Masters and PhD nursing students from Kazakhstan internship at European universities during AccelEd project

Yulia Korzhina¹

Jurgita Gulbiniene²

Stina Wallin¹

Lisbeth Fagerström¹

¹Åbo Akademi University, Faculty of Education and Welfare Studies, Health Sciences

²Lithuanian University of Health Science, Nursing faculty, Nursing Clinics

Abstract

Introduction: In many Kazakhstani universities, doctoral programs in nursing are in process of being developed, so research in the field of nursing is primarily based on master’s theses. Several weeks of internship in EU universities for Kazakhstan Master and PhD nursing students’ during the AccelEd project were organised with purpose to strengthen nursing science development in Kazakhstan. The internship program was developed based on the AccelEd project aims and the possibilities available at each EU university, and when it possible, on the learning outcomes set by each student before their internship period.

Aim: To review the evaluation of the internship of Kazakhstan Nursing master’s and PhD students’ in European universities, which aimed to raise the interest in developing competences for further PhD studies and teaching of nursing science in Republic of Kazakhstan.

Results: The internship for Nursing master and PhD students was carried out at JAMK University of Applied Sciences, Åbo Akademi university (ÅAU) in Finland, and Lithuanian University of Health Sciences (LSMU) in Lithuania. Two 7-week periods were realized during 2022 and 2023. Totally, 7 master students and 8 PhD students from four different university of Kazakhstan. Most of the students (63 % of the participants) evaluated the practice in EU universities as excellent and they reach the outcomes.

Conclusion: The Master and PhD student’s internship periods have been intense and covered many topics and directions. The participants expressed clearly that the internship periods contributed to the expansion of knowledge in the field of nursing research and enabled overall achievement of their individual learning outcomes. The content of the internship programmes that this study is based on can be used as a template for the future ongoing internship projects in nursing science.

Key words: international internship, Nursing master’s and PhD students, nursing science, nursing education

Introduction:

Nursing is the largest profession in health care, with continued growth expected over the next several years. Nursing science plays a critical role in addressing health challenges, generating new knowledge and translating evidence to practice improving patient outcomes (S. S. Chesak et all, 2022).

The internship is fundamental for the training of future professionals during the degree course in Nursing (S. Bambi et all, 2020). Nursing students who undergo well-run international internship programs obtain strong personal and professional transformative growth, improve global health awareness and form realistic strategies for using nursing skills in multicultural and international environments (X. Tan at all, 2023)

To strengthen nursing science development in Kazakhstan, were organised internship in several EU universities during the AccelEd project. The aim of this internship was to increase the interest of master students in developing competences for further PhD studies and teaching of nursing science in Republic of Kazakhstan. The internship program was developed based on the AccelEd project aims for the work package 2.1. (WP 2.1.2 D4) and the possibilities available at each EU university, and when it possible, on the learning outcomes set by each student before their internship period. Almost all the participants listed their learning outcomes before their internship period began. They named among others such learning outcomes as exchange experience, familiarizing and gaining more knowledge on different teaching methods in nursing, improving competencies in research and scientific activities such as methodological and analytical skills in both qualitative and quantitative methods as well as improving skills in search strategy in scientific databases. The master and PhD students have also emphasized the importance of opportunity to participate in, observe and assist researchers in network meeting inside and outside the university and gain some experience in building the future collaborative networks for research.

The internship program in EU universities included familiarizing with the education systems for nurses, teaching methods, organization of the universities, research projects in health care, and health care systems in the hosting EU country.

Master’s and PhD students of the Nursing program who had appropriate English language skills were eligible for the internship. During the internship each student was supported by mentors from EU universities. Weekly meetings with the mentor were organized for consultation and discussion of the results achieved during the week. Each student had opportunity to work individually on their research work in order to reach learning outcomes of internship.

Methods:

The internship for Nursing master and PhD students was carried out at JAMK University of Applied Sciences, Åbo Akademi university (ÅAU) in Finland, and Lithuanian University of Health Sciences (LSMU) in Lithuania. Two 7-week periods were realized during 2022 and 2023. Totally, 7 master students and 8 PhD students from Astana Medical University (AMU), Kazakh National Medical University (KNMU), Karaganda Medical University (KMU), and South Kazakhstan Medical Academy (SKMA) participated in the internship.

After the internship at EU universities student submitted a detailed internship report and answered seven anonymous survey questions.  Each question was evaluated on a 5-point scale, where 1 point is very bad, and 5 points is excellent.

Results:

Masters and PhD nursing students were satisfied with the entirety of the internship programmes at the EU universities. Most of the students of the master’s and PhD studies in the Nursing program (63 % of the participants) evaluated the practice in EU universities as excellent. Most students (75%) indicated that the content of the internship program helped them to reach the outcomes (Table 1).

Table 1. The students’ evaluation of internship in EU universities

Internship evaluation criteria	Evaluation points					Average	Median
	1 Very Poor	2 Poor	3 Satisfactory	4 Good	5 Excellent
The content of the programme was	0,0%	0,0%	0,0%	37,5%	62,5%	4,6	5,0
Skills and knowledge of the experts were	0,0%	0,0%	12,5%	25,0%	62,5%	4,5	5,0
Methods used by experts supported reaching the outcomes	0,0%	0,0%	12,5%	25,0%	62,5%	4,5	5,0
Adequacy of supporting materials	0,0%	0,0%	0,0%	37,5%	62,5%	4,6	5,0
The contents helped me reach the outcomes	0,0%	0,0%	12,5%	12,5%	75,0%	4,6	5,0
The applicability of the contents	0,0%	0,0%	0,0%	37,5%	62,5%	4,6	5,0
The outcomes were fulfilled	0,0%	0,0%	0,0%	37,5%	62,5%	4,6	5,0

 

The students during the internship period achieved learning outcomes in different field such as: educational activities; research and project activities, networking, and collaboration with regional health care sector.

Learning outcomes from participating in educational activities

The Masters and PhD nursing students during the internship in EU universities participated in lectures, course seminars, master thesis seminars, and practical classes and exams for bachelor and master students. They appreciated the opportunity to participate in counselling sessions with master and PhD students and their supervisors. The internship students emphasized improved knowledge and skills in teaching methods during their internship. Teaching methods such as analysis of video films, role-playing game for practice problem-solving, analysis of clinical situations, “four-window method” left a great impression.

The Master and PhD nursing students who had their internship period at ÅAU were impressed by the way the students are taught to develop critical thinking through discussing different topics with each other. They were also impressed by the teaching strategy as the emphasis was placed on how students reflect on and complement the others’ opinions in a friendly and positive atmosphere.  As one of the PhD students described her experience after participating in the several master and PhD seminars at ÅAU:” Indeed, this is a great experience for me. Now I can say that I know how to conduct a lesson on discussing various topics for the development of critical thinking among students, while maintaining mutual respect for each other”.

The Master and PhD nursing students who had their internship period at LSMU were impressed by organization and implementation of the OSCE exam at LSMU. They had a positive impression of the use of Moodle (e-learning) platform at LSMU which are used to upload lecture materials, supplementary resources, assignments for students and communication with teachers. They appreciated seeing modern learning environment such as simulation rooms for training different medical situations, and dummies to practice care on. The internship students also emphasised the active participation of the students in lectures, both in group work and individual tasks, and the continuous dialogue and friendly atmosphere between the teachers and students.

They highlighted that such learning environment help students’ development of critical, analytical, and systematic thinking to independently draw conclusions and solve complex problems.

Learning outcomes from participating in research and project activities

The Masters and PhD nursing students during the internship in EU universities participated in project and research meetings within the host EU university, and in meetings with collaborate research staff outside the university. Some of the students had the opportunity to participate in meetings with collaborative research staff from universities in other countries such as USA (New York University), Japan (Nagoya University) and China (Fudan University, Shanghai).

The Masters and PhD nursing students improved their knowledge and skills in research:

• Use of the academic libraries resource to conduct scientific literature search in international evidence-based data bases such us Clinical Key, Cochrane Library, Nursing Reference Center Plus, SAGE Journals Online; Science Direct; Springer Link; Cochrane Library; EBSCO Publishing and many other. Several of the participants were even guided by the librarian while conducting the scientific literature search.
• Scientific research design: justification of research problems, research questions, sampling methods, data collection methods
• Applications of different research methods (quantitative and qualitative)
• Work on publication of a research article
• Research ethics approval and ethics guidelines

Some of master students had an opportunity to be involved in research projects in the universities, for which they were grateful. From participation in research and project activities, the internship students also expressed development in own ability to communicate with an audience, perform a presentation at conference, and an increased sense of responsibility for assigned tasks.

Learning outcomes from networking and collaboration with regional health care sector

The Masters and PhD nursing students visited and familiarized with the practical work at different wards and clinics LSMU Kauno Klinikos and Nursing and supportive care hospital.

During the visits to LSMU Kauno Klinikos the students had some positive and insightful experiences. The nursing students were surprised and impressed that patients’ relatives were allowed to visit the Intensive Care Unit (ICU) and spend time with the patients. They understood it has a positive impact on the patient’s recovery. In the Obstetrics and Gynecology clinic nursing students appreciated the facilities in the maternity ward, such as aromatherapy, relaxation bath, radio and big balls. The postgraduate students suggested that introducing similar facilities in Kazakhstan could lead to an increase in the number of births each year by making the birthing experience more pleasant for mothers. The visit to LSMUL Children’s Clinic left a great impression on the students because of the child-friendly environment. They noticed that children’s drawings adorned the walls, and there were rooms where children could read books and play educational board games. The students believed that introducing similar child-centered departments in children’s hospitals in Kazakhstan could benefit sick children. Such environments could help distract children from their illnesses, aid in their recovery, foster their creative abilities, boost their spirits, and improve their overall well-being. The participants were introduced to nursing and palliative care for Kaunas County residents at one of Nursing and supportive care hospital either.

The Master and PhD students have also had the opportunity to familiarize with the The Wellbeing Services County of Ostrobothnia in Finland while visiting several of its service providers. The have visited among others The Patient safety and Research Center at Vaasa central Hospital. This way they got the opportunity to familiarize with the systematic work which is focused on the patient safety in this region.  They understood how important it is to collect the data about the causes of nurse’s mistakes in order to systematically prevent those in the future. One of the participants summarized this experience this way:” This is a good practice for developing a safety culture among nurses, I believe it will help me in my research work. I also plan to conduct training among nurses in clinics about the safety culture.” The master and PhD students have also visited Korsholm health care centre (Finland), primary care ward, and had the opportunity to talk with nurses who care for patients with asthma and COPD. They were impressed with the questionnaire which were used for the patients with respiratory diseases. They considered that this questionnaire was very easy to use for both patients and nurses. They have also learned a new device that helps patients use the inhaler correctly to effectively relieve shortness of breath. This device helps to practice, because without practice, the patient cannot assimilate and understand the information. They were also positively impressed by the fact that the spirometer had a program for children in the form of games, which distracted the child from the stress of breathing. The students pointed out the effectiveness of the device. The students also emphasized the fact that the nurses work as a team. It has long been proven that teamwork is much more effective and gives more results than one person.

The Masters and PhD nursing students learned about the organisation and system of health care in the host EU countries, as well as the quality of nursing care. The internship students also learned about current problems in health care systems, how to solve real problems by using design thinking involving the public, and how to present good ideas to an evaluation committee.

Discussion:

The Master and PhD students’ internship duration in EU Universities was 7 weeks. The research indicate that long-term international internships have a greater impact than short-term international internships. The internships, whose duration is typically 8 weeks or less, are mainly perceived as a way for students to get some international exposure that helps them develop a global mindset (Giorgio Di Pietro; 2022).

During the international internship at EU universities, Master’s and PhD students from universities of Kazakhstani gained diverse experiences. Throughout the internship, students enhanced their knowledge in various areas: educational activities; research and project activities, networking, and collaboration with regional health care sector. According to the internship evaluations results we could see the positive results in developing competences of Master and PhD and students for further PhD studies and teaching of nursing science in KZ.

In educational system participants emphasized the importance of starting with a list of competencies and clinical interests that will allow students to approach the subject with a full understanding. To ensure that during their studies, students do not fear their teachers, and the teachers recognize them as equal specialist. As a result, this would encourage students to openly ask questions during lectures and have a dialogue with the teacher without fear of giving the wrong answer.

Internships gave opportunities to build future collaborative networks for research and consolidating the achieved results of all partners in Kazakhstan and beyond. At present, in Kazakhstan, PhD programs in Nursing are only in the process of being established that’s way research in the field of nursing in Kazakhstan is mainly based on master’s theses. However nursing master’s and PhD students are very interested in conducting scientific research in field of nursing at medical universities, higher medical colleges, as well as in clinical practice in order solve the problems in nursing. For the quality of nursing research, it is important that the research topics are relevant and based on the problems of practical nursing.

Conclusion: The aim of this internship was to increase the interest of master and PhD students in developing competences for further studies and teaching of nursing science in Republic of Kazakhstan. The internship periods have been intense and covered many topics and directions. This study shows that the internship as a whole contributed to the expansion of the students’ knowledge in the field of theory and philosophy of nursing. The participants expressed clearly that the internship periods contributed to the expansion of knowledge in the field of nursing research and enabled overall achievement of their individual learning outcomes. The content of the internship programmes that this study is based on can be used as a template for the future ongoing internship projects in the area of nursing science.

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