Author: Alice Juma, BSc student, Bachelor of Healthcare, Nursing, Novia UAS
Supervisor: Anita Wikberg, RN, RM, PhD, Senior Lecturer, Novia UAS

Abstract

Nursing education plays a vital role in the effectiveness of healthcare services. It provides knowledge to nurses and enables them to be able to solve healthcare problems. The profession in recent times, has become more challenging and demanding.

The rising number of international students outside their own country has posed challenges in nursing education. The numbers are expected to grow and economic factors are putting learning institutions on spot to accept these students. International students in addition to adapting to a foreign learning environment, they are oblidged to adapt to the socio-cultural context as well. The most significant acculturation problems for international students are difference in education pedagogy, English as a second language, connectedness and finally integration socially.

Both international and migrant students face challenges which may impact their well-being, mental health and academic outcome. The new challenge for education in nursing is the globalisation of the nursing workforce and the concurrent internationalisation of higher education.

There have been a large movement of people across all borders and one of the reason has been education. The movement cut across all ages and has not been restricted to any age group. The increasing number of immigrants especially from developing nations to Europe has gained interest from people of all professions.

Introduction

Mackay et al. (2011) explains that an international student refers to a foreign student who does not qualify as a domestic student in a residency.

In 2017, it was reported that there were over 5 million international student worldwide (i.e foreign individuals pursuing education in a country other than their resident countries) and the number is increasing every year. In addition to the fact that employers highly value international experience, there is a large growing demand from students for higher education and the limited capacities in some countries to meet this need. Learning institutions are drawing the most talented candidates. They are also looking to expand student enrolment and revenues. The nursing profession is one of the disciplines dominated mostly be foreign born students. Sharing of new ideas, strengthening the workforce capacity, increasing cultural diversity, gender equality, improvement of health outcomes and contribution to economic growth are the benefits associated with the globalization of nursing education (Merry, Vissandjee & Verville-Provencher, 2021).

The demand in clinical trainings and academics can affect the well being of students resulting in mental health problems. Students deciding to withdraw from their studies and failures may be as a result of stress. The migrant status of foreign born nursing students is the main contributor of stress. The challenges of living in a new country include; loss of social support, adapting to a new culture and language, financial concerns, unfamiliarity with the education, discrimination, health and other systems (Merry, Vissandjee & Verville-Provencher, 2021). Research has shown that the main problems faced by foreign born nursing students especially under clinical trainings are language and cultural differences (Latva-Pukkila, 2007).

Challenges

Below are some of the common challenges faced by foreign born nursing students away from home country.

Communication and language challenges

Language has a vital role in psychological and social life and nurtures our understanding of the world (Burr, 1995). It is a way of connecting with other people and is associated with culture as communication is essential in protecting and conveying it (Xu et al, 2005).

Communication is realized in written and verbal language and nonverbal means, it means that the participants are to go beyond just words. Mackay et al. (2011) explains not understanding the language may cause unsafe care, confusion and distress. Students ability to collaborate and communicate with others in clinical placements is assessed in undergraduate nursing programmes. Mandpe (2021, November 26) claims in her blog that inorder to treat patients with good quality care and pursue additional job security, learning a foreign language is important. It moreover helps in professional and personal development.
According to Oxford dictionary (n.d) communication refers to transfer of information by writing, speaking or using some other medium. Communication is usually between two or more people. It can be done through symbol, text, speech, pictures, sounds, body language and eye contact. This concept is important as communication in this century is not only verbal but any means by which people can understand one another by pictures, body language, symbols in which basic information is understood. Communication in clinical placements is the most important way students are able to learn more on what they have done on theory.

For example, in Finland, a foreign nursing student learning in English has the obligation of having knowledge of the Finnish/Swedish language to be able to perform well in clinical studies. If a student is not able to understand any of these languages, the supervisor may be left with no option but to raise the issue with the school and ward’s head. Unfortunately, the student might have to stop the training. Communicating with the supervisor, colleagues and patients is important during clinical studies.

When foreign students cannot communicate with patients effectively during practice placements, it is usually due to language barrrier (Raij, 2013). Stress level of foreign nursing students may rise due to the fact that they are unable to express themselves fluently in the local language and they sometimes are even judged or compared to the locals which makes the situation difficult for the foreigner (Valipakka, 2013).

Culture shock challenges

Owen et al. (2017) explains culture and adaptation is important for anyone living away from home. International students experience substantial amount of stress from cultural shock, homesickness and perceived discrimination. An international student has three phases when transitioning to a new educational system; frustration and cultures shock, getting accustomed to the new institution and lastly experience of gaining confidence and motiviation. Students usually stay and graduate if they feel at home, take part in extracurricular activities and are well connected to teaching staff and other students. Cultural adaptation can be stressful and challenging.

As an individual or as a group, foreign students coming into another country usually already have their own culture. Each one possess a different dimension in understanding, perceiving situations, responding differently as they would in where they come from thus facing the challenges of heritage, values and culture to begin learning. Adaptation to new culture norms and social environment is a challenging process for foreign nursing students. Foreign nursing students are oblidged to adjust to sociocultural differences between home and host country (Chuba, 2019).

Connection challenges

International students need a friendly environment away from home. If they feel ease in communicating with other students and teachers, then they are able to raise their problems and challenges freely. For instance, if a student does not feel connected to his/her environment, they might just pack up and go back home. A feeling of not belonging can be stressful.

Mackay et al. (2011) explains that connecting with teachers and other students assists with personal adaption thus in the end facilitating the development of social cultural awareness and communication that will build connection with patients and significant others. International students are oblidged to connect to the dominant culture while at the same time maintaining and valuing their own cultures. It must not be forgotten that students are likely to be tired from constantly having to adapt, be apprehensive, lack of confidence, dealing with loss and loneliness. It is put forward that good student-teacher connection creates transformative space in which students are assured, grows towards fulfilling personal and professional capacities, gain insight into the potential.

Psychological challenges

Psychological effects are to do with stress, isolation and loneliness. Loneliness is a common feeling felt by all humans at some point in their lives. Loneliness is in most cases experienced as a result of being homesick. Loneliness is attributed to sociology and psychology. Loneliness has been further divided as emotional and social loneliness. Social loneliness is also known as lack of social network with others who shares one’s view of the world and concerns. For it takes a long time to have a friend or peer, social loneliness is a challenge for nursing students (Chuba, 2019).

Owen et al. ( 2017) explains foreign students report poorer physical and mental health results than domestic students. They may experience unfamiliar living environment, challenges balancing study and work, language difficulties, financial problems and isolation from family and friends. Significant financial difficulties and family expectations may also contribute to stress, depression and feeling socially disconnected.

Conclusion

International students face a series of challenges when they study in a foreign country. These challenges may affect mental health, be stressful and impact on student well-being. Learning institutions recruiting international students have the responsibility of providing needed support. Interventions to help international students to overcome their challenges is recommended to help promote positive integration and adaptation.

Managing expectations in regard to daily life and host country’s culture should be addressed transparently at the initial stage of enrolment. Unmet expectations can impact the students life negatively on both student’s success and well being. Host countries should avail clear information to international students on what to expect. The main challenge noted in this review was language. It is therefore among other things important for a host country to offer additional or intense language studies for foreign students to ease integration and adaptation. It is important that nursing students learn the local language of the host country so that they are able to give the patients quality care.

The learning institutions need a way to tackle these challenges. For instance, they can establish an international students psychology coaching centre, incorporate the knowledge of native cultures in class, and hold activities for foreign students. International students also should make efforts in overcoming these challenges. For instance building up social life, developing hobbies and communicating with local people. Personally, as a foreign nursing student I have learned a lot of Finnish words from listening to Finnish music and watching local movies.

References

• Burr, V. (1995). An introduction to social constructionism. London: Routledge
• Chuba, G. (2019). Common challenges faced by foreign nursing students in Finland. Bachelor of Science. Faculty of healthcare. Kokkola: Centria university of applied sciences. Retrieved 2022, September 22 from https://www.theseus.fi/bitstream/handle/10024/267957/Chuba_Youkam.pdf?sequence=2&isAllowed=y
• Latva-Pukkila L. 2007. Education of multicultural nursing in Turku University of Applied Sciences Salo unit. Turku University of Applied Sciences, 2007.
• Mackay, B., Harding, T., Jurlina, L., Scobie, N., & Khan, R. (2011). Utilising the Hand Model to Promote a Culturally Safe Environment for International Nursing Students. Nursing Praxis in New Zealand, 27(1), 13–24.
• Merry, L., Vissandjée, B., & Verville-Provencher, K. (2021). 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. BMC Nursing, 20(1), 1–37. https://doi-org.ezproxy.novia.fi/10.1186/s12912-021-00678-0
• Mandpe, R., Wikberg, A. (2021, November 26). To study nursing in a foreign country-retention and challenges. (Blog post). Retrieved 2022, September 19 from https://www.novia.fi/novialia/bloggar/studerandebloggen/to-study-nursing-in-a-foreign-country-retention-and-challenges
• OWEN, K., DAY, L., & YANG, D. (2017). Promoting Well-Being for Chinese International Students in an Undergraduate Nursing Programme: Reducing Culture Shock. Whitireia Nursing & Health Journal, 24, 13–20.
• Oxford dictionary. (n.d) communication. Retrieved 2022, September 16 from https://en.oxforddictionaries.com/definition/communication
• Raij, K. (2013). Learning by developing in Higher Education. Journal of Education Sciences. Issue II, 6- 21. Eötvös Loránd University, Faculty of Education and Psychology
• Valipakka, H. (2013). International nurses’ experiences and perceptions of their work orientation in finnish health care. Retrieved 2020, September 18 from https://www.semanticscholar.org/paper/International-nurses%27-experiences-and-perceptions-V%C3%A4lipakka/55d2ef81ecd9bc546f31d6bd15792b197ef3baea?p2df
• Wittgenstein, L. (1994). Meaning and understanding. In A. Kenny (Ed.), The Wittgenstein reader (pp. 51-66). Oxford, England: Blackwell.
• Xu, Y., Davidhizar, R., &Giger, J. (2005). What if your nursing student is from an Asian Cu\X.urel Journal of Culturai Diversity, 12(1), 1-11.