Nursing international student mobility in the University of São Paulo

Movilidad internacional estudiantil de Enfermería de la Universidad de São Paulo

ABSTRACT

Objective:

To characterize the experiences of undergraduate students of the School of Nursing of the University of São Paulo (EEUSP) who participated in international mobility programs between January 2011 and July 2017.

Method:

Exploratory, descriptive study with quantitative approach. Of 68 reports, only 38 (56%) were considered valid and were submitted to descriptive statistical analysis. Data were categorized in general, institutional, academic and cultural aspects and cost of living.

Results:

The main destination was Portugal and the years with most participation were 2012 and 2013. The mean stay was six months and the students took a mean of three to four courses. The main funder was the university of origin.

Conclusion:

Academic activities were limited to theoretical and practical courses, with little insertion in research. There is a need to increase investment in learning other languages and to expand partnerships with larger centers of foreign education and research.

Descriptors:
International Educational Exchange; Education, Higher; Students, Nursing; Education, Nursing; Quantitative Analysis

RESUMEN

Objetivo:

Caracterizar las experiencias de los estudiantes de graduación de la Escuela de Enfermería de la Universidad de São Paulo (EEUSP), participantes de los programas de movilidad internacional, entre enero de 2011 y julio de 2017.

Método:

Se trata de un estudio exploratorio, descriptivo de abordaje cuantitativo, de 68 reportes. De estos, solamente 38 (56%) se consideraron válidos y se sometieron al análisis estadístico descriptivo. Los datos se recogieron según los aspectos generales de la experiencia: institucionales, académicos, culturales y costo de vida.

Resultados:

El destino principal fue Portugal, entre los años 2012 y 2013, con permanencia media de seis meses y cursando, promedio, de tres a cuatro disciplinas. La principal financiadora fue la universidad de origen.

Conclusión:

Las actividades académicas se limitaron a disciplinas teórico-prácticas, sin involucrarse mucho en la investigación. Existe la necesidad de aumentar las inversiones para el aprendizaje de otros idiomas y aumentar los convenios con los grandes centros de enseñanza e investigación extranjeros.

Descriptores:
Intercambio Educacional Internacional; Educación Superior; Estudiantes de Enfermería; Educación en Enfermería; Análisis Cuantitativo

RESUMO

Objetivo:

Caracterizar as experiências dos estudantes de graduação da Escola de Enfermagem da Universidade de São Paulo (EEUSP), participantes dos programas de mobilidade internacional, entre janeiro de 2011 e julho de 2017.

Método:

Estudo exploratório, descritivo de abordagem quantitativa, de 68 relatórios. Desses, apenas 38 (56%) foram considerados válidos e submetidos à análise estatística descritiva. Os dados foram apreendidos em aspectos gerais da experiência, institucionais, acadêmicos, culturais e custo de vida.

Resultados:

O principal destino foi Portugal, entre os anos de 2012 e 2013, com permanência média de seis meses, cursando em média três a quatro disciplinas. O principal financiador foi a universidade de origem.

Conclusão:

As atividades acadêmicas limitaram-se a disciplinas teórico-práticas, com pouca inserção na pesquisa. Há necessidade de aumentar o investimento na aprendizagem de outros idiomas e ampliar parcerias com grandes centros de ensino e de pesquisa estrangeiros.

Descritores:
Intercâmbio Educacional Internacional; Educação Superior; Estudantes de Enfermagem; Educação em Enfermagem; Análise Quantitativa

INTRODUCTION

The growing trend of international academic mobility, also called internationalization, is associated with the phenomenon of globalization that results from the increase in the flow of people, ideas, capital, goods and services across borders^(1-5).

This phenomenon also influenced changes in higher education in the health area and had three great moments⁽³⁾. The first occurred in the beginning of the 20th century with the strengthening of knowledge produced by scientific method, which led to a science-based curriculum reform. The second occurred with a shift to a perspective of teaching-learning techniques, based on the solution of problems within the realities of each area. The third began in the 21st century and extends to the present, and its challenge is to improve health systems based on professional competences in specific contexts and global knowledge⁽⁴⁾.

In this sense, student mobility programs are strengthened by exposure to other cultures and their different lifestyles, languages, and health systems, which improves students’ educational ability, as well as their experiences, communication skills and interpersonal relationships⁽⁴⁾. In Brazil, exchange programs seek to promote the consolidation, expansion and internationalization of science and scientific and technical innovations⁽⁵⁾.

The “Science without Borders Program (SwB)”, implemented by the Brazilian federal government in 2011 and extinguished in 2016, was an important initiative with the objective of investing in the training of highly qualified personnel in order to promote advances in the knowledge society, increase the presence of researchers and students of various levels in institutions of excellence overseas and promote the international insertion of Brazilian institutions by opening similar opportunities for foreign scientists and students⁽⁶⁾.

The SwB expanded international exchanges for undergraduates, as it granted 92,880 scholarships, of which 73,353 were for undergraduate students. Engineering and other technological areas were the ones that received most resources, with 41,594 scholarships, followed by biomedical and health sciences, with 16,076⁽⁷⁾. In the health area, 66% of the SwB scholarships were for undergraduate students, and the state of São Paulo received the largest number of benefits. The United States of America received the highest number of Brazilian students, followed by the United Kingdom and Australia. Women had the highest participation rate in the program. The University of São Paulo was the institution that received the most scholarships distributed in the several areas of knowledge (5541). Of these scholarships, 1097 were in the area of biology, biomedical and health sciences⁽⁷⁾.

In nursing, international study programs are an important part of nurses’ training, especially with the emergence of the topic of cross-cultural nursing in the literature during the 1970s and 1980s^(8-9). Studies addressing student mobility in nursing evidence the opportunities to increase cultural competencies, cognitive abilities, personal growth and knowledge regarding nursing practices in culturally different learning environments^(8-11). In addition, these studies document the effects of these programs for students, professors and for the profession⁽¹²⁾.

Therefore, the broad participation of USP students in the SwB program has aroused interest in systematizing personal, academic and institutional information concerning the experience of this internationalization for undergraduate students of the School of Nursing of the University of São Paulo (EEUSP), in order to improve the institutional student mobility processes.

OBJECTIVE

To characterize the experiences of undergraduate students of the School of Nursing of the University of São Paulo (EEUSP) who participated in international mobility programs, based on the reports sent to the International Cooperation Commission (CCint) of EEUSP, from January 2011 to July 2017.

METHOD

Ethical aspects

The study was approved by the Research Ethics Committee of the School of Nursing of the University of São Paulo (EEUSP). The acceptance to participate in the study was preceded by the signing of the informed consent form (TCLE) by the participants.

Type of study, setting and period

This is an exploratory descriptive study with quantitative approach, based on reports from undergraduate students from EEUSP who participated in an international mobility program from January 2007 to June 2017.

Population, inclusion and exclusion criteria

Of 68 reports, 38 (56%) were considered eligible because they were in conformity with the CCint form. Thirty (44%) were considered invalid because they were elaborated in the old CCint forms and did not contain all the variables of this study, described below.

Study protocol

The CCint provided the registration, the contacts and the reports of the students who went on exchange programs. The reports were made available in archives, which were thoroughly analyzed according to the contents and contexts of their production. All students were contacted by e-mail, landline/cell phone or instant messaging apps.

The data collected were categorized, based on the structure of the reports and the model suggested by CCint, with the respective variables: 1) General aspects of the experience - country of destination and language, year and semester of the exchange program, duration and funding of the exchange program; 2) Institutional Aspects - means of dissemination of the exchange program, criteria for choosing the Higher Education Institution (HEI) of destination, selection process, hosting and integration activities in the HEI and infrastructure; 3) Academic aspects - number of courses taken, internships and/or activity in practice, evaluation process of the courses, differences between the courses of the HEI of origin and the HEI of destination and difficulties and facilities such as language; 4) Cultural aspects - number of countries visited, cost per trip and means of transport most used for cultural activities; 5) Cost of living - main expense, expenses with food, housing and transportation.

Data analysis

Data from the 38 valid reports (56%) were typed in the Microsoft Excel software version 2007 and submitted to descriptive statistical analysis (percentages and means).

RESULTS

General aspects of the experience

The destination of 52.6% of the students was Portugal, followed by 13.2% who went to England, 7.9% to Spain and Chile, 5.3% to the United States of America, Italy and Ireland each and 2.6% for Australia and Canada each. This means that only 29% of the students went to Anglo-Saxons language countries and 71% went to countries with Latin languages, especially Portuguese.

Regarding the year the students went on the exchange program, 10.5% went in the years of 2007 to 2011. In the period from 2012 to 2016, 89.5% students left to the exchange program, and 2012 (36.8%) and 2013 (23.7%) were the years with the highest rates. Of this amount, 34.2% left in the sixth semester of the course, 21.1% in the seventh, 18.4% in the eighth and 18.4% in the fifth, 5.3% in the fourth and 2.6% in the second period.

The duration of the exchange program was six months for 55.3% of the students and twelve months for 21.1% of the students, according to Table 1. The main form of funding was the International Exchange Scholarship Program for Undergraduate Students of USP (38%), followed by SwB (29%) and Santander Universities Scholarship Program (24%). A total of 5.3% of the students financed their studies abroad.

Table 1
Distribution of the number of students according to the duration of experience abroad, São Paulo, Brazil, 2017

Duration	Frequency	%
<6 months	5	13.1
6 months	21	55.3
12 months	8	21.1
18 months	4	10.5
Total	38	100.0

Institutional Aspects

The students became aware of the programs mainly by institutional electronic mail (44.7%), information shared among students (26.3%), television (10.5%), internet (7.9%), and through professors and posters at university (2.6% each). A total of 21.1% of the students did not provide this data.

For 44.7% of the students, the main criterion for choosing the institution was the availability of the HEI of destination to receive them. The choice also occurred due to the country for 26.3% of the students, incentive of the HEI of origin for 23.7%, infrastructure for 18.4%, ranking web universities and easier proficiency test for 5.3% each. Only 2.6% reported the choice was due to proximity to Brazil and 2.6% chose the institution for research purposes. The same percentage corresponds to those who did not respond.

The selection process adopted by the Programs was mainly based on a letter of acceptance from the HEI (44.7%), proof of language proficiency (23.7%), academic performance (18.4%), curriculum analysis (7.9%), collaboration with the research group (5.3%) and 28.9% did not respond.

In foreign HEIs, students reported participation in welcoming activities (81.6%) and integration activities (73.7%). As for infrastructure, the most cited resources were: library (73.3%); restaurant, internet access and computer (68.4% each); and printer (55.3%).

Academic aspects

A total of 52.6% of the students took three to four theoretical courses, and 34.2% took five to eleven. One student did not take any course, since he/she engaged in research activity, as shown in Table 2.

Table 2
Distribution of the number of courses taken during the exchange program, São Paulo, Brazil, 2017

	Frequency	%
1 or 2	3	7.9
3 or 4	20	52.6
5 or 6	5	13.2
7 or 8	4	10.5
9 to 11	4	10.5
Did not take any	1	2.6
Did not answer	1	2.6
Total	38	100.0

As for activities in practice, 47.4% engaged in only one, 15.8% in two, 7.9% in three and only 2.6% in four. It is noteworthy that 26.3% did not engage in any type of activity in practice due to legal issues in the country of destination.

As to the evaluation in the courses taken, 68.4% had more than one type of evaluation, such as written, oral or laboratory tests and paper assignments. A total of 47.4% of the students were evaluated by written test, 39.5% had a single evaluation and 10.5% reported continued evaluation.

The main differences between the Nursing courses were: duration shorter than in Brazil (23.7%), content related to technical procedures (21.1%), the preparation before classes was considered as credit hours (15.8%), differences in curricular structure (10.5%) and cultural differences (2.6%). A total of 26.3% did not answer the question.

Regarding language, 63.2% of the students reported they had easiness, 34.2% had occasional difficulties and 2.6% did not answer. This data is possibly related to the fact that 52% of the students went to Portuguese HEIs.

Cultural aspects

Students who engaged in cultural activities only in the country of destination corresponded to 18.4%, while 28.9% visited one to three countries, 15.8% visited four to six countries and 7.9% visited more than seven countries. It is worth noting that 28.9% did not respond to this item.

The average cost per trip was US$78.15, regardless of the currency of the countries visited. The students used various currencies, such as pound sterling, euro, dollar and real. However, the results of this study are presented using only the dollar. The price of the dollar in July 2017 in Brazil was R$3.31.

The means of transportation most used by the students in their trips were bus/taxi/Uber/car (60.5%), subway/train (57.9%) and airplane (52.6%). However, 23.7% did not respond to this item.

Cost of living

The largest expense in the destination country was with housing. The cost of rent was over US$302.11 per month, according to Table 3. Monthly expenses with food ranged from US$57.38 to US$91.23 for 26.3% of the students. A high percentage of students did not respond to the items related to air ticket costs (36.8%), rent (39.5%) and food expenses (36.8%).

Table 3
Distribution of the monthly rent expense during the exchange program, São Paulo, Brazil, 2017

Rent in Dollars	Frequency	%
110 to 150	4	10.5
151 to 300	9	23.7
> 300	10	26.3
Did not respond	15	39.5
Total	38	100.0

• Note: Dollar = R$3.31 in July 2017.

DISCUSSION

Portugal was the main destination of the participants, possibly due to the language and its location in the European continent. A similar result was found with African students, who constituted 43% of foreign students in France in 2011 and only 3% of them were from non-francophone countries⁽¹³⁾. These results are similar in African countries that were former European colonies and still use the colonial language after independence, such as Francophone, Anglophone and Lusophone Africa, where the language tie is an important influence on the international mobility of students⁽¹³⁾.

This fact may also be related to poor preparation or lack of knowledge of other languages, such as English, French and German. A study with 152 students from 20 universities in Australia who used English as a second language revealed that second language anxiety, particularly on the spoken aspect, generates significant marginalization and separation factors, especially in daily academic life⁽¹⁴⁾.

A lower percentage of students went to Spanish-speaking countries, and Chile was the only destination in Latin America. It is possible to perceive the continental isolation of Brazil due to language, since practically all its Latin American neighbors speak Spanish. It should be emphasized that teaching a foreign language became mandatory in Brazil only in 1996, through Law No. 9,394, paragraph 5 of Article 26, which establishes the obligation to offer at least one modern foreign language starting from fifth grade⁽¹⁵⁾. Only on February 16, 2017, Law No. 13,415, in §4 of Art. 35-A established the obligation to teach English in high schools, along with another foreign language, preferably Spanish. However, this is placed as optional and subject to the availability of each educational institution⁽¹⁶⁾.

This reality is different from the European experience, where student mobility between countries is 73% and geographical proximity is a factor that makes mobility programs more attractive to students⁽¹⁷⁾. That is, the diversity of languages in European countries is not a factor that distances the students from these experiences. In addition, there are public policies to encourage mobility, such as the guideline adopted by the European Parliament in 2014 that allows international students to work (without restrictions on the number of hours) during their studies and to stay 1,5 years after undergraduate study to search for employment or start up a company⁽¹⁸⁾.

The years of 2012 and 2013 had the highest number of exchange programs, which coincides with a high demand for Portuguese-speaking countries in the SwB program⁽¹⁹⁾. The significant growth of international academic mobility in Brazil in this period occurred due to changes in the direction of governmental public policies related to higher education⁽²⁰⁾.

The exchange experience occurred mainly on the third and fourth year of the undergraduate course. This was also identified in the USA, one of the countries that received the most exchange students and where 31% of them were taking the last two semesters of their course⁽²¹⁾. In a peer training program with medical students from Haiti and Rwanda in a university in Canada, 51% were fifth and sixth-year students, which participated in the experiment and evaluated it as important for career development⁽⁴⁾. Therefore, this factor can be related to the students’ proximity to graduation, as well as to the concern with professional life and insertion in the world of work.

The duration of the experience may also be related to the proximity to graduation, which may have led some students to not choose to stay longer, even though the institution allowed up to four semesters of residence (Resolution 4974/02).

A study that evaluated the impact of Australian students’ cultural experiences in Tanzania showed that in a period of 10 to 16 weeks there is already personal growth and changes in decision making, values and personal beliefs⁽⁸⁾. In addition, a study showed that experiences lasting up to 10 days, if well conducted, may be significant for sensitiveness and proximity to cultural care⁽¹²⁾. Therefore, the period of one semester seems to be significant for personal and professional training.

USP was the main funder of the experience, which is associated with the University’s International Mobility Program that exists since 1998 (Res. No. 4605/1998), and with the university’s 1363 agreements of different natures⁽²¹⁾. The EEUSP has a technical cooperation agreement with Australia and with the United States of America and an academic agreement with Austria, Canada and Portugal⁽²¹⁾. This experience in international agreements and partnerships favors the student mobility internal program.

The students became aware of the programs through institutional e-mail and contact with friends, which is in agreement with another study that revealed that 59.7% of the students discover the existence of the program through friends and 24.3% find it in the web^(22-23). These results demonstrate that the forms of social interaction and dissemination of information vary between modern (web) and traditional mechanisms (network of friends). The results of this research may be compared to an Australian study on the use of the global computer network, which evidenced that people are increasingly using the Internet to explore, develop and make choices in their careers⁽⁹⁾. In addition, experiences in Canada identified that the Internet was the main tool for communication between people and for expanding access to information⁽²⁴⁾.

The choice of the institution was mainly due to confidence with the language of the country of destination. This result is in agreement with a study on exchange programs between Colombian and Brazilian students, which found that, for Brazilian students, the main reason for choosing the institution was the language of the country and conditions related to the infrastructure of the university of destination⁽²⁵⁾.

The programs use language proficiency as the main instrument for selection and allocation of students in foreign HEIs. However, since the main destination was Portugal, the letter of acceptance of the institution was more important and the language proficiency appeared in second place, given its irrelevance. Insecurity with the foreign language is understandable, since studies with academic students point out that, even though many already knew more than one language, 44.3% faced difficulties with the foreign language^(1,11). Therefore, linguistic competence, or lack thereof, can define the nature of mobility. The fact is that nursing students applying for scholarships abroad have difficulty meeting the minimum criteria for language proficiency required by partner countries in mobility programs^(2,11,26).

The SwB program gave undergraduate students the opportunity to study a foreign language for up to six months before entering the academic learning environment, an opportunity that is not provided by the USP Program and other programs. With the end of the SwB program for undergraduate students, the opportunity to improve the results in the proficiency tests and, consequently, increase access of the nursing undergraduate student to the best universities has diminished.

Recognizing that even after graduation many students still do not have enough proficiency and ability in English, Australian universities have reduced academic standards to help those with little proficiency in the English language. Foreigners represent 20% of enrollments in higher education in Australia and constitute a significant injection of capital into HEIs⁽⁸⁾. Another experience is the cooperation established in the Treaty on the Functioning of the European Union (Articles 165 and 166 TFEU and Article 180), in which the European Union’s actions are aimed at developing European education by encouraging student mobility and promoting cooperation between educational establishments and exchange of information and experience on the education systems of the Member States. In order to stimulate training and mobility in the Union, 15% of students that graduate in schools in these countries will study abroad for at least 10 weeks⁽²⁶⁾, demonstrating the real commitment and the international cooperation between institutions.

The students reported good conditions in the reception, welcoming and integration, and the main resources identified in the universities were: library, restaurant, computer, internet and printer. However, most HEIs do not offer housing in the university itself, which has great financial impact during the study period. An Irish study that evaluated the factors that influenced nursing students in planning and electing a study program abroad, indicated three factors in the following order: financial, personal, and organizational⁽²⁶⁾. Organizational factors are related to the availability of the foreign institution to organize a study program and to provide structure for orientation, support and accommodation at the university⁽¹¹⁾.

Due to agreements already established with Portuguese universities, the academic and institutional aspects were a facilitator for the exchange, unlike what happens with other countries, since there was no inter-institutional relationship prior to the SwB program. In addition, many EEUSP students went to exchange programs after taking classes that enabled them to engage in practical activities. This result is similar to studies carried out in the United States, Dominica and Ireland, where students developed their activities mostly in the hospital area; thus, the practical learning of nursing in another country was one of the main motivations for studying abroad^(11-12).

Regarding the evaluation processes of the courses, the use of more than one moment or instrument was predominant. The main difference between the nursing courses was the shorter training time and the time of preparation that was considered as credit hours, which represents an advance in the teaching-learning model, making it more dialogical and participative. On the other hand, there were also evaluation processes carried out in a single moment, in the form of theoretical tests.

A study that evaluated the SwB program in another Brazilian university showed that the students compared the infrastructure of the Brazilian university with the HEI of destination, considering the latter much better⁽²²⁾. This further exposes the already well-known needs of Brazilian public HEIs regarding structural conditions, but it also reveals a certain lack of interest in institutional pedagogical aspects.

Another aspect that stands out is the fact that only one student went on the exchange program for research purposes, which may evidence the students get little benefit from the opportunity, considering that 10% of “European super elite researchers” produce almost half of the total research output and that international orientation and collaboration is the single most important set of variables predicting their high research productivity⁽¹⁸⁾. The exchange of knowledge through collaborative research activities attracts international talent and is one of the strategies to increase the flow of global knowledge^(5,13-14).

Student mobility during initial training provides a great opportunity for insertion into multicultural and multilingual scenarios, defined as super-diverse environments. These experiences are extremely significant in linguistic-discursive, cultural and ideological aspects, with effects on interpersonal and professional relations⁽²⁾. Therefore, cultural exchange must also be considered as a factor with great influence in professional training.

Cultural experiences are so important to mobility of students that in England only half of the total hours of the exchange program are for academic activities, and the other half is available for cultural activities and sightseeing. In this study, a significant percentage of students omitted information on how many countries they visited during the exchange program. In this sense, there is a fear of being seen as uncommitted to the academic purposes, or that this was their only motivator for the experience, which may have influenced 18.4% of the students to not visit countries near the destination of the exchange.

The means of transport most used to visit other countries resemble the results of a qualitative study in which students expressed their self-confidence with the mastery of the transport system during their experiences and demonstrated how confident they felt when traveling on their own in foreign countries⁽¹²⁾.

The value of the scholarship was considered sufficient to tackle the costs of living in the foreign country. This result is in agreement with another study with Brazilian exchange students, in which 92.7% stated that the value of the scholarship was enough to live abroad and only 7.3% reported it was insufficient⁽²³⁾. The results related to airfare tickets, rent and food costs can be correlated to a study that evaluated the costs of living in a foreign country and showed that housing represents the main expense⁽⁷⁾. Therefore, the financial factor is one of the main reasons that hinder or impede the experience of international student mobility^{(12-14,17-20,25-27)}, and there is a need for future studies regarding this aspect.

Study limitations

This is a study whose data are from an instrument based on the reality of EEUSP.

Contributions to the area of nursing, health or public policy

There should be larger investment for Anglo-Saxons languages, in order to create opportunities for students, favor partner schools with large research centers and strengthen the work networks in Nursing. This study allows for reflections that can improve student mobility programs for undergraduate students, in order to advance learning and experience abroad.

CONCLUSION

The inter-institutional relationships already established between USP and Portuguese universities, which are prior to the SwB program, were determinant both in the field of nursing practice and for the unique research experience. The experiences of undergraduate students in the courses studied abroad were successful, especially with new methodologies, as described in reports presented. However, the limitations in the processes to evaluate learning were also clear.

The characteristics of the experiences of undergraduate students of the EEUSP revealed activities predominantly in theoretical, practical courses and insufficient experiences in the field of nursing research and practice.

Fear of misinterpretation of low academic commitment may hinder sociocultural experience and limit the extension of autonomy. The experience has its financial limitations and the financing programs of the HEI itself were considered an important funder, an incentive and a protagonist of the experience of international student mobility for undergraduate students.

The Brazilian government should invest in international student mobility programs like the SwB, in order to provide Brazilian youth with successful experiences in foreign HEIs. Future research should be developed to evaluate the impact of experiences of student mobility on the development of the country and particularly in the area of health, nursing and professional life of young nurses who participated in international student mobility programs.

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Publication Dates

• Publication in this collection
  2018

History

• Received
  25 Oct 2017
• Accepted
  20 Feb 2018