Coursework in Clinical Settings Abroad

By approval of Deans & Chairs and due to the following considerations, nursing students seeking to undertake activities as UW students in clinical settings internationally must comply with this policy.

This memo provides:

  1. Criteria for Approval of Proposals to Complete Coursework in Clinical Settings Abroad
  2. Required Questionnaire for Student Proposals
  3. Critical Information to be Considered Prior to the Proposal Stage

1. Criteria for Approval of Proposals to Complete Coursework in Clinical Settings Abroad.

Proposals to pursue student activities in clinical settings abroad fall into two categories: first, purely observational, and second, hands-on provision of care. Any perceived grey area between the two will be deemed to fall into the category of hands-on care, in order to err on the side of prudence. Only proposals responding to the questionnaire in part 2. below will be considered.

Criteria for Evaluating Proposals for Observation Only Experiences

Proposals will address fully how the traits of the student, faculty sponsor, and clinical setting will support an effective learning experience that meets required course objectives. Criteria include:

  1. RELATIONSHIP: The supervising faculty member has significant expertise and relationship with the specific international site.
  2. PREPARATION: The student has significant and adequate contextual preparation for the setting, including language as necessary, and is a student in good standing.
  3. STANCE: The student demonstrates how s/he will maintain a stance as learner and possesses an ability to accept feedback and adapt behavior accordingly.
  4. CAPACITY: The site has the wherewithal and desire to integrate the student as an observer.
  5. INTEGRATION: The student, faculty sponsor, and site agree on mechanisms to maintain the student’s stance as learner.
  6. LIMITS: The student, faculty sponsor, and site agree on mechanisms to avoid any provision of care by the student.

Criteria for Evaluating Proposals for Hands-On Provision of Care

Proposals will address fully how the traits of the student, faculty sponsor, and clinical setting will support an effective learning experience that meets required course objectives. Criteria include:

  1. RELATIONSHIP: The supervising faculty member has significant expertise and relationship with the specific international site.
  2. PREPARATION: The student has significant and adequate contextual preparation for the setting, including language as necessary, and is a student in good standing.
  3. STANCE: The student demonstrates how s/he will maintain a stance as learner and possesses an ability to accept feedback and adapt behavior accordingly.
  4. CAPACITY: The site has the wherewithal and desire to integrate the student as a learner.
  5. INTEGRATION: The student, faculty sponsor, and site agree on mechanisms to maintain the student’s stance as learner.
  6. LOCAL LICENSURE: An appropriately qualified and locally licensed preceptor has been identified and is willing to precept the student for clearly articulated clinical actions.
  7. PATIENT SAFETY: The site has in place robust protections for patient safety.
  8. AFFILIATION AGREEMENT: The site is willing and able to undertake a mutually agreed upon affiliation agreement prior to the student’s arrival. Agreement to be initiated ONLY after approval of proposal.
  9. NET IMPACT: The student, faculty sponsor, and site have identified potential negative and positive short and long-term impacts of including the student in the provision of care.

2. Required Questionnaire for Student Proposals

The Study Abroad Questionnaire is the required tool by which proposals to complete coursework in clinical settings abroad will be evaluated. The questionnaire aims to elicit responses related to relevant legal, regulatory, cultural, and pragmatic considerations. These questions may also be useful to students conducting research in non-clinical settings abroad, as an additional resource beyond the requirements of the IRB/Human Subjects review process.

Curricular Goals

  1. Given that course and program objectives are not site-specific, what is the rationale for wishing to meet course and program objectives in the proposed setting?
  2. What are the specific goals and activities at the proposed site? How do these goals and activities align specifically with course objectives? With degree program objectives?
  3. How do the proposed activities involve interaction with clients, if any? Touching of patients? Other human interactions?
  4. How do the student’s goals and activities maintain the student’s stance as learner (not as expert or service provider) throughout the proposed activity?
  5. What alternative means of meeting course and program requirements are available, should the proposed site not work out?

Site Considerations

  1. What site-specific knowledge about nursing licensure; scope of practice; human subjects; and national, local, and institutional policy exists in the instructor and/or members of the supervisory committee?
  2. How does the student meet the site’s national, local, and institutional policies, including considerations of licensure, scope of practice, and liability?
  3. What site-specific knowledge about the culture, language, and professional norms at the site exists among members of the supervisory committee?
  4. Who will serve as the student’s on-site cultural — and language, if applicable — resource?
  5. How will School of Nursing faculty members oversee the work of the student while on-site? How is the designated faculty member prepared for this role at this site?

Site-School Relationship

  1. Describe the proposed site, including detailed contact information. Is the proposed site an institution? Rural clinic? Teaching hospital? NGO? Other?
  2. What evidence does the instructor and/or supervisory committee chair have that suggests that the site wishes and has the required resources (money, time, attention, etc.) to support the proposed goals and activities?
  3. What type and length of relationship exists between School of Nursing faculty and the proposed site?
  4. What resources exist at the School of Nursing and at the site to sustain a reciprocal long term relationship?
  5. In what ways will the resources expended by the site in supporting the student’s proposed goals offset its ability to attend to its own immediate priorities?

3. Critical Information to be Considered Prior to the Proposal Stage

Relevant Policies & Considerations

Proposals for students to complete course work in clinical settings abroad should consider reciprocity, sustainability, equity, discovery, cultural understanding and the Universal Declaration of Human Rights. Additionally, UW School of Nursing Academic Services Memo No. 21 stipulates that the establishment of an affiliation agreement between the School and the Clinical Site is required for placement of a student in any clinical setting for any experience, including purely observational experiences and experiences abroad. Also relevant are the essential qualifications outlined in Academic Services Memo No. 27 and Academic Services Memo No. 31.

From Proposal to Reality: the Steps

  1. Student meets with instructor or supervisory committee chair.
  2. Student creates written responses to the questionnaire above and submits response to the instructor or supervisory committee chair.
  3. Using the written responses, the instructor or supervisory committee chair determines the prudence of pursuing the proposed activity.
  4. The instructor or supervisory committee chair signs the written responses and forwards the document to the chair of the relevant coordinating committee.
  5. Coordinating committee evaluates proposals using the criteria above, in consultation with Academic Services staff members.
  6. If approved by the coordinating committee, an affiliation agreement may be initiated. Students may not undertake any activities as UW students abroad without completion of this process and a fully executed affiliation agreement.

Lessons Learned by Pilot DNP Capstones Abroad

  1. Start preparations far in advance, expect delays, and be flexible.
  2. The relationship with the site is critical to the success of the entire endeavor.
  3. The student’s stance at the site as a learner is imperative for the site to receive the student in ways that enable achievement of the curricular goals. The student must demonstrate a willingness to receive critical feedback.
  4. Above and beyond the usual challenges of achieving the curricular goals, the student will be challenged throughout the experience by immersion in a different culture and different health care system. Before, during, and after the experience, both faculty committee members and the student need to recognize and discuss the potential and real impacts of the site’s particular complexities upon the learning experience.
  5. Students may face unexpected difficulties in achieving curricular goals. The ability of faculty committee members to give seasoned advice about on-the-ground realities is crucial. Only with their guidance can students make academically sound adjustments to plans underway.
  6. Being specific and upfront about the proposed activities and the underlying curricular rationale is important. Doing so helps the site determine how a student might fit appropriately into its academic and health systems. Advance clarity about activity and role expectations helps everyone avoid delays, especially when the site’s local systems require additional reviews that may not be required for the same activity here.
  7. Pay attention to, and leave time for, different degrees of “officialdom” and differences in role expectations (e.g. what is appropriate or inappropriate for a student to do/say, who gets to decide a matter, or who has authority to change student plans). Respect the required steps and norms of local authorities.

Academic Services Memo No. 44