This is the nursing assignment , the unit is inquiry for evidence best practice. we are provided with a qualitative research article and the assignment is to critical appraisal of a given research article
The impact of short term clinical placement in a developing country on nursing students_ A qualitative descriptive study Contents lists available at ScienceDirect Nurse Education Today journal homepage: www.elsevier.com/locate/nedt The impact of short term clinical placement in a developing country on nursing students: A qualitative descriptive study Ingeborg Ulvund⁎, Elin Mordal Molde University College, Specialized University in Logistics, Bj. Bjørnsonsvei 100B, 6410 Molde, Norway A R T I C L E I N F O Keywords: Cultural competency International clinical placement Nursing students Developing country A B S T R A C T Background: Offering nursing students' international clinical placement during the educational program is one response to meet the need of cultural competence among nurses. This paper provides insight into the impact of clinical placement, in a developing country, on third year nursing students. In the study we investigated how short term international clinical placement impacted Norwegian nursing students' development of cultural competency. Design and Methods: In this study we utilised a qualitative descriptive design and used individual interviews with eighteen Norwegian nursing students who had all participated in an international clinical placement. The data were analysed using the principles of systematic text condensation. Results: In spite the international clinical placement only was four weeks, the findings suggested that real life experience culturally awakened the students and forced an ongoing process developing cultural competence. However, it is important to give students time to reflection. Conclusions: Although increased cultural awareness and a growing cultural competence was identified by the students undertaking international clinical placement, further research is required. It is important to investigate the best methods to support the students' reflection such that the experiences lead to learning. 1. Introduction Immigration and the growth of multicultural societies highlight the need for cultural competence in healthcare. The lack of this competence may cause deficits in practice and hinder nurses from providing quality nursing. One strategy for developing cultural competence in nursing is to offer nursing students international clinical placements (ICPs) (Browne et al., 2015; Kokko, 2011; Long, 2014; Taylor et al., 2011). Different models of ICPs have been used within undergraduate nursing programs, and there is a need for research on international experiences in nurse education (Alpers and Hanssen, 2014; Kokko, 2011; Taylor et al., 2011). Cultural competence is a set of congruent behaviours, attitudes and policies that enable professionals to work effectively in cross-cultural situations. A variety of theoretical models define and explain how professionals develop cultural competence (Campinha-Bacote, 2002; Leininger, 2002; Taylor et al., 2011). After analysing the data, we decided to base the current study on Papadopoulus, Tilki and Taylor's Model for Developing Cultural Competence (PTT model) (Papadopoulos and Lees, 2002). In the PTT model cultural competence is acknowledged as an ongoing process and includes four stages. The first stage, cultural awareness, is an awareness of one's own cultural background and cultural identity and begins with an examination of one's own culture, personal value base and beliefs. By becoming aware of one's own norms and values, one becomes aware of preconceived attitudes and pre- judices. Cultural awareness must be supplemented with the second stage, cultural knowledge. Meaningful contact with people from different ethnic groups and theoretical studies can enhance one's knowledge of the health beliefs and behaviours of different groups and provide a better understanding of the problems faced by different cultural groups. The third stage, cultural sensitivity, enhances the development of interpersonal skills with regard to working with people from different cultures. Important elements are empathy, solidarity, trust, acceptance and respect. Clients must be considered true partners, if nurses are culturally sensitive. The fourth stage, cultural competence, represents the synthesis of the preceding stages. This stage requires the application of previously developed awareness, knowledge, sensitivity and culturally appropriate caring skills (Papadopoulos, 2006). Culturally competent nurses must develop both culture-specific and culture-generic compe- tence. Culture-specific competence is defined as the knowledge and skills related to a specific ethnic group that enables the nurse to http://dx.doi.org/10.1016/j.nedt.2017.05.013 Received 3 June 2016; Received in revised form 20 April 2017; Accepted 15 May 2017 ⁎ Corresponding author. E-mail addresses: Ingeborg.Ulvund@himolde.no (I. Ulvund), Elin.Mordal@himolde.no (E. Mordal). Nurse Education Today 55 (2017) 96–100 0260-6917/ © 2017 Elsevier Ltd. All rights reserved. MARK http://www.sciencedirect.com/science/journal/02606917 http://www.elsevier.com/locate/nedt http://dx.doi.org/10.1016/j.nedt.2017.05.013 http://dx.doi.org/10.1016/j.nedt.2017.05.013 mailto:Ingeborg.Ulvund@himolde.no mailto:Elin.Mordal@himolde.no http://dx.doi.org/10.1016/j.nedt.2017.05.013 http://crossmark.crossref.org/dialog/?doi=10.1016/j.nedt.2017.05.013&domain=pdf understand the values and cultural prescriptions within that specific culture. Culture-generic competence is defined as the knowledge and skills that are applicable across ethnic groups (Gerrish and Papadopoulos, 1999). The literature primarily describes ICP as a beneficial teaching and learning method for developing cultural competency in nurses. As shown in empirical studies, international experiences increase the students' understanding of the complex dynamics of culture and nursing in foreign cultures (Bohman and Borglin, 2014, Kohlbry, 2016, Reid- Searl et al., 2011). Students have evaluated the impact of ICPs on their personal and professional development beyond what they might have learned in a theoretical way (Bohman and Borglin, 2014; Edgecombe et al., 2013; Kokko, 2011). A systematic thematic synthesis of the literature identified five primary impacts of ICPs within nursing: 1) developing cultural awareness and competence, 2) providing a global perspective on health care, 3) growing personally, 4) moving theory into practice and 5) successfully meeting challenges (Browne et al., 2015). These findings are consistent with other studies (Kokko, 2011; Long, 2014; Taylor et al., 2011). There are risks associated with ICPs (Egenes, 2012, Hovland and Johannessen, 2015, Morgan, 2012, Reid- Searl et al., 2011). Several studies emphasize the importance of ensuring that differences do not lead to ethnocentric attitudes (Hovland and Johannessen, 2015; Reid-Searl et al., 2011). The litera- ture proposes guided and shared reflection of the experience in a foreign country to avoid ethnocentric attitudes (Kohlbry, 2016; Kokko, 2011). According to the literature, it is a need for research on the methods nursing students use to develop cultural competency and the benefits and challenges involved in their participation in ICPs (Kokko, 2011; Browne et al., 2015). The objectives of the current study was to investigate how short-term international clinical placement impacted Norwegian nursing students' development of cultural competency. 2. Methods This study utilised a qualitative descriptive design and was based on eighteen individual interviews of nursing students who have all participated in an ICP in Ethiopia (Malterud, 2001, 2011). Utilised a qualitative descriptive design, provided us with the ability to analyse complex textual descriptions of how an experience is understood from the perspectives of the participants and we used a semi-structured interview guide to explore the nursing students' experiences and the meaning they attributed to the ICP (Malterud, 2001, 2012; Patton, 2015). 2.1. Setting Ethiopia is one of the poorest countries in the world; more than 80% of the population lives in rural areas. According to the UN, 30% of Ethiopia's population lives below the national poverty line, 35% are malnourished, and the infant mortality rate is 64 per 1,000 live births. Life expectancy is 60 years, and 39% of the population is illiterate (Globalis, 2015). Once a year, a group of six students from the Norwegian University College Bachelor's Programme in Nursing spend four weeks in an ICP in Ethiopia during their final semester. Prior to travel, the students complete their theoretical studies in reproductive health, paediatrics, global health challenges, and knowledge of the culture, population and health systems in Ethiopia. The clinical placement is organized to provide a wide range of cultural encounters for the students and includes Ethiopian students and staff, patients and their relatives, and women and children living in rural areas. During the first three weeks, the students' are placed in clinics in a hospital, in a maternity ward and in a children's ward. The School of Nursing and Midwifery at the university is responsible for the programme and classes. During the final week, a voluntary organization provides students an opportunity to learn about the everyday life and the common health challenges of women and children in underserved rural areas. Supervised by nurses from the voluntary organization, the students participate in a health promotion programme targeted to those women. English is spoken at the hospitals and universities in Ethiopia. Both Ethiopian nurses and Norwegian students speak English as a second language. In Ethiopia, there are many different languages, and many inhabitants do not speak either English or the official language Amharic. Nurses at the hospital translate for the nursing students. When students participate in health programmes in rural areas, they use interpreters to communicate with the local women and children. 2.2. Participants The target population of this study was undergraduate nursing students who experienced four weeks of clinical placement in Ethiopia. All students who participated in the exchange programme from 2012 to 2014 received a letter of invitation that explained the study and a consent form. All 18 students who were enrolled in this ICP participated in this study and were interviewed 3 months after the ICP. 2.3. Data Collection The first author conducted semi-structured interviews with the students. The interview occurred three months after the students arrived home. During the interview, the informants were encouraged to reflect on their learning outcomes and experiences during the ICP. The semi-structured interview guide encouraged the students to speak openly regarding their experiences. The interviewers' intention was to elicit the informants' own opinions and explanations as much as possible and then ask follow-up questions. The interviews lasted 25–60 min and were digitally recorded. 2.4. Data Analysis All interviews were transcribed verbatim. The analysis followed the principles of the four phases of Malterud's systematic text condensation (Malterud, 2001, 2011, 2012). In the first step, we obtained an overall impression of the data. By listening to audio files and reading the text, we extracted some preliminary themes from the data that could illuminate the research question. In the second step the coding started. Coding includes identifying, classifying, and sorting themes in meaning units related to the previously negotiated themes and implies decon- textualization and temporarily removing parts of the text. The third step implies a systematic abstraction of meaning. We reduced the data to a decontextualized selection of meaning units sorted across indivi- dual participants. The fourth and final step represents the “contextua- lization” and synthesis. Follow Malterud it includes a summary in the form of retellings, and conveys loyalty towards the informants' voices (Malterud, 2011, 2012). Both authors participated in all steps of the analysis process to increase validity. First, the researchers separately analysed the interviews, and then meaning units and codes were discussed until a consensus