Enhancing Cultural Competence and Global Awareness for Baccalaureate Nursing Students: An Interdisciplinary Service Learning Approach to Safe Water in a Developing Country

Introduction:

In recent years there have been multiple calls to action for nursing students to gain a global health perspective in an effort to increase cultural competence (Riner, 2011). In addition, interdisciplinary educational experiences have been identified as vital for nurses and other health care professionals (Smit & Tremethick, 2013; Institute of Medicine, 2010). One option to enhance cultural competence, global awareness, and teamwork is to use an interdisciplinary service-learning approach to address an identified issue in a global community. Service learning is a structured, reciprocal learning experience in which both the community and students benefit (Amerson, 2010; McKinnon & Fealy, 2011), while interdisciplinary approaches support the ability to bring multiple perspectives and contributions to global health issues. Communities benefit from the knowledge and creativity that faculty and students from institutions of higher learning bring to address issues, while students benefit from exposure to real-life problems and first-hand experiences as a part of a team to partner with communities to address issues. When communities, students, and multiple disciplines unite, new and different sets of eyes and hands collaborate to facilitate problem-solving and develop sustainable solutions.

Background:

Nursing students in a baccalaureate program had the opportunity to enhance their global awareness through participation in an interdisciplinary service-learning project in the Dominican Republic. The School of Nursing partnered with the School of Engineering (Civil, Environmental and Ecological), Department of Agricultural Economics, Department of Food Science, and the Department of Biological Sciences to design, implement and evaluate a safe water project in the Dominican Republic. The overarching goal of this project was to develop sustainable, community-scale water treatment systems to be established in various communities in the Dominican Republic and, by extension, to improve the health of residents of those communities. With the help of a Rotary Club in the Dominican Republic and Aqua Clara International, both of whom are serving as partners for this project, the Ana Julia School in Las Canas was chosen as the implementation site for this pilot project.  This community is facing critical water issues, and the school serves as a focal point for education and socialization in Las Canas. The two-year project, which included faculty, undergraduate and graduate students from all of the disciplines involved, was set up as a service-learning class which covered content about the culture and community in the Dominican Republic along with the roles and contributions of all of the disciplines participating in the project. Over the two-year span, students and faculty made four trips to the Dominican Republic, successfully applied for and received multiple grants to support the project, participated in a competition for Environmental Protection Agency funding, and developed a strong partnership with the community. Recently, the water system was completed and celebrated via a ribbon cutting ceremony as the first clean water ran through the system. During the week long finalization of the project, students and faculty also provided guidance and support to the community related to health education, safe water practices and hygiene, governance of the water system, and safe operation and maintenance of the system. Additionally, curriculum support was provided to the school along with teacher training to incorporate monthly health education concerning safe water use and healthy hygiene and sanitation practices for the children in the school.

Evaluation and Outcomes:

Overall, nine undergraduate nursing students and two nursing faculty have been involved in this service-based learning class along with 12 students and three faculty from the other disciplines. Students evaluated the experience via personal reflection. They reported gaining an appreciation and understanding of the roles that multiple disciplines and the partnering community play in the development of a sustainable solution to water issues in developing countries. They liked the fact that this was not an “imagine-if” problem, but a real world problem requiring the collective skills of all involved. Along the way students developed leadership skills, grant writing skills, and an understanding of how to provide care within the cultural context of the community they are serving. Additionally, students found that in the true sense of service-learning that they not only educated the community but that the community educated them. The community embraced the university team and the project, including faculty and students in social functions and providing meals on a daily basis in the homes of community members as the team worked to complete the project. Students and faculty became a strong presence in the community served, coming away from the project with an appreciation for the cultural differences in the community served, and an awareness of how these differences can contribute to health issues and impact the development of successful approaches to address the issues. For the students and faculty involved, it was described as truly transformative. One student reported that she “saw aspects of poverty that she had never seen before,” while another reported that it was the “richest experience” of her college years. While this project has been completed, the team will continue to monitor and evaluate the outcomes as they plan the next project in nearby neighboring communities using lessons learned to design and develop the next water system.

Conclusions:

Experiences such as these help to develop nurses who are better able to provide effective care to increasingly diverse client populations. The added skills developed in this type of experience situate these students well for their roles in health care settings functioning as a part of an interdisciplinary team, engages them in public health, and supports an understanding of the importance of existing and emerging global health threats. Community partnerships with universities play a significant role in addressing local and global health problems. These partnerships make future generations aware of these issues by integrating partnership activities into their academic studies and student activities. This service-learning experience combines community service with preparation and reflection that is both discipline-specific, interdisciplinary, and linked to course objectives. Students are able to provide community service in response to community-identified needs and concerns and learn about the context in which service is provided, the connection between service and academic coursework, and their roles as global citizens. Since service- learning can be an empowering process, communities can also be strengthened through this collaboration.