International field schools have been a cornerstone of global health education within the Camosun College (Victoria, B.C. Canada) Nursing Department for over a decade. While anecdotal evidence and student feedback support International Learning Experiences (ILEs) as positive, there has been no researched-based review to clearly identify the added value of ILEs to the overall educational experience of nursing students.
Reviewing the global health and related education literature provides some guidance for ILEs (Kulbok, Mitchell, Glick and Greiner, 2012) as well as opportunities for shared educational experiences for student nurses internationally (Shishani, Allen, Shubnikov, Salman, LaPorte, and Linkov, 2012) ; however, there is little research exploring the student uptake of core global health concepts, the subsequent effects on future student clinical placements in their own country (Curtin, Martins, Schwartz-Barcott, DiMaria and Soler Ogando, 2015), or the perspectives of the related host country (Kulbok et al, 2012). In addition, the notion al ‘global health diplomacy’ has not been fully explored in terms of cultivating diplomacy in nurse educators as well as future nurses (Hunter, Wilson, Stanhope, Hatcher, Hattar, Hilfinger Messias, and Powell, 2013). Indeed, attention to global health competencies and diplomacy skills can be seen as essential to the education of the next generation of nurses (Wilson, Harper, Tami-Maury, Zarate, Salas, Farley, Warren, Mendes and Ventura, 2012).
In order to address the gaps identified above, we conducted an interpretive descriptive research study (Thorne, 2016) from April to December 2016 in two countries, New Zealand and the Philippines, where our first and second year nursing students (n=21) were hosted for their five week consolidated clinical placements. Students were placed in acute specialty areas (intensive care, emergency rooms, neonatal intensive care, labor and delivery, surgical and medical placements, pediatrics) in addition to community-based clinics and outreach work (Mauri and Pacific populations in New Zealand and rural and urban scavenger communities in the Philippines).
A combination of data collection techniques were employed to analyze the impact of ILEs on host countries and nursing students to strengthen these unique international placements. Structured questionnaires (n=60) were administered to host nurses following their shifts with Canadian nursing students to gather their perspective on the benefits and detriments of the ILEs. Focus group discussions with students (4 in total) were held before and after their placements, in conjunction with in-country global health themed critical reflections (n=24) to explore personal and professional growth, motivating factors and specifically global health knowledge acquisition (based on adapted framework ,Riner, 2011; Curtin, Martins, Schwartz-Barcott, DiMaria and Soler Ogando, 2015) which included health promotion, social determinants of health, and infectious disease transmission. A review of students’ academic and clinical performance post-ILE was conducted to examine success rates.
Rich data emerged from the study revealing student’s deeper understanding of the social determinants of health and their impact on vulnerable population’s morbidity and mortality. Poverty, resource allocation, culture and the divergent role of nurses in different countries were dominant themes. Cultural competency and the ethics of nursing abroad were highlighted. Health promotion was a critical dimension of this study and student’s enhanced knowledge levels regarding upstream thinking and effective health education strategies; specifically related to dengue fever, diarrheal disease, lung disease (asthma, pediatric community acquired pneumonia, tuberculosis), cardiac disease and culturally appropriate diet for diabetic Maori patients.
Preliminary research findings will be presented along with significant lessons learned, including recommendations to inform best practice for future ILEs.
Conference participants will develop an enhanced understanding of the complexities involved when planning ILEs, the potential for rich learning related to the unique ethical and cultural differences in divergent nursing climates, and specific ways to capitalize on critical global health concepts necessary for improving population health.