Running&head:&INTERNATIONAL&NURSING&PLACEMENTS& 1& · 2018. 8. 31. · INTERNATIONAL&NURSING&PLACEMENTS& & 2& Critical&QuestionsAbout&International&Placements&in&& UndergraduateNursingEducation&

Running head: INTERNATIONAL NURSING PLACEMENTS

1

Critical Questions About International Placements in Undergraduate Nursing Education

A paper submitted in partial fulfillment of the course requirements of N600

Submitted to: Dr. Jude Spiers December 8, 2014

by Tracy Oosterbroek RN BN MScN (doctoral student)

INTERNATIONAL NURSING PLACEMENTS

2

Critical Questions About International Placements in

Undergraduate Nursing Education

International service learning is a growing phenomenon in undergraduate

nursing curricula, particularly in wealthy nations, such as North America, Europe

and Australia. Levi (2009) suggests that increased global migration has led to an

intensified need for nurses to be educated from an international perspective in

order to prepare them for the culturally diverse workplace. International

placements involve short and long term practical emersion experiences that take

place in both developed and developing countries. The increasing popularity and

demand for international experiences by nursing students is due to a number of

factors, including cultural competence (Kaddoura, Puri & Dominick, 2014; Kelleher,

2013), increased global citizenship (Strickland, et al., 2013; Nicholas, Corless, Fuler

& Meedzan, 2012; Carpenter & Garcia, 2012; Memmott, Coverston, Heise, Mill et al.,

2010; Williams, Maughan, Kohl & Palmer, 2010), social justice, (Anderson et al.,

2009; Boutain, 2004) and social responsibility (Nicholas, et al., 2012; Mill et

al.,2010). However, there is a paucity of research that addresses the long-‐term

benefits of international placements for students or host communities.

For the purpose of this assignment, I will examine the theoretical

underpinnings, values and assumptions that support the movement for creating

curricula that include international placements in undergraduate nursing education.

My discussion is based on specific assumptions about the core values that give

direction and shape to the development of knowledge for nursing practice. The

values, beliefs and assumptions that support development of international


3

placements for undergraduate students are evaluated using Risjord’s (2010) model

of constitutive and contextual values and examined through an analytic postcolonial

feminist analytic lens. These processes of value identification and analysis are used

as a framework to articulate how values influence nursing inquiry. International

placements are a growing phenomenon and it is timely to reflect upon the

theoretical and pragmatic forces underlying proliferation of these experiences and

determine if this is desirable in terms of the core values of nursing. I will conclude

by identifying some key considerations for future development of international

placements.

Background: Internationalization of Nursing Curricula

Internationalization of nursing curricula has been an educational goal since

the 1980s (Mill, Yonge, & Cameron, 2005). Increasing immigration, social media

communication, and popularity of international travel have contributed to growing

emphasis on globalization, global citizenship and social responsibility (Mill, et al.,

2010). Globalization of health is a product of worldwide economic integration (Mill

et al., 2010). Mobility of health care professionals and health consumers, increased

private care providers and use of technology to provide care across borders

remotely and within countries (WHO, 2014) has also contributed to globalization of

health. These factors influence the necessity for internationalization of nursing and

health care curricula.

International placements as a movement have grown in popularity and

incidence in a variety of health and business disciplines not exclusive to nursing as a

way to achieve goals related to internationalization. The driving forces for planning


4

international placements in nursing curricula reflect constitutive ethical and moral

values, including cultural competence and caring, concern for vulnerable

populations, global citizenship, and social justice (Egenes, 2012; Grant & McKenna,

2003; Kelleher, 2013; Kokko, 2011; Koskinen & Tossavienen, 2004; Mill, et al., 2010;

Ruddock & Turner, 2007; Larson, Ott, & Miles, 2010). These constitutive goals align

with some of the core values of nursing as articulated by the professions’ code of

ethics (CNA, 2008; ICN, 2006). For example, nursing is influenced by unique

scientific and moral values that define ethical values central to the profession (CNA,

2008). These values address the responsibility of the nurse to “promote health,

prevent illness, restore health and alleviate suffering” (ICN, 2006, p. 1). Provision of

safe, compassionate, competent and ethical care is encompassed within the

overarching goals of international placements. Embedded in these values are

respect for human and cultural rights, the right to life, choice, and dignity (ICN,

2006). Moreover, these moral and ethical values set out the ways in which nurses

advocate for individuals, families and groups to address social inequities, especially

among underserved populations that are vulnerable and marginalized (CNA, 2008).

While advancement of the profession is crucial and necessary to ensure accountable,

safe practice, the core values in nursing must not be lost (Gortner, 1990).

International experiences are commonly either practice courses to which

course credit is assigned, or elective field-‐study type courses with outcomes focused

on global citizenship and global health, often taken collaboratively with students at

an international destination university (University of Alberta, 2014). Exchange

experiences occur between students from academic programs most commonly in


5

developed countries such as Canada, United States, Europe and Australia. However,

the most desirable and popular international experiences described in the nursing

literature are immersion experiences in developing countries (Kelleher, 2013;

Kokko, 2011; Kulbok, Mitchell, Glick & Greiner, 2012).

The majority of literature regarding international placements provides

examples of immersion with other cultural groups while addressing cultural

competence, globalization and social justice as core values. Evaluation of student

benefits following international experiences dominates currents research (Afriyie

Asenso, Reimer-‐Kirkham, & Astle, 2013; Smith & Curry, 2011; Zanchetta, Schwind,

Aksenchuk, Gorospe, & Santiago, 2013). Educational strategies that engage students

in international service learning emersion experiences with diverse cultural groups

are other common themes found in the current literature (Mason & Anderson, 2007;

McKinnon & Fealy, 2011; Saenz & Holocmb, 2009). Little work has been done to

evaluate the long-‐term benefits of international placements for nursing students

(Evanson & Zust, 2006) particularly related to how students learn about culture

(Afriyie Asenso et al., 2013; Harrowing, Gregory, O’Sullivan, Lee & Doolittle, 2012

Harrowing, Mill, Spiers, Kulig, & Kipp, 2010). Few studies have addressed potential

negative consequences for students who participate in international experiences

(Foronda & Belknap, 2012). What is more, studies that critically examine the

potential impacts, risks and consequences to the host nation and are lacking and

urgently required (Reimer Kirkham, Van Hofwegen, & Pankratz, 2009).

Post-‐Colonial Feminist Analysis of International Placements

Internationalization of nursing curricula and development of international


6

immersion experiences aim to enhance knowledge and skills around core values of

cultural competence, globalization, and social justice. Given that international

nursing placements predominantly occur when students from high-‐income

countries visit less developed and predominantly low-‐income countries, it is

important to critically analyze these taken for granted assumptions and values that

underpin this growing movement.

The feminist perspective provides a way of unpacking the ways culture and

race have been formed over time through complex social processes such as

colonization (Anderson, et al., 2003). Feminism transcends gender and provides a

lens for evaluation of social class and power while challenging historical

constructions (Anderson et al., 2003). The postcolonial feminist perspective

provides a bridge between postcolonial and feminist standpoints by recognizing

intersections between race, culture, society, gender and class. This is accomplished

by identifying ongoing issues related to the historical effects of colonization while

promoting sustainability based on values of social justice and equity (Anderson, et

al., 2003; Mill, et al. 2010).

Cultural competence. Essentialist views of culture persist among nursing

students and lack critical analysis of the socio-‐political, economic, and historical

context of cultural definitions (Vandenberg & Kalischuk, 2014; Harrowing et al.,

2010). Concepts related to culture are embedded in the postcolonial perspective

that endeavors to interpret effects of colonialism and historical construction of race

and gender from a colonial context (Anderson, 2003).

The international experience has the potential to enhance the worldview of


7

culture among participants (Larson et al., 2010). Student desire to travel to exotic

locations to learn about other cultures is evident in the literature (Racine & Perron,

2011; Grant & McKenna, 2003). However, this desire reflects consumerism and

raises issues of appropriateness of international travel as a mechanism for students

who seek international, cultural immersion experiences with vulnerable

populations. Learning simply for the sake of desire or interest about another

culture, must not be limited to passive activities that potentially perpetuate

exploitation of vulnerable individuals and groups by others who are more privileged

and powerful (Freire, 1998). Not all nursing practices deemed normal, appropriate

and necessary from a western perspective will be perceived the same way by the

receiving culture (Levi, 2009). These drop-‐in international experiences may fail to

recognize and address relevant local needs, while superficially meeting the learning

needs of the student through brief exposure to another culture in an exotic location

(Levi, 2009). Core nursing values including right to privacy, informed decision

making and consent, enhanced well-‐being, and preservation of dignity may be

exploited by visitors from the western world, and must be considered.

Immersion in a radically different social, economic, cultural system is the

vehicle through which the nurse shifts her gaze between self and patient, within the

context of the system while recognizing how culture intersects this relationships

and ensuing dialogue (Anderson et al., 2003). However, these considerations must

become part of everyday practice to build an understanding of the impact our

interventions and interactions have on marginalized individuals everywhere. As

educators, we must evaluate whether international experiences that foster student


8

learning trumps the needs of individuals and communities at international

destinations in the developing world.

Globalization. Contextual socio-‐political priorities influence prevalence of

international placements. For example, increased globalization and consumerism

are among the most common overt motivations for international experiences. These

experiences imply an unbalanced power relationship between the student and the

“other” who becomes the recipient of care (Racine & Perron, 2011). A post-‐colonial

feminist perspective prioritizes the individual nurse’s responsibility to reflect upon

personal assumptions and expectations about knowledge and power when

international placements are used as a strategy to confront nurses from wealthy

nations with the realities experienced by the underserved communities. A question

that must be asked is, to what extent do international experiences potentially

exacerbate experiences of colonialism? The vast majority of nursing students bring a

unique worldview created within the context of a wealthy, powerful nation.

Whether or not the western nurses’ presence is needed, requested or valued has not

been examined from the perspective of host communities. In spite of formal

agreements that are developed between academic institutions, it is unclear the

extent to which recipients of care within the underserved community are involved

in planning and operationalization of the international placement experience.

It is difficult to detangle the motivations, benefits and potential risks for the

student travelling to unfamiliar places, but also to the individuals and communities

that are potentially unintentionally exploited as a result of these placements.

Educators must consider both the students’ educational needs and the needs of the


9

recipients of care in the receiving community (Levi, 2009) a priori when planning

international experiences.

Social justice and global citizenship. International placements provide a

context for nursing students to challenge their core assumptions about what

constitutes moral good and justice as they engage with communities that are

underserved. Larson (et al., 2010) found that making a difference was a common

theme reflecting the altruistic, caring foundation of nursing practice. However,

nursing students who participate in international experiences, may unwittingly

contribute to international tensions that precede their visit. Moreover, these

tensions can influence the way in which the student is received by the host

community and the value that the host community places on the international

nurses’ interventions. Anderson (et al., 2003) warns that the nursing student may

inadvertently become the “colonizer” by perpetuating the experience of the

“essentialized other” (p. 200) among the previously colonized. Examination of

power differentials that contribute to systemic and structural inequities through a

postcolonial feminist lens illuminates root causes of social injustice (Anderson, et al.,

2009). This perspective presents the vulnerable population as involuntary

recipients of service learning that originates in the developed world. Whether the

international experience has inherent risk that perpetuates the effects of

colonization by the more powerful nation, must be considered by curriculum

designers. This risk may be unintentional, but as a possible consequence of

international placements, must be addressed during planning and implementation

of service learning in the developing world with communities that are difficult to


10

access, assess and develop collaborative interventions and experiences. Moreover,

the international placement experience should provide students with an

opportunity to address the systemic societal issues while learning abroad.

International placements that promote structural system change from a postcolonial

feminist perspective place emphasis on social justice as a central value while

striving to meet dual needs of the student and host community by promoting

structural system change (Chavez, Bender, Hardie, & Gastaldo, 2010). Numerous

authors have identified a gap in the literature that address international experiences

course design and the responsibility of educational programs to address these

global health concerns and goals (Curtin, Martns, Schwartz-‐Barcott,DiMaria, &

Beliga Milagros SolerOgando, 2013; Kemppanien, et al. 2012).

Motivation Factors

Development of applicable, realistic, and sustainable programming is

paramount from the postcolonial feminist perspective. This enhances creation of

experiences that build knowledge and skills around cultural competence,

globalization, and social justice that are accessible to all students while meeting the

needs of the underserved communities long after the students are gone (Levi, 2009).

Recognition of the motivating factors among students, the educational institution

and host communities should influence development of innovative curricula aimed

at upholding these core values.

Student motivations. Curriculum designers claim students are motivated by

an intrinsic moral imperative to focus on equality, common good and social benefits

and burdens (Boutain, 2005). The international placement offers a venue through


11

which the nursing student can focus directly on these societal issues by working

with socially disadvantaged communities internationally.

However, Campinha-‐Bacote (2002) states that desire and motivation for

these experiences are not enough to ensure provision of culturally competent care:

the nurse must engage in reflexive practice that is flexible, open to others, accepts

diversity and demonstrates willingness to learn from others. This requires more

than simply acknowledging respect for the values and beliefs of others but ensures

provision of care that is a reflection of the intersection between constructs of

cultural awareness, knowledge, skill, encounters and desire (Campinha-‐Bacote,

2002). Each of these interdependent constructs must be addressed and experienced

to ensure care that is culturally competent (Campinha-‐Bacote, 2002). The

international placement provides one type of opportunity for learning that forces

students out of their comfort zone while finding new ways to work with others.

However, how best to teach these constructs and prepare nursing students for the

realities of the diverse workplace is an ongoing dialogue, and must extend beyond

individual humanitarian motivations (Riner, 2013).

Institutional motivations. International placements are an educational

strategy that enhances the students’ ability to relate with and to individuals and

groups who belong to other cultural, racial and ethnic groups. This occurs as the

student learns about the socio-‐political organizational structure that influences

health, health care and access to services in the host country (Grant & McKenna,

2003). Educational institutions have the responsibility to address current issues

related to health care and health care access. Globalization of health has increased


12

the need to educate nurses and other health care professionals that are attune to the

needs of the global community. For example, fostering international and local

initiatives to address globalization is the mandate of the Global Nursing Office at the

University of Alberta (University of Alberta, 2014). Other responsibilities of the

educational institution that address globalization are to enhance knowledge of

cultural competence, global citizenship, and social justice. These values influence

institutional motivation to advance in these areas and are congruent with the

constitutive values held by students seeking international experiences.

Conversely, contextual values must be acknowledged and evaluated against

core constitutive values of nursing. For example, the ability to offer international

experiences for undergraduate students may be a strong factor in recruitment of

students (Memmot, et al., 2010) that influence competitive admissions and

sustainability of academic programs. Professional enrichment is a benefit for faculty

involved with students that participate in the international experience. Global

sociopolitical priorities and goals in relationship to internationalization and global

health serves to benefit the academic institutions that mandate a strong focus on

development of broad perspectives of health and global health issues that cross

international borders. Nonetheless, these contextual values must be compatible

with the mission and vision of the academic program (Memmot, et al., 2010).

Failure to recognize and address potential incongruence, creates risk of developing

international experiences that are costly to both the institution and student and

provide for little more than an opportunity for students to travel to exotic locations.


13

Development of international placements requires tremendous investment

in time, human and financial resources to nurture collaborations between

international partners. Formal agreements are commonly required between

partners that cultivate collaborative relationships that address common goals and

outcomes of the international experience and minimize risks to both student and

host community (Stringer, et al., 2014).

Host motivations. Constitutive values unique to the host nation must be

carefully considered and balanced with contextual values that motivate the host

community. Little can be found in the literature that addresses benefits to host

nations (Chavez, et al., 2010). Incongruence between motivators of host nations and

host communities must also be examined. Most worrisome, is the sheer desperation

of host communities for health care interventions and services. While this may be

beneficial in the short-‐term, it raises issues of access and sustainability of services as

core values of global citizenship and social justice. Active participation of host

communities in planning is crucial to the development of sustainable, realistic

programming that does not end when the international student returns home

(Sossou & Dubus, 2013).

It is difficult to determine from the literature if low-‐income host communities

and villages visited by students and faculty from high-‐income countries during

international experiences are consulted and if so what this looks like. Ongoing

health needs and consequences of relatively short-‐term international placement

must be addressed to ensure congruence between needs of the host community and

educational outcomes for the student. The international placement should meet


14

dual purposes related to student learning and local need. Relationships between

host and academic partners must be based on mutual goals and trust (Wildridge,

Childs, Cawthra, & Madge, 2008). This is accomplished when both high-‐income and

low-‐income partners are recognized as contributing equal value to the collaboration

and resulting outcomes of the experiences (Wildredge et al., 2008).

For example, host nations, especially in the developing world may be

motivated to enter into relationships with richer nations to increase access to

services that are otherwise unavailable. Likewise, international partnerships

between educational institutions may provide a mechanism for educational

advancement in academic settings of the host nation. However, crucial

considerations relevant to host communities must be anticipated and deliberated.

Fostering enriched partnerships may provide additional benefits to host

communities by expanding international opportunities that include international

exchanges between nursing students from low-‐income countries to high-‐income

countries (Chavez, et al., 2010). Nursing students from low-‐income countries who

return home with enhanced knowledge and skills relevant to their local settings

may potentially improve health services accessibility and ultimately health care

outcomes. Evaluation of these long-‐term benefits of international exchanges for host

communities have not been examined and is urgently needed.

Additional questions that have not been addressed relevant to the host

community include; are host communities aware that western nurses will be

visiting? Does the host community understand the role of the student? Is the host

community involved in operationalization of the student experience? Do host


15

community members have the right to refuse care provided by the international

student? Are the educational outcomes and expectations realistic and do they

account for language and other communication barriers? What are the potential

disadvantages for the host community that should be addressed by stakeholders

invested in development of the international placement? Is the evaluation

conducted in collaboration with the host community or other stakeholders? These

and other questions must be addressed when considering motivation of both host

nations and communities to minimize risk and maximize benefits of the

international experience.

Future Considerations

Unique values, beliefs and practices exist among members of particular

cultural or ethnic groups. However, not all members of a specific group share and

engage in practices that are reflective of the same set of values and beliefs (Kulbok,

et al., 2012). This awareness recognizes and values individuality and prevents

prejudice and assumptions about individuals who presumably belong to a specific

cultural, racial or ethnic group or community. This requires the nurse to plan and

provide care for each person in a distinct nature that addresses their unique health

needs and resource accessibility. The essence of cultural competence and sensitivity

recognizes the impossibility of developing a sound working knowledge of the

values, beliefs and practices of a particular cultural group outside one’s own (Levi,

2008). From this perspective, the nurse creates new ways of viewing culture that

recognizes the eccentricity of individuals regardless of background or setting. This

perspective has been referred to as cultural humility (Tervalon & Murray-‐Garcia,


16

1998) and requires students to challenge their personal values and beliefs about

reality, truth, culture, culturally competent care, and different ways of life (Levi,

2008) that are invisible from within the safety of their normal context. However,

little has changed in the way we discuss and teach students about culture

(Harrowing, et al., 2010; Vandenberg & Kalischuk, 2014). For example, the nurse

must recognize each and every patient encounter as a cultural experience (Chang,

Simon, & Dong, 2012) within the increasingly culturally diverse current health care

environment (Strickland, Adamson, McInally, Tittanen, Metcalfe, 2012). To

accomplish this, nursing educators must nurture an international perspective

among students, and not limit this perspective to health care service delivery

experiences in foreign or internationally settings.

Development of long-‐term collaborative partnerships between the Western

institution and host community build and sustain opportunities for educational and

research opportunities (George & Meadows-‐Oliver, 2013). Ensuring congruence

between institutional and host motivators and needs, minimizes potential risks to

host communities resulting from educational or research activities (Harrowing, Mill,

Spiers, Kulig, & Kipp, 2010). Development of strategic partnerships are critical to the

attainment of mutual goals of the international experience (Stringer et al., 2014)

articulated through formal agreements and memorandums of understanding that

represent the interests of each partner and minimize risks.

MacNeil and Ryan (2013) agree that international experiences are an

educational strategy used to teach students about globalization of health and social

justice. However, these authors report that opportunities for international


17

experiences are limited and few students are able to benefit from these strategies.

As a result, the majority of nursing students are not exposed to this foundational

knowledge around cultural competence, globalization and social justice as they

enter practice (MacNeil & Ryan, 2013; Riner, 2013). This is noteworthy considering

these concepts are defined as core values, central to the nursing profession that are

required for nurses working in the current diverse workplace. Implementation of

cultural immersion experiences with local minority or immigrant groups as an

alternative to the international experience (Amerson, 2014) provides opportunities

for all nursing students to gain from these experiences (Riner, 2013). Wros and

Archer (2010) propose that local experiences that aim to address health needs of

local vulnerable populations such as immigrants or other cultural groups, serve the

same purpose as the international placement experience. Moreover, the local

experience nurtures a broader perspective among future nurses who learn to

recognize and value diversity in all settings, not just those in foreign and exotic

locations.

Whether the international experiences truly meet the learning outcomes

aimed at achieving enhanced cultural competence, global citizenship, and social

justice remains unclear (Kelleher, 2013). Scholars have also failed to address

potential harmful effects of international placements on marginalized, underserved

populations in host communities (Campesino, 2006). The postcolonial feminist

perspective requires critical engagement in an uncommon dialogue that addresses

issues around social justice from the perspective of the vulnerable group. This

should not be limited to international experiences, but acknowledge vulnerability


18

and social injustice that occurs locally. Failure to address congruence between local

and national needs is a violation of the core values of nursing around delivery of

ethical care and promotion of social justice. A challenge for the nursing profession

is to determine what type of knowledge is required to simultaneously address

issues of social justice, global citizenship and equity for local, national and global

communities (Anderson, 2009) and how best to teach these concepts to students.

Across Canada, more and more Canadians experience challenges and constraints

related to access and utilization of health care services. This is in part due to

growing challenges related to poverty, and discrimination among migrant and

indigenous populations (Anderson, et al., 2009). It is critical that we shift our view

toward the needs of our local communities to enhance culturally competent

practices that meet the needs of these unique populations. The notion that

enhanced learning about culture, globalization, and social justice is best achieved in

foreign settings may be misguided, disregarding local diversity. Likewise, we risk

sustaining essentialization and objectification of the disadvantaged other and fail to

engage in critical analysis that exposes power relations between rich and poor

(Anderson, et al. 2009). A postcolonial feminist perspective disrupts historical

viewpoints and creates an environment that is conducive to dialogue based on

equality among individuals regardless of socio-‐political, ethnic or racial status.

Nurse educators that endeavor to address social justice issues, must develop and

critique their fundamental philosophical perspectives to ensure educational

activities address social justice and do not in fact perpetuate and contribute to

further social injustice (Mill et al., 2010).


19

Conclusion

I cannot make education into an indisputable instrument of social

transformation just because I desire it, nor can it be made into an instrument

for the perpetuation of the status quo just because the powers that be so

decree (Freire, 1998, p. 110).

The purpose and nature of international experiences for undergraduate

nursing students must adhere to the ethics and core values of nursing while meeting

the needs of host communities. Students’ desire and interest to participate in

international experiences at exotic locations to enhance cultural competence, is not

sufficient rationale for international experiences. Especially if the international

experience makes little contribution to improvements in development and access to

sustainable health services and overall health and wellbeing of vulnerable,

underserved populations. Developing enriched understandings of the philosophical

foundations of international nursing placements will contribute to the growing body

of literature around what is known about international placements, while clarifying

the purpose and long-‐term benefits of undergraduate international experiences.

From the postcolonial feminist standpoint, the nurse must address the historical

context of postcolonial imbalances that persist and ensure that strategies designed

to enhance student learning do not continue to silence voices of the marginalized

(Anderson, et al., 2009). This perspective illuminates the ways in which current

structures contribute to ongoing marginalization, and requires critical reflection

upon motives and activities. Doing so will provide indisputable evidence of the

benefits of international placements for students and the underserved communities.


20

References

Afriyie Asenso, B., Reimer-‐Kirkham, S., & Astle, B. (2012). In real time: Exploring

nursing students’ learning during an international experience. International

Journal of Nursing Education Scholarship, 10(1), 227-‐236.

Amerson, R. (2014). Research-‐based recommendations for implementing

International service-‐learning. Journal of Professional Nursing, 30(2), 175-‐

179.

Anderson, J., Perry, J., Blue, C., Browne, A., Henderson, A., Basu Khan, K., Reimer

Kirkham, S., Lynam, J., Semeniuk, P., & Smye, V. (2003). Rewriting cultural

safety within the postcolonial and postnational feminist project: Toward new

epistemologies of healing. Advances in Nursing Science, 26(3), 196-‐214.

Anderson, J. M., Rodney, P., Reimer-‐Kirkham, S., Browne, A. J., Base Khan, K., &

Lynam, M. J. (2009). Inequities in Health and healthcare viewed through the

ethical lens of critical social justice. Advances in Nursing Science, 32(4), 282-‐

294.

Bishop, A. H., Scudder, J. R. (1999). A philosophical interpretation of nursing.

Scholarly Inquiry for Nursing Practice: An International Journal, 13(1), 17-‐27.

Blondeau, D. (2002). Nursing art as a practical art: The necessary relationships

between nursing art and nursing ethics. Nursing Philosophy, 3, 252-‐259.

Boutain, D. M. (2004). Social justice as a framework for professional nursing.

Journal of Nursing Education, 44(9), 404-‐408.

Campesino, M. (2006). Beyond Transcultural: Critique of cultural education in

nursing. Journal of Nursing Education, 47(7), 298-‐304.


21

Campinha-‐Bacote, J. (2002). The process of Cultural Competence in the delivery of

healthcare services: A model of care. Journal of Transcultural Nursing, 13,

181-‐182. doi: 10.1177/10459602013003003

Canadian Nursing Association (2010). Position Paper: Promoting Cultural

Competence in Nursing. Ottawa, ON: Author.

Canadian Nursing Association, (2008). Code of Ethics for Registered Nursing. Ottawa,

ON: Author.

Carpenter, L. J., & Garcia, A. A. (2012). Assessing outcomes of a study abroad course

for nursing students. Nursing Education Perspectives, 33(2), 85-‐89.

Chang, E., Simon, M., & Dong, XQ. (2012). Integrating cultural humility into health

care professional education and training. Advances in Health Science

Education, 17, 269-‐278. doi: 10.1007/s10459-‐010-‐9264-‐1

Chavez, F., Bender, A., Hardie, K., & Gastaldo, D. (2010). Becoming a global citizen

through nursing education: Lessons learned in developing evaluation tools.

International Journal of Nursing Education Scholarship, 7(1).

Culley, L. (2005). Transcending transculturalism? Race, ethnicity and health-‐care.

Nursing Inquiry, 13(2), 144-‐153.

Curtin, A. J., Martins, D. C., Schwartz-‐Barcott, D., MiMaria, L., Beliga Milagros

SolerOgando, T. N., (2013). Development and evaluation of an international

service learning program for nursing students. Public Health Nursing 30(6),

548-‐556.

Egenes, K. J. (2012). Health care delivery through a different lens: The lived

experience of culture shock while participating in an international


22

educational program. Nurse Education Today, 32, 760-‐764. doi:

10.1016/j.nedt.2012.05.011

Evanson, T. A., & Zust, B. L. (2006). “Bittersweet knowledge": The long-‐term effects

of an international experience. The Journal of Nursing Education, 45(10), 412-‐

419.

Foronda, C., & Belknap, R. A. (2012). Transformative learning through study abroad

in low-‐income countries. Nurse educator, 37(4), 157-‐161.

Freire, P. (1998). Pedagogy of Freedom: Ethics, Democracy, and Civic Courage.

Lanham, Maryland: Rowman & Littlefield Publishers Inc.

Grant, E., & McKenna, L. (2003). International clinical placements for undergraduate

students. Journal of Clinical Nursing, 12, 529-‐535.

George, E. K., & Meadows-‐Oliver, M. (2013). Searching for collaboration in

international nursing partnerships: A literature review. International Nursing

Review, 60(1), 31-‐36.

Gortner, S. R. (1990). Nursing values and science: Toward a science philosophy.

Journal of Nursing Scholarship, 2, 101-‐105.

Harrowing, J. N., Gregory, D. M., O'Sullivan, P. S., Lee, B., & Doolittle, L. (2012). A

critical analysis of undergraduate students' cultural immersion

experiences. International Nursing Review, 59(4), 494-‐501.

Harrowing, J. N., Mill, J., Spiers, J., Kulig, J. C., & Kipp, W. (2010). Culture, context and

community: Ethical considerations for global research. International Nursing

Review, 57, 70-‐77.

Hilton, P. A. (1997). Theoretical perspective of nursing: A review of the literature.


23

Journal of Advanced Nursing, 26, 1211-‐1220.

International Council of Nurses. (2006). The ICN Code of Ethics for Nurses. Geneva:

Switzerland: Author.

Kaddoura, M., Puri, A., & Dominick, C. A. (2014). International academic service

learning: Lessons learned from students’ travel experiences of diverse

cultural and health care practices in Morocco. Journal of Nursing Education,

53(1), 45-‐47.

Kelleher, S. (2013). Perceived benefits of study abroad programs for nursing

students: An integrative review. Journal of Nursing Education, 52(12), 690-‐

695. doi: 10.3928/01484834-‐20131118-‐01

Kokko, R. (2011). Future nurses’ cultural competencies: What are the learning

experiences during exchange and studies abroad? A systematic literature

review. Journal of Nursing Management, 19, 673-‐682. doi: 10.111/j.1365-‐

2834.2011.01221.x

Koskinen, L., & Tossavainen, K. (2004). Study abroad as a process of learning

intercultural competence in nursing. International Journal of Nursing

Practice, 10, 111-‐120.

Kulbok, P. A., Mitchell, E. M., Glick, D. R., & Greiner, D. (2012). International

experiences in nursing education: A review of the literature. International

Journal of Nursing Education Scholarship, 9(1). doi: 10.1515/1548-‐923X.2365

Kundrik Leh, S., Waldspurger Robb, W. J., & Albin, Bjorn. (2004). The student/faculty


24

international exchange: Responding to the challenge of developing a global

perspective in nursing education. Nursing Education Perspectives, 25(2), 86-‐

90.

Larson, K. L., Ott, M., & Miles, J. M. (2010). International cultural immersion: En vivo

reflections in cultural competence. Journal of Cultural Diversity, 17(2), 44-‐50.

Levi, A. (2009). The ethics of nursing student international clinical experiences.

Journal of Obstetrics, Gynecologic & Neonatal Nursing, 38(1), 94-‐99.

MacNeil, J, & Ryan, M. (2013). Enacting global health in the nursing classroom. Nurse

Education today, 33(11), 1279-‐1281.

Manhart Barrett, E. A. (2002). What is nursing science? Nursing Science Quarterly,

15(1), 51-‐60.

McKinnon, T. H., & Fealy, G. (2011). Core principles for developing global service-‐

learning programs in nursing. Nursing Education Perspectives, 32(2), 95-‐100.

Memmott, R. J., Coverston, C. R., Heise, B. A., Williams, M., Maughan, E. D., Kohl, J.,

Palmer, S. (2010). Practice considerations in establishing sustainable

international nursing experiences. Nursing Education Perspectives, 31(5),

298-‐302.

Mill, J., Astle, B. J., Ogilvie, L., & Gastaldo, D. (2010). Linking global citizenship,

undergraduate nursing education, and professional nursing: Curricular

innovation in the 21st century. Advances in nursing science, 33(3), E1-‐E11.

Mill, J. E., Yonge, O. J., & Cameron, B. L. (2005). Challenges and opportunities of

international clinical practica. International Journal of Nursing Education

Scholarship, 2(1), 1-‐13.


25

Nicholas, P. K., Corless, I. B., Fulmer, H., & Meedzan, N. (2012). Preparing nursing

students for education in the global village. The American Journal of

Maternal/Child Nursing, 37(6), 367-‐372. doi:

10.1097/NMC.0b013e318258a9e1.

Racine, L. & Perron, A. (2011). Unmasking the predicament of cultural voyeurism:

A postcolonial analysis of international nursing placements. Nursing Inquiry,

19(3), 190-‐201. doi: 10.1111/j.1440-‐1800.20011.00555.x

Reimer Kirkham, S., Van Hofwegen, L., & Pankratz, D. (2009). Keeping the vision:

Sustaining social consciousness with nursing students following

international learning experiences. International Journal of Nursing

Education Scholarship, 6(1).

Riner, M. E., (2013). Globally engaged nursing education with local immigrant

Populations. Public Health Nursing, 33(3), 246-‐253.

Risjord, M. (2010). Nursing Knowledge: Science, practice, and philosophy. Chichester,

West Sussex: Wiley-‐Blackwell.

Ruddock, H. C., & Turner, d.S. (2007). Developing cultural sensitivity: Nursing

students’ experiences of a study abroad programme. Journal of Advanced

Nursing, 59(4), 361-‐369. doi: 10.1111/j.1365-‐2648.2007.04312.x

Saenz, K., & Holcomb, L. (2009). Essential tools for a study abroad nursing

course. Nurse educator, 34(4), 172-‐175.

Sossou, M. A., & Dubus, N. (2013). International social work field placement or

Volunteer tourism? Developing an asset-‐based justice learning field

experience. Journal of Learning Design, 9(1),


26

Smith, K., & Curry, K. (2011). Is it worth it? Measuring the long-‐term effects of an

international experience for nursing students in Ecuador. Journal of

community health nursing, 28(1), 14-‐22.

Strickland, K., Adamons, E., McInally, W., Tittanen, H., & Metcalfe, S. (2013).

Developing global citizenship online: An authentic alternative to overseas

clinical placement. Nurse Education Today, 33, 1160-‐1165.

doi: 10.1016/j.nedt.2012.11.016

Stringer, M., Rajeswaran, L., Dithole, K., Hoke, L., Mampane, P., Sebopelo, S., Molefe,

M., Rich, V. L., & Polomano, R. C. (2014). Bridging nursing practice and

education through a strategic global partnership. International Journal of

Nursing Practice. doi: 10.1111/ijn.12362

Tervalon, M., & Murray-‐Garcia, J. Cultural humility versus cultural competence: A

critical distinction in defining physician training outcomes in multicultural

education. Journal of Health Care for the Poor and Underserved, 9(2), 117-‐125.

University of Alberta. (2014). Faculty of nursing: Global nursing office. Retrieved

from

http://www.nursing.ualberta.ca/GlobalNursingOffice/Opportunities.asp

Vandenberg, H., & Grant Kalischuk, R. (2014). Conceptualizations of culture and

cultural care among undergraduate nursing students: An exploration and

critique of cultural education. Journal of Cultural Diversity, 21(3), 99-‐107.

Wildridge, V., Childs, S., Cawthra, L., & Madge, B. (2008). How to create successful

partnerships: A review of the literature. Health Information and Libraries

Journal, 21(1), 3-‐19. doi: 10.1111/j.1740-‐3324.2004.00497.x


27

World Health Organization. (2014). Trade, foreign policy, diplomacy and health:

Globalization of health. Retrieved from

http://www.who.int/trade/glossary/story045/en/

Wros, P., & Archer, S. (2010). Comparing learning outcomes of international and

local community partnerships for undergraduate nursing students. Journal of

Community Health Nursing, 27, 216-‐225.

Zanchetta, M., Schwind, J., Aksenchuk, K., Gorospe, I. V., Franklin, F., & Santiago, L.

(2013). An international internship on social development led by Canadian

nursing students: Empowering learning. Nurse education today, 33(7), 757-‐

764.

Documents

Running&head:&INTERNATIONAL&NURSING&PLACEMENTS& 1& · 2018. 8. 31. · INTERNATIONAL&NURSING&PLACEMENTS& & 2& Critical&QuestionsAbout&International&Placements&in&& UndergraduateNursingEducation&