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International academic mobility: the experience of undergraduate nursing students

ABSTRACT

Objective

To understand/reveal the experiences of undergraduate students of the Nursing School of the Universidade de São Paulo in international academic mobility.

Method

A cross-sectional, descriptive study with a qualitative approach conducted between February and July 2017. Data were collected using a semi-structured interview and submitted to content analysis.

Results

Twenty-two (22) students participated in the study. Five analytical categories emerged from the analysis of the interviews: Interinstitutional Relationships Dimension, Personal Dimension, Professional Dimension, Academic Dimension and Cultural Dimension.

Conclusion

There are many advantages that international mobility can bring to vocational training. Greater governmental and institutional investment is considered necessary, but with mutual planning and monitoring by the institutions in order for it to contribute to the development of Nursing and the Country.

International Educational Exchange; Education; Nursing; Students, Nursing; Internationality

RESUMO

Objetivo

Compreender as experiências vivenciadas pelos estudantes de graduação da Escola de Enfermagem da Universidade de São Paulo na mobilidade estudantil internacional.

Método

Estudo transversal, descritivo, com abordagem qualitativa, realizado entre fevereiro e julho de 2017. Os dados foram coletados por meio de uma entrevista semiestruturada e submetidos à análise de conteúdo.

Resultados

Participaram do estudo 22 estudantes. Na análise das entrevistas, emergiram cinco categorias analíticas: Dimensão das Relações Interinstitucionais, Dimensão Pessoal, Dimensão Profissional, Dimensão Acadêmica e Dimensão Cultural.

Conclusão

São muitas as vantagens que o intercâmbio internacional pode trazer à formação profissional. Considera-se necessário maior investimento governamental e institucional, mas com planejamento mútuo e acompanhamento das instituições, de forma que contribua para o desenvolvimento da Enfermagem e do País.

Intercâmbio Educacional Internacional; Educação em Enfermagem; Estudantes de Enfermagem; Internacionalidade

RESUMEN

Objetivo

Comprender las experiencias vividas por los estudiantes de pregrado de la Escuela de Enfermería de la Universidade de São Paulo en la movilidad estudiantil internacional.

Método

Estudio transversal, descriptivo, con abordaje cualitativo, llevado a cabo entre febrero y julio de 2017. Se recogieron los datos mediante una entrevista semiestructurada, los que se sometieron al análisis de contenido.

Resultados

Participaron en el estudio 22 estudiantes. En el análisis de las entrevistas, emergieron cinco categorías analíticas: Dimensión de las Relaciones Interinstitucionales, Dimensión Personal, Dimensión Profesional, Dimensión Académica y Dimensión Cultural.

Conclusión

Son muchas las ventajas que el intercambio internacional puede brindar a la formación profesional. Se considera necesario mayor inversión gubernamental e institucional, pero con planificación mutua y acompañamiento de los centros, de modo a que contribuya al desarrollo de la Enfermería y del País.

Intercambio Educacional Internacional; Educación en Enfermería; Estudiantes de Enfermería; Internacionalidad

INTRODUCTION

Academic mobility is considered one of the main strategies of internationalization and is important for students training, since it provides the acquisition of essential knowledge, skills and attitudes so that the individual can experience the globalized world, in addition to interacting in the multicultural market and contribute to socially and technologically developing their country(11. Reschke MJD, Bido MCF. Potencializando a experiência de internacionalização: reflexões sobre o Programa Ciência sem Fronteiras. Espaço Pedagóg [Internet]. 2017 [citado 2017 nov. 16];24(1):128-38. Disponível em: http://seer.upf.br/index.php/rep/article/view/6997/4161.
http://seer.upf.br/index.php/rep/article...
-22. Luce MB, Fagundes CV, Mediel OG. Internacionalização da educação superior: a dimensão intercultural e o suporte institucional na avaliação da mobilidade acadêmica Avaliação Rev Aval Educ Super [Internet]. 2016 [citado 2017 ago. 08]; 21(2):317-39. Disponível em: http://www.scielo.br/pdf/aval/v21n2/1982-5765-aval-21-02-00317.pdf
http://www.scielo.br/pdf/aval/v21n2/1982...
).

In recent years, academic mobility opportunities have been offered in Brazil through the Science Without Borders Program (Ciência sem FronteirasCsF), which was implemented by the Federal Government in 2011 and aimed to promote the consolidation, expansion and internationalization of science and technology, innovation and Brazilian competitiveness through international academic mobility(33. Brasil. Ministério da Educação; Ministério da Ciência e Tecnologia, Inovações e Comunicações. Painel de Controle do Programa Ciências sem Fronteiras [Internet]. Brasília; 2016 [citado 2017 ago. 08]. Disponível em: http://www.cienciasemfronteiras.gov.br/web/csf/painel-de-controle
http://www.cienciasemfronteiras.gov.br/w...
).

According to the board that controls the CsF Program, 92,880 scholarships have been implemented abroad. Areas corresponding to biological sciences, biomedical sciences and health sciences received 16,076 grants. Of these, 66% were destined to sandwich undergraduate programs. According to the institution of origin of the grant holders, the Universidade de São Paulo (USP) was generally the institution that most participated in the Program, with the areas of biological sciences, biomedical sciences and health sciences of this university responsible for attracting 1,097 grants(33. Brasil. Ministério da Educação; Ministério da Ciência e Tecnologia, Inovações e Comunicações. Painel de Controle do Programa Ciências sem Fronteiras [Internet]. Brasília; 2016 [citado 2017 ago. 08]. Disponível em: http://www.cienciasemfronteiras.gov.br/web/csf/painel-de-controle
http://www.cienciasemfronteiras.gov.br/w...
).

In this context, the Nursing School of the Universidade of São Paulo (EEUSP) had a significant increase of undergraduate students in the various internationalization programs in the last 5 years; programs offered by USP itself and also the CsF program. Between 2011 and 2015, 49 Nursing students were sent to Australia, Canada, Chile, Spain, the United States, England, Ireland and Portugal. During this period, EEUSP received 17 undergraduate Nursing students from Austria, Chile, Colombia and Portugal.

Thus, the main motivation for performing this study was in considering this context and the need for the International Cooperation Committee (CCInt – Comissão de Cooperação Internacional) of the Nursing School of USP (EEUSP) to systematize personal, academic and institutional information of undergraduate students who experienced international mobility and to improve student mobility processes, thereby aiming to understand the experiences of undergraduate Nursing students of EEUSP in international academic mobility.

METHOD

STUDY DESIGN

This is a cross-sectional descriptive study with a qualitative approach.

DATA SOURCE

The participants were students and graduates of the EEUSP undergraduate course who participated in student mobility programs. The students were surveyed using a spreadsheet provided by the CCInt – EEUSP, with data on the international exchanges made by the school since the year 2006. This spreadsheet contained the data of 68 students, such as: their names, e-mail address, period of exchange, country and university of choice for the program and funding. The students were contacted based on their names and emails, and the interviews were scheduled in places and times according to the participants’ and researchers’ availability.

DATA COLLECTION

Data were collected from February to June 2017 through a semi-structured interview script. Twenty-two (22) interviews were carried out individually, ranging from 45 to 90 minutes, in a private room for secrecy and anonymity. Of these, two interviews were conducted by video call due to the distance of the subjects. The subjects’ speeches were recorded in order to provide greater freedom for the researcher to focus on the original speeches, to enter into the students’ world and to approach the meanings extracted from their experiences and data in a pre-reflexive moment. The number of participants was determined during data collection, which ended after the researchers’ agreed on the occurrence of repetitiveness and upon revealing the experiences lived by the students.

ANALYSIS OF THE RESULTS

The results from the interviews were submitted to content analysis which is a set of communication analysis techniques that uses systematic procedures and objectives to describe the content of the messages. This phase was organized into three stages: a) pre-analysis, in which the material corpus was identified and an initial complete reading was performed; b) material exploration, when the material was coded and categorized according to the semantic criterion (significant), which led to creating the thematic categories; and finally c) treatment of the results, in which inferences and interpretations were made in a phase of reflection, anchoring and confrontation between the accumulated knowledge and the scientific literature(44. Bardin L. Análise de conteúdo: retórica. Lisboa: Edições 70; 2012.).

All interviews were recorded as mp3 audio files, stored in a virtual space and transcribed in full. Once the corpus was formed, a thorough analysis by extracting units of meaning and thematic categories was possible.

ETHICAL ASPECTS

The research was only carried out after the approval of the Research Ethics Committee of the EEUSP – Opinion number 1.915.898/2017 – and it followed the recommendations for research with human beings, respecting all ethical aspects recommended by Resolution 466/12 of the National Health Council. Participants were informed about the objectives of the study and invited to participate; after this stage they signed the clear and Informed Consent Term.

In order to preserve the anonymity of the research subjects and to represent the international academic mobility, the participants were identified by the type of grant received, the destination country and the exchange year. The names of professors of the institutions cited in the interviews have been replaced by letters of the alphabet.

RESULTS

The 22 students interviewed were females between 20 and 24 years of age, and most of the students had gone to Portugal, especially in 2012 and 2013 when they were enrolled in the last semesters of their course. The students stayed for an average of 6 months in the destination country, the main source of funding was the university itself and the main source of information about the mobility programs were institutional emails and other students.

Based on the analysis of the interviews, five analytical categories emerged: Interinstitutional Relationships Dimension, Personal Dimension, Professional Dimension, Academic Dimension and Cultural Dimension.

INTERINSTITUTIONAL RELATIONSHIPS DIMENSION

The relationship between Brazilian and foreign institutions influenced the students’ selection process, their administrative process for enrollment in the program, the elaboration of a feasible study plan and in validating their courses taken upon their return to Brazil.

(...) having direct contact from the School here, which was with Professor Y, who is very involved with the Universidade Católica do Porto, this was a great facilitator, the link between these universities (Academic Merit, Portugal, 2014).

It was easier because professor X who had more direct communication with the professors there at the Universidade Autônoma and she sort of helped me choose the courses, write the presentation letter... (Academic Merit, Spain, 2010).

It was observed that the now extinct Science without Borders Program had some characteristics that differed from those of other grant programs. For students funded by the CsF, the communication between the institutions (essential for the students) was precarious, which made it difficult for them to get organized before the trip. The curricula developed in Brazil often suffered changes upon arrival in the country of origin, generating adaptations that did not fully meet students’ expectations and academic planning.

(...) it was this lack of communication between the universities. I felt like ... I felt lost in the middle of nowhere; the lack of relationship with the professor there with anyone from here, the communication between them and what we could do there when I arrived, the course that I could consider (CSF, England, 2016).

(...) I did not have a study plan because I didn’t know, I thought, maybe it was just me, but I thought the relationship with the university here had nothing to do with the university there… it was confusing, and they did not communicate, and then I had to talk to someone here, then talk to someone else (CSF, Italy, 2016).

Another aspect observed from the students’ speeches was that only the students who went to the Universidade do Porto were able to completely validate all their courses taken during the exchange, while those who participated in the Program at universities other than Porto did not have the same success. It is noticeable from the analysis that the interinstitutional relationship between the Universidade do Porto and the EEUSP was a preponderant factor for the validation of the course credits.

(...) I could not use the credits. And when I came back, I had to re-do the last year that was pending, so it delayed me one year (Academic Merit, Spain, 2010).

We had to do it in a group at the time, we took the curriculum and pedagogical project of the university that fit perfectly with the ones from here. We sent it to Portugal and then to the director for her to approve it. It was only validated later when we came back, and we received the curriculum equivalence (Academic Merit, Spain, 2014).

From the speeches, it is also possible to identify the desire for developing research, however the students financed by the CsF were not able to follow this approach because there were no pre-established research partnerships for all areas.

(...) over there we didn’t have this support, and I missed it because I really wanted to have started something with a professor over there and to be able to develop something and to continue with this scientific project, I wanted to do a Master’s degree over there, you know? And because this university does not have contact with anyone here, I could not make that connection... (CSF, England, 2016).

Regarding the research, the Nursing School there did not have the same research structure that we have here at USP, of having professors as tutors, supervisors (...) so when we got there, we had to explain all this, because they did not know that the CNPq had this plan and they are accustomed to receive students just to study, rather than for doing research, then it was very difficult ... (CSF, Chile, 2013).

PERSONAL DIMENSION

For the students, the experience of the exchange during the undergraduation allowed them the development of their autonomy, self-confidence and emotional control. What can have a direct influence is the need for financial planning with their day-to-day expenses, living with people outside of the family environment and other cultures, feeling homesick and missing their family members, discovering new knowledge and confronting challenges; factors that led students to undergo many changes over a short period of time.

(...) I believe that the professional experience was very important, but the individual is even more so, because you learn to stay away from your family, to deal with your own problems and you develop a lot like this... you discover yourself as a person (Academic Merit, Portugal, 2014).

(...) I see it as a possibility in which we get to know other cultures, we develop a differentiated autonomy because when we are always among our own people we end up feeling more secure, because of the affinity with our teachers, tutors and specialists who guide us in the fields during the internship, and when we are in another country, experiencing another reality, I feel that we can create greater autonomy and security... (Academic Merit, Portugal, 2013).

PROFESSIONAL DIMENSION

This dimension is associated to the fact that nursing activities in Brazil are led by nurses, but fragmented and ranked among professional subcategories: nursing technicians and nursing assistants. Therefore, in addition to identifying the inexistence of these professional categories, the experience favored critical reflection on the consequences for the professional activities of nurses at the same time that it provided contact with the professional exercise of comprehensive care, as well as experiences with multiprofessional teams that develop a more integrated work practice.

Because they have many obligations, which are procedures, techniques, getting things done and actually getting their hands on it, it is not like here that the nurse has a little more time to plan the care... (Academic Merit, Portugal, 2017).

There is a huge difference regarding Nursing, which has a positive side and a negative side of it as well: there are no nursing technicians, so everyone is a nurse... (Academic Merit, 2013).

ACADEMIC DIMENSION

This category includes aspects related to the teaching and learning process undergone by the students at the host university. Two subcategories emerged for better understanding of this dimension: differences in the curricular structure and practical disciplines.

DIFFERENCES IN THE CURRICULAR STRUCTURE

The main differences perceived by students were the shorter training periods than in Brazil and the more practical approach to training, especially in Portugal, Spain and Italy, even before the halfway point of the course, which generated insecurity regarding skills in the field.

(...) if I’m not mistaken the curricular internship in my time at USP was 360 hours, I’m not sure it’s still that, it was something like this, and in Portugal it is 600 hours, so we got there and they wanted us to do those 600 hours (...) the internships there were a little different (...) the hours were different, so we had to do night shifts, things that don’t happen in Brazil ... (Santander, England, 2013).

(...) The nursing course there is only three years and I was impressed that they have very little theoretical class time, it is something like this, you have theoretical classes for 1 and a half months and then you go start the internship, it is really very little class time you know? And I thought it was quite exhausting like that, very demanding... (CSF, Italy, 2016).

(...) the contact with the practice is very little compared to what we have for theory, and in Portugal it is the opposite because they have lots of practice and only one or two days of theory. So their week is divided completely different from ours, Monday and Tuesday they are in the university and the rest of the days they are in the hospital or at the primary care, it is a way more practical course than ours, a lot more... (Academic Merit, Portugal, 2014).

PRACTICAL DISCIPLINES

Regarding the practical activities, the opportunities that the students had to take on the direct care of patients stood out, which allowed for reflections on the most diverse aspects of care such as culture, customs, values, new technologies, differences in the health system, interpersonal relationships, nursing procedures and management issues. However, it is also noticed that even during practical activities the students did not have an understanding about the most diverse health systems in which they were involved.

(...) I was very well welcomed in the hospital, despite the great rivalry with the female figure in Portugal ... You have to show them what you are there for, you have to have a lot of flexibility because it is a country that has a lot of prejudice against Brazil. So, in that sense, the hospital environment demands certain cautions, for example, bathing male bedridden patients with their woman companions present, you understand? (Academic Merit, Portugal, 2014).

So, there they also have the public and the private system, just like here, but they say that the public and the private get mixed up. I don’t know how it works if someone needs surgery and the public system (equivalent to the SUS) has to pay for it, but it works like that, they have a health insurance card... (Academic Merit, Spain, 2014).

Some students did not have the same opportunities because the internship was not allowed, especially in Anglo-Saxon countries, as explained in the following speeches.

We could not have contact with the patients, no one from the health area could take the courses that had direct contact with the patient... And the guidelines from the consulate were also the same, we were not allowed to take courses that had direct contact with the patients. I’m not sure if it’s because in the USA it’s very common for a patient to file a lawsuit against the health service, right? So, imagine filing a lawsuit against the health service involving an exchange student, things would take on another proportion (CSF, USA, 2014).

(...) No, I was not allowed, according to the legislation of the country, I could not be in the field. If I were to go to the field I would have needed to get a visa and blah, blah, blah, that was different from the one I got. So I could not take any practical courses... (AUCANI, England, 2014).

CULTURAL DIMENSION

This category includes the students’ intercultural and leisure experiences. It shows us the perception about aspects related to the language, cultural differences and the tourism activities during the exchange period. Students who were part of the CsF exchange program had the opportunity to enroll in a language course for a few months before the start of the academic activities, according to their proficiency level in the language that the student presented upon registering for the Program.

(...) based on my score, the university suggested that I spend 6 months studying English, preparing myself to start the course... (CSF, England, 2015).

(...) So, there were some people that spent 6 months studying English and then 2 semesters attending college and doing research for a period of 2, 3 months, and there was also a group of students who scored average on the TOEFL and who would take a 6-week English course and then take an academic course... (CSF, USA, 2015).

The exchange experience undoubtedly promoted an improvement in the foreign language. For some perhaps to a greater degree, for others to a lesser degree, but the language level was not only high for the language in general, but also for more technical language used in the health area.

I would follow alongside my internship tutor, he would laugh a lot because sometimes I did not understand, I would bring something wrong to him, he would laugh, but over time we broke the ice, it got better and I started speaking much better, I started to understand everything they said, the specific terms of the area, and everything started to get easier... (CSF, Italy, 2016).

It was funny because on my first test of this discipline I score really low, because I did not know the name of the things yet, like... the name of the foods in Spanish... (CSF, Chile, 2013).

The students had the opportunity to meet other exchange students and to visit other places, depending where they went for their exchange program, they were even able to visit different countries. This intercultural experience contributed to an expanded perception of other cultures.

There are plenty of parks and outdoor spaces over there, so it’s very easy to go out without spending too much money. And I also took some trips, I went to Paris again, I went to Italy and to Switzerland and Ireland and to Germany this time, which was what I did for pleasure... (Academic Merit, Portugal, 2017).

I used to save money to go on some mini trips around England. I went to a lot of museums, all the free museums I went to at least three times, one of them was beside the university so it was very easy and just walking around the city was already fun for me... (AUCANI, England, 2017).

DISCUSSION

The analysis shows that the relationship between the educational institutions is a factor that can either facilitate or hinder, mainly depending on the financing organization of the exchange. Proximity to the student makes it possible to choose the location best suited to the student’s interests by collaborating on the preparation of a study plan that will be developed abroad, and even by mediating contacts(55. Dantas RA, Pagliuca LMF. Experiência de intercâmbio em Portugal: uma perspectiva para a pesquisa. Rev Rene [Internet]. 2004 [citado 2017 ago. 08]; 5(1):101-6. Disponível em: http://www.periodicos.ufc.br/index.php/rene/article/viewFile/5592/4031
http://www.periodicos.ufc.br/index.php/r...
).

The lack of communication between the CsF Program and the universities involved was a factor that interfered in the program development, since the students financed by the CsF faced difficulties related to preparing the study plans, as well as having access to information on the available courses, possible credits and their respective start and end dates. This caused feelings of frustration in the exchange students for not being able to enroll into courses of their personal and academic interest.

Regarding the research activities, the academic world is more and more supported by the activities of scientific research and publication of the results. Thus, developing research abroad is extremely important for training students, since it broadens their knowledge, offers them experience with researchers from other countries and the skills of learning from the research. This experience certainly adds great value to the partnerships between Brazilian and foreign teaching and research institutions, also serving as an incubator for potential students of graduate programs(66. Dalmolin IS, Pereira ER, Silva RMCRA, Gouveia MJB, Sardinheiro JJ. Intercâmbio acadêmico cultural internacional: uma experiência de crescimento pessoal e científico. Rev Bras Enferm [Internet]. 2013 [citado 2016 mar. 10];66(3):442-7. Disponível em: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672013000300021
http://www.scielo.br/scielo.php?script=s...
).

It is important to emphasize that the tripod that supports the university “teaching-research-extension”(77. Silva R, Oliveira CBF. Educação nas prisões e universidade pública: reflexões sobre o papel da extensão universitária. Rev Cult Ext USP [Internet]. 2016 [citado 2017 set. 29];15:85-95. Disponível em: http://www.journals.usp.br/rce/article/view/117051
http://www.journals.usp.br/rce/article/v...
) might not have being considered in the context of internationalization. The student’s speeches evidenced that their participation in research groups or research projects in the destination institutions was not feasible during the exchanges, despite it being one of the objectives of the CsF.

With regard to the Personal Dimension, personal growth and development was the most important aspect of the exchange experience. It is in this dimension that the factors considered most important during the exchange experience stand out, especially in planning daily activities and finances, knowledge of other cultures, among others. From this perspective, it can be said that international experience is predominantly and primarily seen as an opportunity to develop as a person, and secondly as a means of seeking academic knowledge and professional development(11. Reschke MJD, Bido MCF. Potencializando a experiência de internacionalização: reflexões sobre o Programa Ciência sem Fronteiras. Espaço Pedagóg [Internet]. 2017 [citado 2017 nov. 16];24(1):128-38. Disponível em: http://seer.upf.br/index.php/rep/article/view/6997/4161.
http://seer.upf.br/index.php/rep/article...
).

A qualitative study carried out in Australia shows that the exchange experienced in Europe significantly promoted personal development of the participants. Changes in students’ attitudes and behaviors and even in the perception of their personal identity were observed by the professors. This became a differentiating factor between students who did not have the same experience(88. Richardson R, Munday J. International Student Mobility Programs and effects on student teachers’ perceptions and beliefs about education and their role as future educators. Univ J Educ Res [Internet]. 2013 [cited 2017 July 05];1(3):240-6. Available from: http://www.hrpub.org/download/201310/ujer.2013.010314.pdf
http://www.hrpub.org/download/201310/uje...
). The international exchange has a positive and significant impact on the Personal Dimension of the Nursing student(99. Green BF, Johansson I, Rosser M, Tengnah C, Segrott J. Studying abroad: a multiple case study of nursing students’ international experiences. Nurse Educ Today. 2008;28(8):981-92. DOI:10.1016/j.nedt.2008.06.003).

The opportunity to experience and learn in different places and cultures favored the perception of the student as a nurse, experiencing other perspectives that will directly influence their care and management practices(1010. Kohlbry PW. The impact of international service-learning on nursing students’ cultural competency. J Nurs Scholarsh. 2016;48(3):303-11. DOI: 10.1111/jnu.12209). This experience has the potential to make the participants better prepared to work with the day-to-day adversities of nurses, as it broadens their vision from a local perspective to an international and global perspective, which favors a process of multidimensional construction and culminates in greater autonomy during life overall(1111. Carvalho JL, Backes DS, Lomba MLLF, Colomé JS. Intercâmbio académico internacional: uma oportunidade para a formação do futuro enfermeiro. Rev Enf Ref [Internet]. 2016 [citado 2017 jul. 04];Série IV(10):59-67. Disponível em: http://www.scielo.mec.pt/pdf/ref/vserIVn10/serIVn10a07.pdf
http://www.scielo.mec.pt/pdf/ref/vserIVn...
).

Regarding the curricular structure of foreign and Brazilian institutions, it can be said that they have agreements and disagreements. In relating theory and practice, it was verified that the curricula organized by courses and when these are inserted into the nursing training in the foreign country brings students into the practice field much sooner than what is commonly structured by EEUSP. This was mainly observed in Portugal, Spain and Italy. This fact is related to the European Training Guidelines, which recognize professional qualifications. Clinical teaching is established as the nurse training component in the curriculum, through which the Nursing student learns from the team and has direct contact with healthy or sick individuals and/or the community(1212. União Europeia. Regulamento (UE) n. 1025/2012 do Parlamento Europeu e do Conselho de 25 de outubro de 2012. Jornal Oficial da União Europeia [Internet]. Bruxelas; 2012 [citado 2017 ago. 08]. Disponível em: http://www1.ipq.pt/PT/Normalizacao/IPQ_Organismo_Nacional_Normalizacao/Regulamento_Europeu/Documents/Regulamento%20Europeu%201025-2012.pdf
http://www1.ipq.pt/PT/Normalizacao/IPQ_O...
).

It is known that curricular guideline construction should meet the needs of the market which is determined at the time of its elaboration. Also, political, historical, epidemiological and organizational aspects of health care of where the course is set should be taken into account(1313. Duarte AP, Vasconcelos M, Silva SV. A trajetória curricular da graduação em Enfermagem no Brasil. REID Rev Eletr Invest Desenvolv [Internet]. 2016 [citado 2017 jul. 04];1(7):49-63. Disponível em: http://reid.ucm.ac.mz/index.php/reid/article/view/120
http://reid.ucm.ac.mz/index.php/reid/art...
-1414. Ito EE, Peres AM, Takahashi RT, Leite MMJ. O ensino de enfermagem e as diretrizes curriculares nacionais: utopia x realidade. Rev Esc Enferm USP [Internet]. 2006 [citado 2017 jul. 12];40(4):570-5. Disponível em: http://www.scielo.br/pdf/reeusp/v40n4/v40n4a16.pdf
http://www.scielo.br/pdf/reeusp/v40n4/v4...
). Therefore, depending on the country, state and city, there may be many variations in curricular experiences.

Considering the present study, although students were inserted into different learning scenarios, they were not part of the process since many were unable to experience practical experiences in health institutions and therefore were not able to clearly understand the functioning of the local health system in the destination country, which limited their evaluation of this functioning.

In relation to the practical activities during the exchange program, two points deserve to be highlighted. The first corresponds to the fact that the students who went to Portugal, Italy and Spain had the opportunity to be inserted in health units and to provide direct patient care with direct supervision of a local nurse. The second is that students who opted for countries such as the USA, England and Canada could not act in the practice field.

Perhaps this fact is related to the language given the very different aspects between the languages of Anglo-Saxon countries and the languages of Latin countries, which may represent an important communication difficulty. On the other hand, it may be related to costs or aspects of country legislation that do not allow students to perform practical activities in health services.

The language barrier is an important aspect due to its impact on communication, social interaction and the development of cultural competence. This is a problem that still remains between students and professionals and needs to be overcome(1515. Wang CC, Andre K, Greenwood KM. Chinese students studying at Australian universities with specific reference to nursing students: a narrative literature review. Nurse Educ Today. 2015;35(4):609-19. DOI: https://doi.org/10.1016/j.nedt.2014.12.005
https://doi.org/10.1016/j.nedt.2014.12.0...
).

Communication in another language involves an adaptation process experienced by foreign students which can have a significant impact on the lives of academics. Studies show that a high level of proficiency decreases social isolation which is often experienced by foreign students, and improves their interaction with local students, and consequently the student’s academic progress(1616. Guan X, Jones G. Unlearning and relearning: Chinese students in a New Zealand first year undergraduate class. N Z J Teach Work. 2011;8(2):208-19. DOI: 10.1.1.461.4432&rep=rep1&type=pdf
https://doi.org/10.1.1.461.4432&rep=rep1...
-1717. Campbell J, Li M. Asian students’ voices: an empirical study of Asian students’ learning experiences at a New Zealand University. J Stud Int Educ. 2008;12(4):375-96. DOI:10.1177/1028315307299422.).

Language appears as one of the greatest challenges faced by students, which can make it difficult to form a bond, both in the social context and in practice scenarios. It is worth emphasizing that facing some obstacles is part of the training process and is considered important and necessary because these challenges enable new interpretations by students, which make them more experienced, critical and creative. These are important attributes for a good professional(1111. Carvalho JL, Backes DS, Lomba MLLF, Colomé JS. Intercâmbio académico internacional: uma oportunidade para a formação do futuro enfermeiro. Rev Enf Ref [Internet]. 2016 [citado 2017 jul. 04];Série IV(10):59-67. Disponível em: http://www.scielo.mec.pt/pdf/ref/vserIVn10/serIVn10a07.pdf
http://www.scielo.mec.pt/pdf/ref/vserIVn...
,1818. Vasconcelos TC, Araújo BFB. Compreendendo os resultados de aprendizagem em intercâmbios voluntários internacionais. Rev Gestão Tecnol [Internet]. 2017 [citado 2017 jul. 12];17(1):154-80. Disponível em: http://revistagt.fpl.emnuvens.com.br/get/article/view/915. DOI: http://dx.doi.org/10.20397/2177-6652/2017.v17i1.915
http://revistagt.fpl.emnuvens.com.br/get...
-1919. Guskuma EM, Dullius AAS, Godinho MSC, Costa MST, Terra FS. International academic mobility in nursing education: an experience report. Rev Bras Enferm [Internet]. 2016 [cited 2017 July 10];69(5):929-33. Available from: http://www.scielo.br/scielo.php?pid=S0034-71672016000500986&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S003...
).

Regarding the nurses’ performance, we can bring this reflection to their work process, since this professional is responsible for providing care to human beings. These are inserted in the most diverse environments and ways of thinking and acting, thus requiring from professionals better development of communication and interpersonal relationship skills. When we see another’s point of view, our relationships tend to go through more gentle and respected paths. This aspect certainly contributes to developing more qualified, differentiated, creative professionals who are more attentive to the human complexity(2020. Isse SF, Silva ODB. Intercâmbio cultural Univates-Brasil/Universidade Pedagógica Nacional-Colômbia: um relato de experiências da formação cultural de estudantes de cursos de licenciatura. Cad Pedagog [Internet]. 2013 [citado 2017 jul. 20];10(2):35-46. Disponível em: http://www.univates.br/revistas/index.php/cadped/article/view/881
http://www.univates.br/revistas/index.ph...
).

From this study we can highlight the need for other investigations which provide an evaluation of the impact of this experience on the nursing care practice and directly in the labor market. As this study aimed to understand the experience during an academic exchange of undergraduate students, it was not possible to explore this cited aspect.

The international mobility of Nursing students still in their undergraduate course provides experiential learning in multicultural realities that favors a differentiated and sensitive training in global health issues.

CONCLUSION

The experiences of EEUSP undergraduate students in international academic mobility programs allows differentiated training as it favors personal and professional development, since it strengthens their trajectory as students and prepares them for the labor market. Despite some difficulties experienced such as adapting to the language; choosing a curriculum and developing research during international mobility are important for the professional and personal development of the students; however some aspects could be better systematized, especially in regards to the interinstitutional relationships. The participation of both educational institutions in the curricula construction carried out by the students is fundamental, as this would facilitate validation of the courses taken abroad and not delay their training.

Within the academic activities carried out by the students, the theoretical and practical courses were the ones that most predominated. However, research experience, which is one of the foundations of the university, was little reported, denoting a lack of investment and interest by host institutions. Perhaps a more effective communication between universities and professors can bring better results in the research field.

There are many advantages that international exchanges can bring to professional training as discussed in this work, related to both the technical-scientific, cultural and personal development as well as the innovative ideas that can emerge and be applied in Brazil. Therefore, we suggest greater governmental and institutional investment in these types of undergraduate programs, but with mutual planning and monitoring by institutions which may enable greater conditions to achieve teaching and research objectives, and that the experience contributes to developing critical and reflexive nurses committed to global health, to the sociocultural understanding of health, to Nursing and to the country.

The international mobility of undergraduate students favors academic and sociocultural experiences and enhances the autonomy of future nurses; however, we must emphasize the need to extend the experience beyond teaching in order to make better use of the experience abroad and to extend contact with the major research centers in Nursing.

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Publication Dates

  • Publication in this collection
    13 Sept 2018
  • Date of issue
    2018

History

  • Received
    06 Oct 2017
  • Accepted
    27 Feb 2018
Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br