What characterizes Norwegian nursing students’ reflective journals during clinical placement in an African country?

Introduction: An increasing number of Norwegian nursing students take part in exchange programmes in African countries. Reflective journals are often used to enhance clinical placements learning outcomes. Aim: To identify the features that characterized students’ experiences reported in their reflective journals during clinical placements in an African country in light of cultural competence. Methods: Qualitative text analysis of 350 reflective journals written by 197 students taking part in an exchange programme in one of three African countries. Results: The reflective journals were characterized by the students’ personal emotions, judgements of others and comparisons between what they had learned in Norway and what they experienced in the African country in which they interned. Discussion: The students experienced cultural shock, and in most cases, their journals expressed ethnocentrism. They had several challenges, including being in another culture without the necessary skills and language to interact or intervene in the situations described in the reflective journals. The reflective journals were characterized by critical judgements with a low degree of reflection based on cultural knowledge and understanding. To demonstrate cultural competence, the practitioner must understand both his or her own cultural values and those of other cultures. Conclusion: The students predominantly expressed strong personal emotions and described their hosts in a judgemental and, in many cases, critical manner, often in comparison with Norwegian conditions. A stronger focus on cultural competence in preparing students for exchange programmes may decrease their level of criticism and negative judgement, and affect the level of reflection in their journals