- (2011) Volume 8, Issue 3
Professor, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Associate Professor, Associate Dean Clinical Affairs, King Saud bin Abdulaziz University for Health Sciences, College of Nursing-Jeddah, Saudi Arabia
Assistant Professor, Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg and Director, Centre of Gender Equality Care, VaÃÆÃââââ¬à ¡ÃÆââ¬Å¡Ãâè stra GoÃÆÃââââ¬à ¡ÃÆââ¬Å¡Ãâè talandsregionen, Gothenburg, Sweden
Received date: 12 July 2010 Accepted date: 12 July 2011
The purpose of this study was to apply the principles of phenomenography to describe Jordanian nurse faculty members’ experiences of participation in international exchange programmes (IEPs) with Sweden. Five faculty members from a large university in Jordan participated in focus group interviews. The findings highlighted the importance of careful planning before the exchange, of developing a programme, and of trying to implement the experiences gained on returning home. The findings suggest that IEPs should be well thought out, particularly in terms of selecting the right people and the right time for the exchange. Developing a programme at the host site, and clear goals, objectives, and activities that incorporate social and cultural events are also important. Participation in IEPs can enhance interest in and awareness of cultural and educational differences as well as similarities. However, sometimes it is difficult to implement experiences gained from the exchange when back at home. A plan for implementation should therefore be included in future programmes. In addition, further research is needed into the giver–receiver relationships inherent in IEPs, and how these relationships influence participants’ feelings about their exchange experience.
• International exchange programmes provide a way to help professionals to become inter-culturally competent.
• Teachers have limited opportunity to engage in international exchange programmes.
• Research on this subject is limited.
• International exchange programmes for teachers require careful planning with clear aims and objectives and a social aspect.
• It is difficult to implement experiences gained from the exchange at home.
international education, learning, nursing education, phenomenography, planning international exchange programmes
Although the need for cultural competence is well established as a priority for nurses, there are still barriers to achieving it in healthcare, because pedagogical approaches fail to prepare nurses to work with people from diverse cultures (Taylor, 2008; Larsson et al, 2010). International exchange programmes (IEPs) have been developed for students and staff as a way of overcoming curricular deficiencies (Hagen et al, 2009; Larsson et al, 2010). Research on participation in IEPs mostly reflects student nurses’ experiences, and only limited attention has been paid to the experiences of teachers (Lange and Ailinger, 2001; McAuliffe and Cohen, 2005). Moreover, only a small proportion of those studies that have addressed teachers’ experiences present views from both sides of the exchange (McAuliffe and Cohen, 2005). This study aimed to contribute to this very limited literature by focusing on Jordanian nursing faculty experiences of participation in IEPs with Sweden. It builds on an earlier study by the authors which examined Swedish nursing faculty experiences of IEPs with countries in the Middle East, Central America, and Asia (Ma¨a¨tta¨ and Lepp, 2010).
In 1995, the Swedish International Development Cooperation Agency (SIDA) and the University of Jordan sponsored collaborative projects for nursing in higher education. In 2001, the collaboration was expanded and focused on education programmes, which involved exchanging nursing faculty and nursing students from both countries through the Linnaeus-Palme (L-P) programme. The aims of this programme include providing opportunities for Swedish and foreign faculty to teach in different language and cultural settings. The visiting faculty are required to teach at least 10 hours per week at the host institution (Exchange Programme Linnaeus- Palme, 2008).
Previous studies of nursing education in Jordan discussed programme development and implementation as part of the collaboration and internationalisation (Halabi et al, 2011a,b). Ma¨a¨tta¨ and Lepp (2010) emphasised the value of international collaboration, especially in education, between developing and developed countries to promote the exchange of knowledge and experience in nursing sciences as well as cultural heritage.
The second author (JH) was the key person to start the L-P exchange connection at a university in Jordan, and took the initiative to start the planning with a Swedish partner in Boras, Sweden in 2001. JH was assigned as the project leader and coordinator from Jordan throughout the different phases of the exchange programme. She also coordinated another programme for nurses and teachers, and she planned and implemented the exchange of all teachers and students from both countries.The first author (ML)joined the exchange programme at a later stage, and was intensively involved in several activities with the Jordanian group. Both ML and JH became the core of the exchange when it expanded to Gothenburg University, and were the Jordanian-Swedish counterparts. SM as a researcher from the Swedish university joined for part of the programme, specifically the research component and publication.
Nursing in Jordan has developed rapidly since 1972, following the establishment of the first Bachelor of Science (BSc) degree in nursing at the University of Jordan (Jordanian Nursing Council, 2003, 2004a,b). However, there are several problematic issues related to faculty members and workforce, including the high teacher–student ratio, supply of versus demand for nurses, and the low number of Jordanian nationals in the faculty, which has led to reliance on expatriate teachers (Al Maaitah and Shokeh, 2009).
In addition, there are cultural issues such as patients’ preference for female nurses (Ahmad and Alasad, 2007). Higher education nursing programmes were first introduced at Master’s level at the University of Jordan in 1986 through collaboration with an international institution in the USA. Three universities provide a Master of Science (MSc) degree in different nursing specialties in Jordan. In 2005, the first PhD nursing programme in Jordan was established at the University of Jordan, through which several faculty members from other countries take part in the teaching and supervision of students. However, the number of staff with MSc or PhD degrees is still limited.
The establishment of the Jordanian Nursing Council (JNC) in 2002 played a major role in developing and organising nursing education, practice, research and management. With this development, it became more important to create open and flexible means of exchange with professionals from institutions at national, regional and international levels. Most universities in Jordan have links and agreements with international institutions in various fields, including nursing. Human resources are the most valuable assets in Jordan. Therefore efforts are directed towards investment in the development of healthcare professionals to enhance international excellence in healthcare services. Faculty members need to meet the challenges of maintaining excellence through innovation and continuous improvements in healthcare. IEPs are crucial for the future planning of nursing education in Jordan.
The aim of this study was to describe Jordanian nurse faculty members’ experiences of participation in IEPs with Sweden.
A descriptive, qualitative design based on the principles of phenomenography was chosen because this facilitated a description of how people experience various aspects of reality (Dahlberg et al, 2001). The idea of perceptions is central to phenomenography; it deals qualitatively with people’s different perceptions of the experienced world (Marton, 1986; Lepp and Ringsberg, 2002; Ma¨a¨tta¨ and Lepp, 2010). It is essential to be aware of perceptions both of our social reality and of ourselves, because they help to explain our everyday lives and practices, guide our judgement and direct our inquiries (Barnard et al, 1999). In this study, the perceptions of Jordanian nurse faculty members taking part in an IEP in Sweden were explored.
Five nurse faculty members from a large university in Amman, Jordan, who had participated in IEPs with Sweden were selected to take part in the study. As some of the faculty had moved to another institution or were on leave for the purpose of working at another university or were doing research in another faculty, only five faculty members were available for the interviews. All five of these individuals were willing to participate.
Those who agreed to take part in the study (four women and one man) were aged 45–50 years. They had been teaching nursing for 2–28 years; one of them had an MSc degree and the rest had PhD qualifications. All five individuals had participated in IEPs funded by the L-P programme in Sweden between 2002 and 2008. In addition, two of them had taken part in other exchange programmes, in 1998 and 1999, through a different Swedish exchange project funded by SIDA. The duration of each L-P programme exchange for the participants was three weeks. The Jordanian university in this study had participated in IEPs through SIDA and L-P programmes since mid-1995.
Focus group interviews were used to gather data. Focus groups are commonly used within phenomenography as a particularly appropriate method of identifying knowledge and frames of concepts within a group withcommoninterests (Kitzinger, 1994; Krueger, 1994, Morgan, 1998; Wibeck, 2000). As a means of qualitative data collection, focus group interviews have become increasingly popular within the health and social care arena. The participants are selected using two criteria, namely that they would have something to say about the topic, and that they would be comfortable talking to the interviewer and each other (Rabiee, 2004). In this study, the participants interacted during their daily work routines and had experience of participation in IEPs with Sweden, and were therefore considered to be a group with common interests.
The focus group interview was conducted in Jordan with five participants in 2009. The interview was in English, semi-structured, informal, and conversational in form. It lasted about 60 minutes, and took place in a separate and neutral room of the university. During the interview, ML acted as a moderator while JH acted as an assistant moderator, taking notes and observing the group’s verbal and non-verbal communication. Everyone spoke and understood English. However, as Arabic, not English, was the native language of the participants, JH (who is fluent in both languages) could translate if necessary.
The moderator began the interview with a broad open question: ‘Can you please tell us about your experiences of IEPs with Sweden?’ The opening question was followed by requests for more detailed explanations, in which examples and questions focused on significant statements. The moderator intervened as little as possible, to avoid disturbing the informants, and to encourage focus on the issues that the participants themselves considered important. The interviews were audio recorded and transcribed verbatim.
The data were manually analysed according to the principles of phenomenography (Alexandersson, 1994). This consists of four phases: (1) becoming familiar with the data and gaining an overall impression; (2) noting the similarities and differences between the statements; (3) determining descriptive categories of conceptions; and (4) examining the underlying structure of the system of categorisation (Alexandersson, 1994). The analysis was conducted by all three authors and, to ensure trustworthiness, a constant discussion was held between all of the authors. For practical reasons the analysis was mainly conducted by ML and SM, who were living and working in the same country. JH participated by transcribing the interviews, and by reading and commenting on the analysis. In addition, discussions of the analysis were conducted during ML’s visits to Jordan and JH’s visit to Sweden.
The authors discussed the themes until agreement was reached. The themes represented qualitatively different ways of experiencing IEPs with Sweden. The informants’ perceptions are illustrated below using quotations from the interviews.
As with all qualitative research, the current study should have an inner logic, that is, it should be easy to follow the researcher’s reasoning throughout the analysis. Trustworthiness depends on the extent to which themes correspond to the informants’ descriptions (Kvale, 1997). Thus the quotes presented in this study are intended to assist the reader’s evaluation of the trustworthiness of the analysis. Trustworthiness also concerns transferability, which refers to the extent to which a finding can be transferred to another group or setting (Graneheim and Lundman, 2004). To ensure transferability, a rich presentation of the findings together with illuminating quotations is given.
Permission for data collection was obtained from the administrative committee of the intended faculty of nursing. It was not necessary at the time of data collection to obtain any other review and approval from the research committee. The participants were informed about the purpose and content of the study, and were also informed that participation in the study was voluntary and that they could withdraw if they became concerned about any aspects of the study. They signed a consent form and were assured of the confidential handling of the data, the source of which would not be identifiable. In addition, the participants were assured that all data would be kept in a secure place and would only be used for the purposes of the study.
Three categories emerged in the analysis of the interviews with the faculty members (see Table 1), namely careful planning, developing a programme, and implementing learning at home. The numbers in parentheses below refer to the participants.
This category referred to a need for careful planning within each IEP before the actual exchange of faculty members took place, including when, with whom, how and why the exchange visit should be conducted. The timing of the exchange was an important factor to consider, and therefore needed to be discussed and decided on in advance. When going to countries such as Sweden, participants considered it important to avoid exchanges during the winter. One of them referred to her experiences of student exchange: ‘I learned not to send students on snowy days, because most of the days we were home. I was spending a long time at home [in the hotel] in Sweden’ (P5). Going abroad involved exposure to another culture, which was challenging for those who had not previously participated in an IEP. Therefore, the participants thought it best not to send single teachers.
Table 1: Categories and sub-categories that emerged in the analysis
In addition, the selection of participants for IEPs should be based on appropriateness rather than personal inclination or workload:
And really we must think of who is going to go there. We need to select the most appropriate person and not only who is wishing to go or the ones who have time to go and not burden with the work, because sometimes selecting the person to go or to come here depends on the availability and not according to the needs or interest, and this is a negative experience of the programme.
(P3)
All of the participants attached the utmost importance to ensuring that the visit and the reason for the exchange were closely connected. It was important to clarify the main reason for the exchange and why this specific exchange should take place: ‘We need to know, will we need this expertise or to have this one, with this qualification or this, so that they can have the best benefits of this programme’ (P3). The objectives of the visit had to be made clear in advance of the visit, before leaving the home country.
Both universities and nursing faculties should be involved in planning the exchange. If the objectives were unclear, the purpose of the exchange might become blurred and the individuals involved in the exchange might be confused.
Some participants felt that their programme was unclear and incomplete when they arrived at the host nursing faculty. However, the reaction to an unfinished programme varied. One participant felt that she coped with an unfinished programme: ‘But I think within a few days when we had the programme, we saw well it is a very easy programme and that we can just go and see the culture there and enjoy Sweden. And then one step at a time, we found ourselves filling the whole programme’ (P2). Others preferred a complete programme in advance of the visit.
One participant proposed an exchange of faculty teaching in the same subject area. Even though this suggestion is in line with L-P, it was not always feasible. Others suggested that the visiting faculty member could take responsibility for various courses.
Participants also stated the importance of a good social programme for making people feel welcome. The programme should include elements of the visited country’s history and culture. The social atmosphere and hospitality of Swedish people were appreciated, and were described using the metaphor of a garden: ‘and at the personal level, I enjoyed being in Sweden. I always see it as a big garden’ (P2). The experience in the host country also gave a feeling of fulfilment, and therefore when they were back home the participants experienced a sense of loss: ‘When I come back and feel that something is missing. No green things, nothing like a lot of trees in Sweden’ (P2). However, not everyone had a positive experience: ‘I felt insulted because nobody paid attention’ (P4). To be taken care of was therefore considered important.
The participants stated that they had learned a lot from the exchange visit, both personally and socially. All of them stated that they had been participating in or observing methods in teaching and clinical practice that they wanted to apply in their home country. One of them explained that she had tried to implement a pedagogical method used by the visited nursing faculty: ‘I attended a class in how they discussed a case. I used it once with my students but I thought it takes time’ (P3). Implementing the pedagogical exchange experiences at home was not an easy process: ‘So reflecting on the experience, we have gained a lot. But sometimes the environment and resources here don’t help us to implement what we learned from the experience’ (P3).
The participants were also impressed by their experiences of clinical practice in Sweden. One of them stated that they ‘want to see this practice in our country’ (P5). Another was inspired by Swedish trauma care: ‘They give a lot to the spiritual care of the patient in Sweden, especially in trauma. So one thing and the first thing I started to establish in [X], when I started my job there, is to offer spiritual care for supporting dying patients’ (P1). However, not everything that the participants experienced was suitable for implementation at home: ‘I have a good impression that we can use something and [that] other things are not for us. It depends on us. Either we apply, or we modify, or we just leave it’ (P2).
This study aimed to explore the experiences of Jordanian faculty who participated in IEPswith Sweden. The findings associated with careful planning supported the findings of our earlier study in which Swedish nursing faculty also commented on the importance of the timing of an exchange, and of selecting the right people (Ma¨a¨tta¨ and Lepp, 2010). The participants’ concerns can be understood through Campinha-Bacote’s model of the development of cultural competence (Campinha-Bacote, 2002). This focuses on becoming, rather than being, culturally competent. There are five elements, namely cultural skill, cultural awareness, cultural encounter, cultural knowledge and cultural desire. Cultural skill reflects the ability to collect relevant data during cultural and physical assessments. To do this efficiently means stepping outside one’s own value orientation to identify and interpret what is important in understanding another culture. Cultural awareness is the in-depth exploration of one’s own cultural and professional background, and involves awareness of assumptions, biases and prejudices. Cultural encounter is the process that encourages cross-cultural interactions, which modifies one’s existing beliefs about a cultural group and prevents stereotyping. Cultural knowledge involves obtaining a sound educational base about culturally diverse groups. Cultural desire comes from within, and is a genuine motivation to engage in the process of becoming culturally aware, rather than being forced to do so. Without cultural desire and cultural encounters, which provide the opportunity to interact with those who are culturally different to oneself, cultural competence is unlikely to develop.
In line with this understanding of cultural desire, the participants in the current study were emphasising the importance of proper selection of participants for IEPs. It seems that the Jordanian participants and their Swedish counterparts intuitively identified the need not only to be willing to expose oneself to cultural encounters, but also to truly desire them. The importance of cultural desire for successful student exchange has previously been described by other researchers (Hagen et al, 2009), but to our knowledge has not been pointed out as influencing faculty international exchanges. In future exchange programmes the presence of cultural desire should be considered by both of the institutions involved.
In contrast to the Swedish counterparts (Ma¨a¨tta¨ and Lepp, 2010), the participants in the present study emphasised the importance of a good social programme for making visiting teachers feel welcome and for achieving a successful and fruitful exchange. This finding can be related to Hofstede’s theory of different cultures (Hofstede, 1991) and to the individualistic nature of Swedish culture. In western cultures in general, people are more accustomed to doing many things on their own by comparison with the Jordanian culture. In this, a twofold outcome of IEPs is revealed. Although IEPs contribute to awareness about oneself as a cultural individual, they also promote understanding of the similarities and differences between diverse cultures. In this way IEPs can enhance cultural knowledge, namely the process that involves seeking and obtaining knowledge about diverse cultural and ethnical groups (Hagen et al, 2009).
The need for a professional programme was emphasised both in the current study and in the study of the Swedish faculty (Ma¨a¨tta¨ and Lepp, 2010). The professional programme should, according to the participants in both of these studies, be prepared in advance of the visit and be constructed by both parts of the exchange. An effective programme should mirror the purpose of the IEPs in including both social and professional grounds for the exchange. In line with the students’ experiences in the study by Hagen et al (2009), an effective programme can contribute to enhanced personal cultural competence. Without the design of an effective programme the purpose of the visit might become overlooked and lead to feelings of time being wasted.
Implementing learning at home highlighted the importance and difficulties of implementing what was learned and experienced during the exchange, and the fact that participants could find this problematic. Different educational contexts and scarce resources were the main barriers. The participants understood that it was their responsibility to use modified versions of their experience and to implement what was practicable. This issue of implementation did not arise in our previous study of Swedish nursing faculty experiences (Ma¨a¨tta¨ and Lepp, 2010). Although the Swedish participants were trying to implement only their individual international experiences in teaching, the Jordanian participants were trying to implement pedagogical, nursing and healthcare organisation changes at home. The Swedish participants did not reflect on pedagogical approaches or clinical practices, and this may reflect ethnocentrism on their part (Capell et al, 2008).
A certain amount of ethnocentrism might also be reflected in the different approaches to visiting another country. In contrast to Swedish nursing faculty experiences of IEPs (Ma¨a¨tta¨ and Lepp, 2010), the participants in the present study emphasised the value of feeling welcomed when visiting Sweden. This difference in experience can be seen in the context of the financing of IEPs by a Swedish agency. In this context, participating in an IEP could be experienced as support and financial assistance provided by a developed country for a developing one. The exchange is thus experienced asymmetrically. Even though the L-P programme regulations (Exchange Programme Linnaeus- Palme, 2008) explicitly state that the goal of the IEPs is a reciprocal exchange, a donor–receiver relationship can be perceived. The question of how this relationship may affect the exchange has yet to be explored.
To enhance mutuality, Dong and Collaco (2009) suggested that it was necessary to reduce individual levels of ethnocentrism. They indicated the need for increasing social intelligence which might help to promote mutual respect and active listening, and therefore ensure intercultural collaboration success. In addition, Lange and Ailinger (2001) suggested bilateral learning as a basis for mutual respect. Our findings indicate that mutuality in IEPs takes time to develop. The sustainability of IEPs is thus of vital importance, in terms both of time and of individuals involved in the exchange (Ma¨a¨tta¨ and Lepp, 2010). To our knowledge, the need for season-related planning has not been demonstrated in previous research, and perhaps warrants consideration by funding agencies in further exchanges.
The literature shows that international research collaboration is a crucial, complex and fragile process, and therefore effective strategies are needed. ‘Valuing diversity and developing cooperative goals, engaging in self-reflection and reflexivity, promoting collaborative dialogue, taking time, and developing trust’ have been cited as strategies to support a fuller international engagement (Bagshaw et al, 2007, p. 433). The benefits of intercultural collaboration are expected to be great for people, groups and countries around the world. It is therefore necessary to have open dialogue and to make it clear to participants that they should expect some differences and problems, and should plan for the management of these as they arise (Dong and Collaco, 2009).
The inclusion of more participants in the focus group would have been advantageous. However, all of the participants spoke freely, and there was a lively and fruitful discussion throughout the focus group interview. Although the number of participants was limited, interesting aspects of the IEP still emerged. The findings of this study need to be confirmed by other larger studies.
The focus group was held in the participants’ second language (English), which might be considered a limitation. However, the participants were familiar with this language, as they had been taught in English during their undergraduate and graduate studies.
Another possible limitation is that some of the participating teachers might have been reflecting on a long-term experience, as their exchange took place at the beginning of the collaborative project.
The faculty members who participated in this study suggested that there is a need for careful planning, and they cited as examples the appropriate selection of participants for and the timing of IEPs. They also emphasised the need to develop programmes that include more scientific and academic aspects as well as social and cultural experience. Future studies need to focus on the relationship between giver and receiver that was highlighted in this study, which may influence participants’ feelings about their exchange experience. The relationship of trust between the two parties involved in the IEP was emphasised, as well as the mutual benefit for both sides of the programme. The exchange with Sweden has developed over many years, and may serve as a guide for planning future programmes with Sweden as well with other western countries.
The authors gratefully acknowledge funding from the Swedish InternationalDevelopmentCooperation Agency (SIDA), the Linnaeus–Palme programme and the University of Jordan throughout these programmes.
None.
