ORGANIZACIÓN DE LOS ESTADOS AMERICANOS
COMISIÓN INTERAMERICANA PARA EL CONTROL DEL ABUSO DE DROGAS
The Nursing Profession and the Drug Phenomenon in Latin
America: Challenges and Perspectives
Paper presented at the International Meeting of New
Doctoral Nursing Programs in Latin America
November 28-30, 2001
By
Maria da Gloria Miotto Wright, Ph.D.
International Coordinator
Schools of Nursing Project on Prevention of Drug Use and Abuse,
Social Integration, and Health Promotion in Latin America
CICAD/OAS
SECRETARÍA GENERAL DE LA ORGANIZACIÓN DE LOS ESTADOS AMERICANOS, WASHINGTON, D.C. 20006
Table of Contents
1.
Introduction
2.
Significance of the Problem
3.
Challenges of Nursing Profession in the XXI Century
4.
Conceptual and Operational Frameworks
5.
Basic Components of the Project, Steps of Implementation, and Main Actors
6.
Results of CICAD Schools of Nursing Project on Prevention of Drug Use and
Abuse, Social Integration, and Health Promotion in Latin America
7.
CICAD Schools of Nursing International Events
8.
CICAD Schools of Nursing Transnational Research Studies
9.
Final Considerations
Bibliography
2
I.
Introduction
Escalating drug abuse is evident in many Latin American countries and is an
embedded social and health problems whose roots include national and international
determinants and conditioning factors. The myriad contributing factors require solutions
that are innovative, realistic, and holistic in their approach (Programa de las Naciones
Unidas para la Fiscalización Internacional de Drogas, 1998).
Analyzing the drug phenomenon and related issues from the international and
national perspectives is useful in understanding the macro and micro determinants and
conditioning factors that affect the production, commerce, consumption, and abuse of
drugs in the Americas (Wright, 1999)
On the macro-political level, the escalating drug abuse in Latin America involves
the overall contextual changes that have occurred during the past decades. Although
national experiences vary from country to country, the following characteristics
summarize the economic and socio-political transformations that shape both the
possibilities and challenges for ameliorating the drug problem in the Region
(Organization of American States, 1999):
(i)
Latin American countries have accepted democracy as the only
appropriate form of government, and have embarked on a path of strengthening and
deepening their political institutions. Expanded participation, while helpful for the
articulation of needs, opens the system to contradictory and powerful rivalries of
competing interests that complicates policy-making.
(ii)
All countries have revised the concept of the role of the State and the
private sector and their respective responsibilities. The provision of services must adopt
to these new roles and meet both equity and efficiency standards.
(iii)
The indebtedness of many Latin American countries, combined with
diminishing income from their basic export products, have required governments to
undertake fiscal austerity measures. At the same time, a more conscious citizenry
demands that government provide for the well being of the population. At the societal
level, there are many cases of increased levels of poverty associated with depressed
economies, creating negative health and environmental pressures.
(iv)
The liberalization of the international trade system, coupled with greater
regional political and economic integration, have opened societies to new products,
ideas, and behaviors, without providing a complementary regulatory apparatus to
manage the ensuing changes.
(v)
Escalating drug use, abuse and related issues within the individual
countries of Latin America stem from political, economic, social, technological, and
health conditions that foster both the supply of and the demand for drugs. In most of the
countries the following factors contribute to a favorable environment for this
phenomenon:

A lack of resources, technology, and information to promote drug awareness
programs.
3






II.
Uncertainty and a lack of economic opportunity, which create psychological
stresses that lead to the proliferation of social diseases such as drug abuse.
Few clear national strategies or policies for drug abuse prevention.
Few comprehensive health promotion strategies and very few effective
treatment, rehabilitation, and social reintegration programs for drug addicts.
The few programs that address drug abuse and prevention target only high-risk
groups, and therefore achieve limited impact at the broader community level.
The large resources and the relative success of international drug interdiction
programs create economic pressures to develop domestic drug markets.
The true challenge to reducing drug demand in the Americas is to design a
project with a two pronged approach to curtailing addiction at both the individual
and societal level. Because the drug phenomenon and related problems arise
from the confluence of all these factors and levels, a successful drug awareness
campaign requires the progressive alteration of national conditioning factors.
Significance of the Problem
Drug abuse trends throughout the Americas reflects an escalating problem of
illegal drug consumption. An increase in the annual incidence of new users and a
decrease in the average age of first use support growing concerns about illicit drugs.
(CICAD/MEM Hemispheric Report, 2000, 5). Despite improvements in some areas, the
overall situation in the Americas is grim. A distinction can no longer be made between
consumer, producer, and transit countries, as the drug problem has manifested itself
throughout the region. Consumption rates are rising in countries formerly considered
drug producers, and cultivation and trafficking are increasing in countries formerly
considered consumers.
The world’s major drugs of abuse include cannabis, cocaine, opium (heroin), and
amphetamine-type stimulants. Over 70% of the world’s cocaine abuse takes place in
the Americas (Global Illicit Trend, 2000, 238), with a life-time prevalence rate of abuse
as high as 11.5% in the United States (Global Illicit Trends 2000, 246). Although illicit
coca cultivation has recently declined in Peru and Bolivia, Colombia reports a
substantial increase in potential production (CICAD/MEM Hemispheric Report, 2000, 5).
The World Drug Report estimates an annual prevalence rate of cannabis use at 36.9
million people in North and South America for the late 1990s (World Drug Report, 2000,
122), and cannabis and opium poppy cultivation have spread to many countries
throughout the region (CICAD/MEM, Hemispheric Report, 2000, 6). With the advent of
the internet and the construction of small illicit laboratories, production and availability of
synthetic drugs, such as MDA (speed) and MDMA (ecstasy), have risen in the
Hemisphere (CICAD/MEM Hemispheric Report, 2000, 7).
The negative effects of drug abuse are evident in both addiction andother drugrelated activities. The sophistication, intensification, and globalization of drug-trafficking
have negatively impacted public safety, economic development, and governance.
Consequently, firearms-trafficking and money-laundering have increased. High rates of
drug abuse are associated with increased crime and violence, susceptibility to diseases
4
such as HIV/AIDS and hepatitis, and a breakdown in social structures (CICAD/MEM
Hemispheric Report, 2000, 7).
The Inter-American Drug Abuse Control (CICAD) and other international
organizations seek to develop and implement demand-reduction strategies to prevent
the onset of drug abuse and to provide treatment of addiction through rehabilitation and
social integration. CICAD was established at the General Assembly of the Organization
of American States (OAS) in November 1986. A specialized conference on narcotic
drugs held earlier that year in Rio de Janeiro, Brazil, suggested the formation of CICAD,
composed of the member states of the OAS. Upon its inception, CICAD adopted the
Inter-American Program of Action of Rio de Janeiro as its working framework and
guiding principles. CICAD is currently made up of 34 member states from the Americas.
Its objectives are to address the production of, illicit traffic in, and abuse of drugs, along
with money laundering and the traffic in firearms, their parts, and ammunition. Since its
creation, CICAD has approved and implemented the Declaration and Program of Action
of Ixtapa (1990), the Inter-American Program of Quito: Comprehensive Education to
Prevent Drug Abuse (1991), the Anti-Drug Strategy in the Hemisphere (1996). The
CICAD’s goals involve the following (CICAD, 1997):









Promoting the participation of citizens in the prevention and treatment of drug
abuse through active community action.
Training nurses and other health and education professionals to promote health,
prevent the use of drugs, and treat and reintegrate drug-dependent persons into
society.
Using scientific criteria for evaluating the results of programs to promote health
and to prevent and treat drug abuse.
Promoting research on trends in drug use and the factors associated with the
consumption of such substances, using standardized questionnaires and
methodologies to assure comparability of data in time and among countries.
Collaborating with the Member States in collecting and analyzing statistics
related to drug control.
Strengthening the controls on psychoactive pharmacological products and
substances and supporting the agencies responsible for this process to reduce
the abuse of legal substances.
Strengthening and promoting the implementation of controls on precursors and
essential chemicals and on money laundering, in accordance with the United
Nations Convention Against the Illicit Traffic in Narcotic Drugs and Psychotropic
Substances (1998) and CICAD’s model regulations.
Fostering the adoption of effective legal systems and mechanisms for promoting
effective harmonization of legalization and research and evidence-compilation
procedures.
Promoting alternative development programs to ensure suitable environmental
protection, economic opportunities and verified eradication, to ensure long-term
reduction of illegal crops.
5



Updating and strengthening national drug commissions with the introduction of
advanced technology, effective organizational systems, communications, the
application of resources, and development and evaluation programs.
Increasing support for maritime and customs cooperation to combat the illicit
traffic in drugs.
Updating lists of controlled chemical substances.
CICAD has an intensive program of cooperative action with the countries of Latin
America and the Caribbean in the following priority areas:







Demand Reduction of Drugs
Supply Reduction of Drugs
Institution Building
Legal Development
Inter-American Observatory on Drugs
Alternative Development
Control of Money Laundering
The challenge of CICAD for demand reduction programs is to identify
new perspectives, approaches, and leadership. Nurses can play an important role in
this area. Nurses form the largest work force in the health field. They tend to be the
primary source of trained health care within the health care system and thus the starting
point of contact with any patient or client within the health care system. However, few
Schools of Nursing in Latin America regularly provide their students with training in
prevention, treatment and social integration activities related to licit and illicit drugs.
Also, there is a lack of formal nursing education programs on the use of narcotics in
pain management, or the potential abuse of pharmaceutics.
Some health professionals and the Ministry of Health in Latin America countries
are becoming concerned that, as drug use spreads, their profession is not doing enough
to understand, treat and contain it. A numbers of programs have been created in recent
years in these countries to address drug abuse prevention and treatment, particularly
among street and working children, and other high-risk youth and their families.
Frequently, however, the staff of these programs does not include trained nursing
personnel, or tap into their potential as healers and agents of prevention. Yet, treatment
and low-cost health care for high-risk families is crucial since many of the street children
leave their families because of drug and alcohol problems and violence at home.
This paper describes the CICAD Schools of Nursing Project on Drug Prevention,
Social Integration and Health Promotion Latin America, as a strategy to prepare a cadre
of professional nurses capable of working in health promotion, prevention of drug use
and abuse, and social integration. The design of capacity-building programs on
international health, drug phenomenon, research, and leadership provide the basis for
demand reduction initiatives in Latin America to achieve CICAD goals for demand
reduction.
6
III.
Challenges of Nursing Profession in the XXI Century
To understand the role and leadership of nursing profession in drug demand
reduction it is necessary to identify the factors that challenge nurses in the XXI century.
Some of the world trends that affect nursing worldwide include ( Rourke, 1999; ICN,
1999; ICN, 1996; ICN, 1995; ICN, 1994; Langston & Corcoran, 2001):
a)
b)
c)
d)
e)
Political – there is political instability in some countries, along with a new
geo-political era, including an increase of fundamentalism religions), terrorism
(September 11, 2001 terrorism attack to the World Trade Center/New York;
and Pentagon/Washington, D.C.), bio-terrorism (spread of Anthrax germs –
U.S. communications--postal service, television), increase of war and use of
weapons in some countries (middle-east, Israel-Palestine, Pakistan – India,
former Yugoslavia, Balkans, African countries and Afghanistan), increase of
nuclear trash, new era of international relations, facing international and
national security threat. There is a lessened nation-state orientation.
Economic/Social - the world is facing new market trends and an increase of
the globalization process and trade among countries, with emphasis on
privatization of the State assets, increased interdependency of countries, with
consequences for poverty, inequality, mobility of services, people, modes of
transport and urbanization; countries are moving from an industrialized mode
of development to an information era.
Health/Environment – the world is facing also the globalization of the health
system, implementing health care reforms with an increase in life expectancy
and well being. However, the planet is facing degradation of the environment,
increasing the risks of transmissible diseases, accidents, urban violence,
drugs, shift on immigration patterns, the situation of refugees, increased
natural and man-made disasters, health status that is more class oriented,
and consumers are more empowered about their rights.
Science & Technology – the world is in a new era of information and
communications that reflects the advance of science and technology,
biotechnology, molecular nanotechnology. This has also influenced the
production and distribution of medicines, involving the development of new
laws to protect intellectual rights and patents. There are new issues regarding
ethics, human rights, and on –line access to health information; the public has
become more empowered regarding access to different therapies, moving
toward medically pluralistic societies.
Nursing Education - nursing has moved to university level in the majority of
the countries of the world. The nursing schools have used new models for
curriculum development. By the end of XX century some schools in the
Americas and Europe had included the topic of international and
environmental health and the drug phenomenon as part of the nursing
curriculum and education. The schools of nursing are also moving to
distance-learning education. We see an increase of graduate nursing
education programs worldwide (specialization, masters, doctoral, and postdoctoral levels); there is a strengthening of nursing research training
7
f)
programs and more support for training nurses at the graduate level in North
America. There is a tendency to use visionary and experienced faculty and
nurses as mentors of new nurse professionals. There is a strong emphasis on
creating national and international evaluation and accreditation systems at
Schools of Nursing for graduate and undergraduate programs. However,
some schools of nursing still have inflexible nursing curricula and lack
government support for advanced nursing education.
Nursing Profession – Nurses have become the entry point for the
consumers in the health care system. Nurses have assumed leading
positions on health promotion and prevention activities worldwide. There is a
shift to primary care strategy and an emphasis on community health
programs. The use of the Internet and technology has advanced the nursing
research base. There is a movement to strengthen research training
programs and more support for research programs. Nursing has become
more visibile and has assumed leadership at national and international levels.
There is a tendency for evidence-based practice to improve the quality of
health care. We see the increase of linkages between nursing and other
health professional groups, and nursing has become more important in
interdisciplinary teams. We see an increase of nursing specialization
organizations. On the other side, we see also a shortage of nurses at
bedsides with a downsizing of the nursing profession. We still have untrained
personnel working as “Nurses” worldwide, along with strikes and unrest over
salary and working conditions.
The major trends that contribute to shape the future of nursing education and the
nursing profession in the world are:
Globalization
Aging Population
Drug Phenomenon
Health Sector Reform
Information & Technology
Terrorism, Bio-Terrorism
Violence, Refugees, Disasters
Environment Degradation
Development Partnerships
Entrepreneurial Opportunities
New Profile Management
High involvement Ad Hoc Groups
Vision-Driven Leadership
Consumer Empowerment
Use of Experts
In facing these trends, what are the alternative future scenarios for nursing?
Below are three possible scenarios for nursing in the next twenty years.
Scenario I
Vision & Leadership for Transformation
Education: The undergraduate and graduate nursing programs will respond to global
problems by internationalizing the nursing curriculum. There will be a need to design a
strategic plan for nursing human resources development at the national, international,
and global levels to advance nursing education in the world.
8
Profession: Nurses will become agents of transformation in new areas of job
opportunities, such as: drug demand reduction; primary environment care; management
care; health and automobile industries; disaster preparedness; and technical
cooperation. Nurses will be considered in providing choice of health care.
Research: There will be an increase of research training programs at the national and
international levels on applied intervention and evaluation research methodologies. The
capacity-building programs will increase the participation and representation of nurse
scientists at the Ministries of Health, Education, Science and Technology, Academy of
Science, national and international scientific committees, and others.
Scenario II Technology Used for the Transformation of World
Education: The undergraduate and graduate nursing programs will become virtual
education. Nursing will have a strong role in informatics (nursing informatics) and will
contribute for the advance of artificial intelligence. Nursing education will include
aspects of emergence nanotechnology, artificial care, and the nursing curriculum will
emphasize technology and business.
Profession: There will be an increased role of nurse practitioners and critical care
nurses. The health care system will combine nanomedicine and nursing care; there will
be more emphasis and opportunity for the use of tele-nursing in remote and rural areas.
There will be an increase of international and national professional network. We will see
more nursing entrepreneurial, environmental-occupational health jobs for nurses, and
also in the technology and health care industry.
Research: There will be a large demand for nurses trained in basic and technological
research methodologies, and a greater number of nurse scientists in the world.
Scenario III Vision, Leadership, and Domain of Technology to
Transform the World
Education: The undergraduate and graduate nursing curricula will provide
opportunities for nursing students to develop a new critical vision of the world and
nursing, will emphasize the use of leadership skills and technology to support the
advancement of nursing in science and technology. The nursing curriculum will be
flexible, creative, participatory, and cover aspects of health, political sciences,
international relations, information technology, and business.
Profession: There will be an increase in demand for nurses in the health care system;
technology and communication industry; international and national organizations;
research centers; government; home care; and at the community level.
Research: There will be: support for advanced research training for nurses; an
increased use of basic, applied, intervention, and evaluation research methods by
nurses; an increase of new scientific nursing knowledge and technology.
Nursing education and practice should evaluate how far they are from these
three scenarios. The nursing graduate programs in the world will be playing a major
role in advancing the nursing profession toward such scenarios.
9
IV.
Graduate Nursing Programs Shaping the Future of Nursing in the Americas
in the XXI Century
The role of nursing graduate nursing programs in shaping the future of nursing in
includes the following actions (AACN, 2001; Wright & Alarcon, 1999):
(i)
(ii)
(iii)
(iv)
(v)
(vi)
(vii)
(viii)
(ix)
(x)
Forces the creation of systematic evaluation and accreditation systems
at institutional and country levels;
Provides elements for the development of strategic plans for nursing
human resources development for graduate level at international, national,
regional, and local levels;
Provides indicators for strategic negotiations with government, national, and
international organizations to support implementation of nursing graduate
education world-wide;
Indicates which scenario is envisioned for existing and new graduate nursing
programs in the Americas;
Indicates the global trends affecting the future of nursing and which graduate
nursing programs have been more effective in solving health problems in the
Americas;
Provides the job market with nurses that possess vision, leadership for action,
and use of technology to improve quality of life;
Facilitate the development of national and international partnerships and
collaboration to strengthen graduate and undergraduate nursing education;
Open opportunities for nursing representation at national and international
scientific and technology councils;
Strengthen nursing research groups and centers;
Increases financial support for nursing graduate programs;
The impact of graduate nursing programs in advancing the nursing professional
will vary from country to country. However, the more forceful the leadership of nurses,
the clearer will be the impact seen by the population.
IV.
Conceptual and Operational Framework
At the turn of the century, many authors reviewed existing theories that
supported drug prevention programs. Iglesias (1999) identified all the theories on drug
prevention and presented them in a book, entitled “Theoretical Bases of Drug
Prevention Programs, ” published by the Ministry of Interior of Spain. According to
Petraitis, Flay and Miller (1995) fourteen theories were identified as theoretical support
for prevention programs of use of drugs. The fourteen theories are in the areas of: (i)
cognitive-affective; (ii) social-learning; (iii) social-interaction; (iv) intra-personal
characteristics; and (v) combination of construct from cognitive-affective, learning,
commitment and interaction, and intra-personal theories.
In Latin America, the study of the drug phenomenon includes the vision of drugs
as a social, legal and disease problem, and more recently as an issue of power and
international relations, with a domestic and international domain. The evolution of these
10
visions follows the progress of political, economic, social, and cultural development of
the countries in the region, along with scientific and technological advancement
regarding the drug issue. A brief description of these visions and models is presented
below:
(i)
Vision of drugs as a legal problem: ethical-juridical model;
(ii)
Vision of drugs as a psychiatric or mental health problem: medical-sanitary
model, and psycho-social model;
(iii)
Vision of drugs as a social problem: social-cultural model, and geo-political
structural model;
(iv)
Vision of drugs as a power struggle and part of international relations: criticalholistic international health model.
The Critical-Holistic International Health Model (Wright, 1999) provides the
theoretical framework for the CICAD Schools of Nursing Project on Prevention of Drug
Use and Abuse, Social Integration, and Health Promotion in Latin America. This model
applies the dialectical approach to the analysis of the drug phenomenon in the
Americas, focusing on the drug phenomenon in the macro and micro dimensions of the
problem: (Wright, 2000):
(i)
Macro Level:
(a)
the power, interest, knowledge, and leadership dimensions of the drug
phenomenon within international relations;
(b)
the technical and financial cooperation dimension of the drug problem
in the Hemispheric;
(ii)
Micro Level:
(a)
the international dimension of drugs and related problems at the domestic
level;
(b)
the strategic development of the country and its challenge to controling the
drug problem;
(c)
the impact of drug use and abuse on the health of an individual,
family, and community
Figure 1 provides more details of the model. The operational framework of
Critical-Holistic International Health Model applied the development of CICAD Schools
of Nursing Project in Latin America is presented below.
(Include here Ficgure 1)
11
V.
Basic Components of the Project, Steps of Implementation, and
Main Actors
The CICAD Schools of Nursing Project in Latin America has three basic
elements that support its operational activities (CICAD Schools of Nursing Project
Technical Report, 2001):
(i)
(ii)
Education:
Research:
(iii)
Extension:
Integrated by curriculum and faculty development;
Implementation of studies in the areas of health promotion,
drug prevention, and social integration; and
Composed of community outreach educational programs targeted
to specific groups and the population in general.
An important and unique aspect of the project design were the holistic principles
of interaction, integration, and equilibrium, which were applied to all activities of each
basic component. The CICAD Schools of Nursing Project was implemented in each
university and School using the following six steps:
(i)
(ii)
(iii)
(iv)
(v)
(vi)
Socialization of the project at the school of nursing and the university;
Faculty educational and training programs on drug-related issues;
Development of a nursing curriculum with the content of drugs;
Implementation of the nursing drug curriculum at the undergraduate and
graduate levels;
Implementation of drug-related extension and research activities;
Development of an evaluation and monitoring system.
The main actors of the project at the macro level are the following members:
(i)
Financial Donors
(ii)
(iii)
Executing Agency
Collaborating International
Organization
Collaborating Universities
(iv)
Governments of Japan, United States,
and Canada;
International Organization – OAS/CICAD;
Pan American Health Organization
University of Alberta/School of Nursing
Canada;
University of Michigan/School of Nursing/U.S.;
University of Maryland/School of Nursing/U.S.;
University of São Paulo/School of
Nursing/Brazil.
The main actors at the micro level are:
(i)
Beneficiary Institutions
10 universities and schools of nursing in
9 countries: Argentina (1) National University of
Cordoba/School of Nursing; Brazil (2) State University
of Rio de Janeiro/School of Nursing, and, Federal
12
University of Santa Catarina/Nursing Department;
Bolivia (1) University of San Andres/Nursing Career;
Chile (1) University of Concepcion/Nursing
Department; Colombia (1) National University of
Colombia/ School of Nursing; Ecuador (1) University
of Guayaquil/ School of Nursing; Mexico(1) University
Nuevo Leon/School of Nursing; Peru (1) University
Cayetano Heredia/School of Nursing; Venezuela (1)
University of Carabobo/ School of Nursing.
(ii) Coordinators of Project
at University Level
The director and vice-director of each School
of Nursing selected to participated in the project are
responsible for the general coordination of the project
and oversee the implementation of all activities.
(ii) Academic Committee
Composed of Department Chiefs and Coordinators
of academic areas. This committee is responsible for
working with the general coordinators of the project to
support the implementation of all the activities of the
project in the areas of education, extension, and
research. The academic committee is responsible for
carried out the development of nursing curriculum
with the content of drugs and faculty development on
issues related to the drug phenomenon.
(iii) “Ad Hoc” Scientific Committee Composed of representatives of national
and municipal drug control commissions, health
secretariat, faculty of other fields who work with
drugs; and other nursing faculty specialists on drug
issues. The “Ad Hoc” scientific committee is
responsible for providing the technical support that
the project needs in each step of its development.
(iv) Administrative Support
VI.
Each project is able to hire a part-time secretary
to support the administrative, technical, and financial
activities of the project.
Results of the CICAD Schools of Nursing Project on Prevention of Drug
Use and Abuse, Social Integration, and Health Promotion in Latin America
In 1997, CICAD, with the financial support of the Japanese, United States, and
Canadian governments, initiated a capacity-building project for nurses for prevention of
drug use and abuse, social integration, and health promotion. The project provided
educational and training seminars for faculty and students regarding the drug
phenomenon, development of nursing curricula that included the topic of drugs for
undergraduate and graduate students, community outreach educational programs, and
13
pilot studies on drug issues. This initiative has been implemented in three phases. The
general overview of each phase in presented below (CICAD Schools of Nursing Project
Technical Report, 2001):
Phase I –
Pilot Experience in Latin America (Implemented)
General Overview
Group I
(1998-2000)
In 1997 three South American universities were invited to participate in the
CICAD Schools of Nursing Drug Pilot Project. The Pan American Health Organization –
Human Resources Development Program indicated names of Schools of Nursing that
could participate in this kind of project due to their excellence in nursing education.
From 1998 – 2000 the three Schools of Nursing were able to implement all steps of the
project for undergraduate nursing education. More details about the implementation
process is presented below:
Composition: National University of Cordoba/School Nursing/Argentina
National University of Colombia/School Nursing/Colombia
University of Carabobo/School Nursing/Venezuela
Activities:
Each School of Nursing developed a nursing curriculum
with a drug content, provided faculty education and training on drug
issues, and implemented extension and research activities.
Results:
(i) Nursing Curriculum with Drug Content
*National University of Cordoba/School of Nursing/Argentina
The Nursing curriculum with the content of drugs has 196 hours, and it
was introduced in 12 courses of undergraduate program, 6 courses of
basic cycle, and 6 courses of professional area.
*National University of Colombia/School of Nursing/Colombia
The Nursing curriculum with the content of drugs has 370
hours, and it was introduced into 9 courses, where 8 courses are
required and 1 is elective in the undergraduate program. Among the
required courses, 4 belong to the basic cycle, 3 to the professional area,
one to the “flexible” area, and one is elective.
*University of Carabobo/School of Nursing/Venezuela
The Nursing curriculum with the content of drugs has ---hours, and it was introduced in 9 courses in the undergraduate program,
4 courses in the basic cycle and 5 in the professional area.
(ii) Extension Activities
*National University of Cordoba/School of Nursing/Argentina
Healthy Neighborhood Program
Alcohol and Drug Abuse Prevention
Programs for Health Professionals
Preparation of Elementary School Teachers on Drug and Family
Violence issues
Health Education Program Against Drug Addiction
14
*National University of Colombia/School of Nursing/Colombia
Youth Healthy Life Training Program
Social Interventions to Control Consumption of Drugs
Prevention of Drug Abuse and Management of Free Time at
Community Level
Prevention of Drug Abuse among Youth Population of a Specific
Community
*University of Carabobo/School of Nursing/Venezuela
The Drug Phenomenon and Related Issues Training Program for
Students at the University Environment
Health Promotion and Drug Use and Abuse Prevention CapacityBuilding Program for Health Professionals and Social Workers
The Health Community Agents in the Fight Against Drug Use and
Abuse
Workshops and Seminars for University Students on Drug Phenomenon
(iii) Research Activities
*National University of Cordoba/School of Nursing/Argentina
Consumption of Drugs without Prescription
Profile of Tobacco Consumption
Profile of Alcohol Consumption Among Youth
*National University of Colombia/School of Nursing/Colombia
The meaning of Youth from the Drug Perspective
The Youth Strengthens to Fight Drugs
Identification of Social Representation of Drugs Among Faculty and
Students of School of Nursing in Colombia
Prevalence of Drug Use and Abuse Among Middle Schools Children
*University of Carabobo/School of Nursing/Venezuela
Risk Factors and Drug Use Perceptions by Nursing Students
Licit Drugs Knowledge (Alcohol and Tobacco) by Middle School
Children
Knowledge of Youth on the Negative Effects of Alcohol and Tobacco
After a Specific Training Program
(iv) Communication & Information
Scientific publication in Peer Journals
Paper and Poster presentation in international and national conferences
Preparation of technical Reports
Preparation of Flyers
Creation of Nursing Journal on Drug Issues
Group II
(1999-2001)
In 1999 three more South American universities were invited to participate in the
CICAD Schools of Nursing Drug Pilot Project. The Pan American Health Organization –
Human Resources Development Program indicated Schools of Nursing that could
participate in this kind of project due to their excellence in nursing education. From 1999
– 2001 the three Schools of Nursing implemented all steps of the project for
15
undergraduate nursing education. More details about the implementation process are
presented below:
Composition: University Mayor de San Andres/Nursing Career/Bolivia
University of Guayaquil/School of Nursing/Ecuador
University Cayetano Heredia/School Nursing/Peru
Activities:
Each School of Nursing developed a nursing curriculum
with a drug content, provided faculty education and training on drug
issues, and implemented extension and research activities.
Results:
(i) Nursing Curriculum with Drug Content
*University Mayor de San Andres/Nursing Career/Bolivia
The Nursing curriculum with the content of drugs has 196 hours; it was
introduced in ---- courses of the undergraduate program, ----courses in
the basic cycle, and --- courses in the professional area.
*University of Guayaquil/School of Nursing/Ecuador
The Nursing curriculum with the content of drugs has ---hours, and it was introduced into ---courses, where, --- courses are
required and 1 course is an elective in the undergraduate program. In
the required courses, --- courses belong to the basic cycle -----, courses
to the professional area, one in the “flexible” area, and one is elective.
*University Cayetano Heredia/School of Nursing/Peru
The Nursing curriculum with the content of drugs has ---Hours. It was introduced in ---courses of
undergraduate program, --- courses in the basic cycle, and ---in the professional area.
(ii) Extension Activities
*The University Mayor de San Andres/Nursing Career/Bolivia;
*University Guayaquil/School of Nursing/Ecuador
*University Cayetano Heredia/School of Nursing/Peru
The three Schools of Nursing are implementing the extension activities
(iii)
Research Activities
*University Mayor de San Andres/Nursing Career/Bolivia
*University Gauyaquil/School of Nursing/Ecuador
*University Cayetano Heredia/School of Nursing/Peru
The three Schools of Nursing are implementinng the research activities
(iv)
Communication & Information
Paper and Poster presentation in international and national conferences
Preparation of technical Reports
Phase II
Expansion of CICAD Schools of Nursing in Latin America
In 2001 the six universities that were already involved in CICAD Nursing Project
started implementing the new nursing curriculum with the content of drug and expanded
the same process to graduate nursing education. Four more South American
universities were invited to participate in the CICAD Schools of Nursing Drug Project.
CICAD is seeking to expand the experience of the Schools of Nursing in some countries
in Central America and Caribbean. This aspect is in its initial aspects of the pre-
16
implementation process. Details about the composition and activities of Phase II are
presented below:
Composition: National University of Cordoba/School Nursing/Argentina
National University of Colombia/School Nursing/Colombia
University of Carabobo/School Nursing/Venezuela
University Mayor de San Andres/Nursing Career/Bolivia
University of Guayaquil/School of Nursing/Ecuador
University Cayetano Heredia/School Nursing/Peru
Federal University of Santa Catarina/Brazil
State University of Rio de Janeiro/Brazil
University of Concepcion/Chile
University of Nuevo Leon/Mexico
Activities:
Each School is involved with curriculum development, faculty education
and training on drug issues, and implementing extension and research
activities. Details about results are presented below:
Results:
(i) Education
All ten schools of nursing are in the process of introducing the theme of
drugs into graduate nursing programs, and four of them (Brazil:UFSC,
UERJ, Chile: UC; Mexico: UANL) are also introducing the theme of
drugs at the undergraduate level.
(ii) Extension
The extension activities are being developed in all ten Schools of
Nursing, which involve the creation of centers of prevention of drug use
and abuse, social integration, and health promotion led by nurses.
(iii) Research
Faculty and graduate students from all 10 universities are developing
and implementing research studies with the theme of drugs.
Phase III
Development of Inter-Institutional Partnerships
(i)
Partnerships with Universities in Canada, United States, and Brazil:
In 2001, CICAD developed partnerships with the Schools of Nursing at the
following universities:
• in Canada (1) The University of Alberta;
• in the United States (2), The University of Michigan and The University of
Maryland; and
• in Brazil (1) The University of São Paulo at Ribeirão Preto.
These universities became CICAD collaborative universities to provide the technical
support to implement a series of research capacity-building programs for nursing faculty
involved with the project. For three years each of these universities will offer three
regional (USP/Brazil) and three international research capacity-building programs for
nurses from Latin America on research methodologies (qualitative and quantitative) to
be applied to the study of drug phenomenon. Upon returning to their countries, the
faculty trained in these programs will be responsible for developing similar research
capacity-building programs for faculty from each school in the country, along with
17
practical nurses. The I Regional Research Capacity-Building Program for Nurses from
Latin America will be implemented at the University of São Paulo School of Nursing,
Ribeirão Preto campus, during 2002, with technical and financial support from CICAD
and the Japanese Government.
(ii)
Collaboration of National & International Associations
In 2001, the CICAD Schools of Nursing Project developed a collaboration with
three organizations. The objective is to develop technical cooperation between CICAD
and these organizations for the provision of technological and scientific support for the
implementation of the activities of Phase II and III of the Schools of Nursing Project in
nine countries in Latin America. The national and international organizations are:

National League of Nursing/NLN

American Association of College of Nursing/AACN

Institute for Nursing Research/INR at National Institute of Health/NIH

International Network of Doctoral Education in Nursing (INDEN)
(III)
Partnership with International Organization
CICAD is developing a partnership with Pan American Health
Organization/PAHO – Human Resources Program, to expand the experience of the
CICAD SON project at Schools of Public Health in Latin America to work on
international/global health issues and the drug phenomenon.
VII.
CICAD Schools of Nursing International Events
Between 1997 and 2001, the CICAD Schools of Nursing Project promoted the
following International events (CICAD Schools of Nursing Project Technical Report,
2001):
(i)
Annual CICAD Schools of Nursing Project Meetings
CICAD Schools of Nursing has organized five international meetings in the
United States and one in Canada to share experiences among project
participants and to discuss specific issues related to the drug
phenomenon and the nursing profession.
(ii)
Specific International Meetings
CICAD Schools of Nursing Project, in Collaboration with the University
of Nuevo Leon/México, organized and implemented the “First
International Meeting on New Doctoral Nursing Programs in Latin
America,” held in Monterrey, Mexico, November 28 to December 01,
2001. The meeting had the objective of discussing the situation of new
doctoral nursing programs in Latin America. Participating in the meeting
were representatives from ten countries in Latin America, the United
States, and Canada.
18
VIII
CICAD Schools of Nursing Transnational Research Studies
CICAD Schools of Nursing Project is leading the coordination of a transnational
study on “ Evaluation of Graduate Nursing Programs in Nine Countries of Latin America:
Challenges and Perspective.” The results of the study will be presented in the VII
Annual International Meeting of CICAD Schools of Nursing Project on Demand
Reduction in Latin America, to be hold on August 2002, Florianopolis, Brazil (CICAD
Schools of Nursing Technical Report, 2001).
IX
Final Considerations
The CICAD Schools of Nursing Project on prevention of drug use and abuse,
social integration, and health promotion in Latin America has been very successful thus
far. The results achieved from 1998 to 2001 in education, extension, and research
indicate that nurses can exercise a leadership role in demand reduction in Latin
America. The project has created a model for human resources development in nursing
to work and do research on demand reduction. This experience can be replicated in
other areas, within and outside of CICAD.
The leadership provided by the administrations of the Schools of Nursing, the
Academic Committee, the Ad Hoc Scientific Committee, and the administrative support
personnel of the project is fundamental to achieving the objectives of the project. The
Regional and International Capacity-Building Programs must prepare faculty on
research methodologies applied to the study of drug phenomenon. They are the basis
for self-sustainability of graduate and undergraduate nursing education in Latin America
and their contribution to drug demand reduction. The next step will be gaining nursing
representation at national, state, and municipal drug control commissions in each
country of Latin America. CiCAD has played a major role in facilitating this process. The
political and technical role of CICAD is fundamental for each country to move in this
direction.
In the last decade of XX Century, CICAD, as an international major actor on the
control of drugs throughout the hemispheric, has contributed to and led several
initiatives to advance Nursing Education and Research in Latin America. The
continuation of technical and financial support of CICAD for nursing profession is
fundamental to achieving its goal of creating a cadre of professional nurses with the
scientific and technical skills to be leaders in reducing the demand for drugs in the
Americas.
19
References
1.
American Association of College of Nursing/AACN (2001). Envision Doctoral
Education for the Future. Proceedings of AACN 2001 Doctoral
Education Conference. Washington, D.C.
2.
Global Illicit Drugs Trends (2000). ODCCP Studies on Drugs and Crime –
Statistics. United Nations Office for Drug Control and Crime
Prevention. Vienna.
3.
Iglesias, E. B. (1999). Bases Teoricas que Sustentan los Programas
de Prevencion de Drogas. Madrid. Ministerio del Interior –
Delegacion del Gobierno para el Plan Nacional sobre Drogas.
4.
Inter-American Drug Abuse Control Commission/CICAD (1997).
Hemispheric Partnership to Combat Drugs. Washington, D.C. (Folder
Information).
5.
Inter-American Drug Abuse Control Commission/CICAD (2000).
Multilateral Evaluation Mechanism/MEM – Hemispheric Report 19992000. Washington, D.C.
6.
Inter-American Drug Abuse Control Commission/CICAD (2001). Schools of
Nursing Project on Drug Demand Reduction in Latin America. Technical
Report from 1998-2001. Washington, D.C.
7.
International Council of Nursing/ICN (1996). Nursing Education: Past to Present.
Vol. I: Current and Future Trends. Geneva.
8.
International Council of Nursing/ICN (1999). Guidebook for Nurse Futurists:
Future Oriented Planning for individuals, Groups, and Associations.
Geneva.
9.
International Council of Nursing/ICN (1995). Career Development for Nurses.
Geneva.
10.
International Council of Nursing/ICN (1994). Planning Human Resources
for Nursing. Geneva.
11.
Langston, N.; Corcoran, R.(2001). The Power of Shared Leadership; Promoting
a Way of Being that Will Endure (editorial). Nursing and Health Care
Perspectives, 22(5):218.
12.
Programa de las Naciones Unidas para la Fiscalización Internacional
de Drogas (1998). Por un Control Global de las Drogas. N.Y.
20
13.
Organization of American States (1999). Challenges for a New Future
1999-2004. Washington, D.C.
14.
Petraitis, J.; Flay, B.R.; Miller, T.Q. (1995).Reviewing Theories of
Adolescent Substance Use: Organizing Pieces in the Puzzle.
Psychological Bulletin, 117, 67-86.
15.
Rourke, J.T. (1999) International Politics on the World Stage. Duskin,
McGraw-Hill.
16.
World Drug Report (2000). United Nations International Drug Control
Programs. New York. Oxford University Press.
17.
Wright, M.G.M. (2000) A Critical-Holistic Paradigm for an Interdependent
World. American Behavior Scientist, 43(5): 808-824.
18.
Wright, M.G.M. (1999) A Critical-Holistic Perspective of the Drug
Phenomenon and Nursing Education. Paper presented at
the 3rd Seminar of CICAD Schools of Nursing Project in
Valencia, Venezuela, January 27-29.
19.
Wright, M.G.M. & Alarcón, N.G. (1999) Análisis Crítico-Holístico de
los Programas de Postgrado en Enfermería en América Latina. In:
Enfermería en las Américas.PAHO/WHO, Publicación Científica
# 571.
21