
researchers

DV 2:
Enhancement
phase

Data
Analysis
Reflective
memos
identified
additional
probes,
emerging
themes, and
the need to
recruit
additional
participants

DV 3:
Developed
countries
DV 4: Less
developed
countries

Findings

3 models of
ICE emerged:
traditional
clinical
education,
global health,
hybrid.
Data
supported
revising
essential core
conditions,
components
and
consequence.

Decision for Use in
Practice/Application
to Practice
LOE: V
Strengths: Global
engagement being on high
level of interest
Limitations: Results
represent the views and
experiences of a small
sample
Conclusions: ICE
conceptual model
provides useful
framework for future
development and
research.
Feasibility: Global
engagement in physical
therapist education

Country: US
Funding: None
identified.
Bias: None
acknowledged.

Citation

Conceptual
Framework

Design/Method

Sample/Setting

Major
Variables &
Definitions

Measurement

Data
Analysis

Findings

Decision for Use in
Practice/Application
to Practice

Table Key: A-Asian, AA-African American, A/C-African/Caribbean Black, C-Caucasian, CC- Cultural Competence, CINAHL-Cumulative Index to Nursing & Allied Health Literature, EBPEvidence Based Practice, ERIC-Educational Resources Information Center, F-Female GDP-Gross Domestic Product, H-Hispanic, HIC-High-Income Country, ICE-International Clinical Education,
ISL-International Service Learning, KAP- Knowledge, Attitude, Practice, L-Latino, LIC-Low-Income Country, M-Male, MHIRT- Minority Health International Research Training, MR-Mixed Races,
N-Native American, P-Pacific Islander, OECD-Organization for Economic Co-operation and Development, OT-Occupational Therapy, PsychINFO-Psychological Information Index, RADARResponsibility, Anticipation Discussion, Assessment, Response, RRI-Rapid Results Initiative, UB-University of Botswana, US-United States

INTERNATIONAL COLLABORATION
Citation:
Sochan, A.
(2008).
Relationship
building through
the development
of international
nursing
curricula: a
literature review.
International
Nursing Review,
55, 192-204.

International
Collaboration

Design: Extensive
literature search
Aim: Explore the
literature related to the
development of
international nursing
curricula as a vehicle
for studying
relationship-building

Country: United
States, Australia,
Brazil, Canada,
China, Denmark,
Kenya, Kiribati,
Mexico, New
Zealand,
Nicaragua,
United Kingdom

35
Databases used:
CINAHL, ERIC,
PsychINFO,
ABI/INFORM
Global
N=25 References
Exclusions:
Terms relating to
generalized
international
collaborative,
partnership and
exchange activities,
and broader terms
generalized
international higher
education
development

IV:
International
nursing
curricula

Extensive search
conducted in CINAHL,
ERIC, PsychINFO,
ABI/INFORM Global

DV 1: Local
curriculum
development
process

Terms used included:
relationship building,
international, curriculum
development, nursing

DV 2:
International
curriculum
development
process

Effective
working
relationships
are essential to
international
development
initiatives.
Positive
interpersonal
relationships
are key.

Developing
international
nursing
curricula
through
cooperative
partnerships
provides a
vehicle to
build
relationships.

LOE: V
Strengths: Unique
opportunity to build
international relationships
Limitations: Complex
nature of donor influences
Conclusions:
Relationship building
through the development
of international nursing
curricula merits focused
investigation
Feasibility: Reports
describe developing
international nursing
curricula as unique
opportunities

Funding: None
identified.
Bias: None noted

Citation

Citation:
Stringer, M.
(2016). Bridging
nursing practice
and education
through a
strategic global
partnership.
International
Journal of
Nursing Practice,
22, 43-52.

Conceptual
Framework
Donabedian
model

Design/Method

Design: Systematic
review

Sample/Setting

UB

Major
Variables &
Definitions
IV: Practice
Models

Measurement

Phase specific
collaborative team model

Data
Analysis

Findings

UB nurse
scholars led
team in
implementing
EBP.

Reduction in
length of stay
for patients in
med-surg
from 7-10
days to 3-5
days

Decision for Use in
Practice/Application
to Practice
LOE: V

N= 5 nurse
Strengths: Key principles
Aim: Engage nurse
scholars
DV 1: RRI
Collaborated over 2in global nursing
scholars from
To improve care month period
partnerships are used to
education, research,
for general
advance education and
practice, and
surgery patients
4-week immersion
practice
administration in work
experience
to advance the
DV 2: RADAR
Formulation
Limitations: Resource
scientific foundations
to promote
Week 1: Teaching and
of plans of
allocation.
for EBP and research
interdisciplinary EBP
care
Interdisciplinary
utilization at PMH and
pain care
Week 2: Palliative care
encounter underscoring
to align education with
and quality improvement
practice by preparing
Week 3: Learning
Conclusions: Continued
Country:
Botswana
nursing faculty and
strategies and peer review
communication in
Table Key: A-Asian, AA-African American, A/C-African/Caribbean Black, C-Caucasian, CC- Cultural Competence, CINAHL-Cumulative Index to Nursing & Allied Health Literature, EBPEvidence Based Practice, ERIC-Educational Resources Information Center, F-Female GDP-Gross Domestic Product, H-Hispanic, HIC-High-Income Country, ICE-International Clinical Education,
ISL-International Service Learning, KAP- Knowledge, Attitude, Practice, L-Latino, LIC-Low-Income Country, M-Male, MHIRT- Minority Health International Research Training, MR-Mixed Races,
N-Native American, P-Pacific Islander, OECD-Organization for Economic Co-operation and Development, OT-Occupational Therapy, PsychINFO-Psychological Information Index, RADARResponsibility, Anticipation Discussion, Assessment, Response, RRI-Rapid Results Initiative, UB-University of Botswana, US-United States

INTERNATIONAL COLLABORATION

36

practice leaders to
collaborate in
addressing health
problems and issues of
greatest concern to the
well-being of the
citizens of Botswana.

Funding:
Partially
supported by
funding from the
University of
Pennsylvania
Tiffany
Foundation
Grant and inkind support
from UPenn,
University of
Botswana,
Princes Marina
Hospital (PMH),
and the
Botswana
Ministry of
Health.

Week 4: Patient safety and
project development

Framework
guides
collaboration
to achieve
goals.

opportunities for
advancing scientific
foundations for nursing
education and practice
Feasibility: Initial time
invested in planning was
successful in
strengthening team
dynamics

Bias: None
acknowledged.

Citation

Conceptual
Framework

Sample/Setting

Design: Quantitative
and qualitative

Quantitative data:
age, gender, level
of education,
nursing setting,
number of years in
nursing, number of
years in current
nursing position,
whether the nurse
spoke English,
whether
participants enjoy
nursing

Major
Variables &
Definitions
IV: Interview
protocol sheet

Measurement

Qualitative questions:
-What made you become a
nurse?
-Describe your typical day.
-What aspects of nursing
do you find rewarding?
-What aspects of nursing
do you find difficult?

Data
Analysis

Findings

Decision for Use in
Practice/Application
to Practice

SPSS
8/12 auxiliary
LOE: VI
descriptive
nurses wanted
analysis
to become
Strengths: Consistency of
Aim: To describe the
-Ages between
professional
single interviewer, broad
current status of
23 and 49 with
nurses, 3/12
sample, accuracy of
healthcare in Honduras
mean of 36
reported an
interpretation, translation
and to learn about the
-Worked as a
interest in
work of Honduran
nurse for
pursuing
Limitations:
nurses.
between 0.5
technical
Convenience sample, data
Quantitative: age, gender,
years and 23
training. 1/3
collected in single area of
level of education, practice years with a
professional
Honduras, participation
setting, number of years in
mean of 8.70
nurses wanted only of nurses employed
nursing, number of years
years
to pursue
by Honduran government
in current position, English -Held their
master’s
-15 Face to face
speaking
current
degree
Conclusions:
interviews (N=15)
positions
Understanding
between 0.5
Qualitative
experiences and needs of
years and 18
data showed
nurses in international
Country:
Honduras
years with a
two themes:
setting is critical to
mean of 5.83
altruism and
develop collaborative
years
impact of
partnerships.
Table Key: A-Asian, AA-African American, A/C-African/Caribbean Black, C-Caucasian, CC- Cultural Competence, CINAHL-Cumulative Index to Nursing & Allied Health Literature, EBPEvidence Based Practice, ERIC-Educational Resources Information Center, F-Female GDP-Gross Domestic Product, H-Hispanic, HIC-High-Income Country, ICE-International Clinical Education,
ISL-International Service Learning, KAP- Knowledge, Attitude, Practice, L-Latino, LIC-Low-Income Country, M-Male, MHIRT- Minority Health International Research Training, MR-Mixed Races,
N-Native American, P-Pacific Islander, OECD-Organization for Economic Co-operation and Development, OT-Occupational Therapy, PsychINFO-Psychological Information Index, RADARResponsibility, Anticipation Discussion, Assessment, Response, RRI-Rapid Results Initiative, UB-University of Botswana, US-United States
Citation:
Tremethick, M.J.
(2014).
Honduran nurses
work-related
rewards and
challenges:
Implications for
international
service learning
and
collaboration.
The Online
Journal of Issues
in Nursing,
19(2), 1-10.

Collaborative
partnership
theory

Design/Method

INTERNATIONAL COLLABORATION

37

Funding: None
noted.

-80% (12
nurses) were
female and
20% (3) were
male
-12 of the
nurses were
auxiliary
nurses, 3 were
professional
nurses
-All nurses
were employed
in government
clinics with six
nurses
employed in
rural clinics
and nine in a
clinical town
of 12,000
people
-2 nurses
spoke English
-All nurses
reported
enjoying
nursing
-26.7% (4)
nurses reported
they had
worked with
nurses or
nursing
students from
the US in the
past

Bias: None
noted.

Citation

Conceptual
Framework

Design/Method

Sample/Setting

Major
Variables &
Definitions

Measurement

Data
Analysis

poverty and
lack of
financial and
human
resources

Findings

Feasibility: Accurate
interpretation of
interviews; validation

Decision for Use in
Practice/Application
to Practice

Citation:
International
Design: Case study
N=2
IV: Partnership
Investigation of structural Dynamics
Participants
LOE: IV
Tupe, D.
partnership
and institutional conditions examined and
have gained
A.(2015).
theory
Aim: To describe a
US school of OT
that shape international found to have
trust and
Strengths: International
DV 1:
Building
partnership between
Governance
partnerships
substance for
diversity via
development towards
international
two US schools of OT
sustainable
collective
equal partnerships
sustainable
and a Cuban
collaborative
sharing of
Table Key: A-Asian, AA-African American, A/C-African/Caribbean Black, C-Caucasian, CC- Cultural Competence, CINAHL-Cumulative Index to Nursing & Allied Health Literature, EBPEvidence Based Practice, ERIC-Educational Resources Information Center, F-Female GDP-Gross Domestic Product, H-Hispanic, HIC-High-Income Country, ICE-International Clinical Education,
ISL-International Service Learning, KAP- Knowledge, Attitude, Practice, L-Latino, LIC-Low-Income Country, M-Male, MHIRT- Minority Health International Research Training, MR-Mixed Races,
N-Native American, P-Pacific Islander, OECD-Organization for Economic Co-operation and Development, OT-Occupational Therapy, PsychINFO-Psychological Information Index, RADARResponsibility, Anticipation Discussion, Assessment, Response, RRI-Rapid Results Initiative, UB-University of Botswana, US-United States

INTERNATIONAL COLLABORATION
partnerships in
occupational
therapy: A case
study.
Occupational
Therapy
International,
22(3), 131-140.
Country: United
States, Cuba
Funding: None
identified.

community based
pediatric clinic.
Examines what
dynamics sustain
partnership.

38
DV 2:
Opportunity
DV 3:
Disability and
social inclusion

international
partnerships

voices and
power

Limitations: Formation
requires awareness of self
and personal biases
Conclusions: Results
gleaned sustainable
partnerships must promote
health benefits molded by
social, economic, and
political contexts
Feasibility: Promote
health benefits,
organizational structure

Bias: None
noted.

Table Key: A-Asian, AA-African American, A/C-African/Caribbean Black, C-Caucasian, CC- Cultural Competence, CINAHL-Cumulative Index to Nursing & Allied Health Literature, EBPEvidence Based Practice, ERIC-Educational Resources Information Center, F-Female GDP-Gross Domestic Product, H-Hispanic, HIC-High-Income Country, ICE-International Clinical Education,
ISL-International Service Learning, KAP- Knowledge, Attitude, Practice, L-Latino, LIC-Low-Income Country, M-Male, MHIRT- Minority Health International Research Training, MR-Mixed Races,
N-Native American, P-Pacific Islander, OECD-Organization for Economic Co-operation and Development, OT-Occupational Therapy, PsychINFO-Psychological Information Index, RADARResponsibility, Anticipation Discussion, Assessment, Response, RRI-Rapid Results Initiative, UB-University of Botswana, US-United States

INTERNATIONAL COLLABORATION

39
Appendix F

Table 2
Synthesis Table
Author
Anderson
Year
2012
LOE
IV
Study Design
Mixed Methods
X
Qualitative
Quantitative
Case Study
Homogeneity
—
Heterogeneity
+
Variables of Interest
Partnership
X
Improvement of Care
Process Development
Reliability
↓
Outcome of Interest
Y
Worth of Study to Practice
Y

Black
2015
IV

Buchan
2015
I

X

Buckner
2014
I

Long
2016
IV

Pechak
2014
V

X
X

X

—
+

—
+

Sochan
2008
V

X
X

—
+

—
+

X

X

—
+

X

Stringer Tremethick
2016
2014
V
VI

Tupe
2015
IV

X
X
X

—
+

—
+

—
+

X
—
+

X

X

↑
Y
Y

↓
Y
Y

X
↑
Y
Y

↑
Y
N

X
↑
Y
Y

X
↑
Y
N

X
↓
N
N

Key: + = Present, - = Not Present, ↑ = High, ↓ = Low, Y = Yes, N = No

X
↑
Y
Y

↑
Y
Y

INTERNATIONAL COLLABORATION

40
Appendix G

Ottawa Model of Research Use (OMRU)

http://ktdrr.org/ktlibrary/articles_pubs/ncddrwork/focus/focus18/figure2.html

INTERNATIONAL COLLABORATION

41
Appendix H

Letter of Consent

INTERNATIONAL COLLABORATION

42
Appendix I
IRB Letter