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Nurse Education in Practice 26 (2017) 64e67

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Nurse Education in Practice

journal homepage: www.elsevier .com/nepr

Utilization of communities of practice for ongoing learning and knowledge dissemination: Making the case for the Global Alliance for Nursing and Midwifery (GANM)

Ashley Gresh*, Fernando Mena-Carrasco, Allison Rauh, Teresa Pfaff Center for Global Initiatives, Johns Hopkins University School of Nursing, Baltimore, MD, USA

a r t i c l e i n f o

Article history: Received 11 March 2017 Received in revised form 22 May 2017 Accepted 2 July 2017

Keywords: Information dissemination Communities of practice Nursing Midwifery Sustainable development goals Global health

* Corresponding author. Center for Global Initiativ Nursing, 525 N. Wolfe St, Baltimore, MD 21205, USA. T 410 367 2442.

E-mail address: [email protected] (A. Gresh).

http://dx.doi.org/10.1016/j.nepr.2017.07.001 1471-5953/© 2017 Elsevier Ltd. All rights reserved.

a b s t r a c t

With the growing connectivity among countries and healthcare practitioners, nurses and midwives in low resource settings are connecting digitally to access information through online platforms. Ninety eight percent of adults online report visiting a social network in the past month, and spend almost two hours per day engaged with social media. In an increasingly interconnected world, innovative strategies are needed to translate knowledge into practice. The Global Alliance for Nursing and Midwifery (GANM), part of the Pan American Health Organization (PAHO)/World Health Organization (WHO) Collaborating Center (CC) at the Johns Hopkins University School of Nursing (JHSON) leverages its Knowledge Gateway to facilitate translating knowledge into practice in order to achieve the Sustainable Development Goals (SDGs). This paper explores the concepts of knowledge dissemination, communities of practice, and makes the case for further using the GANM as an exemplary model to build the capacity of nurses and midwives globally.

© 2017 Elsevier Ltd. All rights reserved.

1. Context of the community of practice of the Global Alliance for Nursing and Midwifery (GANM)

Globally, nurses and midwives provide over 80% of health care services, and their work is critical to achieving Universal Health and the Sustainable Development Goals (WHO, 2016). In order to ensure that the latest evidence-based practice, research and health policies are disseminated globally, contemporary models are needed to provide equitable access to information for nurses and midwives. The question is how do we effectively create access and disseminate knowledge globally in the field of nursing and midwifery?

Increased nursing research and practice in the field of science, technology, innovation and information systems has been identi- fied as a priority on the agenda in the Region of the Americas (Cassiani et al., 2015). Additionally, research has shown that in or- der to design effective knowledge networks, defined here as “col- lections of individuals and teams who come together across organizational, spatial and disciplinary boundaries to invent and

es, Johns Hopkins School of el.: þ1 410 550 2190; fax: þ1

share a body of knowledge,” the following elements are needed: a stated theory of change; clearly defined purpose and target out- comes; an expert-learner duality; equal inclusion and participation of members; cohesion, connectivity, collaboration and engage- ment; social norm development; and evidence of metrics for stated outcomes to find evidence of success or failure in network partic- ipation (Pugh and Prusak, 2013).

Virtual communities of practice provide an innovative and cre- ative platform to facilitate opportunities for continuing education and dissemination of new health care practices (Cronin et al., 2016). Currently, there is no formal definition of community of practice (CoP). The concept has evolved since its development byWenger in the early 1990s, making it difficult to objectively evaluate the effectiveness of CoPs (Li et al., 2009). One definition describes CoPs as “groups of people who share a concern or a passion about something they do and learn how to do it better as they interact regularly” (McDonald and Cater-Steel, 2017). Studies have shown that online learning environments are social systems in which community of practice members develop a social presence, create relationships, and foster a sense of commonality (Wenger et al., 2005). Each of these activities influences resource sharing and fosters a sense of interdependence, which can lead to improved health outcomes when evidence-based practice is shared (Kehrwald, 2007). Research that does examine the effectiveness of

A. Gresh et al. / Nurse Education in Practice 26 (2017) 64e67 65

CoPs utilizes social learning theory, Bandura's social cognitive theory of human behavior, and related concepts of agency and self- efficacy to support the effectiveness of CoPs (Cronin et al., 2016; Kehrwald, 2007). As “the fastest growing type” of learning orga- nization, CoPs have been shown, to be “self-organizing and self- governing groups of people who share a passion for the common domain of what they do, and strive to become better practitioners” (Jameson et al., 2006). Many CoPs emerge informally among like- minded communities, such as nurses and midwives and serve as a foundation for spontaneous social learning (Kehrwald, 2007). CoPs moderated by students and health professionals allow for newcomers to enter the CoP and benefit from the collective expertise of the community (Kehrwald, 2007). The use of digital social networks has grown over the past decade with approxi- mately 98% of adults online reporting that they have visited or used a social network within the last month and that on average people spend just under two hours per day on social media sites (GlobalWebIndex, 2016). For the purposes of this paper, we define a social network as an online community of users with shared in- terests who use digital technologies to communicate and dissem- inate resources and ideas. As common features of most communities, the internet and social media have changed what it means to “be together.” As such, innovative strategies are needed to harness technology to improve healthcare policy and practice (Wenger et al., 2009).

By using mobile social media, collaborative CoPs can foster learning communities for students, and reach a wide global audi- ence (Cochrane and Narayan, 2016). This is particularly important given that the number of mobile subscribers globally continues to increase and in Latin America, is forecasted to grow to over 500 million by 2020 (Cochrane and Narayan, 2016). Increasingly, mobile social media is becoming a catalyst for change, stressing the importance of using technology effectively to positively influence social dynamism and, its collateral progress (Cochrane and Keegan, 2012).

Challenges exist in sustaining CoPs, with the greatest being able to ensure that CoPs are structured for effectiveness. Studies suggest that a coordinated collaborative leadership model is more effective than a traditional authority-based approach at promoting long- term efficacy, sustainability, and consistency (Li et al., 2009; Jameson, 2011).

2. Community of practice of the GANM

The Global Alliance for Nursing and Midwifery (GANM) is a prime example of an online platform and CoP that facilitates equitable access to information and supports global nursing and midwifery. The GANM is a joint project sponsored by the Pan American Health Organization (PAHO) and the World Health Or- ganization (WHO) Collaborating Center (CC) at the Center for Global Initiatives (CGI) at Johns Hopkins University School of Nursing (JHSON). The GANM community is hosted on the Knowl- edge Gateway (https://knowledge-gateway.org/), which is a low- solution online electronic communication platform developed by the WHO in 2004. The platform is designed to facilitate knowledge sharing and exchange and connect individuals working in health and development. The vision of the Knowledge Gateway (2017), is “A world of connected health and development workers who can find the information they need, share knowledge, and build on collective experience to do their work more effectively”.

The GANM community has over 4000 members from over 160 countries, and its membership continues to grow. The GANM em- ploys the latest information and communication technology to connect practitioners, policymakers, researchers and academics globally using low bandwidth technology to create an easily

accessible knowledge network including: a discussion board, on- line library, webinars, blogs and video-blogs, social media cam- paigns, podcasts, and publications. In 2014, the JHSON created a student intern program to assist with GANM activities while simultaneously fostering future nurse leaders and promoting global health nursing competencies among students. Recognizing the PAHO/WHO's 2014 resolution “Strategy for Universal Access to Health and Universal Health Coverage” and the implementation of the Sustainable Development Goals (SDGs) in 2016, the GANM's strategies provide access to the latest research, best practices and policy guidelines for nurses and midwives. Each of the GANM ac- tivities focuses on addressing the targets of SDG 3, “Ensure healthy lives and promote well-being for all at all ages.”

3. Overview of activities and impact of the GANM

3.1. Student interns & collaborative leadership

In order to ensure spontaneous and continuous social learning, the GANM CoP is moderated by both students and health pro- fessionals. Through the Center for Global Initiatives, graduate nursing students have the opportunity to work on PAHO/WHO collaborating center projects and moderate GANM activities, su- pervised by the CGI manager. The manager is a masters-trained, bilingual public health nurse with extensive international and do- mestic experience. The interns are nursing students who each hold previous degrees and have language capabilities in Spanish, French and Portuguese and experiences in public health, global health, or social work. These qualifications add additional depth and breadth to their work with the GANM. By facilitating the GANM's activities, the student interns add invaluable contributions to the CoP and are simultaneously developed as the next generation of nursing leaders engaged in global work locally (Moorley and Chinn, 2016).

3.2. Blogs

The GANM releases blogs, both written and video, on a regular basis through its blog site, http://ganm.nursing.jhu.edu, which is publicly accessible. With the release of the SDGs in January 2016, the GANM produced a series of blogs relating to each target of SDG 3 to engage and educate the GANM community in the new SDGs. Blogs are accepted from any willing and qualified expert on any subject related to SDG 3. Blogs are vetted by students to ensure that content is appropriate and relevant for the community of practice. To date, 24 blogs related to SDG 3 have been published.

The blogs aim to enable the GANM's members and the public to: share knowledge, experience and lessons learned from local prac- tices; create a space for discussion among experts and practitioners from different countries; promote adoption of clear definitions of terminology, concepts and policy directives; and provide capacity building to enable implementation of evidence-based tools, mate- rials and strategies that can improve and scale up effective prac- tices. Blog data is summarized in Table 1.

3.3. Webinars

GANM webinars are 60e90 minute sessions led by an expert or researcher on topics relating to SDG 3. After 30e60 minutes of presentation, the moderator or presenter takes questions from participants and facilitates discussion. In addition to presenting current practice or research findings, some sessions of