Cultural Immersion as a Strategy for Empowerment

For the past several years, faculty in the School of Nursing (SON) at Clayton State University in Morrow, Georgia, located in the southeastern region of the United States, have designed study abroad and study at home programs that have provided cultural immersion experiences for nursing students. Destinations have included the Pine Ridge Indian Reservation near the Black Hills of South Dakota; the jungles of Guatemala; the urban setting of Guadalajara, Mexico; and the isolated island of La Gonâve off the west coast of Haiti. Students involved in these experiences have been undergraduate nursing students, registered nurses enrolled in a baccalaureate nursing program, and students enrolled in a master's in nursing program.

In 2013, the SON expanded international opportunities and entered into a formal agreement with Daejeon University School of Nursing in South Korea. The partnership was initiated by Daejeon University faculty whose goal was to offer students immersion experiences in the American culture so they would learn “to survive the American Jungle” (B. Lee, personal communication, 2014). During summer 2014 and February 2015, 31 South Korean nursing students spent 3–4 weeks on our university campus and participated in classroom, clinical, and service learning activities with our SON students and faculty.

With each immersion experience, faculty and students step out of their usual sociocultural–political contexts. Participants learn of the history and struggles of another culture, and this knowledge begins to change their perspectives. To aid in maximizing the impact of these experiences, two strategies have been used frequently. First, time has been spent in “debriefing” sessions, allowing participants to reflect on each day's experiences. Topics usually surround problems identified during the day, factors contributing to these problems, and possible solutions. Journaling is a second strategy used to process the impact of these experiences. Both faculty and students are expected to engage in journaling, and time is scheduled during each day for this activity.

As faculty, we hoped that these cultural immersion experiences would result in transformative learning for students and at least an understanding, if not a kindled passion, for issues of social justice. What we did not expect was the impact the experiences have had on us, the faculty. Even though most of these immersion experiences have occurred over a relatively short period (10–14 days), planning and executing these trips has not been easy. As we grow older, our recovery time seems to be a bit longer with each trip; yet, we keep designing and marketing new trips with great energy and enthusiasm. Over the last several months, we have challenged each other to consider what the “hook” is for us as faculty in leading these trips. What is it that keeps drawing us back into these immersion experiences that extends beyond our roles as faculty and hopes for the students? In what ways have these experiences shaped us as faculty and nursing professionals?

In wrestling with this question, we began to explore the literature on empowerment. Since the 1970s, there has been increasing dialogue about the concept of empowerment in nursing (Bartunek & Spreitzer, 2006; Rao, 2012). Empowered nurses are those who are “enabled to act” to bring about change (Rao, 2012, p. 396). Empowered nurses have increased abilities to set and reach goals and to problem solve, increased leadership skills, improved self-esteem, a sense of control over life and change processes, a sense of hope for the future, and increased autonomy and sense of responsibility (Hawks, 1992; Rao, 2012). Furthermore, nurses who perceive themselves to be empowered have greater power and access to resources and engage in effective advocacy efforts (McCarthy & Freeman, 2008). Perceived empowerment among nurses is a significant factor. Studies have identified that nurses ‘lack of perceived empowerment results in burnout, job strain, and work dissatisfaction, and can lead to poor patient outcomes (Laschinger, 2008; Manojlovich, 2007).

Fostering empowerment, however, is a complex process. According to Rao (2012), it involves attention to individual, organizational, and social factors that interact to “create the individual's perceived sense of empowerment” (p. 399). At the individual level, psychological empowerment is defined as the individual's capacity for empowerment based on factors of intrinsic motivation (Spreitzer, 1995). At the organizational level, Kanter's (1977) work on structural empowerment identifies strategies, such as shared governance, to create work environments that support empowerment of employees. At the social/institutional level, distribution of power and the work of empowerment involve the emancipation of individuals from institutionally embedded oppressive practices (Casey, Saunders, & O'Hara, 2010). At any given moment, a nurse's perceived level of empowerment is the result of the interplay of factors at each of these levels (Casey et al., 2010; Manojlovich, 2007).

Using this multilevel framework to increase empowerment, individual nurses must be given opportunities to develop competencies, guided to act autonomously, and afforded responsibility to provide effective care and to create significant change. Nurses in organizations must have a practice environment that provides empowering structures. Studies examining the structures of shared governance and professional practice models provide evidence of structures that empower nurses (Bogue, Joseph, & Sieloff, 2009; Harwood et al., 2007; Larkin, Cierpial, Stack, Morrison, & Griffith, 2008). As a profession, nursing practice must be free of socially oppressive forces. A cultural immersion experience dramatically changes the social/institutional level context, creating an opportunity for new insights. Greenfield, Davis, and Fedor (2012) describe study abroad experiences as triggering “constructive disequilibrium” in which new knowledge and experiences challenge one's existing cognitive schemas. If navigated effectively, constructive disequilibrium can result in expanded cognitive schemas, creating “new spaces of meaning” (Che, Spearman, & Manizade, 2009, p. 103).

Greenfield et al. (2012) used a survey pretest, posttest design to examine the impact of a study abroad course and an on-campus course on professional development of 122 social work students (n = 40 study abroad only, n = 73 on-campus course only, n = 9 study abroad and on-campus course). Results demonstrated statistically significant increases in self-rated skills, understanding of international service, and identification as a global citizen at the end of course completion. Increases were also noted in empowerment, hopefulness, and personal mastery but not at statistically significant levels. Empowerment was measured by three items on the survey related to self-perceptions of ability to influence the world for the better. Fletcher's (2003) unpublished dissertation examined the impact of a 12-day engagement in a medical mission project in Nicaragua on 10 adult volunteers including nursing students, social workers, nurses, a physician, and a minister. Qualitative data analysis from interviews with the participants resulted in six major themes: cultural awareness, humanism, spirituality, learner empowerment, factual knowledge, and the occurrence of critical incidents. As a result of the service experience, participants experienced transformational change at varying levels in one or more of the six categories.

Several concept analyses of empowerment found in the literature are helpful in understanding the concept's complexities and linkages to the multilevel framework presented by Rao (2012). Attention is given to the antecedent conditions that provide fertile ground for the realization of empowerment. These antecedents include mutual trust and respect (Hawks, 1992; McCarthy & Freeman, 2008; Rodwell, 1996); education and support and participation and commitment (Rodwell, 1996); an environment that supports openness, honesty, genuineness, communication and interpersonal skills, acceptance of people as they are, valuing of others, courtesy, and shared vision (Hawks, 1992); and willingness to accept change (McCarthy & Freeman, 2008).

Core attributes identify the essential elements of a concept and provide evidence for its existence. Multiple tools have been developed to measure the attributes of empowerment for use in various contexts; none, however, has been used within the context of cultural immersion experiences. In general, the literature reflects hesitation about claims that these tools capture the essence of this complex concept and a call for further research to provide clear measures of empowerment.

Perhaps cultural immersion experiences are most influential at the social/ institutional level. Casey et al. (2010) concluded that the strongest predictor of psychological empowerment was empowerment at the social level. In 2014, I spent 10 days in South Africa as a participant in a women's leadership development conference. We met with various groups to better understand the impact of new social policies since the fall of apartheid in the early 1990s. While in Johannesburg, we met with the Women's Council, now a constitutionally required structure of every city council to build leadership skills and economic parity for women in the workforce. A young South African woman was charged with leading the presentation that day. She whispered to an older woman sitting beside her that she was nervous and hoped to do a good job. The older woman replied, “I expect you to do so. Remember, I went to jail for you.” During apartheid, many women who protested the unequal treatment of women, especially women of African descent, were incarcerated for months at a time. It was actions like these that changed South Africa. When individuals experience a dramatic shift in the landscape of preconceived schemas and power structures, possibilities for the emergence of new leaders and for significant change are created.

Even short-term study abroad programs can open the door to new possibilities. Carefully crafting immersion experiences to create a learning environment of mutual respect and trust that promote effective communication and openness has the potential to empower individuals to foster significant change.

Linking cultural immersion experiences to empowerment has received little attention. Concept analyses of empowerment identify important antecedents and core attributes that suggest why these experiences can increase perceptions of empowerment. The multilevel framework of individual or psychological empowerment, organizational empowerment, and social/institutional-empowerment factors provides additional guidance as to why these immersion experiences can be empowering. Life-changing is a term frequently used by both faculty and students to describe the impact of these experiences. The significant question for future research efforts is, “What are the conditions of a cultural immersion experience that promote increased perceptions of empowerment?” In this age of health care reform and increasing concerns over quality, cost, and safety, the need for nurses who perceive themselves to be empowered to effect change is more critical than ever before.