The value of study abroad opportunities in nursing curricula has been a subject of interest to educators for many years. Researchers have correlated such experiences with a number of outcomes desirable for prospective nurses, including cultural awareness (Bohman & Borglin, 2014), the development of caring (Hegedus et al., 2013), and the promoting of cultural safety (Mkandawire-Valhmu & Doering, 2012). Inclusion of a study abroad option can be transformative for nursing education as participants develop sharper critical thinking and problem-solving skills (Edmonds, 2012).
Educators are faced with the task of not only developing study abroad opportunities that are meaningful, relevant, and pragmatic but also sustaining and improving the experience over time. Even though a study abroad program may meet objectives when introduced, needs can shift. Educators can evaluate repeat programs by comparing experiences, looking for trends, and conjecturing rationales.
An example of needs shifting over time is illustrated by a course for nursing students at our university that involves travel to the Yucatan region of Mexico. This course was developed in 2005 and has been repeated annually during spring break ever since. The course was developed in response to the desire among students and faculty for an effective way to promote cultural awareness in the nursing program. The objectives also included comparisons of each nation's health care system and an opportunity to engage in service-learning.
Students meet monthly from August to March in preparation for the travel and spend the week of spring break in the Yucatan, visiting health care facilities and schools of nursing, attending festivals and markets, participating in city walking tours and lectures by a local expert, and going to archeological attractions such as Mayan ruins. The service activities have included work at a nursing home and home visits in a Mayan village to distribute toiletries. Students chronicle their experiences in journals and participate in debriefing circles at the end of the days in Mexico. They write a research paper before the trip and a reflection essay when it is over.
Although the original objectives for this opportunity are still relevant, changes over 11 years since the course was first offered have led to suggestions for revisions. A comparison of the first six years that the course was offered with the last five years reveals three categories of change. This article discusses the implications of those changes as a means to promote excellence and sustain the relevance of the study abroad opportunity.
CHANGES OVER 11 YEARS
Recruitment
Over 11 years, 118 students participated in the study abroad opportunity. Recruitment was easier in the earlier years with as many as 40 students seeking placement in a course limited to 10 to 12 students. Several reasons underlie the increased difficulty with recruitment. One is that worldwide travel warnings are causing students and parents to be wary. Threats of terrorism, drug problems in Mexico, and disease epidemics spotlight the news and have likely heightened concern about international travel.
Another possible obstacle in recent recruitment has to do with expenses. The total cost, including meals, travel, and lodging, was $900 the first year the trip was offered. The cost for the most recent trip, in 2015, was $2,500. Scholarship opportunities for study abroad at the university have diminished, and students (or parents) are usually responsible for the expense themselves. Students do attempt fundraising, but university restrictions have emerged that have created difficulties with those pursuits.
Logistics
Some changes having to do with logistics are positive. For example, communication to and within the country of Mexico is easier now than it was in 2005. An international calling plan makes phone calls easy, Wi-Fi is readily available, and most students have smartphones, tablets, and/or laptop computers. Paying for services in Mexico is also easier today than it was in 2005. Money can be electronically wired to the bank account of a partner in Mexico, and this liaison assumes responsibility for meal costs, hotels, transportation in country, and entrance fees for attractions. (In the earlier years, the instructor was responsible for handling the fees.)
Another logistical change is that, because of implementation of stricter regulations regarding privacy and transmission of disease, hospitals and health care agencies visited as part of the agenda for this trip have become more cautious about allowing students to tour. In earlier years, students were not only allowed in all parts of a facility but were also, in some cases, invited to don scrubs and participate in care. In recent years, students have been denied entrance to parts of some facilities, such the obstetrics unit and emergency rooms, and one private hospital has declined tours altogether.
Student Goals and Outcomes
The reasons for students indicating a desire to participate in the study abroad program have changed in recent years. In the required papers written before the trip, students from all cohorts have indicated that they wanted to become better acquainted with the Mexican culture. But different goals have also emerged within the last five years.
Many students indicate that the trip will be an excellent addition to their resume in a competitive field following graduation. Most add that they would like to be participants in action-oriented service to a community of people and that this trip would give them that opportunity. Some students are particularly interested in the pursuit of research opportunities or projects to fulfill honors requirements.
Students in the most recent five years of the study abroad experience represent a more diverse group with respect to the outcomes gained from the experience. In the early years, students wrote of similar thoughts in their reflection journals. These students felt sadness regarding the poverty they encountered and enjoyed being able to play with orphans. They were surprised that many facilities had very modern equipment and services.
When journaling about a favorite part of the day, recent students have been more personal in their reflections. Rather than talking about a food or activity, for example, they may offer an insight about disparities or a solution for a perceived problem. They also tend to remark more frequently about service, relationships, and the meaningfulness of their feelings.
RESULTS OF THE COMPARATIVE ANALYSIS
Reflections on the changes impacting this particular study abroad program have resulted in course modifications and updates in recruitment strategies. Recruitment brochures and the Office of International Education university website now highlight the safe distinction of the Yucatan region and the absence of travel warnings to this region. Students and parents of prospective students are encouraged to contact the professor personally to talk about safety. The course professor gives recruitment presentations to all nursing students during which the safety of the trip is emphasized.
In order to address the rising costs for travel abroad, the development office has been approached about the possibility of attaining a donor specifically for nursing study abroad. The partner in Mexico has been consulted about ways to contain costs, and he has offered some ideas, such as changing hotels to less expensive ones and having some meals at base instead of eating out. Fundraising opportunities that do not conflict with university regulations are also being considered.
By using the new and emerging goals that students have conveyed over the past few years, recruitment efforts are enhanced. For example, it is suggested to potential participants that having a study abroad course on one's resume makes the application stand out in a competitive job market after graduation. Honor students who are required to study abroad and who might have interest in research abroad are targeted for recruitment.
Once students for the cohort are recruited, the professor arranges meetings to get to know the group in advance of the trip and possibly develop specific goals. If several students in the group have research interests, for example, it may be possible to orchestrate a group effort. All students in the most recent years have expressed interest in service, so more service is planned to replace the now restricted hospital tours. Having a long-time relationship with a partner in Mexico supports the possibility of making novel service-learning ideas a reality.
SUMMARY
The establishment of a study abroad program in a nursing curriculum is only one part of the process. A comparative analysis of repeat programs can highlight trends resulting from changes in student groups, economics, and other factors. Attempting to determine the reasons for change can lead to strategies for course improvement.
Evaluations may be formal or they may result from a review of student work. Instructors who have led repeat study abroad courses can also do a comparison of experiences over time, including logistics, costs, the composition of student cohorts, and recruitment efforts. These efforts combined together can help sustain and improve the study abroad experience.
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