Understanding and enhancing the learning experiences of culturally and linguistically diverse nursing students in an Australian bachelor of nursing program

International nursing students and clinical learning environments: A convergent mixed-methods study

AIM

To acquire a comprehensive understanding of the international nursing students' clinical learning environments, comparing and contrasting qualitative and quantitative insights.

BACKGROUND

The influx of international nursing students has increased in Italy and across Europe. These students, diverse in culture and language, encounter significant challenges to their education in clinical learning environments.

DESIGN

convergent mixed-methods research.

METHODS

Qualitative and quantitative data were collected concurrently and independently, with equal emphasis, following a QUAL-QUANT structure. Qualitative analysis used descriptive content analysis, while quantitative data were based on descriptive and correlation analyses on surveys using the CALD scale.

RESULTS

Overall 96 international nursing students participated in 24 focus groups. The CALD scale mean scores ranged from 2.7 to 4.5. The qualitative analysis presented two overarching themes: factors that promote a successful clinical learning environment and factors that inhibit a successful clinical learning environment in international students. The integration of qualitative and quantitative data generated four concordant and one discordant meta-inferences about the learning environment.

CONCLUSIONS

Culturally sensitive clinical learning environments are imperative for the holistic development of international nursing students. Nurse educators must cultivate transcultural competencies and pedagogical skills to enhance the competencies and skills of this student population effectively.

Challenges, support, and strategies concerning learning among nursing students who have English as an additional language: A meta-synthesis

AIMS

While studies regarding the learning experiences of international nursing students are increasing, a summary of previous evidence about the challenges, support, and strategies to learning in those students was scarce. The current review was to examine the qualitative literature exploring challenges, support, and strategies for learning in nursing students who have English as an additional language.

DESIGN

A meta-synthesis.

METHODS

A search for relevant reports published between January 2000 and July 2023 was conducted across four electronic databases. Reports focusing on learning experiences among EAL nursing students were eligible for inclusion. Qualitative data were analyzed using the thematic analysis technique and all included reports were appraised by the CASP checklist.

RESULTS

A total of 16 reports were included. The results exhibited that EAL nursing students faced multiple challenges like language barriers, balancing responsibilities, immigration issues, and more, but might benefit from a range of support systems and employ various strategies that enhance their skills and lead to academic success.

CONCLUSIONS

This meta-synthesis on EAL nursing students highlighted their complex academic journey with unique barriers, support systems, and strategies employed to achieve success. The findings also underscored a need for tailored support and inclusive curricula to address their unique needs, fostering an equitable learning environment and enabling their full academic potential in this population.

Self-regulated learning strategies adopted by successful Chinese nursing students in the process of learning Nursing English

As the number of foreign patients and the frequency of international academic exchanges increase, English proficiency has become increasingly essential for Chinese nurses in the treatment and nursing processes, clinical academic exchanges, and ongoing education. However, the overall English proficiency of Chinese nurses is generally inadequate, greatly depending on the English that they acquire during their nursing education. This study aims to explore the challenges encountered by Chinese EFL (English as a Foreign Language) nursing students in the process of learning Nursing English, along with the effective self-regulated learning strategies they adopt to overcome these challenges. Data were collected from nine Chinese EFL nursing students through their reflective journals and thematic analysis was applied. Data analysis revealed the variety of challenges EFL nursing students encountered, including language-related challenges, which are linguistic difficulties that relate to Nursing English learning itself, such as Nursing English vocabulary and terminology, English-to-English translation, limited listening comprehension, and the gap between textbook knowledge and its practical application; learner-related challenges, which are difficulties that affect students' emotional, affective, and mental state, primarily caused by uncertainty about the significance of Nursing English, the unexpected difficulty of Nursing English, and failing quizzes; and context-related challenges, which are difficulties relate to social, cultural, and educational context, such as insufficient learning resources, a lack of language environment, and peer pressure. To surmount these challenges, the participants adopted diverse self-regulated learning strategies, including setting goals, previewing in advance and reviewing in time, utilizing word roots, prefixes, and suffixes to facilitate vocabulary learning, repeating, practicing with sounds and writing systems, translating, highlighting and using imagery to overcome language-related challenges; believing in the usefulness and significance of Nursing English, keeping a growth mindset, enjoying Nursing English learning and teacher support and maintaining grit in learning Nursing English to overcome learner-related challenges; and integrating resources, creating supportive language environments and seeking assistance from teachers and cooperating with peers to overcome context-related challenges. Based on these findings, implications are drawn for Nursing English teachers, material designers, curriculum developers, and program designers. We suggest incorporating explicit strategy instruction into regular Nursing English education to enhance nursing students' self-regulated learning.

Linguistically responsive learning and teaching for non-native speakers in undergraduate nursing education: a scoping review protocol

INTRODUCTION

Non-native-speaking nursing students as well as faculty, preceptors and mentors face specific issues related to language in undergraduate nursing education. A better understanding of the language experiences, needs, requirements, assessments and support activities will guide linguistically responsive learning and teaching and will direct future curriculum development. This scoping review aims to examine and map the extent of literature related to linguistically responsive learning and teaching for non-native speakers in undergraduate nursing education and to describe the lived experiences, barriers and facilitators, language needs, assessment tools and supportive interventions.

METHODS AND ANALYSIS

This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). In May 2023, a preliminary search was conducted. The comprehensive search will include MEDLINE (PubMed), CINAHL (EBSCO), ERIC (EBSCO) and MLA (EBSCO). OpenGrey (DANS) and reference lists of the included articles will be searched for grey literature and additional articles. Two independent reviewers will screen titles and abstracts, then review the full texts of articles. Data will be extracted using a data extraction form and will be presented in figures, tables and narrative syntheses, in line with the review questions. This review will include articles that describe the experiences of non-native-speaking nursing students, faculty or preceptors in undergraduate nursing education and clinical practice environment. Articles that report on language requirements, needs and assessment tools will also be considered as well as articles reporting on supportive activities and interventions within the study programmes. Articles related to exchange students or programmes will be excluded.

ETHICS AND DISSEMINATION

No ethical approval is required. The findings of the review will be disseminated through peer-review publication as well as oral and poster presentations at scientific conferences.

"A different country, a different language, a different culture…" Educational experiences of international nursing students studying in Turkey: A qualitative study

AIM

This study was aimed at investigating the educational experiences of international nursing students in Turkey.

BACKGROUND

Nursing education has now gained an international dimension, which creates an environment where students from different cultures come together. In Turkey, nursing education is expanding internationally due to the increasing number of international students.

DESIGN

A descriptive- phenomenological qualitative study.

METHODS

The study data were collected from nursing students who came to Turkey from 17 different countries between April 2023 and July 2023 to study at a nursing faculty in Turkey using a semi-structured interview form. Of these students, 27 constituted the study sample. The data collected were analyzed using the content analysis. The COREQ checklist was used in reporting the study.

RESULTS

Four themes emerged: a) challenges, b) gains, c) support needs and d) recommendations. Among challenges reported by the participating students were language barriers, cultural adjustment issues and lack of social support. As for the gains of being a foreign student, they stated that they experienced intercultural interaction and improved their language skills, independence and self-confidence. In the study, the need for language support, provision of psychological assistance and cultural adaptation support for these students and the importance of practical recommendations such as mentoring programs and orientation trainings to improve their educational experience were emphasized.

CONCLUSION

In conclusion, in this study, the importance of targeted strategies in nursing education in areas such as language support, psychological assistance and cultural adaptation was emphasized, which helps international students to have a successful educational experience. It was also concluded that mentoring programs and orientation trainings could enrich the educational processes of students by facilitating their adaptation to their new environment. This study is notable in the literature in that students from 17 diverse countries share the same program and the same prerequisites.

Understanding and optimising support resources to facilitate CALD student and supervisor allied health fieldwork experiences

BACKGROUND

Although fieldwork supervisors and culturally and linguistically diverse (CALD) students can experience challenges during allied health placements, there is little holistic understanding of how they view and use support resources to address these challenges. This study sought to identify, codify, and map the perceived value attached to support resources used or sought by CALD students and fieldwork supervisors and to ascertain areas where they could be optimised and better presented to users.

METHODS

We conducted a thematic analysis to examine interview and open-ended survey responses from CALD students (n = 18) and fieldwork supervisors (n = 161) respectively.

FINDINGS

The six generated themes depicted different patterns of perceived value in university and non-university support resources and spanned three levels of specificity: general, discipline-contextualised, and individualised. Fieldwork supervisors valued a staged approach to support resource design and use for CALD students commencing with general level resources to build foundational language skills and socio-cultural familiarisation and moving on to include disciple-contextualised supports, preplacement mechanisms to monitor student readiness, and formalised mechanisms to enable tailoring of placements. CALD students, however, often undervalued institutional general resources relative to discipline-contextualised resources. The commonality of support resources valued and sought by supervisors from different fields suggests they could be optimised for delivery via an inter-professional community of practice.

CONCLUSION

Identifying and mapping the perceived value attached to support resources provides actionable insights into how to enhance the 'fit' between resources and user needs. Drawing the often-fragmented support resources into a cohesive ecosystem focused around perceived value at different levels of specificity allows CALD students and educators to better conceptualise the types of benefits that can accrue from taking a broader and staged approach to fieldwork placement preparations. Knowing this ecosystem encapsulates what prior uses find of value may enhance perceptions of resource relevance in the minds of new users.

Agency in change: Learning experiences of international midwifery students in South Australia

PROBLEM

While literature reports broadly on the experiences of international students of health professions in higher education, the experience of students undertaking an undergraduate midwifery program outside their country of origin has not previously been reported.

BACKGROUND

Midwifery studies incorporate distinct clinical practice and discipline-specific therapeutic relationships which can challenge students familiar with the health system, so it is necessary to understand their impact on the learning needs of international students, who contribute to the diversity of our workforce.

AIM

To explore learning experiences of international students of an undergraduate midwifery program to identify their perceptions and personal strategies which impacted their participation in the program.

METHODS

A qualitative descriptive study, with a purposive sample of nine current international students and recent graduates of a midwifery program at a South Australian university. Participants attended a focus group or individual phone interview to explore their learning experiences, and data were thematically analysed.

FINDINGS

Five themes and sub-themes were identified, built around a core concept of the international midwifery student experience as agency in change: language and culture, teaching and learning, isolation and integration, services and support, and motivation and resilience. Studying abroad was associated with personal and professional growth. Continuity of care for women presented challenges and produced learnings unique to this cohort.

CONCLUSION

Tailored support, such as specialized clinical facilitation and organized peer networking, is required for international midwifery students in Australia. Additionally, effective approaches to facilitate bilingualism to support language concordant care are needed.

Ghanaian Erasmus+ students' experiences of a semester abroad during the COVID-19 pandemic

This article describes two Ghanaian students' experiences of connecting with learning, faculty, family and friends during an Erasmus+ semester abroad in Ireland during the COVID-19 pandemic. University faculty members' experiences are also explored. The students describe their experiences of adjusting to new ways of learning online and living through lockdown in a country far from home. These reflections highlight the students' positive learning experiences during a journey of both personal and professional development while also highlighting the challenges of converting to an online learning environment. These experiences illustrate the students' unexpected opportunities and challenges, demonstrating how support from the university faculty, Erasmus+ team and friends, both virtually and physically, helped them through this unprecedented time. This article presents an account of the students' and staff's learning experiences during a semester that was affected by the pandemic.

Exploring emotional and social competencies in undergraduate students: Perspectives from CALD and non-CALD students

With the internationalisation of higher education, students from culturally and linguistically diverse (CALD) backgrounds represent a significant proportion of the university student body in Australia. Research literature indicates that the unique cultural and linguistic challenges experienced by these students may adversely impact their academic performance and social integration in university settings. However, less is known about how the socio-emotional competencies of undergraduate CALD and non-CALD domestic English-speaking students compare. This cross-sectional quantitative study compares the emotional and social competencies in a cohort of CALD and non-CALD occupational therapy undergraduates. Data were collected at one Australian university from a group of 360 students enrolled in the Bachelor of Occupational Therapy (Honours) course. Participants completed the Emotional and Social Competency Inventory- University edition (ESCI-U). Multivariate regression analyses were used to compare between CALD and non-CALD students, controlling for students' year level of study, age, and gender. Key findings from the regression analysis included the observation of indicate that non-CALD students having significant higher scores than CALD students on all the ESCI-U socio-emotional subscales, especially the Emotional Self-control, Achievement Orientation, Empathy and Teamwork from western perspectives. No difference was found between CALD and non-CALD student on two cognitive competencies- systems thinking and pattern recognition. These findings should be interpreted with caution considering CALD students may interpret the questions differently and demonstrate the competencies in different ways. Specific emotional and social competencies that need to be strengthened in students are discussed and recommendations are made to inform the preparation of evidence-based curricula.

Considerations for Addressing the Needs of Culturally and Linguistically Diverse Speech-Language Pathology Praxis Test Takers

PURPOSE

The primary purpose of this article is to explore the speech-language pathology (SLP) Praxis test, a barrier to culturally and linguistically diverse (CLD) individuals entering the profession, by investigating first-time pass rates and mean scores by test taker race/ethnicity. Other potential barriers to licensure and certification, as well as solutions for mitigating these barriers, will also be addressed.

METHOD

SLP Praxis test data from two windows of time, 2008-2011 and 2014-2020, were compared for the following: (a) proportions of test taker race/ethnicity relative to U.S. demographic estimates of racial/ethnic group proportions overall, (b) proportions of racial/ethnic groups, and (c) trends in test-taker mean scores by race/ethnicity. First-attempt pass rates by racial/ethnic groups were also calculated for the 2014-2020 testing window.

RESULTS

The percentage of some CLD SLP Praxis test-taker groups increased since the 2008-2011 testing window but is still not representative of U.S. racial/ethnic demographics. The first-attempt pass rates and overall mean scores of CLD test-taker groups remained substantially lower than White non-Hispanic/Latinx test takers.

CONCLUSIONS

Despite the encouraging trends in SLP Praxis test-taker racial/ethnic diversity, disparities persist between the racial/ethnic makeup of SLP Praxis test takers and the demographic makeup of the United States. Consequently, these disparities have implications for the continued lack of cultural representativeness seen in our workforce.

Factors Associated With Undergraduate Nursing Students' Academic and Clinical Performance: A Mixed-Methods Study

Background

There is conflicting and limited information regarding factors that influence undergraduate nursing students' academic and clinical performance prior to entry to practice.

Objective

To identify factors influencing the academic and clinical performance of undergraduate nursing students throughout the course.

Design

Mixed methods study utilizing a retrospective cohort and a qualitative study.

Setting

Monash University, Melbourne, Australia.

Participants

Longitudinal existing data of nursing undergraduate students who commenced in 2017 (n = 176) and 2018 (n = 76), and two focus groups with final year nursing students were analyzed.

Methods

Retrospective students' records were used to determine the students' academic and clinical performance using the weighted average mark (WAM) of the theoretical and clinical components of the curriculum, separately. The WAM considered the year level of each unit and was scored out of 100. Multivariate linear regression was used to determine predictor factors of academic and clinical performance. Variables include entry cohort (with no previous nursing qualification vs. diploma of nursing), admission category (domestic vs. international), campus (metropolitan vs. outer metropolitan), and secondary school (year 12) results. Two focus group discussions were conducted and thematically analyzed.

Results

More than two-thirds of the students were aged 18–20 years and mainly female. Almost 20% of the participants were international students. Students with higher secondary school (year 12) results and studying at the outer metropolitan campus achieved a higher academic performance while international students had significantly lower academic performance compared to domestic students. Students with a previous diploma of enrolled nursing and international students had lower clinical performance. Students identified that a comprehensive orientation, interactive curriculum, formal and informal support structure, and educator qualities influenced their academic and/or clinical performance.

Conclusions

A supportive educational environment with an interactive curriculum may enhance students' academic and clinical performance and readiness for practice. Furthermore, targeted interventions for international students, those with lower secondary school (year 12) results, and those with a former diploma of nursing may be required to increase academic and clinical performance.

RETRACTED: International nursing students' perceptions and experiences of transition to the nursing workforce - A cross-sectional survey

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/locate/withdrawalpolicy). This article has been retracted at the request of the authors because the data reported in the manuscript are likely to have been compromised. It came to the co-authors’ attention after the publication of the article that a large proportion of the surveys reported in the study had been completed by a respondent using the first author’s IP addresses. The authors would like to apologize to readers for this error.

Factors that influence international nursing students' experiences and perceptions of their learning environments: a scoping review protocol

OBJECTIVE

The objective of this review is to explore the research on factors that influence international undergraduate nursing students' experiences and perceptions of their learning environment.

INTRODUCTION

International nursing students bring valuable cultural and economic opportunities to universities and health care. It is important that their clinical learning experiences are positive. Factors that influence nursing students' experiences may include cultural and communication differences, diversity related to health care systems, learning and teaching strategies, and programs to improve communication. International nursing students' experiences and perceptions are reported in terms of expressed confidence, perceived competence, and levels of satisfaction. A scoping review is required to identify what is known and to identify the knowledge gaps in this area.

INCLUSION CRITERIA

International nursing students are those who are enrolled in an undergraduate nursing program in a higher-education institution in a country other than their own. International students studying vocational nursing and exchange students will be excluded. The learning environment is considered to be one in which any person who may influence patient care learns. Primary research, both qualitative and quantitative methods, published since 1995 in any language that the research team can translate will be included.

METHODS

This review follows the JBI methodology for scoping reviews. Data extraction will include the factors influencing students' experiences and the concepts that were explored. Data analysis will include frequencies of concepts and associations between them. Results will be presented in tabular form and mind maps.

SCOPING REVIEW REGISTRATION NUMBER

Open Science Framework (osf.io/r4v6q).

Initiation of student participation in practice: An audio diary study of international clinical placements

BACKGROUND

Differences in professional practice might hinder initiation of student participation during international placements, and thereby limit workplace learning. This study explores how healthcare students overcome differences in professional practice during initiation of international placements.

METHODS

Twelve first-year physiotherapy students recorded individual audio diaries during the first month of international clinical placement. Recordings were transcribed, anonymized, and analyzed following a template analysis approach. Team discussions focused on thematic interpretation of results.

RESULTS

Students described tackling differences in professional practice via ongoing negotiations of practice between them, local professionals, and peers. Three themes were identified as the focus of students' orientation and adjustment efforts: professional practice, educational context, and individual approaches to learning. Healthcare students' initiation during international placements involved a cyclical process of orientation and adjustment, supported by active participation, professional dialogue, and self-regulated learning strategies.

CONCLUSIONS

Initiation of student participation during international placements can be supported by establishing a continuous dialogue between student and healthcare professionals. This dialogue helps align mutual expectations regarding scope of practice, and increase understanding of professional and educational practices. Better understanding, in turn, creates trust and favors meaningful students' contribution to practice and patient care.

Challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries: a scoping review with a gender lens

Background

International and migrant students face specific challenges which may impact their mental health, well-being and academic outcomes, and these may be gendered experiences. The purpose of this scoping review was to map the literature on the challenges, coping responses and supportive interventions for international and migrant students in academic nursing programs in major host countries, with a gender lens.

Methods

We searched 10 databases to identify literature reporting on the challenges, coping responses and/or supportive interventions for international and migrant nursing students in college or university programs in Canada, the United-States, Australia, New Zealand or a European country. We included peer-reviewed research (any design), discussion papers and literature reviews. English, French and Spanish publications were considered and no time restrictions were applied. Drawing from existing frameworks, we critically assessed each paper and extracted information with a gender lens.

Results

One hundred fourteen publications were included. Overall the literature mostly focused on international students, and among migrants, migration history/status and length of time in country were not considered with regards to challenges, coping or interventions. Females and males, respectively, were included in 69 and 59% of studies with student participants, while those students who identify as other genders/sexual orientations were not named or identified in any of the research. Several papers suggest that foreign-born nursing students face challenges associated with different cultural roles, norms and expectations for men and women. Other challenges included perceived discrimination due to wearing a hijab and being a ‘foreign-born male nurse’, and in general nursing being viewed as a feminine, low-status profession. Only two strategies, accessing support from family and other student mothers, used by women to cope with challenges, were identified. Supportive interventions considering gender were limited; these included matching students with support services' personnel by sex, involving male family members in admission and orientation processes, and using patient simulation as a method to prepare students for care-provision of patients of the opposite-sex.

Conclusion

Future work in nursing higher education, especially regarding supportive interventions, needs to address the intersections of gender, gender identity/sexual orientation and foreign-born status, and also consider the complexity of migrant students’ contexts.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00678-0.

International nursing students' and international nursing graduates' experiences of transition to the nursing workforce: A systematic review of qualitative evidence

OBJECTIVE

The objective of this systematic review was to identify and synthesise existing evidence on the experiences of international nursing students' and international nursing graduates' transition to the host country's nursing workforce.

BACKGROUND

International students' experiences of transition to the host country has been extensively explored by researchers. International students experience unique challenges related to communication and language, socialisation, finance, and temporary student visa. One under-researched area is the experiences of transition for international nursing students and international nursing graduates. This systematic review examined the existing evidence on international nursing students' and international nursing graduates' experiences of transition to the host country's nursing workforce.

INCLUSION CRITERIA

This review considered published and unpublished studies-qualitative, quantitative, mixed methods, evidence syntheses, and grey literature-that included international nursing students enrolled in an undergraduate nursing programme outside their home country and international nursing graduates, either employed or not yet employed in nursing and within their first year of completing an undergraduate nursing programme outside their home country.

METHODS

A three-step search strategy was utilised in this review. The search strategy aimed to find published and unpublished literature in English from January 2000 to April 2020. The databases searched were Ovid Medline, Scopus, Emcare, ERIC, PsycINFO, ProQuest Central, ProQuest Dissertations and Theses Global, JBI Evidence-based Practice Database, and ScienceDirect. Two reviewers independently screened the titles/abstracts and full texts of studies for inclusion and appraised the methodological quality of the included studies. Findings and accompanying illustrations were extracted by one reviewer, assigned a level of credibility, and checked by the others. Results were analysed using JBI's approach to qualitative meta-aggregation.

RESULTS

This review included three qualitative papers published between 2011 and 2018. All included studies were appraised as of moderate quality. Sixty-five study findings and nineteen categories were aggregated into the following six synthesised findings: international nursing graduates developed confidence and satisfaction through challenges; personal challenges; clinical challenges; discrimination and justice; academic barriers to success; and what international nursing students liked and wanted.

CONCLUSION

The synthesised findings revealed ongoing anxiety, lack of preparedness and role uncertainty that was experienced by international nursing students and international nursing graduates as they transition to the host country's nursing workforce. They expressed the need for information about professional role expectations, guidance, and support to transition. University transition programmes and services could provide support to address the workforce transition challenges faced by international nursing students and international nursing graduates.

TWEETABLE ABSTRACT

Systematic review shows international nursing students and international nursing graduates experience anxiety, limited preparedness and role uncertainty when transitioning to the host country's nursing workforce.

English-As-A-Second-Language (ESL) Nursing Students' Academic Integration: A Review of Literature

AIM

The purpose of this literature review is to provide nurse educators with the evidence necessary to support future research and expansion of programs for English-as-a-second-language (ESL) nursing students.

BACKGROUND

Nursing education has expanded significantly in response to the Institute of Medicine's 2010 call for an increase in the number of baccalaureate-prepared nurses. The demographics of nursing students have also grown to include those who are ethnically and linguistically diverse. This literature review presents a robust compilation of evidence providing insight into the integration experience of nursing students from diverse cultural and language backgrounds.

METHOD

Peer-reviewed articles, along with other seminal sources, were identified.

RESULTS

The evidence highlights student challenges with academic language, cultural stressors, and faculty support.

CONCLUSION

Findings indicate that ESL nursing students experience challenges with academic integration. Future research can provide insight into how these students navigate specific learning environments.

The learning experiences of international students in nursing and midwifery programs: A literature review

Globally, education continues to diversify, with a growing body of literature that describes the experiences of international higher education students. While the research includes representation from the health sciences, nursing and midwifery programs are underrepresented; understanding the experiences of international students therein may assist in determining whether discipline-specific teaching, learning and support is required. This review aims to summarise international nursing and midwifery students' perceptions of challenge and enablement when undertaking an undergraduate or baccalaureate program. A total of 408 articles were identified and after duplicates were removed and inclusion/exclusion criteria applied, eight primary studies were included. No papers were identified that reported on the experiences of international midwifery students. For international nursing students, five themes emerged: language and culture, isolation and segregation, teaching and learning, services and support, and resilience and growth. This review concludes that the available data both affirms the existing body of knowledge around international students and illuminates unique challenges and opportunities for nursing students undertaking clinical placements. There is a need for increased language and peer support, socialisation and specially educated support staff. Research is required to identify best practice in teaching methodology for an increasingly diverse cohort and importantly, to provide a midwifery perspective.

Occupational therapy practice education: A perspective from international students in the UK

Background: Numbers of international students enrolling on occupational therapy (OT) courses in Western institutions have increased. Previous examination of these students' experience of practice education is limited.Objective: To explore the opportunities and challenges experienced by international students in OT practice education.Methods: This study adopted a phenomenological approach, recruiting six individuals from three UK universities. Data from semi-structured interviews was given thematic analysis for result interpretation.Results: Participants identified learning OT in the workplace, working in a multidisciplinary team and personal and professional development as practice education opportunities. Language difficulties, differences in communication styles, multiple cultural differences and unfamiliarity with the National Health Service (NHS) were the main challenges. Good practice educators and supportive team members were the main contributors to positive placement experiences.Conclusions: Participants gained knowledge and skills from practice education that existing healthcare literature suggests they are expected to attain. Several challenges were highlighted regarding participation in practice education. The findings reveal a need to enhance practice educators' skills in supervising international students. Universities are recommended to invest time and resources in supporting the learning needs of these students.Significance: The first study to present international students views on OT pre-registration practice placements in the UK.

Being an international nursing student in Turkey: A qualitative study

PURPOSE

The purpose of this study is to explore the perspectives of international nursing students in Turkey on their learning experience.

DESIGN AND METHODS

Qualitative semi-structured individual interviews and focus group interviews were used to explore nursing students' perspectives on their learning experiences in Turkey. The research population comprised 10 international students.

RESULTS

The students expressed fear of being rejected by patients in a clinical setting, as well as feelings of isolation and discrimination. They feel foreign and experience the typical prejudice against their color and language.

PRACTICE IMPLICATIONS

Educators should take language and cultural differences into consideration and should listen to international students regarding education methods. Teachers of international students, both academic and clinical, need to be cognizant of the "otherness" of international students.

Us and them: The experience of international nursing students engaged in team based learning: A qualitative descriptive study

BACKGROUND

International students report multiple challenges adjusting to educational settings. Instructional strategies such as Team Based Learning (TBL), could provide international students with opportunities that promote academic success, language skills and social connectedness. However, little is known about international students' experience of TBL. The aim of this study was to explore culturally and linguistically diverse (CALD) students' experiences of TBL.

METHODS

This paper reports on a qualitative study that explored the experiences of 15 international students enrolled in an Australian university nursing program, where TBL is used.

RESULTS

Findings indicate that TBL promotes language proficiency and respectful intercultural connections. It also uncovered an unintentional benefit of TBL in interrupting racism towards international students from domestic students. However, it is not enough to rely on TBL to mitigate the impact of racial and cultural power dynamics in educational settings.

CONCLUSION

To improve international student experiences, educators must actively engage students in dialogue about privilege and structural racism as it relates to international students and other people of colour.

Clinical mentors' experiences of their intercultural communication competence in mentoring culturally and linguistically diverse nursing students: A qualitative study

BACKGROUND

Intercultural communication has become increasingly important in nursing due to the cross-border mobility of patients, health professionals and students. Development of cultural competence continues to be a challenge, particularly among professionals such as educators or healthcare providers who work in professions requiring communication across cultural boundaries. Despite challenges in nursing education related to cultural diversity, competence in intercultural communication has been proven to empower students and to help them grow professionally.

OBJECTIVES

The aim of this study was to describe clinical mentors' experiences of their intercultural communication competence in mentoring culturally and linguistically diverse nursing students during completion of their clinical practice.

DESIGN

Qualitative study design.

PARTICIPANTS

The participants were 12 nurses who had previously mentored at least two culturally and linguistically diverse nursing students.

METHODS

Data were collected during spring 2016 using semi-structured interviews of 12 mentors working in specialized nursing care at one hospital located in central Finland. Data were analyzed using deductive-inductive content analysis. The main concepts of the Integrated Model of Intercultural Communication Competence were used during the semi-structured theme interviews and during analysis. These concepts include empathy, motivation, global attitude, intercultural experience and interaction involvement.

RESULTS

Mentors stated that empathy motivates them in the development of intercultural communication. Mentors experienced a lack of resources and support from their superiors, which caused psychological and ethical strain and reduced mentors' motivation. Mentors openly admitted that they had experienced fear towards unknown cultures, but that this fear was reduced through positive mentoring experiences and cultural encounters.

CONCLUSIONS

Continuous education on intercultural communication competence could succeed to further develop clinical mentors' mentoring expertise, which could have the potential to greatly benefit students, patients and staff. Such education could be designed, implemented and measured for its effect in collaboration between health care organizations and higher educational institutions.

Highlights From an English-as-an-Additional-Language Nursing Support Program

English-as-an-additional-language nursing students are more likely to experience academic challenges than nursing students whose primary language is English. In an attempt to improve the learning environment for this group of students, a novel support group was established to address both academic and nonacademic issues. The impact and effectiveness of this support group are explored using an interpretative analytic approach. The findings suggest that English-as-an-additional-language support programs based on the principles of academic safety, purposeful design, curriculum relevance, positive faculty influence, and proactive enrollment have the most potential to facilitate student success.

Culturally and linguistically diverse healthcare students' experiences of the clinical learning environment and mentoring: A qualitative study

Development of educators' and students' global competence in higher education is increasingly important due to internationalization. Internationalization significantly influences healthcare education through an increase in the mobility of students. When conducting clinical practice in healthcare education, culturally and linguistically diverse healthcare students face the challenges of having limited learning opportunities and social isolation. Further investigation is required of students' experiences in this area while asking them to share their experiences. This study aimed to describe students' experiences of clinical learning environment and mentoring. A qualitative research design was used during 2013-2016. Data were collected from 133 culturally and linguistically diverse healthcare students, including exchange students and students studying in English language-taught degree programmes at eight Universities of Applied Sciences in Finland. Data were analysed using inductive content analysis. Students' experiences were related to their mentors' competence in mentoring, culturally diverse pedagogical atmosphere, and aspects of diversity that influence clinical learning. Students reported that they had experienced social isolation, discrimination, bullying, sexual harassment and prejudice during their clinical placements. These issues related to mistreatment of students need to be addressed. Also, structured clinical environments should be developed in which competent mentors assist students in reaching their clinical placement goals.

Learning to interact and interacting to learn: a substantive theory of clinical workplace learning for diverse cohorts

Social interactions are integral to clinical workplace functioning and are recognised to play an important role in clinical workplace learning. How, why and to what end students, in the context of today's culturally and linguistically diverse cohorts, interact with members of clinical workplace communities during clinical workplace learning is not well understood. The aim of this research was to generate a theoretical understanding of students' interactive processes in clinical workplace learning that accounted for high levels of cultural/linguistic diversity. In accordance with constructivist grounded theory methods, data collection and analysis were premised on theoretical sampling and constant comparative analysis, and undertaken from an informed and reflexive stance. This involved iterations of survey, interview and diary data from two diverse cohorts of final year veterinary students who had undergone 11 months of clinical workplace learning. Clinical preceptors were also interviewed. As an aid to theory building, testing and refinement, and in order to test the theory's relevance, usefulness and transferability beyond veterinary clinical education, critical feedback was sought from medical and allied health educators. Our substantive level theory demonstrates that upon entering the clinical workplace community, students learn how to 'harness dialogue' in order to effectively coordinate three, inter-related interactive processes: (i) functioning in the workplace, (ii) impression management and (iii) learning-in-the-moment. We found both positive and negative consequences ensued, depending on how students harnessed dialogue. The theory responds to a perceived need in international student education to move away from a deficit discourse by developing educational theory which focuses on the nature of participation, rather than the nature of the student.

Predictors of academic honesty and success in domestic and international occupational therapy students

Purpose

Academic integrity is the application of honest, ethical and responsible behaviours to all facets of students’ scholarly endeavours and is the moral code of academia. The international literature reports the prevalence of academic dishonesty in higher education across many disciplines (including the health sciences), and there is evidence linking academic dishonesty in health professional students with future unprofessional behaviour in the workplace. International students are reported to be a particularly vulnerable group. This paper aims to investigate the factors that may be predictive of academic honesty and performance in domestic and international occupational therapy students.

Design/methodology/approach

In total, 701 participants (603 domestic students; 98 international students) were recruited from five Australian universities, and data were collected via a two-part self-report questionnaire. ANOVA and multi-linear regression analyses with bootstrapping were completed.

Findings

Tendency towards cheating and self-perception tendency towards dishonesty in research, gender, age and hours spent in indirect study were found to be statistically significant predictors of academic integrity and performance.

Research limitations/implications

Limitations of this study were the use of convenience sampling and self-report scales which can be prone to social desirability bias. Further studies are recommended to explore other potential predictors of academic honesty and performance in occupational therapy students.

Originality/value

A range of predictors of academic honesty and success were found that will assist educators to target vulnerable domestic and international occupational therapy students as well as address deficiencies in academic integrity through proactive strategies.

Becoming a nurse preceptor, the challenges and rewards of novice registered nurses in high acuity hospital environments

Precepting is a common and expected role of nurses in clinical settings worldwide. This research explored novice nurse's experiences of precepting undergraduate nursing students in high-acuity hospital environments. An interpretive study was undertaken with 12 novice nurses (<3-years of post-registration clinical experience), who were precepting nursing students. Data was collected through focus groups and thematically analysed. The zone of proximal development theory was applied to understand the relationship of learning that occurs between students and nurses. Three themes were identified. Firstly, participants established that precepting students enhanced their own self-development, and was a rewarding role, that not only developed the student into a nurse, but provided opportunities for the novice nurse to learn. Second, precepting was both challenging and rewarding. The challenges involved the student, the context, and the preceptors' own teaching and learning skills, resulting in feelings of frustration and conflict between nursing care and preceptor roles. Third, precepting was an expectation of both the nursing role and from senior nurses. At times, the participants felt overwhelmed and drained, particularly when having students that challenged them on multiple consecutive shifts. Participants identified the need for guidance and support from more capable peers to develop confidence while precepting nursing students.

The effects of clinical facilitators' pedagogic practices on learning opportunities for students who speak English as an additional language: An ethnographic study

BACKGROUND

Increasing numbers of undergraduate nursing students speak English as an additional language. Clinical placements can be difficult for many of these students and their clinical facilitators. The causes of challenges are often reported to be students' lack of English language ability or, for some students, learning styles that are not suited to Western style education.

OBJECTIVE

The purpose of this research was to investigate how clinical facilitators' pedagogic practices in hospital settings enabled or constrained the learning of students for whom English was an additional language.

METHOD

This research used an ethnographic design to observe the interactions of twenty-one first year students for whom English is an additional language, and their three facilitators. Observations occurred during three two-week clinical placement blocks, in three large metropolitan hospitals in Australia. Written ethnographic field notes were made during the observations. Field notes were analysed in two stages: firstly, to identify major themes, and secondly, to map the spaces and activities where facilitators and students interacted.

RESULTS

The study found that there were multiple learning spaces in the hospitals, each of which was associated with particular learning activities between facilitators and students. These activities provided access to opportunities for learning core nursing skills, as well as for socialisation into the language of nursing. However, not all students had access to these opportunities. The pedagogic practices facilitators used created or constrained learning opportunities for students.

CONCLUSION

This paper proposes a new way of thinking about the supervision of students for whom English is an additional language in clinical settings. Rather than focusing on a lack of English language proficiency or cultural heritage factors, it proposes that a guided approach to using spaces and activities can maximise students' opportunities for learning.

Occupational therapy international undergraduate students’ perspectives on the purpose of practice education and what contributes to successful practice learning experiences

Introduction

Practice placements (also referred to as fieldwork) are a significant component of occupational therapy education. For international students enrolled in occupational therapy education programmes outside their own country, completing practice placements can be challenging. There is scarce literature that examines the perspectives of international students undertaking practice placements. The study’s aim was to understand international students’ perceptions, what they believe to be the purpose of practice placements and what attributes contribute to successful practice education.

Method

Qualitative, semi-structured interviews were used to elicit the perspectives of seven fourth-year international undergraduate occupational therapy students enrolled at an Australian university.

Results

Thematic analysis identified two key themes: ‘the purpose of practice placements’ (sub-themes: translating knowledge into practice, adapting to real life experiences and building our communication skills), and ‘a successful practice placement’ (sub-themes: the environment, the clinical educator and my responsibilities).

Conclusion

Findings identified what international occupational therapy students believed to contribute to a positive and quality practice placement. All students valued the opportunities that practice education afforded, including developing communication skills and integrating theory into practice. These findings will assist academic and practice educators in the delivery of high quality practice education placement learning experiences for international students.

Exploring similarities and differences among the self-reported academic integrity of Australian occupational therapy domestic and international students

BACKGROUND

Research into the prevalence of dishonest academic behaviours suggests that such behaviours may be extensive among international students in higher education.

OBJECTIVE

To compare the academic integrity of domestic and international occupational therapy students and identify possible contributors to students' engagement in dishonest academic behaviours.

DESIGN

A quantitative cross-sectional study using a survey containing several standardised scales was used to collect the data.

SETTINGS

Five Australian universities.

PARTICIPANTS

701 occupational therapy students.

METHODS

Students completed a self-report questionnaire comprising demographic questions and six standardised scales: Academic Dishonesty Scale; Academic Dishonesty in the Classroom Setting Scale (ADCS); Academic Dishonesty in the Clinical/Practice Education Setting Scale; Moral Development Scale for Professionals; Academic Dishonesty Tendency Scale; and Perceived Academic Sources of Stress. One-way analysis of variance (ANOVA) was conducted to compare the scores of domestic and international students on academic dishonesty factors, moral development, and perceived sources of academic stress.

RESULTS

Significant differences between domestic and international students were observed on age; grade point average; hours per week spent in paid work; moral practice; tendency towards cheating; tendency towards cheating in research assignments; pressures to perform; and self-perception. No significant differences were found on students' self-reported scores on academic dishonesty in academic classroom education contexts, fieldwork practice education settings or perceived stresses of workload and examinations and time restraints.

CONCLUSIONS

The reported incidences of dishonest academic behaviours in the classroom and fieldwork settings were low for all occupational therapy students, irrespective of origin and were comparable to findings from cohorts of other health professional students. However, concomitant with existing research, international students were found to have a greater tendency to engage in dishonest behaviours particularly on research assignments. This may be reflective the socio-cultural issues and external pressures that international students experience. Further study in this area is recommended.

Am I Being Understood? Veterinary Students' Perceptions of the Relationship between Their Language Background, Communication Ability, and Clinical Learning

During clinical workplace learning, effective communication between veterinary students and clinical staff is of paramount importance to facilitating learning, assessment, and patient care. Although studies in health sciences education have indicated that students may experience communication difficulties as a result of linguistic, cultural, and other factors and that these difficulties can affect clinical learning and academic outcomes, this has not yet been explored in veterinary clinical educational contexts. In this study, the authors sought to identify whether final-year veterinary students perceived that their communication ability influenced their clinical learning and, if so, whether language background was of significance. Seventy-one students from a final-year cohort at an Australian veterinary school completed a student perception survey at the end of their clinical training. Exploratory factor analysis was used to investigate the extent to which learners perceived that their communication ability influenced their clinical learning. Two factors explained 72.3% of total variance. Factor 1 related to communication ability as a source of concern; Factor 2 related to comprehending and contributing to clinical conversations. Communication ability as a source of concern differed significantly ( p < .001) between students who did and did not have an English-speaking background, but there was no significant difference between these two student groups for Factor 2. Although language background was associated with self-perceived communication ability, evidence also emerged that students may experience communication challenges during clinical learning, irrespective of their language background.

Exploring nursing students' experiences of a drop-in support-centre: A mixed-methods study

BACKGROUND

The increased use of blended learning approaches in undergraduate nursing programs has resulted in reduced on-campus contact with academic staff and other students.

OBJECTIVES

To explore student's experiences of a Drop-In-Support-Centre and assess the impact of attendance on academic performance.

DESIGN

Concurrent mixed-methods.

SETTING

A large metropolitan, multi-campus university in Sydney, Australia.

PARTICIPANTS

Undergraduate nursing students enrolled in a 3-year Bachelor of Nursing program.

METHODS

In March 2016, to support students' learning, a weekly Drop-In-Support-Centre (DISC) initiative was piloted. The DISC provided an informal, learning space one day a week for students to access academic support. Baseline quantitative data was extracted from the University administrative dataset with a 12-month follow-up Grade Point Average (GPA) in January 2017. Attendance at the DISC was collected progressively throughout 2016. Qualitative data were collected using semi-structured interviews.

RESULTS

Of 1016 undergraduate nursing students enrolled on the campus, 163 (16%) attended DISC at least once. Attendees were older, more likely to be Overseas-born (74% versus 45% native-born, p < 0.001). Sub-group analysis of first year students revealed attendees had a higher grade point average than non-attendees (4.20 versus 3.85, p = 0.005). Controlling for demographic factors, they were over three times more likely (Adjusted Odds Ratio: 3.75, 95% CI: 1.44-9.78) to achieve a higher GPA (>4.0) compared to non-attendees. Thirteen students were interviewed. Two main themes emerged; 1) 'Home away from home' and 2) 'A sense of community: Everyone supports each other' with three accompanying sub-themes.

CONCLUSIONS

This study supports the usefulness of a Drop-In-Support-Centre in enhancing students' learning experiences and outcomes. The success of the program is highlighted by an improvement in academic performance of students who attended the DISC.

Conflict between nursing student's personal beliefs and professional nursing values

BACKGROUND

Studies have established that negative perceptions of people living with HIV/AIDS exist among nursing students throughout the world, perceptions which can be detrimental to the delivery of high-quality nursing care.

OBJECTIVES

The purpose of this research was to explore socio-cultural influences on the perceptions of nursing students towards caring for people living with HIV/AIDS.

RESEARCH DESIGN

The study was guided by stigma theory, a qualitative descriptive research approach was adopted. Data collected via semi-structured interviews were thematically analysed.

PARTICIPANTS AND RESEARCH CONTEXT

Participants were 21 international and Australian undergraduate nursing students enrolled in a Bachelor of Nursing programme at an Australian university.

ETHICAL CONSIDERATIONS

Ethical approval was granted by the Social and Behavioural Research Ethics Committee at the study university. Participation was entirely voluntary; informed consent was obtained before the study commenced; confidentiality and anonymity were assured.

FINDINGS

Three major themes were found: blame, othering and values. Complex and interrelated factors constructed participant perceptions of people living with HIV/AIDS, perceptions underscored by the prevailing culturally construed blame and othering associated with HIV/AIDS. The study found discordance between the negative personal beliefs and perceptions some nursing students have towards people living with HIV/AIDS, and the professional values expected of them as Registered Nurses.

DISCUSSION

There was considerable commonality between this and previous studies on how homosexuality and illicit drug use were perceived and stigmatised, correlating with the blame directed towards people living with HIV/AIDS. These perceptions indicated some nursing students potentially risked not fulfilling the ethical and professional obligations the Registered Nurse.

CONCLUSION

Nursing curriculum should be strengthened in relation to comprehending the meaning of being stigmatised by society. Educational institutions need to work towards enhancing strategies that assist nursing students to reconcile any incongruity between their personal beliefs and requisite professional nursing values.

Clinical learning environment and supervision of international nursing students: A cross-sectional study

BACKGROUND

Previously, it has been shown that the clinical learning environment causes challenges for international nursing students, but there is a lack of empirical evidence relating to the background factors explaining and influencing the outcomes.

OBJECTIVE

To describe international and national students' perceptions of their clinical learning environment and supervision, and explain the related background factors.

DESIGN

An explorative cross-sectional design was used in a study conducted in eight universities of applied sciences in Finland during September 2015-May 2016.

METHODS

All nursing students studying English language degree programs were invited to answer a self-administered questionnaire based on both the clinical learning environment, supervision and nurse teacher scale and Cultural and Linguistic Diversity scale with additional background questions. Participants (n=329) included international (n=231) and Finnish (n=98) nursing students. Binary logistic regression was used to identify background factors relating to the clinical learning environment and supervision.

RESULTS

International students at a beginner level in Finnish perceived the pedagogical atmosphere as worse than native speakers. In comparison to native speakers, these international students generally needed greater support from the nurse teacher at their university. Students at an intermediate level in Finnish reported two times fewer negative encounters in cultural diversity at their clinical placement than the beginners.

CONCLUSION

To facilitate a successful learning experience, international nursing students require a sufficient level of competence in the native language when conducting clinical placements. Educational interventions in language education are required to test causal effects on students' success in the clinical learning environment.

Mentor experiences of international healthcare students' learning in a clinical environment: A systematic review

BACKGROUND

Globalisation has brought new possibilities for international growth in education and professional mobility among healthcare professionals. There has been a noticeable increase of international degree programmes in non-English speaking countries in Europe, creating clinical learning challenges for healthcare students.

OBJECTIVE

The aim of this systematic review was to describe mentors' experiences of international healthcare students' learning in a clinical environment. The objective of the review was to identify what influences the success or failure of mentoring international healthcare students when learning in the clinical environment, with the ultimate aim being to promote optimal mentoring practice.

DESIGN

A systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination.

DATA SOURCES

Seven electronic databases were used to search for the published results of previous research: CINAHL, Medline Ovid, Scopus, the Web of Science, Academic Search Premiere, Eric, and the Cochrane Library.

REVIEW METHODS

Search inclusion criteria were planned in the PICOS review format by including peer-reviewed articles published in any language between 2000 and 2014. Five peer-reviewed articles remained after the screening process. The results of the original studies were analysed using a thematic synthesis.

RESULTS

The results indicate that a positive intercultural mentor enhanced reciprocal learning by improving the experience of international healthcare students and reducing stress in the clinical environment. Integrating international healthcare students into work with domestic students was seen to be important for reciprocal learning and the avoidance of discrimination.

CONCLUSION

Many healthcare students were found to share similar experiences of mentoring and learning irrespective of their cultural background. However, the role of a positive intercultural mentor was found to make a significant difference for international students: such mentors advocated and mediated cultural differences and created a welcoming environment for international students by helping to minimise feelings of social isolation.