Enhancing Cultural Competence in Undergraduate Nursing through Short Term International Immersion: A Content Analysis of Students' Reflective Journals

Purpose:

     The purpose of this presentation is to explore the impact of international immersion of undergraduate nursing as a means of enhancing cultural competence.  A major component of nursing education is to prepare undergraduate nursing students with opportunities to develop the capacity to deliver compassionate care to diverse populations. Pilot work was done while examining the culturally competent practices which might be incorporated in the curriculum at a small university school of nursing.  A group of undergraduate senior nursing students participated in a volunteer experience in Guatemala.  The students were invited to join a mission team traveling to work at Casa Angelina Orphanage just outside Antigua.   Although the students did not receive course credit and personally paid for their trip, they all agreed to maintain and share individual reflective journals during the full week experience.

Background:

     Students interacted with locals in Antigua, orphans at Casa Angelina Orphanage, and other church volunteers from their team and additional teams from the United States. The students attended a church service in Antigua with the entire team. Afterwards, they explored the Mayan culture in the streets of Antigua. Some sought the service of a local who was eager to share all the sights with them as well as advise them on the best places to eat and shop.

     Each day began traveling about 45 minutes through beautiful mountains to Casa Angelina Orphanage located near Antigua. Each day, the group had the opportunity to interact with the orphans prior to them attending school and then after they returned from school.  After waving goodbye as orphans boarded the bus, the morning began with about an hour of worship, singing, and individual orphans sharing their testimonies and life occurrences that resulted in their living at Casa Angelina. The nursing students heard extremely sad stories of a culture of which they were completely unaware. Additionally, students interacted with personnel and local workers during a service-learning project at the Casa Angelina Orphanage in a variety of projects from working in the orphanage clinic, mixing cement, painting, and digging ditches. The students were allowed to choose the projects they wanted to work on at the orphanage. Surprisingly, they did not simply choose to work in the clinic. More assistance was needed with other projects and they eagerly volunteered.  Some spent hours moving large brick tiles to be used in building a house at the orphanage. Afterwards, they began mixing cement and assisting the workers in the construction of the walls of the house.  Others were involved with cleaning and painting while still others were busy with shovels digging a two foot deep by two foot wide by 90 foot long ditch. 

     Although this was extremely hard and dirty work, the students never complained throughout the day. They reported in the journals that the reward came at the end of the workday.  Every afternoon, they rushed to wash off the dirt, mud, and cement because they had the opportunity to greet the orphans as they returned from school.  The students found renewed energy as they ran, laughed, and played with children from age two to eighteen.  Few of the students spoke Spanish but reported they had little problems with communicating with the orphans. No words were needed with smiles, hugs, and laughter from all.  The young children clung to many of the students not wanting them to leave in the afternoons.

Method:

     Content analysis of the reflective journals was completed with many themes identified.  Within nursing programs, nursing students are expected to gain a sense of cultural competence either from lectures, simulation, or videos.  The content analysis revealed the following themes: 1) value of actually seeing cultural differences in another country; 2) value of nonverbal communication; and 3) value of service learning and selfless giving to the needy.

     The most frequently used word throughout the reflective journals is “amazing”.  This word was used to describe the beautiful mountains, lakes, and volcanoes; the various mouth-watering Guatemalan dishes that were served daily; and most importantly, all the people they interacted with, the orphans, the workers, the team members, and the administration at the orphanage.

Results:

     Overwhelmingly, every student reported having a life-changing experience.  They were able to identify the presence of the less fortunate and less privileged living in poverty and very unlike their own lives including numerous material comforts. Many have expressed a desire to return for another trip after completing their nursing program.  Some have even spoken of pursuing professional opportunities abroad as they begin their nursing careers. Study abroad and service-learning programs allowing this type of experience may certainly enhance preparation of nursing students for culturally competent practice in the future. 

     In conclusion, an international immersion suggests an opportunity for enhanced cultural competence of nursing students.  However, continued investigation including study abroad courses and service-learning opportunities which include integrating cultural safety and competence throughout the undergraduate program are necessary to determine the extent and overall value of the learning experience.  Teaching and learning strategies as well as issues focused on curricular design may result in greater student and faculty cultural awareness and appreciation.

Limitations:

     This is pilot work completed prior to incorporating a formalized study abroad component at one small university school of nursing.  Hence, it is not generalizable and transferability is exceedingly limited.