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This paper describes a collaborative program between St. Georges University, Grenada, West Indies and Regis College, Weston, Massachusetts, where faculty from both schools worked to provide an international, interdisciplinary health care experience for nurse practitioner students at Regis College, and for the medical and nursing students in Grenada.
The literature review presented provides a strong rationale for the benefits of this project which relates to the theme of the convention to Serve Locally, Transform Regionally and Lead Globally.
In March 2010, four family nurse practitioner students from Regis College School of Nursing, Sciences and Health Professions (SNSHP), in Weston, Massachusetts, spent a week at St. George’s University (SGU) Grenada, West Indies. The goal was to understand health care in Grenada in order to broaden students’ competency in treating patients from other cultures. Research has shown that nursing students who participate in an international nursing experience reap many benefits, including but not limited to: increased cultural sensitivity, increased self-awareness of one’s own cultural values, and increased self-confidence skills (Smith & Curry, 2011). Working with local health care providers helped students to bridge the gap between diverse international health care systems. As a result of such experiences, the academic, professional and social lives of nursing students have been changed, with an increased appreciation and understanding of poverty, socio-political health issues, and world geography.
The goal of educating the Nurse Practitioner is to develop clinical and professional expertise necessary for comprehensive primary care and specialty practice in a variety of settings. Nurse practitioners must achieve core competencies in management of the patient problems, nurse practitioner-patient interaction, teaching and coaching patients, students and staff, managing and negotiating health systems, ensuring quality of health care practices, and cultural competence. (American Academy of Nurse Practitioners 2013 Position Statement on Nurse Practitioner Curriculum)
The specific objectives of the Grenada international experience were to engage in a hands-on clinical learning experience, learn challenging decision making and clinical diagnosis with limited options for diagnostic testing, and interact with patients from races and cultures other than the students own. Additionally the students were tasked to learn how culture, lifestyle and diet affect general health in Grenada, to understand how patient education and learning takes place in Grenada, and to participate in the care of the underserved.
Students from Regis College were invited to submit a written application, with a statement of personal and professional goals, for selection to the Grenada experience. There were several criteria for selection of students which included good academic standing at Regis College, personal and professional maturity; capability of adapting to a new culture; a positive attitude during challenging situations; and an interest and /or experience in international learning. Recommendations from faculty at Regis College were helpful in determining some of these criteria.
The varied clinical experiences that provided cultural immersion included governmental clinics, private practices, university health services and health fairs for residents of Grenada. However, clinical experiences were designed to meet each student’s specific educational focus, such as women’s health, pediatrics, general medicine, or geriatrics; the process enabled by individual sessions with preceptors. Group visits to a local nursing home, and a psychiatric hospital included performance of physical exams, with a specific focus on breast exams, and vision exams for the residents. In addition, students visited a home for severely disabled children and adults, where they participated in assessing the residents’ health status and any recommended treatments. They also participated in rural community health fairs, located in schools or community centers, working under the supervision of licensed health care providers. During the entire program they worked alongside medical and nursing students from Grenada, as well as other nursing programs who were visiting at the same time.
The paper also presents in-depth information on the evaluation process. In every clinical session, preceptors provided a written evaluation of each student, and students, in turn evaluated their preceptors. A summary and analysis of these evaluations are described in the paper. At the end of the experience, there was a joint meeting for students who have participated from Regis College, St. George’s University and other nursing programs that were present that week. This provided a venue for sharing and reflection on the varied experiences.
The opportunity for interdisciplinary education enabled students from varied health care Programs, to benefit from the exchange of ideas and approaches to health care. An Institute of Medicine report (2011) called upon health educators to incorporate more interprofessional learning into the curriculum. This was restated in 2013 by the Joint Commission where improved interprofessional communication was found to be a critical area to help prevent patient errors.
The program expanded student learning and awareness of the necessity for cultural competence in health care; a required component of health education in the US. The welcome reception, with emphasis on culture, the island and hospital tours, all oriented the American NP students to Grenada. Working directly with Grenadian residents, and with physicians educated there, or in other countries, the NP students gained a different perspective on health care systems, patient expectations, and provider–patient relationships. In addition, students lived in the community and worked with minimal equipment and technological support. They spoke with patients, staff, and residents of the surrounding communities, took public buses, and ate in local restaurants.
The program, now in its fifth year, has expanded from four to six students, and approximately half of those who apply are accepted. Some students had many years of nursing experience while others had backgrounds in biomedical research, Peace Corps, military, journalism, business, and public health.
The international visiting nursing student programs have become the St. George’s University Global Nursing Initiative, which has included nursing students from Barry University, Indiana Wesleyan University, and University of Toronto. It has expanded the Regis International experience, and brought a new dimension to the St. George’s University’s (SGU) Program in Nursing. Some of the many benefits reported from the experience were an increased confidence in clinical skills, becoming more culturally sensitive and competent, and a broader view of health care delivery.