Globally networked learning: Deepening Canadian and Danish nursing students' understanding of nursing, culture and health☆,☆☆,☆☆☆
Introduction
Understanding how culture influences health and healthcare is a key learning outcomes in Bachelor of Science in Nursing (BScN) education programs in Canada and Denmark. As such, learning experiences that involve encounters with different cultures are important, as these support self-awareness and contribute to the knowledge and skills necessary to consider, and integrate cultural perspectives in healthcare (Chan et al., 2017). While studying abroad is a common and well-documented strategy that enhances intercultural abilities (Bohman and Borglin, 2014; Kokko, 2011; Philips et al., 2017), there are particular challenges to nursing students completing exchanges given that nursing education and practice are highly regulated. For instance, the stringent preparation and approval processes prior to students entering clinical placements, and language proficiency requirements can create barriers to nursing student exchanges. Furthermore, given the costs associated with studying abroad, this is not possible for every student. To overcome potential barriers to offering an intercultural learning experience abroad, the authors developed a strategy and assignment where students connected through internet-based applications, and engaged in an international learning experience without leaving home. The authors refer to this as Globally Networked Learning (GNL). The purpose of this paper is to describe the process used to create the GNL assignment and to report on student experiences and learning from using GNL and how GNL supported students to develop cultural awareness and a global understanding of health and nursing.
Section snippets
Background
Studies reporting how internationalization-at-home strategies can help build cultural perspectives have been sporadically presented in the literature and were helpful to build an evidence-base for GNL in clinical courses. The studies are grouped into two categories: those that support the use of social media for learning between countries; and those that support the use of social media to specifically develop nursing knowledge. Only studies affirming the use of social media as an intercultural
Description of the organization of the GNL project
Prior to embarking on the GNL project, the first two authors engaged in discussions to understand the ontology and epistemology underpinning the two BScN programs to ensure commensurability. Subsequently, the first two authors conducted a review of the Canadian and Danish curricula to locate a course where learning outcomes and stage of student development would support a GNL assignment. These were important steps to ensure that the assignment would be suitable for both groups of students. In
Methods
All students who completed the GNL project during the fall of 2017 and winter of 2018 were invited to participate in the research. Prior to participant recruitment for the study, approval was obtained from the Research Ethics Board (REB) of the Canadian School and from the Danish Data Authority for the Danish school. Data sharing followed the REB approved methods and the European General Data Protection Regulation. Informed consent was obtained from those who responded to the emailed invitation
Data analysis
The data analysis is based upon three sources of data: i) biographical information to describe the sample, ii) face to face interviews using semi-structured questions which lasted about 30 min, iii) assignment and reflective writing that were guided by a series of questions. The data sources were read and re-read, and the themes were discussed amongst the first two authors (A & B) until consensus was achieved. These themes were then validated with the last two authors (X & Y). The interviews
Sample
Fifteen participants (six Canadian and nine Danish students) out of the 24 students completing the GNL Assignment, agreed to join the study. The demographics are provided in Table 1. The Danish participants were slightly older than the Canadian students and most of the Danish students entered nursing directly from high school. All Canadian students had some prior postsecondary education and more international travel experiences than the Danish students, while three Danish students, but no
Findings
Three themes emerged from reading the transcripts and student assignments. Students detailed their experiences with GNL, how GNL helped them learn about culture, health care and the health system, and lastly, how GNL helped students understand the global reach of nursing. The similarities in how the 15 participants experienced GNL were striking and reinforced the confidence in our findings and conclusion. Table 2 illustrates how the themes emerged from the data.
Discussion
The learning and collegiality from participation in GNL was impactful for the students (and faculty) involved in the project. The assignments and interview transcripts indicate that the GNL project was successful and supported participants to achieve meaningful learning about nursing, culture, health systems and nursing practice. The participants also enjoyed the opportunity to work in a group to enhance their organizational and collaborative writing skills, and refine research utilization.
Conclusion
Participants benefitted from their experiences with the GNL assignment. GNL is an accessible and affordable strategy that provides an inter-cultural learning experience without the need to leave home. Working with students from another country assisted the participants to build a broader understanding of nursing as a global profession and raised awareness of how culture influences health and the health system. Learning about another health system also strengthened the participants'
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No funding.
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No conflict of interest.
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Approved by the Georgian College Research Ethics Board and Danish Data Authority.