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.

Supporting culturally and linguistically diverse (CALD) undergraduate nursing students undertaking clinical placements in Australia: An exploratory qualitative study of clinical facilitator and CALD student perceptions

BACKGROUND

Internationalisation of higher education has contributed to the increasing number of culturally and linguistically diverse students in higher education programs worldwide. While there is some literature on the experiences and needs of these students, there is little evidence on what resources can be used to support these students when learning in the clinical setting.

AIM

This study aimed to evaluate the usefulness of an existing handbook developed for clinical facilitators to enhance culturally and linguistically diverse nursing students' learning, and to explore the facilitator and student perceptions of their clinical placement support needs.

DESIGN

This exploratory qualitative study, involving culturally and linguistically diverse Bachelor of Nursing students and clinical educators, was conducted in a multi-campus School of Nursing and Midwifery at Griffith University, Australia, in collaboration with health services. Focus groups and individual interviews with clinical facilitators and culturally and linguistically diverse nursing students were conducted. Activity theory provided the conceptual framework for this study and the qualitative data analysis was informed by grounded theory.

RESULTS

Clinical facilitator focus groups and interviews generated three themes: understanding culturally and linguistically diverse students' needs; supporting culturally and linguistically diverse students; and improving learning resources for facilitators and students. Student focus groups generated three themes: wanting to be more prepared for clinical placement; feeling supported by facilitators and interacting with others in a different context; and creating resources to support learning.

CONCLUSIONS

Supportive clinical environments are key to the work-integrated learning success of culturally and linguistically diverse nursing students. The findings of this qualitative research study, involving clinical educators and culturally and linguistically diverse Bachelor of Nursing students identify the pressing need to develop readily accessible resources to support the clinical learning of culturally and linguistically diverse students and their educators. Resources development should be attentive to complexities at the intersection of workplace culture and students' developing understanding.

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.

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.

Language support improves oral communication skills of undergraduate nursing students: A 6-month follow-up survey

BACKGROUND

With the widening of participation in higher education, it is essential in the discipline of nursing that students are able to communicate proficiently to deliver quality patient care. However, undergraduate students can experience significant difficulties with spoken communication critical to professional nursing, which places them 'at risk' of failure during the nursing course.

OBJECTIVES

To examine the relationship between students' use of academic literacy support and oral communication skills.

DESIGN

Prospective, correlational survey design.

SETTING

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

PARTICIPANTS

A total of 1699 assessment ratings of first and second year nursing students were completed at both baseline and at the 6-month follow-up in 2015.

METHODS

The CLIP index was embedded as an assessment requirement in four clinical skills-based units and assessed at the end of each semester in the first two years of the Bachelor of Nursing program. In this study, first and second year students were assessed in Semester 1 at baseline and also six months later in Semester 2.

RESULTS

From Semester 1 to Semester 2, the mean CLIP scores improved from 15.8 (SD: 3.7) to 17.2 (SD: 3.3) and all four components of the mean CLIP index improved. The smallest improvement was in the area of pronunciation while the lexical component had the greatest improvement. In addition, students who attended an academic literacy consultation or workshop for oral language support were over 1.5 times more likely to achieve an improvement in CLIP score (AOR: 1.58, 95% CI: 1.26 to 1.98).

CONCLUSION

The CLIP tool can be used to track and monitor students' oral language skills over the course of their study, and identify 'at risk' students requiring additional support through on-campus language support programs.

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.

Can Nursing Students Practice What Is Preached? Factors Impacting Graduating Nurses' Abilities and Achievement to Apply Evidence-Based Practices

BACKGROUND

In order to meet national Australian nursing registration requisites, nurses need to meet competency requirements for evidence-based practices (EBPs).

AIMS

A hypothetical model was formulated to explore factors that influenced Australian nursing students' ability and achievement to understand and employ EBPs related to health care provision.

METHODS

A nonexperimental, descriptive survey method was used to identify self-reported EBP efficacy estimates of 375 completing undergraduate nursing students. Factors influencing participants' self-rated EBP abilities were validated by Rasch analysis and then modeled using the partial least squares analysis (PLS Path) program.

RESULTS

Graduating nursing students' ability to understand and apply EBPs for clinical improvement can be directly and indirectly predicted by eight variables including their understanding in the analysis, critique and synthesis of clinically based nursing research, their ability to communicate research to others and whether they had actually witnessed other staff delivering EBP.

LINKING EVIDENCE TO ACTION

Forty-one percent of the variance in the nursing students' self-rated EBP efficacy scores is able to be accounted for by this model. Previous exposure to EBP studies facilitates participants' confidence with EBP, particularly with concurrent clinical EBP experiences.

A systematic review of assessment and intervention strategies for effective clinical communication in culturally and linguistically diverse students

OBJECTIVE

Culturally and linguistically diverse (CALD) students often experience difficulties with the clinical communication skills that are essential for successful interactions in the workplace. However, there is little evidence on the effectiveness of assessment and intervention strategies for this population. The two aims of this study were: to evaluate the effectiveness of assessment tools in identifying and describing the clinical communication difficulties of CALD health care students; and to determine whether communication programmes improved their clinical communication skills.

METHODS

Systematic review based on the Cochrane protocol. Articles were identified through a search of established databases using MeSH and key search terms. Studies published in English from 1990 to March 2015 were included if they described assessment strategies or a training programme for communication skills of CALD students. Studies were excluded if they did not describe implementation of a specific assessment or intervention programme. Data were extracted independently by the first author and verified by the second author. Quality was measured by the Best Evidence Medical Education guide and the Educational Interventions Critical Appraisal Tool. The Kirkpatrick hierarchy was used to measure impact. Meta-analysis was not conducted because of the heterogeneity of programme design and outcome measures.

RESULTS

One hundred and twenty-nine articles met the criteria for full text review. Eighty-six articles were excluded. Thirteen articles addressing assessment and 30 articles reporting on communication training programmes were included in this review. Assessment tools used rubrics and rating scales effectively. Intervention studies focused on speech and language skills (n = 20), interpersonal skills (n = 7) and faculty-level support (n = 5). Although 17 studies reported positive findings on student satisfaction, only eight reported improved skills post-training.

CONCLUSIONS

The development of effective assessment and intervention programmes should have an integrated design and include specific outcome measures to increase educational impact.

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.

The critical factors that influence faculty attitudes and perceptions of teaching English as Second Language nursing students: A grounded theory research study

BACKGROUND

As the demographics of the United States change, nursing will need to become more ethnically diverse in order to provide culturally responsive healthcare. Enrollment of English as Second Language nursing students is increasing; however, these students often encounter academic difficulties. The increase in English as Second Language nursing students in the classroom and clinical setting has posed challenges for nurse faculty.

OBJECTIVE

To explore the critical factors that influence faculty attitudes and perceptions of teaching English as Second Language nursing students.

DESIGN

A grounded theory method based on the philosophical underpinnings of symbolic interactionism and pragmatism was used to explore the critical factors that influence faculty attitudes and perceptions of teaching English as Second Language nursing students.

SETTINGS

The study took place at various schools of nursing in the Southeast Florida area.

PARTICIPANTS

Educators teaching in an associate, baccalaureate, and/or graduate nursing program at an accredited school of nursing.

METHODS

Semi-structured interviews and a focus group were conducted to collect data from nurse faculty. Data segments from interviews were coded, categorized, and analyzed. Theoretical sampling and a focus group interview were used to validate the concepts, themes, and categories identified during the individual interviews. A substantive level theory was developed.

RESULTS

The core category that developed was conscientization. The three dominant categories that emerged from the data were overcoming, coming to know, and facilitating. The theoretical framework of conscientization provided an explanation of the social processes involved in teaching English as Second Language nursing students.

CONCLUSIONS

The theoretical framework developed from this study can be used to increase the effectiveness of teaching English as Second Language nursing students, improve their chances of success, and enhance diversity in the nursing profession.