Comparative Healthcare Systems – Nursing and Midwifery Response to Global Health Crises

The major aim of this course is to compare the response of nursing and midwifery to COVID-19 in different countries – the United States, the United Kingdom, Australia, Ireland, and Norway, in this case. Virtual class experiences are designed to keep pace with changing responses to COVID-19. Students will conduct fieldwork that will enrich their understanding of how nurses are dealing with the pandemic. This course also aims to provide a forum for cultural exchange among students from these different countries, wherein they can share not only changes in the nursing profession but also cultural activities they individually enjoy.

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​Program Features

Education Abroad Program Name	Nursing and Midwifery COIL: Multinational Exchange
Level	Undergraduate
Number of Credits for Course	1 credit unit (typically equates to 4 credits at most US institutions)
Number of Credits for Education Abroad Program	1 credit unit (typically equates to 4 credits at most US institutions)
Does this course carry major/minor credit? Elective credit?	Elective
Typical Enrollment	50-60
Language of Instruction	English
Duration	Semester
Time Spent On-Site	Semester
Last Taught	Spring 2021
Curriculum Strong Points/Innovations	Virtual exchange; Collaborative Online International Learning; Multinational Exchange; Sustainable Programming

 

FACULTY LEADER BIO

Maria White
​Affiliation: University of Pennsylvania
Maria White, MSN, RN, CCRN, Senior Lecturer in the Department of Biobehavioral Health Sciences (University of Pennsylvania), serves as associate course director for two courses: “Nursing Care of the Young and Middle-Aged Adult” and “Nursing Care of the Older Adult."

Nina Juntereal
​Affiliation: University of Pennsylvania
Nina Juntereal is a doctoral student at the University of Pennsylvania School of Nursing. Her research interests involve the childbearing family and lactation care for vulnerable families.

Sarah Hope Kagan
​Affiliation: University of Pennsylvania
Sarah Hope Kagan, PhD, RN, FAAN, Lucy Walker Honorary Term Professor of Gerontological Nursing (University of Pennsylvania), specializes in working with older people living with cancer, which is under-addressed in nursing despite the increasing number of older adults for whom cancer is now a chronic disease.

What are the learning objectives for this course?
The learning objectives for the course included:

• Examine and compare nursing practice, evidence-based practice (EBP), and related research or needs for research across nations around the world.
• Participate in synchronous, global weekly seminars, learning from each other and experts from participating universities and other institutions around the world.
• Conduct fieldwork, questioning nurses and other healthcare professionals, about their practice during COVID-19, those nurses’ EBP pertaining to care of people diagnosed with COVID and prevention of this infection, and their awareness of relevant research and needs for future investigations.
• Generate an individual report of fieldwork completed, reflecting trends in EBP, relevant research, and future needs for research.
• Participate in weekly, synchronous, international small group discussions, comparing reactions to seminar guests and sharing notes from fieldwork with peers from other societies.
• Create a video synthesis of lessons learned from fieldwork and comparative analysis of reactions to seminars and shared fieldwork. Video synthesis comes from the small group and offers three to five highlighted best practices and lessons learned for future practice.

How do you measure student learning and development outcomes?
This course utilized a number of evaluation methods, although each member of the exchange was encouraged to evaluate their own students independently. The students at the University of Pennsylvania were evaluated based upon the following mechanisms:

• Participation in synchronous meeting discussions
• Reflective cultural journal (4 journal entries submitted on Canvas)
• Video interview project
• Term paper (2,000 words)

How does the curriculum support participants’ understanding of the social, historical, political, economic, linguistic, cultural, and environmental contexts?
The curriculum was designed to provide global perspective of the response to the COVID-19 pandemic by addressing a wide array of topics related to the nursing and midwifery professions. By examining the response of each country represented in the multinational exchange, students could come to recognize the ways in which healthcare is rooted in cultural, political, economic, social, and historical contexts. From birth during the pandemic to mental health to long-term care, students had the opportunity to hear from practitioners, academics, NGO workers, and contact tracers from around the world each week, read journal articles, blogs, and op-eds, discuss their reactions with their fellow students, and interrogate the successes and failures of each country’s response to the pandemic. By learning through a global lens rather than a national one, the students broadened their understanding of nursing and midwifery practice.

How do the curricular and co-curricular programming, including assigned readings, excursions, and guest speakers, include diverse perspectives and practice inclusive pedagogy?
Each week, a topic was addressed in a synchronous session which included guest speakers from around the world who worked in that particular niche of nursing/midwifery. Moderating duties cycled through the teaching team in order to be inclusive and highlight diverse perspectives.

Readings were sourced by the multinational teaching team and posted on Canvas, thereby providing students with literature and perspectives outside their typical milieu. Breakout groups were intentionally mixed to include representation from each of the exchange partners and remained consistent throughout the semester, thereby allowing the students to forge strong and lasting bonds with their classmates.

Breakout session prompts and cultural journal prompts intentionally asked students to reflect upon their own cultural background and interrogate how their cultural, national, ethnic, and socioeconomic perspectives inform their response to the weekly topics.

What are your policies and procedures related to evaluation, awarding and/or transfer of credit, grade conversions, grade appeals, research ethics, and academic integrity? How do you make them accessible to interested parties?
Each virtual exchange partner was free to evaluate student work and award credit in whatever way worked best for them. While a master syllabus was shared amongst the teaching team, each partner was able to modify it according to what their respective institution required. Some of the exchange partners found it difficult to get the course through curriculum committee in time for the first run, so their students participated as auditors (with great success). The intent and design of the multinational virtual exchange was to make it as accessible to each partner institution as possible, as well as to make it as financially accessible to each student as possible. No program fee was charged to participate.
School and national holidays were an interesting area to navigate, and certain class dates were listed as “optional” for the entire exchange as needed, but each exchange partner could develop a separate required class session to meet their minimum number of didactic hours.

Did you consult any resources on education abroad that were particularly helpful in designing this course? If so, please describe.
Much of the inspiration for this course was rooted in the SUNY system’s Collaborative Online International Learning program and resources found on their website. The teaching team referred to the best practices on setting up a COIL collaboration using those resources.

If you feel that you have valuable information to contribute to this project that is not addressed in the body of this survey, please elaborate here.
The teaching team of Nursing 535: Comparative Healthcare Systems – Nursing and Midwifery Response to Global Health Crises developed a truly groundbreaking course that was tailor-made to address the regional responses to the COVID-19 crisis. The course, which was taught for the first time in the Spring 2021 semester, utilized a supercharged version of the Collaborative Online International Learning (COIL) modality, bringing together six institutions from five countries in a dynamic experience for both students and instructors. The group of 65 (54 students + 11 instructors/administrators) met synchronously each week throughout the Spring 2021 semester. Although it was challenging to find a time that was mutually convenient for each member of the exchange, with some members showing up for the start of class as early as 5:30AM and others as late as 930PM, the group nevertheless convened each week with a renewed sense of excitement and enthusiasm for the topic.

The course was structured around the philosophy that students and instructors are both learners and teachers. Each week, guest lecturers joined the group on Zoom and discussed the ways in which the COVID-19 pandemic was affecting their professional space. Nurses, professors, supply-chain professionals, and public health experts interacted in a “chat show” style panel moderated by a revolving member of the international teaching team. Creating a space where the entire group could interact with these guest speakers from around the globe, followed by small group discussions that intentionally included student representation from each institutional partner, had the effect of crossing international borders, providing vibrant cultural exchange, and bringing people closer together in a time where many felt so isolated.

These efforts were never intended to be invested for a single run of the course; following the successful first run of the course, the US-based teaching team developed a series of best practices and recommendations that will be utilized to improve future iterations of the course. Next year’s course will focus on the salient theme of social isolation and the existing exchange partners intend to welcome even more institutions into the fold, ideally with representation from South America and Africa. Beyond the student impact of the course itself, the international teaching team has already launched an ambitious research and publication agenda to help measure the impact of the multinational exchange and to introduce the COIL modality as a means of providing equitable and affordable exchange programs for students. The team plans to present at nursing and education abroad conferences and already has articles under review at peer-reviewed journals.
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Finally, the teaching team was particularly interested in the sustainable nature of this course. Not only is this course sustainable from an environmental perspective (the course did not include any travel and was conducted entirely online), but it is also sustainable from a funding perspective and can therefore run each year without consideration of cost.