Educational Efforts for Enhancing Global Health Competencies Among Undergraduate Nursing Students in South Korea

Purpose: Globalization happens everywhere. Many of culture, information, resources, and workforces can be easily exchangeable without national boundaries. In South Korea, special demands are noted for nurses and nursing students. Domestically Korea currently goes multicultural very fast. To take care of patients/clients with different background, global health care industries are drastically expanding now and demanding health care providers, especially nurses, who have global competencies. Internationally, since Korea came to reverse its position from a recipient to a donor of Official Development Assistant in the 1990s, it is required to share experiences, resources and workforces, including health care systems and workers, with developing countries. To meet these domestic and international demands to Korean nurses, nursing schools start to put educational efforts for nursing students to be prepared. This study introduced educational efforts from a 4 year nursing school in Korea, which aimed to enhance global health competencies among undergraduate nursing students. In addition, it examined associations of taking the courses with increased global health competencies among them.

Methods: Since nursing schools have been initiating global health movements in Korea, two courses were taught to undergraduate nursing students in a 4-year nursing school: ‘multicultural health’ for the 1^st year nursing students, and ‘global leadership’ for the 2^nd year ones (both were 2 credits). The course ‘Multicultural health’ provides an overview about multicultural societies and related policies and health issues. The course contents include theory and concepts of multi-culture, examples of multicultural societies, law and policy on multi-culture, and concepts and issues of multicultural health. The ‘Global leadership’ course is designed to provide the concept of leadership within the contexts of global health systems. More specifically, this course provides an overview of major issues affecting global population health and the leadership roles of nursing in global health. In the 2013 Fall semester, the 1^st year students were taught multicultural health and the 2^nd year ones received the lectures of the global leadership course. The 2^nd year students took multicultural health last year (in 2012). Otherwise, the 3^rd and 4^thyear students were not received any of those. These differences allowed to examine associations of taking the courses with increased global health competencies among nursing students. For this, a cross-sectional survey was conducted to all nursing students in this school at the end of the semester (November and December 2013). Global health competencies were measured for 1) knowledge and interests in global health and health equity (11 Likert-type items, scale range 11-33) , 2) global health skills (4 Likert-type items, scale range 4-20), and 3) learners’ needs about global health (7 Likert-type items, scale range 7-42), using Veras and colleagues’ (2013) global health competencies instrument for health professionals and students. The survey instrument showed reliable (all Cronbach alphas>0.80 for the 3 subscales). Additional data were also accessed on 1) whether they had ever lived abroad in the past 10 years, 2) whether they had ever participated in student exchange programs, and 3) whether they had ever met any patients/clients with different (multicultural) background in their clinical practicums. Global health competencies were examined for their means by the school years using ANOVA with Tukey post hoc tests.

Results: Out of the 698 undergraduate nursing students, 578 completed the survey (252 freshmen, 199 sophomore, 79 junior, and 48 senior) yielding the response rate of 83%. The students were average 20 years old (range 18-28) and mostly female (91%). Out of the students, 13% had lived abroad in the past 10 years. While overall 10% of the students had participated in student exchange programs, higher year students tended to have more experiences in the programs: 5% of the 1^st year, 11% of the 2^ndyear, 19% of the 3^rd year and 23% of the 4^th year students.  Among the 3^rd and 4^th year students (n=127), 65% had met patients/clients with different background in their practicums. The 2^nd year nursing students reported higher knowledge and interests in global health and global equity than the 1^st and 4^th year students (22.8 for the 2^nd year students vs 20.1 for the 1^st year and 21.0 for the 4^th year students, F=16.56, p<0.01). The 3^rd year students showed higher knowledge and interest than the 1^styear students. There were no differences in global health skills and learners’ need about global health despite more experiences of and exposure to patients/clients with different background and international social contacts with students in other countries.

Conclusion: Educational efforts through the two courses focusing on global health may have positive effects on enhancing global health competencies, especially on knowledge and interests in global health and health equity, for undergraduate nursing students. Experiences of and exposure to contacts with students and clients with different background may increase students’ concerns to global health issues. Study findings should be interpreted with limitations. As the data were all self-reported, respondents might respond to the socially acceptable way. This was a cross-sectional design, and the study findings could not be confirmed for their causal relationships. Due to unbalanced sample sizes across the school years, statistical analysis could inflate the findings. Nonetheless, Welch F test, which corrects violation of homogeneity of variance in ANOVA, showed the same results. In conclusion, structured courses designed to increase global health competencies for nursing students may be a good strategy to meet social demands for nurses’ roles in the globalized society in South Korea.