Kang, J., Song, J., & Noh, W. (2020). A systematic review and meta-analysis of the effects of global health competency improvement programs on nurses and nursing students. Journal of Advanced Nursing, 76(7), 1552–1566. https://doi.org/10.1111/jan.14355

The increase in global health awareness and nursing research has advanced the implementation of global health competency improvement programs. These advances provide great opportunities along with new challenges for cultural competence in healthcare. It has become apparent that nursing students entering clinical nursing practice in any nursing specialty cannot remain focused on local health care problems. Kang et al. (2020) systematic review attempts to identify global health competency improvement programs by trending their effects on nurse and nursing student multicultural competence. What is clear is that nurses and nursing students must render care under the scope of clinical and multicultural competence.

Although this article is impactful to the global health cultural awareness of nursing, endorsing the concept of nursing multicultural self-efficacy seems to limit the research to representing Korea and the United States of America (U.S.A.). The purpose of this editorial response is to present appreciation of utilizing studies from the U.S.A., as this country does represent different cultures; nonetheless, the integration of global health and cultural competency lacks meaning if other global regions such as Europe, Africa, Caribbean countries and Latin America are not represented in the study. The systematic review and meta-analysis of the effects of global health nursing competency programs would greatly benefit from study abroad programs emphasizing teaching cultural diversity. Only two articles cited in this review suggest a potential service-learning opportunity conducted in the U.S.A.; however, they omit to highlight the international clinical placement for the service-learning program, suggestive of the learning experiences remaining within the U.S.A. To efficiently improve health competency efforts, nursing education programs should understand the critical role of nurses in meeting global health goals, affirmed by the Global Advisory Panel on the Future of Nursing and Midwifery (GAPFON) Summary Report. The GAPFON aims to enforce global health goals and initiatives to achieve improved outcomes through a globally nurse-driven shared governance model. Nurses and nursing students across the globe should recognize that no single global region can achieve global health competency alone. Therefore, the cultural competencies of nurses and nursing students must achieve the collaboration goals of the GAPFON Model to understand and address healthcare challenges within its unique cultural realm (Klopper et al., 2020).

Nurses in all facets must understand that globalization means that health care challenges are no longer a problem ‘over there’ or ‘those people’ but a global health challenge that warrants a competent approach. The concept of service-learning is promising to benefit nursing students to understand the cultural complexities of global health. Knecht et al. (2019) suggest that post-undergraduate nurses are inadequately prepared to provide culturally competent care. The author declares that pedagogy style education cannot support the cultural competence needed to meet the demands of the increasing diversity of population health. A mixed-method study that addressed multi-ethnic and religious parallels to race and culture is examined. The author applied a service-learning approach to the nursing curriculum. The themes which emerged from the qualitative arm demonstrated enlightenment, cultural competence, awareness, knowledge and skill. The quantitative data analysis supported a service-learning-based group that demonstrated a statistically significant difference and is better positioned to provide cultural-competent care. Knecht et al. (2019) declare that all undergraduate nursing students should be afforded the opportunity of service-learning education. Similarly, Roller & Ballestas (2017) provide the outcome of a 1-week, one-credit elective nursing course from Adelphi University, Long Island, New York, of the U.S.A. Nursing students experienced adult health clinics, hospice home visits, vision and dental screening within the tropical country of Costa Rica. A quantitative comparison design measured cultural competency-based learning and compared results immediately after the international service-learning program and 1 year after the experience. Results suggest the cultural competency scores were sustained during the 1-year post-experience.

Schleiff et al. (2020) aimed to identify the best ways to implement competency-based training into nursing learning curricula. The relevance in comparison to your study is the review of published literature in the pursuit of implementing global health nursing competencies. The author makes appreciably clear, training nurses on diverse elements of global health ‘needs to extend beyond disease-specific…to include a skill-base that is cross-cultural’ to meet global health competency improvements (Schleiff et al., 2020, p. 2). Of 68 publications and grey literature used to analyse critical global health competency-based educational models, 18 peer-reviewed articles yielded the notion that cultural and clinical practice setting competency-based education must be emphasized to meet the goals of global health nursing.

Kang et al. (2020) indicate that the examination of the systematic review demonstrates that health competency improvement programs impact multicultural self-efficacy and cultural competence of nurses and nursing students. However, how much more prepared would nurses meet the global health goals of the GAPFON from global service-learning programs embedded in nursing curricula.