The Experience of Undergraduate Nursing Students in South Africa: Promoting Cultural Awareness With Reflective Writing

Global health experiences influence nursing students by shaping their understanding of cultural and health behaviors. Students who perform nursing care in other cultures learn through these actions that nursing is indeed influenced by cultural awareness. Cultural awareness includes recognition of one’s own biases and beliefs, as well as identifying health care disparities, promoting wellness among medically underserved populations, and recognition of barriers to care (Stone et al., 2014). Students are required to provide professional patient-centered care to diverse populations within a myriad of clinical and practicum settings. Professional standards of conduct including empathy, respect for others, and social accountability are paramount to effectively provide quality care in a globally diverse society. Furthermore, nursing graduates must be competent in critical thinking and problem-solving for the comprehensive care of patients and their families. These skills are essential for improving healthcare quality and patient satisfaction as well as reducing health care costs and promoting population health among diverse settings (Visovsky et al., 2016). In January of 2017, three nursing faculty mentors facilitated a three-week study abroad course providing maternity care to women and families in South Africa. This presentation will examine the use of reflective writing assignments to improve cultural awareness among undergraduate nursing students to improve global health.

Increasing emphasis on cultural competence and diversity in healthcare education has provided a theoretical framework for faculty to address students’ unconscious biases and value systems, as well as provide guided experiences congruent with the paradigms of social justice and global human rights (AACN, 2008). International study abroad courses provide undergraduate nursing students with the opportunity to explore global health policy and practice nursing care in developed and under-developed countries, diverse settings, and varied cultures. It is well supported throughout literature that reflective writing is a valuable pedagogy especially when used with experiential learning, cultural immersion, and community and global hands-on experiences (Amerson, 2010). Students develop cultural awareness and critical thinking by reflecting upon their values, experiences and ideas through journaling. Global health requires cultural sensitivity, awareness, and competency to provide congruent health care to diverse populations throughout the world (Schmidt & Brown, 2016).

The evaluation process was based upon a grading rubric using a qualitative analysis of the depth of personal reflection. Faculty read the journal entries to provide formative feedback two times during the study abroad experience. The grades reflect the process of integration of feelings and self-awareness. For example, if a student journal is an inventory of events without a personal reflection into their feelings or linking prior knowledge to attitudes and beliefs, the score will be lower. Strategies for promoting meaningful reflection will be identified throughout this presentation, including examples of reflective questioning and action plans to initiate rich personal student reflection through journaling. Implications for nursing practice and education will be described. By using best practices associated with service learning-based reflection, students can improve their cultural awareness and sensitivity as well as think critically about the world and how their service can achieve personal, community and global health goals.