Transformative events while studying public health nursing in a developing nation

Nurse educators have become increasingly focused on the development of intercultural proficiency among nursing students who engage in experiential learning during study abroad programs. While current literature is almost universally positive with respect to the potential for meaningful cross-cultural exchange, questions remain about what makes specific experiences and events transformational during these study abroad courses. Existing assessment tools may not help educators understand which experiences are most meaningful in changing students' lives or future clinical practices. Two parallel sections of the same senior level nursing course were offered to students willing to travel abroad to either Bangladesh or Uganda to learn the skills of public health nursing and selected aspects of global public health. Although there are unique activities and foci for each country, all students were required to write reflective journals and discuss concerns. Comparative analysis of student journals over a two-year period provides insight into the process of cultural immersion, engagement, and re-entry into the home country, as well as into the features of each setting that facilitate or inhibit transformational learning. Students identified circumstances in which they felt either empowered and useful, or powerless and frustrated as 'life-changing'. Recognition of their limitations as change agents had a temporarily dampening impact on their sense of self efficacy. Lack of language proficiency was seen as a barrier. Nurse educators may want to structure experiences that challenge students' self-conceptions and encourage them to stretch beyond their capacities, while acknowledging their potential for continued growth.