Quality Advancement in Nursing Education - Avancées en formation infirmière Volume 1 | Issue 2 Article 2 June 2015 Integrating Global Citizenship through Local Teaching Practices Sharon D. Simpson Thompson Rivers University, ssimpson@tru.ca Sonya L. Jakubec Mount Royal University, sjakubec@mtroyal.ca Cheryl Zawaduk Thompson Rivers University, zawaduk@tru.ca Cheryl Lyall clyall@tru.ca Follow this and additional works at: https://qane-afi.casn.ca/journal Part of the Curriculum and Instruction Commons, Curriculum and Social Inquiry Commons, Other International and Area Studies Commons, and the Other Nursing Commons Recommended Citation Simpson, Sharon D.; Jakubec, Sonya L.; Zawaduk, Cheryl; and Lyall, Cheryl (2015) "Integrating Global Citizenship through Local Teaching Practices," Quality Advancement in Nursing Education - Avancées en formation infirmière: Vol. 1: Iss. 2, Article 2. DOI: https://doi.org/10.17483/2368-6669.1031 This Article is brought to you for free and open access by Quality Advancement in Nursing Education - Avancées en formation infirmière. It has been accepted for inclusion in Quality Advancement in Nursing Education - Avancées en formation infirmière by an authorized editor of Quality Advancement in Nursing Education - Avancées en formation infirmière. Integrating Global Citizenship through Local Teaching Practices Cover Page Footnote Acknowledgements: We respectfully acknowledge the inspiration and original work of the late Dr. Sharon Simpson, who consented to this paper before her death, in addition to the support and contributions of her supervisory committee and examiners: Michael Manley-Casimir, Sonya L. Jakubec, Kathryn A. McNaughton, Wendy Cassidy, and Cheryl Segaric. Remerciements : Nous souhaitons reconnaître l'inspiration et le travail unique de la regrettée Sharon Simpson, Ph. D., qui a autorisé ce travail avant son décès, ainsi que le soutien et les contributions de son comité de thèse et de ses examinateurs : Michael Manley-Casimir, Sonya L. Jakubec, Kathryn A. McNaughton, Wendy Cassidy et Cheryl Segaric. This article is available in Quality Advancement in Nursing Education - Avancées en formation infirmière: https://qane-afi.casn.ca/ journal/vol1/iss2/2 Simpson et al.: Global Citizenship Teaching Practices Introduction Over the past decade many universities and colleges across Canada and beyond have revised their mission statements and strategic plans to include the perspective of global citizenship (see, for example, University of British Columbia’s (2004) Road to Global Citizenship 1 and the University of Alberta’s (2008) Connecting with the World: A Plan for International Engagement plans). Such actions emphasize the critical role of post-secondary institutions (PSIs) to prepare students for successful engagement with the globalized world, to participate in the increasingly globalized economy, and to contribute to solving trans-national concerns and problems (Abdi & Shultz, 2008; Brustein, 2007; Jorgenson & Schultz, 2012; Larsen, 2014; Rhoads & Szelényi, 2011). The nursing profession adds to this global perspective, drawing on a long history of concern for broader public health (Community Health Nurses Association [CHNA], 2011; McIntyre, Thomlinson, & McDonald, 2006; Tyer-Viola, Nicholas, Corless, Barry, Hoyt, Fitzpatrick, & Davis, 2009). While these educational and professional mandates (Canadian Nurses Association [CNA], 2009; Mill, Astle, Ogilvie, & Gastaldo, 2010) of global health and citizenship are emerging as essential in nursing education, scholarly understanding of how best to integrate these concepts in nursing curriculum and pedagogy is just beginning. An interpretive descriptive (Sandelowski, 2008; Thorne, 2008; Thorne, Reimer Kirkham, & MacDonald-Emes, 1997) study was undertaken to inform undergraduate nursing curricula and pedagogy with knowledge derived from expert informants’ experiences and recommendations for the inclusion of global citizenship within nursing education. Simpson’s (2013) study explored the curricular development practices and pedagogical practices that can promote the development of undergraduate nursing students as global citizens. In this paper the authors extend Simpson’s (2013) interpretative descriptive doctoral research2 – focusing on specific and applied dimensions of global citizenship for nursing education. Here, the authors (including Simpson, posthumously, along with one of the thesis supervisors, and Simpson’s long-time colleagues) draw upon finding from the original research and present specific pedagogical practices for nurse educators to integrate global citizenship into undergraduate nursing curricula. Background For over two decades the Association of American Colleges and Universities (AACU) has worked with PSIs to promote global learning as a key characteristic of undergraduate education. Involving students in the dynamics that shape the interconnected and unequal world are considered among the universities’ most important tasks (Hovland, 2005). Among key themes, universities across Canada have put forward definitions of global citizenship focused on respect for others (Piper, 2006), appreciation of the connectivity in the world (Goodman & Richardson, 2010; Goodman, 2011), and attention to environmental concerns or ecological citizenship (Dobson, 2005; Korgman & Foote, 2011). Oxfam (n.d.) described a global citizen as someone who is aware of the wider world (economically, politically, socially, culturally, technologically and environmentally) and their role as a world citizen, respects and values 1 Further to the 2004 strategy, in 2011 The University of British Columbia, UNICEF, and CIDA created a related resource called Road to Global Citizenship: An Educator’s Toolbook edited by Yael Harlap (2011). 2 The doctoral thesis research extended and referenced in this paper was completed just prior to Dr. Sharon Simpson’s passing in 2013. Simpson was an expert nurse educator who contributed to the development of practice and the discipline of nursing for over 40 years. She was a champion of nursing education and global citizenship well ahead of her time. Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2015 1 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 1, Iss. 2 [2015], Art. 2 diversity; is outraged by social injustice; contributes to the local and global community; and is willing to act - and takes responsibilities for their actions - to make the world a more sustainable place. A sound understanding of one’s positioning within local and global relations; care-giving, co-operation, and conflict resolutions skills; and integration of global citizenship within a curriculum are all recommended features of global citizenship education (Noddings, 2005). In terms of curriculum and pedagogical practice, global citizenship education is said to begin with moral, knowledge, and action-oriented lessons, with the promotion of relationships and connections of self to others, connection to the environment, and critical appraisal of nationalism and globalism (Pike, 2008). Others suggest the starting place for global citizenship is in interdisciplinary global health learning (Hanson, 2010; Koplan, Bond, Merson, Reddy, Rodriquez, Sewankambo, & Wasserheit, 2009; Merry, 2012). Increased interest in global health, awareness of greater international connectedness related to global health, and concomitant growth in academic initiatives and programs (MacFarlene, Jacobs, & Kaaya, 2008; Merson & Page, 2009) has occurred over the past decade. Several undergraduate and graduate-level texts focusing on global health have been produced in recent years (Holtz, 2008; Jacobsen, 2014; Markle, Fisher, & Smego, 2013; Seear, 2012; Skolnik, 2012). Similarly, social responsibility (Kelley, Connor, Kun, & Salmon, 2008) and the social determinants of health (CNA, 2008; Public Health Agency of Canada, 2015; Raphael, 2009), central to discussions of global health, have been commonly incorporated into undergraduate nursing curricula to guide assessment and practice. The place of clinical nursing practice experiences for students is one side of global health and global citizenship learning. Nursing research provides evidence that international clinical experiences advance cultural competence and confidence in student transitions to independent practice, in particular working through language barriers supports students’ development of intuitive knowing and non-verbal communication (Lee, 2004). A growing body of literature examines the use of international placements to promote intercultural consciousness as well as a direction for integrating global citizenship concepts into existing curriculum, specialized courses, faculty development and leadership buy-in (Mill et al., 2010). Despite the growth of international placements in nursing programs, a stronger emphasis on global concepts for all students is recommended in the literature (Ogilvie, Paul, & BurgessPinto, 2007). Several nurse researchers recommend that diverse clinical and cultural learning experiences within students’ local contexts can be valuable as global health learning experiences (Boutain, 2008; Burgess, Reimer-Kirkham, & Astle, 2014), described as “internationalization at home” by Soria and Troisi (2014, p. 261). Despite the expanded landscape of global citizenship education and research over the past decade, general practices in higher learning continue to concentrate on international placements and broader global citizenship education rather than on integrated curricular and pedagogical practices (Larsen, 2014). In addition to PSI mandates, research trends and recommendations, there is a professional mandate for nurses to practice global citizenship. Provincial practice standards (for example the College of Registered Nurses of British Columbia [CRNBC], 2014) and international codes of ethics (International Council of Nurses, 2012) emphasize knowledge of emerging global health and population health issues, culturally safe practice, and advocacy for social justice. A specific educator mandate is also articulated in the following CNA (2010) statement: Educators are responsible for integrating concepts of cultural competence and diversity into curricula. They are responsible for promoting cultural competence within the faculty and student populations (p. 1). https://qane-afi.casn.ca/journal/vol1/iss2/2 DOI: 10.17483/2368-6669.1031 2 Simpson et al.: Global Citizenship Teaching Practices Many challenges exist to the integration of global citizenship into already content-laden nursing curricula (Giddens & Brady, 2007). Integrating concepts in curriculum requires significant commitment, resources, and leadership. Students also come with their own values and preferences as to what they will obtain through a baccalaureate education. Nonetheless, the importance of integrating global citizenship into curricula cannot be understated. Integration includes the focus on theoretical perspectives such as critical social theories, cultural knowing, social justice, social determinants of health, political theories, leadership, and policy. For the purposes of this paper these concepts are not discussed in detail but rather assumed as foundational, philosophical, or theoretical perspectives that underpin the design of global citizenship and global health learning activities. Despite these educational and professional mandates for global citizenship and global health, Thorne (1997; 2007) found that the profession of nursing was failing to engage nursing students in global health concerns. Curricular trends are being explored, in particular weighing the balance of select courses versus integration of curriculum (Chavez, Peter, & Gastaldo, 2008). Still, there exist relatively few studies of the specific practices and outcomes for global citizenship learning in nursing education. Research initiatives investigating pedagogical approaches that can best facilitate global citizenship and global health education are timely. This paper presents particular pedagogical directions to promote the integration of global citizenship education within nursing programs. Interpretive Descriptive Approach The pedagogical directions presented in this paper were drawn from Simpson’s (2013) qualitative interpretive descriptive findings (Sandelowski, 2008; Thorne, 2008; Thorne, Reimer Kirkham, & MacDonald-Emes, 1997). Ethical approval for the original study was obtained through the research ethics board of Simon Fraser University, with Simpson’s permission granted for the extended analysis in this paper. The original research methods included semistructured telephone interviews conducted with 12 Canadian expert informants, all nursing education leaders with experience in global health or international education. The experts were all female, between 50-70 years of age, 11 of 12 prepared at the doctoral level, and all had held leadership positions at schools of nursing across Canada. Many had been involved in planning or implementing international student placements, and all had conducted and published research. Guiding interview questions focused on personal and professional experiences with global health, involvement in education related to global health and influences/inspiration for global health. Interviews also focused on the meaning of global citizenship for global health and nursing education, and questions about creating the conditions for global citizenship in nursing education. Responses were analyzed inductively by repeated immersion to discover important patterns, themes, and interrelationships (Denzin & Lincoln, 2005; Thorne, 2008). In this paper, the authors extend Simpson’s (2013) original research, reviewing the thesis and the interview transcript data contained within the thesis, employing the same interpretive descriptive approach in order to focus the analysis on specific pedagogical practices for global citizenship. In this approach the authors, immersed in the thesis data, and from the basis of considerable global health educational experience, made specific observations followed by an open exploratory analysis in order to develop into broader generalizations (Thorne, 2008). The focus of the description and the extended analysis was related to pedagogical practices for fostering global citizenship in nursing education. Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2015 3 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 1, Iss. 2 [2015], Art. 2 Themes and Teaching Pr Practices Expert informant data pointed the way to several pedagogical directions for fostering global citizenship in day to day teaching. This paper focuses on three key areas of pedagogical activities considered useful in the students students’ professional growth towards global citizenship: cultural consciousness, compassion compassionate citizenship in action, and knowledge transfer (see Figure 1). The themes are briefly defined and include informant quotes to illuminate the themes and give direction to possible learning activities. While pedagogical strategies are identified with a particular theme they are not considered exclusive. Figure 1: Integrative Pedagogical Practices for Global Citizenship in Undergraduate Nursing Education Compassionate Citizenship in Action Cultural Consciousness (knowing self & others) Knowledge Transfer (local global praxis) Integrative Pedagogical Practices for Global Citizenship in Undergraduate Nursing Education Cultural Consciousness: Awareness of self and others Self-awareness providess the starting pedagogical direction for nursing education. education Strategies in these areas encourage students to reflect and to develop knowledge of their own values, biases, and world values, and “to question their position in the world and to do so with curiosity and humility” (Simpson, 2013, p. 205). Many informants (presented with pseudonyms throughout this paper) emphasize the importance of self self-knowledge knowledge as the first step ste in developing cultural competence and becoming a global citizen. For instance, Alice (in Simpson, 2013) explained the relationship of self-knowledge to what she called “cultural positioning”, or consciousnesses of self and others in context: https://qane-afi.casn.ca/journal/vol1/iss2/2 DOI: 10.17483/2368-6669.1031 4 Simpson et al.: Global Citizenship Teaching Practices Self-knowledge is so profound for students...to understand the impact of their world view or their cultural positioning …and to try to locate one’s self within the social context (Alice, in Simpson, 2013, p. 116). Alice further articulated this practice of cultural positioning as recognition that students are informed by time and place, and an awareness that “I do come from somewhere and that does have an impact on how I see the world” (Alice, in Simpson, 2013, p. 116). Informants emphasized that critical self-consciousness and engagement, established through skilled inquiry, were important aspects of global citizenship education. Ann further described the importance of awareness of one’s place and situation and the pedagogical role of curiosity and simply asking questions: …being able to situate yourself in the world of the other as much as that is possible… awareness of asking the question of yourself and the people you care for… understanding that the world view of the persons you are working with will very likely not be the same as your world view (Ann, in Simpson, 2013, p. 118). Alice describes the questions to be asked as distinct from a cultural interest, with a view to inquiry into a deeper personal self-awareness: … students need to be clear it’s not about voyeurism and going off somewhere and seeing something new and exotic. It’s not about going as the helper...it’s not about “what can I do to help these poor people that need my help” (Alice, in Simpson, 2013, p. 123). The value of open inquiry, with asking and responding to important questions about power and privilege, was consistently raised by the expert informants. The exploration of cultural consciousness is aligned with Giddings’ (2005) model that takes a dialogic approach to understanding cultural knowing for nurses. How then, do educators help students develop self-awareness and greater cultural knowledge, with awareness of their positioning in relation to others? How is it that educators can support students in sustaining curiosity and a spirit of inquiry alongside the skills in safely and respectfully asking questions and engaging with people and communities? Knowing how one’s behaviour influences others, and how self-knowledge influences one’s understanding of others requires reflective practice (Somerville & Keeling, 2004). Inquiry with a view to understanding power relationships from a critical perspective (Canales, 2010; Hartrick Doane & Varcoe, 2015) is also necessary to engage in meaningful, respectful relationships as global citizens. Pike describes the role of educators in this work as those “who are suggesting revisions to the prevailing legend…a legend shaped by patriarchy and colonialism, and driven by the free market force of capitalism” (2008, p. 226). Learning activities that inspire and enable students to practice self-reflection and inquiry with a political/economic critique are similarly seen by the informants as foundational pedagogical strategies for global citizenship. In this way, and with a concerted effort by educators, selfreflection and critical inquiry with people and communities does not depend upon a cultural immersion or travel experience to a far or remote destination. Our diverse Canadian context and networked and inter-connected world provides a rich context for learning experiences of engagement and diversity, a reality not lost on the expert educators interviewed. Learning activities that encourage students to engage in self-inventory, for instance exploring earliest awareness of marginalization (for one’s self or for another person), or examination of privileges that result from living in a particular society and comparing these with other societies can be productive self-awareness learning strategies. Examples include free writing and “think, pair, share” activities (Brookfield, 2011) or focused workshops for both educators and students (Parcells & Baernhold, 2014) that explore critical self-other awareness. Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2015 5 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 1, Iss. 2 [2015], Art. 2 Guided learning journal activities including workbooks and photovoice exercises (Carlson, Engebretson, & Chamberlain, 2006) are also useful pedagogical practices for cultural consciousness. Such activities involve an element of vulnerability and risk-taking within an environment of uncertainty, conflict, and debate that are considered necessary for critical reflection and growth (Duffy, 2001). Simulations that require students to analyze interactions of self or others can also assist in cultural consciousness and self-awareness (Wilson & Rockstraw, 2012). Simulations that mimic encounters steeped in cultural tension that require culturally safe approaches or communication without speaking the language are recommended strategies (Mitchell, Fioranvanti, Founds, Hoffmann, & Libman, 2010). Simulation learning activities may include standardized scenarios where students explore inquiry and encounters with others in order to critically analyze attitudes, feelings, reactions, and behaviours in response to situations and to practice approaches that demonstrate cultural competence. Compassionate Global Citizenship in Action Compassion is an active way of being and doing “right” by groups, populations, or communities with or without being present, remaining mindful that a critical perspective underpins compassion. Compassion that extends beyond family, friends, and the immediate environment (Nussbaum 2002) with an emphasis on cultivating a sense of outrage for injustice to motivate an individual to act (Davies, 2006) are emphasized. Others suggest that being compassionate as a professional is not an inherent quality and therefore requires educational attention to develop global citizenship in students (Crigger, Brannigan, & Baird, 2006). A sense of social justice, inherent in the role of a global citizen, is intertwined with the notions of interconnectedness and social responsibility with an emphasis on equity, rights, and fairness (CNA, 2009; Brock, 2009; Fraser, 2009; Cohen, 2010; Hartrick Doane &Varcoe, 2015). The study informants suggest creating conditions to foster students’ compassion in relation to global health as another important step towards integrated global citizenship education. These expert educators also advise that pedagogical practices can assist students to move compassion into action in response to social injustice and suffering. How then do nurse educators instill the desire to act compassionately as a global citizen and, perhaps, to care about others a world away? Informants expressed the need for educators to seek diverse opportunities and learning experiences to foster compassionate action. For instance Doris expressed the learning that she personally experienced in humility, compassion, and action: You need to be in a major humility kind of place… our Western ways are not always the right ways. So we do have some things to offer, but I can assure you that every time I’ve offered something to others, I’ve learned way more myself (Doris, in Simpson, 2013, p. 124). Karen described the kind of compassion crucial to global citizenship as a feeling experienced by being with people, observing and being part of advocacy efforts. She explained: We [educators] talk about vulnerable populations, vulnerable children, our aging population, our mentally challenged, etc. These things come to life when they actually have these experiences… from there it moves into teaching advocacy (Karen, in Simpson, 2013, p. 120 [underlined for emphasis]). Doris asserts that this feeling and action are indeed integrated aspects of curriculum that can be operationalized in a number of pedagogical strategies in a comprehensive approach: It doesn’t have to be a separate course… you don’t have to get all students going to other places in the world to practice these things, although those experiences are invaluable. https://qane-afi.casn.ca/journal/vol1/iss2/2 DOI: 10.17483/2368-6669.1031 6 Simpson et al.: Global Citizenship Teaching Practices You bring it through in every single thing you teach in nursing… you are talking political action… you can bring the global angle into political action in many, many ways (Doris, in Simpson, 2013, p. 127). Other informants emphasized the value of hearing from different voices and becoming immersed in the lived experience of others (through practice experiences, conferences, workshops or guest speakers). Karen highlighted the significance of both guest presenters and dialogue as pedagogical strategies: … hear their [guest presenters’] stories. Hearing their stories and getting informed about the types of experiences they have had. Encourage the students to talk about their own different experiences... through storytelling or a skit… encourage creativity, have them really unpack it for us (Karen, in Simpson, 2013, p. 126). Pedagogical strategies are required to help students foster the compassion and action of a global health citizen in the undergraduate nursing student. Story-telling (for example in guest presentations and role playing), film viewing/film making, and nurse educator role modeling are all learning activities that fit within this broad theme that connects with the self-awareness of cultural consciousness discussed previously. As suggested, guest speakers who represent diversity can instill the desire in students to take action to promote social justice. People willing to share their life, their world, inspire empathy and compassion (McIvor, 2013). MacKinnon and Young (2014) emphasize the value of story-telling as a pedagogical practice to engage safely in critical inquiry and exploration. Educators may consider showing films or documentaries, and exploring novels, poetry, music, or related narrative explorations as powerful vehicles to empathy and compassion (Keen, 2011; Parcells & Baernholdt, 2014). Facilitated role play-exploring the experience of marginalization--may also support compassion and critical inquiry. Another, much less explored pedagogical practice influencing global citizenship learning is educator role modeling (Simpson, 2013, p. 206). Most informants expressed a strong need for nurse educators to role model behaviours of global citizens in a similar manner as they need to role model other professional behaviours (Simpson, 2013, p. 125). Role modeling cultural consciousness requires faculty to learn about innovative ways to bring lessons of race and racism into the curriculum and pedagogical practice. Practices that are thought to be best learned over time and with personal experiences (Holland, 2015). Role modeling compassion as a global citizen requires nurse educators to take action in a socially responsible way that is evident to the students. Global citizen educators live their espoused values by providing local and global community service, as Julie said: “we can talk about compassion in class but we also need to model it” (Julie, in Simpson, 2013, p. 119). Diane also emphasized the importance of nurse educators and their practices in her statement: “the instructor has to behave in a way that shows the compassion that students need to see” (Diane, in Simpson, 2013, p. 125). Role modeling compassionate action by nurse educators may include, though is not limited to, acknowledging and responding to diversity within the classroom, bringing global issues forward in the class, supporting student and educator exchanges, and providing guidance to students groups that engage in international sponsorships. Educators may role model global citizenship by participating in fundraising to support international nursing students to travel, live, and study locally. Furthermore, nurse educators may role model global citizenship by engaging in purposeful selection of supervised clinical placements for global citizenship development and culturally safe practice with diverse populations such as, homeless, aboriginal or immigrant people. These activities take substantial commitment so as to establish and preserve reciprocal relationships. Other ways that educators model global citizenship is supporting diverse student Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2015 7 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 1, Iss. 2 [2015], Art. 2 admission and hiring practices as well as engagement of students in research or project work focused on global health concerns. Role modeling global citizenship is evident when students witness socially responsible educators who advocate and engage in actions that contribute to the health of communities, locally or globally. Knowledge Transfer: Local - Global Praxis International practice experiences to advance student awareness of self and others through engaging in compassionate action in culturally safe and relevant ways seems like an ideal method for developing global citizenship knowledge and skills. Students may perceive the notion of travelling to international sites as a more authentic, exciting, and meaningful experience than remaining in one’s usual local context. Karen (in Simpson, 2013, p. 12) notes that “most of the students want to leave Canada to have global experiences”. Understandably it is unrealistic that all nursing students will experience international nursing given the complexity and expense of designing and implementing socially responsible international placements. Recognizing that global issues have an influence locally and local health issues are likely to have connections with global health issues, Alice summarized: It isn’t just about getting on a plane and going somewhere. This is also about what happens next door (Alice, in Simpson, 2013, p. 119). Teaching Global Citizenship Locally. It is imperative that educators explore the rich local resources to promote the development of nursing students as global citizens regardless of their opportunity to engage in international practice experiences. Local communities often have robust learning experiences that potentiate global citizenship development. Educators need to identify, develop, and sustain local resources for learning global concepts. Connecting local learning with the notion of becoming a global citizen is a unique nursing education mission. Educators who serve to develop global citizenship assist students to understand how local knowledge and relational skills promote growth as a professional and a global citizen. Alice explains that clinical practice experiences can take place anywhere that vulnerabilities or inequities are present, for instance in certain locales or with different high priority populations who may be considered vulnerable. She states that nurse educators can support learning for global citizenship in an integrated way throughout the curriculum, practice and theory courses alike: ... that way the students start to see that stronger link between local and global (Alice, in Simpson, 2013, p. 119). Janet also notes that raising awareness of global health issues can happen in any clinical setting – including acute care, with careful attention to the assignment of patients and facilitation of the global citizenship learning in the clinical situation. She goes on to discuss the educator’s role to support guided practice experiences designed to expose students to all manner of diversity: look for the local opportunity, to focus on it, and discuss it with students everywhere (Janet, in Simpson 2013, p. 128). Alice also notes that the knowledge of global citizenship is not dependent upon an international practice experience. Rather, educator emphasis on the knowledge of poverty, access to healthcare, infectious disease, marginalization, equity issues, and explorations of these experiences in order to apply to local and global everyday nursing practice. According to Alice: https://qane-afi.casn.ca/journal/vol1/iss2/2 DOI: 10.17483/2368-6669.1031 8 Simpson et al.: Global Citizenship Teaching Practices Student’s need not to go far to experience the concepts of population health, primary health care, health promotion, social determinants of health, social justice health and equities (Alice, in Simpson, 2013, p. 119-120). Theoretical learning activities in global citizenship and health are limited only by the educators’ knowledge and creativity. Other examples of everyday teaching practices that encourage global mindedness include creating thoughtful activities wherein students compare and contrast local and global situations, bring forward demographic information, discuss disease prevalence and international healthcare delivery models, the complexity of changing cultural practices that prevents the spread of disease. For example the lessons being learned by the World Health Organization during the Ebola pandemic in 2014 might be a starting point to the examination diverse health systems, demographic diversity, and cultural health, medical, and nursing practices. Case studies and media watches focused on critically examining current global health issues that actually or potentially impact local communities can serve to foster student understanding of global health issues. Betty identifies case studies as invaluable: I think the old case study is still very useful but it is important how you build it and how you draw the conclusions, for the individual and in group discussions (Betty, in Simpson, 2013, p. 125). Doris suggests that a critical global media watch can expand student awareness of global politics that influences health. She explains: Educators need to push students to access the media to learn more about the world and politics (Doris, in Simpson, 2013, p. 113). Creating opportunities for students to share their lived experience and growing theoretical understanding of nursing diverse populations is a useful global citizenship practice. Joint seminars with students in local and international practice experiences using information communication technology such as Skype© or blogging can provide immediate dialogue and knowledge transfer focused on global health (Stephens & Hennefer, 2013). Going Global: Relating to Local. Making explicit how international practice experiences can have lasting meaning for students who travel and for students who remain in local settings is a key educator responsibility. Expert informants recognized the value of an international placement despite the associated challenges of cost, the perception of educational tourism and charity (Tiessen & Huish, 2014), and the extensive preparation of students and infrastructure required for socially responsible international relationships. Kirkham, Van Hofwegen, & Pankratz (2009) noted that students who have international clinical experiences generally experience a raised social consciousness yet note the challenge of sustaining and transferring their learning back to a local setting. Marg discusses how an understanding of global experiences relates to students’ local context: It’s an encompassing context in which we understand health, and that should lead us to understand how the health issues in the global context link very directly to the health issues in the local context (Marg, in Simpson, 2013, p. 123). Alice emphasized, however, that the experience is not the lesson; rather the educator’s facilitation of a critical analysis is paramount, stating: My other big hobby horse in all of this… is to ask for whose benefit?… [they are] very tricky these relations of power (Alice, in Simpson, 2013, p. 123). The value of international practice experiences requires careful consideration by educators. Planning for local knowledge transfer, with intensive critical analysis, with students who have Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2015 9 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 1, Iss. 2 [2015], Art. 2 had international experiences is a key educator responsibility, seen as central to the citizenship lessons in international practice experiences. As Doris explains: There is no guarantee that the students are going to take what they saw internationally and actually know how to apply that when they’re going to work back in a home setting (Doris, in Simpson, 2013, p. 124). Stoner et al. (2014) echo Doris’ sentiments from their examination of the outcomes of educational travel explaining that these “experiences without critical reflection are just experiences,” and critical reflection is the essential ingredient to the work of “reshaping, reforming, and reimagining of perspectives and beliefs that serve as the departure point for transformation toward global citizenship” (Stoner et al., 2014, p.160). A high level of support is needed for students to reflect on their personal, experiential, scientific and cultural knowledge gained during an international experience. The role of the educator is emphasized as instrumental to contextualize knowledge, establish critique and to foster knowledge transfer (Koskinen & Tossavainen, 2004). Given the likelihood that many nursing students will not be able to travel internationally, a student’s capacity to share their professional growth to promote global citizenship in the local student population is essential to sustain their learning while also informing others. Suggested pedagogical strategies in this theme include media watch/case studies, facilitated discussion and debates using information communication technologies such as Skype©, online learning managements systems, or other like forums that promote global citizenship conversation across time and space Health system comparison is highlighted as a key area of knowledge to be gained from international experiences (Pross, 2005). Comparative mapping activities, for instance with reflection and comparison of WHO Health Atlas data or other mapping software, such as geospacial databases, that incorporate census and biostatistical data (Jakubec, Mascaro, Judd, & Nordstrom, 2014) or narratives across contexts such as the Canadian Public Health Association’s Frontline Health Atlas can provide a springboard for in-depth critical reflection for global citizenship. These tools can bring distant and local contexts into view for students wherever they may be physically located. Regardless of where practice experiences take place, facilitation and knowledge transfer post experience are pivotal nursing education practice. Educators can draw out student experiences around specific global citizenship concepts (social justice) in subsequent course seminars, assignments, or other public forums that make the bridge to local meaning, including meaning to the student, profession, and local community. Educators can also engage students in creating scholarly media or publications that can inform future students and promote educator development regarding international practice experiences and global citizenship. Contributions and Considerations Global citizenship is more than a theoretical standpoint or philosophical exercise. Pedagogical practices illuminated in this study offer a variety of teaching and learning strategies (see Box 1) that bring global citizenship into nursing education practice. https://qane-afi.casn.ca/journal/vol1/iss2/2 DOI: 10.17483/2368-6669.1031 10 Simpson et al.: Global Citizenship Teaching Practices Box 1: Recommended Pedagogical Practices for Global Citizenship Recommended Pedagogical Practices for Global Citizenship Cultural Consciousness: Self & others • • • Self-inventory Photovoice Simulation Compassionate Global Citizenship in Action • • • Story-telling/guest presentations Film viewing/film making Nurse educator role modeling Knowledge Transfer: Local-global praxis • • • • Student Presentations/Publications Global-Local Praxis Media watch/case studies Facilitated discussions/debates via ICT Comparative Geomaping Exercises In order to promote integration of global citizenship, these findings have implications for educator development and scholarship in these three domains of Cultural Consciousness, Compassionate Citizenship in Action and Knowledge Transfer. Reflection on the application of the three integrative pedagogical practices for global citizenship in undergraduate nursing education could be explored in curricular reviews and accreditation assessments as well as nurse educator orientation and development activities. Experienced nurse educators can mentor other educators in the development, management, and integration of global citizenship in theoretical and practice education. Supporting students to make meaning of local learning opportunities that foster global citizenship is a complex aspect of educator practice in today’s world and a requisite competency for future nurse educators. Further scholarship regarding creative approaches to develop the professional nurse as a global citizen is warranted, for instance with longitudinal study of desired global citizenship characteristics in relation to certain pedagogical practices, or comparison of student experiences of these practices. Published by Quality Advancement in Nursing Education - Avancées en formation infirmière, 2015 11 Quality Advancement in Nursing Education - Avancées en formation infirmière, Vol. 1, Iss. 2 [2015], Art. 2 While the study design is not intended to produce generalizable findings, the panCanadian sample of expert informants and analytic attention on practice applications does offer a suite of broad recommendations. Educational programs within university settings and other global health initiatives outside of the discipline of nursing may also benefit from this exploration of global citizenship. In particular the findings may be useful to other professional practice disciplines such as education, social work, business, and leadership. The results of this study may also contribute to professional nursing practice and leadership where concerns related to global health such as migrancy and global influences on health care are ever present. Ultimately the results of the study have the potential to strengthen the quality of nursing and other students or professionals in their contributions in practice and in their roles as agents of change and leaders in initiatives related to global health. Challenges to implementation arise from content saturation in nursing education (Giddens & Brady, 2007), as well as barriers from nurse educators and the student population were highlighted. The authors’ involvement in global health and nursing education contributed to potential biases in the interpretation. A supervisory and advisory committee for the original project brought awareness of the goals of authenticity and credibility during the initial analysis. A collaborative analysis and writing process in the extended analysis contributed to further reflection and review of biases. Closing Thoughts Specific pedagogical practices to support the integration of global citizenship education were illuminated from an interpretive descriptive study of expert nurse educators in relation to global citizenship and global health (Simpson, 2013). Teaching roles and activities necessary to the integration of global citizenship curriculum were found to include: contextualizing knowledge, facilitating diverse experiences (and experiences of diversity), mentoring and role modeling. While institutional and curricular strategies cannot be ignored, the role of the educator is also seen as paramount in these integrated practices of cultural consciousness, compassionate citizenship in action, and knowledge transfer. https://qane-afi.casn.ca/journal/vol1/iss2/2 DOI: 10.17483/2368-6669.1031 12 Simpson et al.: Global Citizenship Teaching Practices References Abdi, A., & Shultz, L. (2008). Educating for human rights and global citizenship. Albany, NY: Suny Press. Boutain, D. M. (2008). 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