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Nurses’ Role in Achieving the United Nations Sustainable Development Goals from Local
to Global Context: A Proposed Model for Engagement
Mohammad Alsadi1, Huthaifah Khrais1, Tariq Afaneh2, Abdulqadir J. Nashwan3,4,5*
1. Faculty of Nursing, Zarqa University, P.O. Box 132222, Zarqa, 13132, Jordan
2. King Hamad University Hospital, P.O Box 24343, Busaiteen, Kingdom of Bahrain
3. Hazm Mebaireek General Hospital (HMGH), Hamad Medical Corporation (HMC), P.O Box
3050, Doha, Qatar
4. University of Calgary in Qatar (UCQ), P.O. Box 23133, Doha, Qatar
5. College of Health Sciences, Qatar University, P. O. Box:2713, Doha, Qatar
Mohammad Alsadi
Assistant Professor, Faculty of Nursing, Zarqa University, P.O. Box 132222, Zarqa, 13132, Jordan. Tel
+962 5 3821100, Ext: 1780, Fax: +962 5 3821120. Tel: +962795365766. E-mail: malsadi@zu.edu.jo
ORCID ID: 0000-0001-7383-1938
Huthaifah Khrais
Assistant Professor, Faculty of Nursing, Zarqa University, P.O. Box 132222, Zarqa, 13132, Jordan. E-mail:
Hkhrais@zu.edu.jo
ORCID ID: https://orcid.org/0000-0003-2350-1599
Tariq Afaneh
Nurse Manager, King Hamad University Hospital, P.O Box 24343, Busaiteen, Kingdom of
Bahrain. E-mail: tareq.afaneh@khuh.org.bh
*Corresponding Author
Abdulqadir J. Nashwan, RN, MSc
Director of Nursing for Education & Practice Development, Hazm Mebaireek General Hospital
(HMGH), Hamad Medical Corporation (HMC), P.O Box 3050, Doha, Qatar
Adjunct Senior Instructor, University of Calgary in Qatar (UCQ), P.O. Box 23133, Doha, Qatar
PhD Student, College of Health Sciences, Qatar University, P. O. Box:2713, Doha, Qatar
E-mail: anashwan@hamad.qa
ORCID: https://orcid.org/0000-0003-4845-4119
Twitter: A_nashwan
This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4208662
Preprint not peer reviewed
Running head: Nurses’ Role in Achieving the UN-SDGs
1
Nurses’ Role in Achieving the United Nations Sustainable Development Goals from Local
to Global Context: A Proposed Model for Engagement
Introduction
In 2000, eight Millennium Development Goals (MDGs) were established and adopted by
189 country leaders in the United Nations (UN) millennium declaration. The aim was to create a
global mobilization to reset health and social priorities worldwide. The target year for achieving
the MDGs was 2015, and the goals expressed many global concerns, including poverty, unmet
schooling, gender inequality, hunger, and the spread of diseases. Right after the announcement of
MDGs, they were criticized as they ignored many developmental and social aspects. However,
they became more adopted and understandable by establishing measurable and time-bound
objectives (World Health Organization, 2016; International Council of Nurses, 2017). When the
MDGs achievement due date was reached in 2015, efforts continued to achieve the unfinished
global agenda and address new health priorities included in the Sustainable Development Goals
(SDGs). Another 15 years were given to achieve them by 2030 (International Council of Nurses,
2013).
Living in a globally interconnected world means that health problems that affect any
region of the world can effortlessly travel to other regions, as witnessed in the different outbreaks
during recent years (Davis, 2016). Nurses are well-positioned to achieve the MDGs, now known
as SDGs, by providing quality, effective, and safe care (Gresh, 2016). This paper discusses the
role of Jordanian nurses in achieving the SDGs at both global and national levels. Then, the
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Running head: Nurses’ Role in Achieving the UN-SDGs
2
authors propose a model for fostering SGDs implementation and integration within the
healthcare systems.
From MDGs to SDGs
The Sustainable Development Goals (SDGs) agenda is broader and goes beyond the
earlier MDGs; the consultation process has been far more inclusive and more credible than those
for the MDGs (Kurth, 2017). By comparing both, SDGs include 17 goals, 169 targets, and 230
indicators, while MDGs were focused on only eight goals, 18 targets, and 48 indicators
(Maurice, 2016). The SDGs were welcomed and rapidly gained strong ground due to the
increased and critical need for real, sustainable development for the entire world. Even though
each country has different goals and action plans, almost all countries agree that the goal is to
combine economic growth, environmental sustainability, and social inclusion (ICN, 2017).
SDGs and Global Health
World leaders have agreed upon the implementation of 17 SDGs. In terms of linkage to
healthcare, some of the SDGs are directly linked to global health, while others indirectly pertain
to global health. In a later section of this paper, the authors propose a model of different levels of
engagement of nurses in implementing the SDGs based on the interrelation between the SDGs
agenda and the nursing scope of practice. Figure 1 below presents the 17 SDGs as announced by
the UN on September 25, 2015:
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Running head: Nurses’ Role in Achieving the UN-SDGs
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Figure 1. The 17 Goals - Sustainable Development Goals
This Photo is licensed under CC BY
Achieving SDGs: A Global Nursing Challenge
Healthcare-related problems in one part of the world notably affect the entire world. The
recent outbreaks of Ebola, severe acute respiratory syndrome, and Zika virus are obvious
examples (Sachs, 2012), and the latest COVID-19 pandemic is the biggest example in this
concern. Therefore, SDGs are raising the attention of world health stakeholders toward main four
key areas (1) advocacy for the SDG health targets; (2) harmonization of existing World Health
Organization (WHO) health strategies with the SDG targets; (3) identification of more effective
mechanisms for multi-sector actions, both within countries and at the regional and global levels;
and (4) strengthening of health information systems to support progress monitoring (Sridhar,
2016).
Promoting global awareness, political accountability, and public pressers are factors that
require many developing countries to make substantial progress towards the achievement of the
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Running head: Nurses’ Role in Achieving the UN-SDGs
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MDGs. However, the progress was highly variable across countries. After the economic
revolution in China, many developing countries have achieved the most of MDGs in 2015
(Sachs, 2012). With their global policy focus, the MDGs influenced the developing countries'
national policy planning and were incorporated within non-governmental organizations and civil
society strategies. Also, countries' progress in this area is diverse and vary. For example, the
WHO Western Pacific Region has made remarkable progress in achieving the MDGs target, as
all but two of the goals have been achieved (Alwan, 2016). However, the performance indicators
in developing countries are different; only five countries categorized as low-income economies
reached the WHO minimal criterion of 23 health care providers per 10,000 population to provide
essential mother and childcare. The rest of the countries are still straggling to achieve this target
(WHO, 2016).
Globally, young nurses represent the largest workforce of health care systems. As they
are delivering the majority of health care, nurses’ contributions are essential for improving health
outcomes and meeting the SDGs. With the current complicated and outpacing growth of health
care systems, advancing technology, uneven geographical distribution of the health workforce,
and continuing human resources crisis, nurses are a significant part of the solution (Maurice,
2016; Sun, et al., 2017; Kurth, 2017).
Nursing Roles in Achieving SDGs Globally
Young people should be actively involved in working towards the SDGs at all levels.
Today’s young people will be the policymakers of 2030. Hence, allowing them to take leadership
roles will increase their awareness about global issues, thus providing them with invaluable
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Running head: Nurses’ Role in Achieving the UN-SDGs
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experience in policymaking (Sun et al., 2017; Benton & Shaffer, 2016). Furthermore, nurses are
acutely aware that many factors affect people’s health and well-being for their critical positions.
Therefore, to scale up numbers of future leaders and competent nurses, redirecting the focus
toward constructing robust nursing curriculums sensitive to global issues is highly recommended
(Sun, et al., 2017).
Well-educated nurses will be able to recognize the complex nature of maintaining
wellness. Nurses have the advantage of accessibility to many people in their lifetime. They see
the actual context for well-being, assess it, and accordingly, nurses can reach beyond the
immediate presenting problems (Alwan, 2016; Sridhar, 2016). Furthermore, during the MDGs
era, nursing had the greatest contribution to goals 4, 5, and 6, which concerned reducing child
mortality, improving maternal health, and combating HIV/AIDS, malaria, and other diseases.
Nursing had roles in shaping and delivering SDGS and outcomes beyond 2015 (Benton &
Shaffer, 2016). Also, nurses must engage in advocacy, lobbying, and development of any
program introduced to improve health services. Nurses have practical knowledge of how health
service delivery can be designed, coordinated, and effectively implemented. Indeed, global
organizations like the World Health Organization (WHO) and the International Council of
Nurses (ICN) tended to highlight the contribution of the profession to MDGs achievements and
to reinforce nurses toward successful implementation of SDGs (ICN, 2017).
The International Council of Nurses (ICN) has selected “Nurses: A Voice to Lead,
Achieving the Sustainable Development Goals” as the theme for international nurses’ day on 12
May 2017. This initiative aimed to encourage nurses to lead and inspire others to take on SDGs
challenge. Nurses’ voice is urgently needed to develop policies and make future decisions. The
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Running head: Nurses’ Role in Achieving the UN-SDGs
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SDGs are an opportunity for nurses to demonstrate how their actions make a difference and how
they help shape decision-making processes and healthcare policies (ICN, 2013; ICN, 2017).
Back again to the MDGs era, the nursing profession remarkably contributed to achieving
all MDGs' goals. For example, ICN, in collaboration with the Florence Nightingale International
Foundation, contributed to MDG number 2 (achieve universal primary education) and MDG
number 3 (promote gender equality and empower women) (Davis, Matthews, Szabo, & Fogstad,
2015). In 2005, nurses established “The Girl Child Education Fund” to keep orphaned daughters
of nurses in Kenya, Swaziland, Uganda, and Zambia in school. To date, 316 girls are still
benefitting from this initiative. However, at the same time, most of the nursing profession’s
activities were restricted to those goals that had clear health dimensions: MDG number 4
(Reduce child mortality), MDG number 5 (Improve maternal health), and MDG number 6
(Combat HIV/AIDS, malaria and other diseases) (ICN, 2017).
Nursing has been more proactive in addressing the SDGs, although engagement is more
focused. Nursing does not need to lead on every front but should be a supportive coalition of
advocates for others and prime mover in achieving some goals at all SDGs levels (Benton &
Shaffer, 2016). As trusted leaders, nurses can help plan and build resilient health systems. But to
develop health beyond health care, nurses must move into expanded roles, working with other
sectors and individuals, to support the development of resilient communities (Davis, Matthews,
Szabo, & Fogstad, 2015; Sridhar, 2016).
SDGs in Jordan
Jordan was one of the first countries to implement the MDGs; Her Royal Majesty Queen
Rania Al-Abdullah was one of the 27 world leaders who provided advice to the UN Secretary
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Running head: Nurses’ Role in Achieving the UN-SDGs
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Jordan
2025
National Goals
Long term Sectors Goals
/(SDGs)
Objectives
Initiative/Policies
Programs /Projects
regarding the shape of the 2030 agenda’s framework for SDGs. The national wide
implementation of the goals is led by the Ministry of Planning and International Cooperation
(MOPIC) and supported by the United Nations Development Program (UNDP) team in Jordan.
Also, the National Higher Committee on Sustainable Development continues to provide strategic
guidance and supervision (United Nations, 2017). As a result, the Key visionary planning
document for Jordan “Jordan 2025: A National Vision and Strategy” and its action plan
“Executive Development Programs” were developed in harmony with the SDGs. Moreover,
different national strategies from different disciplines in Jordan were developed in harmony with
the 2030 agenda (Figure.2). Examples of those national strategies are summarized in Figure 3.
Figure 2. SDGs Implementation Model in Jordan (United Nation, 2017)
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Running head: Nurses’ Role in Achieving the UN-SDGs
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Comprehensive
National Plan for
Human Rights (2016-
2025)
The National Strategy for
Women.
The National Strategy
for People with
Disabilities.
The National Strategy
for Human Resource
Development (2016-
2025).
The National Strategy
for Reproductive
Health/Family
Planning (2013-2018).
The National Climate
Change Policy (2013-
2020).
The National Strategy
and Action Plan for
Sustainable
Consumption and
Production (2016-
2025).
Figure 3. National strategy examples
Health and Well-being in Jordan
Jordan witnessed many improvements in health and well-being indicators, “Life
expectancy at birth has increased to 72.7 for males and 76.7 for females. Under-five mortality
rates have dropped from 37 per 1,000 live births in 1990 to 21 per 1,000 live births in 2012.
Similarly, infant mortality rates have decreased from 34 to 17 per 100.000 over the same period
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Running head: Nurses’ Role in Achieving the UN-SDGs
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… Maternal health has greatly improved over the last decades, and the Maternal Mortality Ratio
is 19 per 100,000 live births based on a maternal mortality study conducted in 2008, while
99.6% of births are attended by a qualified birth attendant” (United Nation, 2017).
Despite those improvements, disparities in healthcare are still a major concern, especially
among the poorest people and southern governorates; of the 17 SDGs, nursing can play a critical
role in implementing SDG number 3 “Ensure healthy lives and promote well-being for all at all
ages” as its directly related to the philosophy and practice of the nursing profession (United
Nation, 2017).
Nursing Role in Implementing SDGs in Jordan
Nursing in Jordan is supported by Her Royal Highness, Princess Muna Al Hussein; she
was a great supporter of the SDGs and was very keen to reduce poverty levels and achieve
equitable care for the family and society. In view of her important position in the local and
international community, her royal highness contributed to establishing the Princess Muna
nursing college in 1962 and the Jordanian Nursing Council (JNC) in 2002, which had an
important impact on the development of the nursing profession in Jordan.
JNC has developed the national strategy for nursing and midwifery in alignment with the
SDGs; in fact, The strategy’s vision and mission were predominantly driven by SDG Goal 3:
Ensure healthy lives and promote well-being for all at all ages, the WHO Framework for Action:
Strengthening Nursing and Midwifery in the Eastern Mediterranean Region 2015-2025” and the
WHO Global Strategy on Human Resources for Health: Workforce 2030. Furthermore, JNC
contributes to achieving the SDG.3 through launching different national initiatives and policies
that correspond to Executive Development Program and Higher Health Council, and this
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Running head: Nurses’ Role in Achieving the UN-SDGs
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includes developing the national strategy for nursing and midwifery 2016-2025, Monitoring and
evaluation plan for the national strategy for nursing and midwifery, nursing classification system,
mitigating associate nursing program, establishing nursing licensure exam, improving nursing
staff capacity through continuous education programs, establishing regional nursing examination
center, establishing Advanced Practice Nursing system including specialization examination,
and competency-based education program (JNC, 2016).
An interview was conducted with the Secretary-General of the Jordanian Nursing
Council, Professor Muntaha Gharaiebeh, to highlight the council role in implementing the SDGs;
she mentioned that
The Jordanian Nursing Council launched a national strategy for nursing and midwifery in 2016,
and continues working to implement the strategy with the JNC partners who represent all
nursing profession stakeholders. This national strategy was developed in alignment with SDGs,
Jordan Vision 2025, the national health strategy, and the executive development plan 2016-
2018. JNC has continued working with national policymakers to achieve universal health
coverage as one of the cornerstones of our strategic vision, "Transformed nursing and midwifery
profession to lead the future of health care to ensure the well-being of the population" and
mission, "To maximize nursing and midwifery contributions through effective regulation and
governance, innovative education, evidence-based practice, and empowered workforce to
achieve better health outcomes including Unversal Health Coverage". JNC works to improve
access to quality and essential healthcare services by strengthening primary healthcare and
shifting the healthcare delivery paradigm toward primary healthcare services. One of the most
important things that JNC does to help with universal health coverage is to help with midwifery
education and practice in Jordan. It does this in a number of ways, such as by putting out
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Running head: Nurses’ Role in Achieving the UN-SDGs
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regulations for classification and specialization, strategies for keeping midwives, research
priorities that help midwives, and professional standards and competencies. JNC also works to
improve universal health coverage by establishing advanced practice nursing through nursing
specialization programs. We work to institutionalize the advanced practice roles in healthcare
organizations. JNC currently offers 6 different specialization exams and is working to offer 12
specialization exams in the future. Through the American Nursing Credentialing Center, JNC
also offers high-quality continuing nursing education programs.
A Proposed Model for Nursing Engagement in Achieving SDGs
After exploring different dimensions of the nursing role in implementing the SDGs, it was
noticed that nursing's contribution to achieving the SDGs varies based on different factors, more
specifically, the relationship between the nursing scope of practice and the nature of the SDG.
The authors divided the SDGs into three categories based on the level of engagement and the
nature of the anticipated nursing response to the SDG. Level 1: Primary level engagement (PLE)
requires a direct response from nursing to achieve the corresponding SDGs. Level 2: Secondary
Level Engagement (SLE) corresponds to SDGs that require an indirect response from nursing.
Finally, Level 3: Tertiary Level Engagement (TLE) requires minimal or no response from
nursing.
Table 1 provides an example of the expected nursing response to the three levels of
nursing engagement. Moreover, the authors suggest five enablers for the successful
implementation of the SDGs. Those include Shared Vision, Multi-Disciplinary Collaboration,
Nursing Leadership Commitment, Community Awareness, and Financing.
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Running head: Nurses’ Role in Achieving the UN-SDGs
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Table 1. Nursing Actions to Achieve SDGs by Level of Engagement
Level of
Engagement
Related SDG
Examples of engagement actions
Good Health & well being
Well-being and health-based
nursing curriculum
Improving UHC through APN
Partnership for the goals
Agreements with organizing
bodies
Collaboration between Regulatory
bodies for nursing research,
nursing education, and nursing
practice
Primary Level
Engagement
(PLE)
Quality Education
SDGs based education programs
Accreditation
Continuous professional Education
Peace, Justice
Shared governance
Gender Equality
Supporting female nurses
education
Clean water &sanitation
Including sanitation in the
community nursing program as
appropriate
Reduced Inequality
Advance APN roles
Climate Action
Rapid response nursing teams
Secondary Level
Engagement
(SLE)
Life on land
Community Awareness
No poverty
Addressing health determinants in
assessment
Zero Hunger, Improved
nutrition
Community awareness
Affordable &clean energy
Community awareness
Decent work and economic
growth
Expand nursing roles
Industry, Innovation
Life below water
Responsible Production
Tertiary Level
Engagement
(TLE)
Sustainable cities and
infrastructure
Conclusions
The nursing profession has contributed to achieving MDGs and continues to contribute to
the SDGs; the adoption of SDGs by international nursing bodies has contributed to fostering
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Running head: Nurses’ Role in Achieving the UN-SDGs
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nursing efforts to achieve the SDGs. However. This involvement in achieving SDSs varies
among regions and countries. For example, Jordan is one of the countries that could integrate the
SDGs within its national health plans. To enhance nursing contribution to global health, nurses
should recognize the healthcare system from a global context.
Implications for Nursing Management
As an outcome of this paper, the authors invite all nurse
managers at the different levels of management in the healthcare delivery system in the local
setting in Jordan, in the region, and maybe in the global context to adopt the proposed nursing
engagement model to potentiate nurses’ role in achieving the goals. It may increase the visibility
of nurses’ work, which accounts for the majority of the healthcare taskforce worldwide, to
achieve sustainable development goals. Furthermore, customized action plans can be formulated
at the different levels of proposed engagement to address the local needs in the different settings
where the model may be adopted.
Declarations:
Ethical Approval
Not applicable
Funding
None
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Running head: Nurses’ Role in Achieving the UN-SDGs
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