"Leaving the comfort of the familiar": fostering workplace cultural awareness through short-term global experiences

Qualified Nurses’ Perceptions of Cultural Competence and Experiences of Caring for Culturally Diverse Patients: A Qualitative Study in Four European Countries

Background: European nurses are expected to provide appropriate care for patients from diverse cultural backgrounds. However, there is limited knowledge and understanding of this process. The aim of this study was to analyse the perceptions of culture and experiences of caring for patients from diverse cultural backgrounds of a purposive sample of qualified nurses from four European countries, namely Belgium, Portugal, Spain and Turkey. Methods: A qualitative phenomenological approach was selected in order to understand complex phenomena through the participants’ lived experiences, meanings and perspectives. Individual interviews and focus groups took place with 28 staff nurses and 11 nurse managers from four European countries. The sociodemographic and cultural characteristics of the sample were described and analysed using descriptive statistics. Qualitative data were transcribed verbatim, translated into English and analysed following Braun and Clark’s phases for thematic analysis. Results: Five themes and twelve subthemes emerged from thematic analysis of the transcripts. The themes included: (1) relevance of culture for nursing; (2) culture in the healthcare service; (3) qualities of the healthcare professionals; (4) challenges to culturally competent care; (5) becoming a culturally competent nurse. Conclusions: There are challenges to the delivery of culturally congruent care, namely language and communication difficulties, prejudices and stereotyping in the health service, a tendency for ethnocentrism, a lack of education and training in cultural competence and a lack of support from the health service to facilitate new ways of acting.

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.

International clinical placement - Experiences of nursing students' cultural, personal and professional development; a qualitative study

The purpose was to capture the experiences of cultural, personal and professional development during International Clinical Placement (ICP) among nursing students from three European countries. The paper presents findings based on the analysis of 23 reflections written by students immediately after returning from their ICP. The design builds on a qualitative study using a phenomenological approach and meaning condensation inspired by Kirsti Malterud. The analysis revealed four themes: Communication and barriers to be overcome, Culture as a serious business, Personal and professional achievements and Challenges and the importance of preceptorship. The ICP impacted on the participants' personal as well as professional way of understanding themselves as students and future nurses. A profound difference was seen between the achieved learning outcomes of participants completing an ICP in a high- or low-income country, respectively. Language barriers, the local culture and different nursing cultures were often challenging and pushed participants out of their comfort zone. All participants developed their cultural understanding in accordance with the Papadopoulos, Tilki and Taylor Model for Developing Cultural Competence. Findings indicate that educational institutions should establish well-planned exchange opportunities that adopt a two-way reciprocal (Erasmus) exchange programmes and be aware of the value of an appointed preceptor in the host country.

Nursing Lecturers' Perception and Experience of Teaching Cultural Competence: A European Qualitative Study

Cultural competence is an essential component in providing effective and culturally responsive healthcare services, reducing health inequalities, challenging racism in health care and improving patient safety, satisfaction and health outcomes. It is thus reasonable that undergraduate nursing students can develop cultural competency through education and training. The aim of this paper was to investigate nursing lecturers' perception and experience of teaching cultural competence in four undergraduate nursing programs. A phenomenological approach was selected to illicit nursing lecturers' perception of culture and experience of teaching cultural competence. Semi-structured personal interviews were held with a sample of 24 lecturers from four European universities. The anonymized transcripts were analyzed qualitatively following Braun and Clark's phases for thematic analysis. Six themes and fifteen subthemes emerged from thematic analysis of the transcripts. Cultural competence was not explicitly integrated in the nursing curricula. Instead, the lecturers used mainly examples and case studies to illustrate the theory. The integration of cultural content in the modules was unplanned and not based on a specific model. Nursing programs should be examined to establish how cultural content is integrated in the curricula; clear guidelines and standards for a systematic integration of cultural content in the nursing curriculum should be developed.

The Teaching and Learning Cultural Competence in a Multicultural Environment (CCMEn) Model

BACKGROUND

Within the European higher education context, students and lecturers are encouraged to engage in teaching and learning activities abroad. This frequently involves using a second language and being exposed to students and lecturers from culturally different backgrounds.

OBJECTIVE

To design a model for teaching and learning cultural competence in a multicultural environment (CCMEn).

DESIGN

Theory development from empirical experience, research, and scholarly works.

METHOD

This model was developed based on our experience of teaching and learning cultural competence in a multicultural environment in a nursing education context; it rests on three pillars, namely, Coyle's Content and Language Integrated Learning educational approach, the concept of social and emotional learning, as defined by the Collaborative for Academic, Social and Emotional Learning, and the existing literature surrounding teaching and learning cultural competence in higher education.

RESULTS

The CCMEn model is intended to guide the process of teaching and learning cultural competence in a multicultural environment through the use of a second language and has been adapted from existing educational approaches and theory.

CONCLUSION

Teaching and learning in multilingual and multicultural contexts in Europe is becoming more common. Students who learn alongside students and teachers from different cultural backgrounds need to be supported from an academic, linguistic and socioemotional perspective. We believe that the CCMEn model can serve as a guide to enhancing student learning in this context.

"It Was a Different Environment": Evaluating a Cultural Exchange Program

BACKGROUND

As nursing colleges seek to respond to the demands of the profession for nurses who are globally engaged and of the students for global health educational experiences, Riner's Globally Engaged Nursing Education framework is an effective tool for developing and evaluating an experience.

METHOD

Using Riner's framework, faculty and students at a nursing college evaluate an inaugural cultural exchange program between their U.S.-based college and a partner in India.

RESULTS

The framework helps the team identify the strengths of the program, as well as areas for improvement for future global endeavors. The framework as an evaluation tool is also critiqued in light of this process.

CONCLUSION

Overall, this inaugural program was a success and with this evaluation will inform future cultural exchanges between these institutions. [J Nurs Educ. 2019;58(12):704-711.].

How do we facilitate international clinical placements for nursing students: A cross-sectional exploration of the structure, aims and objectives of placements

BACKGROUND

International clinical placements provide undergraduate students with a unique and complex clinical learning environment, to explore cultural awareness, experience different health care settings and achieve clinical competencies. Higher education institutions need to consider how to structure these placements to ensure appropriate and achievable aims and learning outcomes.

OBJECTIVES

In this study we described the structure, aims and learning outcomes associated with international clinical placement opportunities currently undertaken by Australian undergraduate nursing students in the Asia region.

PARTICIPANTS

Forty eight percent (n = 18) of the institutions invited responded. Eight institutions met the inclusion criteria, one of which offered three placements in the region, resulting in 10 international placements for which data were provided.

METHODS

An online survey tool was used to collect data during August and September 2015 on international clinical placements conducted by the participating universities. Descriptive data on type and numbers of placements is presented, along with results from the content analysis conducted to explore data from open ended questions on learning aims and outcomes.

RESULTS

One hundred students undertook 10 International Clinical Placements offered in the Asian region by eight universities. Variations across placements were found in the length of placement, the number of students participating, facilitator to student ratios and assessment techniques used. Five categories related to the aims of the programs were identified: 'becoming culturally aware through immersion', 'working with the community to promote health', 'understanding the role of nursing within the health care setting', 'translating theory into professional clinical practice', and 'developing relationships in international learning environments'. Four categories related to learning outcomes were identified: 'understanding healthcare and determinants of health', 'managing challenges', 'understanding the role of culture within healthcare' and 'demonstrating professional knowledge, skills and behaviour'.

CONCLUSIONS

International clinical placements in the Asia region appear to vary greatly from one education institution to the next with no clear consensus from either this study's findings or the literature on which structure, support and assessments lead to greater student learning.

Pre-departure preparation and co-curricular activities for Students' intercultural exchange: A mixed-methods study

BACKGROUND

Nurses are required to be culturally competent to provide quality care to an increasingly diverse and ageing population. International exchange programmes were developed to support the traditional nursing curriculum. These programmes have often overlooked the importance of pre-departure preparation and co-curricular activities to the development of intercultural competency.

OBJECTIVES

To explore the influence of pre-departure and co-curricular activities on the intercultural learning experiences of both exchange and host students in a short-term international summer programme.

DESIGN

A mixed-methods study.

SETTING

Students were recruited from international and mainland exchange partners, with host students as ambassadors. The international summer programme involved a week of online pre-departure activities and two weeks of face-to-face meetings.

PARTICIPANTS

A convenience sample of 62 students from diverse cultural backgrounds was recruited on a voluntary basis. The participants were aged between 19 and 27.

METHODS

Data were collected from students' pre- and post-visit questionnaires, discussions within the workshops, their online discussion threads, and focus group discussions.

RESULTS

The quantitative findings suggested that students' cultural intelligence improved significantly after the exchange programme. Qualitatively, three themes emerged as: 1) Students' motivation to engage in intercultural learning; 2) Barriers to intercultural communication; 3) Enablers of intercultural communication.

CONCLUSION

Pre-departure preparation enabled students to discuss their common goals and expectations, while exploring differences, asked for practical living information, and used the basic intercultural concepts in their discussion on the care of elderly. This virtual encounter has lay the foundation for students' subsequent discussions about the why and how the differences that inform their own practices and about global ageing and poverty issues during their co-curricular activities. While the pre-departure preparation could serve as a stimulus, the value of this programme for intercultural learning also rests with the importance of debriefing to further students' reflective and experiential learning.

Exploring the Use of Critical Reflective Inquiry With Nursing Students Participating in an International Service-Learning Experience

BACKGROUND

Increasing interest in providing international educational experiences for nursing students has led to a variety of short-term international service-learning experiences. However, the impact of these experiences has not been clearly articulated.

METHOD

In this qualitative descriptive research study, Kim's critical reflective inquiry model was used to help guide students in reflecting on and identifying the impact of an international service-learning program in the Dominican Republic.

RESULTS

The model was helpful in promoting in-depth description and reflection on the students' underlying assumptions and values, as well as identifying beginning strategies for emancipation in specific patient care situations.

CONCLUSION

Providing a group process for critical reflection may optimize the perspective transformations in meeting the goals and objectives of the experience.

Studying abroad: Exploring factors influencing nursing students' decisions to apply for clinical placements in international settings

BACKGROUND

For over 15 years the College of Nursing at the University of Saskatchewan has facilitated study abroad clinical placements in a number of countries to enhance student learning. Nursing students often find their study abroad experience to be a defining moment in their educational program, and in their personal and professional growth.

OBJECTIVES

The main objective of this research was to explore factors influencing nursing students' decisions to study abroad.

DESIGN

A descriptive longitudinal design study was conducted using an online survey.

SETTINGS

The Study Abroad Survey was distributed to all undergraduate and graduate nursing students, in all years of all programs, at all sites of the College of Nursing, University of Saskatchewan in Saskatchewan, Canada.

PARTICIPANTS

A total of 1058 nursing students registered in the 2013-2014 academic year were surveyed.

METHODS

The data were collected using an online survey administered by Campus Labs™ (2014).

RESULTS

Students indicated that their interest in study abroad international experiences was high (84%), with many perceived benefits, but barriers to participation were also high for these students. Financial barriers topped the list (71%), followed by family responsibilities (30%) and job obligations (23%).

CONCLUSION

The research highlights the factors behind student decision making related to international placements, and provides the basis for improvements to the College of Nursing's International Study Abroad Program (ISAP). Previous travel and international service learning, resulting in increased perceived value of a study abroad experience may prove to be the more significant factor influencing decision making, rather than financial barrier.

The critical factors that influence faculty attitudes and perceptions of teaching English as Second Language nursing students: A grounded theory research study

BACKGROUND

As the demographics of the United States change, nursing will need to become more ethnically diverse in order to provide culturally responsive healthcare. Enrollment of English as Second Language nursing students is increasing; however, these students often encounter academic difficulties. The increase in English as Second Language nursing students in the classroom and clinical setting has posed challenges for nurse faculty.

OBJECTIVE

To explore the critical factors that influence faculty attitudes and perceptions of teaching English as Second Language nursing students.

DESIGN

A grounded theory method based on the philosophical underpinnings of symbolic interactionism and pragmatism was used to explore the critical factors that influence faculty attitudes and perceptions of teaching English as Second Language nursing students.

SETTINGS

The study took place at various schools of nursing in the Southeast Florida area.

PARTICIPANTS

Educators teaching in an associate, baccalaureate, and/or graduate nursing program at an accredited school of nursing.

METHODS

Semi-structured interviews and a focus group were conducted to collect data from nurse faculty. Data segments from interviews were coded, categorized, and analyzed. Theoretical sampling and a focus group interview were used to validate the concepts, themes, and categories identified during the individual interviews. A substantive level theory was developed.

RESULTS

The core category that developed was conscientization. The three dominant categories that emerged from the data were overcoming, coming to know, and facilitating. The theoretical framework of conscientization provided an explanation of the social processes involved in teaching English as Second Language nursing students.

CONCLUSIONS

The theoretical framework developed from this study can be used to increase the effectiveness of teaching English as Second Language nursing students, improve their chances of success, and enhance diversity in the nursing profession.

Development and evaluation of an international service learning program for nursing students

OBJECTIVES

(1) Using Riner's framework, the development of an international service learning program in the Dominican Republic (DR) for Baccalaureate nursing students will be described, and (2) an initial impact of the students' experiences will be examined.

DESIGN AND SAMPLE

A qualitative descriptive research design was used to examine its impact. The international service learning program included (1) didactic (five, 2 hr and one full day educational sessions) prior to (2) immersion (2 weeks in country), and (3) posttrip debriefing session. Ten females, senior nursing students participated in the program. Students' daily journals were examined using thematic analysis.

RESULTS

Five major themes that emerged were as follows adapting physically, encountering frustration in their inability to fully meet patients' needs, increasing confidence in speaking Spanish and assessing health problems, and increasing cultural awareness. Students were descriptive regarding their daily activities, and did some, but limited, critical reflection.

CONCLUSIONS

Models of reflection need to be explored to select the most appropriate technique to facilitate students' critical reflection in meeting the goals and objectives of the experience. Curriculum integration of global learning, social consciousness, and global cultural competence development is needed.

Motivation and International Clinical Placements: Shifting Nursing Students to a Global Citizenship Perspective

Nursing programs are increasingly offering international clinical experiences as part of nursing curricula. The purpose of this study was to understand what motivates student nurses to take part in these experiences. Related to motivation, student awareness of emerging nursing discourses on global citizenship was also examined. As part of a qualitative study, nine undergraduate nursing students were interviewed about their motivations for choosing a clinical placement to a low-income country. While students appeared to have a sincere desire to make a difference, closer examination of the data revealed that the majority approached their international clinical placement in ways that could be construed as paternalistic to some degree, rather than reflective of broader professional imperatives such as social justice. This finding suggests that additional education preparation may be needed prior to these experiences; global citizenship frameworks may be helpful in shifting perspectives towards a more critical enquiry of global issues.

In Real Time: Exploring Nursing Students’ Learning during an International Experience

Nursing education has increasingly turned to international learning experiences to educate students who are globally minded and aware of social injustices in local and global communities. To date, research with international learning experiences has focused on the benefits for the students participating, after they have completed the international experience. The purpose of this qualitative study was to explore how nursing students learn during the international experience. The sample consisted of eight nursing students who enrolled in an international learning experience, and data were collected in “real time” in Zambia. The students were observed during learning activities and were interviewed three times. Three major themes emerged from the thematic analysis: expectations shaped students’ learning, engagement facilitated learning, and critical reflection enhanced learning. Implications are discussed, related to disrupting media representations of Africa that shape students’ expectations, and educational strategies for transformative learning and global citizenship.

A global service-learning experience for nursing students in Tanzania: a model for collaboration

PURPOSE

This article addresses a model for creating a short-term global service-learning program. The Global Standards for the Initial Education of Professional Nurses and Midwives guided the development of a collaborative program involving a school of nursing in the Midwestern United States and one in Tanzania.

CONCLUSIONS

Evaluation of the school of nursing and subsequent collaborative planning led to development and implementation of a 3-week global service-learning experience for nursing students.

PRACTICE IMPLICATIONS

International academic partnerships, developed in accordance with WHO standards, will enhance educational experiences for nursing students both in the United States and abroad.

A critical analysis of undergraduate students' cultural immersion experiences

PURPOSE

This paper is concerned with the impact of an international health promotion experience on the understanding of culture among university students. Such immersion experiences are often cited as a strategy to prepare nurses for culturally appropriate practice. We describe students' epistemic movements over time with respect to cultural perspectives prior to, during and after a field study in Malawi.

DESIGN

Data were collected at three time points from students in undergraduate nursing (n = 14) and non-nursing (n = 8) programs at a Canadian university. Two essays narrating participants' understanding of culture were submitted by consenting class members. A subgroup of nine participants (four nursing students, five from other disciplines) completed a third narrative following a subsequent field study course in Malawi.

METHOD

Using narrative analysis, themes and structures in the participants' writing were identified and located within a constructivist or essentialist paradigm of cultural understanding.

FINDINGS

Overwhelmingly, students' narratives were initially portrayed and informed by an essentialist understanding of culture. Later narratives demonstrated varying degrees of epistemic movement towards more constructivist viewpoints. Narratives that initially exhibited constructivist characteristics tended to display strengthened convictions in that paradigm.

CONCLUSION

We challenge the claim that an international immersion experience immediately transforms participants into cultural experts; our evidence suggests that students experienced existential growth, but their understanding of culture did not change as a result of their brief stay in a different cultural context. Cultural immersion is a phenomenon that requires more critical analysis and systematic investigation to determine how such experiences contribute to learning about culture among nursing students.

Meeting tomorrow's health care needs through local and global involvement

Strengthened efforts to achieve the United Nations Millennium Development Goals by 2015 are urgently needed. A fundamental step toward achieving these goals is strengthening global partnerships for development. This article describes critical challenges and opportunities in global health and the social responsibility of the nursing profession in this area. Examples and suggestions for nursing action are provided for consideration by those interested in influencing global health. Engaging in global health activities such as study abroad programs, interprofessional exchanges, continuing education workshops, and seminars with a global health focus can have significant implications for nursing education, research, policy, and practice. Equipping nurses with the leadership skills, knowledge, and attitudes needed to advance global health is integral in the delivery of effective, culturally relevant health care.