A new partnership between a School of Nursing in the United States and a non-profit charitable organization (NPO) serving patients in Honduras resulted in benefits to students, the School, the NPO, and the patients served by the NPO. Despite the globalization of healthcare, pressure for a culturally competent workforce, and the noted benefits of study abroad experiences, no published examples of academic nursing and NPO partnerships for graduate nursing students were found in the literature. One example of a partnership between a School of Nursing in the United States and four non-government agencies in Guatemala was found (Goodman, 2016). Benefits of study abroad experiences have been identified in the literature and include: deeper understanding of nursing practice in another country, cultural competence development, professional and personal growth, and a global view of health (Kent-Wilkinson, Leurer, Luimes, Ferguson, & Murray, 2015). A systematic thematic synthesis of the literature focusing on undergraduate Australian nursing students and international clinical placements identified similar benefits (Browne, C. A., Fetherston, C. M., & Medigovich, K., 2015). However, barriers to study abroad participation from nursing students include: cost of study abroad, relationship responsibilities, work responsibilities, language barriers, safety concerns (Kent-Wilkinson, Leurer, Luimes, Ferguson, & Murray, 2015), and curricular demands (Napolitano & Duhamel, 2017). It is possible that the barriers to participation have delayed development of international clinical experiences for graduate nursing students. In addition to lack of published data on academic nursing and NPO partnerships, there is an overall paucity of evidence related to study abroad experiences for nursing students, particularly for graduate nursing students.
Process
A faculty member leveraged a personal volunteer opportunity into a new mutually beneficial partnership between the School of Nursing and an established NPO. The faculty member volunteered to be part of a medical mission team to Honduras. The faculty member recognized the potential learning opportunities for graduate nurse practitioner students and received approval from the Dean, the Office of Global Engagement, and the President of the NPO to proceed with development of the partnership.
One student traveled with the faculty member the first year, and the teaching-learning environment was evaluated. Based on positive experience and feedback from the faculty and the student, a formal course was developed, and a cohort of six students participated the following year.
Barriers in the Process
Barriers had to be overcome in order to successfully navigate the partnership. The NPO has a very specific goal, which is to provide health care in remote areas of Honduras. Due to capacity limits on the facilities used by the NPO team members, the balance of skills on a team must be carefully monitored. This means there is a limit to the number of students that can be on a given team. Within the School of Nursing, the experience had to be approved for clinical practicum. Additionally, the course had to go through the process of development, curriculum committee review, and finally approval at all levels in the University. The faculty member had to work closely with the Office of Global Engagement for the University to ensure all requirements were met and followed.
Key Factors to Success
Several factors were key to success of this partnership. The vision and mission of the School of Nursing aligned with the mission of the NPO. This particular NPO has been engaged in patient care in a specific geographic region of Honduras for over three decades. The leadership of the NPO is able to provide significant support to participants. The NPO has worked with members of the local community to identify needs and has hired Honduran staff and a Honduran Director of Operations to work with each team. Each team typically consists of physicians and/or nurse practitioners, nurses, dentists, pharmacists, optometrists, lab techs, and other volunteers.
In order to address both the financial and time costs of participation, the NPO sends teams for seven to ten days at a time. To ensure continuity of care, the NPO schedule twenty teams a year. The short time commitment for individual team members overcomes one of the noted barriers to nursing student participation in international clinical placements (Kent-Wilkinson, Leurer, Luimes, Ferguson, & Murray, 2015), without compromising patient continuity and access to care. The ability to meet both team member needs of short time commitment and patient needs of regular access to care are unique features to this partnership.
Outcomes
The School of Nursing benefited by being able to offer an international experience to graduate nursing students, which appears to be unique in the duration of the trip and in the targeting of graduate nursing students. The experience provided each of the seven nurse practitioner students forty clinical practicum hours, which relieved some of the burden for clinical placement in the United States.
Students benefited from the experience by being part of an international and inter-professional team. Students were able to participate in care, similarly to clinical rotations in the United States. The patients’ health issues included chronic diseases and rare and tropical diseases across the lifespan. Students also gained experience in providing care in limited-resource areas. Student learning about the Honduran culture and social determinants of health was evident in their reflective journal entries and course evaluations.
The NPO benefited from this partnership by having a full team of health professionals. Based on student comments, there is potential that students as team members may lead to future participation after students become advanced practice professionals.
Patients in the host country benefited from the care provided. Each team cared for over 700 patients in less than seven days and dispensed over 2500 prescriptions. Many patients traveled hours or days to get to the clinics and would not have had access to healthcare if the teams had not been there.
Conclusion
Significant opportunities exist for real-world learning and patient care in mutually beneficial partnerships between academic nursing and NPOs. Studies are needed to determine the long-term benefits of short-term medical trip participation during graduate nursing programs. These studies should consider not only the outcomes to patients in the host country, but also longitudinal studies on outcomes for the new nurse practitioners’ patient population, the student perception of the educational program, and whether there is an influence on future participation in humanitarian work. There is a need for global health competencies to be defined and accepted across academic institutions related to all levels of nursing curriculum. Further investigation of academic and non-academic partnerships for clinical placements should also be explored so best practices can be developed.