Nurse Education Today 31 (2011) 892–897

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Rediscovering the essence of nursing: Exploring the impact of in clinical experiencein Thailand for undergraduate nursing students from Australia

Kerry Reid-Searl a,1, Trudy Dwyer b,2, Lorna Moxham c,3, Brenda Happell d,⁎, Teresa Sander e,4

a School of Nursing and Midwifery, Institute for Health and Social Science Research, CQUniversity Australia, Bruce Highway, Rockhampton, 4702, Queensland, Australiab School of Nursing and Midwifery, and Institute for Health and Social Science Research, CQUniversity, Australiac Dean of Research and Research Training, and Institute for Health and Social Science Research, CQUniversity Australia, Bruce Highway, Rockhampton, 4702, Queensland, Australiad Institute for Health and Social Science Research, and Contemporary Nursing, School of Nursing and Midwifery, CQUniversity Australia, Bruce Hwy, Rockhampton, Queensland, 4702, Australiae School of Nursing and Midwifery, CQUniversity Australia, Bundaberg campus, Australia

⁎ Corresponding author. Tel.: +61 7 49306971; fax:E-mail addresses: k.reid-searl@cqu.edu.au (K. Reid-S

(T. Dwyer), l.moxham@cqu.edu.au (L. Moxham), b.happt.sander@cqu.edu.au (T. Sander).

1 Tel.: +61 7 49309741; fax: +61 7 49309871.2 Tel.: +61 7 49306538; fax: +61 7 49309871.3 Tel.: +61 7 49309894.4 Tel.: +61 7 41507098; fax: +61 7 41507080.

0260-6917/$ – see front matter © 2011 Elsevier Ltd. Aldoi:10.1016/j.nedt.2010.12.024

s u m m a r y

a r t i c l e i n f o

Article history:Accepted 27 December 2010

Keywords:CaringCultural competenceGroup dynamicsNursing educationNursing students

Cultural competence is now widely recognised as an essential characteristic for undergraduate nursingstudents. Clinical experience in foreign countries has become increasingly popular as a strategy to enhancecultural awareness and competence. However, published research articulating the experience and outcomesof these initiatives is relatively rare, particularly from an Australian perspective. This paper presents thefindings of a qualitative, exploratory research project. Individual semi-structure interviews were conductedwith eight undergraduate nursing students before, during and at the conclusion of a four week clinicalplacement in Surin, Thailand. Data analysis identified the following major themes: first interview –

anticipation; second interview – making a difference; contrasting worlds; and part of the group; thirdinterview — reality check and group dynamics. These findings suggest that international clinical experiencehas potential benefits beyond the development of cultural competence. The importance of caring in nursingand the importance of group dynamics were particularly valued by student participants.

+61 7 49309871.earl), t.dwyer@cqu.edu.auell@cqu.edu.au (B. Happell),

l rights reserved.

© 2011 Elsevier Ltd. All rights reserved.

Introduction

Clinical experience is an important component of undergraduatenursing education, as it facilitates the opportunity for students toacquire practical skills and knowledge in real life contexts (Field,2004). This assists students to develop sound clinical reasoningabilities (Byrnes and West, 2000). An Australian Government report(Australian Government, Department of Education, Science andTraining, 2002) noted that while it is important for nursing studentsto practice skills in university laboratories, experience gained from thehealth care settings is pivotal.

Not only does clinical experience contribute to the development ofcompetent practice, it enhances students' socialization into thenursing profession. Active participation in the functions and activitiesof nursing helps students to acquire the cultural values and norms of

the wider nursing profession (Randle, 2003; Tiwari et al., 2005). Itenables students not only to do nursing, but to become a nurse(Levett-Jones and Bourgeois, 2007; Tiwari et al., 2005).

Cultural competence is now considered an essential componentfor undergraduate nursing programs in Australia (Caffrey et al., 2005;Jirwe et al., 2006; Momeni et al., 2008; Pinikahana et al., 2003).Recognising that the importance of cultural issues in health, theAustralian Government through the National Health and MedicalResearch Council (NHMRC) has identified the need to increasecultural competency in health as a matter of priority (NHMRC, 2005).

A nurse who is culturally competent can communicate sensitivelyand effectively with people who have different languages, cultures,religions, genders, ethnicities, disabilities, ages and sexualities (NewSouth Wales Department of Health, 2010). Paying heed to this,undergraduate nursing students need to develop a broad repertoire ofskills, knowledge, attitudes, perspectives and practiceswhich they canuse to enhance their cultural competence and therefore positivelyinfluence the therapeutic relationships they have with their clients.Clients who feel that their concerns have not been understood,dismissed or ignored, or who have not received optimum servicesbecause of their cultural background will find it hard to develop asense of trust in a practitioner or a service (NSW Health Department,2010). Assisting nursing students to develop their cultural compe-tence increases their capacity to more effectively interact withprofessional colleagues in a more sensitive and supportive manner.

893K. Reid-Searl et al. / Nurse Education Today 31 (2011) 892–897

Culturally competent nurses build trust and respect which leads toincreased client satisfaction and improved health outcomes. Improve-ments include better use of the nurses' and clients' time, moreaccurate information, andmore effective and acceptable outcomes forboth the staff and the clients for whom they are providing care (NSWHealth Department, 2010).

Regional and rural communities are geographically isolated andcannot access specialist services. This is particularly evident forCulturally and Linguistically Diverse (CALD) populations, it isnecessary that nurses be culturally competent (Moxham and Pegg,1998; Ward et al., 2005). Achieving cultural competence as a part ofan Australian curriculum can however present a challenge. This isparticularly so, in areas of Australia where students may not beexposed to different cultures. Regional and rural Australia may wellprovide examples of this. Active participation via a cultural immersionprogram enables nurses to better meet the needs of CALD commu-nities by translating this embedded learning into their professionalpractice within the Australian context.

Building cultural competence can be achieved in a number of waysand undertaking clinical experience in a foreign country has beenidentified as promoting understanding of the inter-relationshipbetween culture and health (Atkins and Stone, 2006; Lee, 2004;Levine and Perpetua, 2006; Maltby and Abrams, 2009; Wallace, 2007;Walsh and DeJoseph, 2003). Anecdotal evidence suggests an increasein the number of undergraduate nursing programs within Australia inrecent years.

A review of the literature suggests that this reflects an interna-tional trend, with nursing students from a number of differentcountries engaging in overseas learning experiences by placingstudents in the health care facilities of foreign countries, predomi-nantly Africa and Asia in order to enhance their understanding andappreciation of cultural diversity (Ailinger, 2002; Atkins and Stone,2006; Lee, 2004; Levine and Perpetua, 2006; Maltby and Abrams,2009; Newson, 2009; Wallace, 2007; Walsh and DeJoseph, 2003).Research into the outcomes of these experiences is limited with manypublished articles presenting a description of the process rather thanresearch findings (Ailinger et al., 2009; Bosworth et al., 2006; Karosaset al., 2008; Mason and Anderson, 2007).

Although limited, some research has been undertaken to investi-gate the nature and outcomes of these experiences. Green et al.(2008) examined the experiences of two cohorts of Swedish andUnited Kingdom nursing students undertaking an internationalplacement during their undergraduate studies. Through the use ofinterviews and documentary analysis they identified three majoroutcomes of international placements — personal development,professional development, and culture awareness. Personal develop-ment was identified as the result of living andworking in a health caresystem within a different culture. The participants identified profes-sional development occurred through the exposure to a differenthealth care system that included differing roles for health professionalthat their own country. Finally participants acknowledge thedevelopment of increased cultural sensitivity and competenceoccurred as a result of their emersion in the culture on a day to daybasis.

Personal and professional growth and enhanced cultural aware-ness are common themes in other qualitative research exploring theexperiences of students from international clinical placements(Callister and Cox, 2006; Duffy et al., 2003; Lee, 2004; Levine andPerpetua, 2006; Maltby and Abrams, 2009). Inglis, Rolls and Kristy(Inglis et al., 2000) undertook a comparison between students whoundertook a clinical placement in Nepal and those who did not. Theyreported greater attitudinal change in respect to cultural sensitivity,personal growth and cultural competence.

A quantitative study (Caffrey et al., 2005) was undertaken using a28 item scale to measure students' perceived knowledge, self-awareness and cultural competence. Pre and post-test findings were

compared between 7 students who completed a five week clinicalplacement in Guatemala, and 25 students who did not. The resultsindicated small to moderate improvement for those students who didnot complete the placement and very large improvement for thosewho did. However, the small sample size precludes these findingsfrom being considered as statistically significant.

Only one study (Inglis et al., 2000) was conducted in Australia.Given the increase in the number of nursing students undertakingclinical experience abroad, research into the experience of overseasclinical placements appears timely. The aim of this paper is to presentthe findings of a research which examined the experiences ofundergraduate nursing students when undertaking a clinical place-ment in Thailand.

Method

Research design

The study utilized the qualitative exploratory framework de-scribed by Stebbins (2001). This approach provides the opportunity toexamine the experience from the perspective of the studentparticipants. Qualitative exploratory research is an appropriatemethod where there is little documented knowledge about thetopic under investigation.

Setting

Eight nursing students from CQUniversity together with twonursing academics undertook a volunteer nursing placement in Surin,Thailand for a four week period in December 2008. The groupconsisted of 1st, 2nd and 3rd year undergraduate nursing students.The clinical placement was facilitated with the assistance ofAntipodeans' Abroad. The project was partially funded by the AuspiceUniversity and through fund raising activities organized by thestudents and staff. The students experienced nursing in a variety ofclinical contexts. These included community, schools, orphanages andthe hospital setting.

During their first year of study all participants were all introducedto the theoretical constructs of cultural competence in a subjectentitled indigenous and cross cultural health care. Throughout thesubject students explored their own cultural orientation and theimpact this could potentially have on the delivery of culturally safecare. In addition all students attended a compulsory one dayorientation specifically addressing cultural considerations within theThailand context. At this session students were shown photos of thelocal people and the health care settings in country. Students andsupporting academic staff were encouraged to share expectations andconcerns about the forth coming experience.

Participants

Undergraduate nursing students from a CQ University, Australia,who would be undertaking clinical placement in Surin Thailand, werethe target population for this study. An invitationwas sent to the eightundergraduate involved in the clinical placement inviting them toparticipate in the study. This pack included a letter of invitation withan explanation of the research and a consent form. All eight studentsagreed to participate.

Procedure

To develop a conceptual understanding of the experience,participants were interviewed on three occasions throughout thejourney, immediately prior to leaving, midway through the clinicalexperience and immediately prior to returning home. Data wascollected via in depth semi-structure interviews. Through the series of

894 K. Reid-Searl et al. / Nurse Education Today 31 (2011) 892–897

three interviews students were asked to describe their expectationsof, involvement in and the impact of this clinical experience.Participants were encouraged to raise any other issues theyconsidered important.

Ethical issues

Ethics approval was obtained from the relevant University HumanResearch Ethics Committee. All potential participants were assuredthat their participation was completely voluntary, that they had theright to withdrawwithout prejudice and that non participation wouldnot affect their academic standing. Additionally, they were advisedthat their identity would not be revealed and measures would betaken to protect privacy and confidentiality. This was reinforced inwriting on the consent form.

Data analysis

All interviews were audio-taped and then transcribed verbatim.Data analysis was based on the approach developed by Ritchie andSpencer (1994). This method comprised five key stages: familiarisa-tion with content; identifying a thematic framework; indexingthemes; charting themes; and the mapping and interpretation ofthemes. Three members of the team undertook this processindependently. The findings were discussed and disagreementsnegotiated in order to arrive at the final themes.

Findings

The themes identified are presented in Table 1. In this section abrief overview of each of the themes will be presented and supportedwhere relevant with quotes from participants.

The first interview

The one theme to emerge from the first interview was that ofanticipation.

AnticipationThe theme of anticipation emerged from the first interview, and

included anticipation of the personal and of the professional journal.At a personal level the participants described an array of emotionsincluding nervousness, excitement and apprehension. Students wereconcerned about a number of issues such as personal safety, languagebarriers andmissing their family and friends back at home. The mixedemotions were clearly articulated by one student:

A little bit nervous, very excited. This is something that I havewanted to do for a really long time. So I sort of feel like I am on thebrink of something very big. (P1, Year 2 student)

Similarly another participant describes high expectations:

I am expecting this to be a bit of a revelation in many ways (P1,Year 2 student)

Table 1Themes from interviews.

Interview Theme

One AntcipationTwo Making a difference

Different worldsPart of the group

Three Reality checkGroup dynamics

Anticipation of the nursing experience was primarily focused onthe skills of nursing and opportunities that may be available to utilisethese skills. Most participants saw it as an opportunity to look atnursing from a different cultural perspective, as the followingstatement illustrates:

Connecting I think with people, with the people from anotherculture and seeing how we work that way in another culture. (P2,Year 2 student)

Participants also expressed concerns that they would not have thenursing skills or communication skills to be useful in this setting, forexample:

I don't know if my abilities will help much. I just want to get thereand feel like I am actually doing something that's my only realworry. That I am not going to be useful. (P6, Year 1 student)

At the core of the communication were concerns that they wouldnot be able to adapt to the culture and the language barrier

…it [communicating] will be quite hard, quite difficult to be ableto communicate with patients and staff (P5, Year 2 student).

The second interview

The three themes to emerge from the second interview were:making a difference; contrasting worlds; and part of the group.

Making a differenceMidway through the rotation there was a merging of personal and

nursing expectations to where the personal and professional journeywas viewed as one. Participants weremoving beyond the desire to useor practice the skills of nursing to reflecting on how they, as a studentnurse, could make a difference to peoples' lives, for example:

We have seen some really good stuff and I think that my initialworry that I wasn't going to be very helpful and … I'm not goodenough as a student nurse to kind of make a difference … I feelthat we were a positive influence here. (P6, Year 1 student)

Concerns about not fitting in and not being helpful were alsodissipated as one participant described:

I felt like part of a team and I felt like we were here doing what…..I don't know. It was what I wanted to do when I was here, help, beactive, be involved, get hands on. (P6, Year 2 student).

Contrasting worldsThe participants frequently made comparisons between the two

health care systems and cultures and the availability of resources.There was a growing realisation of the limited resources available andhow, in spite of this health care workers were still able to delivereffective care:

The way the treatments are so far behind the times. The staff arejust so dedicated and there is just not the resources to really dobest practice (P1, Year 2 student).

Participants became acutely aware of the important role of thefamily and community health in providing care, for example:

Connecting with the people in their homes, in their villages andbeing welcomed into their very humble poor homes and seeingthe way they care for their family with the limited resources theyhave. (P2, Year 2 student)

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Some participants identified a contrast between the resource richhealth care system of Australia with the social support rich health caresystem of Thailand:

… the elderlyman thatwe visitedwho is palliative care now, but heis surrounded by his family and his wife cares for him on a sort ofday bed … But he is surrounded by his family, his children andchooks and the dogs and the sounds of his home and the gardenwith a lovely breeze going through. It is not like anything inAustralian palliative care in the pain relief or the beds or themedication… but there is a familywarmth in the care thatmight belacking in Australia that I find very touching. (P2, Year 2 student).

As a result a greater understanding of holistic care was developed:

… the family centred care in Thailand was really significant… inAustralia we have sort of lost that context of family centred care,especially with in the health care system. (P5, Year 2 student).

Part of the groupParticipants acknowledged the importance of the group to the

success of their placement. Many were overwhelmed by the closenessof the relationships with their peers. While they came from differentbackgrounds and had different personalities, as a group they grew andvalued each other:

… students that have come from all different backgrounds and alldifferent interests… I guess we have one commonality of wantingto help which is what nurses do…I think we are all really reallydifferent people, and its being really fantastic to be getting toknow each other in this environment. (P6, Year 1 student).

Additionally the influence of the teacher facilitating the experienceemerged as important

…the lecturer who is with you, really has to be a really special sortof lecturer..It has to be someone who can transcend the culturalbarrier which is not easy. There is always the language barrier, soyou have got to have exceptional people skills I think to make itwork. Exceptional interpersonal skills. And a passion for volun-teering and people. (P3, Year 3 student).

The third interview

Reality check and group dynamics were the two themes identifiedfrom the third interview.

Reality checkParticipants described the experience was soul cleansing and a

personal awakening. A personal awakening to the opportunitiesavailable that was not so overt prior to the trip, opportunity to work,access health care and life in general. One participant described theneed to:

… be more appreciative of the life we have. For me, I tend to be abit lazy and I can see that there is really no excuse for that. Tohave the opportunity to work is just a lot more special than I …realised. (P1, Year 2 student).

The experience was also viewed as having influenced attitudestowards their own nursing education and career:

It makes you so much more grateful that you even have theopportunity to even have that [Australian nursing] education. Geta good job and help people and the process. I've learnt a lot andit's not part of the curriculum but it's a wonderful extra curricula.(P1, Year 2 student).

Once again the participants reflected on the differences betweenhealth care provision between Australia and Thailand, as the followingquote illustrates:

We [Australian health care system] are way ahead of them withresources …, but we are not way ahead of them when it comes tobeing in touch with humanity and treating, having a spiritualaspect of work. (P2, Year 2 student).

Group dynamicsAgain in the last interview participants revisited the importance of

the group who shared the experience with them. Many felt that theyhad begun their journey as strangers and would be leaving as friends.The influence of the group was again reported as significant to thesuccess of the placement:

… we've all had emotional experiences and it brings you closer asa group and I feel there is quite a bond there, and I'll be sad if wedon't all keep in touch. Very worthwhile, opening you up to a sortof a little part of yourself that you'd be happy to stay in touch withand you don't want to loose. Little softer part inside yourself. (P6,Year 1 student).

At this stage participants spoke again of the role of the academicstaff on such journeys. They saw the value of the lecturer beinginvolved as part of the student experiences and taking off their ‘hat’ asthe academic at the end of the day to become a group member:

they [academic staff] have to be the person that opens up theexperience for the students. They have to be able to get in thereand… help the students find the learning opportunity and… theyhave to be really flexible. …they have to be able to switch off atthe end of the day and be one of the gang I think. (P4, Year 3student).

Discussion

The findings from this research suggest that international clinicalplacements can present a valuable learning experience for under-graduate nursing students. The main themes identified in this studyreflect the impact on personal and professional development andenhanced cross-cultural competence as important aspects. Theparticipants in the current study described how the experience hadimpacted on them as people and as nurses, and had assisted them togain an understanding of how culture impacts on health care beyondwhat could have been learned at a theoretical level.

Cross-cultural competence is defined as “the ability of systems,organizations, professions and individuals to work effectively inculturally diverse environments and situations” (Bean, 2006, p. 2).Cross-cultural experiences, like this immersion program, seek todevelop the awareness, knowledge and skills needed to interacteffectively with patients and co-workers from cultural backgroundsdifferent from the nurse. Theoretical understanding and clinicalexposure to working with patients and co-workers from differentcultural backgrounds is limited in regional Queensland universities asmajority of communities where clinical placement is undertaken donot have the wide variety of cultures of metropolitan communities.This aspect of the findings supports the major themes identified insimilar research (Callister and Cox, 2006; Duffy et al., 2003; Ingliset al., 2000; Lee, 2004; Levine and Perpetua, 2006; Maltby andAbrams, 2009).

An important feature of the current study is that participants wereinterviewed at three time points. Conducting an interview before theplacement commenced enabled insights into the experience theywere about to undertake. Anticipation was the term that best

896 K. Reid-Searl et al. / Nurse Education Today 31 (2011) 892–897

reflected their thoughts at this time. Most participants described acombination of excitement and nervousness. This theme of anticipa-tion is consistent with findings of other researchers and reflects thecultural learning cycle (Drake, 2004). The participants had someconcerns including difficulty in communication due to the languagebarrier, also identified in other research (Caffrey et al., 2005; Callisterand Cox, 2006; Duffy et al., 2003; Jirwe et al., 2006; Lee, 2004; Walshand DeJoseph, 2003).

The participants also identified personal safety and professionalcompetence as potential concerns. These issues were not raisedelsewhere in the literature. Given the increase in terrorist activity inrecent years, this is likely to become an increasing concern forstudents and in fact may become a barrier to participation in thesetypes of initiatives.

The participants also described uncertainty as to whether theycould make a positive contribution to nursing care rather than being aburden in the environment. This information could be used to preparestudents for overseas placements. Providing an overview of the typeof role they will be expected to play, and some feedback from formerparticipants, for example, could play a role in minimizing thisanticipatory anxiety. This could form part of an overall preparatorytraining for the role. The importance of being prepared for theexperience emerged in the data as fundamental to the success of theirplacement. The students in this study reported feeling unprepared forthe experience prior to departure that is they were not familiar withlanguage, culture, the health care system or what they could do asstudent nurses. As the placement proceeded students became moreimmersed into the experience because preparation was lessimportant. However the initial settling period was likely to bedelayed with lost learning opportunities due to the initial lack ofpreparation.

A particularly important finding from this research was the valuethe participants placed on caring as a result of this experience. Amajor theme for students during the placement involved acomparison between the health care settings they were used to inAustralia and Surin, Thailand. While they acknowledged that Surinfell well behind terms of technological advances and resources, theybelieved that the care provided to patients was far superior to thatprovided in Australia. In particular they acknowledged the impor-tance of family and the wider community to health care. A greaterappreciation of family and community involvement was acknowl-edged as a benefit of international clinical experience by Wallace(2007). Indeed awareness of the importance of community partner-ships is integral to the process of becoming culturally competent(Campinha-Bacote, 2008).

Most of the research literature in this area emphasises culturalcompetence as a major outcome of international clinical placements(Caffrey et al., 2005; Callister and Cox, 2006; Inglis et al., 2000; Levineand Perpetua, 2006; Mason and Anderson, 2007; Ryan and Twibell,2002; Stringer et al., 2008).While the participants in the current studyrecognised the value gained from immersion in another culture, whatthey attained from the experience is clearly far more than that.Acknowledging the importance role that nurses can play in providingholistic care in all settings regardless of the technology and supportavailable, is a crucial lesson to learn. It is suggested in the literaturethat caring is the fundamental principle of nursing and shouldtherefore underpin nursing education (Frisch, 2003; Roach, 2008;Sawatzky et al., 2009; Touhy and Boykin, 2008). The theoreticalconstructs of clinical competence and how to teach them aredescribed in the literature. However, the affective or attitudinalconstructs demonstrated in this study are more difficult to teach(Campinha-Bacote, 2008). Cultural competence starts with thedevelopment of a genuine passion and commitment to caring(Campinha-Bacote, 2008). In this study the students were able tolook beyond the physical and resource differences to engage in andembrace the cultural encounter. This respect and understanding of the

differences have been termed as ‘cultural desire’. Cultural desireallows students to begin the process of becoming culturallycompetent (Campinha-Bacote, 2008).

The importance of the group and group dynamics emerged as animportant theme in both the second and third interviews. Theparticipants described the strong sense of collegiality that developedbetween them and saw this as an important ingredient of success.This theme was not apparent in other studies of overseas clinicalexperience. As nursing practice depends on effective teamwork(Clark, 2009; Kalisch and Lee, 2009; Kalisch et al., 2009), collegialityis considered essential for the nursing profession (Baltimore,2006), particularly in reducing the occurrence and impact ofhorizontal violence within the profession (Dewitty et al., 2009;Gallant-Roman, 2008; Grover, 2005; Thobaben, 2007). An en-hanced sense of the importance of collegiality may therefore be anunintended consequence of this experience that is worthy offurther exploration.

Finally, the students regarded the experience as a ‘reality check’.They felt better able to appreciate the privilege enjoyed by healthservices in comparison to Thailand. This type of understanding is animportant component of enhanced cultural competence (Ailingeret al., 2009; Caffrey et al., 2005; Green et al., 2008; Levine andPerpetua, 2006; Maltby and Abrams, 2009; Wallace, 2007) and thesefindings suggest the clinical placement was successful in achievingthese outcomes.

Although this experience was primarily a positive one, somebarriers were also noted. The financial burden was raised as it was inthe work of Duffy et al. (2003) and Lee (2004). Participants didexperience some anxiety and apprehension before the commence-ment of the placement, regarding issues such as personal safety,language barriers and professional competence. Green et al. (2008)suggested adequate preparation and support for students andacademic staff would enhance the success of these initiatives.

On the basis of this finding it is recommended that Universities andvolunteer organizations involved in student international placementsneed to ensure that students are well prepared for the experienceprior to departure. Including: information about the type ofplacement, what they can contribute in terms of nursing care andtheir scope of practice; providing information about the locationincluding language, food, culture, appropriate behaviour and anoverview of the health care system; an understanding of groupdynamics. Finally academic staff should also be prepared and fullybriefed regarding their roles and responsibilities.

Limitations

As a qualitative exploratory study involving only a small number ofstudents, the findings from this study cannot be generalised to awiderpopulation. The participants were from one Australian university andattended a clinical placement in one area only.

Conclusions

Increasingly within undergraduate nursing programs in Australia,the value of international clinical placements has been recognised. Todate there has been a dearth of literature within Australia that reportson students experiences during international placements. This studyreported on the experiences of eight undergraduate nursing studentsas they undertook a clinical experience in Surin Thailand. The mainthemes to emerge from this study were anticipation; contrastingworlds; part of the group; reality check; and group dynamics. Thefindings and recommendations from this study have implications foruniversities and volunteer organizations who organize internationalclinical placements for students.

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Acknowledgements

The authors acknowledge the funding and support provided byAntipodeans Abroad and CQUniversity Australia. We extend ourthanks to the students who shared their thoughts and insights.

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