Case Study 2: Nursing

Using an online version of the QIC to stimulate the Review and Reflect Stage 

Institutional context

The university’s approach to internationalisation is embedded in its policies and mission. University policy documents describe a comprehensive approach to internationalisation of the curriculum.

Recognition and reward for staff actions in internationalisation is specifically addressed in documentation, primary responsibility for which is born by the Deputy Vice Chancellor International. The DVCI emphasises the University’s commitment to internationalising the curriculum for all students. The University demonstrates this commitment in various ways, including by promoting and supporting opportunities for students to acquire international experience and develop inclusive perspectives.

University documentation describes a multi-level approach to internationalisation, encompassing elements such as joint degrees involving collaboration with international partner institutions; recognising and rewarding student endeavours in internationalisation; finding ways to facilitate quality interaction between international and domestic students in both academic and non-academic settings; as well as committing to an ongoing process of internationalising the curriculum to produce graduates with the skills, knowledge and experience necessary for living and working in a globalizing society.

The university offers students the opportunity to study a foreign language concurrently with their degree program and a Diploma in Global Issues, which can be taken concurrently with any degree program.

Disciplinary context

Nursing

Reviewing and Reflecting

The Nursing team involved in the initial stage of the IoC process consisted of the three program leaders. The undergraduate program is highly practical and students go into a clinical placement in their first semester. The majority of the clinical teaching is done on placement, so teaching staff are quite dispersed. There is a strong focus on the health-care consumers, the clients. In many ways the clients are the starting point, and the analysis of client needs provide the impetus for deciding on what the students need, and from there what the teaching staff need to do with the students. The Nursing teaching team is very much focussed on approaching global aspects of the curriculum through the local in the first instance, and very aware that health-care consumers are highly culturally diverse, and increasingly so.

The main drivers for internationalisation of the nursing and midwifery curriculum include the need to prepare graduates for work in multi-cultural workplace settings in Australia, but also possibly abroad. Another important driver is the broad cultural diversity reflected in both the staff and student cohorts. At the beginning of the process the teaching team indicated there was no shared understanding of what was meant by internationalisation of the curriculum in the context of the program or the university. Some staff were concerned that internationalisation should not occur at the expense of important local content. Some even commented that the ‘typical white Aussie’ no longer seemed to be present in the curriculum.

It was noted that international and intercultural aspects already had an important place in the nursing curriculum. The curriculum used Problem Based Learning (PBL) methodology. All cases contained an intercultural element and raising awareness of the range of intercultural issues that students would face in professional practice was considered an important aim of the curriculum. Hence in the cases presented to student the names cultural backgrounds of patients were often changed and the clinical staff who facilitated discussion of the cases presented were instructed to discuss what this might mean for the nursing practitioner.

All students are encouraged to participate in international or intercultural experiences as part of their study, up to and including the option of working with Indigenous communities in Australia and in Cambodia. Team members commented on the ‘transformational’ nature of these international and intercultural experiences for those staff and students who were involved.

It was concluded that from many perspectives the nursing and midwifery programs could already be considered to be significantly internationalised. The program leaders wondered, however, if current internationalised elements of the curriculum could be made more explicit and overt to both staff and students, as could the professional and academic rationales for internationalisation – including the intercultural demands of professional practice locally. They also wondered if the curriculum might also benefit from a more strategic overall approach to internationalisation of the curriculum. They saw internationalisation is an ongoing process and believed that room for improvement always exists but they were concerned that the approach taken be evidence-based.

They decided to approach the internationalisation process as a piece of action research and were keen to write articles for publication based on their experiences. They chose as their research question: ‘How can we internationalise the curriculum in this discipline in this particular institutional context and ensure that as a result we improve the learning outcomes for all students.’

The Questionnaire on Internationalisation of the Curriculum (QIC) (see Figure 9.2) was put into Qualtrics (an online survey software platform) and administered to all teaching staff. In this way the team leaders sought to establish what different understandings of internationalisation of the curriculum were held by members of the teaching team. One of the particular challenges faced was that the significant proportion of the staff who were casually employed clinical practitioners, whose primary identity was related to their role as clinicians, rather than their role as teachers. Therefore they did not necessarily identify strongly with the nursing school or the university. Because of this the decision was taken to embed the internationalisation process in already established, periodic meetings in the school, rather than trying to engage staff separately. The response rate to the online version of the QIC was 60%.

An initial overview of the results of the QIC showed that a great deal was already happening in the realm of internationalisation across the program. Nevertheless, focus groups were run to ensure this impression was justified, and to uncover the gaps that might exist. The group established that while the PBL cases selected appropriately represented the multicultural community the students would be working in when they graduated many of the teaching staff felt poorly prepared to work with students on the ‘international and intercultural’ aspects of the PBL cases that were used in the curriculum materials. Some said they avoided discussing them all together. This surprised the program leaders and highlighted the need to do more professional development with staff in this area if they wanted to truly internationalise the Nursing curriculum.

Overall, the Nursing team drew the conclusion that while much was being done across the program to internationalise the curriculum, the rationale for including some of the PBL cases needed to be more clearly communicated. A more explicit narrative of internationalisation in the program was created to assist teaching staff to build on and interconnect the many separate pockets of practice and thus deliver a more coherent and connected international curriculum for all students. Professional development activities and specific guidelines on how to approach discussion of PBL cases focussed on intercultural issues were planned.

Imagining

The team began to imagine what their program might look like if they better utilised the multicultural backgrounds of existing staff. They began to discuss ways of using this diversity of experience in a more productive way.

They started to imagine how they might use the learning of those staff and students who went on clinical placement to Cambodia each year. While only a small number of students took part in these placements, they began to imagine ways to use this very rich learning of a few students and staff as a resource to enrich the learning of all students. A growing study abroad program was identified as another activity with similar potential.

Discussions continued around the meaning of internationalisation of the curriculum in the particular context of the Nursing program. The initial response was that it needed to be about skills, specifically intercultural communication skills. In analysing the meaning of intercultural competence, however, the Nursing team were confronted by the question of whether to focus only on skills, the ‘doing’ domain, or whether they should also focus on conceptual aspects, the ‘knowing’ aspects of intercultural competence as well as the identity of nurses as global professionals.

This deeper discussion about the professional identity of nurses in a globalised world and the meaning of intercultural competence for nurses in the local environment focussed the energies of the team for a considerable amount of time.

The process to this point took around 12 months.