In nursing curricula around the world, educators are recognizing the need to develop undergraduate nurses as global citizens. This occurs in both developed and developing countries in a milieu of collaboration, partnership, and relationship between institutions offering undergraduate programs. The aim of this chapter is to highlight a partnership between two schools of nursing in northern regions of Norway and Canada. This partnership is unique because of the circumpolar locations of each school and their rural and remote practice setting. This chapter will highlight the journey of two nurse educators as they engage and develop a collegial relationship between their two facilities. The narrative begins with an initial student exchange from northern Canada to northern Norway, continues with shared lecturing and/or presentations in the host country, and carries on with scholarship and research activities. The benefits of the collaboration and partnership are a shared understanding of what it means to live and work in rural and northern locations. Working together for innovative education and nursing practices enhances global citizenship for both students and faculty. The informal partnerships are as beneficial as formal partnership. This chapter shares some living conditions and histories of colonization of Indigenous peoples. Through our understandings of these histories, we can create meaningful ways to reframe past grievances towards more positive and equitable negotiations.
Key Terms: partnership, collaboration, rural and remote, circumpolar, nursing education
In 2009, a nurse educator and an international liaison of Finnmark University College, Norway travelled to northern areas of Canada in search of exchange opportunities for their students. One of the sites they selected was Aurora College in Yellowknife, Northwest Territories. Interest in student exchange in a circumpolar setting was appealing to faculty in both schools. Our collaboration, beginning almost a decade ago, started with an undergraduate student exchange, then continued with graduate rural and remote education, and has culminated to an evolving shared research partnership. Each of these initiatives will be described briefly in this chapter ending with benefits and challenges within the partnership.
Aurora College School of Nursing
Aurora College is a decentralized postsecondary institution located in the Northwest Territories (NWT), Canada. The college has three campuses located in Inuvik, Fort Smith, and Yellowknife, and 23 Learning Centres scattered in communities across the North. The nursing program is located in Yellowknife at the Yellowknife/North Slave Campus. The program began in 1994 as a three-year diploma nursing program and was enhanced to an undergraduate university program with intake beginning in 2002. The annual intake of students is approximately 30 and there are approximately 80 to 100 full-time students on campus. The Bachelor of Science in Nursing (BSN) curriculum was developed in collaboration with several schools of nursing from British Columbia. Aurora College was part of the Collaborative Nursing Program (CNP), which was later renamed the Collaboration for Academic Education in Nursing (CAEN) Program, from 2001 to 2012. When the collaboration dissolved, three colleges from British Columbia and Aurora College remained in partnership with the University of Victoria and continued to share a concept-based curriculum. All four years of the nursing program are taught on site in Yellowknife.
Students in the nursing program attend classes on campus and complete practicums in local agencies (hospital acute and chronic care, home care, public health). The majority of their clinical experience is acquired at a 100-bed regional hospital in Yellowknife. Because nurses provide care to a diverse population with a major Indigenous component, students are provided with a course about Indigenous People of the NWT and attend cultural camps where they learn about Indigenous beliefs and practices. Theoretical perspectives and philosophies are geared to rural and remote, Indigenous, and contemporary ontologies, and are conceptually threaded throughout the curriculum.
The Arctic University of Norway, School of Nursing in Hammerfest
The school of nursing in Hammerfest was established in 1960. During a period of 53 years, it has expanded and merged twice. First, it merged with the Finnmark University College in 1994, and then with the University of Tromsø, The Arctic University of Norway (UiT), in 2013. This university’s main site is located in Tromsø, which entails approximately a 40-minute flight from Hammerfest. The school of nursing is now merged with the Department of Health and Care Sciences, Faculty of Health.
The university has ten campuses located in the three most northern counties in Norway and Svalbard, which is an archipelago north of Norway. Four of the campuses deliver nurse education; two of them use the same three-year bachelor program and curriculum. In 1960, the school had approximately 20 students each year. Today, the annual intake of students is 80 each year. In addition, the school has approximately 25 students in a decentralized nursing program every second year, located outside the campus. Internet and skype are used for educational purposes and meetings. Fifty percent of the program is practice. Students have to travel and stay outside the campus for six to ten weeks, practicing both in local hospitals in Hammerfest and Kirkenes, Finnmark (approximately 53 and 85 beds), and in homecare and elderly centers in the municipalities. Many of the students stay in Finnmark after their graduation, despite the fact that it is located in a remote and rural area (Nilsen, Eriksen & Huemer, 2012). Our theoretical perspectives today were not mirroring rural aspects of nursing or the fact that Norway has a Sámi population (approximately 40,000 – 60,000 people). The school has started to integrate Sami perspectives in the bachelor curricula since the inclusion was random in the past (Eriksen, Bongo & Mehus, 2017). Rural nursing perspectives, inspired by the colleagues in Yellowknife, Canada, have been included as well. In 2015, the school started the first specialization in Rural Nursing in Norway (which has a yearly intake) as a component of the Master of Science in nursing program. Thus far, twenty-five students have passed with this distinction.
Nursing Student Exchange and Global Citizenship
Burgess, Reimer-Kirkham and Astle (2014) described global citizenship with student exchange to low income countries as a means of social responsibility and social justice. They explicated themes of global awareness, global engagement, and global citizenship and social justice that explained student motivation for the international exchange in low income countries. Although we are discussing student exchange in developed countries, both Norway and Canada share a history of colonization of Indigenous people living in our circumpolar regions. Social responsibility and social justice expressed through awareness, engagement, and social justice are significant principles for both Canada and Norway, as we begin our processes of peace and reconciliation for equitable and reciprocal relationships with Indigenous people. We contend that student exchange between our schools provides students with insights and knowledge leading to cultural safe practices.
Nursing student exchanges between developed countries are an opportunity for personal and professional development (Button et al., 2005; Kent-Wilkinson et al, 2012) In particular, nurses learn about diversity, and cultural similarities and differences. They learn about values and beliefs that inform health care delivery systems and broaden their knowledge of nursing practice approaches. Intercultural sensitivity is also learned by faculty who become tutors for students from away (Koskinen & Tossavianen, 2003).
Undergraduate Student Placement and Exchange
Although Finnmark College was placing students in Russia, Scandinavia, and other parts of Canada, student exchange and placement was a new initiative for Aurora College. There were no international department at the school, or existing policies or procedures, resulting in a limited sense of what a nursing student exchange entailed. The Arctic University of Norway, School of Nursing in Hammerfest did have a circumpolar connection as a member of the University of the Arctic, which is an education network for northern regions of the world.
The nursing programs did not align in terms of student placement. In the Northwest Territories, theory is integrated with practice, so students spend two days a week in nursing practicum and the other three days in class. At the end of each year, there is a consolidated practice that is 6 weeks in duration. In Finnmark County, the students have theory front-loaded, then a blocked approach to nursing practice is used. For the Canadian students, the time of year that best accommodated Norwegian student needs was the spring consolidated practice (May/June).
Planning between the two schools began; and after many online meetings, a memorandum of understanding was created and implemented. Aurora College developed a selection process for students going abroad. Specifically, at the beginning of the school year, Aurora College nursing students were informed of the opportunity and were advised of the application process. Students interested in international placement were required to submit a formal request to the International Placement Coordinator in Yellowknife; write a letter of interest; submit their academic transcript; and provide names of references. A selection committee was struck and six applications were received. Four students were selected to go to Norway with the first author accompanying the students. The Aurora College School of Nursing then began to fundraise in earnest. It also approached the Institute for Circumpolar Health Research for funding assistance and they provided the students with travel bursaries.
Prior to the travel to Norway, students participated in a week of orientation and preparation. Karen Binder, a graduate from the Beaufort Delta region, had an important Sami connection. Her mother was Sami from Kautokeino, Norway. She came to Canada with her father when reindeer herds were introduced to the Canadian Arctic and today, her brother manages a reindeer herd in Inuvik. Reindeer herding is a way of life in Northern Norway. She presented to students about northern Norway, Sami people, and her perspectives of how to prepare for their travels.
Since the Aurora College School of Nursing was the new partner in the process, it relied on their Norwegian colleagues to advise on the model that should be used. Both parties agreed upon a Canadian student being buddied with a Norwegian student and supervised by a Registered Nurse at the hospital in Hammerfest. This preceptor and buddy model worked very well. The students provided care in the hospital on the medical and surgical units. They did not document their nursing care since charting was in Norwegian and record keeping was electronic. Instead, they reported their care to the RN. Faculty member, Pertice Moffitt, visited the first group of students in the hospital and found that the scope of practice, in terms of physical assessment was quite different. Norwegian students were focused on patient symptomology, while in Canada, students learned and practiced physical assessment. The second group of students who went to Norway were connected to the Canadian liaison via skype, rather than in person.
In Hammerfest, both students and faculty were introduced to the Norwegian health care system whereby similarities and differences were highlighted, in terms of nursing care, hospital policies and procedures, the community and its history, and the culture of the people. Students listened to lectures and visited facilities. Norwegian faculty provided a guided tour through northern Norway where students learned of the effects of WWII, saw remnants of a hospital built by the Germans, and learned of the evacuation of the community when the community was burned to the ground, the animals were killed, and the people were deported to the south.
Two groups of students travelled to Norway, with the first four visiting in 2010 and the next four visiting in 2012. Then there was a lapse in exchange, while both schools transitioned into new collaborations. When the School of Nursing in Hammerfest became affiliated with UiT, an international liaison in Tromsø assumed responsibility for all four sites in Northern Norway. In 2016, the first three students from Norway experienced placement in Yellowknife at Aurora College. Each semester since that time, Aurora College has accepted exchange students and there are plans in place in 2018 for Canadian students to go to Tromsø, Norway. In Canada, the second year Norwegian students were oriented to the Canadian health care system, the integrated nursing programme, and the hospital. Before beginning their practicum, they were given a one-day physical assessment review. They were set up in a preceptorship with RNs and under the supervision of Aurora College’s International Student Coordinator. They toured two remote communities, visited nursing stations, and then were able to spend a few days in a remote community.
Graduate Rural and Remote Education
Scholarship was integral to the collegiality between the two schools. The schools took every opportunity to network both personally and professionally, support each other, build the relationship, and together create and enhance new programs in each other’s institution. When Norwegian faculty came to Yellowknife, they were introduced to the NWT health delivery system, Aurora College’s nursing curricula, and the culture of the Canadian North. In Hammerfest, Canadian faculty was similarly introduced to Norway.
While in Yellowknife, the second author shared her doctoral research on snowmobiling safety in northern Norway with a lecture open to the public at the Prince of Wales Museum (Mehus, Germenten & Henriksen, 2012). There was a great deal of interest in her topic as snowmobiling is a way of life in both jurisdictions. In a similar fashion, with the establishment of the rural and remote master’s program in Norway, the first author provided lectures to the students. Most of the lectures occurred over skype and were provided in English; however, the guest lecturer role began for the Canadian faculty with a road trip from Oulu Finland to Hammerfest Norway. When the International Circumpolar Health Conference was held in Oulu Finland in June 2015, both authors attended and gave oral presentations. The Canadian faculty extended their visit to Europe and travelled by car with their Norwegian colleagues back to Hammerfest. A professional development excursion was planned to London, England. The first author provided a lecture on rural and remote nursing practice in Canada to the group of Norwegian nurse educators in Hyde Park. In addition, both authors, along with Norwegian graduate students and faculty, conducted an educational retreat on a remote Island in northern Norway, Rolvsøy. We read each other’s papers and provided feedback. Thus, the relationship building so important to collegiality and international exchange was created (Ryan-Krause, 2016; Sochan, 2008).
Shared Research Interests and Activities
Throughout our meetings and gatherings, we shared our research interests in Indigenous, circumpolar and rural and remote health. We collaborated on a research project about Sami experience of the Norwegian healthcare system, highlighting principles of cultural safety (paper was accepted July, 2018 and will be published in Spring, 2019). We met for data analysis in Guovdageaidnu (Sami name for Kautokeino), Norway in the home of our research team member, Berit Andersdatter Bongo. On her kitchen table, we conducted a thematic analysis reviewing documents that were translated first in Sami, then in Norwegian and English. We attended the Arctic Indigenous Education Conference (AIEC) held during that time March 2016 where the focus was on language revitalization. Furthermore, we are writing research grants together to continue our partnership and enhance our schools’ global citizenship.
This chapter highlights the journey of two nurse educators from different circumpolar countries with a common goal to create opportunities for faculty and students to enhance their knowledge, skills and capabilities as global citizens. As global citizens and nurses, we shared our knowledge to learn from each other about health care issues in our countries, our cultures, and our personal and professional lives. These activities afforded us professional development, enhanced our capacities in international scholarship, and generated global nursing knowledge and curricula for both schools. We experienced many similarities related to rural nursing practice, teaching practices in rural communities, Indigenous people’s challenges, rurality and “small place’s sociology.” For nursing students, a circumpolar exchange enhances their cultural awareness of peoples who live in the most northerly countries of our world; they expand their knowledge of social, political, and historical contexts that exist in other circumpolar countries; and, they appreciate the differences and similarities of health care delivery systems. Students and faculty develop cross-cultural communication skills and abilities that are an important asset for future international work. Despite the fact, that we are living on two different continents, it is like coming home when we visit each other’s places. We recommend that other education institutions across the circumpolar world connect through research, visiting lecturing and student exchange to further global citizenship within their education programs.
Immonen, I., Anderssen, N., & Lvova, M. (2008). Project work across borders in the arctic Barents region: practical challenges for project members. Nurse Education Today, 28(7), 841-848. doi:10.1016/j.nedt.2008.02.01
Leh, S.K., Robb, W.J.W., & Albin, B. (2004). The student/faculty international exchange: responding to the challenge of developing a global perspective in nursing education. Nursing Education Perspectives, 25(2), 86-90.
Kokko, R.(2011). Future nurses’ cultural competencies: what are their learning experiences during exchange and study abroad? A systematic literature review. Journal of Nursing Management. doi: 10.1111/j.1365-2834.2011.01221.x
Burgess, C.A., Reimer-Kirkham, S., & Astle, B. (2014). Motivation and international clinical placement: shifting nursing students to a global citizenship perspective. International Journal of Nursing Education Scholarship, 11(1), 75-82.
Button, L., Green, B., Tengnah, C., Johansson, I., & Baker, C. (2005). The impact of international placement on nurses’ personal and professional lives: a literature review. Journal of Advanced Nursing,50(3), 315-324.
Eriksen, L., Bongo, B.A., & Mehus, G. (2017). Urfolksperspektiv I utdanning. Sykepleierutdanninger I Norge uten urfolkskunnskap? [Indigenous perspectives in education. Nurse education in Norway without knowledge about indigenous peoples?] Nordisk sygeplejeforskning [Nordic Nursing Research]7(4). Retrieved 22.1.18 http://www.idunn.np/nsf/2017/03/urfolksperspektiv_i_utdanning
Kent-Wilkinson, A., Starr, L., Dumanski, S., Fleck, J., LeFebre, A., & Child, A. (2010). International nursing student exchange: rural and remote experiences in Australia. Journal of Agromedicine, 15, 58-65. doi:10.1080/10599240903389672
Koskinen, L., & Tossavainen, K. (2003). Relationships with undergraduate nursing students. Journal of Advanced Nursing, 41(5), 499-508.
Mehus, G., Germeten, S., & Henriksen, N. (2012). How young people communicate risks of snowmobiling in northern Norway: a focus group study. International Journal of Circumpolar Health, 70, 205-214.
Mill, J.E., Younge, O.J, & Cameron, B.L.(2005). Challenges and opportunities of international clinical practica. International Journal of Nursing Education Scholarship, 2, Article 18. Retrieved from ttps://www-degruyter- com.ezproxy.library.uvic.ca/downloadpdf/j/ijnes.2005.2.1/ijnes.2005.2.1.1119/ijnes.2005 .2.1.1119.pdf.
Nilsen, F., Huemer, J., & Eriksen, L. (2012). Bachelor studies for nurses organized in rural contexts- a tool for improving health care services in circumpolar region? International Journal of Circumpolar Health, 7(1). doi: 10.3402/ijch.v71iO.17902
Ryan-Krause, P. (2016). Short term global experiences: reflections, themes and implications. Journal of Nursing Education, 55(7), 379-384.
Sochan, A. (2008). Relationship building through the development of international nursing curriculum: a literature review. International Nursing Review, 55(2), 192-204. Doi : 10.1111/j.1466-7657.2007.00595.x