The impact of international placements on nurses' personal and professional lives: literature review

AIM: This paper presents a critical review of research literature on the impact of international placements on the lives and practice of nurses. BACKGROUND: Health care institutions are progressively more aware of the need to respond to diverse patient populations and cultivate leaders to enrich the nursing profession, both locally and globally. One response has been to establish international exchange programmes for nursing students to give them experience of different cultures and health care systems. METHODS: A search of the literature from 1980 to 2003 using electronic databases was undertaken using the databases CINAHL, ERIC, British Nursing Index, Web of Science, the BIDS Social Science Citation Index and Medline. The keywords used were 'international exchange experience', 'international studies', 'international education', 'international placement(s)', 'exchange programme(s)', combined with 'nurses/nursing', combined with 'evaluation', 'practice', 'education' and/or 'policy'. The papers retrieved used both qualitative and quantitative approaches and were scrutinized for recurring themes. FINDINGS: Nurses reported significant changes in their personal development, perspectives on nursing practice and critical appraisal of health care systems. They also indicated an increased appreciation and sensitivity towards cultural issues and cross-cultural care. Moreover, differences in placement programmes, such as duration, preparation and debriefing were found to have affected the reported overall international placement experience. However, the primary effects of international placements were identified as personal development and transcultural adaptation. CONCLUSION: Students should be exposed to a variety of nursing experiences within the host country. This would give them a broad spectrum for comparisons between cultures, nursing practice and health care delivery in those cultures. Therefore, educational institutions are strongly encouraged to provide opportunities for students to participate in nursing care and education in another country.     

Opening our hearts and minds: the meaning of international clinical nursing electives in the personal and professional lives of nurses

Although international opportunities are the hallmark of nursing education at a large private university, the meaning of participating in such clinical nursing electives has not been described. The purpose of this phenomenological study of nurses was to examine the personal and professional meaning of participating in international clinical nursing electives during their undergraduate nursing studies. Audiotaped interviews were conducted with 20 former nursing students who had had this opportunity. "Opening our hearts and minds" was described by the study's participants, with the following themes: increasing understanding of other cultures and peoples, increasing understanding of global sociopolitical and health issues, increasing the commitment to make a difference, experiencing personal and professional growth, contributing to professional development in the host country, making interpersonal connexions, and developing cultural competence. This study makes an important contribution to the documentation of the meaning of participating in international nursing clinical experiences. Data are being used for long-term curricular planning in the development and refinement of future international clinical nursing electives and to provide outcomes data for professional accreditation. There are broader implications for the movement beyond individual cultural competence to increasing global consciousness and the improvement of global health care.     

Transformative 'cultural shifts' in nursing: participatory action research and the 'project of possibility'

Transformative 'cultural shifts' in nursing: participatory action research and the lsquo;project of possibility'
For some time scholars have called for changes in nursing in order to address the subjugated position of nurses within health care. This paper argues that through an engagement with participatory action research, nurses open up a possibility to bring about transformative shifts in nursing culture. The motivation for nurses to engage with this research process arises out of an acknowledgement that they can no longer live with the sense of pain and crisis endemic in much of their nursing practice, and a desire to take action to bring about transformative change within their local ward cultures. However, their participation in critical reflective and collaborative processes that underpin action research exposes an array of minor scattered nursing practices which frustrate possibilities for transformative change. Drawing on empirical accounts from research conducted by the author, the paper argues that once made explicit, these minor practices and the regimes of truth that nurture and sustain them, can be reconstructed and the possibility of transformative cultural shifts in nursing will then emerge.     

Drawing on antiracist approaches toward a critical antidiscriminatory pedagogy for nursing

Although nursing has a unique contribution to advancing social justice in health care practices and education, and although social justice has been claimed as a core value of nursing, there is little guidance regarding how to enact social justice in nursing practice and education. In this paper, we propose a critical antidiscriminatory pedagogy (CADP) for nursing as a promising path in this direction. We argue that because discrimination is inherent to the production and maintenance of inequities and injustices, adopting a CADP offers opportunities for students and practicing nurses to develop their capacity to counteract racism and other forms of individual and systemic discrimination in health care, and thus promote social justice. The CADP we propose has the following features: it is grounded in a critical intersectional perspective of discrimination, it aims at fostering transformative learning, and it involves a praxis‐oriented critical consciousness. A CADP challenges the liberal individualist paradigm that dominates much of western‐based health care, and the culturalist and racializing processes prevalent in nursing education. It also situates nursing practice as responsive to health inequities. Thus, a CADP is a promising way to translate social justice into nursing practice and education through transformative learning.     

Transforming nursing curricula for a global community

With nurses and midwives providing the majority of health care globally, nursing education in all countries must prepare students for broader responsibilities to move the agenda forward for equitable care and universal health coverage. Columbia University School of Nursing developed and implemented a vibrant approach to curriculum transformation that included a new didactic course followed by a program of global clinical experiences to expand students' learning environments in global health. Program planning included defining learning objectives, mobilizing support within the school, establishing new sites, recruiting and preparing students, overseeing of students with host institutions, and evaluating the program. A total of twenty-four students were placed over five sites for a six-week credit-bearing global clinical experience. Students had varied clinical experiences with new understandings of the reality of health disparities. Host sites expressed a commitment to have students return in the next year, and all students stated that they would chose a global experience again. This innovation provides a transformative addition to nursing education with a deepened understanding of health disparities and nursing roles in different health systems. It strengthens the school's network of nursing and midwifery educators and opens doors for new exchanges.     

Critical reflections on culture in nursing

The purpose of this paper is to raise awareness of a view of culture as a sociopolitical construction, and to explore implications for incorporating this view into U.S. nursing education and practice. Current definitions of culture, cultural diversity, and cultural competence are examined to highlight ways in which a traditional, essentialist view is reflected. Examples of an alternative, constructivist view are provided through discussion and in a series of questions. These questions serve as the basis for considering new approaches in U.S. nursing education and health care based on view of culture as a dynamic and ever-changing sociopolitical construction.     

Facilitating transformation through collaboration

The philosophical underpinnings of transformative education were utilized to redesign a course taught to special education majors and nursing students at a rural southeastern university. The main goal when restructuring the class was to develop a course that would encourage communication and collaboration between education and nursing majors within the school community. The current course, "Health Care Perspectives of Exceptional Students," focuses on specific health care topics, with nurse faculty presenting the health care aspects and education faculty discussing educational implications for the classroom teacher. Every class includes dialogue and activities that require interaction. The last two classes are devoted to first-aid training and CPR certification. During the evaluation phase of the course, both education and nursing majors responded positively to the question of whether or not medically fragile children belong in the classroom. Furthermore, they saw the need for communication and collaboration between the classroom teacher and the school nurse as essential for effectively serving the medically fragile child in the school setting.     

The concept of spiritual care in mental health nursing

AIM: In this paper we aim to clarify the issue of spiritual care in the context of mental health nursing. BACKGROUND: The concept of spirituality in nursing has received a great deal of attention in recent years. However, despite many articles addressed to the issue, spiritual care remains poorly understood amongst nursing professionals and, as a result, spiritual needs are often neglected within the context of health care. METHODS: A series of focus groups was conducted to obtain the views of service users, carers and mental health nursing professionals about the concept of spirituality and the provision of spiritual care in mental health nursing. RESULTS: According to the views expressed in our focus groups, spiritual care relates to the acknowledgement of a person's sense of meaning and purpose to life which may, or may not, be expressed through formal religious beliefs and practices. The concept of spiritual care was also associated with the quality of interpersonal care in terms of the expression of love and compassion towards patients. Concerns were expressed that the ethos of mental health nursing and the atmosphere of care provision were becoming less personal, with increasing emphasis on the 'mechanics of nursing'. CONCLUSIONS: The perceived failure of service providers to attend adequately to this component of care may be symptomatic of a medical culture in which the more readily observable and measurable elements in care practice have assumed a prominence over the more subjective, deeply personal components. In order for staff to acknowledge these issues it is argued that a more holistic approach to care should be adopted, which would entail multidisciplinary education in spiritual care.     

Constructivism applied to psychiatric-mental health nursing: an alternative to supplement traditional clinical education

With the popularity of accelerated pre-licensure nursing programmes and the growth in nursing student enrolments, traditional clinical education continues to be a challenge to deliver. Nursing faculty members are required to develop and implement educational innovations that achieve effective learning outcomes, while using fewer resources. The purpose of this qualitative study was to explore the effectiveness of a constructivism-based learning project to achieve specific learning outcomes and to supplement approximately 30 clinical hours in a psychiatric-mental health nursing course. Students participated in a 10-week, multistage project that examined life histories, treatment resources, and evidence-based practice, as applied to a single individual with a mental illness. Students reported increased understanding of mental health and illness, developed personal relevance associated with the knowledge gained, and learned to problem solve with regard to nursing care of individuals diagnosed with mental illness. For many students, there also appeared to be a reduction in stigmatized attitudes towards mental illness. Constructivism-based learning is a promising alternative to supplement clinical hours, while effectively achieving learning outcomes. Future research is needed to further validate the use of this method for the learning of course content, as well as the reduction of stigma.     

Seeking Balance to Dialectic Tensions in Teaching Through Philosophic Inquiry

Purpose: To propose a plausible means of cultural criticism of nursing's educational environment for preparing new nurses by exploring epistemological tensions and their consequences from the perspective of educators.
Design: Naturalistic, qualitative, philosophic.
Method: Six nurse educators teaching in a university-based traditional BSN program were interviewed in one southeastern state of the United States about their experience as creative, innovative teachers during 1991.
Findings: Three major themes were reflections of the positivist work culture of teaching, reconciliation of tensions, and repercussions from personal choices. Educators reconcile dialectic tension by suppression, subordination, or equilibrium and are influenced by their sense of tension and willingness to be risk takers.
Conclusions: Philosophical conflicts are inherent in nursing when commitments to empirical knowledge and personal meaning are both valued. A plausible means for moving beyond this tension is to increase awareness of the dynamics and consequences that occur when perspectives seem contradictory. Schools of nursing socialize future nurses. Calling into question the context in which the professional nursing culture is transmitted and reproduced is necessary if nurses of the future are to be in the forefront of changing health care.     

Cultural safety in New Zealand and the United States: looking at a way forward together

Cultural safety emerged in Aotearoa, New Zealand as a nursing response to bicultural interactions between indigenous Maori and other New Zealanders. The purpose of this research is to describe the meaning and experience of cultural safety as depicted by nurses in New Zealand and to illustrate the potential for this to inform U.S. nursing education and practice. This interpretive hermeneutic study explored cultural safety as described by 12 experienced nurses who were selected through snowball and purposive sampling. Audiotaped interviews were conducted after ethics approval. Interpretive analysis uncovered five themes that are described with data and paradigm cases. Cultural safety considers the perspective of the patient as the norm in contrast to the culture of health care. Understanding historical power differences and personal biases can help challenge victim-blaming responses by health care providers. Incorporating these understandings into reflective practice enhances the possibility of culturally safe learning for students and culturally safe care for patients.     

Towards an individualized client's care: implication for education. The transcultural approach

The nursing profession is faced with the challenging role of providing individualized client care within the context of the whole person Individualized care cannot be achieved without considering the factors associated with the personal being, such as culture, beliefs and tradition As nurses interact with clients from various cultural backgrounds, the need to consider and be aware of their own values is essential to enable them to provide unbiased care Nurse education plays a major role in developing individuals who are able to examine their own views with regards to cultural biases The importance of acknowledging other cultures as opposed to the nurses' own is essential in order to ensure that the knowledge learnt will enhance the qualities of caring, competence and professionalism This is necessary because cultural context is viewed according to how it is perceived by the clients and the nurses themselves     

A review of transcultural nursing

In this article, transcultural nursing is reviewed in the light of the literature mainly relevant to the British context. The key features of transcultural nursing are examined in the context of multicultural Britain as follows: definitions, racism, ethnocentrism, culture, diversity, transcultural health care practice and nurse education. Models of transcultural care practice and contemporary developments in cultural care are also explored. There is evidence from emerging literature that innovations are taking place in promoting transcultural care practice and education. However, the article concludes that much practice-based research is still needed to establish transcultural nursing in Britain.     

A ward-based writing coach program to improve the quality of nursing documentation

A ward-based writing coach program was piloted at a metropolitan hospital in Australia to produce a quality improvement in nursing documentation. This paper describes the education program, which consisted of two writing workshops, each of one-hour duration followed by one-to-one coaching of nurses. This program could be carried out in any clinical area as a part of the regular education program. Nurses are encouraged to view their documentation practices in a critical light to ensure that the documentation is meaningful to readers within or outside the profession. The importance of nursing documentation as a communication tool for all health care professionals is emphasised. Barriers to meaning, such as fragmentary language or the use of unofficial abbreviations, are discussed. Nurses are also encouraged to document the patient's condition, care and response to care using defined principles for nursing documentation. This program would be transferrable to any clinical setting looking for a ward-based education program for nursing documentation.     

Cultural encounters in reflective dialogue about nursing care: a qualitative study

Title.  Cultural encounters in reflective dialogue about nursing care: a qualitative study.
Aim.  This paper is a report of a study to explore how students developed reflective nursing practice through cultural encounters between students from Tanzania and Norway.
Background.  Nursing students need to develop cultural care competence to care for patients in a globalized world. One way to achieve this goal may be through international practice experience. Previous studies have shown that students visiting developing countries matured personally and intellectually more than those who experienced encounters between developed countries.
Method.  The study was exploratory, using qualitative data about nursing practice and cultural encounters experienced by nursing students from Tanzania and Norway. Data were collected through participatory observation, students' logs and focus group interviews in 2006.
Findings.  The encounter was characterized with an open attitude facilitating a good context for co-learning between the students. Three main themes were identified. The Norwegian students emphasized nurse–patient relationships, individualized care, direct communication and emotional involvement. The Tanzanian nursing students demonstrated a collectivist approach in nursing characterized by nurse–relative–patient relationships, and they emphasized curing attributes with skilful performance of procedures.
Conclusion.  A cultural encounter between students from different culture proved to be a fruitful way of teaching nurses. The opportunity to share thoughts, reflect on value systems and personal practice through dialogue with students from a different culture offer possibility in terms of cultural competence, reflexivity and consciousness of various ways practising nursing. This may contribute to bringing the practice of nursing a step forward in both cultures.     

Beyond transculturalism: critiques of cultural education in nursing

New and innovative educational approaches are needed to prepare a workforce that responds to diverse needs of people from a wide variety of cultural backgrounds, languages, and worldviews. Despite some movement toward standardization of cultural curricular content, there remains a lack of consensus regarding pedagogical approaches to cultural education in nursing. An increasing number of nurse scholars have identified significant limitations in the process of cultural education in nursing and transcultural nursing theory. These critiques reflect a schism in the discipline regarding foundational theoretical perspectives and conceptualizations of culturally competent health care. This article offers a synthesis of transcultural nursing critiques that have appeared in the nursing literature over the past decade and explicates the philosophical tensions that underlie the varying pedagogical approaches to cultural education in nursing.     

Cultural competency and nursing care: an Australian perspective

AIMS: To propose a process that will facilitate cultural competence in Australian nursing practice. BACKGROUND: Cultural diversity is a prominent feature of the Australian health system and is impacting significantly on nursing care quality. A fictitious, but typical clinical exemplar is profiled that identifies cultural insensitivity in care practices leading to poor quality outcomes for the health consumer and her family. Strategies are proposed that will reverse this practice and promote culturally competent nursing care and that locates overseas qualified nurses in this process. CONCLUSION: This paper contributes to nursing care quality internationally by articulating strategies to achieve cultural competence in practice. Nurses must pay attention to interpersonal relationships and develop respect for the health consumer's value systems and ways of being, in order to protect their rights and avoid the tendency to stereotype individuals from particular cultures. The expertise of qualified nurses from different cultures can greatly assist this process.     

Learning preferences of paediatric intensive care nurses

AIM: This paper reports the views of students on the teaching and learning strategies used in paediatric intensive care nursing courses. STUDY METHODS: Qualitative methods of data collection and analysis were used. A case study of one paediatric intensive care nursing course was carried out, followed by group interviews with students from a further seven courses. Local ethics committee protocols were followed. Data were analysed using constant comparative analysis. STUDY FINDINGS: Qualified nurses undertaking paediatric intensive care nursing courses seek a specific knowledge base, relevant to their clinical practice. Their preferred way of learning in this situation is teaching by knowledgeable experts who are also prepared to discuss issues that arise. Although in some instances student centred or self-directed approaches were considered acceptable, Students still require clear guidance and structure in their learning. Students did not summarily oppose student centred approaches to teaching and learning, however, time considerations and whether this would reduce the amount of study time provided by their employers were important factors. There was evidence that students do not necessarily have one specific learning preference. LIMITATIONS: This study explored only paediatric intensive care nurse education, and was not intended to be generalizable beyond this field. CONCLUSION: The findings from this study indicate that no single educational approach is universally seen as the most attractive for PICU nurses. The major considerations in designing and implementing PICU nursing courses should be that content is clearly rated to the clinical speciality, theory is clearly linked to practice, and that the time constraints for students who are additionally in full time employment are taken into account.     

Incorporating cultural diversity in nursing care: an action plan.

This article examines the context of culture from the perspective of the increase in immigration and concomitant growth of diversity within the United States. It proposes that nurses who deliver culturally competent care are brokers of three cultures: their own; the health care system; and the client. The mechanism for creating approaches to care that utilize this concept is the nursing process. A culture-specific assessment can be achieved using the explanatory model of illness. The inadequacies of some frequently used strategies such as nursing diagnosis are also discussed with suggested changes.