For this special issue of Nursing Education Perspectives, we solicited manuscripts on global nursing education, hoping to receive a plethora of robust studies and innovations of educational activities happening across the globe. Although the plethora part did not materialize, this issue contains stellar work from colleagues in the United States and international partners. As you read this special issue, you will arrive at the realization that global nursing is hard work, full of purpose, creativity, and passion, with challenges that prevent many from engaging in this area of education, research, and scholarship. These challenges include difficulties developing and sustaining partnerships; lack of evidence-based pedagogical strategies, a framework to guide curricula, and the means to measure student learning; and confusion surrounding how or if international clinical experiences (ICE) can be used for required clinical hours.
The first article sets the stage for the importance of critical dialogue on shared values and understandings in expanding global health through partnerships. Drs. Horton-Deutsch and Van Rensburg discuss how appreciating philosophical orientations, ethical perspectives, and broadening what counts as evidence through a critical reflective process supports the development of shared values and meaning, strengthens connections, and leads to new knowledge for sustaining global health partnerships. Drs. Healey-Walsh, Stuart-Shor, and Muchira also focus on partnership formation, using postcolonial theory to examine factors related to equitable partnership formation within an innovative US-Kenyan service-learning program in nursing education. They similarly conclude that preconceived assumptions, imbalances in privilege, and issues surrounding power and decision-making must be addressed for impactful partnership development.
Previous research has shown that significant barriers to students engaging in ICE are cost and inability to travel abroad for long periods of time (McKinnon & McNelis, 2011), and three articles describe innovative strategies to address these barriers. The team of Miles, Eramaa, and Parkkinen, through a unique partnership, created a learning experience where nursing students from Finland and the United States engaged in immersive and sustained activities. This innovative approach provided opportunities for students to learn together with international peers and showed how promotion of collaborative behaviors and global citizenship development can occur without physically traveling abroad. Drs. Kako and Klingbeil developed and evaluated a short-term interprofessional study abroad program in Kenya, with results indicating that students gained beginning awareness of cultural humility. Similarly, Drs. Graber, Saylor, and Johnson describe a global experiential learning approach using clinical internships and microsemesters as an alternative to a full-semester study abroad experience.
Given the dearth of tools to measure the impact of global experiences, Drs. Foronda and Phitwong provide a much needed instrument to measure the impact of study abroad on students' perspective transformation. Drs. Palmer and Miles observed and compared nursing tasks/roles in Ecuador, Finland, Ghana, the Navajo Nation, the Russian Federation, Taiwan, and Tonga as a way to understand what nurses do in different parts of the world. This critical information is needed to help define a global nurse, facilitate development of ICE, and build partnerships. Providing even more specific pedagogical strategies, the team of Davis, Bustos, and Spoljoric share how they innovatively integrated cultural competence into the PICO structure to support colleagues who were abroad in countries where evidence-based practice is not available.
McKinnon, McNelis, de Leon, Whitlow, and Fitzpatrick conducted a national survey of deans and/or directors of prelicensure programs on the ICE in their schools. Only 241 of 900 programs indicated they had ICE, yet almost all were interested in developing or expanding this opportunity. In addition to institutional and financial support, they needed more information on ICE development, curricular implications, benefits, and purpose, indicating the ability to use ICE for clinical hours as required by state boards of nursing was essential to move forward. Dr. Torres-Alzate's work addresses some of these issues by giving us the Nursing Global Health Competencies Framework to guide the development of competencies and relevant curricula to reflect the core values and principles of nursing.
We hope this special issue ignites interest and passion in all readers to support, pursue, and/or expand global nursing education in your institution. Despite the great work being done, as exemplified in this special issue, this area of research and scholarship remains distressingly scant. The evidentiary base must be greatly increased to provide the necessary guidance and support to schools of nursing and faculty as they engage in the endeavor to educate and develop true global citizens.
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