The call to promote international initiatives and greater global engagement in education and practice appear regularly from leading professional nursing and health organizations. Current examples include the Global Advisory Panel on the Future of Nursing & Midwifery (GAPFON) Report,1 National League for Nursing's "A Vision for Expanding US Nursing Education for Global Health Engagement,"2 International Council of Nurses' "The Health of Migrants, Refugees and Displaced Persons Position Statement,"3 and World Health Organization's "Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020."4 Nursing Now's5 vision also advocates strengthening connections between nursing education and practice worldwide to devise strategies for addressing global nursing shortages. Such international efforts in shaping nursing education policy, practice, and education are viewed as vital and interconnected in our increasingly interdependent, globalized world of the 21st century.
Problem
According to a recent report from the American Council on Education Center for Internationalization and Global Engagement, only 64% of the higher education institutions surveyed had developed global learning outcomes, and only 49% indicated general education requirements that included a global component.6 Furthermore, the 2018 National Survey for Student Engagement found that only 41% of graduating seniors in the health professions reported any inclusion of global-learning focused coursework.6 Therefore, greater attention to internationalizing nursing curricula, courses, and teaching approaches, along with needed faculty development, appears warranted.
Internationalization of the curriculum has been defined as "the incorporation of an international and intercultural dimension into the preparation, delivery, and outcomes of a program of study so that it purposefully develops all students' international and intercultural perspectives as global professionals and citizens."7 A nursing program's curriculum, including its student learning outcomes, can be viewed as the master guidepost for preparing nursing students as global citizens. Specifically, faculty are advised to create internationalized courses with student-centered learning activities as an important strategy in improving institutional global learning outcomes. How then can faculty determine the breadth and depth of internationalization within a designed curriculum to meet these important outcomes?
Approach
An initial question for nursing faculty to ask is: "Is an internationalization assessment a component of established program improvement processes within the school of nursing?" Determining the extent of internationalization can demonstrate the current level at which students are exposed to international perspectives. Furthermore, an internationalization assessment can stimulate curiosity about newer pedagogical approaches for consideration in course improvements and programmatic changes.
Individual faculty can begin the process by addressing the current level of internationalization within their courses. An internationalization review would comprise various components of course evaluation: its content, materials, activities, and student learning outcomes. Helms and Tukibayeva8 suggest asking these questions: "What are the elements of an internationalized course?" "How does one know if a course is really internationalized?" and "What does an internationalized course syllabus look like?"
Faculty can use a rubric to assess the extent of internalization in nursing courses. Faculty can also provide the rubric to students during course evaluation processes at midsemester, to garner feedback for course improvements during the current semester, or at the end of the semester as an adjunct to usual evaluation processes. The rubric's 4 dimensions include Content (course materials were drawn from international sources), Presentation (lectures, discussions, or other classroom presentations focused on international or multinational perspectives or comparisons), Learning Activities (homework and class activities incorporated consideration of international or multinational perspectives), and Evaluation (examinations, papers, graded discussions, and/or additional methods required consideration of international or multinational perspectives).9
The author used this rubric to evaluate the internationalization of a graduate-level nurse educator course taught in a blended format. Evaluation was based on discussion questions' posts and responses, a state-of-the-science presentation, a teaching philosophy paper, and a reflection paper; no examinations were given. Students were asked to rate each of the 4 dimensions on a 5-level scale from level 0 (no evidence of internationalization present) to level 4 (>60% evident). Descriptions exemplifying each performance level were included in the rubric.
Outcomes
In the initial assessment completed for this particular graduate nursing course, 20 students completed the rubric for a response rate of 43%, with 13 (65%) of the participants identifying as international students and 7 (35%) as US students. The majority of students (70%) rated the 4 course dimensions of internationalization at either a level 2 (10% to <30%) or level 3 (>30%-60%). In response to the question, "Do you think the international content in this course could be increased to a higher level?" 90% of respondents suggested an increase to level 3 or 4. Suggestions for improvement included "international students could be asked to share a study they see relevant to their nursing education and analyze it together as a class"; "comparing and contrasting nursing philosophies, educational expectations, and international nursing teaching practices from different countries could be added"; and "more readings could be specifically taken from international sources." One participant commented, "I incorporated many examples from my experiences in the weekly discussions, which added to the viewpoints from international perspectives."
Importantly, course improvements resulted from this review. Examples included more readings from internationally based nursing education research articles. The reflection paper assignment previously focused on culturally inclusive teaching practices and chapter readings by students from diverse cultural backgrounds. As an improvement, the student's own cultural identity was added, and new perspectives from international educators and students were incorporated. Likewise, the teaching philosophy paper assignment now includes a section on self-awareness about global diversity, complexity, and internationalization.
Findings from this project were shared with faculty colleagues. Using a rubric to assess current internationalization levels in their courses and with their students was encouraged. Such course-level assessments represent one important step in a program's overall internationalization strategy.
Conclusion
An evidence-based approach for assessing the level of internationalization within a nursing course yielded important results. From this initial assessment, students clearly articulated their viewpoints and provided specific suggestions for pedagogical improvements in extending the degree of internationalization in course content, presentations, learning activities, and evaluation methods. Giving students an opportunity to provide detailed course feedback beyond that usually afforded in standardized, programmatic course evaluations also demonstrated a heightened valuing of student perspectives and affirmed their role as course cocreators and investors in future students' success.
Faculty can begin by using a rubric to review the degree of internationalization at the individual course level. An assessment of nursing courses also provides faculty the opportunity to advance the scholarship of teaching and learning today beyond subject matter to pedagogical approaches that are evidence based. Such scrutiny may further lead into needed assessment of internationalization processes at the nursing program level by an entire faculty group. In conclusion, while the overall impetus for internationalization may come from institutional leadership, parallel efforts can start with faculty and students, from the ground up, beginning with individual nursing courses to prepare all nurses as globally engaged health care professionals and citizens.
References