This document discusses the importance and benefits of study abroad programs for nursing students. It provides an overview of the growth of study abroad and common goals such as personal growth, a global perspective, and career enhancement. The document then describes a specific study abroad program where nursing students and faculty traveled to Romania. It details the objectives, student experiences, and lessons learned from setting up collaborations and educational initiatives abroad. Guidelines are provided for developing a study abroad nursing program and ensuring student safety and success.

1. Chapter 29
Study Abroad as a Strategy for
Nursing Education

2. Study Abroad as a Strategy for
Nursing Education
• Importance of Study Abroad Programs for
Students’ Education
• Overview of the Growth of Study Abroad
Programs
• Common Goals of Study Abroad Programs
• Study Abroad in Health Professions Versus
Mission Trips

3. Study Abroad as a Strategy for
Nursing Education
• Faculty and Student Experiential Learning in
Eastern Europe: Brasov, Romania
• Guidelines for Setting up a For-Credit, Elective,
Study Abroad Program for Student Nurses
• Setting up for Success

4. Study Abroad as a Strategy for
Nursing Education
• The United States is experiencing the largest
sustained immigration wave in its history.
• 15% of the U.S. population is comprised of
people from Latin American (both legal and
illegal immigrants).
• The United States accepts more legal
immigrants as permanent residents than any
other country in the world.

5. Importance of Study Abroad
Programs for Students’ Education
• As a result of globalization, nursing graduates
are likely to care for individuals from diverse
cultural and ethnic backgrounds and may find
themselves in work settings outside the United
States.
• Increase in global immigration has changed the
cultural tapestry of American society.
• Immigration has challenged public and private
institutions to respond to groups that are of
different religions, cultural beliefs, and
traditions.

6. Importance of Study Abroad
Programs for Students’ Education
• The challenge to gain a more multicultural
perspective of health and traditions of health
care is particularly essential among nurses.
• Clients from cultures other than that of the
nurse often do not benefit from nursing care
because of miscommunications,
misunderstandings, and/or conflicts of values,
beliefs, norms, and attitudes between
themselves and the nurse.

7. Importance of Study Abroad
Programs for Students’ Education
• Cultural competence is an ongoing process of
seeking cultural awareness, cultural
knowledge, skill, and cultural encounters.
• Maintaining an open attitude in examining
one’s own prejudices, attitudes, and
stereotyped perceptions is essential before one
can learn about people of other cultures.

8. Importance of Study Abroad
Programs for Students’ Education
• It is not the client’s responsibility to be
understood, but the nurse’s responsibility to
understand and meet the client’s needs.

9. Overview of the Growth of
Study Abroad Programs
• Study abroad programs can be effective in
facilitating students in gaining a more global
perspective, including cultural understanding
of individuals from different health traditions,
is an evolving component of their role as
educators.
• The goal of study abroad programs is to
expand students’ perspectives of the world,
promote a sensitivity to beliefs and traditions
different from their own, and promote a sense
of intellectual openness.

10. Overview of the Growth of
Study Abroad Programs
• Study abroad education provides students
with a distinct advantage upon graduation.
• An increasing number of healthcare
corporations are looking for candidates who
have the ability to communicate and work with
people from various cultural backgrounds.

11. Common Goals of Study
Abroad Programs
• Personal growth and experiential
learning
• A global perspective of the world
• Career enhancement

12. Common Goals of Study
Abroad Programs
• Personal Growth and Experiential
Learning
– Faculty and students who return from a
study abroad program often see it as an
experience that matured them personally
and intellectually.
– They praise being exposed to new ways of
thinking and living, which encourages
growth and independence.

13. Common Goals of Study
Abroad Programs
• Broad Perspective of the World
– Study abroad can broaden intellectual
horizons and deepen knowledge and
understanding of international, political,
social, and economic issues.
– A person learns how others view the United
States and its world role.

14. Common Goals of Study
Abroad Programs
• Career Enhancement
– Study abroad can enhance employment
prospects, especially in health care,
informatics, international affairs and
government service.
– Employers increasingly seek graduates who
have studied abroad.

15. Study Abroad in Health
Professions Versus Mission Trips
• Study abroad in health professions
provide students with specific goals and
objectives to achieve within an academic
setting.
• The emphasis is intellectual,
professional, and objective.
• Mission trips have similar goals, but they
also have a religious, political, or
economic focus.

16. Faculty and Student Experiential
Learning in Eastern Europe:
Brasov, Romania
• Background
• Creation of an Eastern European Nursing
Collaboration
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei

17. Faculty and Student Experiential
Learning in Eastern Europe:
Brasov, Romania
• Background
– The need for palliative care for patients with
malignant disease in southeast Europe is
immense.
– In 2002, Romania had one practicing
physician for every 580 people.

18. Faculty and Student Experiential
Learning in Eastern Europe:
Brasov, Romania
• Background
– Many people do not seek health care
because of fear.
– Education regarding prevention, early
diagnosis, and treatment is lacking, and
healthcare costs are assumed by individuals
and their families.

19. Faculty and Student Experiential
Learning in Eastern Europe:
Brasov, Romania
• Creation of an Eastern European Nursing
Collaboration
– Establishing collaborative nursing education
and practice programs ultimately improves
clinical experiences and patient care.

20. Faculty and Student Experiential
Learning in Eastern Europe:
Brasov, Romania
• Creation of an Eastern European Nursing
Collaboration
– The vehicles for collaborative education
included clinical site visits at home, visits at
the inpatient hospice, and continuing
education programs with the Romanian
nurses via on-site conferences. The
collaboration was sustained following
return of the visit by teleconferencing,
research, and publications.

21. Faculty and Student Experiential
Learning in Eastern Europe:
Brasov, Romania
• Creation of an Eastern European Nursing
Collaboration
– In the beginning, cultural and language
differences challenged the growth of the
collaboration
– In Romanian hospitals, clinical nursing
practice does not change according to the
new findings in the research field.

22. Faculty and Student Experiential
Learning in Eastern Europe:
Brasov, Romania
• A current emphasis on developing
nursing literature, obtaining skill for
writing articles, and expanding support
for palliative care training programs in
remote countries affiliated with the
Hospice of Hope are the current
priorities of the NEA.

23. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Objectives
– Setting up the Program
– Nursing Student Experiences
– Forging the Educational Initiative
– Student Prerequisites and Preparation
– Recruitment of Students for the Trip

24. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Orientation
– Donations of Supplies and Equipment
– Educational Planning for the Visit
– Teleconferencing
– Course grade requirements
– Student course evaluations

25. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Objectives
• Explore personal attitudes and beliefs
about patients in Brasov, Romania.
• Examine structure and function of
healthcare delivery to patients in
hospices and patients receiving palliative
care in Brasov and Bucharest.

26. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Objectives
• Explore main health issues identified by
local communities, including the Roma or
gypsy community.
• Participate in healthcare delivery.
• Improve Romanian Language Skills
• Explore health beliefs and cultural
customs.

27. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Setting up the Program
• The initial process in developing the
nursing experience in Brasov began with
a visit to the area to determine the
feasibility of establishing a 2-week
intensive study abroad nursing course.

28. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Setting up the Program
• The NEA team visited Romania and
practiced with nursing colleagues
biannually in 2005–2011.
• Quarterly teleconferences with the
Romanian nurses have deepened the
professional relationship.

29. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Nursing Student Experiences
• Face-to-face contacts provided
opportunities to develop an
understanding of cultural differences,
discuss expectations regarding
educational approaches, and begin to
establish a relationship based on mutual
respect.

30. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Nursing Student Experiences
• The visiting American students and team
members accompanied the hospice
nurses on their home visits
• In their journals and in postconference
meetings, the students noted that
meeting patients and hearing their stories
was engaging and saddening.

31. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Nursing Student Experiences
• ELNEC – End –of-Life Nursing Education
Curriculum
• Focuses on pain and symptom
management, communication and
culture, care at the time of death, and
grief

32. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Forging the Educational Initiative
• The students and the faculty team
discussed a number of alternatives for
responding to the request from Romania.
• Teleconferencing was identified as the
most cost-effective approach, although
they had no equipment.

33. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Forging the Educational Initiative
• The administrators from Hospice Casa
Sperantei began looking for a source of
funding for the project, and a well-known
philanthropic organization donated the
equipment and oversaw the installation

34. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Student Prerequisites and Preparation
• Prerequisites for all student nurses
included having completed at least the
initial core graduate nursing courses with
a clinical component, giving them skills in
advanced health assessment.
• Most students were more advanced

35. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Student Prerequisites and Preparation
• Reading material assignments were given
along with the student course syllabus so
that students could prepare for their
experiences ahead of time
• Payment included health insurance,
emergency air evacuation and
immunizations.

36. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Recruitment of Students for the Trip
• Fliers, information sessions, financial info

37. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum
– Orientation
• 3 sessions about 3 months prior to trip
• Group discussion addressed lodging, personal
safety needs, documents, money, packing needs,
special health challenges, housing, transportation,
working in the field and in hospices, group
dynamics and collaboration, culture shock and
adjustments, cultural excursions, and cultural
sensitivity and appropriate dress and behavior

38. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Donations of Supplies and Equipment
• Romanian nurses did not have sufficient
medical supplies for the patients being
treated
• Supplies assembled from a variety of
sources and brought with the team.

39. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov, Romania, at
Hospice Casa Sperantei
– Educational Planning for the Visit
• Specific topics were picked by the Romanian
hospice director
• Us Team Members were paired with Romanian
nurses to accompany them on home visits.
• Romanian nurses lacked confidence and US
nurses could validate and encourage them.

40. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Teleconferencing
• Teleconferencing is a very flexible and
cost-effective teaching strategy.
• In the United States, clinical supervision
and education of 10 psycho-oncology
staff was provided monthly through the
use of videoconferencing. One-hour
educational programs were followed by
1-hour discussions.

41. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Teleconferencing
• Several topics were suggested by the
Romanian team and addressed on a
scheduled basis.
• Electronic communication has presented
opportunity to advance practice methods
and provide validation for nursing
actions.

42. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Course Grade Requirements
• The student work was graded according
to the expectations and outcomes
outlined in the course syllabi.
• Students were required to attend all pre-
and post-practice conferences, as well as
participate in the hands-on clinical work
with the Romanian nurses.

43. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Course Grade Requirements
• All students were asked to keep a journal
in the format of critical reflective
thinking. Their feelings, thoughts,
responses, observations, and activities
were recorded.

44. Faculty and Student Experiential
Learning in Eastern Europe:
• The Nursing Practicum in Brasov,
Romania, at Hospice Casa Sperantei
– Student Course Evaluations
• Formative and summative evaluations
usually provide valuable information
about immersion experiences. Reported
student observations during and after the
visits can be helpful in shifting day-to-day
priorities and course objectives to
improve the experience for the future.

45. Guidelines for Setting up a For-Credit,
Elective, Study Abroad Program for
Student Nurses
• Create a proposal
• Obtain support from the University
• Make a preparation visit to the proposed
location
• Meet with a tourist travel agency
• Recruit Students
• Plan and document the experience while
at the location

46. Setting up for Success
• 1. Always write a code of behavior, emphasize
it at recruitment, at orientation, and during the
visit to the host country. Have students sign
the behavior code.
• 2. Always have health insurance with
evacuation coverage for all students and
faculty. It is very reasonable. Do not rely on
local healthcare facilities for serious accidents
or illnesses. For minor problems, they usually
will be fine.

47. Setting up for Success
• 3. Make sure that all students stay in the local
city at all times and spend the night with host
families every night.
• 4. Review safety precautions for money
(under-the-clothing money bags for traveling)
and locking valuables such as passports,
money, credit cards, and cameras with their
host family.

48. Setting up for Success
• 5. Constantly remind students about what and
where is safe to eat and drink, and be sure that
they are always aware.
• 6. Always watch luggage and carry-ons at
airports. Things may disappear very quickly,
especially in developing countries, if they are
valuable and unattended.

49. Setting up for Success
• 7. Be prepared to deal with culture shock.
Language, customs, and in some locations
tremendous, never-before-seen poverty can
overwhelm faculty and students. Many poor
people, including those begging in the streets,
can be overwhelming. Giving away prepared
sandwiches and fruit or bread can be a group
activity that can help some of the
overwhelming feelings of frustration.

50. Setting up for Success
• 8. Have students always travel in groups and
always carry information with them regarding
their host family homes and contact
information for reaching faculty 24/7.
• 9. Always be available to students 24/7. This is
not like the responsibility of a classroom on
campus.