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Given the limitations imposed by the COVID-19 pandemic, a better understanding of how nursing programs around the globe have implemented distance education methods and related initiatives to provide international collaborative learning opportunities as well as complementary aspects of practical education would be constructive for nursing students. It is expected that international collaboratives through web-based communication will continue to be increasingly utilized after the pandemic; therefore, it is time to discuss the effects and direction of these developments.
We aimed to examine the impact of an online international collaborative learning program on prelicensure nursing students’ international and global competencies in South Korea.
We conducted a mixed methods study (web-based surveys and focus group interviews). A total of 15 students participated in the study. The surveys were used to examine changes in participants’ global leadership competencies, and the focus group interviews were used to evaluate the program’s effectiveness and to identify opportunities for improvement. The online international collaborative program consisted of 7 synchronous web-based classroom sessions. Each session ran for 60 to 90 minutes. Faculty experts and nurses working in the United States discussed various topics with students, such as nursing education in the United States and evidence-based teaching and learning. The students gave presentations on the South Korean nursing education system. Data were analyzed with descriptive statistics, the Mann-Whitney U test, and content analysis methods.
Participants reported improvement in their global leadership competencies. Four main categories emerged from analysis of the focus interviews: (1) realistic applicability, (2) clarification, (3) expansion of perspectives, and (4) initiative.
The online international collaborative learning program had a positive impact on the development of students’ international competencies. The findings support the further development of international exchange programs through web-based meetings in the postpandemic era.
Since the first COVID-19 infection was diagnosed in South Korea, rapid changes designed to contain the spread of the virus have affected all aspects of society [
University international exchange programs have been especially affected by the COVID-19 pandemic [
Attempts to promote and enhance global competencies via international exchange have taken various forms. The Korean Accreditation Board of Nursing Education [
Despite the importance of international exchange programs in developing nursing students’ global competencies, there has been insufficient research to evaluate program content and learning demands. In a study [
Global nursing competencies are reinforced as students from different nursing education systems exchange information and ideas, compare and weigh differences and similarities in nursing curricula, broaden their perspectives, and develop more mature critical thinking abilities [
A mixed method design was used in this study. We used quantitative research methods to evaluate the program quality of online international collaborative learning programs and the global leadership competencies of nursing student participants; we used qualitative research methods (focus group interviews) to explore the impact of participating in the program.
Undergraduate students applied to and participated in the online international collaborative learning program led by the Office of International Affairs at Ewha Womans University. Students who completed the program with at least 70% attendance were eligible to be included in the study. All 16 students were eligible to participate and were offered the opportunity to participate in the study. Of them, 15 agreed to participate in the study.
Global leadership is a competency that positively influences the thoughts, attitudes, and behaviors of stakeholders beyond the national, cultural, and linguistic differences based on open-mindedness and diversity for organizational growth [
We used the Student Evaluation of Educational Quality [
The Office of International Affairs at Ewha Womans University funds an international exchange program each semester; a lead professor plans, supervises, and facilitates the entire program, and students receive a small scholarship upon completion of the program. However, due to the spread of COVID-19, the program was conducted using a videoconferencing platform (Zoom, Zoom Inc). The program was operated by the lead professor in collaboration with a nursing professor at Duke University in the United States; the program consisted of 7 synchronous sessions (running 60 to 90 minutes per session) presented from November 17 to December 22, 2020 (
Online international collaborative learning program.
Data were collected from December 23 to 29, 2020 from college-level nursing students who had completed the program. Quantitative data were collected through a web-based survey using Google Forms, and respondents were asked to complete the survey after providing consent to participate in the study. Focus group interviews were conducted via Zoom by a researcher who was not involved in supervising the educational program. Although the number of participants in a focus group interview varies depending on the literature, it has been found that 7 to 10 participants per group are desirable [
During the interview, the interviewer summarized answers to the questions, asking whether the summary was accurate and if anything had been missed. Data collection through interviews continued until the meaning of experiences and subject matter reached theoretical saturation [
Quantitative data were analyzed using SPSS statistical software (version 23.0; IBM Corp). The general characteristics of participants were represented by frequency and percentage or mean and standard deviation. Global leadership competency improvement (on a 72 point-scale) and program quality were represented by mean and standard deviation. Global leadership competency improvement and participant characteristics were analyzed using a nonparametric method (Mann-Whitney
The focus group interviews were analyzed using a qualitative content analysis method [
We attempted to ensure the quality of research in terms of credibility, applicability, consistency, and neutrality, which are suggested criteria for evaluating the rigor of research [
This study was conducted after obtaining approval from the institutional review board of Ewha Womans University (202012-0009-01). Participants were allowed to voluntarily access the web-based survey link. At the beginning of the survey, we provided instructions on the purpose of the study, contents, procedures, audiorecording for the interviews, anonymity of the data, and the right to withdraw participation at any time; after that, informed consent was obtained when the user clicked to indicated whether or not they agreed to participate in the study. Confidentiality and anonymity were maintained during data collection and analysis; personal information was not revealed when recorded data were transcribed. Collected data will be discarded after being stored for 3 years.
Of the 15 students who agreed to participate, the data from 14 participants were used for quantitative data analysis; data were omitted from 1 participant due to a missing response on the questionnaire. All participants were female (
Participant characteristics.
Characteristic | Value (n=14) | |||
Age (years), mean (SD) | 22.5 (1.16) | |||
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Male | 0 (0) | ||
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Female | 14 (100) | ||
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Sophomore (2nd year) | 3 (21) | ||
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Senior (4th year) | 11 (79) | ||
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Acquire new knowledge | 6 (21) | ||
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Personal achievement | 11 (39) | ||
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Cultural contact | 6 (21) | ||
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Intellectual curiosity | 5 (18) | ||
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No | 6 (43) | ||
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Yes | 8 (57) | ||
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≤5 | 3 | |
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6-9 | 1 | |
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≥10 | 4 |
aMultiple answers were possible.
Mean improvement of global leadership competencies was 51.1 (SD 17.9) (
Improvement of global leadership competencies.
Theme and subtheme | Score, mean (SD) | Undergraduate level | Experience in international exchange programs | |||||||||||||||||
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All (n=14) | Sophomore (n=3) | Senior (n=11) | Yes (n=8) | No (n=6) | |||||||||||||||
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51.1 (17.9) | 45.0 (17.1) | 52.7 (15.6) | 0.86 | .39 | 57.9 (15.1) | 42.0 (18.4) | 1.81 | .07 | |||||||||||
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Global mind | 8.5 (2.4) | 8.0 (1.7) | 8.6 (2.6) | 0.45 | .63 | 9.4 (2.1) | 7.3 (2.4) | 1.45 | .15 | ||||||||||
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Open mind to diversity | 12.7 (3.9) | 12.3 (3.5) | 12.8 (4.2) | 0.47 | .64 | 14.0 (2.6) | 11.0 (5.0) | 1.44 | .15 | ||||||||||
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Global network | 10.4 (4.7) | 9.0 (5.3) | 12.8 (4.2) | 0.71 | .48 | 11.6 (4.6) | 8.7 (4.6) | 1.31 | .19 | ||||||||||
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Performance improvement skills | 7.9 (3.6) | 6.0 (2.7) | 8.4 (3.8) | 1.18 | .24 | 9.6 (3.0) | 5.5 (3.1) | 2.08 | .04 | ||||||||||
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Basic behavioral competency | 11.6 (4.1) | 9.7 (4.2) | 12.2 (4.1) | 1.02 | .31 | 13.3 (3.7) | 9.5 (4.0 ) | 1.82 | .07 |
The mean program quality score was 48.1 points (SD 3.1) (
Student evaluation of program quality.
Program quality items | Mean (SD) |
1. Program was intellectually challenging and stimulating. | 4.6 (0.6) |
2. Learned something considered to be valuable. | 4.7 (0.5) |
3. The instructor was dynamic and energetic in conducting the program. | 4.9 (0.4) |
4. The instructor’s explanations were clear. | 4.9 (0.3) |
5. The learning objectives were in line with the course content. | 4.9 (0.3) |
6. Students were encouraged to participate in discussions. | 4.7 (0.6) |
7. Students were encouraged to ask questions and were given meaningful answers. | 4.8 (0.4) |
8. Students were invited to share ideas and knowledge. | 4.8 (0.4) |
9. The instructor was friendly towards all students as individuals. | 4.9 (0.3) |
10. Feedback on group presentation was valuable. | 4.9 (0.4) |
Content analysis revealed 14 subcategories in the categories
Content analysis of students’ experience in the program.
Categories and subcategories | Example statements | ||
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Obtaining answers to realistic questions | “From the standpoint of students, I could learn directly about how the practice was being conducted there [in the US], and I think it was a very good opportunity for comparative studies because I could listen to firsthand experiences of the treatment of nurses there.” |
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Listening to vivid experiences of clinical and practice sites | “I think it was good to be able to hear stories from the standpoint of nurses who are currently working or are students there [in the US].” |
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Bridging the difference between direct and indirect experiences | “I have heard a lot of stories about the nursing environment in the US on the internet. Even though I have heard stories from across the globe, it felt very new hearing stories directly from the people in question.” |
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Demystifying vague aspects of practical problems | “I think the vague fear of the real problem I was concerned about has disappeared to an extent.” |
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Clarifying vague aspects of careers | “In the past, I was only vaguely thinking about working abroad and obtaining very general information about the job of a nurse abroad. However, through this program, I was able to learn, in great detail, what the basis of going abroad should be and what is really needed for it, which has positively changed my attitude toward going abroad.” |
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Solving queries through Q&A | “It was nice to have a lot of time to ask questions to satisfy my usual curiosity. I think it was a good opportunity to learn a lot.” |
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Addressing various topics as well as the work aspects of being a nurse | “I believe that learning about real-life issues regarding racism and how to deal with it, in addition to the actual job as a nurse, is a part of education, and this is helpful in that sense.” | |
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Approaching the problem from a self-centered to system-centered perspective | “I also practiced at a university hospital for two years, and I never thought that it was natural for me to learn because this is a teaching hospital. I did not think that the nurses, the patients, or even the department head thought that way, but I was jealous that the American students were able to practice with that mindset. However, knowing that this is a systemic issue, I thought it would be good if it could be improved in Korea as well.” | |
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Broadening of international perspectives | “It was very nice to hear about the American system because I was always interested in it but never had the chance to hear about it around me.” |
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Widening of career vision | “Originally, I was thinking of working in a clinic or preparing to work in public service in Korea, but this has helped me expand my vision and also consider being a nurse in the US.” |
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Expanding relationships through collaborative learning | “It was nice to be able to interact with people who work in the clinic or with students attending school there.” |
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Positive changes in job perception and perspective | “I was able to be more open-minded. I was a little skeptical about the attitude of the people around me in the job as a nurse, but learning that this may be because of cultural and environmental differences has made me more hopeful.” | |
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Realizing the need for holistic nursing | “The most meaningful part for me was that it made me think about the nature of nursing. I think it was nice to be able to think about holistic nursing once more while listening to experiences of nursing in the US.” | |
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Changing to a positive attitude for the development of nursing | “Interacting with the American students has made me think that I should make a more active effort to develop nursing skills. I think I will be more proactive in thinking about and acting on problems in the future.” |
We sought to evaluate the effectiveness of an online international collaborative program for nursing students by assessing global leadership competencies and program quality. Participants’ global leadership competencies improved compared to before their participation in the program, and improvement in
There was no significant difference in improvement in global leadership competencies between students who had participated in face-to-face international exchange programs before and those who had not (
Focus group interview analyses revealed that participants experienced realistic applicability through the program. In the web-based learning environment, realism is an important factor for enhancing learning effects [
Participants expressed that their concerns and uncertainties about their future careers were addressed or clarified by listening to field stories about the clinical experiences of US nurses and nurse specialists and the practical experiences of students in the United States. It can be said that this program helped participants to refine the details and objectives of their career paths and specify active plans to achieve them. According to adaptive career decision-making theory, career decisions can be molded by personal experiences and stimuli from the outside world [
Participants showed initiative in changing themselves and their environment through this program. After listening to field stories from the United States, they indicated that they recognized the need for comprehensive nursing care practices that respect patients’ emotional and cultural needs. This result supports those from a previous study [
Students evaluated program quality highly overall, but the item on whether the program was intellectually challenging and stimulating had the lowest score. This could be improved by assessing the topics of interest of participating students before developing the program, including activities on identifying current relevant issues, and discussing them. As for the evaluation of the operation process, the strength of the program was that it was conducted online to allow students to participate during the semester without temporal and spatial constraints and burden of cost. Active interactions between learners and the outside world are important for higher learning effects [
This study has several strengths. The effectiveness of an online international collaborative learning program for nursing college students, developed within the restrictions imposed by the COVID-19 pandemic, was verified by combining quantitative data (surveys) with qualitative data (focus group interviews).
Limitations exist because this was a single-group postdesign study, and there is no feasibility study for pre and postcomparison verification. It is necessary to conduct research to confirm the effectiveness of the program based on practical experiences and college grade levels of student participants. In addition, because most research on international exchange programs has focused on field trips, there were limited tools to verify the effectiveness of our web-based programs; therefore, it is necessary to develop a tool that reflects the characteristics of distance education to measure the effectiveness of the program.
Previous research on international exchange programs has focused on field trips, yet this study examined the program effectiveness of an online international collaborative learning program for nursing college students. We confirmed the effectiveness of the program in improving global leadership competencies during the COVID-19 pandemic, which had restricted the ability to operate traditional exchange programs between countries. We suggest conducting follow-up studies to verify the mid- to long-term intervention effects of continuous operation of the program, rather than one-off training, after planned incorporation into the nursing education global nursing course curriculum. We further suggest developing programs in connection with various organizations that utilize the advantages of web-based learning environments.
DJ and JCDG conceived and designed the study. DJ was responsible for project administration and supervision. DJ, JCDG, EC, and KL collected and analyzed data. DJ, JCDG, EC, and KL wrote reviewed and edited the manuscript. All authors have read and approved the final manuscript.
None declared.