‘Global issues are affecting professional practice’
The theme for this year's International Nurses Day is ‘Nurses: a voice to lead—health for all’. This is a great opportunity for nurses around the world to pause and reflect, and to celebrate the contributions nurses make to societies around the world.
This year's theme is all about nurses who lead to promote health and wellbeing for their patients, their families and themselves. This requires nurses to be strong advocates to lead change.
However, our advocacy efforts must extend beyond the patient. We are at the forefront of leading change and are required to be advocates for legislation and regulation changes as well as within local communities. Our world is changing and many global issues affect health care.
The current workforce challenges are just one example. Others include the global burden of disease and the age of our populations. These global issues are affecting professional practice. We must ensure that, to be a true advocates, nurses have the knowledge and skills, and this starts with taking care of ourselves and each other.
As a nurse, the experience of nursing care and development of knowledge in another country is one opportunity to see healthcare practice from a different perspective. It provides opportunities to visit another country, develop new skills and become immersed in a new culture.
At Northumbria University, we have a growing portfolio of international partnerships, which enables learning, teaching and knowledge development. Below are personal accounts and insights from staff and students engaged in international exchanges, which are contributing to self-development to be an advocate for change.
Spanish steps
In an international nursing context it is recognised as valuable to support student nurses to develop personally, professionally and, in particular, to progress towards cultural competence (Button et al, 2005; Callister and Cox, 2006; Morgan, 2018).
At Northumbria University, around 20 student nurses per year are offered the opportunity to participate in an optional study abroad placement as part of the Erasmus exchange programme (European Commission, 2012). Within this programme, students undertake an international clinical nursing placement in a European Union (EU) country.
As a result of their international nursing experience, students report being transformed. For example, one student stated:
‘I am a totally different person … I take a lot more pride in my achievements. Now it's “I went to Spain and I did that and how amazing is that”.’
On their return, students apply their developing cultural competence to their nursing care. For example, a student who visited Finland identified:
‘I think I'm more confident and observant of things … Because on an [international] placement you had to observe more, ‘cos of the language, so I think I notice things more now like body language.’
Another student noted:
‘Going to Spain, I understood the expectations they [patients and families in a southern EU country] had from health. So I felt I could relate to them better and have an awareness of expectations of us. It was good to have that idea that they want to spend as much time as they can with family and look after them, bathing or whatever, which we don't expect as English people. So, even though this family couldn't speak English, I had a better relationship; it enhanced the experience for that family.’
Having the opportunity to experience international nursing during pre-registration studies not only provides positive learning outcomes for students but also, in turn, enhances the care of service users.
World view from a small island
On this small island in the Caribbean nurses can no longer remain focused on local or even national healthcare problems. In an era of global citizenship they must be prepared for health issues in any setting. Nurses are expected to collaborate globally, influencing research, practice and policy to advance health.
Enabling student nurses' exposure to international experiences increases their preparation and lets them see first hand the impact of global issues on health care.
Often, the international experience students gain is from a developing country. However, students in Grenada travel to developed countries to enhance and expand their professional and personal growth.
Our students who travelled to Cardiff last summer (pictured left) reported increased confidence as they came out of their comfort zone. They heard different dialects, tried local dishes and interacted with fellow students and nurses, enriching their cultural experiences. At the large teaching hospital where they were placed many noted similarities and how caring is a universal construct.
On returning, they spoke of the diversity within the patients and colleagues and how cultural competency became less of a theory and more of a practical application. Many are still in touch with the nurses they met in their clinical settings, which continues their awareness and growth.
In Grenada, we encourage students to ‘think beyond’—exposing students to these experiences expands their horizons and encourages international collaboration.
Simulation teaching for Thailand brings nurses together
Simulation-based education (SBE) has become a vital learning and teaching methodology in healthcare education and, as a result, many organisations have invested in state-of-the-art SBE technologies (Nursing and Midwifery Council, 2007; Harder, 2009).
Pivotal to the effective delivery of SBE and the use of the technologies are faculty staff with expertise in all aspects of this approach and, in particular, the debriefing process (Association for Simulated Practice in Healthcare, 2016; International Nursing Association for Clinical Simulation and Learning, 2016).
Northumbria University has been commissioned over a number of years by the Ministry of Public Health in Thailand to deliver a UK-based residential SBE faculty development programme for selected healthcare educators from Thailand to ensure they can deliver state-of-the-art SBE to their healthcare workforce.
To meet this need, the university developed a bespoke 2–3 week SBE faculty development programme. The aim of the programme was to develop an understanding of SBE across a range of healthcare and educational environments, with the delegates being able to:
These high-quality programmes, which were designed and delivered based on current best practices within SBE and nursing, were delivered by the university's SBE and healthcare experts, including experts by experience. They cover all aspects of SBE, such as scenario design and debriefing, and cover the breadth of SBE modalities.
The programmes are constructivist in nature and, as such, are interactive and centred on the participant's educational needs. Key to this approach has been the sharing of expertise and experience in a collaborative manner that enables participants to design and develop their own SBE materials and scenarios to help improve patient care and staff clinical practice.
Soraya Niha Benyala, senior lecturer in midwifery at Boromarajonani College, said:
‘This is the first time that I've seen simulation-based education in the UK and I think the atmosphere for learning and teaching is fantastic at Northumbria. The equipment is of the highest quality and the support for staff who deliver simulation-based learning is very good.
‘I have enjoyed the teaching very much and I will be taking a lot of what I have learned back to Thailand.'
Additional comments included:
‘Thank you … I have plan to use SBL [simulation-based learning] for teaching in my subject. Miss you all.’
‘Thanks for giving me an inspiration to be a good teacher like you and your team.’
‘[We have] great memories of Northumbria University.’
This collaborative transnational education approach includes students from our undergraduate healthcare programmes who participate in the scenarios and offer feedback on the development and delivery of these.
This pioneering approach ensures participants have SBE resources that they can then use and deliver in their own organisations to their own students (Harder, 2009). In addition, this enhances the skills, knowledge and experiences of the nursing students, using the transnational education of SBE, bringing nurses together globally.
Nursing programmes for students from home and abroad
The university welcomes students from all over the world. The MSc Nursing and MSc Nursing Leadership programmes and the BSc (Hons) Nursing Science programme are designed for international and UK-registered nurses who wish to advance their study.
Students learn from knowledgeable and enthusiastic lecturers from diverse backgrounds, which helps them to develop their capacity to synthesise nursing theories and to further their research and leadership potential. They are also encouraged to challenge their own beliefs about nursing practice from local, national and global perspectives.
Although placements are not offered, students (pictured above) engage in activities in a state-of-the-art clinical skills centre and learn about nursing practice and management in the UK through visits to local hospitals and from guest lecturers, including clinical educators and NHS leaders.
A BSc Nursing Science programme graduate from China appreciated being able to compare health care in different countries:
‘It was a fantastic learning journey. I have learned a lot of things that are quite different from China. All of the teachers are very nice, patient … everything is well set up and updated. We had the chance to visit the local hospital and compare things with how they are China, which gave me advanced knowledge. I have made foreign friends and we can exchange cultures and experience, which has broadened my horizon.’
A graduate from Canada said the MSc nursing leadership course provided the most ‘worthwhile months of your life’x and, equally, appreciated the city:
‘The time that you spend here will challenge you and be some of the most worthwhile months of your life. The programme enhanced my writing skills in research; it also consistently encouraged the students to think critically and help students to develop themselves throughout the course. Take the time to enjoy this great city. Go for long walks and discover the little treasures that will become your favourite places.’
Malta movers
Northumbria University has collaborated with the Malta College of Arts and Technology (MCAT) to develop a BSc (Hons) degree in nursing studies.
Northumbria staff visited Malta for the validation process, then taught at MCAT on alternate weeks. The students were at first unsure about what was expected of them on the course and having teaching staff whom they did not know.
However, within a short time, they relaxed and valued what they were being taught, and thrived on learning not only new topics but also benefiting from the Northumbria staff 's experience. The MCAT staff appreciated Northumbria's involvement, and they have stated that it has enriched the knowledge and skills not only of the students, but also the MCAT teaching staff.
The students loved the group work and practical sessions. They found that they became more involved in not only their own learning but also in developing relationships with each other, valuing others' opinions and friendships. The students have stated that they feel more prepared to go into practice not only from a theoretical perspective, but also because they have developed their ability to work both independently and within a group.
Ten students from Malta have taken advantage of the Erasmus student exchange programme and have been taught at Northumbria University. They have benefited from their exposure within Northumbria's simulation suites and the excitement of being in a foreign country, experiencing a different perspective on their learning. They have valued their different experiences and identified how this has helped in their development.