A series of research studies was completed over 3 years to evaluate baccalaureate nursing students' transcultural self-efficacy following the completion of service-learning projects. A quantitative pilot study was completed in 2007 with a convenience sample of students (n=60) enrolled in a community health nursing course. Several clinical groups worked with local communities and one clinical group took part in a one-week program in Guatemala. The Transcultural Self-Efficacy Tool (TSET) was administered at the beginning and completion of the semester. A paired-samples t test demonstrated a significant increase for pre-test to post-test total and subscale scores.
A follow-up field study was completed in 2008 using a sequential explanatory mixed method design. The quantitative component followed the same format as the pilot study conducted in 2007. Pre-test and post-test surveys (n=45) again revealed a significant increase in total and subscale scores. The qualitative component of the research project utilized a case study approach with two clinical groups (n=16). Each student maintained reflection notes which were completed prior to, during, and at the conclusion of the experience. One clinical group completed a service-learning project in a local, African American community, while the other group participated in a one-week international service-learning experience in Ecuador. Themes were categorized based on the learning dimensions of cultural competence. The with-in case analysis of the local group revealed 4 themes, while the international group revealed 6 themes. The cross-case analysis of the 2 clinical groups revealed similar themes, yet the students who participated in the Ecuador trip were able to provide more explicit details of culturally relevant knowledge and experiences.
In 2009, an explanatory case study was used to explain how participation in an international service-learning project influenced transcultual self-efficacy of baccalaurate nursing graduates following graduation and their subsequent clinical practice. Telephone interviews were conducted with 14 nursing graduates, who had participated in international experiences. Comparative analysis revealed increased self-efficacy in cognitive, practical, and affective learning dimensions. As a result of the increased transcultural self-efficacy, graduates were able to provide culturally congruent care. Findings suggest that international service-learning is an effective teaching strategy for cultural competence.