Title : Ciao! Implementation of an international clinical capstone experience
Abstract:
Introduction: To better prepare graduating nurses to enter the ever-evolving, complex world of health care, a clinical capstone experience was developed. Graduating nursing students were joined with a selected preceptor to complete 108 hours of the final clinical experience. Students followed the schedule of their preceptor. One year later, the clinical capstone experience was extended to an international clinical experience. Faculty from a baccalaureate nursing program in the Northeast, joined with faculty at Agostino Gemelli University Policlinic Hospital/Universitá Cattolica del Sacro Curoe (henceforth known as Gemelli Hospital), a Joint Commission International Accredited institution in Rome, Italy to allow students to complete their clinical capstone experience. Students experienced a 4-week clinical capstone experience and cultural immersion. This experience launched in 2023, provided a unique clinical experience for graduating nursing students to participate in nursing care at a top European hospital and gain new insights as to how quality care is delivered abroad. It also allowed students to experience the cultural norms of another country. Students praise the program and highly value the experience.
Purpose: Clinical capstone rotations are an important tool to help bridge the theory to practice gap for graduating nurses (Martin et al., 2011). These rotations allow soon to be new-to-practice nurses to immerse themselves in the role of a bedside nurse to put the final pieces together of their education. Providing opportunities to improve cultural competence is also an important piece of bridging the theory to practice gap. International clinical placements can improve cultural knowledge which can then impact student's personal and professional growth (Jansen et al., 2021).
Background: The clinical capstone experience is a component of a 10-credit Clinical Judgement Applications course that runs in the final semester of an undergraduate baccalaureate nursing program. The first eleven weeks of this course consists of didactic lessons and traditional clinical experiences, where 6-8 students are with one clinical instructor. In the final four weeks of the course, after successfully passing all didactic course work, a student is then placed with a selected preceptor (bedside nurse) to work alongside them to complete the remaining clinical hours.In 2022, the Dean of the College of Nursing was presented an opportunity to have Bachelor of Science Nursing (BSN) students complete this clinical capstone rotation at Gemelli Hospital, a 1,575-bed facility in Rome, Itay. Approval was obtained through the Pennsylvania State Board of Nursing to utilize Gemelli Hospital as a clinical site.
Implementation Process: Two faculty members were selected to accompany the students on this capstone experience: one faculty member for their in-depth knowledge of college and university policies, and another who was familiar with international travel. After several months of preparation by the Dean of Nursing and the Associate Dean of Academic Affairs, a 5-day trip to Rome occurred to engage with faculty and staff at Gemelli hospital, to learn about the hospital, and develop a plan of how to best implement the capstone experience abroad. An application portal was opened for students with a limit of 12 students who could attend the inaugural clinical capstone experience. Students submitted an essay, professional recommendations, and attended a zoom interview with faculty. Eleven students were selected to attend this experience. To prepare for departure, students attended four mandatory "lunch and learn" sessions where important information about Gemelli Hospital, the culture in Rome, and safety tips were discussed. Students chose from the neuro intensive care unit, the cardiac intensive care unit, the pediatric intensive care unit, the medical intensive care unit, the post-operative intensive care unit and a women’s health unit. Housing was secured via the university in a long-term stay hotel about 1.5 miles from the hospital. Faculty and students arrived on Saturday, March 25, 2023 and on Monday, March 27, 2023, attended a hospital orientation. On Tuesday, March 28, 2023, students began working on their assigned unit with an Italian nurse. Faculty were on-site and rounded on the students several times each day during the first week. Shifts were 0700-1400, followed by a post-conference. Students completed weekly journals to reflect on their experiences. Three excursions were planned by faculty to promote cultural immersion: a cooking class, a tour to Tuscany, and a local food tour. Students also attended a required weekly dinner to discuss the clinical experience.
Outcomes: The experience was overwhelmingly well received by students. Specific comments that led to an increase in personal and professional growth include, "I found the language barrier to be a challenge at times since I would be confused about what was being asked of me, but this has been very humbling and I have more empathy for patients in the US who are not able to speak English," and, "My role model showed dedication to patient care and commitment to professional development. He taught me valuable life-lessons, that it is okay to make mistakes and mistakes provide an opportunity to learn and grow. Instead of fearing failure, I now embrace it as a necessary learning process." This program ran again in 2024 and 2025. Students reported positive outcomes and similar experiences.
Conclusions/Recommendations: There was and continues to be immense interest and support for this program from both health systems. When entering any institution either stateside or abroad, it is important to remain culturally vigilant and to be aware of the cultural norms of each institution, and to adopt their cultural norms. At times, additional flexibility was required by faculty and students, yet this just improved our own growth. At this time, additional sites are being considered to expand the international experience which would allow more students to benefit from studying and learning abroad.
