The Impact of International Service-Learning on Nursing Students’ Cultural Competency

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.

Linking Immigrants with Nutrition Knowledge (Project LINK): An Innovative Approach to Improve Cultural Competence in Dietetic Education

Linking Immigrants with Nutrition Knowledge (Project LINK) was a service-learning cultural competence training programme completed by undergraduate dietetic students enrolled in the University of Saskatchewan's (USASK) nutrition and dietetic programme.This paper evaluates the impact of participation in the programme on students' cultural competence. We conducted a cross-sectional survey and qualitative analysis of reflective essays of 107 participants of Project LINK from 2011 to 2014. Cumulative logistic regression models assessed the impact of the intervention on students' cultural competencies. The Akaike information criterion compared models and Spearman correlation coefficient identified possible correlation among pre- and post-intervention data points. Student reflective essays were analyzed by inductive thematic analysis.All cultural competencies improved comparing pre- and post-participation in Project LINK. Odds of increasing one level of student knowledge were 110 times of that prior to Project LINK. Comparing student competencies before and after Project LINK, the odds of increasing one level of students' skills were six times greater, five times greater for increasing one level of students' ability to interact or encounter, and 2.8 times greater for increasing one level of students' attitude.The results of this study indicate Project LINK has successfully increased cultural competence and underscores the importance of combining opportunities for practical experience in addition to classroom-based training on cultural competence.

Designing, implementing, and evaluating a mobile app-based cultural care training program to improve the cultural capacity and humility of nursing students

BACKGROUND

Given the growing cultural diversity among healthcare clients, it is crucial for nursing education to have a clear mission: to effectively train future nurses by incorporating cultural care curricula. The goal is to equip them with the necessary cultural capacity and humility. This study focused on designing, developing, and evaluating a mobile app-based cultural care training program, with the aim of enhancing the cultural capacity and humility of nursing students.

METHODS

This experimental study utilized the five steps of the ADDIE instructional model (analysis, design, development, implementation, and evaluation) to design a mobile app-based cultural care training program. The first three steps involved designing and developing the program, drawing upon Purnell's model for cultural competence and Foronda's rainbow model of cultural humility. In the fourth step, the cultural care training program was implemented in 16 modules among 80 internship nursing students. These students were randomly assigned to either the intervention or control groups, with 40 students in each group. Finally, in the fifth step, the effectiveness of the mobile app-based program was evaluated by administering the Cultural Capacity Scale, and the Foronda Cultural Humility Scale before and one month after the cultural care training. The collected data were analyzed using SPSS22, employing techniques such as paired t-test, chi-square test, and independent samples t-test.

RESULTS

A total of 76 students completed the study, with 39 students in the intervention group and 37 students in the control group. Prior to the mobile app-based cultural care training program, there were no significant differences in cultural capacity and humility scores between the two groups (p > 0.05). However, following the completion of the program, the intervention group exhibited higher scores in cultural capacity and humility compared to the control group (p < 0.05).

CONCLUSION

Based on the findings, it can be concluded that the mobile app-based cultural care training program had a positive impact on the cultural capacity and humility of undergraduate nursing students. These results indicate the importance of nurse educators designing comprehensive training programs that incorporate innovative approaches to enhance cultural capacity and humility among nursing students at all academic levels.

Facilitating a Virtual International Experience for Undergraduate Students: Creating Global Awareness and Connection

BACKGROUND

Preparing nursing students for practice is supported by developing a global perspective of health care delivery models. However, many schools of nursing and students lack the resources for study abroad.

METHOD

Using a virtual stay-in place model, 42 international students applied an evidenced-based approach to study statistics, research, transitions in care, and elder care models that supported collaboration among peers from Austria, Switzerland, Chile, the United Kingdom, and the United States. Students explored social, economic, and reimbursement factors not encountered in the typical classroom.

RESULTS

Student beliefs and perspectives changed after completing a program with global peers. Survey results and themes in reflection papers indicated increased ability to conceptualize content in new ways, including holistic elder care, cultural practices and reimbursement options, and effects on future practice.

CONCLUSION

Virtual international learning experiences are an effective education innovation that allows student to connect and learn from one another using a stay-in place model. [J Nurs Educ. 2023;62(11):647-649.].

Recognizing and Adapting to Cultural Differences: Influence of International Educational Programs on Future Nursing and Midwifery Practice

INTRODUCTION

International educational programs build cultural humility and safety skills in nursing and midwifery students; however, long-term outcomes of these programs are unclear. The purpose of this study was to explore the impact of international educational programs on nurses' and midwives' future professional practice.

METHOD

Using grounded theory informed by Charmaz, 13 general nurses, two mental health nurses, three midwives, and four dual-qualified nurse/midwives across eight different countries were interviewed. Three categories evolved from the analysis. This article reports on the category Recognizing and adapting to cultural differences.

FINDINGS

Participants developed cultural safety and awareness from participation in programs extending into future practice. Experiencing and adapting to cultural similarities and differences, they developed culturally congruent practices many years after program completion.

DISCUSSION

International programs contributed to participants' professional practice. Positive and ongoing influences are important for employers to promote patient safety and culturally congruent quality care. Findings are also relevant for education providers to inform quality cultural learning.

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.

From proposal to action: evaluating the results of a nursing student project to promote student-community engagement

BACKGROUND

A focus on community engagement is encouraged when educating nursing students on preventative care and advocacy. Students often struggle to connect theory to practice and benefit from real-world experiences.

AIM

This paper describes the effect of a student-led health project on student development.

METHODS

A descriptive, correlational design was used to explore end of semester feedback from undergraduate nursing students (N = 174) completing a semester long community project. Chi-square analyses and thematic coding were performed to determine measures of association and student perceptions.

RESULTS

Across 83 completed surveys (47.7%), self-efficacy was a key factor in project completion, development, bias awareness, and commitment to community.

CONCLUSIONS

Civic duty and professional responsibility are challenging concepts for students, thus, impacting transition to practice. Engagement in self-efficacious experiences is encouraged.

IMPACT STATEMENT

Community engagement influences undergraduate nursing students' development. Enhanced support of student self-efficacy may promote attainment of nursing values and improved care delivery.

Patient-Identified Solutions to Primary Care Access Barriers in Canada: The Viewpoints of Nepalese Immigrant Community Members

BACKGROUND

Accessing healthcare for immigrants in Canada is complicated by many difficulties. With the continued and upward trend of immigration to Canada, it is crucial to identify the solutions to the barriers from the perspectives of different immigrant communities as they encounter them including the relatively smaller and less studied population groups of immigrants. As such, Nepalese immigrants in Canada are a South Asian ethnic group who have their own distinct language, culture, and socio-economic backgrounds, however, their experience with accessing healthcare in Canada is scarce in the literature.

METHODS

We conducted 12 focus group discussions with first-generation Nepalese immigrants who had experiences with primary care use in Canada. Informed consent and demographic information were obtained before each focus group discussion. The verbatim transcription of the focus groups was analyzed using thematic analysis.

RESULTS

The participants expressed a range of potential solutions to overcome the barriers, which we presented using the socio-ecological framework into 4 different levels. This includes individual-, community-, service provider-, and government/policy-levels. Individual-level actions included improving self-awareness and knowledge of health in general and navigating the healthcare system and proactively improving the language skills and assimilating into the Canadian culture. Examples of community-level actions included community events to share health information with immigrants, health literacy programs, and driving/carpooling to clinics or hospitals. Actions at the service provider level were mainly focused on enhancing communications, cultural competency training for providers, and ensuring to hire primary care workforce representing various ethnocultural backgrounds. Overall, focus group participants believed that the provincial and federal government, as appropriate, should increase support for dental and vision care support and take actions to increase the healthcare capacity, particularly by employing internationally graduated health professionals.

CONCLUSIONS

Access to primary care is essential for the health of immigrant populations in Canada. Individuals, community organizations, health service providers, and governments need to work both individually and collaboratively to improve immigrants' primary care access.

Cultural competencies in Polish and Lithuanian nurses: A cross‐sectional comparative study

BACKGROUND

Cultural competencies are known as a multidimensionalconstruct; however, they usually refer to an individual's sensitivity orcultural attitudes, cultural awareness, knowledge, and skills.

AIM

The aim of the study was to compare the cultural competences of nurses in Poland and Lithuania based on an adaptation of the Nurse Cultural Competence Scale (NCCS).

DESIGN

The design was a comparative cross-sectional study.

METHODS

A total of 383 Polish nurses and 184 Lithuanian nurses took part in the study. The questionnaires of the NCCS-Polish version (NCCS-v.PL) and the NCCS-Lithuanian version (NCCS-v.L) were used after linguistic adaptation and an evaluation of psychometric properties.

RESULTS

As a result of the comparative analysis, a higher general level of cultural competences (based on the NCCS) was found in the Lithuanian group M-148.09 (SD = 22.85). The results show statistically significant differences among the respondents in the subscale of Nurse Cultural Competence Scale-Cultural Knowledge (NCCS-CK; p ˂ 0.001); higher competences of the nurses were found in the Group LT (M = 31.05; SD = 6.75) than in the Group PL (M = 28.82; SD = 7.82). In the group of Polish nurses (Group PL), the intensity of cultural competences was found to increase along with age (NCCS-v.P r = 0.157, p < 0.05); this, however, was not observed in the Group LT (NCCS-v.LT, p > 0.05).

CONCLUSIONS

Both the nurses in Poland and in Lithuania are characterised by an average level of cultural competences. Diversity in the level of cultural competences was found in both groups depending on age, education and work experience.

Service Learning in the Nursing Bachelor Thesis: A Mixed-Methods Study

The Final Degree Project (FDP) is a module that, although intended for the completion of a bachelor thesis (BT), consists of theoretical and clinical teaching. Therefore, introducing service learning (SL) can support student adjustments to the real-world professional role. This study plans to evaluate a teaching innovation project that combines BT and SL through Kirkpatrick's four-level model (reaction, learning, behaviour and results). It takes the form of a convergent parallel mixed-methods design study. The participants were 15 final-year students obtaining a Bachelor of Nursing degree, 4 BT supervising mentors and 4 nurses. At the request of a hospital institution, in their BT, students completed a review of evidence-based nursing protocols. For data collection, the researchers used: an SL questionnaire, student narratives, mentor field diaries and nurse interviews. According to student opinion, the results showed high satisfaction rates (4.44 out of 5), the most developed skills were Independent Work and Information Management, but they signal the need to reinforce the research methodology skills. Finally, positive feedback from all participants is that using SL promotes both the opinion that the BT is useful and also promotes a collaboration between academic and clinical settings.

Impact of Service-Learning educational interventions on nursing students: An integrative review

BACKGROUND

Service learning is an innovative educational approach that enables nursing students to directly participate and engage in the community while providing them and the community with benefits.

OBJECTIVES

To summarise the evidence from service learning activities for nursing students, the educational and non-educational benefits derived through implementing this methodology, and the participating students' perceptions.

DESIGN

An integrative review including qualitative, quantitative, and mixed methods designs was conducted.

DATA SOURCES

The articles were identified through a systematic search in the following electronic databases: PubMed, Cochrane Library Plus, Scopus, CINAHL Complete (EBSCOHost), and Education Source (EBSCOHost).

REVIEW METHODS

The search for studies was conducted in December 2020 using the following search terms: "Service learning", "Service-learning partnership", "Nursing", "Benefits" and "Intervention".

RESULTS

A total of 22 articles were included. A positive relationship was found between the nursing students participating in service learning programmes and the acquisition of educational benefits, such as theoretical and practical learning, communication skills, and teamwork, and non-educational benefits, such as empathy, questioning prejudices, and commitment. In addition, a wide variety of activities and interventions were found to have been implemented using this academic approach, as well as a positive evaluation by the participating students.

CONCLUSIONS

Service learning programmes with the active participation of nursing students generate benefits for both them and the community. First, these interventions receive positive evaluations from participating students. Furthermore, the interventions developed using service learning are varied and require motivation and creativity to implement them. However, there is a need for more experimental studies and the use of larger samples in service learning programmes.

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.

Open-mindedness trait affects the development of intercultural communication competence in short-term overseas study programs: a mixed-method exploration

BACKGROUND

Overseas study trips can enhance healthcare students' intercultural communication competence. An opportunity to immerse in the new culture enables them to develop their ability to offer services to people from different countries. However, the role that open-mindedness (i.e., a personality trait) can play in this process has not been explored.

METHODS

The present study adopted a mixed-method design to identify how open-mindedness trait affected this overseas learning process. Thirty-two undergraduate healthcare students in Australia took part in the study. Questionnaires, which measured socio-demographic information, intercultural communication competence and open-mindedness trait were administered to the participants before and after their overseas trip. Half of the participants (n = 16) were interviewed after the overseas trip.

RESULTS

The correlational analysis showed that the open-mindedness trait was correlated with cultural skills, a component of intercultural communication competence, but not significant with the other three components. Three themes emerging from the qualitative data indicated that the open-mindedness trait affected students' cultural exposure. This trait enabled participants to be actively involved in the immersion in the local culture. They were willing to learn from peer fellows, and keen to embrace novel challenges.

CONCLUSION

It is concluded that open-mindedness trait is vital for increasing cultural immersion, and hence promote intercultural communication skills.

Development of a 1-Week Intensive Course on Diversity and Equity in Veterinary Medicine

While colleges of veterinary medicine continually strive to promote diversity and inclusion on their campuses, few offer dedicated diversity courses within their curriculums. This article provides details on the development and implementation of a 1-week intensive course on equity and diversity in veterinary medicine, discusses the strengths and challenges encountered, and provides suggestions for those seeking to develop similar learning experiences into their curriculum. This selective course was developed to introduce students to the principles of social justice and provide them with the opportunity to examine systems of power, privilege, and oppression within the context of veterinary medicine.

Nursing students' experiences with service learning: A qualitative systematic review and meta-synthesis

OBJECTIVE

The aim of this review was to synthesize qualitative evidence on nursing students' experiences with service learning (SL).

DESIGN

A systematic review.

DATA SOURCES

Comprehensive searches were performed using databases including PubMed, MEDLINE (Ovid), Embase (Ovid), CINHAL (EBSCO), ProQuest Dissertations and Theses, Web of Science, Wangfang (Chinese), CNKI (Chinese), Google Scholar, and Baidu Scholar (Chinese).

REVIEW METHODS

The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the methodological quality of the included studies. We conducted a meta-aggregation to synthesize the findings of the included studies. The Confidence in the Output of Qualitative Research Synthesis (ConQual) approach was used to assess confidence in the synthesized findings.

RESULTS

Forty-two studies were identified, and 39 studies were included in the meta-aggregation. One hundred and sixty-seven findings, 16 categories, and 6 synthesized findings were identified. The six synthesized findings identified from the 39 studies concerned the following topics: adaption and emotion shifting, knowledge translation and skills development, leadership and collaboration in multidisciplinary teams, cultural sensitivity, discovery of nursing roles and professional growth, and overall appraisal and suggestions.

CONCLUSIONS

We recommend empowering nursing students by developing their self-confidence in their leadership abilities and their identities before they participate in SL programs. During SL, educators should provide sufficient space for students and should not become involved in students' teams to avoid decreasing their self-confidence in their leadership abilities. After SL programs, maintaining long-term relationships between the university and the community is a prerequisite for students working smoothly in the community and is a key factor for program sustainability.

Nursing students' experiences of moral uncertainty in the context of global health practicums

More students than ever are electing to take part in international practicums from health-related disciplines. With the goal of better understanding the moral experiences and ethical implications of global health practicums (GHPs), the purpose of this Interpretive Descriptive study was to examine the moral uncertainty of nursing students from one university in Canada. Seventeen nurses who had participated in a GHP in their undergraduate nursing program participated in semi-structured interviews. Data were analyzed inductively using constant comparative data analysis techniques, and a thematic account of participants' experiences was developed. Findings suggest that nursing students experienced considerable amounts of moral uncertainty during their GHP. Most often, participants' experiences of uncertainty stemmed from a misalignment between their expectations and reality, including encountering different approaches to healthcare, being situated in new cultural and clinical care environments, and grappling with how best to stay within one's scope of student professional practice. Participants inconsistently reflected on these experiences, which may present a missed opportunity for professional growth through the development of a heightened social consciousness. Educators can facilitate this process by implementing robust predeparture training for GHPs, clarifying program objectives, and providing clinical debriefing.

A Descriptive Analysis of the Experiences of Nursing Students Who Participated in an International Service-Learning Project in Haiti

BACKGROUND

Studies have demonstrated multiple benefits of international service-learning experiences in nursing education. These benefits include personal and professional growth, increased cultural sensitivity, and increased self-efficacy.

PURPOSE

The purpose of this project was to describe the experiences of nursing students engaged in an international service-learning experience in Haiti.

METHOD

A descriptive qualitative outcomes evaluation project was utilized to understand student perceptions of this experience. Nine respondents were interviewed about their experiences that took place as part of a nursing capstone course offered at a private liberal arts university in the Midwest. Interview transcripts were analyzed by the authors for common themes.

RESULTS

The six themes identified included: a desire for an international experience to better understand healthcare in a developing country; culture shock; context of poverty; excitement and a sense of "helping" amidst the chaos; feelings of increased confidence, independence, and competence; and personal and professional growth. Responses indicated students felt more confident in caring for individuals from other cultures as well as in basic nursing skills and interprofessional communication after this experience. Participants' narratives also indicated intent to serve vulnerable populations in the future.

CONCLUSIONS

The nursing students perceived increased sociocultural understanding and self-efficacy following a 10-day international service-learning experience.

The impact of cultural immersion international learning experiences on cultural competence of nursing students: A critical integrative review

BACKGROUND

Cultural immersion international learning experiences (CIILEs) are commonly offered in undergraduate nursing education programs worldwide, often with the goal to enhance students' cultural competence.

PURPOSE

The purpose of this integrative review was to explore the most recent existing literature concerning the impact of CIILEs on nursing students' cultural competence and to cast a critical eye on the findings.

METHOD

We searched the CINAHL database for articles published from 2015 to 2019 and found 30 that met inclusion criteria.

RESULTS

The majority of the studies were descriptive or qualitative designs and reported positive overall student cultural competence outcomes.

CONCLUSION

The findings support the use of CIILEs with a critical eye for potential negative consequences. The authors recommend further longitudinal, observational studies to identify factors that facilitate substantial long-term positive outcomes.

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.

The Role of Debriefing in a Community Health Study Abroad

Study abroad experiences offer nursing students the opportunity to develop cultural competence and sensitivity while providing care within the context of a different culture. Debriefing is a strategy that engages students in conversation and active reflection to process emotions, examine personal values, and synthesize knowledge gained from active learning experiences. While debriefing can enhance learning outcomes in study abroad programs, there is currently a paucity of literature that explores its use within the context of study abroad. In this article, we describe a structured debriefing approach we use in an international community health clinical experience. We conclude with a discussion of the lessons we have learned to improve the effectiveness of our debriefing sessions and recommendations for future research.

Addressing the effects of transcultural nursing education on nursing students' cultural competence: A systematic review

AIM

This study aimed to synthesize the findings of studies evaluating educational programs providing curricular transcultural nursing education.

BACKGROUNDS

Nursing care education about cultural diversity and experience with taking care of patients from different cultures and special populations are significant factors that could likely influence cultural competence. The effect of transcultural nursing education given to nursing students has been investigated by different researchers and different methods. Addressing the effects of transcultural nursing education on nursing students' cultural awareness, knowledge and attitudes can contribute to future transcultural nursing education activities and the creation of training content.

DESIGN

This study was a methodological systematic review study.

METHODS

Methodological quality was assessed following the PRISMA guidelines. PubMed, Science Direct, APA PsycArticles, OVID, EBSCO, and Web of Science databases were searched from 2010 to 2020. The following keywords were used: "Transcultural nursing", "education", "curriculum", "course", "effectiveness", "cultural competence", "knowledge", "skills", "attitudes", and "nursing students". Studies published in peer-reviewed journals in English using both experimental and quasi-experimental designs were included.

RESULTS

Total of 11 research papers, (n = 1375) nursing students' outputs were included in this review. Cultural competence interventions/programs were provided as part of the core theoretical courses or as elective courses. Different durations and types of teaching methods included debates, discussions, case scenarios, practicums, simulation, international learning projects, experiential learning, storytelling, and traditional teaching lectures. In ten studies, an increase in the level of culture-related competences was reported as statistically significant (p < 0.05).

CONCLUSIONS

Limited studies have generally proven the effectiveness of transcultural nursing education provided to nursing students. Education content, training methods and training periods were not standard in the literature. More comprehensive, valid and reliable measurement tools are needed to evaluate the education provided for nursing students.

How much can our universities do in the development of cultural intelligence? A cross-sectional study among health care students

BACKGROUND

Cultural intelligence reflects the competence to adapt to new cultural settings. Universities offer students various opportunities to gain cultural learning and develop cultural intelligence. However, there has been little empirical research to compare the effects of cultural learning and other related psycho-social factors in this process.

OBJECTIVE

This study explores the importance of cultural learning and identifies the unique contribution of cultural education in universities to health care students' cultural intelligence.

DESIGN

Cross-sectional survey study.

METHODS

271 health care students completed a survey measuring social desirability, demographics, personality, prior cultural exposure, previous cultural learning and cultural intelligence.

RESULTS

Hierarchical regressions showed that cultural learning could affect cultural intelligence and its three components (i.e., metacognition, cognition, motivation, and behaviour) under the control for related psycho-social factors. However, its effect on the behavioral component was not significant. Considering the different types of cultural learning, overseas study experiences were more related to cultural intelligence, compared to in-class cultural learning.

CONCLUSION

Cultural learning, especially overseas study experiences, plays a significant role in the development of health care students' cultural intelligence.

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.

Preparation of undergraduate health and care students from the United Kingdom for an international learning experience in Japan: A phenomenological study

BACKGROUND

Globalisation, economic migration and people seeking refugee status require cultural competence skills and knowledge to be embedded in undergraduate health and care programmes. International learning experiences can support the development of cultural competence skills. Students require preparation before undertaking international learning experiences to support adjustment to cultural differences. Inadequate preparation could have a negative impact on their ability to learn. Therefore, investigating concerns undergraduate health and care student experience prior to an international learning experience has the potential to enhance the preparation received.

OBJECTIVES

To investigate the experiences of undergraduate health and care students from the United Kingdom prior to participating in an international cultural visit to Japan.

DESIGN

A qualitative study using Interpretative phenomenological analysis.

METHODS

The lived experience of 7 undergraduate health and care students were explored using reflective semi structured surveys.

FINDINGS

The findings suggest that prior to the visit, undergraduate health and care students experienced a range of fears and anxieties. These were themed under the heading of "Barriers to Learning" and further sub themes of "Being a Stranger", "Cultural Differences and "Communication".

CONCLUSION

Preparation for undergraduate health and care students undertaking international learning activities is required to enable them to adapt to the culture they are visiting as well as the culture of the group they are travelling with. Recommendations are made for preparing undergraduate health and students for this.

The Talent Training Mode of International Service Design Using a Human-Computer Interaction Intelligent Service Robot From the Perspective of Cognitive Psychology

To effectively improve the efficiency of international service design talent training and make it more in line with society's needs, we analyze the current status of international service design talent training and its professional training focus. Based on the above problems, from the perspective of cognitive psychology, artificial intelligence and human-computer interaction (HCI) technology are used to construct the international service design talent training mode of the HCI intelligent service robot. This mode can be used to solve the existing teaching problems by using novel means to ensure the quality of teaching. Finally, through the actual analysis of teaching cases, the effectiveness of the proposed talent training mode is verified. The HCI system is based on knowledge of cognitive psychology. According to the characteristics and functions of an educational robot, the robot is combined with traditional teaching activities, and the robot-assisted talent training mode is designed. Robot-assisted talent training is a feasible training method that can improve the efficiency of talent training. Students have confidence in their learning skills before the course, and the confidence is further strengthened after the end of the course. After the course, the students have a stronger sense of cooperation. This study can provide theoretical ideas for the research of international service talent training mode.

Development and Implementation of a Spanish Minor for Nursing Majors

ABSTRACT

Cultural competence is a recognized standard in baccalaureate nursing education, but nursing programs are challenged by a predetermined course sequence and mandated requirements. Interaction with and immersion in a Spanish-speaking country have been found to increase knowledge, skills, and attitudes related to cultural competence. This article describes the development and implementation of a Spanish minor for nursing majors, a unique set of experiences with an educational focus on language and culture related to the Hispanic/Latino population.

Student's satisfaction and intercultural competence development from a short study abroad programs: A multiple cross-sectional study

Nurses should be culturally competent to care appropriately to all patient groups. Whilst there are many opportunities to obtain clinical experiences, there are less curriculum-based opportunities to develop cultural competencies. This multiple cross-sectional study aimed to explore the development of intercultural awareness, knowledge, and competence in two different nursing students' groups (2016 and 2017 program edition) during a one-week study abroad program hosted by a European network of 14 higher education institutions. A questionnaire was designed specifically for the study and reliability established. Factor analysis confirmed three dimensions: perceived benefits, satisfaction, and acquisition of learning outcomes. Fifty-eight students (71.6%) completed the questionnaire for the April 2016 group, and 60 (88.2%) from the April 2017 group. There were minimal differences in responses between the two groups which suggested perceived benefits were retained one year later. Ratings were high for perceived satisfaction, perceived benefits; and the learning outcomes with regard to cultural competencies. Overall, the one-week program was considered a success and students would recommend it to others. This study concludes that a short, one-week study abroad program enabled nursing students to develop individually as well as develop cultural competencies in healthcare.

Nurse Cultural Competence-cultural adaptation and validation of the Polish version of the Nurse Cultural Competence Scale and preliminary research results

Introduction

Measuring nurses’ cultural competence is an important aspect in monitoring the acceptable quality in multicultural populations, and is a means for efficient modification of the educational process of nurses based on this assessment.

Purpose

The goal of this article is to offer a preliminary assessment of the cultural competence of nurses based on a Polish-language and -culture version of the Nurse Cultural Competence Scale (NCCS).

Research method

An adaptive and diagnostic cross-disciplinary concept was used in the research. Two hundred thirty-eight professionally active nurses in the southeast region of Poland took part in this study. The NCCS-Polish version (NCCS-P) questionnaire was used after linguistic adaptation and analysis of psychometric properties.

Results

Moderate levels of competence in the Cultural Knowledge Subscale (M = 3.42) were found in the group of nurses studied. The results indicate lowest competency levels in the Cultural Skill Subscale (M = 3.14). The highest values were obtained for the Cultural Awareness Subscale (M = 3.98) and the Cultural Sensitivity Subscale (M = 3.72). The Cronbach's alpha reliability coefficient for the NCCS-P scale was 0.94, with the subscale values ranging from 0.72 to 0.95. Factor validity analysis of the Polish adaptation of the NCCS-P scale pointed to its four-factor structure. The Kaiser-Mayer-Olkin sampling adequacy test was 0.905, and the Bartlett test of sphericity result was χ2 = 5755.107; df = 820; p<0.001. The four-factor structure is affirmed by the Kaiser criterion and the scree test result.

Conclusions

The NCCS-P psychometric properties were highly reliable and significant because of the opportunity for using them for research in Poland.

Practical implications

The scale can be used in intercultural research for comparing cultural competence of nurses, including Polish ones. This scale facilitates the precise monitoring of cultural competence among nurses and nurse managers, which may help in developing nursing policies geared toward a commitment to expanding cultural competence.

Black women in nursing history: the cultural competence in Maria Barbosa Fernandes´ trajectory

OBJECTIVES

to know the professional trajectory of the black nurse Maria Barbosa Fernandes and to analyze elements of her professional practice based on the cultural competence model of CampinhaBacote.

METHODS

historical-social study with an analysis of the findings in light of the Cultural Competence model.

RESULTS

Maria Barbosa was the first black woman to earn a nursing degree at the Escola de Enfermagem Carlos Chagas (Carlos Chagas Nursing School) (1935-1938), and the documentation about her history allowed us to infer the experience of discrimination and invisibility. However, her professional trajectory was marked by careful attention to the singularities and the sociocultural reality of individuals, with an emphasis on acting in vulnerable scenarios. Final Considerations: the pairing of the theme of black women in nursing with the reference of Cultural Competence consists of an invitation to value diversity in the profession and seek to move towards care committed to overcoming inequalities, through inclusive practices and culturally sensitive care.

I Teach Nursing as a Male Nursing Educator: The East Asian Perspective, Context, and Social Cognitive Career Experiences

Social and cultural backgrounds, as well as understanding, play key roles in workforce development and human resource shortages, which are associated with the transition to nursing education and teaching from frontline nursing practices. A qualitative method, with the direction of the general inductive approach, was employed in this study. The researcher collected information from 18 male nursing educators who switched their senior roles (from the frontline and practicing fields to nursing education) at nursing schools in South Korea, Japan, Taiwan, China, and Malaysia. Three interview sessions were used to collect information. Three themes were merged from the information: (i) gender-oriented knowledge, teaching and learning; (ii) respect; and (iii) health promotion. More importantly, participants advocated that their male roles and identities provided uniqueness to patients, students, parents, and the general public concerning Asian customs and practices. Based on the social cognitive career theory, personal goals and achievements of career satisfaction took important roles. Although the general public may not agree with these career decisions, due to gender and social biases, participants continued to contribute their energy and knowledge in the health and social caring professions.

Developing Korean nursing students' global health competencies: A mixed methods approach to service learning in rural Vietnam

BACKGROUND

Owing to globalization, there is a need for enhanced global health competencies among nursing students. In this context, global service learning programs are important opportunities for nursing students.

OBJECTIVES

To explore the effect of a short-term service learning program in a developing country on the global health competencies of students attending a South Korean nursing college.

DESIGN

A mixed methods design.

SETTING

The Global Nursing Internship is a two-week pre-experience, eight-day on-site, and one-week post-experience program.

PARTICIPANTS

The on-site activities involved 15 nursing students participating in global health activities in a rural Vietnamese community.

METHODS

A self-reported questionnaire was used to assess changes in global health competencies in six domains, measured on a four-point Likert scale. Student satisfaction with each activity was measured on a five-point Likert scale. After completing the program, the participants wrote a self-reflection essay. The Wilcoxon signed rank test was used to analyze global health competencies, and content analysis was used to analyze participants' self-reflections.

RESULTS

Regarding global health competencies, the overall mean score showed a significant increase at the post-program evaluation (Z = -3.41, p = .001). A pre-post-program comparison showed that the domain of "health care in low-resource settings" displayed the greatest increase in scores. The mean overall satisfaction with the program was high (mean = 4.31, standard deviation = 0.17). In the students' view, as expressed in their essays, their global health knowledge and attitude had improved.

CONCLUSIONS

The program was useful in promoting global health competencies, empathy, and confidence and should be embedded among the essential requirements of nursing curricula. Suggestions are provided to develop an enhanced pre-experience program that could help students prepare better for on-site activities. As cultural competency is crucial for nurses, nursing educators should consider integrating similar global service learning programs into their existing nursing curricula.

Comparing Photovoice to Traditional Reflection to Identify Student Learning on a Medical Mission Trip

Objective. To compare the effectiveness of photovoice with traditional reflection as a methodology to identify student learning during an international advanced pharmacy practice experience (APPE). Methods. Over seven years, seven cohorts of two to three pharmacy students completed an APPE in which they participated in a medical mission trip to Guatemala. Cohorts were assigned to use either photovoice or traditional reflection techniques to identify and document their learning. After returning from the mission trip, a focus group was conducted with each cohort of students. Students' comments were audio-recorded and the audio recording was transcribed and the text was qualitatively analyzed. In addition, all students completed the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals (IAPCC-SV) before and after travel. Results. All 18 students who participated in the mission trips, (nine in each group) agreed to participate in the study. Several themes were identified when the transcripts of the focus group sessions were reviewed. Students in both groups emphasized learning about the enhancement of pharmacy skills, cultural appreciation, and self-examination in their reflections. However, students in the photovoice group emphasized three additional areas that were not emphasized by students in the traditional reflection group: emotional impact, critical reflection on privilege, and ethical distribution of health resources. Students' post-intervention mean scores on the IAPCC-SV increased more for the photovoice group (8.5 points) than the reflection group (6.8); however, this difference was not significant. Conclusion. Students who used photovoice focused more on the connection between their learning and emotional or moral experiences than did students who used traditional reflection techniques. Photovoice may represent a promising methodology for deeper reflection into affective learning domains because of students' connection between visual images and their lived experiences.

Structural Competency of Pre-health Students: Can a Single Course Lead to Meaningful Change?

Scholars within the medical sciences recently have called on undergraduate educators to incorporate the social sciences in order to teach pre-health students structural competencies - or the ability to articulate how social structures produce racial, ethnic, gender, class, and other disparities - in order to better serve these populations medically. Authors used a semester-long course to assess how experiential learning focused on the topic of structural inequities improves structural competency. In Fall 2018, 27 students completed a hands-on, experiential, course focused on structural factors and health disparities. The authors conducted a mixed-methods, pre-/post-test design to solicit data on students' views on the reasons for high rates of obesity, gender pay disparities, and racial/ethnic housing segregation. Using systematic qualitative data analysis and statistical analysis of coded answers, the authors were able to detect pre-/post-test differences in the number of times students identified structural reasons for the disparities. Statistical analysis showed that students were able to identify an average of 4.63 structural reasons at pre-test, and that increased to 5.93 reasons at post-test (statically significant (p = 0.007)), indicating an increase in structural awareness after participation in the course. Qualitative analysis, using systematic methods of coding and a modified constant comparison method, demonstrated that students' ability to articulate structural reasons for inequality greatly improved. This experiential learning course, while relatively short, was found to increase students' ability to identify structural factors and articulate them with deeper understandings. Future curriculum development should consider incorporating experiential learning to promote structural competency, rather than a more traditional passive, content-delivery method of training.

Teaching Cultural Humility and Implicit Bias to Veterinary Medical Students: A Review and Recommendation for Best Practices

Cultural humility, with its concomitant understanding of the importance of the influences of diversity and inclusion, improves health outcomes in the human medical field. Recent changes to the American Veterinary Medical Association Council on Education requirements in veterinary medicine include teaching the impact of implicit bias on the delivery of veterinary medical services. Because overt enhancement of self-awareness is not fodder for traditional veterinary medical education delivery systems, in this article we review existing literature on the impact of recognition of implicit bias on health care and offer insights on ways to help veterinary students learn this skill, drawing on evidence from an inter-professional intervention called WisCARES (Wisconsin Companion Animal Resources, Education, and Social Services).

Assessing student expectations and perceptions of a short-term international service-learning experience

OBJECTIVES

Despite nursing students' need for cultural education, few studies have measured what students expect from international service-learning experiences and how their perceptions of the actual experience compare to these expectations. To increase understanding of global nursing experiences, the purpose of this study was to examine the similarities and differences between nursing students' anticipated (pre-travel) personal and professional developmental expectations and reported (posttravel) personal and developmental outcomes.

DESIGN

This study employed a mixed descriptive research design. Quantitative data was secured through survey methodology. Written responses to open-ended questions provided qualitative data for analysis.

SAMPLE

Between 2012 and 2017, 43 undergraduate and graduate nursing students at a Midwestern university completed surveys and narratives about their participation in an international service-learning course in Kenya.

RESULTS

Students' anticipated learning was achieved through their international experiences. Participants also experienced personal growth, professional development, cultural competency enhancement, and transformation from the educational experience. They also described how their experiences would change their personal and professional lives.

CONCLUSION

The depth and breadth of the growth and learning described by students is consistent with the expectations of high-impact educational practices.

Nursing Student Engagement in Cultural Humility Through Global Health Service Learning: An Interpretive Phenomenological Approach

Introduction: This study explored how global health service learning supported nursing student engagement in the process of cultural humility and how it shaped student understanding of themselves and their ability to develop supportive intercultural relationships. Methods: Written reflections were collected from eight second-year students while on a 9-day practicum in a low-resource Caribbean country. Six students participated in posttrip interviews. Thematic analysis was used to illuminate the students' lived experience. Results: Four student themes emerged: (1) overcoming challenges, (2) opening our eyes, (3) seeing difference as a strength, and (4) learning with and from each other. While participants were inherently ethnocentric, the process of cultural humility curbed their sense of superiority and enabled the development of supportive intercultural relationships with their hosts. Discussion: This global health service learning was an effective strategy to enhance student nurses' learning about themselves and intercultural relationships and to develop the attributes of cultural humility.

Facilitating Cultural Humility and Attunement for Nursing and Health Professions Students Through a Study Abroad Program in Kenya

AIM

This qualitative descriptive study aimed to evaluate the role of a short-term interprofessional study abroad program in Kenya on beginning awareness of cultural humility.

BACKGROUND

Students in the health care professions, including nursing, must learn to work effectively with diverse patient populations and provide culturally safe care.

METHOD

Course assignments of 21 students were thematically analyzed to discover how students applied concepts of cultural attunement to learn cultural humility while interacting with people in rural and urban Kenya.

RESULTS

Student narrations acknowledged all aspects of cultural attunement during the experience: the pain of oppression; acted with reverence; reported coming from a place of not knowing; engaged in acts of humility; engaged in mutuality; and reported attaining harmony, cooperation, and accord.

CONCLUSION

Findings suggest a short-term community-focused study abroad experience can be a valuable tool for beginning stages of becoming culturally humble and providing culturally safe health care.

Through the Lens of Postcolonial Theory: Establishing Global North-South Partnerships

AIM

This study used postcolonial theory as a critical lens to examine the factors that supported or hindered equitable partnership formation within an innovative international service-learning (ISL) program in nursing education.

BACKGROUND

As ISL programs proliferate, ethical concerns have arisen as minimal attention has been given to both the host and visiting partners' experience and perceptions and how these impact partnership development and outcomes.

METHOD

A hybrid intrinsic, instrumental, single embedded case study design, including observations, interviews (n = 70), and document analysis, was used to analyze in depth varied partnerships within a US-Kenyan ISL program.

RESULTS

Central themes of dispelling assumptions, making connections, revealing privilege, and sharing power emerged and formed a theoretical model, Establishing and Strengthening Partnerships.

CONCLUSION

Attention needs to be given to preconceived assumptions, imbalances in privilege, and issues surrounding power and decision-making for equitable, impactful, partnership development. Leadership philosophy, style, and approach make a difference.

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.].

Coping: "This Is More Than a Trip-It Is a Journey"

A 2-week community health clinical experience in Ghana, Africa, provided undergraduate nursing students a study abroad opportunity to expand their cross-cultural skills. Journal entries (N = 512) of four cohorts were analyzed for common themes using Atlas.ti 7 in this descriptive qualitative study. No emphasis was placed on how to cope with cultural shock in Ghana, nor any attempt made to teach effective coping skills during the trips. Bochner's ABC cultural learning response model provided the framework for grouping themes. Positive coping skills included the need for control, humor, normalizing, and reframing as well as a need for a break and relaxation. Venting, frustration, and physical ailments were coded as negative responses to culture shock. Due to these findings, student preparation for short-term study abroad should include discussions on effective coping with culture shock during orientation sessions and on-going debriefing.

Fostering Global Health Practice: An Undergraduate Nursing Student Exchange and International Service-Learning Program

BACKGROUND

Nurses increasingly are identified as key health care members on global health initiatives, and nursing curricula should address this competency to prepare students to work in a global environment. This article will share how processes and structures were established for an international undergraduate nursing student exchange and service-learning experience between two schools of nursing.

METHOD

The goals of the project were to (a) implement an annual nursing student exchange of approximately 3 weeks in length; (b) select eight students from each school, accompanied by a faculty member, to participate; and (c) provide opportunities for students to participate in service-learning assessments in identified communities.

RESULTS

To date, an annual exchange is in its fourth year of existence.

CONCLUSION

An international service-learning opportunity is one way to improve nursing students' ability to provide culturally competent health care. [J Nurs Educ. 2019;58(4):235-239.].

Preparing Undergraduates for the Global Future of Health Care

BACKGROUND

Health professionals must be academically and experientially prepared regarding the social determinants of health to reduce health disparities at the global level. The emerging literature reflects a trend for incorporating global health competencies for health care. Specifically, recommendations from the Consortium of Universities for Global Health, National Academy of Medicine, and multiple nursing organizations encourage the inclusion of a global health curriculum.

OBJECTIVES

To describe the development of an undergraduate global health certificate program and provide recommendations for the development of future global health programs.

FINDINGS

At the completion of the certificate program, students felt better prepared to apply course content to culturally diverse populations in low resource settings.

RECOMMENDATIONS

Before developing a global health program, preconceived ideas about study abroad experiences and faculty concerns associated with course overload should be dispelled through evidence-based, educational sessions. Curricular time constraints in content-laden programs should be mitigated through an appropriate mix of e-learning formats. Last, a strong value must be placed on interprofessional education to facilitate capacity building through a bi-directional flow of knowledge and resources between the educational institution and the host country.

Mobilidade estudantil internacional: a experiência de estudantes de graduação em Enfermagem

RESUMO Objetivo Compreender as experiências vivenciadas pelos estudantes de graduação da Escola de Enfermagem da Universidade de São Paulo na mobilidade estudantil internacional. Método Estudo transversal, descritivo, com abordagem qualitativa, realizado entre fevereiro e julho de 2017. Os dados foram coletados por meio de uma entrevista semiestruturada e submetidos à análise de conteúdo. Resultados Participaram do estudo 22 estudantes. Na análise das entrevistas, emergiram cinco categorias analíticas: Dimensão das Relações Interinstitucionais, Dimensão Pessoal, Dimensão Profissional, Dimensão Acadêmica e Dimensão Cultural. Conclusão São muitas as vantagens que o intercâmbio internacional pode trazer à formação profissional. Considera-se necessário maior investimento governamental e institucional, mas com planejamento mútuo e acompanhamento das instituições, de forma que contribua para o desenvolvimento da Enfermagem e do País.