A study abroad immersion program to build nursing students' cultural competence

Background: The 6-week, 6-credit, international immersion program in Guadalajara, Jalisco in Mexico was designed to enhance nursing students' awareness and acceptance of their patients' health beliefs and students' skills for working with people from varied backgrounds. We examined students' perceptions of the program's effect on their personal and professional lives. Our guiding questions were: 1) How did the study abroad experience influence participants' awareness, sensitivity, knowledge, and skills related to the culture of the people of Guadalajara, Mexico? 2) How did the study abroad experience influence participants' clinical nursing practice upon return to the US? Methods: This program evaluation used quantitative and qualitative methods. Data from 18 undergraduate and graduate nursing students enrolled in the fourth year of the study abroad program were collected using the Cultural Awareness Survey (adapted from Rew, 2003) to describe the students' beliefs at the start of the program. Open- and close-ended questions asked students about the program's impact on their knowledge, skills, attitudes, and beliefs at the end of the program. We also analyzed students' reflective journals submitted during the program and individual and group interviews after the program. Qualitative data were analyzed for themes. Results: Students scored high on cultural awareness in the areas of their general education, clinical experiences, and comfort with cross-cultural interactions at the start of the program. At the end of the program, they reported they believed the study abroad program enhanced their cross-cultural abilities. Their journals and interview data describe their perspectives during and after the program. The main themes that emerged were that students were more confident in their Spanish language skills and they had a new appreciation of Mexican culture and health care systems, their own culture and US health care systems, and of the relationship between culture, communities, and health. Conclusions: These findings suggest that an international study abroad experience incorporating cultural immersion, language instruction, interaction with patients, families, and health care providers, and use of ecological models to examine health care beliefs and practices increased nursing students' awareness of social determinants of health and increased all aspects of cultural competency.