Over the past two decades, there has been a significant increase in the number of nursing global health programs at both the undergraduate and graduate levels. This growth reflects greater student awareness and interest in global issues; a demand for educational opportunities to meet this interest; heightened public awareness of the global health agenda; and expansion of public and private funding for international health initiatives (Merson & Page, 2009). Edmonds (2010) studied nursing students abroad and found the programs to have strong implications for nursing education, practice and research. The benefits include learning to adapt in an unfamiliar environment, an increase in personal growth and an increased awareness of cultural diversity. Nurse educators have a responsibility to ensure that future generations are prepared to assume their roles as global citizens to address emerging global health challenges (Ballestas & Roller, 2013). Additionally, Nurse educators and working professionals have identified several domains for Global Health Competency, and key among those are Capacity Strengthening, Teamwork/Collaboration & Communication, as well as Professional Practice (Wilson, et al., 2014), which often is used to inform curriculum and program design for such programs.
As part of a shared commitment to enhance local and global health and education outcomes, a university and local hospital began collaborating in 2012 to develop a unique academic-service partnership in which experienced nurses serve as clinical instructors to student nurses during an international public health rotation. The university, in support of its International Strategic Plan, identified this as a priority partnership for the professional practice development of its students, while the local hospital recognized the value in providing continuing professional development and training in an intercultural setting for its employees while improving culturally-congruent patient care. In the development stages of this partnership, the leaders of both organizations discovered a shared vision for global outreach and impact. The purpose of this partnership was to enhance awareness of global health priorities and advance World Health Organization goals to improve equity in health, reduce health risks, promote healthy lifestyles and settings, and respond to the underlying determinants of health by integrating nursing students, faculty, and working professionals in a team-based clinical setting in Public Health while abroad. This presentation will provide an actionable framework for an effective academic-service partnership to inspire and engage nurses – from students, to faculty, and working professionals - in global health priorities.
Methods
Academic-service partnerships are strategic relationships between educational and clinical practice settings that are established to advance their mutual interests related to practice, education, and research (Beal, 2012). Strategies for successful academic-service partnership include formal and regular meetings between university and hospital leadership (Dobalian et al., 2014). This has facilitated open communication between the university and the hospital and led to the identification of agreed upon mutual interest and common goals.
In this unique academic-service agreement, expert clinical nurses are paid by the hospital to travel abroad and serve as clinical instructors. In return, the university supports the instructors’ travel and hotel accommodations, and also provides training on site-specific public health issues, culture, team-building and intercultural communication prior to departure. Participants have provided care and student supervision in various international settings including: Panama, Costa Rica, South Korea, Argentina, and Spain for two weeks during the regular school term. The university partner sites abroad do not change their annual rotation cycle year-over-year due to the desire to have a sustainable impact with long-term partners and locations. Educators are tasked with not only developing study abroad programs but must work to sustain and improve them as well (Johanson, 2016). 40 clinical hours are earned abroad and applied towards required clinical hours in public health nursing. This program offers participating students and experienced nurses an unparalleled opportunity to work hands-on with patients in an international setting while learning to navigate through a different medical, legal, political system. Participants are often exposed to medically underserved communities where they are able to assess the health of individuals, families and populations while exploring the role of community-oriented nursing care. Participants experience another culture while making a real difference in the lives of vulnerable populations around the world. Clinical work undertaken during the public health program abroad depends on the needs of the local community and has included: home visits, community health assessments, health screenings, and immunization projects. Additionally, all participants share academic and cultural activities while on program in a team-based working atmosphere. Nurses from the local hospital provide professional advice and working narratives on topics related to the curriculum, and serve as leaders and mentors to students. Faculty are also able to share and inspire students and nurses alike with their engagement in the academic and clinical settings, while the students also learn from the model of team-based nursing across the entire course of the experience. Upon return, nurses from the local hospital provide critical reflections to summarize the impact that the experience has had upon their professional journey, while students and faculty provide a similar critical reflection in addition to the tasks and assignments included in the bespoke Public Health coursework while abroad.
Results
Over the past three years, over 200 students and 25 clinical nurses have traveled to 5 different countries. This program is meeting its goal to train transformational leaders who are prepared to address disparities and inequities in health care delivery. Participants gain a deeper understanding of the impact of cultural and socioeconomic differences on healthcare and describe a new found awareness and passion for healthcare issues that extends beyond the walls of the hospital and the boundaries of our local community. In addition, this powerful shared experience has resulted in lasting and meaningful relationships among international peers and faculty. One of the unanticipated results of the program has been that several of the experienced nurses have reported that this program ignited a passion for teaching which has inspired them to return to school and pursue higher education. Two are completing their masters’ programs next year and two have applied to doctoral programs.
This model of academic-service partnership can be adapted and applied to collaborations between universities and health care organizations around the world to drastically increase the number of students and nurses engaged in global health experiences.