Purpose: The purpose of the study was to determine the lived experience of Jordanian nursing students in Jordan. It is hoped that the results of this study will provide an insight into the lives of Middle Eastern nursing students. These findings may subsequently lead to a greater understanding of this population and thereby improve recruitment and retention of Middle Eastern students by U. S. nursing instructors and eventually to the availability of more culturally and linguistically diverse nurses in the United States of America (U.S.).
Significance: Culturally and linguistically diverse nursing students face many barriers in nursing school. In U.S. institutions, these students fail to complete nursing programs or delay graduation at far greater rates than native English speakers (Greenberg, 2013; Donnell, 2015). As the general U.S. population increases in diversity, the failure of these students is especially problematic, since the need for culturally and linguistically diverse nurses is not being met. According to The Joint Commission, “safe, quality care requires effective communication” between healthcare providers and patients (The Joint Commission, 2010, p. 40). The most recent data from HRSA indicates that the majority of registered nurses speak a single language; English. The most common second language for nurses was Spanish at 5.1% followed by Tagalog at 3.6% (HRSA, 2010). Without linguistically diverse nurses in the healthcare workforce, effective communication is difficult to achieve. Limited English proficient (LEP) patients are a significant part of the healthcare landscape and this number is growing every year. By the year 2021, approximately 50% of insured individuals will be minorities and less likely to speak English (The Joint Commission, 2015).
The reasons English-as-a-second-language (ESL) nursing students fail to graduate are complex; finances, family responsibly, cultural adaptation and employment while attending classes all play a role (Mooring, 2016). However, one of the most troublesome obstacles to ESL student success may be the faculty-student relationship (Mooring, 2016). The majority of nursing faculty in the United States (U.S.) are Caucasian females (Salvucci & Lawless, 2016). Therefore if the student and faculty speak a different language, come from different academic traditions and cultural backgrounds, misunderstandings can develop that may diminish student achievement. By uncovering experiences of Jordanian nursing students, U.S faculty may increase their cultural understanding and thereby improve the critical teacher-student relationship resulting in improved retention of Middle-Eastern students.
Methods: Twenty-four undergraduate students from the University of Jordan participated in this qualitative study. Two methods were used to collect data; semi-structured focus groups and personal narratives. Colaizzi’s method for analysis of phenomenological data was used to uncover meaning from the participants responses.
Results: Six themes were discovered.
- Educational Dissatisfaction: Dissatisfaction with the Jordanian academic nursing program including time allotted for didactic and clinical; lack of faculty expertise; lack of resources.
- Time: Lack of time; a need for time management; time and nursing appeal.
- Nursing negativity: negative cultural attitudes toward nursing as a profession; lack of respect for nurses from physicians and role confusion.
- Gender expectations and limitation: Cultural requirement to practice same-gender care; no exposure to opposite gender care; expectation for women to prioritize husband and children above career.
- Culture: Attraction to nursing related to Rufayda al-Aslamiyyah, recognized as the first female Muslim nurse; benefit to family because of health care knowledge; the religious conviction that followers of Islam should care for all people.
- Fear, desire and utopia: Strong desire to work in the U.S.; perception that nurses are highly respected professionals, well paid with clear standards of practice; fear that being Muslim and wearing the hijab will result in harassment and rejection.
Conclusion:
The results of the study indicate several strategies that should be included in an effort to recruit and retain Middle Eastern nursing students.
Recruitment
- Appreciate that the concept of caring and nursing is supported by Islam.
- Realize that some elderly Middle Easterners may view nursing negatively.
- Involve the entire family, decisions are commonly made as a group.
- Recruitment information should be available in English and Arabic
- Discuss the role of the professional nurse in various care settings.
- Communicate potential employment shifts and locations.
- Share clear expectations of opposite gender care and training.
- Describe program expectations for didactic and clinical hours.
- Discuss time required inside and outside of the classroom for success.
Retention:
- Recognize that students may need additional support during religious holidays.
- Connect with students frequently to discuss challenges and barriers.
- Designate faculty and student mentors.
- Encourage development of culturally specific clubs or organizations.
- Support continued communication with the entire family as appropriate.
Nursing faculty in the U.S., being predominantly female and Caucasian, frequently encounter students that are culturally different from themselves. Faculty may not be cognizant of cultural variances and therefore may be ill-prepared to recruit, retain and mentor, these diverse students. This research explored the experience of being a nursing student in the Middle East, specifically nursing students in Jordan. The new knowledge gained from this research can help faculty members to understand the culturally unique Middle Eastern ideas about nursing. Using this knowledge, nursing instructors may be able to anticipate some of the challenges and barriers these students will encounter and aid them as they mentor students through the realities of nursing school.