Editorial

Listening to the radio a few days ago in Northern California, where I live, a prominent local woman was being interviewed about her ideas on social-cultural diversity and its implications for the future of US society. Ours is an extremely diverse nation and becoming more so. Canada, by comparison, is very homogenous. The woman being interviewed used the term ‘edgewalking’. This was new to me. And so I listened closely to her explanation. Edgewalkers are people who live between two or more cultures — who ‘walk’ at the edge of two or more socio-cultural groups because they understand the cultural values of both. In the United States, this might be the Hispanic American who values both the Mexican love of family and appreciates the US respect for individualism: who appreciates the values of community ownership, but also recognizes the good in private property, in private enterprise. Americans value individualism, equality, and democracy. The edgewalker understands these values. She criss-crosses between two cultures respectfully as she plots a life path that captures the better of two worldviews, melding at times and at other times keeping that which is unique separate. We need nurses in every country who are edgewalkers. We need nurses who think globally, but act locally. We need nurses who are international, who think beyond the borders of their locality, and beyond their discipline in order to advance knowledge. Ketefian and Redman (1997) are concerned with nursing’s parochialism. They state, and I agree: Despite the increase in international activities, the nature of nursing theory, research, education, and practice has not changed appreciably to be globally relevant (p. 11). Continuing they state: Given the global society in which we live, nursing science now faces the challenge of moving to its next phase of development…becoming globally relevant. The movement entails a variety of activities and changes in the way we do science (p. 15) I assume that becoming global by expanding our understanding of differences and diversity is widely valued by nurses. Based on this premise, then, it behooves us to find every possible way to increase our international activities to meet the challenges of advancing nursing scholarship to ensure that it is globally relevant. The Journal of Advanced Nursing (JAN) is seeking manuscripts from authors in the Americas — North, Central, and South America; the West Indies; and Bermuda — that convey, for example, the health and nursing needs of ageing populations. In the United States, in the next 20 years the number of seniors over 65 years of age will likely increase by more than 50% to nearly 55 million. This change will accelerate the demand for health services of a particular type, and may well also accelerate a shortage of doctors and nurses. Comparative analysis of these changes is needed to better understand nursing’s contribution to elder care, to the measurement of quality, and to outcomes analysis from a variety of normative perspectives. Hirschfeld, in her discussion of World Health Organization priorities for research, cites diseases and maladies of the elderly. She foresees, too, the supply and demand for personnel in the healthcare workforce as a future high priority. We need nurses throughout the world who are knowledgeable about these facets of their own society, but are also aware and sensitive to ageing and all that it implies in several cultures. We need nurses who are edgewalkers, who can expand our inquiry and practice with their more global, multidimensional perspective of ageing and workforces. We need nurses and articles for JAN, too, reporting on the ‘technology imperative’. Many American nurses (myself among them!) love new, complex medical technologies. Medical science in the United States may be only a few years away from deciphering the 100,000 or so human genes, with all this implies for the future of genetic engineering and a mighty wave of new therapies and diagnostics. Also, health care consumers in the United States are rushing into cyberspace. Internet-based industries are springing up everywhere. Last year, nearly 20 million US citizens went on-line to seek information about health and health services. What are the epidemiological implications of new types of health communication? What is the nurses’ role in patient and family education given the information revolution? How is new information technology valued and viewed in the European Community compared to North and South America? These are questions edgewalkers need to address given our global society, if nursing is to be globally relevant in its education and practice. Edgewalkers are also knowledgeable about research methods and their underlying premises and assumptions. A methodology that some of us in the United States think can have a great impact on improving health care services throughout the world is cost-effectiveness analysis. Much mention is made of cost-effectiveness care, but very little attention is paid to this applied method in nursing research texts and therefore in nurses’ research. When analysing the cost of an intervention, researchers examine then calculate direct and indirect expenses and other elements of the cost equation. Effectiveness basically is about the quality of a new intervention or technology. Cost effectiveness analysis is about the problem of resources and their allocation for improved results. In the United States this form of analysis has begun to be applied seriously to health care. Are nurses in the United Kingdom moving toward applied methodologies and away from the more esoteric and basic methods? Are they formulating studies to analyse cost and quality? What are the driving forces pro and con and how do these differ compared to the United States with its strong bent toward privatization and capitalism as compared to the more socialistic norms one finds in Europe? Edgewalkers can respond to these questions and in so doing advance the nature of global nursing. When thinking about high priority research one of the criteria commonly agreed on in most scientific disciplines is the extent to which an initiative will contribute to international understanding. As each of us tries on the shoes of the edgewalker, as each of us takes up the challenge of moving nursing to its next stage of development…becoming globally relevant, we must ask of our philosophic and empirical inquiry: Does it contribute to international collaboration? Does it contribute to international understanding? What special sensitivities to the concerns of other nations are apparent? We must also ask, How does the initiative contribute to national pride and prestige? Does the initiative provide attractive opportunities for involving leading scientists from other countries? Are there international organizations that should be involved? When we anticipate questions such as these, we begin to walk at the edge of our own and others nationalities. In so doing, I believe we begin to move nursing science to its next stage of scientific development…becoming globally relevant. What do you think? Write to me at JAN ! In the United States we are especially concerned about patient’s pain and how it is alleviated; about nursing staffing levels and mixes in hospitals and nursing homes; about individual and organizational level performance indicators to assess quality; about post-surgical patient nutrition and nutrition in long-term care; and about the physical and ethical implications of pre-term low birth weight infants, to name a few of the more prominent. It is on these topics that we have the most to learn from other countries, other peoples. It is here that we need you as edgewalkers who can ask tough, perceptive questions and provide insightful, useful and new answers. Which I hope you will submit for report in JAN.

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