Overseas Clinical Placement

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East meets West The partnership experience with
overseas/local students in their workplace
Ms Sharon Cheung Ms Sandra Pun School of
Nursing, The Hong Kong Polytechnic University
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Exchange Programme/Overseas Clinical Placement
The programme was introduced by the School of
Nursing from 1998 with increasing no. of students
recruited
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
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Aims of student exchange/overseas clinical
placement

• 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.

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Exchange programme

• Aims
• provide opportunity for students to enhance
  cultural and knowledge exchange during overseas
  studying/placement
• offered the exposure to a global dimension to
  students university life and personal or
  professional development
• Development on three aspects
• Enhance intellectual development
• increased global understanding
• Enhance personal development
• (Thompson, Boore Deeny, 2000)

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Background 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 among western countries.
• Explore the difficulties that students might
  encounter
• Strategies students used to deal with the
  encountered problems during placement
• None of these studies explored-
• the exchange experience of nursing students
  between the Western and Asian countries in their
  workplace

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Aims of the study

• Understand the actual learning process
• Understand the exchange experience of nursing
  students from these countries.
• Allows the local nursing students to share their
  partnership experience with overseas students
• Explore the mentorship experience of local
  mentors with both inbound and local students
• Students who would like to join the programme
  will be better informed and prepared for their
  exchange

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Objectives

• 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

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Design of the study

• A descriptive/exploratory approach
• Investigate the experience of students mentors
  participated in the overseas exchange programme
• A phenomenological approach
• to explore the lived experience
• gives meaning to each persons perception of a
  particular phenomenon
• (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 without leading the discussion

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Sample 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 students 6 --- outbound exchange students
8 Local students had clinical placement with inbound students
3 Local clinical mentors supervising inbound local students in a group (gt 4 weeks)
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Data 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.

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Data 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

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Framework for data analysis

• Before the start of exchange
• ?Learning objectives
• ?Students preparation
• ?Students feeling about the exchange programme
• After completion of exchange programme
• ?Professional development
• ?Difficulties encountered
• ?Strategies used to overcome these difficulties
• Partnership experience with local students
  supervisors
• Recommendations from students and supervisors
• Mentorship experience of local supervisors

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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 country Improve various clinical skills Try to look after 3-4 patients independently ensure safety Learning attitudes -learn actively -making effort to learn Deal with language barrier Want to make good impression Try to do best -work harder -listen to mentor, patient Gain personal goals expose to different health care system being able to know the common diseases more familiar with case management Learn to be independent open-minded
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Preparation before exchange
Inbound exchange students Outbound exchange students
Personal context Search information on University Hospital Government health care system Common diseases in HK SARS, Flu Other tourist information packing luggage Searching information about Melbourne and VU Searching emergency contact no. in Melbourne, with university contact person Join English activities (Big mouth corner) Watch TV (Pearl)
Professional context (not mentioned) drug knowledge Focus on geriatric and pediatric area communication skill with kids Practice in laboratory Search information on the web about health care system Review study materials Review subject contents syllabus of clinical practice
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Feelings before exchange
Inbound 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, excited Learn from nursing students from different culture Looking forward, positive for the chance of working with exchange students Feel worried about communications skill but solved by speaking more Able to meet new friends from other countries Experience stress (New partners from overseas)
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Professional development after the completion of
exchange program
Inbound exchange students Outbound exchange students Local students (partnership with inbound students)
Professional context Clinical skills improved Active application of TPC approach in nursing care Understand HK epidemic Infection control More competent How to prepare for RN related their own preference More reflection on learning Promoting Chinese health practice Tai Chi Good working relationship with patient, team, students, supervisor (Appreciate group dynamics) More competent with TPC and active on learning and seeking help Learn 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 practice More competent, efficient in working Learn from inbound students (learning professional attitude) More communication with patients Improvement in Clinical skills Use of medical terms
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Personal development after completion of exchange
program
Inbound exchange students Outbound exchange students Local students (partnership with inbound students)
Personal context Leadership skills Being more observant, become more independent Make new friends Culture exchange Make new friends Time management skills improved Recognized self strength weakness Interpersonal skills improved improve spoken English Insight of students - set goals for personal development ? e.g. participate in volunteer activities More consideration on future development Make new friends Being more flexible
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Difficulties encountered during placement
Inbound exchange students Outbound exchange students Local students (partnership with inbound students)
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 patients Buddy nurse didnt understand students ability (due to different training systems) Fail to communicate with mentor (misunderstanding) Building a trustful relationship with mentors Home sickness Adaptation on lifestyle Low competence of spoken English Not many resource in hospital library for case presentation Patients unwilling to receive care from foreign students Language fast speaking Different Culture
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Strategies to overcome difficulties encountered
Inbound exchange students 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
Outbound exchange students Misunderstanding with mentors -Seek opportunity actively on how to improve communication skills Lacking of communication with mentors Seek advice from buddy nurse for improvement
Local students (partnership with inbound students) Adapt to their spoken English Ask them to speak slowly and listen attentively Ask other classmates for translation
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Comments from students
Comment 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
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Comments on arrangement of the exchange programme
Inbound exchange students Outbound exchange students Local students (partnership with inbound students)
Positive Enjoyed the placement Enhanced personal and professional development Would like to have opportunity to participate in more extra-curricular activities Will recommend the program to fellow students AECO is helpful on arrangement, with good service and adequate information Good briefing done by coordinator in HK Positive Recommend to stay in accommodation with local students or staff (enhance cultural exchange) Positive Longer duration of partnership was advised Prefer working with inbound students at same year of study Role of supervisor Balance on work arrangement
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Recommendations to student who would like to join
the exchange programme
Inbound exchange students Outbound exchange students Local students (partnership with inbound students)
Well-organized for the trip Set realistic expectation Join the programme with open-mind Need to taste and try, to get valuable experience Being more flexible Prepare for cultural shock Equip with knowledge Collect and utilize different kinds of resources Be more active, clarify with different parties e.g. nurse, supervisor, local students Precious experience Open to share experience
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Comments on mentorship
Inbound exchange students Outbound exchange students Local students (partnership with inbound students)
Calm, observant, approachable, teaches, explains gently Set high expectation Give positive reinforcement to students Discussion freely Make sure to assign students for translation Receive care from mentors Post-conference is useful Supportive Facilitate learning Arrange different visit to various units Received care from mentors More freedom given by supervisor Trustful relationship Provide more practice opportunity to exchange students (refer to one mentor only)
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Partnership experience from mentors perspectives
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Focus group interview of mentors

• 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

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Results- 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

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PPD of Students (from mentors perspective)
Local students Inbound students
Learn 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
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Feedback on how to improve the 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
  15 or 24 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

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Evaluation of the programme (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.

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Inbound exchange students from Huddersfield
University (UK)
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Inbound exchange students from Victoria
University (Australia)
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Acknowledgement

• 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

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Thank You!
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References

• Grant, E., Mckenna, L. (2003). International
  clinical 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.