The Salud Nuevas Fronteras initiative serves as a catalyst to improve nursing education, prepare the nursing workforce for the unique needs of Mexico and South Texas, and shift cultural perceptions of nursing as a profession in Mexico by providing the best care possible for its citizens. The collaboration between UTHSCSA-SON, FAEN-UANL, UM-SON, UPenn-SON and MATT resulted in the creation of a more holistic curriculum aligned with that of one being taught in the US and designed to better capacitate nurses at the FAEN-UANL with stronger critical thinking skills and the ability to treat contemporary health care trends facing the region.

Once the participant institutions agreed in building a proposal, they established a person responsible to maintain communication, and to proceed to execute the accords. UM-SON and UPenn-SON were included in curriculum matters. UTHSCSA-SON worked with the undergraduate studies, while UM-SON and UPenn-SON were to assist with graduate education. UTHSCSA-SON and FAN-UANL designated professors respectively, who worked out the activities by themselves and/or supported by personnel within the organization. One important activity in this process was the writing of short reports that were distributed among the whole group. For the reviewing of the curriculum, FAEN-UANL included a faculty in charge of the operation of the ongoing program; two bilingual nursing professors from UTHSCSA-SON, visited Monterrey to support that activity and resequencing of the curriculum. The process of building the new curriculum, was extended because the established procedures in the UANL took extra time; it had to be approved by two internal commissions (FAEN), and then by the University Council at the central level. Preparing and developing the curriculum to train the 8 professors was also led by a responsible professor in FAEN-UANL; UTHSCSA-SON appointed an expert on Nursing Education to deliver the academic program, and an administrative person to deal with the logistics in the University, the housing of the 8 students, and the registration process in the University. Along these events, there was constant communication between UTHSCSA-SON and FAEN-UANL leaders.

In this experience the 8 Salud Nuevas Fronteras Scholars were enrolled into UTHSCSA SON classes designed to teach how to incorporate critical thinking skills into their own curriculum and clinical experiences. The schedule totaled 12 semester hours and 180 clinical clock hours. Course taught included Nursing Education Theories and Trends, Facilitation of Learning in Academic Settings, Process of Curriculum Development & Evaluation, Strategies that Facilitate Learning Across Delivery Modalities and Systems. Many of the courses were taught in Spanish and included United States based accredited courses and certificate training. Throughout the program scholars were exposed to state of the art facilities and tools such as patient care manikins. These professors will eventually replicate the experience with local professors, and share best practices, in order to extend the number of faculty prepared in new and stronger learning-teaching methodologies. This pilot program participants were enrolled in the eight UTHSCSA-SON classes for four semesters between Fall 2014 and Spring 2016. Key training included Team STEPPS and ELNEC Palliative Care. For the students to properly absorb the information, much of the content needed to be translated to Spanish. For the Palliative Care Course - Certification powerpoints for each of the eight modules were provided in Spanish. Case studies included Baby Boy Jones and Nino Chapa Martinez; both translated culturally and into Spanish. Team STEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) is an evidence-based framework to optimize team performance across the healthcare delivery system. The core of the Team STEPPS framework is comprised of four skills: Leadership, Situation Monitoring, Mutual Support, and Communication. This was also taught in Spanish. At the end of every period, the students applied the new skills in their teaching activities, allowing us to identify important aspects of the clinical practice that go beyond the clinical professors performance.

Communication began between UTHSCSA-SON and MATT (August/2012). UM-SON coordinated with UTHSCSA-SON to host a workshop for the FAEN-UANL to develop a Nurse Practitioner program in chronic illness management. UTHSCSA-SON took on the role of preparing the FAEN-SON faculty, while UM-SON continued the partnership assisting in curriculum design. From here, UTHSCSA-SON invited FAEN-UANL to be the counterpart for the initiative proposed by MATT: To strength the Nursing profession in Mexico. Three stages can characterize the route to combine the efforts of the five institutions who took part in the Salud Nuevas Fronteras initiative. First, the participants, and MATTA's executive personnel learned about the nursing situation in Mexico. Specifically, the analysis of different curricula operated in selected nursing schools in Mexico. Several virtual meetings took place, in order to exchange and analyze data and documents collected and prepared by FAEN-UANL faculty. During the second stage, a memorandum of understanding was settled by FAEN-UANL, UTHSCSA-SON and MATT. Two main activities were outlined and initiated simultaneously via the memorandum. One was the preparation of a new FAEN-UANL curriculum, closer to the content of the Nursing UTHSCSA-SON, which resembles the Essentials of Baccalaureate Education for Professional Nursing Practice in the USA. Concurrently, 8 young faculty from the FAEN-UANL, who would later supervise the clinical practicum in Mexico, were chosen to be trained in UTHSCSA-SON. All these arrangements were discussed and reviewed through telephone conversations, and also face to face meetings The third stage consisted in preparing the courses for certificate program in San Antonio for the selected faculty, translating materials from English into Spanish, and preparing documents for the participants to be admitted into the Country and in the University. This coordination was managed by UTHSCSAs International Program Office and UTHSCSA-SON Office of Admissions & Student Services. in the UTHSCSA-SON. At the same time, during this period personnel form FAEN-UANL kept working on renewing the curriculum and having communication with central offices of the Universidad Autonoma de Nuevo Leon, responsible for the changes in curricula. The Dean of UTHSCSA-SON was the one responsible for keeping the communication among the four institutions following the working process, lasting 2012 to 2014. Progress of the program participants from FAEN-UANL was evaluated by measuring the 8 core competencies outlined by the National League for Nursing for Nurse Educators. Assessments were made pre and post program to evaluate participants degree of personal mastery of task statements.

Facultad de Enfermera - Universidad Autnoma de Nuevo Leon (FAEN-UANL), University of Texas Health Science Center San Antonio - School of Nursing, University of Michigan -School of Nursing (UM-SON), University of Pennsylvania -School of Nursing (UPenn-SON), Mexicans and Americans Thinking Together Foundation.