Whether caring for children and families in rural Haiti or designing a curriculum to improve patient safety in Latin America, the School of Nursing and Health Studies plays a pivotal role in shaping health care throughout the Americas and the Caribbean. With its recent designation as a Pan American Health Organization/World Health Organization (PAHO/WHO) Collaborating Centre, the school is poised to extend its leadership even further. One of just 11 such centers in the United States, the school’s WHO center will pursue a vast and varied agenda designed to advance patient safety and workforce development. “The global nursing shortage and the migration of nurses out of their home regions are critical workforce issues that impact patient safety,” says Nilda P. Peragallo, DRPH, RN, FAAN, dean and professor, who serves as director of the center. “Collaborating with international leaders in the profession will greatly increase our ability to find solutions and ultimately improve patient safety throughout the Western Hemisphere.”
Silvina Malvarez, PAHO regional advisor for human resources development, notes that the school was selected because of its strong reputation in nursing education and research, as well as its established ability to work with neighboring nations: “Both geographically and culturally, the University of Miami is in a strategic position to form partnerships and help other countries in the region.”
Prioritizing Patient Safety
From left to right, Dr. Cristina Beato, Deputy Director, WHO-Pan American Health Organization; Dr.John Ruffin, Director, NIH-National Center on Minority Health and Health Disparities; Dr. Nena
Peragallo, Dean and Professor, UM School of Nursing and Health Studies; and Dr. Silvina Malvarez,
PAHO Regional Director of Human Resources in Nursing and Health Services Systems.
Patient safety has been a priority for the World Health Organization since 2004, when it launched its “Clean Care is Safer Care” campaign, which focused largely on preventing infection through hand contact. A second campaign advocates the development of a surgery checklist to make procedures safer. Nurses and organizations around the globe, including the University of Miami, have advanced the campaign’s mission by participating in regional networks geared toward patient safety issues.
Members of the regional network on patient safety met at the School of Nursing and Health Studies in March to discuss how patient safety is being addressed on both the individual and collective levels. The health ministries of many countries represented have taken the step of adopting patient safety as an official priority; specific programs to achieve that goal vary.
In Haiti, for example, a group of educators is helping auxiliary nurses, the backbone of the rural health system, improve their knowledge of medications; in Mexico, nurses are designing protocols to prevent patient falls; in Brazil, a network of nurses is focusing on enhancing transparency and error reporting.
The United States has made great strides in creating a culture of patient safety, Peragallo says, and the University plans to share those lessons with regional leaders through a culturally tailored, virtual course in patient safety. The University also will invite regional faculty to workshops on patient safety using the school’s state-of-the-art simulation and research facilities.
Attendees of the March event were amazed by the facilities. “We have mannequins in our schools, but they’rejust that—mannequins, not simulators,” said Leonor Vera Macías, head of nursing at the Hospital de los Niños Roberto Gilbert in Guayaquil, Ecuador, and a member of the hemispheric patient safety network.
Nurturing Nursing Resources
Members of the Pan American Health Organization (PAHO) Patient Safety Network who attended the workshops and opening reception at the nursing school included representatives from Argentina,
Brazil, Ecuador, Chile, Haiti, and Mexico, as well as the PAHO office in Washington, DC.
Developing new faculty across the region is a high priority for the center, particularly as the average age of educators hovers at 55. “We can’t prepare more nurses if we don’t have faculty,” Peragallo notes.
The global nursing shortage is particularly acute in the English-speaking Caribbean, where nurses are often recruited to work in the United States and Canada. South America also sees substantial migration among its nurses to Europe. The University plans to research the impact of these patterns on patient safety and to explore recruitment and retention strategies.
Five years ago, Peragallo reached out to the National University Andrés Bello, in her native Chile, to help develop the nation’s first doctoral nursing program. The program graduates its first eight students this year.
“The program is critical to preparing new researchers and visionary leaders, and the involvement of the UM School of Nursing and Health Studies has been integral to its development,” says Luz Angelica Muñoz, dean of Andrés Bello’s nursing school. Andrés Bello plans to develop a doctorate in nursing practice program like that recently launched by the school.
From left: Dean Peragallo presents at the PAHO Patient Safety Network in March; a patient safety working group; faculty member Marie Chery.
The school also plans to create other postgraduate training opportunities such as post-baccalaureate certificate programs at partner institutions around the hemisphere.
The poorest country in the Western Hemisphere, Haiti faces unique health care challenges, including high rates of HIV infection and maternal mortality. With just one physician for every 17,000 people, much of the health care falls to auxiliary nurses who receive only the most basic training, says Marie Chery, a faculty member who lives year-round in Haiti’s Central Plateau.
According to Chery, nurse anesthetists, in particular, are at a prime in the Haitian countryside. “Having more [nurse anesthetists] available in peripheral and satellite hospitals in rural areas will make it possible to perform more surgeries in a timely fashion,” she says. “This will help save many people’s lives.”
Ultimately, whether geared to improving clinical nursing resources or designing new curricula, all of the programs developed by the school’s WHO center will be tailored to the working conditions and culture of the countries in which they’re implemented.
“We do not have all the solutions,” Peragallo says. “Countries have their own challenges and must develop their own strategies to address them. But we can share insights that we have gained from our experience.”
