Cambio de Colores 2003, Kansas City

Collaborative Learning Across Borders: Partnering Students, Faculty, and Community
Alice Kuehn, Associate Professor, Sinclair School of Nursing, University of Missouri-Columbia

PROJECT DESCRIPTION

Background

Professional nurses are challenged by the increasing complexity of their own health care delivery systems and by the growing inter-connectivity of these health care systems worldwide. The role and scope of nursing practice within each country are often unclear, resulting in underutilization of nurses or inappropriate role assumptions by nurses with differing levels of education and/or experience (Rafferty, 2002; O’Brien-Pallas & Baumann, 1992; Styles, 1986). Nurse roles are often unclear and ill defined. Consequently they are often misunderstood by nurses from other countries, despite the increasing calls for practice across boundaries in times of disaster, during international travel and due to immigration and relocation. (Nájera, 1996). Nurse theorist Dorothea Orem (1995) noted that nurses must be accountable for examining the legitimacy of the role within the context of each practice situation and setting. This mandate is even more critical in relation to a nurse’s assumption of roles within another country (Trossman, 2001).

The increasing diversification of patient populations demands a workforce prepared to deliver culturally competent health care. This impacts the nursing workload. Nurses need to be prepared to work with this changing diverse population in all three countries. Nurses in all three countries value the opportunity to learn about the cultural diversity, health care resources and health care technology and work opportunities in the neighboring countries of North America in order to better serve their patients.

Racial and ethnic disparities in health care access and utilization exist in our countries, due often to a lack of cultural awareness and competency on the part of "mainstream” nurse providers (Clinton, 1996). Studies have addressed a number of components of "culturally competent care" such as culture, race, gender, sexual orientation, and /or socioeconomic issues (Meleis, Eisenberg, Koerner and Stern, 1995). The nurse who is culturally competent is not only aware of differences (cultural awareness) but has developed the ability to intervene appropriately and effectively. Cultural competence therefore requires more than simply acquiring knowledge about another ethnic/ cultural group, rather it is a combination of knowledge, attitudes and skills which enables the nurse to translate cultural awareness into the reality of culturally competent clinical practice, achieved by participation in three interacting components of a cross-cultural encounter: subjective, objective and contextual (Lipson & Steiger, 1996). This student-centered North American professional nursing project will focus specifically on how these issues relate to the role and scope of practice of the professional nurse within each country.

Benefits

Students will be more aware of issues involved in delivering culturally competent health care. Their ability to secure employment opportunities in all three North American countries will increase. Participating institutions will benefit from the variety of valuable experiences that come out of international cooperation in higher education. This project will serve as a template for adding a unique North American perspective to institutions of higher education in nursing.

Strengths of each partner and country

Each partner school is committed to facilitating student exchanges and making necessary arrangements for study at home and/or abroad to fulfill course work requirements. Learning will be enhanced by the use of distance communications technology. The University of Missouri and Iowa Schools of Nursing have considerable expertise and technical support for such endeavours. The partnering schools in Mexico and Canada also utilize technology for communication and education, and can support distance communications projects. Students in each partner institution have access to supplemental travel funds through the universities, the Centers for International Studies, and/or the Schools of Nursing. In addition, advisory committees of local nurses and citizens are being established at each partner institution to assist project faculty and staff in recruiting students and designing appropriate student experiences .

1. Canada: Dalhousie University & University of Prince Edward Island

The role of the nurse within Canada’s publicly funded health care system will be highlighted, focusing on Primary Health Care (health promotion/illness prevention, participation, accessibility, appropriate technology, intersectoral cooperation). Dalhousie University will facilitate cross-cultural learning experiences for visiting students with families in both provinces. Undergraduate students at Dalhousie have recently established the Student International Nursing Initiative (SINI), and share interests in international clinical placements as part of their academic work. The university is committed to international development activities, and promotes student mobility through the establishment of student exchange agreements. The University of Prince Edward Island has a strong language department and participates in exchange programs with the United States and Europe.

2. Mexico: Universidad Autonoma de San Luis Potosi, Universidad Autonoma de Nuevo Leon, and Benemerita Universidad Autonoma de Puebla.

All universities have strong commitments to enhancing the diversity of their students, with international exchange programs available. The Universidad Autonoma de Nuevo Leon, for example, has an exchange program in social work with the University of Texas at Austin. The Universidad Autonoma de San Luis Potosi participates actively in the America Latina Formacion Academica of the European community. Student involvement in international initiatives and programs is encouraged at both universities.

3. United States of America: University of Missouri-Columbia and University of Iowa.

The MU School of Nursing is dedicated to increasing student exchange opportunities and is supported by a MU Strategic Plan calling for additional student international experience. The MU International Center Study Abroad Report of 2000-2001 noted that students took part in 109 programs in 30 countries, including Mexico. However, the School of Nursing did not participate in the Mexican program, and no exchange program exists with Canada. This project would greatly enrich the study abroad programs for nursing students. The University of Iowa has well-established international exchange programs. They desire to expand programs to Canada and Mexico. Faculties of both programs are experienced in the study of nurse role, information technology, health care systems, and the impact of changing demographics in their states. Two MU faculty participated in a cultural immersion course in Cuernavaca, Mexico in June 2002 and Dr. Kuehn has visited Nova Scotia frequently over the past two years in preparation for this project.

Course Development

The partner schools are in the process of completing the shared core course. It will be offered to all nursing students in combination with unique local and/or international clinical opportunities. The course Cultural Expeditions in Nursing, will be offered simultaneously at all six sites with web-enhanced ongoing discussions among faculty and students (Course numbers will be unique for each academic institution. For the University of Missouri- Columbia it is N302. ) The partner schools are working on a final document of agreement which finalizes issues of language development, academic credit, and exchange opportunities and are working to create a learning environment that will accommodate all students who wish to participate.

Language Development

The Spanish language departments of both the United States and Canadian partner schools recommend that students enroll in the beginning and intermediate Spanish courses. In addition it is strongly recommended that tutoring be made available, focusing on the Mexican health care system and medical terminology. Students in Mexico have courses in beginning English. Their language development will be enhanced with participation in the N302 course.

Sustainability and Evaluation

The six partners are committed to the sustainability of the project. This will be achieved through ongoing institutional and faculty support for student exchanges and the establishment and ongoing delivery of the N302 Cultural Expeditions in Nursing course and web site (www.nursingfutures.org ). Project evaluation strategies will begin at the first annual meeting of consortium partners. An independent evaluation will be conducted. Students who have completed part of the program will be required to develop a mentoring program for new students intending to participate in the international exchanges.

International Exchanges

International exchanges for students from all three countries are planned for from two to four weeks. These experiences will include classroom lectures and seminars, fieldtrips and clinical opportunities. The objectives and the content of the cultural exchanges will be the same for all students. However, the syllabus will be delivered in a flexible timeframe, depending on the length of each student’s visit.

Summary

References

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Lipson, J.G. & Steiger, N.J. (1996). Self-care nursing in multi-cultural context. Thousand

Oaks, CA: Sage Publishing Company.

Meleis, A, Isenberg, M., Koerner, J., & Stern, P. (1995). Diversity, marginalization, and

culturally competent health care: Issues in knowledge development. Washington

DC: American Academy of Nursing.

Najera, R.M., & Moriel, L. (1996). State of graduate nursing education in Mexico. New

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O’Brien-Pallas, L. & Baumann, A. (1992). Quality of nursing worklife issues: A unifying

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Rafferty, H. (Winter, 2002). In our own backyard. Minority Nurse, 54-60.

Styles, M.M. (1986). Report on the Regulation of Nursing. Geneva, Switzerland:

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Trossman, S. (2002). The global reach of the nursing shortage. American Journal of

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