International academic mobility in nursing education : an experience report

Objective: report the experience of international academic mobility in Ireland through the program Science Without Borders during undergraduate education in nursing. Method: a report of experience presented in chronological order, with a descriptive nature. Results: the opportunity to know and be able to discuss questions regarding health and nursing in Ireland allowed the review of concepts and a more refl ective perspective regarding nursing practices. Additionally, the exchange promoted personal strengthening regarding the confrontation and solution of problems, development of technical and scientifi c abilities, improvement of linguistic competences and construction of personality, independence and maturity. Conclusion: regarding such constructive and enriching experience that this mobility provides to students, to the governing authorities, to the population and to Brazilian nursing, sharing this experience is expected to serve as encouragement for those who search for new horizons, with the objective of adding knowledge for their personal and professional life. Descriptors: International Educational Exchange; Nursing; Higher Education; Education, Nursing; Universities. RESUMO Objetivo: relatar a experiência da mobilidade acadêmica internacional na Irlanda por meio do programa Ciência sem Fronteiras durante a graduação de enfermagem. Método: trata-se de um relato de experiência apresentado em ordem cronológica e de natureza descritiva. Resultados: a oportunidade de conhecer e poder discutir as questões de saúde e de enfermagem na Irlanda possibilitou a revisão de conceitos e um olhar mais refl exivo a respeito das práticas de enfermagem. Além disso, o intercâmbio promoveu o fortalecimento pessoal em relação ao enfrentamento e solução de problemas, desenvolvimento de habilidades técnico-científi cas, aperfeiçoamento das competências linguísticas e construção de personalidade, independência e maturidade. Conclusão: diante de uma experiência tão construtiva e enriquecedora que essa mobilidade proporciona ao graduando, aos governantes, à população e à enfermagem brasileira, espera-se que o compartilhamento dessa vivência sirva de encorajamento para aqueles que buscam novos horizontes, com o objetivo de agregar conhecimentos para a vida pessoal e profi ssional. Descritores: Intercâmbio Educacional Internacional; Enfermagem; Educação Superior; Educação em Enfermagem; Universidades. RESUMEN Objetivo: relatar la experiencia de movilidad académica internacional en Irlanda a través del programa Ciencia Sin Fronteras durante el curso de enfermería. Método: relato de experiencia expresado en orden cronológico, de naturaleza descriptiva. Resultados: la oportunidad de conocer y pode discutir cuestiones de salud y de enfermería en Irlanda permitió la revisión de conceptos y una visión más refl exiva respecto de las prácticas de enfermería. Además, el intercambio promovió el desarrollo personal respecto a enfrentar y solucionar problemas, adquisición de habilidades técnico-científi cas, perfeccionamiento de competencias lingüísticas y formación de la personalidad, independencia y madurez. Conclusión: frente a la experiencia tan constructiva y enriquecedora que la movilidad le otorga al estudiante, a los gobernantes, a la población y a la enfermería brasileña, se espera que compartir la vivencia aliente a aquellos que buscan nuevos horizontes, con el objetivo de sumar conocimientos útiles para la vida personal y profesional. Descriptores: Intercambio Educacional Internacional; Enfermería; Educación Superior; Educación en Enfermería; Universidades. International academic mobility in nursing education: an experience report Mobilidade acadêmica internacional na formação em enfermagem: relato de experiência Movilidad académica internacional en la formación de enfermería: relato de experiencia Erica Mayumi Guskuma E-mail: mayumierica@hotmail.com CORRESPONDING AUTHOR


INTRODUCTION
University plays an essential role in society development through its three constructive dimensions (learning, research and extension), promoting the production and acquisition of knowledge and the education of qualified and prepared individuals to integrate the labor market (1) .Currently, in Brazil, there are many popular programs created in the 21 th century that democratize people's access to higher education.Some programs that encourage access to and stay in higher education, offered to students by the Ministry of Education (MEC), include the University for All Program (ProUni), the Financing for Higher Education Students (Fies), and the Unified Selection System (Sisu).In addition, the program Science Without Borders (CsF) was recently created, which allows higher education students to receive improvement and qualification at international levels (2) .
Science Without Borders is an initiative of the Federal Government in partnership with the Ministries of Science, Technology and Innovation, MEC and the secretariat for higher education and technological education of MEC, promoted by the National Council of Technological and Scientific Development (CNPq) and the Coordination for Personal Improvement of Higher Education Personnel (CAPES).This program aims to provide, through international academic mobility, education and qualification of Brazilian students on technology and innovation.Additionally, Science Without Borders seeks to attract Brazilian researchers in areas of priority set in the program, as well as allowing these researchers to receive specialized training in foreign countries (3) .
Regarding nursing, the internationalization and contact of the student with a different nursing teaching and practice model provides the exchange of knowledge and aggregation of new values and abilities to the future of the profession in both involved countries.The exchange of strategies between countries fosters small and gradual changes in daily practices of the nursing care (4) .
All of the benefits and advantages that international academic mobility can add to the education of nursing students justify the investment and maintenance of partnerships between international and Brazilian institutions of higher education.The participation of nursing programs in the Science Without Borders program is important to the education and qualification of students regarding technology and innovation and the development of qualified scientific production for recognition and appreciation of Brazilian nursing journals (5) .Notwithstanding, the exchange of experiences among former students that received the funding is essential to the improvement of the strategies of international academic mobility and diffusion of the knowledge and abilities acquired during this experience.
Through this report, the authors hope to disseminate nursing experiences and abilities obtained during mobility to the academic community, especially to nursing students and people interested in this program, and encourage the reflection about differences and similarities of the education and performance of nurses between the higher education institutions involved, in order to increasingly improve academic education and nursing care to the population.The aim of this study was to report the experience of international academic mobility in Ireland through the Science Without Borders program, during an undergraduate nursing program.

EXPERIENCE REPORT
This is an experience report of an academic student in the 8 th period of the undergraduate nursing program of Federal University of Alfenas -Minas Gerais, during the international academic mobility experience developed between January 2014 and May 2015, in the Institute of Technology Tralee (ITT), in Ireland.The setting of the activities performed in Ireland occurred at three different times: 1) intensive English course during the first six months; 2) International English Language Testing System (IELTS), evaluation of English proficiency and 3) general nursing course and other subjects that interested the student.
It is important to emphasize that because of linguistic barriers, a curricular internship was not possible, and nursing students were advised to select programs of the first years of the course and other subjects related to the Irish culture.In the scientific field, opportunities for development of scientific research were not offered as well.In the nursing department of ITT, however, the infrastructure of two hospitals was presented -the Kerry General Hospital and the Bon Secours Hospital -and all the questions of the students were answered regarding the organization of these institutions.Even though the expectations regarding a curricular internship and scientific research were not answered, classes and technical visits to the hospitals added knowledge about new equipment, materials, technology and nursing practices different than those available in Brazil.
In addition to disciplines that were attended during academic mobility, speeches were provided: "Elderly care: degenerative dementia and cognitive dysfunction"; "Elderly care: national policies on abuse and self-negligence"; and "Child and adolescent protection policies"; training on the use of a glucometer when verifying patients' glucose levels; a compulsory online course approved by the Irish Heart Foundation on cardiopulmonary resuscitation and use of automatic extern defibrillator in adults and children.Participation in nursing congresses and speeches was also very important to increase knowledge and exchange of experiences with other students.Additionally, in December 2014, the student was invited by the international office of the institute to act as a nursing ambassador in the Science Without Borders program, in order to clarify questions of the next students that would receive the scholarship and provide social media communication to the institute.
The disciplines attended included the development of learning strategies to support students to become independent learners in higher education; improvement of linguistic abilities and cultural consciousness needed for academic and social purposes; development of competences to expand the understanding of the practice based on nursing evidence; International academic mobility in nursing education: an experience report Guskuma EM, et al.
introduction and training of the student on nursing concepts and their attributions to provide a dependent level of individual care focused on the person, as well as exploration of these fundamental grounds of nursing theory and practice.
Despite its similarities to Brazilian teaching strategies, the nursing course of ITT stands out by its practical nature, with less time on theory in laboratories and in classes and more hours dedicated to learning in hospitals and clinics.During clinical internships, the nursing students practiced in many sectors such as surgical rooms, emergency units, and basic care, outpatient, pediatric, maternity and mental health clinics.It is important to highlight that the program also has thoughts similar to the Brazilian nursing curricular dynamics, emphasizing the importance of working with a multiprofessional staff and planning nursing care individually, encouraging the participation of patients in their own care.Similar to nursing educational programs, the course aims at care, communication and the understanding of the health and disease processes.
Another aspect observed during mobility is the existence of only nurses, residents and nursing students in the sectors of the hospital, which is different from Brazil because of the existence of nursing technicians.It is important to highlight that in Ireland, since 2007, obstetrician nurses are able to prescribe medications.Professionals that aim to prescribe need to attend a course named Prescriptive Authority, which lasts six months and is offered by certified higher education institutions, in order to attain the title of a nurse prescriber.Additionally, in some categories, nurses are allowed to prescribe narcotics and medications for palliative care (6) .
A characteristic that is very singular to this country is the existence of a nursing category named Advanced Practice Registered Nurse (APRN), which is also common in countries such as Australia, Belgium, Czech Republic, Finland, France, Japan, Poland, USA, Canada and United Kingdom.Licensed nurses in this category are professionals that work autonomously, they are responsible for their own practice and they acquired specialized knowledge through a master's degree.These professionals must demonstrate high abilities of evaluation, diagnosis, analysis and clinical judgement and the elements of this practice level, aiming to ensure well-being for patients and their families, offering health interventions with the collaboration of other professionals.This kind of nurse is responsible for working in: 1) clinical practice; 2) collaborative practices and leaderships; 3) education and learning; and, 4) research and evidence-based practice (7) .
During the period of academic mobility, highs and lows were experienced.The experience of moving to a country with a weather different than that the student was used to, confronting linguistic and sociocultural barriers and psychophysiological conditioning to Irish routines, in the beginning, caused strangeness and insecurity.The problems, however, did not stop the student from searching for new horizons, continuing her studies, planning travels, starting friendships, and acquiring new values and world perspective.These difficulties are inherent to the adaptation of students to a new country and, therefore, they are not worth further emphasis.

THEORETICAL REFLECTION
The quality of undergraduate and graduate nursing programs all over the country has been increasingly improved, evidencing the growth of scientific production and skilled workforce, as well as the strengthening of the qualification of Brazilian nursing journals, in addition to their contribution in the process of internationalization of the Brazilian science (5) .International academic mobility is an essential strategy to the growth of Brazilian and international nursing and its implications to people's health.
Regarding structural differences in the hospitals and universities among countries, a discrepancy in the availability and quality of materials and technologies used in nursing care in some of these countries is clear.However, noticing these differences and comparing them is an important step for reflecting on future investment policies and strategical changes in health.Other countries, such as Spain, invest in materials aimed at the quality of the offered services regarding biosafety of those involved, both patients and professionals.Some of these materials are: catheters of peripheral venous access with an automatic needle recapping system, transparent plasters, automatic and individual hypodermic needles for measuring glucose, options of latex and latex-free procedure gloves and other materials (8) .
Something that stands out in the Irish health care model is the tax exemption available only to people/families with low income and individuals up to 16 years of age.The rest of the population that is not included in this social setting must pay some taxes in order to receive health care in hospitals and emergency units as well as pay for the prescribed medications.In some cases of chronic diseases, the government offers free medications.Regarding collective health, especially in primary care, there are health centers located in most Irish cities that are very similar to the organization of the Family Health Strategy in Brazil.These centers have a multiprofessional staff made up of physicians and nurses specialized in public health, occupational therapists, physical therapists and support staff.There is also the support of speech therapists, nutritionists, advisers/psychologists, and dentists.Some studies on reports of this experience in a foreign country, used to base this discussion, showed that nursing students executed an extracurricular internship and developed scientific research during the mobility, and that provided a significant and enriching gain to their nursing knowledge (4)(5)(6)(7)(8) .It is noteworthy that the chance of working in other health settings, with other professionals and multiprofessional staffs, allows students to observe practical differences, learning on the many ways of health caring and working as a team, focusing on health education and prevention (4) .It makes it even clearer the importance of agreements between Brazilian and foreign higher education institutions regarding these activities, in order to provide students with the opportunity of exploring other curricular internships and research fields.
Similar to the experience in this mobility, participation in foreign nursing programs brings new knowledge and reflections to students, who tend to compare the foreign teaching International academic mobility in nursing education: an experience report Guskuma EM, et al.
methodology and the practices of health policies with those of their original country.Disciplines attended promote expansion and critical reflection of the knowledge about ethical and care concepts that can be implemented to the Brazilian public policy.Additionally, some disciplines may not be included in Brazilian undergraduate nursing programs, ensuring students a differential factor in their education.
Regarding prescription of medications, Irish nurses have significant autonomy to prescribe antibiotics, antiviral drugs, antidepressants and other prescription medications.The main goals of nurses' prescriptions are: 1) to improve services to the population, and their quality of life (for example, palliative care and elderly care); 2) to reduce delays; 3) to use the education and specialization of nurses in the best possible way and, 4) to aid the development of a service based on the right person, providing the right care in the right setting.Additionally, the nurse can also prescribe ionizing radiation (x-ray), which supports health services on a faster, more effective and accessible provision of services.
In addition to the autonomy given to this class of workers, the literature affirms that nurses and midwives can safely prescribe.Patients see these professionals positively, because they have attributes such as responsibility and empathy, and also the ability to effectively communicate and provide suitable information about the conditions and their patients' treatment.Prescriptions made by nurses/midwives reduce the costs and the time waiting for them; compliance rates from patients to prescribing nurses/midwives are high; nurses/midwives perform a detailed anamnesis before taking a decision about an intervention and tend to prescribe nonpharmacological interventions (9) .
In addition to the abovementioned, the role played by nursing professionals in both countries have similarities and differences regarding the autonomy of these professionals in decision making and interventions.This leads to a reflection about freedom and the autonomy of nursing in Brazil.Even though they were sanctioned by the Ethics Committee of Nursing Professionals, they still condition and delimit the nursing practice.In order to overcome the obstacles that affect the Brazilian nursing practice, it is necessary to advance in relationships among professionals of different categories, avoiding to impose one of them over the rest, seeking teamwork and the care of patients.The acquisition of new knowledge on a certain practice places professionals at a privileged position to practice their autonomy (10) .
Regardless of the differences between the experiences reported by the nursing students in the Science Without Borders program and the limitations of this program, the importance and significant difference enabled by mobility in nursing education is noteworthy.Moreover, the role of students is emphasized as the main character of their own academic career, always aiming to overcome difficulties, profiting as much as possible from the opportunities that are offered to them in their search for knowledge.Regarding the nursing practice, there is still a long way to go before these professionals achieve the ideal freedom/autonomy, and the category must keep fighting for better work conditions and more professional recognition.

FINAL CONSIDERATIONS
International academic mobility offers a set of opportunities to the expansion of scientific knowledge and world perspective, providing students with a broad, reflexive and critical vision about social, political, economic, personal and professional issues.The opportunity to know and be able to discuss public health and nursing questions in Ireland allowed the review of concepts, a paradigm break and a more reflexive view of the nursing practices.Additionally, it was a moment of development of technical, scientific and interpersonal abilities, improvement of linguistic skills and construction of personality, independency and maturity.
Regarding the benefits that the international academic mobility program Science Without Borders can bring to students through personal development and technical and scientific abilities, and to the nation as a whole through the insertion of innovative technologies in the health field, and consequently, improvement of quality of services offered, better dissemination and investments are suggested to the program.As a constructive and enriching experience provided by this mobility to students, to the governing authorities, to the population and to Brazilian nursing, it is expected that the sharing of this experience serves as encouraging for those who search for new horizons, with the objective of adding knowledge to their personal and professional life.