The Impact of International Service-Learning on Nursing Students' Cultural Competency.

PURPOSE: This article reports research findings on the effect of an international immersion service-learning project on the level and components of cultural competence of baccalaureate (BSN) nursing students.

DESIGN: A triangulated methodology was used to determine changes in components and level of cultural competence pre- and postexperience. The theoretical model The Process of Cultural Competence in the Delivery of Healthcare Services was used. It identifies five central constructs in the process of becoming culturally competent: cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. The sample of 121 BSN nursing students was gathered from three southern California universities. Data were collected from 2009 to 2013.

METHODS: Using the Inventory for Assessing the Process of Cultural Competence Among Healthcare Professionals-Student Version© and Cultural Self-Efficacy Scale, constructs of cultural competency were measured in pre- and posttest participants who participated in international service-learning immersion experiences. A demographic survey and open-ended qualitative questions were completed at the posttrip meeting. Mean, frequencies, and correlations with demographic data and survey data were calculated. Pre- and posttrip means were analyzed. Qualitative analysis from six open-ended questions completed at the posttest were coded and themes emerged.

FINDINGS: The research findings demonstrated the impact of the international service-learning project on building cultural competency in nursing students. Quantitative findings revealed statistically significant differences between pre- and posttest surveys for two of the five constructs of cultural competence. Qualitative analysis supported the quantitative findings in cultural competency constructs found in the model.

CONCLUSIONS: The research findings support nursing education program use of international service-learning immersion experiences to foster cultural competence in nursing students. Findings from student participants demonstrated and articulated that these program experiences strengthen the process of becoming culturally competent. The research findings support the inclusion of international service-learning experiences with debriefing and reflective learning as effective teaching strategies. Researchers have demonstrated that poor healthcare outcomes are a result of health disparities, which are then compounded by healthcare workers not being prepared to care for clients from differing cultures. The American Association of Colleges of Nursing identified innovative ways for nursing students to develop skills in cultural competency, which included international experiences.

CLINICAL RELEVANCE: In nursing education, this study demonstrated that international service-learning immersion experiences are of value as they impact and improve cultural competency. Nurses graduating with enhanced cultural understanding will contribute to decreased health disparities and improved patient care quality and safety. Further research that examines nurses' cultural competency in the patient care setting who have had previous education in international nursing could further inform nursing education and contribute to the understanding of patient satisfaction.