The increasing global population of the United States means that nurses need to be able to provide appropriate care for patients and families from all areas of the world. Additionally, the increasing global changes in health have the potential to affect persons who reside anywhere in the world. MSN-NE students are registered nurses (RN) who have returned to graduate school via distance/online technology to learn how to become nurse educators. Upon graduation, our students are often employed as nurse educators in community colleges, universities, or as educators in hospitals or other community settings where they teach students, patients and families, or staff members. Having an increased global perspective will enable our students to be better prepared to teach these leaners.
Included within the 2011 American Association of Colleges of Nursing (AACN) “Essentials of Master’s Education in Nursing” document was the statement that an essential core outcome was to “Apply advanced knowledge of the effects of global environmental, individual and population characteristics to the design, implementation, and evaluation of care” (p.28). To meet this standard, one of the strategies in our NE courses was to assign students to complete the educational modules at the “Think Cultural Health” web page (Office of Minority Health, 2012). While this was helpful to our students, we felt that a different strategy that more closely aligned global perspectives with our NE course objectives was needed.
Identifying strategies to teach global nursing across all curricula is important (Wilson et al., 2012). Wilson et al. (2012) identified essential global health competencies for undergraduate nursing students and stated that more work was needed to clarify competencies at the graduate level. In a systematic review of studies of strategies to teach a global perspective, Gallagher and Polanin (2015) found only four of the 25 studies included graduate students. None of the studies were MSN students in an NE concentration in an online environment. The most common teaching strategies found by Gallagher and Polanin (2015) were lecture, simulation, role play, and immersion experiences. Dawson, Gakumo, Phillips and Wilson (2016) stated the most common teaching strategies were service learning, immersion courses, stand-alone and integrated courses, technology, or other partnerships. Strickland, Adamson, McInally, Titanen, and Metcalfe (2013) more fully described their teaching strategy for a pilot that included undergraduate and graduate students in the online environment as an alternative to an overseas immersion experience. Students were from two European countries and a university in the United States. The students collaborated online to compare the health, social perspectives, and nursing roles in other countries. The researchers found that the students were satisfied with the online platform and their learning increased. In the online platform, more students were able to engage with their international colleagues than through an immersion strategy.
The theoretical basis for the study is the theory of cultural care and sunrise model by Leininger (1995). We will report on phase I of the study and the lessons we learned. Some of the lessons learned included finding an easy to use virtual software platform and creating interview questions based on the theoretical framework and the NE course objectives. Nurses and nursing faculty from Nigeria, England, Finland, Canada, Philippines, and Puerto Rico were interviewed separately by the researchers and asked about their experiences as nursing faculty members, or if not faculty, a reflection from when they were nursing students in their native country. The following questions were asked:
- How is or was your undergraduate nursing curriculum organized and what clinical experiences do your students have or did you have?
- What do you think are the major health and socio-political factors that impact or impacted undergraduate nursing education in your native country?
- What do you foresee for the future in nursing education in your native country?
- How does one become a nursing faculty member or educator in your native country? Are there other roles for nurse educators, such as in hospitals or communities? Is there a particular degree or curriculum that faculty or nurse educators must have?
- Tell us about your class of undergraduate nursing students related to background, culture, etc.
- Tell us about the types of patients nursing students care for or should be prepared to care for upon graduation in your native country.
- How does or did the background of your classmates, students, or patients impact your teaching or learning? Has it changed? Do you foresee there will be changes and if so, how?
- How do you teach or did you learn about the culture of patients and their families?
- What are the ways that you evaluate students’ learning or that you were evaluated as a nursing student? Do you think this will change and if so, how?
- How do or was the effectiveness of your native nursing program assessed? Is or was this dictated by external and/or internal forces? Is there an accreditation agency or agencies for nursing education programs or universities in your native country?
We will include an overview of phase II in the poster session, which includes how testing of the strategy will be accomplished after Institutional Review Board approval. The research aims of this quasi-experimental study will be that MSN-NE concentration students in the treatment group will be able to better:
- Describe the health and socio-political factors that impact nursing education in other countries;
- Assess the impact of having multi-cultural learners in nursing courses;
- Explore the teaching and evaluation strategies used in nursing education in other countries; and
- Appreciate the changes in nursing education affected by globalization.
Phase II of the study will include treatment group and non-treatment groups in the online course entitled, Education Concepts, Theories, and Strategies in Nursing. We expect to have a total of 20-25 students in each of the treatment or non-treatment groups. Students will be randomly assigned to either treatment or non-treatment group, with 6-8 students in one of several small group discussions. Students will be asked to compare the experiences of educators from either viewing the interviews (treatment) or their readings (non-treatment) and discuss them.
Prior to implementation of the activity, the students will receive an anonymous online survey to rate their agreement with the following four statements below (1 Strongly Disagree to 5 Strongly Agree):
- I can describe the health and socio-political factors that impact nursing education in other countries.
- I can assess the impact of having multi-cultural learners in nursing courses.
- I know teaching and evaluation strategies used in nursing education in other countries.
- I appreciate the changes in nursing education affected by globalization.
After implementation of the treatment and non-treatment, students will be asked again to rate their agreement to the above statements and will also be asked the following open-ended questions in the online survey:
- What was the most surprising thing that you learned? (Please elaborate)
- Please fully describe how you see yourself using the information you learned as a nurse educator$
- Do you recommend the continuation of this activity?
(Choose from yes, no, undecided.) (Please explain your answer.)
4. What changes do you recommend in the activity? (Please explain as thoroughly as possible)
Descriptive statistical analysis will be performed comparing responses of the treatment group to the non-treatment group to each of the individual questions using measures of central tendency. T-tests will be conducted to analyze for differences in the ratings of students between the treatment and non-treatment groups after the implementation of the activities and between the pre and post surveys. Content analysis will be used for the open-ended responses.
This is a study of an online strategy to meet the guidelines of the AACN for graduate students and to increase the global perspectives of MSN-NE students. It involves 1) phase I - the creation of virtual video-recorded interviews with nurses and nursing faculty members from other countries, and 2) phase II - the testing of interviews (treatment) to readings (non-treatment). Rather than the ideal, but unrealistic ability to provide an immersion experience for all NE students, we are confident that this online strategy, in which all NE students can participate, will demonstrate merit in increasing their global perspectives.