Double nursing degree: potentialities and challenges of an international student academic experience

ABSTRACT

Objective

To share the experience of a Double Nursing degree promoted between the Nursing School of the Universidade de São Paulo and the Health Sciences Institute of the Universidade Católica Portuguesa, reflecting on the potentialities and challenges of this opportunity for graduate students.

Method

This is an experience report presented in chronological order and of a descriptive nature. The double degree in Nursing was accomplished over a period of 6 months in a different institution from the institution of origin.

Results

Among the activities developed during the Double Degree are: participating in examining boards, congresses, seminars, courses, meetings, lectures, colloquium, classes, research groups and technical visits to health services. A table presents and describes the main benefits of the experience experienced by the authors.

Conclusion

When well-planned and well-developed, a double degree can promote personal, cultural and professional development of the students, favoring internationalization and contributing to the qualification of graduate programs.

DESCRIPTORS
Education; Nursing; Education; Nursing; Graduate; International Educational Exchange

RESUMO

Objetivo

Compartilhar a experiência da dupla titulação em enfermagem promovida entre a Escola de Enfermagem da Universidade de São Paulo e o Instituto de Ciências da Saúde da Universidade Católica Portuguesa, fazendo uma reflexão sobre as potencialidades e os desafios dessa oportunidade para o estudante de pós-graduação.

Método

Trata-se de um relato de experiência apresentado em ordem cronológica e de natureza descritiva. A dupla titulação em enfermagem foi realizada no período de 6 meses, em instituição diferente da de origem.

Resultados

Dentre as atividades desenvolvidas durante a dupla titulação destacam-se: participação em bancas de defesa, congressos, seminário, cursos, encontros, palestras, colóquios, aulas, grupos de pesquisa e visita técnica aos serviços de saúde. Um quadro apresenta e descreve os principais benefícios da experiência vivenciada pelas autoras.

Conclusão

A dupla titulação, quando bem planejada e desenvolvida, pode promover o desenvolvimento pessoal, cultural e profissional do estudante, favorecendo a internacionalização e contribuindo para a qualificação dos programas de pós-graduação.

DESCRITORES
Educação em Enfermagem; Educação de Pós-Graduação em Enfermagem; Intercâmbio Educacional Internacional

RESUMEN

Objetivo

Compartir la experiencia de la doble titulación en enfermería promovida entre la Escuela de Enfermería de la Universidad de São Paulo y el Instituto de Ciencias de la Salud de la Universidad Católica Portuguesa, mediante una reflexión acerca de las potencialidades y los desafíos de esa oportunidad para el estudiante de posgrado.

Método

Se trata de un relato de experiencia presentado en orden cronológico y de naturaleza descriptiva. La doble titulación en enfermería fue llevada a cabo en el período de seis meses, en centro distinto de aquel de origen.

Resultados

Entre las actividades desarrolladas durante la doble titulación, se destacan: participación en tribunales de defensa, congresos, seminarios, cursos, encuentros, charlas, coloquios, clases, grupos de investigación y visita técnica a los servicios sanitarios. Un recuadro presenta y describe los principales beneficios de la experiencia vivida por las autoras.

Conclusión

La doble titulación, cuando bien planificada y desarrollada, puede promover el desarrollo personal, cultural y profesional del estudiante, favoreciendo la internacionalización y contribuyendo a la calificación de los programas de posgrado.

DESCRIPTORES
Educación en Enfermería; Educación de Posgrado en Enfermería; Intercambio Educacional Internacional

INTRODUCTION

Nursing education in the 21^st century requires a broad understanding of the health needs of the local and global community⁽¹⁾. The Millennium Development Goals⁽²⁾ address the importance of global health and the need of building a global alliance for development. Nursing students are enthusiastic about engaging in global nursing experiences⁽¹⁾. Considering the increase in the global migration of nurses⁽³⁾, strategies that contribute to the development of students’ skills, their personal development and their sensitivity to global and cultural issues are essential⁽⁴⁾.

One of the current challenges of Brazilian nursing is to train doctorate/PhD students with research skills at the level of the best international research centers, making them able to work in partnership with other national and international researchers⁽⁵⁾. In order to achieve this goal, universities have increasingly invested in internationalization programs to address the need for culturally competent care of diverse populations⁽⁶⁾.

Double degrees seek to increase the level of collaboration and joint publications between researchers working in Brazil and abroad, providing greater international visibility to scientific, technological and cultural production, increasing the access of Brazilian researchers to international centers of excellence. The internationalization of Brazilian Graduate Programs is defined by international cooperation guidelines that complement the education and training of its teachers and students. The objective of double degrees is to promote the progress of science and solve specific problems in Brazil and specific problems of humanity, as well as to enhance the dissemination and promotion of knowledge, which should be guided by an ideal of solidarity⁽⁷⁾.

In 2014, the Nursing School of the Universidade de São Paulo (EEUSP) approved an agreement for the double doctorate degree in Nursing with the Health Sciences Institute of the Universidade Católica Portuguesa (ICS-UCP). This partnership for the double degree in Nursing presents itself as an opportunity to enhance research skills, to stand out in the academic environment and to establish and/or expand work opportunities in a different context from the one in which the study is carried out.

This agreement between Brazil-Portugal opens pathways for comparative research between Brazilian and Portuguese nursing, allowing for the identification of influential factors that lead to development of the profession and the discipline in both countries. This type of experience should be reported in order to make it known among the scientific community and thus encourage the participation of new graduate students⁽⁸⁾. Our goal is to arouse the interest of students from nursing graduate programs to undergo this type of experience.

In this context, this article aims to share the experiences of the double degree in Nursing promoted by the Nursing School of the Universidade de São Paulo (EEUSP) and the Health Sciences Institute of the Universidade Católica Portuguesa (ICS-UCP), reflecting on the potentialities and challenges of this opportunity for the graduate students.

METHOD

This is an experience report on student academic internationalization, within the framework of a doctoral program with a double degree in Nursing. The double degree agreement between EEUSP and ICS-UCP was established in 2014.

The report describes the experience of three fellows who completed the double degree program. One of the authors, a student at the EEUSP, went to the ICS-UCP with the financial support of a scholarship granted by the National Council for Scientific and Technological Development (CNPq – Conselho Nacional de Desenvolvimento Científico e Tecnológico) from July to December 2014; and two authors, students at the ICS-UCP, went to the EEUSP from February to July 2015 with the financial support of a scholarship granted by the Coordination for the Improvement of Higher Education Personnel (CAPES – Coordenação de Aperfeiçoamento de Pessoal de Nível Superior).

The results are described according to the chronological order of events and from a descriptive nature. Therefore, the experiences, activities and observations resulting from this experience of student academic internationalization, as well as the difficulties and potentialities of this type of formative experience seeking high-level training of professionals, teachers and researchers with differentiated knowledge can be found along the text.

In this pathway, the documents for completion of the double degree were: a commitment term duly signed by the student, the supervising professor and the co-supervising professor; curriculum lattes; application form; and the student's study plan. The documents are not only necessary for obtaining the visa, but also to present to the immigration service when entering the foreign country.

All costs including airfare, school fees, housing, meals and health insurance are the sole responsibility of the student. The minimum length of stay required by the agreement is 6 months, with the appointment of a co-supervising professor at the destination institution.

RESULTS

Among the activities developed during the double degree program stand out: participating in examining boards, congresses, seminars, courses, meetings, lectures, colloquium, classes, research groups and technical visits to health services; as well as the completion of the objectives set out in the student's study plan, and the publication of articles in highly qualified scientific journals with a high impact factor^(9–11).

The availability of co-supervisors with recognized expertise in the research area in both of the experiences enables development and growth of the thesis. The objective was to expand the capacity to plan, design and carry out an investigation, respecting all the requirements of academic quality and integrity.

The activity plan for the double degree had to be planned out to be feasible in the 6-month period, hence the need to develop a good relationship with the co-supervising professor, with colleagues, and with other professors and staff in order to facilitate the development of the proposed activities, thereby enabling the successful completion of the activities according to schedule.

The three students developed the following theses: 1. The moral sensitivity of nurses to ethical problems in primary health care, which aimed to evaluate the moral sensitivity of nurses working in primary health care in Portugal and Brazil⁽⁹⁾; 2. Moral suffering: risk assessment among nurses, with the objective to analyze the phenomenon of moral suffering in Brazilian and Portuguese nurses⁽¹⁰⁾; 3. Health conceptions and care of integrative/complementary and humanizing practices in Primary Care: a systematic review, which sought to build (based on the systematic review) what are the conceptions of health and care underlying the integrative/complementary and humanizing practices for care in Primary Care⁽¹¹⁾. Thesis 1 and 2 have the ICS/UCP as main institution, being part of the research line “history and philosophy of Nursing”. Thesis 3 has the EEUSP as the main institution, in the area of health care.

The double degree carried out at the ICS-UCP allowed for densifying the theoretical reference of the thesis, enriching the discussion, as well as incorporating a multicultural perspective into the results. The double degree conducted at the EEUSP allowed for data collection and analysis, providing an elaboration of a Portuguese-Brazilian comparative research. Other benefits that can be generated from student internationalization are listed in Chart 1.

During the Double Degree at the EEUSP, the students developed the following activities: participating as a listener in the course of “Bioethics in the primary care”; a course on Ethics with Professional Confidentiality at the Regional Nursing Council of São Paulo; participating as a listener in the lectures: Network contra network and the gap between policy and practice: a study case of organisation of major trauma network; The construction of implementation: why is there difficulty to transfer knowledge into day by day practice? at the EEUSP; a conversation with medicine students of the Faculty of Medicine of the Universidade de São Paulo to discuss the topic: What is it like to be a nurse and how is the work relationship with physicians in our service. The students had a sharing moment during the Graduate Colloquium of the EEUSP, where the thematic Health system of Portugal and the doctorate at the Universidade Católica do Porto was presented; they participated in the 10^th Luso-Brazilian Nursing Meeting, conducted by Centro Universitário São Camilo in São Paulo, with the presentation of talks resulting from the thesis; they participated in a Seminar held by the CNPq Research Group on Bioethics and Collective Health, of the Graduate Program in Collective Health of the Universidade do Vale do Rio dos Sinos; and also participated in the VII Congress of Humanization and Bioethics and the 1^st Ibero-American International Congress of Bioethics at the Pontifícia Universidade Católica of Curitiba, also with the presentation of talks.

The student who attended the ICS-UCP participated in the following activities: the 13^th National Congress of Bioethics and the 5^th Luso-Brazilian Forum of Bioethics: Equality and Non-discrimination at the Portuguese Association of Bioethics and Department of Social Sciences and Health of the Medicine Faculty of Porto; the 3^rd National Seminar on Commissions in Ethics at the Universidade Católica Portuguesa; the 8^th International Seminar on Nursing Research held at the Universidade Católica Portuguesa; the 9^th Luso-Brazilian Nursing Meeting at the Universidade Católica Portuguesa; the International Conference on Nursing Knowledge (NNN) – From concepts to translation at the Universidade Católica Portuguesa; the 4^th Nursing Research Congress of Ibero-American and Portuguese Speaking Countries; the 9^th Luso-Brazilian Nursing Meeting: Nursing Challenges and Trends for the 3^rd Millennium; the International Symposium on effectiveness and quality of nursing care; and the 10^th Conference of the Global Network of the World Health Organization Collaborating Centers for the development of nursing and obstetrics at the Nursing School of Coimbra.

Undergoing any internationalization, as is the case in the double degree, is a demanding stage for the students, since it requires great dedication and availability during this period. In this context, the experience was only possible because all the students could count on financial support from institutions that promote research.

Chart 1
Benefits of student internationalization – Porto, Portugal, 2017.

Field	Benefits
Curriculum	Obtaining a double degree Possibility of scientific publication with international researchers Participation in scientific events in the nursing area Participation in research groups
Thesis	Enhancing research skills Thesis development and theoretical densification Integrating different perspectives and cultures into the results International dissemination of the thesis results
Personal	Contact with renowned researchers Developing cultural competencies Getting to know other realities Exchanging experiences with fellow nurses Becoming an independent researcher
Future projects	Establishing an international network Creating job opportunities Possibility of publication with colleagues in the area

There are other challenges related to the cultural adaptation, even though both countries share the same language, the culture and customs are different; immersion into the academic environment, meeting other students and researchers, joining a research group, identifying common interests; being away from family – especially if the student has a hard time making new friends and bonding with others, which can make them feel alone during the process; and finding housing, as the universities do not have university housing, and it is the student's responsibility to find a place to live in that period.

Undoubtedly, completing an academic double degree is an essential step in the professional and teaching career of the students. In this sense, a double degree works in a complementary way to the efforts generated in Brazil by graduate programs seeking high level training of professors and researchers, aiming at their insertion into the academic and research environment of the country. The double degree allows the students to get to know and experience other cultures, to cross boundaries and to relate with renowned international researchers, creating a professional network of international contacts, as well as gaining academic recognition in both countries.

DISCUSSION

Globalization provides institutions in different countries with the opportunity to share knowledge and innovation through creation of overseas study programs and academic mobility for nursing students⁽¹²⁾. This favors the creation and expansion of bonds and partnerships between countries, as well as increased educational opportunities for the participants⁽¹³⁾. In this sense, the double degree allows integrating two perspectives into the construction of Nursing practices and knowledge.

The creation of new directions for training has been possible thanks to the continuous efforts from universities along with the support of funding sources such as CAPES, leading to the dissemination of scientific knowledge beyond borders⁽¹⁴⁾. The opportunities for academic internationalization for graduate students have proven to be fundamental to acquiring a global perspective of nursing, fostering increased religious, ethnic and cultural diversity within the academic environment⁽¹⁵⁾.

It can be said that scientific production is directly related to the excellence of the research groups, organized by thematic axes or lines and based on the knowledge gaps in health. It is important that the student can be part of a research group, who welcomes and accompanies them during their internationalization period, to help them respond to the accelerated pace imposed on researchers to meet the productivity criteria⁽¹⁶⁾. In this sense, it is worth mentioning the influence of the capitalist model in scientific research, the American term “publish or perish” alludes to the pressure on researchers to constantly publish articles in order to maintain their academic career⁽¹⁶⁾, and which was experienced by the students of the double degree in order to meet the production requirements.

The development and strengthening of nursing demands the training of doctorate students who are prepared for teaching, research and leadership, and who are able to build a solid and committed career with the professional collective. In this context, internationalization appears as an important step in consolidating a scientific career and professional satisfaction⁽¹⁷⁾.

CAPES provides for training of highly qualified PhDs for research with scientific competence and with additional preparation for teaching. Thus, CAPES is concerned in training human resources of excellence, having the philosophy of respecting the diversity and the free debate of ideas in order to favor a society with better quality of life, better health and full exercise of citizenship⁽¹⁸⁾. Articulation with other universities is fundamental in this process, contributing to the development of multi-centric research with joint production⁽¹⁴⁾.

Unlike in Brazil, nursing in Portugal does not yet have an area of its own knowledge within the scope of external agencies fostering research; in this case, the Science and Technology Foundation (FCT – Fundação de Ciência e Tecnologia) inserts nursing within the broad area of health⁽¹⁶⁾. Nursing in Portugal works to conquer a space within the FCT knowledge tree. It is necessary to invest in promoting science and technology for the construction of nursing knowledge⁽¹⁶⁾.

In seeking this improvement and this training of excellence, institutions have increasingly sought to establish partnerships by signing agreements that highlight the exchange of knowledge among international researchers in order to promote advances in the nursing teaching model⁽¹⁹⁾.

As described in this experience report, other studies corroborate our results, indicating that studying abroad can have a positive influence on the development of nurses’ competencies^(10,15). In this regard, three main themes were highlighted during the development process of the competencies: increased cultural knowledge, increased personal growth and impacts on student nursing practice⁽²⁰⁾.

The literature describes a process that called “preparation theory”, which is the level of preparation required for a student to enroll and succeed in a graduate course, and in which four elements are included: key cognitive strategies (intellectual openness, curiosity, analysis, reasoning, interpretation, precision, problem solving); knowledge and academic skills (skills in research, writing, knowledge of major educational areas); and academic behavior (understanding of the educational system, human relationship skills and coping skills)⁽²¹⁾. According to the author, these elements influence themselves and are improved over time; they are not static or exclusionary.

Other benefits of studying abroad include: professional growth^(12,22); personal growth; cognitive development⁽²²⁾; a broader understanding of the social determinants of health and their impact on care systems⁽²³⁾; greater awareness regarding global health problems and the development of global citizenship⁽²⁴⁾; greater cultural awareness and development of skills^(12,20); also an increase in self-confidence, self-sufficiency^(12,25), independence, and the ability to make decisions and face challenges⁽¹²⁾; all resulting from the internationalization process⁽²⁵⁾.

In a study conducted with nursing students from Canada, decision-making related to studying abroad was also based on weighing these advantages⁽²⁶⁾. In general, nursing students referred to the following as advantages: getting to know a different culture⁽¹²⁾, having an international experience in nursing, gaining self-knowledge and independence, increasing their nursing competence, participating in international research, acquiring clinical experience, developing social responsibility, providing future employment opportunities and learning a new language⁽²⁷⁾.

On the other hand, the challenges of students participating in internationalization include: having to quickly adapt to a new culture; engaging in challenging academic settings; using a foreign language (in some cases); and being away from their families and country of origin. Students need to be prepared to make significant emotional and financial investments⁽²⁸⁾. There are also barriers related to health insurance, travel insurance, security, cultural immersion in unfamiliar environments, ethical issues and emotional responses to difficult situations⁽¹⁾.

A study corroborates the results regarding the reduced number of nursing journals qualified in the Qualis Capes system, with a Qualis A rating⁽²⁹⁾, which may lead to difficulties publishing in these journals, as well as a consequent increase of a repressed demand of Nursing publications in Brazil, leading researchers to publish in foreign journals. Moreover, the professor and student evaluation system regarding the scientific production in nursing in Brazil has a productive characteristic.

In general, the literature states that internationalization is an opportunity to broaden horizons and incorporate new research methodologies⁽³⁰⁾. Internationalizing science is a daily achievement of every researcher who believes in the future, in universities and in students⁽¹⁴⁾. Internationalization helps develop skills, acquire a global perspective of care, apply theory to practice, personal growth, and to overcome challenges⁽³¹⁾.

Completing a double degree in international teaching and research institutions allows for improving both knowledge advancement and the training of new researchers, thus aiming at the scientific, technological, economic, cultural and social progress of our country. Therefore, we can highlight the importance of training human resources with competence to overcome the challenges in a developing country, such as in the case of Brazil.

This study has limitations as it presents an experience report of a certain reality in the view of three students. Thus, we suggest that further studies about the experiences of other doctorate students are carried out with the aim of approaching different realities and thinking about innovative projects that can contribute to nursing that is solidarity-based, critical-reflexive and having transforming capacity.

CONCLUSION

By focusing on the experience of the double Nursing degree, this study made it possible to reflect on the potentialities and challenges of this opportunity for graduate students. In the internationalization experience, students identify an opportunity of personal growth, of valuing the cultural aspects acquired by the provided experiences as essential for nursing advancement. The desire to become a professor is a consequence of the stricto sensu training qualification process. From this perspective, it is worth emphasizing the importance of training human resources with competencies to overcome the challenges in a developing country, such as in the case of Brazil.

The results of this experience report are useful for nursing research and care, in that it broadens the knowledge of researchers and inserts them in the care process committed to advancing the profession, in addition to serving the educational institutions and research centers, as there is a current need for internationalization of higher education. Therefore, the double degree presents itself as a way to strengthen strategic actions, aiming to: position nursing at an international level (visibility); to enable joint (multicentric) research; to foster academic mobility with a view to complementing research developed within the country; to import knowledge acquired in other social contexts; and to export the nationally produced knowledge translated into publications and innovations.

Participating in the double degree in Nursing was an enriching experience both professionally and personally. The agreement between the universities allowed the students to meet other research groups, to network and to create partnerships with researchers in different countries. The intention of this study is to encourage other graduate students to take part in the double degree, since it generates many positive results and strengthens knowledge. Nurses can understand other realities, be more autonomous researchers and also contribute to the scientific world by disseminating their research results.

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Publication Dates

• Publication in this collection
  2018

History

• Received
  20 Apr 2017
• Accepted
  21 Nov 2017