According to Campinha-Bacote (2007), cultural competence is the ability to effectively work within the cultural context of a client. Cultural competence is developed through cultural awareness, encounters, knowledge acquisition, and skill attainment. Exposing students to other cultures increases their motivation to gain knowledge and skills. Although education abroad is an effective way to develop cultural competence (Zorn, Ponick, & Peck, 1995), few nursing students have the opportunity to study abroad while enrolled in nursing programs. Bringing international visitors to campus can help nursing faculty achieve curriculum goals related to cultural competence and expose students to individuals from different cultures, which reduces the expense, risk, and liabilities of foreign travel.
In 2007, a study abroad program to Guanajuato, Mexico, was developed by nursing faculty at the University of North Carolina at Charlotte (UNCC) to promote cultural competence, provide opportunities to observe and understand nursing in another culture, and examine differences in the U.S. and Mexican health care systems. Over several years, a close relationship developed between UNCC and the University of Guanajuato at Irapuato (UG) Schools of Nursing. However, only a limited number of students were able to take advantage of the study abroad experience. To provide meaningful cross-cultural opportunities for more students, the UNCC School of Nursing arranged for two faculty and two students from the UG School of Nursing to visit. The cost of the visit was shared between the two universities, and UNCC students planned and led aspects of the visit.
This two-way exchange created an opportunity to promote cross-cultural knowledge and awareness for a much larger number of students. Although study abroad has become widespread, exchanges that involve a reciprocal visit from a host university are less common. According to a literature review of study abroad programs (Kulbok, Mitchell, Glick, & Greiner, 2012), only two of the 23 programs reviewed reported a two-way exchange. Another article reported two-way exchanges that were limited to practicing nurses and nursing faculty (McAuliffe & Cohen, 2005). None of the two-way exchanges involved universities located in economically disadvantaged countries.
During their stay, the Mexican visitors presented a lecture about their community outreach programs to the UNCC community. They also participated in panel presentations in nursing courses and visited student clinical sites in hospitals and in the community. Shared visits by U.S. and Mexican nursing students to local nonprofit organizations, including social service agencies and free health care clinics, were used to introduce the issues faced by Mexican immigrants. During a visit to a hospice agency, the hospice staff discussed the challenges they faced in getting Latino families to participate in hospice programs. The Mexican visitors suggested that the term hospice may be perceived as a place where you leave your loved one to die alone. As a result, the hospice agency redeveloped their Spanish language marketing and educational materials.
The visit promoted dialogue regarding the needs of Latino patients and their families. The UNCC students were surprised to learn that many nursing concepts are universal: the UG students were well versed in the nursing process, nursing research, and evidence-based practice. One student noted, “though we seem worlds apart, there are more similarities than differences between our two schools.” Another UNCC student stated, “their students spend more clinical hours in community settings than we do. Partnering with a high-risk community is a really interesting idea.” Constructs of cultural competence were promoted through meaningful interactions between the U.S. and Mexican faculty and students. Learning objectives and outcomes for the exchange are shown in the Table.
Table: Learning Objectives and Outcomes for Two-Way Cultural Exchange
Traditionally, nursing students learn cultural competence by reading textbooks, participating in classroom lectures and discussions, and caring for diverse patients in clinical settings. Although travel abroad provides a unique cultural experience, few students are able to participate. A cost-effective visit by a small number of international nursing faculty and students offers a firsthand cultural experience to a larger number of students.
Maren J. Coffman, PhD, RN, CNE
Allison H. Burfield, RN, MSN, PhD
Jane Neese, PhD, RN
University of North Carolina at Charlotte
Maria Elena Ledesma-Delgado, PhD, RN
Maria Leticia Campos-Zermeño, MSN, RN
University of Guanajuato at Irapuato
- Campinha-Bacote, J. (2007). The process of cultural competence in the delivery of healthcare services: The journey continues (5th ed.). Cincinnati, OH: Transcultural C.A.R.E. Associates.
- Kulbok, P.A., Mitchell, E.M., Glick, D.F. & Greiner, D. (2012). International experiences in nursing education: A review of the literature. International Journal of Nursing Education Scholarship, 9(1), 1–21 doi:10.1515/1548-923X.2365 [CrossRef] .
- McAuliffe, M.S. & Cohen, M.Z. (2005). International nursing research and educational exchanges: A review of the literature. Nursing Outlook, 53, 21–25 doi:10.1016/j.outlook.2004.10.004 [CrossRef] .
- Zorn, C.R., Ponick, D.A. & Peck, S.D. (1995). An analysis of the impact of participation in an international study program on the cognitive development of senior baccalaureate nursing students. Journal of Nursing Education, 34, 67–70.
Learning Objectives and Outcomes for Two-Way Cultural Exchange
|Learning Objective||Construct of Cultural Competence||Outcome||Exemplar|
|Compare nursing education in the United States and Mexico.||Cultural knowledge: Nursing students understand similarities and differences in nursing education.||Students and faculty understand that nursing principles cross languages and cultures.||“I was fascinated to learn that nursing students in Mexico use nursing diagnosis the same way we do.”|
|Understand strategies for teaching and learning in nursing education in the United States and Mexico.||Cultural awareness: Students examine their own cultural beliefs regarding nursing education in other cultures.||Students and faculty are able to observe nursing education from different cultural perspectives.||“Though we seem worlds apart, there are more similarities than differences between our two schools.”|
|Describe clinical settings used in nursing education in the United States versus Mexico.||Cultural skill: Nursing students and faculty observe and understand nursing practice across cultures.||Students and faculty understand the importance of community-focused practice across different cultures.||“The Mexico students spend more clinical hours in community settings than we do in the [United States]. Partnering with a high risk community is a really interesting idea.”|
|Understand the social and political issues faced by Latino immigrants living in the United States.||Cultural encounters and cultural desire: Exposing students to other cultures improves their motivation to provide high quality nursing care.||Nursing students who are exposed to other cultures become culturally competent nurses.||“I now understand the challenges Mexican immigrants face. They make a lot of sacrifices to come to the [United States].”|