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treatment, and alternative approaches to care.
Data that are generated by focus groups may not be easily obtainable through other meth- ods, such as surveys, face-to-face interviews, or questionnaires. Beliefs and practices about health and disease can be deliberated on within the context of a group of individu- als who share knowledge and experiences about various phenomena, and a large clus- ter of data can be generated in a short period of time (Fern, 2001; James, McGlone West, &
Madrid, 2013).
There are some methodological require- ments that should be considered when using focus groups; typically, they are 90 to 120 minutes in duration and consist of 7 to 12 individuals (Fern, 2001). The inherent nature of focus groups suggests that they should be well-planned and tightly orga- nized events with a stated purpose and a specifi c outcome use for the data. A set of soundly written research questions that are based on the current state of knowledge that is being explored should serve as the basis for the questions, which guide a discussion (Gibbs, 1997; Merton & Kendall, 1946).
Recent research studies suggest that focus groups are widely used to explore approaches to improving health outcomes.
Focus groups can be advantageous when there are divergent opinions and differences among people who must make important decisions regarding a variety of issues, such as those that confront nursing and health care (Higgins, Porter, & O’Halloran, 2014;
Then, Rankin, & Ali, 2014). Matters that could be explored with this methodology might include identifying health disparities in rural and underserved populations, or exploring the needs of patients with severe mental ill- ness and their caregivers (Then et al., 2014).
Even though educators and researchers might be aware that these disparities or needs exist, the opulent and/or candid information that focus group data provide can allow for more accurate identifi cation of specifi c areas for intervention, or barriers to care that might not otherwise be revealed (Angelo, Egan,
& Reid, 2013; James et al., 2013; Kreuger &
Casey, 2009; Then et al., 2014).
teaching practice. Nursing Education Perspectives, 28(3), 164–167.
Mupinga, D. M., & Maughan, G. R. (2008).
Web-based instruction and community college faculty workload. College Teaching, 56(1), 17–21.
Townsend, B. K., & Rosser, V. J. (2007).
Workload issues and measures of faculty productivity. The NEA Higher Education Journal, Fall 2007, 7–20.
Yuker, H. E. (1984). Faculty workload: Research, theory and interpretation. ASHE-ERIC Higher Education Research Report No. 10, 1984. Washington DC: Association for the Study of Higher Education.
Maria A. Mendoza
F
OCUSG
ROUPSDEFINITION
The focus group is a form of qualitative research used to organize group discussions around a specifi c topic or set of issues that will yield focused experiences, opinions, or points of view that are deliberated on dur- ing group interactions. Topics such as the causes of societal stigma about mental illness or examination of a public health announce- ment for cultural and developmental sensi- tivity are examples of its utility (Kitzinger, 1994). Focus groups are widely used in mar- keting, social research, and, in recent years, health care, including nursing. The key ele- ments that differentiate focus groups from other types of inquiry are the insights and data that are produced during interactions among participants (Kitzinger, 1994).
APPLICATION
Focus groups provide an excellent approach for determining why and how people think the way they do about specifi c phenomena.
Focus groups can be used to explore how individuals understand health and disease,
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are being generated by the group (Higgins et al., 2014; Kitzinger, 1994).
RECOMMENDATIONS
Focus groups can be powerful tools in nursing when data are needed about atti- tudes, perceptions, behaviors, and moti- vations about a particular phenomenon such as health and disease. They are also useful when working with groups that have limited literacy and might otherwise be excluded from other types of research protocols. Technological advances make the method more accessible to nurse edu- cators and researchers through the use of audio- and video-recording devices that capture the essence of discussions, and computer software that can aid in data analyses. However, the essence of the value of the focus group is embedded in the interpretation and application of the information that can be gleaned from group interactions. The application of the findings from a focus group should be carefully employed. Within the context of focus group methods and data generation, the 15 National Standards for Culturally and Linguistically Appropriate Services (CLAS) in research and clinical practice might provide guidance for the advance- ment of health equity and the improve- ment of health outcomes for all people (U.S. Department of Health and Human Services, 2012).
ACKNOWLEDGMENT
Ms. Lindsey Irwin has assisted with the development of this chapter. She has added an additional dimension to this chapter.
Her knowledge and expertise are deeply appreciated.
Angelo, J., Egan, R., & Reid, K. (2013). Essential knowledge for family caregivers: A qualitative study. International Journal of Palliative Nursing, 19(8), 383–388.
Fern, E. E. (2001). Advanced focus group research.
Thousand Oaks, CA: Sage.
Importantly, the challenge to accurately identify and respond to the health needs of America’s dramatic demographic population shifts could be enhanced through the use of focus groups (Angelo et al., 2013; McDonald, Kidney, & Patka, 2013). When working with people from varied racial/ethnic back- grounds and perspectives, focus groups can provide powerful methods for exploring cultural infl uence on morbidity, mortality, and well-being. Focus groups can help to galvanize trust among health care workers and individuals with chronic or terminal ill- nesses and their families. This method can help patients and families unravel personal experiences with specifi c disease conditions in the service of improving health care, or structuring salient research questions for future exploration, or addressing changes in nursing curricula.
SYNOPSIS
Whether addressing health dispari- ties or overall improvements in care, the rich details afforded by this data col- lection approach has led to an increase in the use of focus groups in health care research over the last several decades (Then et al., 2014). Focus groups provide a forum through which the needs and perspectives of all involved parties are identified and on which future inquiry and evidence-based practice can be gen- erated (Ryan, Lillie, Thwaites, & Adams, 2013). Another distinct advantage of focus groups is that they give people with lim- ited literacy a chance to express concerns within the group milieu, where a comfort- able and welcoming environment can be established and maintained by the leader.
However, the researcher must be aware of some of the disadvantages of focus groups:
guidelines about how confidentiality will be handled should be addressed, and some group members might decide to remain quiet because of disagreement with the decisions that the group could make or because they feel their thoughts are not within the mainstream of the themes that
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be heard”: Research participants’
views on research. Journal of Intellectual Disability Research, 57(3), 216–225.
doi:10.1111/j.1365–2788.2011.01527.x
Merton, R. K., & Kendall, P. L. (1946).
The focused interview. American Journal of Sociology, 51(6), 541–557. doi:
10.1086/219886
Ryan, S., Lillie, K., Thwaites, C. M., &
Adams, J. (2013). “What I want clinicians to know”—experiences of people with arthritis. British Journal of Nursing, 22(14), 808–812.
Then, K. L., Rankin, J. A., & Ali, E. (2014).
Focus group research: What is it and how can it be used? Canadian Journal of Cardiovascular Nursing, 24(1), 16–22.
U.S. Department of Health and Human Services Offi ce of Minority Health. (2012).
National CLAS standards. Retrieved from https://www.thinkculturalhealth.hhs .gov/Content/clas.asp
Faye Gary Gibbs, A. (1997). Focus groups. Social
research update (University of Surrey, UK).
Retrieved from http://sru.soc.surrey.ac .uk/SRU19.html
Higgins, A., Porter, S., & O’Halloran, P. (2014).
General practitioners’ management of the long-term sick role. Social Science and Medicine, 107, 52–60. doi:10.1016/j.
socscimed.2014.01.044
James, R. D., McGlone West, K., & Madrid, T.
M. (2013). Launching native health leaders:
Reducing mistrust of research through student peer mentorship. American Journal of Public Health, 103(12), 2215–2219. doi:
10.2105/AJPH.2013.301314
Kitzinger, J. (1994). The methodology of focus groups: The importance of interaction between research participants. Sociology of Health, 16(1), 103–121. doi:10.1111/1467–
9566.ep11347023
Kreuger, R. A., & Casey, M. A. (2009). Focus groups: A practical guide for applied research.
Thousand Oaks, CA: Sage.
McDonald, K. E., Kidney, C. A., & Patka, M. (2013). “You need to let your voice
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G
G
LOBALL
EARNINGDEFINITION
Global learning in nursing education is an integrated comprehensive framework that provides students with multiple ways of learning, including theoretical, experiential, and refl exive learning. Global learning is “a critical analysis of and an engagement with complex, interdependent global systems and legacies (such as natural, physical, social, cultural, economic, and political) and their implications for people’s lives and the earth’s sustainability” (Rhodes, 2010). Through refl ective and critical thinking, global learn- ing provides students with a deeper under- standing of themselves and members of the global community, both “around the corner and across the globe.”
APPLICATION
Nurses need to be educated as global citi- zens who have a moral responsibility and professional competency to care and pro- mote health beyond their local communities and national institutions (Chavez, Peter, &
Gastaldo, 2008). The new global interde- pendence calls for all persons across the globe to extend their thinking about moral responsibility and health beyond their local communities and national citizenship and to become citizens of the world (Crigger, Brannigan, & Baird, 2006). Nussbaum (1997) describes three capacities necessary for the cultivation of global citizenship. The fi rst is refl exivity, the capacity to examine our
beliefs, traditions, habits, and ourselves critically. Nussbaum’s second capacity for global citizenship entails the notion of
“moral cosmopolitanism,” meaning adopt- ing the fundamental view of all persons as fellow citizens who have equal moral worth and deserve equal moral consideration.
Narrative imagination is the third capacity.
This requires the ability to imagine what it might be like to be a person different from oneself, and to allow such imagination to inform understanding of the other per- son’s experiences, emotions, and desires (Nussbaum, 1997). Being exposed to other cultures and people is one aspect of devel- oping this kind of narrative imagination (Chavez, Bender, & Gastaldo, 2011).
A theoretical framework in global learn- ing, specifi cally postcolonial framework, provides an analytic lens to look at the impact of health with the intersecting fac- tors of power, race, gender, and social class.
Postcolonial feminism represents an oppor- tunity for nurses to acknowledge their mul- tiple locations as individuals and health care professionals. It challenges deeply held cer- tainties about the “right way” to provide care and values all knowledge as being situated within a given place and within the power relations therein. Using this perspective enables us to consider multiple perspectives on meanings of health and illness (Anderson
& McCann, 2002), as well as the complex issues associated with the global locations of nursing practice.
Through global learning, nursing stu- dents become sensitized to their own cultur- ally established perspectives on health care and become capable of identifying and chal- lenging underlying values and assumptions
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inform the impact of global learning. Benefi ts of international experiences include changed values, increased consciousness of social jus- tice and global health issues, signifi cantly improved communication skills, learning to think unconventionally about other cul- tures, development of confi dence, growth in competency, and the therapeutic use of self (Evanson & Zust, 2006; Lee, 2004; Mill, Yonge, & Cameron, 2005; Sloand, Bower, &
Groves, 2008).
RECOMMENDATIONS
While there is increasing emergence and investment in many forms of global learn- ing interchangeably used for global service learning, global health practica, international placements/exchange, and so on, systematic evaluation receives comparatively less atten- tion. While nursing researchers have begun to evaluate the effectiveness of student learn- ing within local contexts, a challenge exists in applying their fi ndings to international set- tings, settings that represent a complexity of factors that infl uence learning in particular ways (Stuffl ebeam, 2001). There is a need for more tested strategies to evaluate learning and practice related to international experi- ences and global learning. Evaluation results will contribute to a growing body of evidence supporting the integration of global learning in nursing education. Evaluation of Critical Perspectives in Global Health (CPGH) rein- forces many of the common themes refl ec- tive of transformative learning. CPGH, like many global learning initiatives, can only accommodate limited numbers of students and continue to be an elective course instead of a credit course. This begs the question as to why many nursing curricula do not inte- grate global learning as a required or foun- dational course.
Anderson, J. M., & McCann, E. K. (2002).
Toward a post-colonial feminist method- ology in nursing research: Exploring the convergence of post-colonial and black feminist scholarship. Nurse Researcher, 9(3), 7–27.
of their nursing education and practice. They are able to examine how social inequalities are located and constructed within a political, historical, cultural, and economic context.
SYNOPSIS
Over a decade ago, Thorne (1997) argued that nursing education has traditionally fos- tered social awareness within a limited local sphere of infl uence. At that time, the litera- ture refl ected an ongoing interest in interna- tional nursing and an inherent goodness of educational exchange programs. However, there was little analysis of what motivates students or, beyond simply providing “prac- tical” experience, how leaders/teachers pro- mote an attitudinal shift in students involved in such programs (Thorne, 1997). Studying the experiences of globally aware nurses, Thorne specifi cally explored the origins of their global awareness and their analysis of nursing as a whole in relation to the larger global perspective, in order to shed light on these more critical questions. Findings raised two key points regarding nursing educa- tion specifi cally. First, most of these nurses reported little or no formal learning in their nursing programs on topics they considered relevant to a global perspective. Second, some noted that their desire to incorporate preexisting interest in global health into their clinical learning was generally not sup- ported, either by faculty or peers. Nursing education that recognizes the importance of cultural sensitivity in cultivating global consciousness ought to encourage “critical analysis of the status quo in health care and the larger society” (Thorne, 1997, p. 440). In this vein, international exchange programs offer particularly rich learning with regard to alternative (i.e., non-Western) health and social structures. She concluded by calling for a reexamination of uncritical approaches to international nursing work with their roots in colonial paternalism, those framed simplistically as charitable efforts to assist needy nations.
Some of the recurring benefi ts that appear in international nursing studies can