Globalization: grasping the concept within the context of nursing


  • Tom Keighley RN, FRCN

    1. Independent Consultant, and Frances Bloomberg International Distinguished Visiting Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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KEIGHLEY T. (2013) Globalization: grasping the concept within the context of nursing. International Nursing Review60, 86–87

Globalization is a phenomenon traceable historically from the beginning of time as clans and tribes migrated and learnt from each other. The article in this issue of INR by Grootjans and Newman ‘Globalization and nursing: a concept analysis’ (pp. 78–85) makes the case for nurses to be educated about globalization as it applies to modern health care. The concept is complex and requires insight not only into health care itself but also fields such as human migration, economics, the significance of English as a universal language and the use and availability of information technology. Writings on the impact of global technology and social capital are also important. In addressing globalization, nurses need to access research and writings well beyond the standard healthcare oeuvre.

A rapid Internet search reveals the daunting fact that there are hundreds of definitions of globalization. The paper by Grootjans and Newman in this issue of INR demonstrates the challenge of rendering something so nebulous, but so significant, into concepts that are transmissible in a nursing education context. There is no doubt that much is said and written about globalization, but so often, the assumptions behind the assertions are not explored, or shared, meaning that globalization has become a weasel word meaning what its author wants and open to great suspicion as a notion to be researched and taught. The available literature is immense and it is critical to choose a particular perspective to undertake such work if the grip on the concept is not to be lost.

Grootjans and Newman helpfully take the reader through some of the current healthcare literature and conclude that it is possible to identify what it is that nurses need to know to work in a globalized world. This includes knowledge of the environment, and of health promotion, and by having the capacity to think globally and act locally. They also focus on issues of social justice and equity. They write on the basis that ‘There is little doubt that our world is globalized’. In this, they are reiterating the current perception of commentators generally and it is helpful that they have identified the need for nurse students at master's degree level to study globalization in some depth. As their course progresses, they will evaluate their own and their students' experience of the subject. It maybe that certain concepts will be added to the module that have been of concern to other authors in the field.

Kingma (2006) and Weinstein & Brooks (2007) consider migration in the international nursing workforce and identify the drivers for it. This literature underlines migration as a significant global nursing phenomenon, and Keighley (2007) in addressing the development of mutual recognition agreements between countries identified some of the structural components that enable migration. Robinson (1999) had previously flagged up the significance of agencies outside of the usual nursing universe by focusing on the impact of the World Bank and the World Health Organization policies for nursing and health care. Approaches such as these identify a conceptual base, which grounds nursing in the day-to-day realities of a wider global life.

Other lenses can also be used: that finance now operates as a global phenomenon is indicated by the contagion of the current economic crisis. I have learned from several personal communications from Scandinavia and Asia that here are now numerous schools in countries worldwide where English is no longer taught because children learn the language at such an early age from the television and computer. Information technology, within a consistent format capable of interconnectivity, is available globally. Computers or Internet access may not be available widely in the poorest countries but mobile phones are, and it is this technology that is being used most widely now by healthcare agencies.

Two thinkers in particular have given deeper insights into globalization. Castells (1989, 1996), a social geographer, has examined the implications of technology for social living. He describes an emergent individualism and what he describes as the ‘space of flows’. This is when things are not done either face-to-face or via technologies that require people to be able to communicate simultaneously. Communication can be out of sync from others because of the technology. One only has to think of emails sent at 10:00 pm to be read at 8:00 am next day. This reveals communities of such variable geometry that schizophrenia develops between what is driven by international finances and the capacity of regions, or even countries, to influence that process. This stands in contrast to Putnam's (2000, 2002) positing of the nature of social capital where the pressures of globalization and its implicit pressure to achieve uniformity is now challenged by the emergence of new ways of being a community. Castells points to one globalization tension of ever bigger cities combined with very individualistic lifestyles. Putnam, in contrast, points to how despite these pressures, groups are coming together at numerous levels varying from sports clubs and local history societies, to ad hoc protest movements.

This diverse literature highlights the complexity of coming to terms with what might be meant by globalization. It is important to remember that this move to globalization is matched by an equal pressure to identify difference and separateness. Many larger countries can point to increased regionalization and localism in decision making, including the delivery of health care. On a different scale, some countries are still working to identify what it means to be a separate country. Baloban's (2005) study of Croatia is an excellent example.

While therefore, it may be possible to identify some features that might unite the delivery of nursing care globally, there is also a deep and rich backdrop, which emerges like a badly woven tapestry, a bricolage, into which such efforts need to be placed. Each nation and, indeed, region is deeply proud of its nursing traditions and while wishing to be modern, have features that they will not easily surrender. Equally, the variation in national global domestic products and the available disposable incomes of individuals leads to questions concerning the extent to which globalization in health care will or can occur. This complexity therefore underlines the need for nurses of the future, as they progress their professional development profiles to include significant work in their portfolios in order to understand the nature of globalization and how it is affecting the environment in which they are working. Globalization remains one of the key external influences on the development of health care and therefore of nursing; it is important that emergent nurse leaders are enabled to engage with the concept and develop a more comprehensive view on how globalization influences nurses, and conversely, can be influenced by the nursing profession.