It is acknowledged that, due to globalisation and increasing levels of migration, undergraduate nursing students require cultural competence skills to be able to deliver care to diverse populations (Sharifi et al, 2019). International exchanges and cultural visits have been identified as one of the ways cultural competence can be developed (Crawford et al, 2017; Gower et al, 2017). As a result, an element of my role as International Lead for nursing programmes involves facilitating cultural exchanges for students in Japan and the USA.
Research suggests that students do learn about cultural competence from international exchanges (Hilde et al, 2018; Choi and Kim, 2018). However, I am often asked: ‘What is the value of such visits to students and people they care for?’ I am currently undertaking research on the impact of international visits on the development of undergraduate healthcare students' cultural competence. These critical questions have encouraged me to consider the outcomes of cultural exchanges in relation to the person's personal and/or professional development, and whether these could justify international visits in view of the financial costs for both students and university staff.
In June 2019, I accompanied a group of undergraduate students from across the Faculty of Health and Wellbeing to a partner university in Japan for an 8-day cultural visit. The visit included a tour of a hospital providing acute care, joining Japanese students for lectures, activities led by Japanese students, including calligraphy and wearing Kimonos, and visiting an Earthquake Memorial Museum to learn about disaster management. During the visit, I became aware that the experience appeared to have a positive and significant impact on one of the students in the group, Keeley. She had recently completed a Certificate in Health and Social Care and was planning to commence the undergraduate pre-registration Child Nursing programme in September 2019.
Keeley identified development of communication skills as a significant area of personal growth. She did not know any of the staff or students in the group. This led to some anxiety and she recognised that initially she was quiet and reserved. However, she acknowledged that her confidence in talking and participating in activities developed as the week progressed. Communicating with people who spoke very little English, and not being able to speak any Japanese herself, posed many difficulties for her. However, she acknowledged that, by watching how others in the group used mobile phones and drew simple pictures, she learnt to overcome this. In addition, Keeley discovered that talking slowly, using simple language and avoiding slang and colloquialisms greatly enhanced her ability to communicate.
She recognised that these newly developed communication skills could be useful in future clinical placements. By communicating in a different way she identified that, instead of using medical language, she would now use terms and phrases that were based on an individual's understanding and access additional communication aids, if necessary.
Keeley's newly found confidence in communication was seen by her to be a transferrable skill that would benefit her in her academic work. Before the trip, Keeley admitted that she found asking for help difficult. In addition, she was reluctant to participate in group discussions, and preferred to listen to others. She was now more willing to take an active role in group activities.
Keeping in touch and communicating with her own family was very important to her because she was in a different environment and a long way from home, and she had never been abroad without her family. Keeley spoke to her family using Facetime. This highlighted to her how important it is to ensure people in hospital can access technology to enable them to maintain contact with friends, family and loved ones. Keeley also found it difficult to adjust to Japanese food, which she did not always like. This led to an appreciation of how important it is for people to have access to foods they are used to when in hospital and how important food can be to provide comfort in an unfamiliar environment.
Observing how important customs and tradition are to the Japanese allowed Keeley to gain insight into a different perspective of what respect and respectful behaviour might mean to people from a different cultural background. For example, as a tourist visiting shrines where people were actively praying and showing deference to others, she was able to experience how important spiritual and religious expression could be.
It appeared from her feedback and my own observation that the cultural exchange had had a significant impact on Keeley, only some of which has been shared. The value of a cultural visit is difficult to quantify and whether the learning she encountered is translated into her practice as a nurse remains to be seen. However, the discussion with Keeley suggests these visits are potentially transformational experiences that could help equip students with lifelong and graduate skills that cannot be taught in the lecture theatre or the comfort of our own country.