School of Healthcare

FACULTY OF MEDICINE AND HEALTH

Organising International Exchange into an undergraduate programme

Audrey Reed

Aims of this discussion paper

To discuss the experience of developing a 10 credit module which incorporates international exchange in an undergraduate programme To analyse the issues involved in this development To evaluate student experience and the benefits for students in their future professional life

Conference Theme

T7 – “Deliver excellent and inspirational learning and teaching” “Inspire our students to develop their full potential” Key Theme – University of Leeds Strategy

University of Leeds Strategy

T8 – To provide an exceptional student experience Goal 2: To develop outstanding graduates – knowledge and skills for international employability leading to excellent career opportunities In practice, “provide opportunities and support to gain an international perspective”

Faculty of Medicine and Health International Strategy “Ensure all students taking courses in the Faculty are exposed to international health issues as a core part of their educational provision and develop this as a brand hallmark of Leeds Medical and Health education” “Encourage and support all staff to take an international perspective including a recognition of the potential for learning from other health systems.” p3

Professional Driving Forces

Social and political changes required to be reflected within nursing curricula ( Department of Health, 2000)cited by Watts, Law, Ots and Waago (2002) Nursing exists within a multi-ethnic society – Gerrish, Husband and Mackenzie, (1996) Focus on culturally competent care – Leininger (1995) Nursing education entering into universities.

History of European Nursing Module In 1994, representatives of the School of Healthcare attended a meeting in Lewes, Sussex. Seven countries were represented 1995-1996, planning meetings took place in Finland, Sweden and Russia. 14 countries now involved.

At this last meeting, a 4 week module was finalised. In 1997, the first exchanges took place.

Module development

The principle behind the Network was to develop a module that was agreed on and accepted by all member institutions that could be accessed by nursing students within their programme.

Duffy et al (1999) and Ryan and Twibell (2000) cited by Button et al (2005)found that students were less likely to exchange if no credits or it lengthened their programme of study Wilkinson (1998) cited by Watts et al (2002) challenged assumption that learning abroad only takes place over several months.

Issues in Development

Variations in expectation about the nature, structure and length of the module Regulatory bodies – UKCC/NMC Language issues Timing Stage of Education Placements/clinical practice Memoranda of co-operation Assessment, ECTS, accreditation Evaluation Accommodation Finance

Structure of the Module 4 weeks – one week preparation, 2 weeks exchange and one week reflection/assessment as defined by the home institution 3 exchange periods each year. Purpose of this is to maximise student cultural experience . http://www.leeds.ac.uk/enm

School of Healthcare, University of Leeds 1998-2002, 20 Diploma students used their elective period to undertake the European Nursing Module. Countries visited were: Lithuania, Estonia, Finland, Tenerife, Romania, Bulgaria and Denmark. Only one of these students elected to submit the assignment for 10 credits at level two The School of Healthcare received students from Finland, Denmark Sweden, Tenerife and Austria Network sought to promote exchange amongst professionals allied to medicine.

BHSc(Hons)Nursing Validation 1999 10 credit module at level 3 as an optional module Learning outcomes: at the end of the module, the student will be able to: - analyse the value of sharing and exchanging multi-cultural knowledge and experience.

- debate learning experiences with colleagues - gain understanding of and empathy for being a “stranger” within another country - undertake an analysis of healthcare provision within a European country - analyse how different nursing cultures define the nurse’s role.

Module Assessment

Coursework; reflective diary. The Network developed a format for the reflective diary but students may develop their own.

Diary is used as basis for reflective sessions before, during and after the exchange. It is also the basis for the summative assignment Summative assignment; 2,500word essay reflecting on personal and professional development.

Countries visited by Leeds students 2002 –

2 students

visited Biel, Switzerland 2003 2004 -

2 students

visited Kuusankoski, Finland

7 students

: 2 to Galati, Romania, 1 to Plovdiv, Bulgaria, 2 to Stockholm, Sweden and 2 to Tartu, Estonia 2005 2006 -

11 students:

2 to Tartu, Estonia, 2 to Plovdiv, Bulgaria, 1 to Bucharest, Romania, 2 to Biel, Switzerland, 1 to Sweden and 3 to Vejle, Denmark

14 Students:

3 to Tartu, Estonia, 2 to Plovdiv, Bulgaria, 4 to Bucharest and 1 to Pitesti, Romania, 2 to Vejle, Denmark and 2 to Leiden, Holland 2007 –

18 students

have places to exchange in March.

Promoting International Exchange Since 2005, approximately 50% of students on the BHSc(Hons)Nursing adult have undertaken the module.

Increasing numbers on the programme (20 in 1999 to 75 in 2007) has resulted in increased demand. The module has just become available to child branch students.

Therefore, to meet demand a new module, International Healthcare has been developed. This will be available across the School.

Operational Issues Communication Observational Practice Travel arrangements Accommodation Problems on exchange procedure

Benefits to students

Cultural awareness/sensitivity Communication Personal and professional development Evidence based practice Exposure to different healthcare systems Increased employability

Cultural Awareness

“I feel I will have a better understanding of how cultural norms can impinge upon and dominate our way of working and how sometimes, this is not always a good thing as it doesn’t facilitate change.” “developed my awareness of culture and being the minority in a situation” “Excellent opportunity to compare and contrast professional cultures whilst reflecting on my own professional culture”.

Communication

“The position I have been in i.e. being only English speaker: the feelings of isolation this can produce provokes you to think how can this experience be applied at home.” “It made me realise the thinks I took for granted about my own patient care communication skills. It made me think about being helpless and from a minority patient group in a vulnerable position.”

Personal and Professional Development “Wonderful – an amazing experience for me both personally and professionally”.

“Personally and professionally, a very valuable experience” “The knowledge I gained while in Bulgaria will be invaluable to my professional development”.

“one of the most interesting and enjoyable things I have done during my course.” “this has been one of the most memorable experiences of my life and the ENM should be recommended/part of all nursing curricula.”

Evidence Based Practice

“It’s made me much more aware of my training and what I have learnt over the past three years, made me more aware of why we do things. I feel very appreciative of my education.”

Healthcare Systems

“It has given me the opportunity to see an alternative system to the NHS. An excellent learning experience and very thought provoking.” “I have seen a completely different perspective on healthcare. I will be able to use the skills I have developed while away.

“Allowed me to look more objectively about our own healthcare system.

“Truly valuable experience to allow me to observe different Healthcare systems and appreciate the culture differences.”

Benefits of Exchange as identified in literature review by Button, Green Tengnah, Johansson and Baker(2005) Learning cultural differences; transcultural experience increased student awareness of cultural differences among patients.

Knowledge of gender roles and issues between cultures.

Healthcare systems; international exchange enhances student ability to evaluate own healthcare system More mature and objective appraisal of their own system.

Button et al’s (2005)Benefits of exchange cont.

Personal Development; “profound and influential impact and Participants mature personally and professionally”. p318 Increased self-confidence (Haloburdo & Thompson (1998), Inglis et al (1998) Coping and self-reliance (Ryan and Twibell 2000) Self- awareness (Zorn 1996, Inglis et al 1998) Zorn et al (1995) found an increase in cognitive development in students who had experienced international exchange which they attributed to the placement experiences challenging established beliefs and perspective.

External Appraisal of European Nursing Module Major Review 2005 N.M.C. Annual Monitoring visit 2006 External Examiners’ Reports

2006 External Examiner’s Report

ENM is a “particularly innovative and interesting feature of the BHSc(Hons)programme. It provides students with an opportunity to experience health care delivery in a European context. … The student account of the experience is always insightful and interesting…… The assessment enables students to develop skills of reflection, critique and an understanding of alternative models of health care service delivery and management.”

Conclusion

The European Nursing module contributes to the University of Leeds Learning and Teaching Strategy by enhancing student experience, developing their international perspective and increasing their employability.

In particular, it helps to “inspire students to develop their full potential.” The module is an important marketing asset for the programme in a competitive field

References

Button, l, Green, B, Tengnah, C, Johansson, I & Baker C(2005) The impact of international placements on nurses’ personal and professional lives: literature review. Journal of Advanced Nursing, 50(3) 315-324 Gerrish, K, Husband, C & Mackenzie, J Nursing for a multi-ethnic society. Buckingham UK Open University Press Leininger, M.M. (1995) Transcultural nursing; Concepts, theories, research and practices (2 nd ed) New York McGraw-Hill Watt, S, Law, K, Ots, U & Waago, K (2002) Reflections Across Boundaries: The European Nursing Module Journal of Transcultural Nursing vol 13 no 4 p318-324