Cultural competence is a vital component of undergraduate nursing education, as it is essential to prepare future nurses to care for persons in a global society. To meet this challenge, nursing educators must prioritize developing cultural competence in nursing students, yet there is little evidence about the most effective way of doing this. Cultural competence is a topic that is difficult to teach via the traditional pedagogy of lectures, texts, and clinical experiences in the local community. Also, teaching the concepts in isolation is often the method used and does not necessarily support the cultural readiness of student nurses. The literature suggests that the most optimal way to foster cultural awareness, sensitivity, and competence in nursing students is a complete immersion in another culture, such as a study abroad.1,2

Furthermore, faculty often use reflective journals to capture students' self-reflection of their experience during a study abroad to develop cultural skills. In previous course iterations of a study abroad for baccalaureate nursing students, one required assignment was to write a reflective journal and present a 10-to-15-minute presentation summary to their peers. Course evaluations from the students revealed that they did not see the value of reflective writing, nor did they enjoy hearing their peer's presentations and learning from them. However, the faculty felt that writing reflective journals promoted students' understanding or 'making sense' of their immersion experiences and encouraged them to acquire new insights regarding their cultural beliefs. Also, the faculty valued the guided group reflection during the students' presentations because it helped students challenge their assumptions and enhanced intercultural reflection and learning.

Nurse educators are challenged to develop educational methodologies that meet the characteristics of today's learners. Millennial and Generation Z students often prefer to use technology and smartphones rather than traditional formats. An alternative teaching strategy for a written journal that may have a pedagogical advantage for this group of learners is the Pecha Kucha 20 x 20 method (Pecha Kucha).3 The Pecha Kucha's anecdotal structure paired with its use of technology support students' twenty-first-century literacies. This paper discusses using this learner-centered approach in a study abroad in Italy to foster reflection of their cultural encounters.

Pecha Kucha

Pecha Kucha, which means "chit-chat" in Japanese, is a strategic style of presenting information to maintain the audience's engagement and interest. Pecha Kucha is a storytelling format where a presenter shows a 20-slide presentation displaying each slide for 20 seconds. The entire presentation lasts less than 7 minutes. Architects developed the Pecha Kucha in 2003 to make various presented materials more interesting for all parties involved.3

In Pecha Kucha presentations, the designer uses slides filled with images, pictures, graphics, and very few words. This presentation structure creates a more narrative-style approach rather than solely focused on delivering information. The lack of text on the slides encourages the presenter to make more eye contact and engage with their audience more than in traditional PowerPoint presentations. The presenter also must go through a process of intentional preparation and rehearsal to adhere to the timing requirements of the Pecha Kucha. The time constraint also forces the presenter only to include the most pertinent information and to explain it clearly and concisely.

Study Abroad

This study abroad program spanned 2-weeks, during which students had opportunities to learn about Italian culture and health care through observational experiences in acute care hospitals and outpatient settings. Students also took basic Italian language lessons and participated in guided tours of important cultural sites. The group was composed of 3 faculty members, 3 graduate MSN-Education students, and 23 undergraduate BSN students. The graduate students assisted with program facilitation and gave various seminars to the undergraduate students while in-country, covering topics such as cultural competency and proper presentation and formatting skills.

During the study abroad experience, the undergraduate students were encouraged to reflect and journal their feelings, thoughts, and observations. Suggested topics for reflection were individual daily experiences related to nursing practice; interactions with people in the community; descriptions of sights, smells, sounds, and tastes encountered; and beliefs about Italy and Italian healthcare prior to the course. Along with this journaling, the students documented their experiences via photographs. The journaling and photographs aided the students in developing a Pecha Kucha presentation submitted following the completion of the study abroad. The students had a detailed rubric outlining the specific expectations of the assignment. The Pecha Kucha presentations were recorded, submitted to an online platform, and graded using the criteria outlined in the rubric.

Feedback From Nursing Students

The Pecha Kucha assignment received positive feedback from the students' course evaluations and verbal comments. The students highlighted the importance of choosing from their many pictures to create a summary of their cultural encounters. Also, the students benefited from each other's presentations because of the shared perspectives related to their cultural experiences. Students stated that it gave them an avenue to introspectively reflect on their prior assumptions and evaluate whether their cultural skills improved.

Assessment by Nursing Faculty

Students demonstrated a beginning understanding of the customs and practices of Italy's art, architecture, music, and food. Also, there was a noticeable synthesis of the intersection of culture and health care delivery for individuals living in an Italian community, from students' pre-perceptions to post-perceptions, meeting the learning outcomes of the course and indicating enhanced cultural awareness. Additionally, the faculty concluded that the Pecha Kucha supports students' 21st-century literacies by developing their digital skills to effectively communicate to an authentic audience about their cultural experiences. The Pecha Kucha promoted students' ability to combine speech, images, and written sources to convey meaning through a creative composition.

Conclusion

Implementing a Pecha Kucha as a reflective tool is an innovative pedagogical strategy that may not only be beneficial for just studying abroad but also transferrable to other nursing courses or online education.4 Pecha Kucha provides an alternative method of engaging with content and helps to involve students and promote learning resulting in increased student enjoyment, creativity, and improved presentation skills. Studies are needed to investigate if using the Pecha Kucha as alternative to the traditional reflective journal affects the development of cultural competence.

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