Preparation of undergraduate health and care students from the United Kingdom in an international learning experience in Japan: A phenomenological study

Background
Globalisation, economic migration and people seeking refugee status requires cultural competence skills and knowledge to be embedded in undergraduate health and care programmes. International learning experiences can support the development of cultural competence skills. Students require preparation before undertaking international learning experiences to support adjustment to cultural differences. Inadequate preparation could have a negative impact on their ability to learn. Therefore, investigating concerns undergraduate health and care student experience prior to an international learning experience has the potential to enhance the preparation received.

Objectives
To investigate the experiences of undergraduate health and care students from the United Kingdom prior to participating in an international cultural visit to Japan

Design
A qualitative study using Interpretative phenomenological analysis

Methods
The lived experience of 7 undergraduate health and care students were explored using reflective semi structured surveys

Findings
The findings suggest that prior to the visit, undergraduate health and care students experienced a range of fears and anxieties. These were themed under the heading of “Barriers to Learning” and further sub themes of “Being a Stranger”, “Cultural Differences and “Communication”.

Conclusion
Preparation for undergraduate health and care students undertaking international learning activities is required to enable them to adapt to the culture they are visiting as well as the culture of the group they are travelling with. Recommendations are made for preparing undergraduate health and students for this.

References
Abo-Zena, M.M., 2012 Sampling and retention of underrepresented groups in Salkind, N.J., 2012 (ed) Encyclopaedia of research design Sage Thousand Oaks
Baltruks, D., and Daly, G., 2018 U.K Health Faculties Global Engagement London Council of Deans
Baumeister, R,. Twenge, J., and Nuss, C., 2002 Effects of social exclusion on cognitive processes. Anticipated aloneness reduces intelligent thought Journal of Personality and Social Psychology 83 817-827.

Berger, R., 2013 Now I see it, now I don’t: Researchers position and reflexivity in qualitative research Qualitative Research 15 (2) 219-234

Best, S., and Williams, S., 2019 Professional identity in teams: findings from a scoping review Journal of Inter Professional Care 33 (2) 170-181

Braun, V., and Clarke, V., 2014 Successful qualitative research: a practical guide for beginners London Sage
Brown, C.A., Fetherstone, C.M., and Medigovich, K., 2015 International clinical placements for Australian undergraduate nursing students: A systematic thematic synthesis of the literature Nurse Education Today 35 1028-1036.
Brown, M., Boateng, E.A., and Evans, C., 2016 Should I stay or should I go? A systematic review of factors that influence healthcare students’ decisions to study abroad Nurse Education Today 39 63-71.
Browne, C.A., and Fetherstone, C.M., 2018 How do we facilitate international clinical placements for nursing students: A cross sectional exploration of the structure, aims and objectives of placements Nurse Education Today 66 1-7.
Carpenter, L.J and Garcia, A.A., 2012 Assessing Outcomes of a study abroad course for nursing students Nursing Education Perspectives 33 (2) 85–89.

Chan, A.E,. Wa Liu,J.Y., Kee Fung, K.H,. Tsang, P,L and Yuen, J., 2018 Pre-departure preparation and co-curricular activities for Students' intercultural exchange: A mixed-methods study Nurse Education Today 63 43-49

Charles, L,. Maltby, H,. Abrams., Shea, J., Brand, G., and Nicol, P., 2014 Expanding worldview: Australian nursing students’ experience of cultural immersion in India Contemporary Nurse 48 (1) 67-75.
Cone, P. H and Hayley, J.M., 2016 Mobile clinics in Haiti: Preparing for Service Learning Nurse Education in Practice 21 1-8.
Crawford, E,. Caine, A,M,. Hunter, L,. Hill, A,E,. Mandrusiak, A,. Anematt, L,. Dunwoodie, R,. Fagan, A, and Quinian, T 2017 Service learning in developed countries: Student outcomes including personal success, seeing the world in new ways, and developing as health professionals Journal of Interprofessional Education and Practice 9 74-81.
Creswell, J.W., and Miller, D.L., 2000 Determining Validity in Qualitative Inquiry Theory into Practice 39 (3) 124-130.
Creswell, J.W., and Plano Clark, V., 2017 Designing and conducting mixed methods research Los Angeles Sage
Cronin, C.J., and Lowes, C., (2016) Brief Encounters with Qualitative methods in health Research: Phenomenology and Interpretative Phenomenological Analysis. Cumbria Partnership Journal of Research and Practice Learning 5 (1) 8-12 ISSN 2046-0317
, S., 2017 Evaluating a nursing Erasmus exchange experience; Reflections on the use and value of the Nominal Group Technique for evaluation Nurse Education in Practice 28 68-73.
Curinckx, H., Welsh, M., and Nieuwenhuijze, M., 2018 The lived experience of Flemish midwifery students undertaking an internship in Suriname: A phenomenological study Nurse Education in Practice 30 79-85.
Duranto, P.M., Nishida, T., and Nakayam, S., 2005 Uncertainty, anxiety and avoidance in communication with strangers International Journal of Intercultural Relations 29 (5) 549-560
Gudykunst, W.B., and Mody, B., 2002 Handbook of International and Intercultural Communication Sage Thousand Oaks
Gudykunst, W.B., and Nishida, T., 2001 Anxiety, uncertainty and perceived effectiveness of communication across relationships and cultures International Journal of Intercultural Relations 25 (1) 55-71

Gower, S., Duggan, R., Dantas, J.A.R., and Boldy, D., 2017 Something has shifted: Nursing students’ global perspective following international clinical placements Journal of Advanced Nursing 73 2395-2406.

Hall, P., 2008 Inter professional team work: Professional culture as barriers Journal of Inter Professional Care 19 (1) 188-196
Hassan, H.A., 2017 Migration: The Choices we Face Science 356 (6339) 667.
Health Care Professions Council 2014 The standards of proficiency for operating department practitioners https://www.hcpc-uk.org/standards/standards-of-proficiency/operating...
Holmes, P., Bavieri, L and Ganassin, S., 2015 Developing intercultural understanding for study abroad: students’ and teachers’ perspectives on pre-departure intercultural learning, Intercultural Education 26 (1) pp.16-30.
Illeris, K., 2015 The development of a comprehensive and coherent theory of learning European Journal of Education, Research, Development and Policy 50 (1) 29-40.
Kamali, A., Clary, P. and Frye, J., 2017 Preparing BSW Students for Practicum: Reducing Anxiety Through Bridge to Practicum Course Field Educator Simmons School of Social Work 7.1 1-16.
Keeping, C., (2015) The processes required for effective inter professional working. In: Thomas, J., Pollard K.C and Sellman, D 2015 Inter professional working in health and social care: professional perspectives 2nd ed Palgrave Macmillan Basingstoke

Keogh, J, and Russel-Roberts, E., 2009 Exchange programmes and student mobility: meeting students expectations or an expensive holiday Nurse Education Today 29 (1) 108-116

Leask, B., 2009 Using formal and informal curricula to improve interactions between home and international students Journal of Studies in International Education 13 (2) 205-221.
Levett Jones, T and Lathlean, J., 2008 Belongingness: a pre requisite for student learning Nurse Education in Practice 8 (2) 103-111.
Lotz, S.L,. Shim, S and Gehrt, K.C., 2003 A study of Japanese consumers’ cognitive hierarchies in formal and informal gift-giving situations Psychology & Marketing 20 1 59– 85.
Lovett, T., 2018 Participating in a study abroad program Concerns and hopes of intending international students Australian Universities Review 60 1 3-8.
Maltby, H.J., de Vries-Erich J.M and Lund, K., 2016 Being the stranger: Comparing study abroad experiences of nursing students in low and high income countries through hermeneutical phenomenology Nurse Education Today 45 114-119.
Marshall, J.E., 2017 Experiences of student midwives learning and working abroad in Europe: The value of an Erasmus undergraduate midwifery education programme Midwifery 44 7- 13.
McGaha, K.K and D’Urso, P.A., 2019 A non-traditional validation tool: using cultural domain analysis for interpretive phenomenology International Journal of Social Research Methodology https://doi.org/10.1080/13645579.2019.1621474 on 8 July 2019
Nursing and Midwifery Council 2018 Future nurse; standards of proficiency for registered nurses London Nursing and Midwifery Council
Papadopoulos, I., (ed) 2006 Transcultural Health and Social Care: Development of Socially Competent Practitioners Churchill Livingstone Elsevier London
Pawar, M., 2017 Reflective learning and teaching in social work field education in international contexts British Journal of Social Work 47 198-218.
Piaget, J., 2001 The Psychology of Intelligence Routledge London
Potts, D., 2015 Understanding the Early Career Benefits of Learning Abroad Programs Journal of Studies in International Education 19 (5) 441-459.
Repo, H., Vahlberg, T., Salminen, L., Papadopoulos, I., and Leino-Kilpi, H., 2017 The cultural competence of graduating nursing students Journal of Transcultural Nursing 28 (1) 98-107
Rodham, K,. Fox, F and Doran, N., 2015 Exploring analytical trustworthiness and the process of reaching consensus in interpretative phenomenological analysis: lost in transcription International Journal of Social Research Methodology 18 (1) 59–71.
Rogers, C.R.,1983 Freedom to Learn for the 80’s. Merrill Columbus
Sakakibara, T., 2017 Intercultural understanding through inter group dialogue between Japanese and Chinese university students Integrative Psychological and Behavioural Science 51 (3) 359-378
Sakashita, R., 2018 Features of Women’s Leadership and Nursing in Japanese Culture Asian/Pacific Island Nursing Journal 3 (2) 50-55.
Seale, C., 1999The quality of qualitative research, Sage London
Shen, Z .,2015 Cultural Competence Models and Cultural Competence Assessment Instruments in Nursing: A Literature Review Journal of Transcultural Nursing 26 (3) 308–321

Smith, J. A., Flowers, P., & Larkin, M., 2009. Interpretative phenomenological analysis: Theory, methods and research. Sage London
Smith, J.A., 2015 Qualitative Psychology: A practical guide to research methods Sage London
Somers, M., 1999 Development and preliminary validation of a measure of belongingness. Unpublished Ph.D., Temple University, Philadelphia. Cited in Levett-Jones, T., Lathlean, J., Maguire, J, and McMillan, M., 2007 Belongingness: A critique of the concept and implications for nursing education Nurse Education Today 27 210–218.

Strong, J., Chipchase, L., Allen, S., Eley, D.S., McAllister, L and Davidson, B., 2014 Interprofessional Learning during an International Fieldwork Placement International Journal of Practice-based Learning in Health and Social Care 2 (2) 27-39.

Trolian, T.L,. Jach, E.A,. Hanson, J.M and Pascarella, E. T., 2016 Influencing academic motivation: The effects of student-faculty interaction Journal of College Student Development 57 (7) 810-826.
Tuckett, P and Crompton, P., 2014 Qualitative understanding of an international learning experience: What Australian undergraduate nurses and midwives said about a Cambodia placement? International Journal of Nursing Practice 20 135–141.

Wolfe Kohlbry, P., 2016 The Impact of International Service-Learning on Nursing Students’ Cultural Competency Journal of Nursing Scholarship 48 (3) 303-311.