Achieving Clinical Learning Outcomes in a Community/Public Health Nursing Course Through an International Immersion Experience

International clinical immersion experiences are valuable in that students are exposed to diverse cultures and ways of living, but these experiences can also provide an unconventional setting for clinical learning and the opportunity for culturally congruent care. Research has shown international immersion experiences to be beneficial in providing students comparison of U.S. health care systems to international systems, collaborate and form symbiotic partnerships with other institutions and providers, and share knowledge related to specific healthcare disparities. These experiences also enhance professional and personal development, enrich the understanding of healthcare concepts, and validate global citizenship. Clearly, international immersion experiences offer valid high impact learning opportunities for students and may prove to be a solution to limited clinical sites with increased competition for available placement.  Thus, an international immersion experience in baccalaureate nursing may indeed provide a resolution for such courses as Community and Public Health Nursing. The purpose of this project was to determine if clinical course learning outcomes could be achieved in an international immersion experience.

Partnering with the Social Work Department, the School of Nursing planned a six-day clinical immersion experience for undergraduate nursing students in Guatemala. Twenty-eight pre-licensure nursing students enrolled in Community and Public Health Nursing completed a 13-week theoretical course prior to the international immersion experience. The students received an orientation to the country including its historical and political perspectives, social classes, geography, cultural practices, and healthcare education and delivery systems. The University Study Abroad Office also provided a general informational session regarding international travel as an undergraduate student. Upon completion of the theoretical course, students participated in the clinical immersion experience and provided care in remote and rural villages of Guatemala in the Department of Zacapa.

Clinical learning outcomes achieved in the international immersion experience were: (1) understanding and application of an ecological perspective to practice, (2) incorporation of evidence-based practice to aid in health promotion, (3) use of social and environmental factors of health to enable student to work effectively with diverse populations, (4) integration of vital statistics and population data in planning health services in the community setting, and (5) identification of team strategies, both interdisciplinary and transdisciplinary, that would improve community health.

The international immersion experience provided students a unique clinical learning environment that promoted successful achievement of student learning outcomes. Student journaling revealed increased cultural awareness, resourcefulness, positivity with the experience, and gratitude. Challenges encountered during the immersion experience included communication barriers, lack of resources and equitable distribution, and various ethical dilemmas. Future recommendations for the international immersion experience include collaboration with advanced practice graduate students, formal division of clinical groups, and improved translation services. This project demonstrates that clinical learning outcomes can be achieved in alternative learning environments such as international immersion experiences.