Nursing requires culturally competent practitioners. It is the responsibility of faculty to assist students to achieve this goal. Study abroad programs are recognized as an effective method for increasing cultural competence. However, these experiences have primarily been evaluated using qualitative measures and focused on short term outcomes, those immediately following the experience. This study focused on this gap by also including a quantitative measure of cultural competence and assessing the effects of the study abroad experience with both measures before, within two weeks after the trip, and again 3 months later.
This study assessed the cultural competence and perceptions of the study abroad experience at three points in time to determine (1) outcomes of the program, (2) how sustained those findings were and (3) to identify experiences or factors that influenced the development of cultural competence in undergraduate nursing students.
Methods:
Forty nursing students from one northeastern university in the United States attended study abroad programs in 2014 and 2015 that included clinical learning. Each student travelled to either the Philippines, Costa Rica, Ecuador, or Italy for about a week and were asked to participate after securing IRB approval. Using a repeated-measures, exploratory, mixed methods design, this study evaluated cultural competence using the Inventory to Assess the Process of Cultural Competence-Revised (IAPCC-R) (Campinha-Bacote, 1999) and student perceptions of those experiences with a reflective questionnaire at three points in time, before the trip, within two weeks after the trip and three months later.
Results:
Prior to the trip, most participants scored at the “culturally aware” level and increased to “culturally competent” within two weeks of the trip. A dependent samples t test identified this change as a significant improvement. Students remained “culturally competent” three months after the trip. Content analyses of multiple student reflection assignments indicated that the major factors influencing students’ experiences were related to cultural immersion, role relationships, and challenges encountered. Students from all trips reported their experience as very positive. Some students were “upset by the poverty” especially “the children following us and asking for money.” Three months after the study abroad experience, students typically reported positive memories about patients and their fellow students. “I think back to the poor individuals we helped in clinics and their smiles. Think I should have done more….”
Conclusion:
Nursing students increased their cultural competence after study abroad, immersion trips and this was sustained three months later. Students reported personal growth stemming from this experience. Perhaps the inclusion of a seminar either before or during the trip may help prepare students for some of their experiences and serve as a supportive avenue for discussing those experiences. Additionally, more students need to be encouraged to participate in these evaluations so that comparisons between different ethnic groups can be examined at each point in time with adequate power.