During the summer of 2017 two faculty members and 15 nursing and non-nursing students engaged in an inaugural three-week health promotion in Ghana course. The course incorporated primary health care focused on organizing health services around the needs and expectations of Ghanaians living in rural communities (World Health Organization, 2014). To promote transformational learning (Mezirow, 1991), semi-structured reflective writing assignments were integrated throughout the course.
Purpose: The purpose of this presentation is to describe the findings of a qualitative analysis of students’ final reflective writing assignment that was intended to help students understand themselves in connection with the Ghanaians in their shared practice experiences.
Methods: A phenomenological approach was used to explain what the students thought of their shared experiences (Kasdovasili & Theofilou, 2016). Data were collected in the form of student participants' final reflective writing assignment that was guided by the following cue questions:
- How did this trip measure up to your expectations?
- What did the trip mean to you?
- How did the trip change you?
- Would you recommend this trip to someone else?
- What suggestions do you have for someone who may want to participate in a return trip in the future?
Data were analyzed for evidence of emerging themes and supportive quotations validated the themes.
Results: The following eight themes with supportive quotations emerged:
- Life-changing
I was not expecting to have changed and become someone completely new…
This experience was a life-changing event for me because of the knowledge I gained. I was expecting to impact someone but what I never expected was to be impacted and influenced from this country and its people.
2. Dispelling stereotypes
Although I have never thought I was subject to believing stereotypes, I noticed when arriving I was nervous and felt unsafe because I was the minority. This really made me reevaluate myself and my preconceived notion of minority populations. By the end I was able to notice a big change in my personal perception as the minority and was much more comfortable in my surrounding, often.... not even noticing that I was the only Caucasian in the hotel lobby.
3. Emotionally binding relationships
I was expecting to just tour around the place, take pictures and work at the hospital. I never expected to be inspired. I never expected to make new relationships with friends and families.
This experience has meant so much more to me than I ever thought possible. I never dreamed that I would develop the relationships that I did or be so affected by the people that I met.
4. Vulnerability
The little kids … were vulnerable. One of the babies [at the orphanage] I was taking care of seemed very fearful and sad ….she looked so innocent, pure and she was being raised without her actual parents’ love
Numerous times we saw young girls walking the streets trying to sell items they carefully balanced on their heads ...to continue their education in hopes of attending college and acquiring a good job.
5. Self-awareness
I feel more grateful for the things I have… even for some of things I don’t have.
I have become humble.
I have learned to be less selfish.
6. Influence of Christianity
The people in Bompata taught me how to find joy, not in material items, but in things of the kingdom. The ladies who cooked for us especially exemplified Christ. They spent all day cooking, sewing and serving.
Going on this trip broadened my understanding of loving my neighbor as myself and made me more aware of all that still needs to be done for the impoverished around the world.
7. Being back home
Growing up in Nepal, I went through the same living conditions, the same day to day (sic) life, I felt like I was back home.
8. Healthcare access
In the outpatient clinic the physician assistant referred a woman with a breast infection to a hospital… but she did not have money to get the treatment she needed. This is when I realized how privileged I am to live in the U.S... better healthcare and benefits.
Implications: The findings suggest that this three-week study abroad experiential learning course facilitated the transformational learning of undergraduate nursing students engaging in health promotion activities in rural Ghana. Reflective writing guided by cue questions was an effective strategy whereby students demonstrated transformational learning and global health competencies (Clark, Raffray, Hendricks, & Gagnon, 2016) expected of baccalaureate graduates. In fact, students who participated in a three-week Health Promotion in Ghana course that combined hands-on experience, reflective writing, home visits and opportunities to live and work in the community deemed the experience "life-changing."
Conclusions: As undergraduate nursing programs increasingly use international immersion trips to facilitate global health leadership, faculty are challenged to develop evidence based teaching strategies to foster development of core competencies and transformational learning. Future research is indicated to determine if the effects are sustained.