Internationlaisation of higher education: A basic understanding – A nursing perspetive

I am currently undertaking an online module ‘Globalisation and internationalisation of Higher Education’ as part of an extra credit award scheme at my university. Having spent time abroad studying I have developed a new found passion and interest in the globalisation and internationlisation of education and more specifically nurse education and healthcare. Norway was a very interesting experience and my study while I was out there considering the similarities and differences between my education and theirs, has supplied this interest with its driving force and first acknowledgement of its presence in my profession.

One of the things we have been asked to do is write a blog post about what we understand about internationalisation in higher education so far. It is only supposed to be 200 words max in length so the writing below will outline this, however there is a very great chance that I will continue to babble and consider other options afterwards. I have never been very adapt to concise writing. My lecturers could tell you that in a flash.

So what do I understand about the internationalisation of higher education?

First of all what is internationlistion? Knight (2004) defined it as the ‘process of integrating an international, intercultural or global dimension into the functions and delivery of post-secondary education’ After further reading I have begun to understand how international, intercultural and global dimensions influence my university and course and will use this as a reflection.

In terms of international this would be study abroad programs for instance. Our course has a specific elective placement element where students are encouraged to go all over the world to experience nursing in a different context. I chose my university based on the fact that it offered this as not all institutions do, and I felt that it was a vital element to be part of my training. Regarding intercultural, we have a lot of cultural teaching which is seen as an essential element to our course. Our professions in based on caring for those from all different backgrounds, cultures, beliefs an countries. We are a multi-national nation and by default our profession training is intercultural centered because that is a part of what we do. On a global scale, my institution is part of a network called Universitias 21, a global network for leading research institutions which has a health sciences collaboration. Being part of this, students on my course have the opportunity to take part in working/studying/attending conferences abroad including 4 weeks in Nepal to carry out health education programs and nurse education conferences in Dublin and China.

Although I knew the above before starting this module, I had not put it into context about what the above was actually about and the bigger picture that this fits into. Considering all of this, I would say at a very foundation level that my course is quite internaitonliased in its delivery already and compared to other institutions offering nursing courses, rather far out in front.

That is defiantly my 200 words done and a few more. The rest is an trail running of thought processes about what influences internationalisation of higher education, and some attempt at looking at how my course and nursing fits into this….

I have begun to realise that there are many factors that drive HE institutions to be more internationliased. There is;political ‘soft power’, the academic preparation of students being more prepared to be able to work in an international capacity (the movement of the nursing workforce is high, so preparation in your pre registration years is valuable, and it helps you to understand the wider context of nursing), social and cultural – this I feel is more personal, so it allows for a great deal of professional and personal development. The final one is economic which I feel is the one you have to be most careful of that it doesn’t begin to dominate the reasons behind HE institutions becoming more internationlised. Things like research funding and increased revenue from international campuses are a big driving factor. You cannot underestimate the importance of research, as the most recent REF publication has shown (my own institutions impact factor is very high regarding nursing and allied health professions = more money and status).

I do not have the knowledge and more in-depth understanding of these issues yet to fully understand how these can relate to nursing and how the can and do impact on the profession. This is something that I hope to be able to explore further and see how this can fit in with the globalisation of nurse education. There are many other issues to explore and discuss, and internationlisation is certainly more complicated that I have expressed, but I feel this can give a basic outline of the principle and the starting point of its relation to nursing and nurse education.

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But you have been taught the theory behind it right?

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(Wall mount within the Stavanger Acute Medicine Foundation for Education and Research aka SAFER)

One of the main things I wanted to look at when I came to Norway was the difference/similarities between the clinical education content/delivery to that of my own Univeristy. Since I started my nurse training I have been very interested in the comparison of skills needed for practice in the real word, and those taught within the program of study. I personally feel that they do not correspond to each other, and there is work and progress to be made in bringing undergraduate nurse education more into the 21st century.

While many may argue that nursing is an art not a science, I would beg to differ that it is in fact very much both these things. As once described and explained to me by a lecture that I very much admire at my University; with all the good graces of a nurse being kind, caring and compassionate (which I am not dismissing in the slightest they are essential in the profession), those things alone are not going to be able to settle a patient who is attached to a cardiac monitor which starts alarming and gets upset, alarmed or anxious without the nurse being able to interpret the monitor and explain why it may be doing what it is with the sound background of anatomy and physiology in that area. Or in pediatric nursing, how would a nurse explain to parents or the child themselves why they were receiving a certain medication or procedure. It is not always the doctors that are asked the questions and the nurses are often the most available source of information for patients/parents and next of kin. A nurse cannot always keep referring the questions to the doctors. Though of course nurses need to explain and work within the ream of our profession and sphere of competence, they cannot start offering out tip bits of information without the necessary qualifications. Our duty of care extends to ourselves having sufficient enough and up to date knowledge to care for our patients in the safest and most excellent manner.

In Norway one of the things I noticed first is that nursing students here are expected to learn and carry out cannulation in their second year. In the UK this is something most qualified nurses cannot do as it requires you to take an extra training package while you are working. This includes the need of supervision, which given the current climate mostly only doctors and phlebotomists can provide. The time they have to spare in not in great quantities. When I spent some time in the accident and emergency department here in Stavanger, the nursing and medical body were equally surprised that not only are we (as nursing students in the UK) not taught cannulation, we are not even taught the theory in our training either. One of the doctors was very quick to jump in and ask when we then did our cannulation training and I explained that it was not even mandatory on qualification. The puzzled and confused expression in their face more or less said it all. Here in Norway the majority of doctors do not cannulate (they have the option to learn but it is not mandatory), it is seen a nursing role. I have seen the benefit of nurses being able to undertake this skill on the wards as well, as when we are administrating antibiotics for example, and the cannula is not working, or has been removed. There is no time delay or hesitation in it being replaced and the antibiotics going through as the nursing staff can immediately put one back in. Treatments are not delayed, and from my experience in the UK, if a cannula is not working, it is often very difficult to find someone to replace it quickly. This means antibiotics and other medications are delayed and this may have an impact on the effectiveness of the prescribed treatment. I am by no means qualified to state that allowing and teaching nurses within their undergraduate training to cannulate would make the treatment for patients more effective and successful, but you can see the logic and the argument in the implementation. Nursing students here are also able to carry out male cathatrisation, another skill that nurses in the UK can only carry out on qualification with a specific training package.

Simulation training is used a lot more in undergraduate nurse training here than that of the UK. In the first month that I was in Norway I visited Stavanger Acute Medicine Foundation for Education and Research (SAFER) which provides simulation training to nursing students along with all emergency service personnel including the off shore workers on the oil rigs. There is nothing really of this size in the UK though Bristol is home to the Bristol Medical Simulation Center (BMSC), which offers a similar service. In Nottingham, simulation training is not used prominently in undergraduate nurse education, however there is talk that it may be introduced.

In my visit I joined a simulation lesson with other Norwegian nursing students and we carried out a basic refresher of CPR and the use of defibrillators. Afterwards we were split into two groups and put into a simulation room with one of the facilitators controlling the sound/movements/clinical condition of an electronic dummy that was laid out in a mock ward environment. We were fortunate enough that the educators and the majority of the other nursing students had good enough English to be able to attempt the simulation in English! There is a lot of research and studies being published at the moment which look at the use of simulation training and its benefits/suitability to nurse training. So far, much of the research would suggest that simulation in nurse education is beneficial in terms of increasing confidence, transitioning between theory and practice and clinical skills competence. Tough there are still questions which lie around simulations suitability to improving actual patient care. Its use however is on the increase and a number of reasons could be sited for things including a decreasing availability of placement areas and an increase in student numbers, the variations in competence in communication, administration of medicines and decision making among nursing students as found by the Nursing and Midwifery Council (NMC). Finally the increasing challenges nursing educators face in developing and  preparing students for the real world of nursing practice the variety of placement/clinical training opportunities available (which can impact on students exposure to certain environments and situations like acute and deteriorating patients), are other reasons that simulation training may become more prominent in future training.

It has been announced recently that there is going to be a review into undergraduate nurse education in the UK. Health Education England along with the NMC are to launch the `State of Caring Review´ in May this year lead by Lord Willis. It comes after the Francis Report highlighted concerns with nurse education and training. It will be interesting to see if the final report which is to be released early 2015, will consider or report on the clinical skills education and delivery along with any mention of need for increased simulation training.

 

 

 

 

 

 

 

 

A nurse educational structure breakdown & and In other news I miss the price of bananas in the UK


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(I Found these outside a toy shop, couldn’t help but find them entertaining)

Despite the expense, slight location isolation (still missing my four wheels) and that people just don’t seem to smile around here (going for  run, you nod acknowledge say good morning, etc…nothing, blank stare through..) this place is beautiful and I have never experienced cars stopping so far in advance for you to cross the road. We are talking you just have to be near a crossing or even look at it and they will stop. That never happens in the UK.

The week just gone did allow me to have a meeting with our academic link here at the University of Stavanger (UiS) and I was able to gain some enlightenment on the structure and general situation for nursing here in Stavanger.

Student nurses here at UiS (which I have discovered is a common thing in Norway generally) train as general nurses. They do not specialise unless they take on a masters. There are no specific adult, child, mental health or learning disability nurses training at an undergraduate level.

Their placement and theory time like ours is split 50/50 and they have placements in throughout their three years. They have one placement in there first year in which all students go to a nursing home. Students do not enter a hospital environment until there second year, where, continuing into there third year, they undertake placements in medical, surgical, community and mental health settings. Unlike our system they do not have anything that resembles a management placement. The end of their third year consists of them carrying out their thesis (dissertation) and then going on a six week elective. This I found a very interesting deviation, as up until this point we share many similarities in the structure of our training to Norway. This has brought me to think thus far, that, in this instance, student nurses in the UK are prepared and exposed to a far greater amount of leadership and management training and experience than our Norwegien counterparts. What will be very interesting to see is if this has any reflection in practice. I also hope to find out when I have a greater exposure in practice, to understand why that is.

I mentioned that we are similar in our training structure. This is the case, however one other element which does deviate slightly is that their theory and practice assessments are given the same weight as each other. In the UK, and in Nottingham I can only directly relate this, our placement grading makes up a far smaller proportion of our final grade. This also only came in in the year I started my training (2012), as until then, your performance in practice held no direct influence over your final grading. Personally, I prefer this over the current system we have. I feel that your ability and performance in practice should count for a far greater amount in your degree than it currently does. To give an example, each semester at UiS you get 20 ETC (European Transfer Credits though it goes up to 30 in the third year), and a practice block is weighted at 10 ECTs the same as a theory block.

The students here at UiS have a similar work load when it comes to assessment, however, what is most obvious from the offset is that exams are used more frequently. I tend to feel that we have death by written assignment, and that a more balanced way of assessing students would not go amiss.

Nurse education here in Norway is potentially undergoing a radical change. At present there is a national curriculum set, a bit like the NMC sets in the UK, which every institution has to follow. There is a greater North and South divide in Norway, with Northern areas and districts (those outside of a main city) not having the full range of services on offer. With Norway being a much larger and longer country than the UK, things here are very spread out and the current thinking is that the curriculum is to strict, and instead, to hand over control of the curriculum to individual universities and colleges. There would still be a minimum standard set, but it would be far more flexible. I can see the benefits of doing this, however, I can see that this might produce a much greater variance in the experiences and abilities of nurses on qualifying. How do you govern and ensure that patient care is going to be of a high standard from nurses no matter where they have trained, if the educational standards and training are not on an equal footing?

I could go into a list of the clinical skills students get taught/are expected to be able to perform, but I am currently still wading through the pack which details them. Trying to decipher the differences and understand the system may be something I get a greater understanding off in practice. Plus I would really like to get mentors and qualified nurses opinions here about where they think about the the diversity, amount and importance of those clinical skills taught. 

I will leave you with a nice little statistic which has become one of the most obvious things I have noticed since I have been here. People generally are of of a slim disposition. Despite the rates for men and women regarding being overweight or obese on the rise, they currently only sit at about 21% for women and 33% for men (Statistics Norway, 2013). Compare this to the UK where 57% of women and 67% of men are overweight or obese (Public Health England, 2o14). Now that is quite a contrast. To be honest, you can rarely go out anywhere without seeing people out walking/running/or pavement skiing (no I am not joking, think wheels on the bottom of skis and then just push yourself along). It will be interesting to see the rates of diabetes and cardiovascular conditions here compared to that of the UK. I really cannot wait to start in practice. I have a feeling there are going to be some massive contrasts (I have already been tipped off about the lack of paper work compared to the UK, this excites me).