Influence of International Service Learning on the Development of Cultural Competence in Undergraduate Nursing Students

Becoming culturally competent is a worthy goal for nurses and health care professionals to work more effectively with patients in our increasingly diversified country. However, research reveals that many nurses and nursing students don’t feel confident in dealing with diversified patient populations due to their own lack of training and experience.

Cultural competence training has become necessary in undergraduate nursing programs to meet changing demographics in the U.S., meet mandates required by accrediting boards and improve patient safety and satisfaction. Such training may improve clinical outcomes when the patient receives appropriate care that meets their needs.      

In the era of evidence based practice, all clinical practice including teaching strategies requires current research to validate practices. The effectiveness of the variety of teaching methods being used to teach cultural competence to nursing students should be evaluated with evidence based research. Multiple curricular approaches are being used to teach cultural competence to nursing students in the United States in accordance with accrediting board standards.  Various strategies with the most favorable results include the use of purposefully planned clinical experiences in diverse settings, using ethnically diverse standardized patients and international service learning experiences.  

One effective method of gaining knowledge, skills and experience with different cultures is through an international immersion experience with training in language, culture and community nursing.  A review of the literature reveals that the earliest studies using international immersion experiences for nursing students began in 1998 using grounded theories as an intervention to teach cultural competence skills. Results concluded that the international experiences were statistically significant to be effective in increasing confidence and awareness in working with culturally diverse patients.

Research that will be presented reveals that nurses and nursing students who participate in an international service learning experience, even for as little as two weeks, have increased self-confidence in working with patients of a different cultural other than their own. Three mixed-methods studies were completed for nursing student groups who served two weeks in Belize, Peru and Colombia. The groups were compared to a control group of nursing students who served clinically in their own inherently diverse community for the same time. Quantitative data analysis showed that the intervention and control groups all improved in cultural awareness and sensitivity, however the positive qualitative self-reflections of the nursing students who served internationally far exceeded the control group who worked in their own local community.

Empirical evidence in using international service learning as a teaching and learning strategy is available for both students and nurse educators to consider in gaining confidence, awareness, sensitivity and skills to become culturally competent. Such conclusions are valuable for nursing faculty to consider when planning curricula.