Transcultural Nursing - Annual report of the course.
Background information
Trans-cultural Nursing (TCN)
The course is a pilot 3 ECTS intensive module administered during two weeks in the fourth semester of bachelor programme (first circle) in nursing.
Responsible teacher and course manager: Irena Dychawy Rosner, PhD, Senior Lecturer in Caring Science.
Registered students attending Malmö programme was four students from Holland, two students from Norway and nine students from Sweden a total of fifteen students. The formative evaluation during the course was conducted 2012-02-03.
The general evaluation after finishing the course was conducted 2012-02-10.
Feedback to the students was provided by e-mail correspondence and available on the internet web page in April 2012.
Feedback to the partners’ universities at was conducted at deans meeting during the Florence Network conference, Malmö University 12th April 2012.
Malmö University
Faculty of Health and Society
Irena Dychawy Rosner, PhD Med Sci 2012-05-03
Didactical summary of the course
Teacher’s overall comments
The course module was developed as a part of a deeper collaboration within the “Preferred Partners Project”, which was aimed at international pedagogical issues in nursing education. The partner universities collaborating with Malmö University in this course were Tellemark University College, Norway, Hanza University School of Applied Sciences, Holland and University College of Leuven. The overall content of the course curricula was developed together by teachers representing the partner universities and conducted in Malmö, Tellemark and Groningen simultaneously, having largely the same subject matter and pedagogical method.
In spite of this collaborative planning each performed way of carry out the course had a specific and unique didactic approach as the courses were conducted in different institutional environments and by separate teachers.
As both Swedish and foreign students attended the educational program conducted at Malmö University the project was a part of the Malmö University concept related to Internationalisation at home (IaH). The focal point of IaH model is international exchange and collaboration that gives new broadened perspectives to staff and students as well as more opportunities to participate in international classes and practice their skills together with other participants from home university and exchange students (Nilsson, 2006)1. The exchange program within this Prefered Partners project and realisation of the course included both students and teachers. The visiting lecturer Maj-Lisa Spjelkevik from Tellemark and the responsible teacher and course manager from Malmö Irena Dychawy Rosner was carrying out the course.
Didactic approach
How societies respond to health care issues and cultural differences is of fundamental importance in fast growing minority populations and increasing glocalisation. The term glocalisation that was used in the context of this course, point to the local and global interaction that influences the individual in constructing an academic identity (Tubin and Lapidot, 20008)2. At the heart at the idea of transcultural education lie serious issues concerning human rights and equal opportunities to health care
1
Nilsson B (2006). Some experiences from Malmö University. The Swedish Linneaus-Palme Program. Malmö: Malmö University.
2
Tubin D., & Lapidot O (2008). Construction of “glocal” (global-local) identity among Israeli graduate students in the USA. Higher Education, 55: 203-217.
(Andrew and Boyle, 2012)3. Conservative learning traditions use to be understood primarily as a top-down process involving the transfer of knowledge and skills from expert/teacher to the learner. However, planning of pedagogical technology in this course was directed towards technical approaches recognising power relations in the classroom, students’ initiatives as well as their ownership and responsibility for their process of learning.
What are the actual discourses and what are culture-informed provisions to challenge the nursing practices regarding transcultural nursing, were topics highlighted through problem based learning (PBL). Further, study visits at the selected wards and
inspirational lectures were planned in to support students’ development in their knowledge and to give inspiration for the important curricula areas.
Each course week focused on a case study; during the first week the case was
predetermined and the second week it was students’ free choice of a case design. The aims of learning activities were to support a development of culture related reflective thinking and sharing of interpretations from students’ engagement in all learning activities. Further, it was didactically important to connect the revealed issues and their implications to context and attitudes of each individual student.
Figure 1. Considered learning parameters in supporting student’s attainment of skills promoting transcultural nursing.
3
Andrews M M., & Boyle J S (6th ed.) (2012). Transcultural concepts in nursing care. Philadelphia: Lippincott Williams & Wilkins.
Nurse Patient
Communication
The curriculum theorising nursing professional role related to transcultural nursing was taking place simultaneously. The theoretical foundations used in didactical planning and scheduling students learning activities for this course were structured accordingly to Andrew and Boyle’s (2012) conceptual model for understanding cultural influences on nurse-patient interactions.
The transcultural competence has been defined as an ongoing process, rather then a fixed condition. This process includes course of actions where the nurse strives to work successfully within the cultural context of an individual, family or society from varied cultural conditions (Camphinha-Bacote and Munoz, 2001)4. The major
categories included are basically depicted in figure 1.
4
Camphina-Bacotte J., Munoz C (2001). A guiding framework for delivering culturally competent services in case management. The Case Mange, 12 (2): 48-52.
Learning outcomes
Assessment
A necessary link between assessment, learning and schooling is recognized by many researchers. The teaching approach in this TCN course put forward a distinction between assessment of learning e.g., grading and reporting the level of learning and
assessment for learning, whose purpose is to enable students by giving them feed back to understand their own learning. Applied assessment for learning involved in this course was an integral aspect of the teaching and learning cycle (Biggs, 1996)5. The educational methods range from PBL group discussions, oral demonstrations of learning, classroom-based discussions and student self-assessment. Figure 2
demonstrates an example of students working with their PBL projects.
Picture: Mia Kolak
Figure 2. Students from Holland and Sweden during their PBL working
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Biggs, J. (Ed) (1996) Testing: to educate or to select? Education in Hong Kong at the crossroads. Hong Kong: Hong Kong Educational Publishing Company.
The pedagogical PBL approach, where the large group was divided into two smaller groups, intents to provide a structure within which each student could discuss the reading associated to particular topic. This formative function of assessment was used systematically during the process of learning and provided useful feedback to both students and teachers.
Check-outs after each learning goings-on gave an important feedback to the teachers about how to modify teaching and learning activities during the course. To the summative discussion with the students during the last course day, were likewise experts responsible for the conducted field visits invited. These practitioners gave possibility to all involved to get a deeper discussions and meaningful revision of students’ questions.
For example, in the second week of the course students perceived a lecture given by invited practitioners working at a hospital in the area of general practice as to little connect to their learning process. The intent of the seminar was to give an overall picture of Swedish health care system. As a follow-up of the discussions connected to students’ perception, the responsible teacher collaborating with the visiting teacher put on the schedule an extra seminar presenting and discussing projects connected to harmfully traditional practices in non European cultures.
All learning sessions were designed and developed so that there would be a mixture of both student- and lecturer led sessions. Thus, the students from Norway planned and presented a topic connected to the course issue related to their preparation of bachelor thesis which was a question of reproductive and sexual health for young women in Somalia.
Summary of students’ views and ideas about their learning
Findings from the students’ evaluations were integrated in providing feedback and supporting the dissemination of learning activities during the course. The final evaluation was recorded using self-administered questionnaires constructed of both structured and open-ended questions and check-out with whole class.
When asked what impact students felt the learned issue had on them, most of
respondents commented with a “we were very motivated” or “ I did value all aspects
of educational parts in this course” and “ the course have help me a lot in many
different ways. I really like that we have a lot of discussions …” the students also appreciated “… to study together with students from other countries” and become aware on cultural issues in nursing care which was expressed “I think that this course
is very useful for you as a nurse in your work and gives you more awareness and new perspective on culture and transcultural nursing”.
They also stated growing awareness of the importance of “understanding the cultural
influences” and to “communicate with the patients”. Other students’ voices expressed the “hardness of discussing and reflecting on demanding attitudes” and the
importance of awareness to see the patient as an “individual being” rather than “belonging to the entire ethnical group”.
There were also a lot of social interactions among students and they were enjoying their formal and non-formal exchange of ideas and issues. Some of pictures received from the students are down here showing students different ways of their grouping and working with the cases.
Picture: Mia Kolak
Figure 3. Students attending one of PBL groups in TCN course at Malmö University during their bicycle excursion.
All students expressed their collaboration with other students as very well working and they dare to have challenging discussions about their own attitudes as well as how to process the learning projects. All students have even stated that they improved their knowledge about the issued topics as a result of this course. These two subjects were agreed in total having higher students ranking.
The contribution of findings selected in the issues including learning and teaching was supported by the more cross sectional evaluation provided by the whole group of students. These findings are highlighted in the figure 4.
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Question 1
Q3
Q5
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Question 1
Q2
Q3
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Figure 4. Summary of the evaluation performed by the students attending course in Transcultural at Malmö University.
Note: (1 = disagree and 6 = agree)
Question 1: I found the course content meaningful and relevant to the professional aspects of nursing.
Question 2: I found cooperation with teachers working well.
Question 3: I found cooperation with other students within the PBL tasks working well.
Question 4: teaching methods suit content and aims of this course.
Question 5: My knowledge and critical analysis about the issue has improved as a result of this course.
Broad-spectrum discussion
Analysis
One response to the IaH model associated with this course was beyond the theoretical knowledge paying attention to the social involvement of students. Responding to the social needs of foreign students was accomplished by having coffee brakes together within and between groups. Responsible course teacher arranged a joint lunch once every study week. These activities were much appreciated by both students and teachers.
Further, each group has got a task to organise a social event for whole class. First group has organised a social activity by spending time together invited home to one of Swedish students. During the second week the second group organised a bicycle excursion showing Malmö new West Harbour area.
This extended course content approach cultivated a climate supporting involvement in life beyond the campus and classroom, reinforcing influences and connections
between the student groups. In addition, it was given that lecturer knows that these students when academic or behavioural issues arise, might be able to address the problems as a group, rather than to be left to deal with them alone.
Extending the educational approach beyond the educational institution offers not only concrete classroom knowledge but also involves informal learning which can include non-cognitive skills such as self-sufficiency, social abilities or team spirit. These skills are essential in today’s workplaces and may help students adapt to changing working conditions and incorporate new forms of knowledge or information. Supplementary, the responsible course lecturer offered joint activities for the guest lecturer, which gave opportunities to relaxed pedagogical discussions and to learn about each other. Such policies reshape how the university views its obligations to students, but also obviously have implications on the role of lecturer.
Donald Schön (1988)6, writing about reflective practice, makes connections between the contexts, approaches and practical terrain of a profession. A variety of
transcultural nursing scenarios depicted during study visits and confronting by
nursing practice scenarios at the ward could be regarded as the tangible reality for the students in their perception of nursing work contexts and existing transcultural
professional approaches. However, not all versions of transcultural perspectives could be exposed as no single perspective exists, whether from the value driven aspects or reflective point of the professional or student from which to consider the core of the actual matters of practice. After all, the content of the course points out that
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transcultural practice in nursing is plural in the sense that it can take different forms and that its nature can take many different forms in different settings.
There has been a move in the nursing field in Sweden towards developing
occupational standards based on competence approaches identifying common base of values, knowledge and skills. Since the transcultural nursing practice is complex and inherently problematic it was important to encourage students in critical
understanding of nursing process and in the reflective conceptualisation of cultural encounters and of anti-oppressive practice rather than focusing on skills training.
In summary the students were challenged to be creative, think freely and given independence to structure their own process of learning. They were encouraged to collaborate and communicate their ideas, for example through care projects. For students from a more traditional authoritarian teaching culture, this can be more challenging. Some students also comment that the discussions were too long and that the PBL learning was not comfortable. In spite of this the perception of the course can be exemplified by the comment presented in figure 5.
Further development
The theoretical approach and didactical tactics seem to meet students’ needs and were very appropriate for their knowledge development. Based on the students’ feed-back, some minor changes in the schedule are planned for the future.
There have also been more discussions with the partner universities in regard to students’ accommodation abroad and their admission to the course. If there are to be more courses like this one, the question of accommodation has to be resolved. Free stay worked this time, but hosts were difficult to find and it will not be easier in the future.
The group of students attending Malmö course was representing first (Holland), second (Sweden) and third year (Norway) of bachelor education programme. This spread was shown to have a significant importance in relation to students’ critical reflections and their skills in deepening of discussions. In the future it would be wise to reflect on this fact and more clearly state the goal of this kind of gatherings with regard to progression of the bachelor degree.
