Prelicensure International Immersion Illuminates Shared Professional Values and Discovery of Nursing Voice in Cultural Humility

Saturday, 29 July 2017

Gina B. Diaz, DNP
School of Nursing, The College of St. Scholastica, Duluth, MN, USA
Paula Byrne, DNP
Chair, Traditional Undergraduate Department at the School of Nursing, The College of St. Scholastica, Duluth, MN, USA
Edna Imperial, MA
College of Nursing, Philippine Christian University-Mary Johnston College of Nursing, Tondo, Manila, Philippines


 This project’s purpose is to explore collaborative strategies for developing a sustainable international pre-licensure nursing educational experience. Nursing scholars and the International Council of Nurses (ICN) recognize that as our world becomes more culturally diverse, nurses will be the linchpin for transforming healthcare that is culturally flexible and responsive to the needs of patients and their families (ICN, 2013; Henly, 2016). The two goals of this project are (a) to deepen the student’s understanding of shared professional values and (b) develop the nursing voice. This project is framed by the assumption that when students are immersed into healthcare systems different from their own, they witness how nursing leaders model the shared values of the profession and demonstrate intercultural and collaborative skills of respect and humility. Kumagi & Lypson (2009) describe how the ability of understanding and bracketing one’s own assumptions, biases, and values, enables one to see care through different lenses and expand their perspectives on what constitutes the genuine art and science of nursing. Complex pre-licensure nursing curricula rarely offer pre-licensure students the opportunity to engage in actual patient care that occurs in different health systems, which may delay students’ experiences with recognizing their own positionality and understanding the positionality of others.


This program involves a collaboration between a small Midwestern private college and a private nursing school which operates in a highly underserved community in Manila, Philippines. A collaboration was initiated by a faculty member at the Midwestern private college who is an alumna of the nursing school in Manila. Students initially meet before the two-week trip using social media and then travel to Manila to be immersed in clinical practice and community nursing projects. Filipino students are matched with American students in clinical to serve as translators and guides within the organizations. Experiences include OR, Labor and Delivery, ICU, ER, and medical surgical floors. In addition, there is a pre-school screening and family feeding project that enhances family nursing and developmental assessment skills. The aim of the immersion for the students of both colleges is to identify their shared professional values while practicing cultural humility during different nursing educational experiences. The aim for faculty and administration is to explore best practices in nursing education and evaluation that can support the growth of future international nursing leadership. Leaders from each college have visited alternate sites each year to exchange ideas and plan for the future. Fifty seven American nursing students aged 21-23 years have participated and shared their perceptions. The underlying framework of collaboration balances the prioritized educational needs of both colleges as identified by the leaders. This shared vision of the purpose of the immersion has allowed the pilot to expand the length of the trip and to offer faculty development opportunities.


 Students wrote reflective papers before and after the experience to examine their assumptions before the trip and to validate their growth upon their return. Critical reflection is one of the guidelines for culturally competent nursing care. Nurses shall engage in critical reflection of their own values, beliefs, and cultural heritage in order to have an awareness of how these qualities and issues can impact culturally congruent nursing care (Doulas et al., 2014). Reframing care delivery is the main theme gleaned from the students’ reflections of the intercultural immersion experience. Reframing care delivery refers to application of therapeutic communication with cultural context, enhancing care through high human contact (touch), providing quality care despite low use or no technology used, and acute awareness of social justice within healthcare delivery systems.

American Student Reflection: “This course offered an amazing learning experience for me. I am so grateful to have had the opportunity to participate in this experience. I am able to evaluate personal, professional, and cultural values that impact clinical decision-making that are respectful of patients’ values and preferences after participating in this intercultural exchange.”

Filipino Student reflection: “The cultural differences adds up new dimensions in taking care of patients. We learn from them and they learn from us. And also a lot of Filipinos are very happy seeing them because it unusual to be taken care by foreigners, they brought joy to the patients and also to the working area. The nurses enjoys talking to the CSS students even they are not so good in speaking English.”


Developing a sustainable international immersion experience allows both students and faculty the opportunity to examine cultural bias and practice openness and empathy in a diverse healthcare setting. Clarity in the vision regarding the outcomes for the immersion experience allows leadership to align each of their unique faith based missions and address curricula needs for highly desired cultural humility outcomes. The strength of the collaboration is catalyzed by the shared interests of alumna and alignment of faith based colleges. The sustained collaboration encourages the organizations to develop new initiatives; the most recent plan includes designing a synchronous semester long class focused on leadership and assertive communication techniques such as TeamSTEPPS (AHRQ, 2016) to promote patient safety. Integrated technology will narrow distances between students.