Rediscovering the essence of nursing: exploring the impact of in clinical experience in Thailand for undergraduate nursing students from Australia

International short-term placements in health professions education-A meta-narrative review

INTRODUCTION

In order to be prepared for professional practice in a globalised world, health professions students need to be equipped with a new set of knowledge, skills and attitudes. Experiential learning gained during an international placement has been considered as a powerful strategy for facilitating the acquisition of global health competencies. The aim of this review was to synthesise the diverse body of empirical research examining the process and outcomes of international short-term placements in health professions education.

METHODS

A systematic review was conducted using a meta-narrative methodology. Six electronic databases were searched between September 2016 and June 2022: Medline, Embase, CINAHL, PsycINFO, Education Research Complete and Web of Knowledge. Studies were included if they reported on international placements undertaken by undergraduate health professions students in socio-economically contrasting settings. Included studies were first considered within their research tradition before comparing and contrasting findings between different research traditions.

RESULTS

This review included 243 papers from 12 research traditions, which were distinguished by health profession and paradigmatic approach. Empirical findings were considered in four broad themes: learner, educational intervention, institutional context and wider context. Most studies provided evidence on the learner, with findings indicating a positive impact of international placements on personal and professional development. The development of cultural competency has been more focus in research in nursing and allied health than in medicine. Whereas earlier research has focussed on the experience and outcomes for the learner, more recent studies have become more concerned with relationships between various stakeholder groups. Only few studies have looked at strategies to enhance the educational process.

CONCLUSION

The consideration of empirical work from different perspectives provides novel understandings of what research has achieved and what needs further investigation. Future studies should pay more attention to the complex nature of the educational process in international placements.

From a learning opportunity to a conscious multidimensional change: a metasynthesis of transcultural learning experiences among nursing students

BACKGROUND

Several educational activities in nursing schools worldwide have been implemented to promote transcultural nursing and cultural competence. Despite the diversity of their experiences and outcomes, the available evidence has not been systematically reviewed and reinterpreted. This study aimed to review and reinterpret all rigorous qualitative evidence available, providing an opportunity to understand how students learn transcultural nursing and assisting faculties, researchers, managers, and practitioners in designing new interventions to improve transcultural training.

METHODS

A meta-synthesis was conducted to review and integrate qualitative studies of these phenomena. English, Spanish and Portuguese articles were searched in Pubmed and Scopus databases. Only peer-reviewed journals in which qualitative approaches were used were included. Quality was assessed using the CASP qualitative version checklist. The metasynthesis technique proposed by Noblit and Hare was used to analyse the data.

RESULTS

Twenty-nine studies were included in the analysis. Most studies used phenomenological approaches that were conducted in Australia and the United States of America, with international internships being the most popular learning method. The data revealed one central theme, "From learning opportunity to conscious multidimensional change," and six subthemes. The transcultural nursing learning experience is not a simple or linear process. Instead, it appears to be a complex process formed by the interaction between a) self-awareness, b) reflective thinking, c) Cultural Encounters, d) cultural skills, e) Cultural Desire, and f) Cultural Knowledge.

CONCLUSIONS

Transcultural nursing learning is a multifaceted process that arises from specific learning opportunities. This process is still to evolving. Therefore, specific educational strategies should be implemented to encourage attitudinal change and promote reflective thinking.

Nurses benefit from international clinical placement as nurse students: A qualitative study

BACKGROUND

A goal of studying abroad is increased cultural knowledge as well as strengthening the participants' disposition for active participation in society and in future careers. Empirical studies have shown a positive impact on nursing students', but little is known about the effects of international clinical placement on professional nursing. The aim was to investigate nurses' experiences after participating in international clinical placement as students, and how the stay influences their future career as professional nurses.

DESIGN

Qualitative design, and a hermeneutic phenomenological approach.

METHODS

Individual semi-structured interviews were conducted with a sample of eight nurses who had participated in an international clinical placement as nursing students and worked for at least two years as nurses. The participants were students at one University College in Norway. The data analysis method was inspired by Max van Manen's thematic analysis.

RESULTS

The international clinical placement promoted personal and professional development of importance to professional nursing practice. The informants benefited from increased global and cultural awareness and noted that mastering the emotional challenges during the placement strengthen their ability to manage demanding situations in nursing work. The students evaluated guided reflection before, during and after the stay to contributing to learning outcome.

CONCLUSION

The potential for increased global and cultural competence and personal and professional development is high in international clinical placements. If the opportunity is taken, the participants' future careers can be affected in a way that benefits patients and colleagues. We recommend that educators and supervisors of students on international clinical placements should facilitate guided reflection to the participating students.

Empathy development and volunteering for undergraduate healthcare students: A scoping review

OBJECTIVES

Empathy in healthcare benefits patients and healthcare providers. However, empathy decline is a recent trend within healthcare education. There is a paucity of literature that investigates the impact of volunteering on the empathy levels of undergraduate healthcare students. This scoping review explores the literature regarding empathy and volunteering for healthcare students.

DESIGN

The Joanna Briggs Institute methodology for scoping reviews guided this study.

DATA SOURCES

The electronic databases MEDLINE, CINAHL, ProQuest, JBI, Cochrane, PubMed, PsychInfo, and PsychNurses were searched from January 2001 to August 2021. The original search was developed in MEDLINE and then adapted to the other databases.

REVIEW METHODS

This scoping review used the Joanna Briggs Institute scoping review methodology. The search retrieved a total of 310 articles. Following deduplication, 271 articles were reviewed by title and abstract. Thirty articles were reviewed in full text with twelve articles meeting the criteria for inclusion. Included studies were assessed using the Mixed Methods Appraisal Tool (MMAT).

RESULTS

Five qualitative, four quantitative and three mixed method studies were included. A variety of volunteering interventions for undergraduate healthcare students were identified from countries including the United States of America, Singapore, Australia, and Brazil. Thematic analysis identified that volunteer undergraduate healthcare students practiced and developed empathy, and experienced professional and personal development.

CONCLUSIONS

Volunteering interventions were primarily in a service-learning modality within community health and palliative healthcare settings. Inconsistencies exist in empathy definitions and empirical empathy measurement. There is a need for more research that explores empathy development through volunteer activities in acute care settings.

Reported outcomes of nursing or midwifery students participating in international educational programs in their pre-registration education: A narrative systematic review

OBJECTIVE

To identify outcomes of nursing or midwifery students participating in international educational programs in their pre-registration education.

DESIGN

A systematic review of the literature was conducted in keeping with JBI methods.

DATA SOURCES

A range of databases were searched, including Medline, Embase, ERIC, CINAHL, ProQuest Central and DOAJ. Studies published in English from 2010 to 2020 were considered.

STUDY ELIGIBILITY CRITERIA

The review included qualitative and quantitative primary peer-reviewed research studies involving nursing or midwifery students who participated in international educational programs in their pre-registration education.

REVIEW METHODS

Thematic analysis informed by Braun and Clarke was used to identify key outcomes emerging.

RESULTS

56 studies were included. The results highlight similarities in outcomes for students who had undertaken international educational programs in three thematic areas: Cultural learning, Personal growth, and Professional development. Short-term outcomes are well documented, however there is a lack of research investigating long-term outcomes.

CONCLUSIONS

Further research is required to investigate long-term outcomes of international educational programs and means for measuring the effects on students' future professional practice. In addition, further research is needed to explore the perspectives of, and impact on, others including host communities and universities, and other stakeholders.

Reflections on an international nursing placement experience in Nepal: A thematic analysis

BACKGROUND

Increasing patient diversity, as a result of growing global interaction, has necessitated that nursing academics better prepare nursing students to provide culturally appropriate and respectful care to their patients, particularly in culturally diverse countries such as Australia. One approach to improve cultural awareness of nursing students is a cultural immersion placement, and this paper describes such an experience which has been embraced by undergraduate participants. Purpose of this paper was to describe experiences, cultural awareness and challenges encountered by final year undergraduate nursing students undertaking a 22-day cultural immersion placement in Nepal. The researchers accompanied one group of students per year on this trip, which was repeated for three consecutive years. Describing and reflecting on the lived experience of nursing students engaged in this cultural immersion placement has helped to discern how this experience affects the cultural awareness of undergraduate nursing students and helps to decrease the challenges for similar placements in the future.

DESIGN AND METHODS

To gain insight into the way this initiative impacted on the development of the participant's cultural competence, a qualitative descriptive design was chosen. Semi-structured interviews were carried out over three consecutive years with final year undergraduate nursing students upon their return from Nepal over three consecutive years. Data analysis followed standard suggestions for a systematic, unbiased approach to dealing with the condensed text, and was analysed using thematic analysis.

RESULTS

The findings suggested that this experience, albeit of limited duration, provided a significant contribution to students' understanding of cross-cultural awareness in the context of providing health care.

CONCLUSIONS

There was a strong implication from the outcomes that this cultural immersion placement should be permanently integrated into the undergraduate nursing course. There was, however, indication that there is room for added reflection and advantages to be made from the experience.

Learning Outcomes Attributed to Prelicensure Clinical Education in Nursing: A Systematic Review of Qualitative Research

BACKGROUND

Educators agree that clinical experiences are vital to the development of a graduate nurse; however, there is little research on student learning outcomes related to these experiences.

PURPOSE

The purpose of this systematic review was to examine qualitative studies of student learning in traditional clinical models.

METHODS

A systematic review was conducted following the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Nine electronic databases were searched using 43 search terms. Full-text review was completed on 109 articles, with 26 undergoing critical appraisal.

RESULTS

Only 6 qualitative studies reported learning outcomes attributed to clinical education models, focusing on experiences in foreign clinical placements, nurse-run clinics, the night shift, transition to professional identity, practicing as a clinical dyad, and development of caring skills.

CONCLUSIONS

The results of the systematic review of qualitative research that studied outcomes of prelicensure clinical education were insufficient to provide recommendations for traditional clinical education that are supported by evidence.

Improvement in the Cognitive Aspects of Cultural Competence after Short-Term Overseas Study Programs

Universities are providing short-term overseas study programs for healthcare students to increase their cultural competence (i.e., capacity to work effectively in cross-cultural situations). However, there is limited empirical research evaluating the effects of these programs using well-controlled research designs. In the present research study, undergraduate healthcare students in an Australian university were selected as participants. Group 1 (n = 32) participated in a short-term overseas study program in Asia (i.e., China, Vietnam, Singapore, and Taiwan), whereas Group 2 (n = 46) stayed in Australia to continue their university education as usual. All participants completed a self-developed demographic questionnaire, Cultural Intelligence Scale, and Multicultural Personality Questionnaire. Cultural competence was surveyed pre- and post-short-term overseas programs. After controlling for prior overseas experiences and the open-mindedness trait, an ANCOVA indicated that Group 1 had a significantly higher scores than Group 2 in cultural knowledge (p < 0.05), but not in cultural awareness, attitude, or skills. It is suggested that short-term overseas study programs may increase healthcare students’ cultural knowledge, a component of competence, and that more needs to be accomplished to improve other areas of cultural competence.

Objective structural clinical examination for evaluating learning efficacy of Cultural Competence Cultivation Programme for nurses

BACKGROUND

Culture serves as an adhesive to bind the lives of people. There are no objective, useful tools to assess cultural competence and practice. In this study, we evaluated whether the cultural competence of nurses was strengthened through the Cultural Competence Cultivation Programme.

METHODS

A quasi-experimental research design was used to evaluate nurses working at a medical centre in Taiwan. They were randomly allocated into an experimental group (n = 47), which received the Cultural Competence Cultivation Programme, or a control group (n = 50), which did not receive the educational programme. After the intervention, learning efficacy of the participants was assessed using an Objective Structured Clinical Examination (OSCE). The research data were statistically analysed on SPSS.

RESULTS

The average score of the experimental group was significantly higher in the 'communication ability and skill' category. Furthermore, OSCE scores and Standardised Patient Survey assessment and total scores were significantly and positively correlated.

CONCLUSION

The findings of this study can serve as a reference for designing future clinical education programmes.

One Year On: Cultural Competence of Australian Nursing Students Following International Service-Learning

BACKGROUND

The effective delivery of health care to the growing multicultural population within Australia is a challenge for the nursing profession. A breakdown in cross-cultural communication and understanding, which stems from the tendency of nurses to project their own culturally specific values and behaviors onto patients and colleagues from other countries, can contribute significantly to non-compliance in migrant populations and conflict in collegial relationships.

METHOD

The Inventory for Assessing the Process of Cultural Competence-Revised was administered to Australian undergraduate nursing students immediately before, immediately after, and 12 months after returning from international clinical placement. Data were analyzed using descriptive and inferential functions of SPSS.

RESULTS

Overall cultural competence increased immediately following the placement and was sustained over time. However, there were significant differences among the five constructs measured.

CONCLUSION

International clinical placements enhance cultural competence but targeted activities need to be undertaken pre-placement to develop specific aspects, in particular cultural desire. [J Nurs Educ. 2019;58(1):17-26.].

Contested discourses and culture sensitivity: Norwegian nursing students' experience of clinical placement in Nicaragua

Aim

The purpose of this study was to gain understanding of Norwegian students' practical experience of “culture sensitivity.”

Design

Using focus‐group interviews and individual written assignments, we draw on a Foucauldian‐inspired approach to analyse nursing students' narratives about their clinical placement in Nicaragua.

Method

Seven third‐year bachelor nursing students enrolled in a clinical placement programme on the Caribbean coast in Nicaragua and participated in focus‐group interviews. Interviews were conducted prior to their departure to Nicaragua and after their return to Norway. Other sources of data included learning objectives for clinical placement, written individual assignments with students' reflections about their experiences and achievement of learning objectives.

Results

Students expressed gradually increased awareness about the nursing discourses and power relations shaping clinical encounters throughout their learning trajectory in clinical placement. They became more aware of the politics of nursing practices through their experiences of clashes between different nursing discourses.

The impact of short term clinical placement in a developing country on nursing students: A qualitative descriptive study

BACKGROUND

Offering nursing students' international clinical placement during the educational program is one response to meet the need of cultural competence among nurses. This paper provides insight into the impact of clinical placement, in a developing country, on third year nursing students. In the study we investigated how short term international clinical placement impacted Norwegian nursing students' development of cultural competency.

DESIGN AND METHODS

In this study we utilised a qualitative descriptive design and used individual interviews with eighteen Norwegian nursing students who had all participated in an international clinical placement. The data were analysed using the principles of systematic text condensation.

RESULTS

In spite the international clinical placement only was four weeks, the findings suggested that real life experience culturally awakened the students and forced an ongoing process developing cultural competence. However, it is important to give students time to reflection.

CONCLUSIONS

Although increased cultural awareness and a growing cultural competence was identified by the students undertaking international clinical placement, further research is required. It is important to investigate the best methods to support the students' reflection such that the experiences lead to learning.

Predictors of cultural competence among nursing students in the Philippines: A cross-sectional study

BACKGROUND

With the continued emigration of Filipino nurses and increasing globalization, there is a need for globally competent nurses. Thus, the development of cultural competence among nursing students is critical in their preparation to assume their future responsibilities in the profession.

OBJECTIVES

This study investigated the predictors of cultural competence among nursing students in the Philippines.

DESIGN

This is a descriptive, cross-section study.

PARTICIPANTS AND SETTING

This study included 332 Bachelor of Science in nursing students in three nursing schools situated in the northern Philippines.

METHODS

The Cultural Capacity Scale was used to gather data from the respondents. The demographic characteristics and cultural background of the students were entered in a regression analysis to predict their cultural competence.

FINDINGS

The respondents manifested appreciably good cultural competence with a mean score of 68.98±11.73. The ability to understand the beliefs of various cultural groups received the highest mean of 3.65±0.86, while the ability to identify the care needs of patients with diverse cultural backgrounds received the lowest (mean, 3.31±0.74). Living in an environment with culturally diverse people, prior diversity training, being in the latter years of the nursing program, and with experience of caring for patients from diverse cultures and special population groups, were identified as predictors, accounting for 68.1% of the variance of cultural competence.

CONCLUSIONS

Nursing education should devise strategies to ensure future culturally competent Filipino nurses. Considering the fact that most of the Filipino nurses will potentially work overseas, they should be well prepared to provide competent care that is culturally sensitive.

The Cultural Competence of Graduating Nursing Students

Purpose: Cultural competence is an essential component in nursing. The purpose of this study was to evaluate the level of cultural competence of graduating nursing students, to identify associated background factors to cultural competence, and furthermore to establish whether teaching multicultural nursing was implemented in nursing education. Design: A structured Cultural Competence Assessment Tool was used in a correlational design with a sample of 295 nursing students in southern Finland. Findings and Conclusions: The level of cultural competence was moderate, and the majority of students had studied multicultural nursing. Minority background ( p = .001), frequency of interacting with different cultures ( p = .002), linguistic skills ( p = .002), and exchange studies ( p = .024) were positively associated to higher cultural competence. Implications for Practice: To improve cultural competence in students, nursing education should provide continuous opportunities for students to interact with different cultures, develop linguistic skills, and provide possibilities for internationalization both at home and abroad.

International clinical placements for Australian undergraduate nursing students: A systematic thematic synthesis of the literature

OBJECTIVES

International clinical placements provide undergraduate nursing students with the opportunity to experience or practice nursing care in diverse countries, settings, and cultures. This systematic review aims to ascertain the current knowledge on international clinical placements offered by undergraduate nursing programs in Australia. It seeks to explore three questions: (1) How have previous experiences of nursing students' international clinical placements been described? (2) How have participants and stakeholders determined if the placement has been successful? And (3) What benefits or challenges have been identified by stakeholders as a result of participating in international clinical placements?

DESIGN

A systematic thematic synthesis was undertaken.

DATA SOURCES

A search of electronic databases including CINAHL, Proquest Central, Scopus, PubMed, and Health Collection was undertaken between September and October 2014.

REVIEW METHODS

Key terms including 'international clinical placement', 'study abroad', 'international exchange', 'nursing', and 'Australia' were used to identify articles that appeared in peer-reviewed English language journals and that explored international clinical placements offered to undergraduate nursing students by Australian universities.

RESULTS

Eight studies were identified that meet the inclusion criteria, and through thematic analysis, five key themes were identified including developing cultural awareness and competence, providing a global perspective on health care, translation of theory to practice, growing personally through reflection, and overcoming apprehension to successfully meet the challenge. A comparison search of literature from Canada and the United Kingdom revealed that similar themes occurred internationally.

CONCLUSIONS

Although personal successes were identified by students undertaking international clinical placement, further research is required to identify all stakeholder experiences including those of the educators, the educational institutions, and travel providers supporting these placements and the communities where the placements take place.

The significance of communities of practice: Norwegian nursing students' experience of clinical placement in Bangladesh

AIM

The purpose of this study was to gain understanding of Norwegian students' experience of learning in clinical placement in Bangladesh without formal one-to-one supervision, by a personal mentor in the ward.

DESIGN

Using focus group interviews with bachelor nursing students we explored the significance of 'communities of practice' in nursing practicum abroad, socialization and knowledge transfer.

METHOD

Seven third year bachelor nursing students enrolled in a clinical placement programme in Bangladesh participated in focus group interviews prior to their departure to Bangladesh, during their stay in Bangladesh and after their return to Norway.

RESULTS

The Students' marginality and 'peripheral participation' triggered insight and reflection. The challenging but advantageous position of the peripheral students was heightened further due to the lack of one-to-one supervision in the clinic. Their previous experience with problem based learning and group learning was an asset that made them more resilient and helped them to cope.