1. CONFIDENTIAL ©2014 Chamberlain College of Nursing, LLC. All rights reserved. 0414pfccn
Gigi Sabado Melendez, DNP, MSN, RNC-OB
National Associate Professor
International Studies Program
Effects of an
International Studies
Nursing Program on
Cultural Competency:
Philippines

2. Objectives
• Comprehend historical background of international
studies program
• Outline the three components of the international studies
immersion experience
• Recognize four community health activities students
participated in
• Identify the themes from the immersion experience
which highlighted the increased cultural competency
in nursing students

3. Population Trends
• More than half of all children will
be minorities
By 2023
• > 54% of total population will be minorities
• Projected percentages:
• Caucasian  44%
• Hispanic 30%
• African American 15%
• Asian  9%
• American Indians & Alaska Natives 2%
By 2050
(Reference: Health Resources and Services Administration Bureau of Health Professions
National Center for Health Workforce Analysis April 2013, p. 15-16; The U.S. Health Workforce Chartbook- Part I)
(U.S. Census Bureau, 2009)

4. Diversity Among Nurses
Minorities are generally underrepresented
by nursing workforce
• Caucasian 75.4 - 83.2%
• African American 5.4 - 9.9%
• Hispanic  3.6 - 4.8%
• Asian and Pacific Islander  5.8 - 8.3%
• Native-American & Alaska Native 
0.3 - 0.4%
(Reference: Health Resources and Services Administration Bureau of Health Professions
National Center for Health Workforce Analysis April 2013, p. 15-16; The U.S. Health Workforce Chartbook- Part I)

5. National Initiatives Addressing Racial
and Ethnic Disparities

9. Philippines Experience
• A 17-day intense immersion experience in Manila,
Philippines with experiences in the provinces as well
• A collaborative effort
– Prayers of Day Foundation
– Gawad Kalinga, USA
– Medical Surgical Mission of Texas
• Meant to be a long-term partnership
– With the ultimate goal of improving health outcomes in
the Philippines

10. Continuing Relationship is Important
• Partnership
• Opportunities to expand education
– social, cause-related and field experiences
• Learn about the host country’s culture
• Provide healthcare in impoverished urban and rural areas

12. Aim of Capstone Project
• To validate and enhance the current international
studies nursing program in which senior level
nursing students participate
• To describe the effects of a cultural immersion experience
in the Philippines on nursing students

13. Does an international cultural immersion combined
with community health nursing and cultural diversity
courses promote the achievement of cultural awareness
and/or cultural competence while working towards “optimal”
cultural competence in senior level nursing students?

14. Literature Review
Value of immersion
experiences in
increasing cultural
competency is
confirmed (Amerson,
2010; Bentley &
Ellison, 2005; Bentley
& Ellison, 2007;
Caffrey, Neander,
Markle, & Stewart,
2005; Kirkham, Van
Hofwegen, &
Pankratz, 2009;
Larson, Ott, & Miles,
2010; Worrell-
Carlisle, 2005).
Not all international
nursing experiences
are entirely positive.
• Experienced some
degree of culture
shock (Jenkins,
Balneaves &
Lust, 2011)
Most studies of
American nursing
students were
quantitative
(Edmonds, 2012)
Best practice
recommendation:
teach cultural
competency and offer
these experiences
during nursing school

16. Design
Post-trip Phase
Re-entry Meeting Community Health Cultural Diversity
Trip Phase
Medical Clinics Surgery Home Visits
Pre-trip Phase
Recruitment Interviews Meetings Packing Day
International Service Project
Pre-trip Trip Post-trip

17. Healthcare Needs

18. 18

19. Home Visits

20. 20CULTURAL IMMERSION

21. 21COMMUNITY EXPLORATION

22. Methods

24. Themes Emerged
• Helplessness
• Lessons learned
• Affirmation
• Reverse culture shock
• Differences in healthcare
• Life-changing experience
• Culture shock
• Communication
• Collaboration
• Adaptability and creativity
• Teamwork
• Self-confidence
• Appreciation

25. What concerns do you have about
being the minority culture?
“I was actually not a minority anymore
which made me feel good. I was able
to communicate with my patients
with broken Tagalog which made me
feel great because I felt they trusted
me and appreciated me more when
I started speaking Tagalog.”
“It never really crossed my mind that
I was a minority until Heidi and I
were shopping at Mall of Asia alone.
The people were so welcoming that
I felt pretty normal in regards to
being different. Once Heidi and I
were alone somewhere we didn’t
know and no one with us who did
know
I started to feel a little uneasy. I noticed
people staring and could feel that I
was different than practically
everyone there.”

26. Final Reflection: As I prepare to board the
airplane to go back home, my main thought
about the international nursing experience is…
“It was a life changing experience.
I am so glad that I got this opportunity.
Not only did I learn about another
culture, I learned about myself.
I now have a new outlook on life.
My nursing skills were put to the
test and I passed. I am ready to
be a nurse. I will remember this
trip forever.”
“This experience was amazing and I
can’t believe that it’s over! I learned
so much about myself, my patients,
my team, the Philippines and
especially my culture. I am so happy
that I applied and was selected for
this trip. This is definitely a life changing
experience and I wish to do more
medical missions in the future.”

27. 27

29. References
• Amerson, R. (2010). The impact of service-learning on cultural competence. Nursing Education Perspectives, 31 (1),
18-22.
• Callister, L. C., & Cox, A. H. (2006). Opening our hearts and minds: The meaning of international clinical nursing
electives in the personal and professional lives of nurses. Nursing and Health Sciences, 8, 95-102.
• Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of
care. Journal of Transcultural Nursing, 13(3), 181-184.
• Campinha-Bacote, J. (2011). Delivering patient-centered care in the midst of a cultural conflict: The role of cultural
competence. Online Journal of Issues in Nursing, 16(2), 5-5. Retrieved from
http://search.proquest.com/docview/905670307?accountid=27965
• Chen, H. C., & McAdams-Jones, D. (2011). Developing cultural competence in nursing students through service-
learning. Paper was accepted for poster presentation in the 2011 WIN Annual Communicating Nursing Research
Conference, April 13-16, 2011, in Las Vegas, Nevada.
• Dickenson-Hazard, N. (2004). Global health issues and challenges. Journal of Nursing Scholarship: An Official
Publication of Sigma Theta Tau International Honor Society of Nursing / Sigma Theta Tau, 36 (1), 6-10.
• Edmonds, M.L. (2012) An integrative literature review of study abroad programs for nursing students. Nursing
Education Perspectives, 33 (1), 30-34.
• Fitzgerald, E., Cronin, S., and Campinha-Bacote. (2008). Psychometric testing of a proposed student version of the
tool inventory for assessing the process of cultural competence among healthcare professionals-revised.
• Marie, J. (2010). Influence of an overseas clinical placement on the acquisition of cultural competence in chiropractic
students. Murdoch University, Australia.

30. References
• Okere, S., Gleeson, P., Melzer, B., Olson, S., & Mitchell, K. (2011). Psychometric testing and the effects of a cultural
competence education module on the cultural competence of student physical therapists: a pilot study. Presentation at
American Physical Therapy Association 2011 Annual Conference and Exposition. National Harbor, MD.
• Olt, H., Jirwe, M., Gustavsson, P., & Emami, A. (2010). Psychometric evaluation of the swedish adaptation of the inventory for
assessing the process of cultural competence among healthcare professionals- revised (iapcc-r). Journal of Transcultural
Nursing, 21(1), 55-64.
• Palombaro, K.P. & Lattanzi, J.B. (2012). Calculating the minimal detectable change and the minimal clinically important
difference for a cultural competency tool. Submitted to Physical Therapy Journal of Policy, Administration, and Leadership, in
review.
• Schmidt, N. A. & Brown, J. M. (2008). Evidence-based practice for nurses: appraisal and application of research. Burlington,
MA: Jones & Bartlett Publishers.
• Wilson, S. (2011). A comparison of nursing student's levels of knowledge: cultural competence in providing care public versus
private colleges.
• Wilson, A., Bennett, D., Dorman, G., Holtz, C. and Bairan, A. (2012). Cultural competence and perceptions of the mexican
culture among undergraduate and graduate nursing students. Presentation at Sigma Theta Tau International STTI Biennial
Convention.
• Young, S. (2009). An assessment of cultural diversity training: An experiment for hawaii nursing students. Medical University of
South Carolina - College of Health Professions. ProQuest Dissertations and Theses, 84-n/a. Retrieved from
http://search.proquest.com/docview/305158157?accountid=27965. (305158157).