Learning to thrive in transcultural nursing education: A Constructivist Grounded Theory approach

BACKGROUND: Global nursing education increasingly emphasizes cross-cultural competence development through international exchanges. While existing research highlights that cross-cultural training enhances nursing students' language proficiency, clinical skills, and cultural awareness in the short term, less is known about their long-term professional and personal growth. OBJECTIVE: This study explored the growth trajectory of Chinese nursing students in Sino-U.S. exchange program, focusing on their experiences and transitions. DESIGN: A constructivist grounded theory approach was employed. SETTING: This study examined Chinese nursing students who completed a one-year, three-semester program at a U.S. nursing school during their junior year. PARTICIPANTS: From October to December 2024, 15 Chinese nursing students were recruited using purposive and theoretical sampling methods. Eligible participants had completed a one-year Sino-U.S. nursing exchange program during their junior year (program period: 2015-2024), with the length of time since program completion ranging from 1 to 8 years (mean ± standard deviation: 5.47 ± 2.23 years). METHODS: Semi-structured interviews were conducted via Zoom, exploring participants' growth trajectories. Data analysis followed constructivist grounded theory, using constant comparison to progress from initial to theoretical coding, identifying core concepts. RESULTS: Fifteen participants were included in the study. Analysis of the interview data generated four theoretical codes: (1) Self-Awaking, (2) Self-Responsibility, (3) Self-Empowerment, and (4) Self-Expansion-along with ten focused codes. These codes collectively formed the 4S Spiral Growth Model (4S-SGM) within the context of transcultural nursing education. CONCLUSION: This study employed Constructivist Grounded Theory to examine nursing students' personal growth after studying abroad. It introduces a novel model illustrating the impact of international exchange on their development. The findings offer practical insights for improving exchange programs and provide empirical support for fostering globally competent nursing professionals.