Nursing Students' Intercultural Learning via Internationalization at Home: A Qualitative Descriptive Study ☆ E. Angela Chan a, ⁎, Timothy Lai a , Arkers Wong a , Suki Ho a , Bessie Chan a , Marie Stenberg b , Elisabeth Carlson b a School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong Special Administrative Region b Department of Care Science, Faculty of Health and Society, Malmö University, Jan Waldenströms gata 25, SE 214 28 Malmö, Sweden 1. Introduction Nursing graduates worldwide are expected to be culturally compe- tent to provide quality care to an increasingly diverse population. With the growing emphasis on internationalization in education, many learners have studied abroad as exchange students (Baernholdt et al., 2013). While not all students are able to take part in overseas ex- changes, it is possible for them to achieve cultural capability through the use of technology within the concept of Internationalization at home (IaH) (Trahar and Hyland, 2011). Earlier studies on cross-cultural learn- ing through video conferences (Iwasiw et al., 2000) and pedagogical tools (Lepp et al., 2003) focused on nursing practice as an outcome. Chan and Nyback's (2015) study revealed the development of cultural sensitivity and competencies in nursing students through the use of web-based technology and a final Skype meeting. Nursing literature on the topic of intercultural learning through communication and inter- action is limited. Language learning or practice has been the main focus of such studies, which have not solely been about intercultural learning (Çiftçi, 2016). Intercultural learning is defined as the development of an under- standing of and appreciation for one's own culture and that of others (Hollinderbäumer et al., 2013). Kohn (2013) asserted that intercultural communicative competence (ICC) is the ability to communicate effec- tively and appropriately with people of different languages and cultural backgrounds. ICC is considered key to the success of virtual forms of in- teraction (Helm and Guth, 2010), and is seen as “an acquired quality” (Kupka et al., 2007). Hence, it is important not to assume that all of the misunderstandings in the students' online exchanges are related to the interface of “cultures” (O'Dowd, 2007). Internationalization at home (IaH) blends the concepts of self, strangeness, and otherness (Teekens, 2006). When technology is adopted, a “third space” is created (Bhabha, 1994) for the participants' cultural learning. This third space is a space between cultures, wherein cultural differences are negotiated with the awareness that other perspectives exist in the world besides one's own. Given the growing use of interactive technology, Macharaschwili and Coggin (2013) argued that more research is needed to determine if learning through an understanding of the way by which intercultural communication takes place in this environment is indeed a new way of accessing cultural knowledge. The digital environment on which this study on the intercultural learning of students is based is that of Skype (Morgan, 2013). Skype is a user-friendly voice over internet protocol (VoIP) software that allows users to make video and voice calls (Michels and Chang, 2011). It is free, easy, and accessible. Blau and Caspi (2008) examined the differences between audio conferencing (using Skype with an audio-only compo- nent) and traditional face-to-face learning. While the learning that took place was the same in both groups, the emotional-experiential as- pects of learning favored face-to-face communication. Through its syn- chronous feature, Skype can simulate a face-to-face environment and allow students to participate from a distance. In this paper, the authors will explore the process of intercultural learning between nursing students from Hong Kong and those from Sweden through their intercultural communication, interactions, reflec- tions, and their perceptions of the process via Skype. 2. Methods Since the research team was interested in direct descriptions of the students' perceptions of their intercultural experience of interactions in a virtual learning environment, the methodology that was adopted was the qualitative descriptive approach (Sandelowski, 2000). Using this method, the research team described the students' reports of their experiences and encouraged the students to provide explanations of their behaviors. 2.1. Ethical Considerations This project was approved by institutional research ethics boards at MalmoU (no. 2014/836) and PolyU (no. HSEARS20141216001). The students were briefed about the project and informed that their partic- ipation was voluntary. Nurse Education Today 52 (2017) 34–39 ☆ This work was collaboratively supported by the Hong Kong Polytechnic University and the Malmö University Collaborative Fund. We expressed our gratitude to the funding from the Collaborative Research Grants Scheme 1-ZVEN, The Faculty of Health and Society (FHS), Malmö University (MalmoU) & The Faculty of Health and Social Sciences (FHSS), The Hong Kong Polytechnic University (PolyU). ⁎ Corresponding author at: School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region. E-mail address: e.angela.chan@polyu.edu.hk (E.A. Chan). http://dx.doi.org/10.1016/j.nedt.2017.02.003 0260-6917/© 2017 Elsevier Ltd. All rights reserved. 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