East meets West: The partnership experience with overseas/local students in their workplace

East meets West: The partnership experience with

overseas/local students in their workplace

Ms Sharon Cheung & Ms Sandra PunSchool of Nursing,

The Hong Kong Polytechnic University

2

Exchange Exchange Programme/Overseas Programme/Overseas

Clinical PlacementClinical Placement

Year Number of students Location

1998 31 Chinese Mainland Overseas countries

2000 63 29 out of 63 students participated in a study tour in Hawaii, USA

2005 139 107 to mainland (20 to Henan) 6 to Thailand 20 to UK & Australia 6 outbound exchange to Australia

The programme was introduced by the School of Nursing from 1998 with increasing no. of students recruited

3

Aims of student Aims of student exchange/exchange/overseas clinical overseas clinical

placementplacement Provide exposure to overseas nursing experience

Enrich the clinical experience through participation in the patient care and observation from delivered care

Develop understanding of overseas health care system

Further develop students’ ability to communicate with people of other culture and ethnic groups

Acquire an understanding of the trend and development of health care services in that country

Gain professional and life experience in a different culture.

4

Exchange programmeExchange programme Aims:

provide opportunity for students to enhance cultural and knowledge exchange during overseas studying/placement

offered the exposure to a global dimension to student’s university life and personal or professional development

Development on three aspects: Enhance intellectual development increased global understanding Enhance personal development(Thompson, Boore & Deeny, 2000)

5

Background of the studyBackground of the study

Past studies highlighted- Positive aspects of the learning experience Personal growth of exchange students(Grant & Mchenna, 2003)

Few of them described- Clinical practice experience Problems encountered by students with exchange placement a

mong western countries. Explore the difficulties that students might encounter Strategies students used to deal with the encountered problem

s during placement None of these studies explored-

the exchange experience of nursing students between the Western and Asian countries in their workplace

6

Aims of the studyAims of the study Understand the actual learning process Understand the exchange experience of nursin

g students from these countries. Allows the local nursing students to share their

partnership experience with overseas students Explore the mentorship experience of local men

tors with both inbound and local students Students who would like to join the programme will be b

etter informed and prepared for their exchange

7

ObjectivesObjectives To understand the expectations and objectives of

exchange students prior to their departure To explore the learning experiences of exchange

students (including inbound, outbound & local students) To identify any difficulties that the exchange students

might encounter during the exchange programme and explore their strategies to overcome these difficulties

To explore students’ post experience reflection on the exchange programme

To describe the partnership experience of local/overseas students during their clinical placement

To identify effective teaching strategies and the benefits of the exchange programme from local mentors’ perspective

8

Design of the studyDesign of the study A descriptive/exploratory approach: Investigate the experience of students & mentors participated in the ove

rseas exchange programme

A phenomenological approach: to explore the lived experience gives meaning to each person’s perception of a particular phenomen

on (Polit, Beck & Hungler, 2001)

Main sources of data: The in-depth conversations from the researcher and informant as the

full co-participant. The informants was asked to describe their lived experiences witho

ut leading the discussion

9

Sample recruitmentSample recruitment Subjects in this study:

Students and local mentors who had undertaken/partnership experience with the exchange programme at the School of Nursing, the Hong Kong Polytechnic University in academic year 2004 & 2005 (Both inbound and outbound exchange)

Number of exchange students/local mentors recruited

Participated programme

12 6 --- inbound exchange students6 --- outbound exchange students

8 Local students had clinical placement with inbound students

3 Local clinical mentors supervising inbound & local students in a group (> 4 weeks)

10

Data CollectionData Collection •Ethnical approval was obtained prior to study

•An information sheet and consent form was given to the selected participants for their consent to participate in the study

Methods to collect data:•Group interviews and/or individual interviews (A semi-structured questionnaire was used as an interview guide)•Students’ learning objectives prior to their departure of home country•Reflective journal during overseas placement & their expectations of the programme•Post-experience reflective journal upon completion of programme

Remarks: Callister (cited in Grant & McKenne, 2002) highlighted the benefit of journal writing - can allow students to release their emotions and feelings about clinical experience.

11

Data AnalysisData Analysis By categorization scheme:

Classify and index the materials in order to facilitate further retrieval and review.

Collected data was transcribed into word processing document

The data further converted into smaller and manageable units

Coding schemes was used with clear named category

Researchers meetings: Review the contents of the narrative data.

Results of data analysis were sent back to participants for clarification and ensuring accuracy

12

Framework for data analysisFramework for data analysis Before the start of exchange Learning objectivesStudents’ preparationStudents’ feeling about the exchange programme

After completion of exchange programme Professional developmentDifficulties encounteredStrategies used to overcome these difficulties

Partnership experience with local students & supervisors

Recommendations from students and supervisors

Mentorship experience of local supervisors

13

Learning objectives for exchange clinical placement

Inbound exchange students(from UK and Australia)

Outbound exchange students (to Victoria University)

Professional context

Expose to different clinical setting in other countryImprove various clinical skillsTry to look after 3-4 patients independentlyensure safetyLearning attitudes: -learn actively -making effort to learnDeal with language barrierWant to make good impressionTry to do best: -work harder -listen to mentor, patientGain personal goals

expose to different health care system being able to know the common diseases more familiar with case managementLearn to be independent & open-minded

14

Preparation before exchange Inbound exchange students Outbound exchange students

Personal context

Search information on:UniversityHospitalGovernment – health care systemCommon diseases in HK – SARS, FluOther tourist information

packing luggageSearching information about Melbourne and VUSearching emergency contact no. in Melbourne, with university contact personJoin English activities (Big mouth corner)Watch TV (Pearl)


(not mentioned) drug knowledge Focus on geriatric and pediatric areacommunication skill with kidsPractice in laboratorySearch information on the web about health care system Review study materialsReview subject contents & syllabus of clinical practice

15

Feelings before exchangeInbound exchange students

Outbound exchange students

Local students (partnership with inbound students)

Worry about communication skills (language barrier)

Worry due to uncertainty but eased by setting learning objectives

Difficult to pack luggage, afraid of missing necessary items

The Leader decision making required to raise questions to coordinator for groupmates

Feel happy, excitedLearn from nursing students from different culture Looking forward, positive for the chance of working with exchange studentsFeel worried about communications skill but solved by speaking moreAble to meet new friends from other countriesExperience stress (New partners from overseas)

16

Professional development after the completion of exchange program

Inbound exchange students




Clinical skills improvedActive application of TPC approach in nursing careUnderstand HK epidemic – Infection control More competent How to prepare for RN related their own preferenceMore reflection on learningPromoting Chinese health practice –Tai ChiGood working relationship with patient, team, students, supervisor (Appreciate group dynamics)

More competent with TPC and active on learning and seeking helpLearn to provide holistic care (know and practice more about Total patient care) More communication with patients trustful relationship with nurses, patients(being treated as team member in ward)More competent with spoken English

Experience different practiceMore competent, efficient in working Learn from inbound students (learning & professional attitude)More communication with patients Improvement in :-Clinical skills-Use of medical terms

17

Personal development after completion of exchange program




Personal context

Leadership skillsBeing more observant, become more independentMake new friends

Culture exchangeMake new friends Time management skills improvedRecognized self strength & weaknessInterpersonal skills improved

improve spoken English Insight of students: - set goals for personal development e.g. participate in volunteer activitiesMore consideration on future developmentMake new friendsBeing more flexible

18

Difficulties encountered during placement




Differences between overseas and local clinical practice e.g. aseptic technique for wound dressing Language barrier with Chinese patients-Rotation of supervisor-Stressful with assessment/evaluation(final year students)

Not competent to care unstable patientsBuddy nurse didn’t understand students’ ability (due to different training systems)Fail to communicate with mentor (misunderstanding)Building a trustful relationship with mentorsHome sicknessAdaptation on lifestyleLow competence of spoken English Not many resource in hospital library for case presentation

Patients’ unwilling to receive care from foreign studentsLanguage: fast speakingDifferent Culture

19

Strategies to overcome difficulties encountered


Differences of practice -Listen to the advice and understand rationales behind, appreciate the benefit and apply with principles (Not to obey and just follow)Language barrier with Chinese patients - use simple Cantonese for greeting, aided by written tools and body language, seek help from local students for translation, have eye-contact, smile


Misunderstanding with mentors-Seek opportunity actively on how to improve communication skillsLacking of communication with mentors-Seek advice from buddy nurse for improvement


Adapt to their spoken English-Ask them to speak slowly and listen attentively-Ask other classmates for translation

20

Comments from studentsComment from Inbound exchange students on HK local students

Comments from outbound exchange students on foreign students

Comments from Local students on inbound students

HK local students are:-More “obedient”, not to speak out -passive-Friendly-Welcoming behavior-Helpful-Willing to share feelings of taking care patients

Foreign students are:-Good time management

- they did not have many opportunities to work with foreign students

Overseas students are:-Able to practise holistic care-Confident-More knowledgeable-Active in learning -Eager to teach and share knowledge & experience-Friendly, open, sincere-Few of them were unwilling to try using simple Chinese language to communicate with patients affect nurse-client relationship

21

Comments on arrangement of the exchange programme




PositiveEnjoyed the placementEnhanced personal and professional developmentWould like to have opportunity to participate in more extra-curricular activitiesWill recommend the program to fellow studentsAECO is helpful on arrangement, with good service and adequate informationGood briefing done by coordinator in HK

PositiveRecommend to stay in accommodation with local students or staff (enhance cultural exchange)

PositiveLonger duration of partnership was advisedPrefer working with inbound students at same year of study Role of supervisor:-Balance on work-arrangement

22

Recommendations to student who would like to join the exchange programme




Well-organized for the tripSet realistic expectationJoin the programme with open-mindNeed to taste and try, to get valuable experienceBeing more flexiblePrepare for cultural shock

Equip with knowledgeCollect and utilize different kinds of resourcesBe more active, clarify with different parties e.g. nurse, supervisor, local students

-Precious experience-Open to share experience

23

Comments on mentorshipInbound exchange students



Calm, observant, approachable, teaches, explains gentlySet high expectation Give positive reinforcement to students Discussion freelyMake sure to assign students for translationReceive care from mentorsPost-conference is useful

SupportiveFacilitate learning Arrange different visit to various unitsReceived care from mentorsMore freedom given by supervisorTrustful relationship

Provide more practice opportunity to exchange students (refer to one mentor only)

24

Partnership experience from Partnership experience from mentors’ perspectivesmentors’ perspectives

25

Focus group interview of Focus group interview of mentorsmentors

To explore & identify: Mentors’ role and teaching experience Professional and personal development

of both inbound and local students as perceived by mentors

Feedback on how to improve the exchange programme

26

Results- main themesResults- main themes Role of mentors:

communicators, facilitators, supervisors, resource persons

Teaching experience: All mentors felt challenging with positive attitude

towards supervising inbound and local students in a group

All mentors addressed the importance of understanding the differences between overseas and local practices, extra effort was put into helping inbound students understand & learn about local practice

27

PPD of Students PPD of Students (from mentors’ perspective)(from mentors’ perspective)

Local students Inbound studentsLearn more about overseas practices (e.g. holistic care)

Cultural adaptation- learn more about Chinese culture, local policies & practice

Clinical, communication & presentation skills in English improved

Communication skills with Chinese patients improved (e.g. using body language)

Interpersonal skill enhanced (having good relationship with inbound students)

Interpersonal skill enhanced (having good relationship with local students, mentors and ward staff)

More active in learning Self initiation to learn & seek opportunities to practise holistic care

28

Feedback on how to improve Feedback on how to improve the programmethe programme

Provide more background information of inbound students to mentors before starting the placement (e.g. course outline, clinical experience)

Suggest mentors (supervising inbound students) to share their teaching experience with colleagues who may have chances to supervise inbound students

Allocate inbound students to mentors with overseas experience or experience of supervising overseas students

Suggest the ratio of inbound to local student as 1:5 or 2:4 and not more than 6 students /clinical group

Would be better to allocate inbound students to clinical group with less AT/AOM assessment

Similar year of study for inbound & local students

29

Evaluation of the programme Evaluation of the programme (aims achieved)(aims achieved)

Provide exposure to overseas nursing experience

Enrich the clinical experience through participation in the patient care and observation from delivered care

Develop understanding of overseas health care system

Further develop students’ ability to communicate with people of other culture and ethnic groups

Acquire an understanding of the trend and development of health care services in that country

Gain professional and life experience in a different culture.

30

Inbound exchange students froInbound exchange students from Huddersfield University (UK)m Huddersfield University (UK)

31

Inbound exchange students Inbound exchange students from Victoria University from Victoria University

(Australia)(Australia)

32

AcknowledgementAcknowledgement This study is funded by SLTC of SN at the

Hong Kong Polytechnic University Special thanks to overseas and local

students, and local supervisors for their sharing of experience

33

Thank You!Thank You!

34

ReferencesReferencesGrant, E., & Mckenna, L. (2003). International clin

ical placement for undergraduate students. Journal of Clinical Nursing, 12(4), 529-535.

Polit, D.F., Beck, C.T., & Hungler, B.P. (2001). Essentials of Nursing Research: Methods, Appraisal, and Utilization (5th ed.). Philadelphia: Lippinocott.

Thompson, K., Boore, J., & Deeny, P. (2000). A comparison of an international experience for nursing students in developed and developing countries. International Journal of Nursing Studies, 37, 481-492.

Documents

East meets West: The partnership experience with overseas/local students in their workplace