Disparities in health care suggest a need for greater social justice in national and international health care systems. Nurses are uniquely involved with disparities since the nursing profession has emphasized social justice not only as a moral value but also as the foundation for social action. Social justice, however, may be difficult to conceptualize, especially for nursing students. Since cultural competence has been identified as an important aspect for decreasing disparities, it may be a vehicle or tool students could use for the social action necessary for social justice.

A focused ethnographic design was selected for this study because of the shortened period of the international clinical immersion experience, the researcher's background and experience, and the dynamics of the concepts involved. Interview and focus group data were collected in two phases. The first phase concentrated on ten American students' perceptions while in Zambia, Africa during January 2008. The data included information on the students' definitions and examples of social justice and cultural competence, along with their journaling and summary papers. The second phase included Zambian nursing students' and tutors' perceptions, obtained again through focus groups for the students and interviews with the tutors during June 2008.

Emergent themes were identified. The American students' perceptions and themes suggested that a change in view, like the twist of a kaleidoscope, along with self-awareness, aids understanding cultural sensitivity and competence, which in turn aids implementation of social justice. The Zambian perspectives suggested that professional competence is practicing "as a nurse" which incorporates cultural competence and social justice.

Implications from the study include the addition of cultural humility as a concept when discussing cultural competence and social justice. Synthesis of the findings suggests a "kaleidoscope effect" motif, in that the novice student should be affected by nursing education so as to become a well-rounded competent professional acting "as a nurse" for social justice. The shards of glass at the bottom of the kaleidoscope represent the multiple ways and concepts involved with initiating social justice for an individual or community. Motivated by cultural humility, twisting the kaleidoscope should reveal different but equally beautiful possibilities for accomplishing social justice. The hope is that sharing knowledge from these different perspectives will lead to meaningful change as nurses work to decrease health disparities by "doing the best for all" and attaining social justice.