Advances in medical technology, free traffic between countries, and burgeoning multicultural families provide new challenges to nursing education. In Korea, and in other countries, how to prepare students majoring in healthcare sciences has generated fervent discussion. Appropriate methods for training students to demonstrate appropriate attitudes regarding a culturally diverse landscape are needed (1–3).

Conceptualizing global health nursing has also been challenging. Archambault (4) outlined the following core factors: being a global citizen, social justice, equity in health, and health determinants. Subsequently, the Canadian Association of Graduate School of Public Health implemented research to identify core global health competencies, which include six categories: global burden of a disease; health implications of migration, travel, and displacement; social and environmental determinants of health; globalization of health and healthcare; healthcare in low-resource settings; and health as a human right and developmental resource. Previous research provides a useful guideline for improving global nursing competence within undergraduate nursing programs (3). Nursing education in the Republic of Korea developed during the pre-committee of nursing education accreditation in 2000. In 2011, the committee was designated as an accreditation board by the Ministry of Education. The committee has since been evaluating and accrediting 4-year bachelors in nursing programs and 3-year college programs. One of the educational objectives of a bachelor’s degree in nursing program is global nursing competency, and most programs strive to attain this goal through diverse efforts (5).

In other countries, several studies have clarified global health competency since the late 1990s (3, 5–9), and quantitative and qualitative data analytic methods have been implemented (10–12). Some work has even been done in South Korea since 2000 (13–16). Especially, four consecutive programs to increase undergraduate nursing students’ global nursing competency were provided by a university where the author works (14–18). However, few studies have done a student needs assessment before program operation and design. Thus, we have been limited in our ability to assess program efficacy both before and after its implementation (14–18).

On the other hand, the United Nations has enacted a resolution of outlining 17 sustainable development goals for global citizenry. This resolution is aimed at reducing health service inequalities while improving individuals’ overall health status (19). Prior to this resolution, the World Health Organization (WHO) recommended a global nursing education standard in 2010, and global nursing competence was included as a necessary core outcome (20, 21). Therefore, an effective global health nursing program model needs to include nursing competence for implementation, and the program model proposed by this research would contribute to preparing potential global nursing leaders undertaking nursing programs.

Case 4 was the only program that assessed participants’ educational needs in order to do a pre- and post-implementation investigation for improving global health nursing competency. The other programs intended to provide relevant knowledge developing self-studies and workshops. Additionally, Case 4 operated as a one-semester course before in situ training. Overall, to accomplish objectives for global nursing competency education, it is necessary to create a fundamental and systematic plan for building curricula in accordance with students’ desired level of competency (18).

Hwang (22) recommended an educational program that was devised by analyzing trainees’ educational needs. Curtin (23) and Dirk (24) also argued the importance of assessing students’ needs. Considering the current status of global nursing programs, which are mostly provided as an extracurricular program rather than curricular program, it is more necessary to plan for the achievement of the program’s purpose within a very limited time duration.

During the design phase, all programs operated for 1 week within a one or two-semester student exchange program. This type of strategy helps to ease financial burden and forces implementers to be efficient with their program, which can help increase program efficacy. When designing a global health nursing program, global disease burden, health globalization, and social determinants were considered first based on previous research (9). Field experience was recommended for students from diverse social and cultural backgrounds in order to boost program effectiveness. All four cases within the current study included this within its program design.

The field experience component is a unique strategy that can help overcome language and cultural barriers during health education activities, special lectures, and group work discussions and presentations. For instance, Case 1 excluded health education for refugees because visitation to a refugee camp was strictly controlled (14). Thus, students conducted visits at refugee-related UN and non-governmental organizations, lectures, and discussions. Case 1 provided four instances where students could analyze and submit a case report. This was deemed as an important substitute to direct, in situ learning experiences (13, 14).

The other three programs (except Case 1) compared the effect of the program using paired t-tests and two of them added content analysis for further understanding of participants’ attitude change in global health nursing. It is highly recommended to plan a similar program to attain the objective of global nursing competency in 4-year nursing programs. Quantitative and qualitative methods were used to assess most of the cases. Quantitatively, assessments of changes in knowledge and attitudes were common; qualitative methods included group interviews, open-ended questions, and journal/diary reviews. Results from Case 4 are similar to those from Saiboon et al. (25) in terms of overseas field experience provisions for stimulating career advancement and facilitating global leadership, as well as understanding cultural diversity.

In conclusion, what would be an effective model for improving global nursing competency programs for undergraduate students? It is very useful to identity the benefits and limitations of analyzed programs in this research. As shown in Table 6, during the first assessment phase, credit-based or non-credit-based formats need to be considered. Previous knowledge should also be examined in order to engage student interest. A baseline needs assessment should follow so as to adequately accomplish the nursing program’s educational objectives. Finally, a training site needs to be decided upon and additional factors (e.g., finances, route, and program content) need to be determined.

During the second phase (design), program content is developed based on the prior needs assessment and comments from field experts. Participant selection should then proceed by considering requirements and course objectives. If participants are “global citizens,” sustainable developmental goals for health equality or any effort therein could maximize the field experience.

In the implementation phase, grouping participants should help promote better understanding of the healthcare and cultural environment, providing a more mutually dynamic learning experience. Furthermore, real-time monitoring and feedback from staff, professors, and field experts can aid program efficacy.

To evaluate the program’s effectiveness, both quantitative and qualitative methods are necessary to determine program effectiveness, as well as changes to knowledge and attitudes among participants. However, evaluations of participants’ critical thinking and leadership abilities may be somewhat inappropriate when addressing program effectiveness. This is because most participants embody these traits more than the average student.

The present study outlined an effective model for improving global health nursing competency. Based on needs assessment pre-survey, specific variables representing program effectiveness should be scrutinized to better promote a program’s objectives.

A few program limitations should be noted. For instance, only a small number of students could reasonably participate due to financial strains and the ability to select an appropriate field site. Thus, table-top case simulations and field program briefing sessions may be needed to provide indirect learning experiences. Nevertheless, both direct and indirect methods could have immense utility for facilitating global health nursing competency.

The author confirms being the sole contributor of this work and approved it for publication.

The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.