Global Health Through the Eyes of Nursing Students: An Immersion Experience

Background/Purpose: Despite the vastness of the world, advances in technology and transportation have provided ways for people to be connected across the globe. The ability to visit other countries and even relocate to a foreign land is a reality for many. This mobility has led to an increase in diversity among the populations of countries all around the world, making it likely that future nurses will care for many people in their careers who come from a wide range of backgrounds, ethnicities, cultures, belief systems, religious groups, and social settings. This diversity creates a necessity for undergraduate nursing students to be engaged in didactic and clinical experiences that expand their horizons and help them see the world from a broader perspective. In the current Essentials of Baccalaureate Education for Professional Nursing Practice (2008), the American Association of Colleges of Nursing (AACN) acknowledged an increase in “globalization of healthcare and the diversity of this nation’’ (p. 6), which has led to a mandate that nurses be prepared to provide safe, high quality care in a diverse and multicultural environment. As a result, baccalaureate nursing programs are expected to prepare their graduates to “apply knowledge of social and cultural factors to the care of diverse populations” (AACN, 2008, p. 12). The National League for Nursing (NLN) has also demonstrated their support of professional nurse development in the area of cultural awareness in their NLN Excellence Hallmarks for Curriculum. Hallmark #2 states that “The curriculum provides experiential cultural learning activities that enhance students’ abilities to think critically, reflect thoughtfully, and provide culturally-sensitive, evidence-based nursing care to diverse populations” (NLN, 2009, p. 1).

Program/Methods: To fulfill these directives and prepare nursing students for lives of diverse service opportunities, a small, liberal arts Christian college in the Midwest United States implemented a Global Health course and immersion experience at the time of the nursing program’s inception in 2009. A required semester long course in the junior year of the baccalaureate program covers Global Health topics and international travel preparation, which is then followed by a two week immersion experience in the country of Zambia in southeast Africa. The trip to Africa has taken place every year since 2011 and to date, over 130 nursing students have had the opportunity to experience daily life and observe healthcare delivery in Zambia.

During the Global Health course, students are introduced to the Sustainable Development Goals and the worldwide progress on each of the Goals. Early in the semester, each student selects one of the Sustainable Development Goals (SDG) as an area of focus and research during the course and during the immersion experience. Students research their chosen SDG before the trip to gain knowledge and understanding about the background and history of the goal and the benchmarks currently in place for meeting the SDG in Zambia. During the trip, students gather additional information about Zambia’s progress toward meeting the SDG through observation, interviews with healthcare workers, and conversations with local people. This work provides students with the ability to gain a deeper understanding of the SDGs and the complexities involved in the country’s attempts to meet the designated Goals. In the final paper that students are required to submit upon returning from the immersion experience, students provide a summary of their chosen SDG and the information they collected during the trip. Students are also required to provide their own personal recommendations about what they feel the country must do to continue to progress toward meeting the benchmarks for the SDG.

The immersion experience is multifaceted. Housing and evening meals are provided at a local seminary in Lusaka, the capital city of Zambia, which provides the students with an authentic perspective of living arrangements and food. The seminary students and their families live on the seminary grounds, which gives the nursing students opportunities to interact with Zambians. Each weekday is a clinical day for the students. A rotation schedule provides opportunities to visit a children’s hospital, a government sponsored clinic, and a center where programs are offered for special needs children and their mothers. The students also visit elementary schools in the area where they provide health teaching and conduct vision screening. An additional day is spent at a rural health clinic where students spend time observing in areas for HIV medication distribution and infant immunizations. The various settings provide the nursing students with multiple opportunities to observe patient care in facilities where supplies are limited, to witness the vast numbers of people who are affected by HIV, and to see the challenges that are created by extreme poverty. In contrast to these seemingly difficult situations, the people that the students meet are resourceful, creative, happy, and content.

Outcomes/Results: The Global Health class and Zambian healthcare immersion experience provide the nursing students at this Midwest College with a unique opportunity to observe healthcare and life issues in a resource-poor country. While the nursing students can never fully gain an emic view of Zambian culture, this experience does provide a glimpse into life in this developing country. The trip has yielded life-changing experiences for students as evidenced by qualitative data that is collected during daily debriefings during the immersion experience and a final paper after the trip. Major themes that have immerged from this data include “being content with so little”, “feeling humbled”, “finding ways to be resourceful”, and “needing to adapt how we teach”. Exit interviews with graduating students reveal that the Zambia trip continues to be a significant highlight of the students’ learning.

Future Recommendations/Conclusion: While data gathered about the trip is always very positive in the short-term, there is a lack of information regarding the long-term impact of the experience on the students’ nursing careers. Future research needs to be conducted to determine how students use information from the course and how the insight gained from the immersion experience is applied in their professional nursing careers.