Mutual Learning and Cultural Awareness Insights From an International Nursing Placement Program: A Mixed Methods...

This study had two aims: (1) to explore the experiences, challenges and development of cultural humility and ethnocultural empathy in Australian baccalaureate nursing students participating in a Study Abroad program to Nepal (2022-2024); and (2) to examine the impact of this exchange on Nepali healthcare professionals and nursing students.

A convergent mixed methods design was employed.

A regional hospital in Nepal.

Forty Australian nursing students completed a pre-placement survey and 29 completed a post-placement survey. Of these, 26 participants were successfully matched across both time points and included in the pre-post analysis. Thirty-two Australian nursing students participated in nine post-placement focus groups, with group sizes ranging from three to six participants. Nineteen Nepali participants (three doctors, two hospital managers, four registered nurses and 10 nursing students) completed semi-structured interviews.

Australian nursing students completed the Abridge Scale Ethnocultural Empathy before and after placement participation. Matched pre-post survey data were analysed using paired samples t-tests, with effect sizes and 95% confidence intervals calculated. Focus groups with Australian students and interviews with Nepali healthcare professionals and nursing students were analysed using reflexive thematic analysis. Quantitative and qualitative findings were integrated during interpretation.

Matched pre-post analyses included 26 students who completed both surveys. Significant improvements were observed in Empathic Perspective Taking (EPT) (mean difference = -1.21, t(25) = -6.26, p < 0.001, Cohen's d = -1.23), Empathic Awareness (EA) (mean difference = -0.42, t(25) = -2.50, p = 0.019, Cohen's d = -0.49) and Empathic Feeling and Expression (EFE) (mean difference = -0.52, t(25) = -4.29, p < 0.001, Cohen's d = -0.84). No statistically significant change was observed for Acceptance of Cultural Differences (ACD) (p = 0.316). The largest improvements were observed in EPT and EFE, indicating enhanced ethnocultural empathy following the placement experience. Thematic analysis of qualitative data generated three core themes: (1) Building confidence through structured preparation and immersive experience, (2) Mutual learning and professional collaboration and (3) Contrasting models of care.

Participation in a short-term international clinical placement was associated with higher ethnocultural empathy scores in three domains and increased self-reported cultural awareness. Qualitative findings suggest that immersion in a culturally different healthcare environment encouraged reflection on nursing practice, professional identity and cross-cultural care. While the findings support the educational value of international placements, they should be interpreted considering the small sample size, participant self-selection and absence of a comparison group.