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An Interpretive Qualitative Study of Baccalaureate Nursing Students Following an Eight-Day International Cultural Experience in Tanzania

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An Interpretive Qualitative Study of Baccalaureate Nursing Students Following an Eight-Day International Cultural Experience in Tanzania AN INTERPRETIVE QUALITATIVE STUDY OF BACCALAUREATE NURSING STUDENTS FOLLOWING AN EIGHT-DAY INTERNATIONAL CULTURAL EXPERIENCE IN TANZANIA A dissertation submitted to the Kent State University College of Education, Health, and Human Services in partial fulfillment of the requirements for the degree of Doctor of Philosophy by Mary Lou Gemma Ferranto May 2013 © Copyright, 2013 by Mary Lou Gemma Ferranto All Rights Reserved ii A dissertation written by Mary Lou Gemma Ferranto B.S.N., Kent State University, 1974 M.S.N., La Roche College 1987 Post Master’s Adult Nurse Practitioner Kent State University, 1997 Ph.D., Kent State University, 2012 Approved by _______________________________, Co-director, Doctoral Dissertation Committee Teresa J. Rishel _______________________________, Co-director, Doctoral Dissertation Committee Kenneth Cushner _______________________________, Member, Doctoral Dissertation Committee Tricia Niesz Accepted by _______________________________, Director, School of Teaching, Learning and Curriculum Alexa L. Sandmann Studies _______________________________, Dean, College of Education, Health and Human Daniel F. Mahony Services iii FERRANTO, MARY LOU GEMMA Ph. D., May 2013 TEACHING, LEARNING AND CURRICULUM STUDIES AN INTERPRETIVE QUALITATIVE STUDY OF BACCALAUREATE NURSING STUDENTS FOLLOWING AN EIGHT-DAY INTERNATIONAL CULTURAL EXPERIENCE IN TANZANIA (265 pp.) Co-Directors of Dissertation: Teresa Rishel, Ph.D. Kenneth Cushner, Ph.D. Intercultural competence through study abroad is widely recognized as a preferred teaching approach for the development of globally competent health care practitioners. Colleges and universities are looking for multiple ways to encourage students to study abroad because of the noteworthy effects that these experiential opportunities have on students. Sparse research has been conducted to determine if short-term study abroad trips of less than two weeks are achieving these same outcomes. The purpose of this basic interpretative qualitative study was to describe the nature and meanings of a short-term international cultural experience for nursing students, and whether or how their understanding of the role of the professional nurse was changed. A group of baccalaureate nursing students traveled to Tanzania and took part in professional and social opportunities over an 8-day period. All participants were required to complete a nursing course with global objectives prior to the trip and pre- immersion seminars. Data were collected from reflective journals during the study abroad experience, focus group discussions one month after returning home, and personal interviews 6 months later. The results indicated that the participants experienced culture shock, but they also gained in self-awareness, cultural empathy, leadership skills, a desire to learn more, and a new perspective of the role of the professional nurse. Langer’s theory of Mindfulness, Bennett’s Developmental Model of Sensitivity and Campinha- Bacote’s Process of Cultural Competence provided the theoretical framework for this study. ACKNOWLEDGMENTS My passion to expand my knowledge in order to improve patient and student outcomes has led me to pursue my Doctor of Philosophy, at the ripe old age of 60. I would like to express my gratitude to my dissertation chairs Dr. Teresa Rishel and Dr. Kenneth Cushner. I thank you for your patience, support, and invaluable insight. I am so grateful that you ignored the fact that I was probably the oldest Ph.D. student in the program. Without your support and knowledge, I would not have made it through this long and arduous process. Thanks to Dr. Rishel for her endless editing and to Dr. Cushner (the culture guru) for sharing his wealth of knowledge with me. I want to extend a special thanks to Dr. Tricia Niesz, one of the finest educators that I have had the pleasure of knowing and a member of my dissertation committee. She began this journey with me long ago while I was a student in her Qualitative Research class. It was with Dr. Niesz that I developed my research questions and methodology, and I will forever be grateful. A special thanks to my extraordinary friends Lorene, Karen, Celeste and Debbie; I do not know how I would have managed without your friendship, editing and advice. To my Salem campus colleagues who cheered me on . thank you for your support. For the nursing students at the Salem campus . thanks for stopping by and asking, “how is it going?” You are the reason for this dissertation. For my family and close friends, thanks for the good times and the distractions (and the wine) it helped! A very special thank you to my children Michael, Vanessa, and Alysse . this is for you. I could not have done this without your steadfast support and iv your belief in me. You bring so much passion and joy to my life; you have always made me so proud! To my “other” children, Mauris, Khalen, and Michael, thanks for your “humor” and patience . you made me laugh at myself on many occasions, which helped through this process. To my twin grandbabies, Isla and Oliver . I know that you thought that the computer was an extension of my body, but it is not. Now we can play!!! Finally, to my friends from Tanzania . you will always hold a special place in my heart. I hope that we will meet again soon! TABLE OF CONTENTS Page ACKNOWLEDGMENTS ................................................................................................. iv LIST OF TABLES ...............................................................................................................x CHAPTER I. INTRODUCTION ......................................................................................................... 1 Growing Body of Evidence Supporting International Study .................................. 4 Problem Statement .................................................................................................. 7 Purpose of Inquiry................................................................................................... 8 Research Questions ................................................................................................. 9 Research Methods ................................................................................................... 9 The Epistemology of the Constructionist ............................................................. 10 The Ontological Framework of This Study .......................................................... 11 The Constructivist Paradigm and the Ontology of Holism ................................... 12 Theoretical Framework of This Study .................................................................. 14 Langer’s Theory of Mindfulness ................................................................... 14 Bennett’s Developmental Model of Intercultural Sensitivity (DMIS) .......... 15 Campinha-Bacote’s Process of Cultural Competence in the Delivery of Healthcare ...................................................................................................... 16 Definitions of Terms ............................................................................................. 17 Cultural Awareness and Cultural Sensitivity ................................................. 17 International Cultural Experiences Defined .................................................. 20 Limitations and Delimitations ............................................................................... 20 Limitations ..................................................................................................... 20 Delimitations .................................................................................................. 20 Assumptions .................................................................................................. 21 Contribution to the Knowledge Base as a Result of This Research ..................... 21 Dissertation Outline .............................................................................................. 22 II. LITERATURE REVIEW ............................................................................................. 25 Introduction ........................................................................................................... 25 The Impact of Culturally Incompetent Practitioners on Health Care Outcomes ...............................................................................................................25 Teaching of Intercultural and Transcultural Content ......................................27 Current Approaches to Intercultural and Transcultural Learning in Nursing ...........................................................................................................28 International Study Abroad Programs as Pedagogy .......................................32 Outcomes of International Cultural Experiences ............................................32 The Benefits of Long-Term Study Abroad Programs ................................... 34 Is a Long-Term International Experience Necessary? ................................... 36 Alternative Experiential Learning Opportunities .......................................... 39 Deterrents to Study Abroad or Immersion Programs .................................... 42 Challenges in Study Abroad .......................................................................... 44 Effective Pedagogy in Study Abroad ............................................................ 47 The Use of Reflection and Short-Term Immersion Experiences ................... 48 The Need for Short-Term
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