Globally Networked Learning: Linking Canadian and Danish nursing students

Globally Networked Learning: Linking Canadian and Danish nursing students May 29, 2018 Jacqueline Limoges PhD RN Kirsten Nielsen PhD RN Lesley MacMaster, MScN RN Randi KontniMScH & E RN

Objectives of the presentation • Examine Globally Networked Learning (GNL) strategies used by a Canadian and Danish BScN program to offer an intercultural learning assignment without the need to leave home. • Discuss the student experience with GNL • Consider how GNL can be implemented on a on a larger scale through discussions with Canadian and Danish nursing faculty presenters.

Participants in the research • 1. pilot project: (8) 6 students • 2. pilot project: 16 students 2 Danish & 2 Canadian students/group • Interviews with (to date) • 6 Canadian students & • 3 Danish students Model photos

Background • Requirements for international and inter-cultural learning • Calls for education to develop culturally safe care

The assignment was created by the Danish and Canadian faculty to align with the course learning objectives and nursing theory orienting the course. • Situated the assignment in a med/surg year two course. • Due dates were collaboratively negotiated given the two different semester systems.

Process • Students volunteered • Faculty placed students into groups of four (2 Danish and 2 Canadian) • Students completed the project using the assignment due dates as a guide and also by negotiating with their course schedules. • Students linked using Facebook, Google Docs, Skype and Email.

Participating in GNL was seen as an innovation that would enhance their resume • “I like to do things that are out of the norm” (P02, Anna, Cecile) • “I feel like [participating in GNL] has put me a foot forward in my learning. I am able to say now, I wrote a paper with students in Denmark, I have been through the process, I put the work in” (P02) • Also the fact that GLN will be noted on my diploma is an advantage. Later on in the programme, I want to study abroad, so this is a kind of preparation (Anna) • [I called the Danish students Anna, Betty & Cecile, but we might use the same way of anonymizing the students]

The Global Reach of the Nursing Community • “it really starts to bring home that we are a community no matter where you are, and that as nurses, we can always help each other grow. We can always work as nurses and identify things that we can do better. You really start to understand how much nursing is about one big huge family” (P01) • We [nursing] becomes more and more international and an increasing amount of people from other countries come to DK. Maybe once, you will work as a nurse in another country, so you can always use it [what you learned from the assignment]. It [nursing] becomes more and more work across of cultures and countries (Celine] • It is a good way to learn it [culturally safe nursing] you need to study another culture … it is important – even in DK there are different cultures – to respect the patient is very important (Celine) • Indeed, our understanding of nursing has been extended (Anna).

Step 1 – comparing and contrasting the lived experience the focus on home care and prevention and how this shaped the health experience was a strong theme for the Canadian students • “even while I was doing the project, it made me look at my patients differently and just try to, not look at them differently, but realize that there is a lot more going on than just them now in the hospital.” (P05) • “It really made me reflect on the way we treat our patients … much is similar. The way we see the whole patient is a little bit different than in Canada … we focus more on each individual patient” (Celine) • ”You need to know about the patient’s life to understand what resources he/she has to understand the disease” (Betty)

Step 2: Comparing and contrasting the health system • “I can see that Canada is good, but I found Denmark really went forward and have done more with it and that they are really handling primary prevention. And it makes me realize as well, how much healthcare can be improved. We think it is great, and of course it can be so much better and learning from other countries can take us in that direction. There are a lot of things that can happen to make it even better. There is a lot more innovation, and teaching and so on that we could be doing” (P02) • Students all noted the focus on home care and prevention. They noted how our system is very geared to acute care. “To them, it just seems normal to have someone at home, but for us, it is more focused on the acute care” (P03) • “When you go to your general practitioner to get help to quit smoking, the GP refers you to a quit-smoking programme. This is for free, and you get a lot of help and e.g. patches and chewing gum with nicotine in it to help you stop. The process in Canada is very similar, but the treatment is only offered to you for free when you are under the age of 30. If you are older than 30 years, you have to pay for the treatment yourself” (Anna & Celine) • “Both countries …prioritize the importance of having the same terms and conditions as a diabetic as it is for a non-diabetic citizen. There must be a room for everyone in the society, whether you are diabetic or have another disorder” (Betty & Dora) • “In Denmark we are well-supported if we have diabetes. It is different from area to area in Canada, how much help you get as a person with diabetes” (Betty & Dora)

Step 3 – picking a culturally appropriate nursing strategies There was good learning, but not what we expected • “It is important to have an understanding that we can be similar, because it gives me an idea that the patient may be experiencing this, but it is not necessarily his or her experience” (P03) • “So medication and hospitalization were the only methods she was using to cope with COPD. Whereas in Denmark, the patient was using YouTube, he was doing a diet, exercise, he just had more variety in what he was doing” (p04) • “Overall, by ensuring that both healthcare systems applied the use of APCLN’s for lung cancer patients, it will relieve excessive stress, enhance care provided, and give rise to more patient autonomy” (Anna & Celine) • “The article give us a picture of how to regulate the blood sugar when a diabetic have a high HbA1c (long term blood sugar), and how self-management education programs effect the quality of life and the patients´ perception of disease” (Betty & Dora).

Step 4 Reflection – using this knowledge for practice in the future • “I really like that I was able to make a connection in another part of the world” (P05) • “making sure that I take those moments to really talk to my patients to see what is going on with them” (P01) • ”Cooperation across the world. (what does this mean Kirsten? I was loyal to whatshesaid. Though, I guess it willbe al right to change it to ”acrosscountries”) It was exciting as I didn´t know much of Canada before I got to know the Canadian students” (Anna) • ”You really need to look at the situation from the perspective of the patient” (Betty) • ”Nurses have a great influence on patients’ health … we have an obligation to support people to live in a healthy way, how they can promote … diseases” (Celine)

General findings • Required organization given the time zones and different semester structure • When explaining nursing theory & practice to someone, who does not know it in beforehand, learning outcome increases as you need to understand it yourself • Students had a really good experience and recommend this become a routine assignment • They see GNL as a strategy that is accessible and achieves an inter-cultural experience.

Literature • De, D. & Richardson, J. (2008) Cultural safety: an introduction. Paediatric Nursing, 20(2), 39-43. • Scheel, M.E., Pedersen, B.D., Rosenkrands, V. (2008) Interactional nursing a practice-theory in the dynamic field between the natural, human and social sciences. Scandinavian Journal of Caring Sciences, 22(4), 629-639.

Differences in Semester Structure, Spring Canada Denmark

Denmark overview Population 5.7 million people Capital city: Copenhagen Holstebro 36,000

Globally Networked Learning: Linking Canadian and Danish nursing students