Nursing International Programs of Education Overview of International Programs in Nursing Education

An international program in nursing education is a structured component of a nursing school’s curriculum in the United States, emphasizing global health, cultural awareness, and understanding of globalization and human diversity (Hinrichs, 2003). These programs vary significantly in their duration, purpose, and complexity. The duration of such programs can range from short-term, faculty-led experiences lasting one to three weeks, to longer-term immersion experiences that may involve a single episode or the development of long-term programs.

The purpose of international programs may be centered around education or designed as travel/study experiences. Travel/study programs help students learn about international sites, cultures, health systems, and health challenges, while service-oriented programs focus on direct service or capacity building in underserved areas. These programs may involve one-way outreach, with either students or faculty participating, or two-way exchanges involving both, fostering multi-level, complex interactions.

Impact of International Programs in Nursing Education

The development of international programs in nursing education has been driven by the need to prepare future nurses for a rapidly changing global environment. This landscape includes increasing population mobility, advancements in communication and information technology, the pervasive influence of social media, and a growing diversity in patient populations. A key objective of these programs is to cultivate a nursing workforce that possesses the cultural awareness, sensitivity, and appreciation necessary to provide competent care to diverse populations.

Civic engagement through international programs offers a platform for teaching nursing’s social responsibilities, such as advocacy for population health, health policy development, social justice, and fulfilling nursing’s social contract with society (Nicholas, Corless, Fulmer, & Meedzan, 2012). Moreover, integrating academic service learning (ASL) into these programs provides experiential learning opportunities, helping students develop the assessment and caregiving skills needed to provide culturally competent care. ASL programs also foster international leadership, clinical reasoning, professional role development, and inter-professional teamwork (Kaddoura, Puri, & Dominick, 2014).

Outcomes of International Programs

The literature on international programs in nursing education highlights three main areas: the value and challenges of developing these programs, their impact on students, and their effect on international sites.

1. Development of International Programs: Early studies, such as Linquist’s (1986) survey, revealed that only 14% of 319 nursing schools in the United States had study-abroad programs integrated into their curricula. Although support for these programs has increased, recent surveys show that less than half of nursing schools in the U.S. currently offer such programs (McKinnon & Fitzpatrick, 2012).

   Significant obstacles to developing these programs include a limited number of faculty members qualified to lead them and constraints on incorporating them into the required curriculum (McKinnon & McNelis, 2013). When these programs are not part of the regular curriculum, resource allocation to support them becomes limited. Furthermore, elective courses may not be considered a critical aspect of faculty work, potentially leading to increased demands on faculty time and resources.

2. Integration into the Curriculum: For an international program to be an integral part of the curriculum, it must align with the school’s overall mission and clearly articulate its contribution to learning outcomes (Memmott et al., 2010). Although participation in such programs is often seen as a valuable experience, literature reviews show that evaluations are mostly anecdotal, with limited formal assessment beyond personal reflections (McAuliffe & Cohen, 2005). Existing studies are predominantly descriptive and highlight students’ increased understanding and appreciation of different cultures, along with a deeper appreciation of their own cultural identities.
3. Student Experiences and Transformational Learning: Student experiences in international programs are often described as transformational and life-changing. For instance, in a qualitative study by Evanson and Zust (2006), former baccalaureate students were interviewed two years after their international experiences. The overarching theme identified was “Bittersweet Knowledge,” which included three sub-themes: (1) “Coming to Understand,” which reflected positive feelings of cultural awareness and long-term connections; (2) “Unsettled Feelings,” which encompassed questions about the value of their experiences and guilt over existing economic disparities; and (3) “Advocating for Change,” which reflected a transformed worldview and a commitment to advocate for changes at personal, local, and global levels.
4. Balancing Benefits for Host Sites: A critical issue in sustaining international programs is ensuring that the benefits to the host sites are balanced with the sporadic, short-term nature of student involvement. While these programs can significantly enrich a nursing school’s curriculum, their sustainability requires careful planning and alignment with the overall mission of the institution.

Recommendations for Sustainable International Programs

To ensure the sustainability and effectiveness of international programs, the following recommendations are proposed:

• Alignment with Institutional Mission: The program should align with the overall mission of the school of nursing and the broader college or university. It should contribute to the learning objectives of the nursing curriculum.
• Integration into the Core Curriculum: International programs should be theoretical and evidence-based components of the required curriculum rather than optional electives. This integration will ensure sufficient resources and regular faculty involvement.
• Collaborative Development with Host Sites: Programs should be developed in collaboration with host site personnel, identifying specific outcomes for both the host site and the students. This partnership should include a detailed evaluation plan.
• Evaluation with Clear Goals: The program should be evaluated based on short-term and long-term goals that are planned before the program’s initiation. This evaluation will help assess both the educational outcomes for students and the impact on host sites.

Conclusion

International programs in nursing education are increasingly essential as globalization continues to shape societies worldwide. These programs not only provide students with invaluable cultural and professional experiences but also contribute to a globally competent nursing workforce. By aligning international programs with institutional missions, integrating them into core curricula, fostering partnerships with host sites, and conducting thorough evaluations, nursing schools can enhance the sustainability and impact of these programs.