“My Wish Is Not Big, I Just Want to Pass”: Clinical Learning for International Students

International students enrolling into courses at university and college are not a new phenomenon and currently international student mobility is increasing. According to the OECD (2013) more than 4.5 million students are enrolled in courses outside their country of birth. In terms of market share The United States of America (USA) attracts the largest number of students, followed by the United Kingdom (UK) and Australia (AUS) in 4^th place. Together these three countries educate 36% of the worlds’ international students (OECD, 2013). Whilst in their host country students make significant contributions to social diversity and culture and to the local the economy. The Australian higher education sector generated $10.8 billion in the 2013-2014 financial year, making education the 4^th largest export (Aust Govt, 2014). What is interesting about international students and where they come from is that they travel from countries where English is not the dominant language and the culture not western, posing a unique challenge to nursing educators in host countries.

 The International Council of Nurses (n.d) defines nursing as encompassing:

 Autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of the ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles.

 Inherent in this definition is that practitioners of nursing worldwide share the same understanding of fundamental key points, such as the meaning and practice of care. However, nursing is a practice based discipline that is governed and structured by national authorities that aim to maintain safe, effective and professional standards of care for the population. These standards reflect the notion of care, the role of the nurse, and the language of nursing as it is constructed in the social culture. Recently, Scott, Matthews and Kirwan (2014) argued that some common concepts such as safe, quality and compassionate care are identified in international nursing literature, however practice variations persist. Walton- Roberts (2012) presented a comprehensive argument to support the notion that that the work and practice of nursing is considerably different across cultures. What this means for a clinical nurse an educator is that a comprehensive understanding of the international student’s context requires understanding so that appropriate learning support is enacted.

Undergraduate nursing courses are expected to prepare students to meet the professional and social expectations of the nurse, so that they are prepared for graduate practice. These courses rely on the clinical practice learning experience to socialize students into the profession as well as integrate theory with practice. International students who come to study nursing have been found to experience difficulty with learning to nurse in the clinical environment (Malecha, Tart, & Junious, 2012; Pitkäjärvi, Eriksson,& Pitkälä, 2012; Vardaman, 2012).

Through the method of interpretive description (Thorne, 2008) interview data was collected and analysed to provide a comprehensive understanding of learning to nurse in the Australian clinical environment for international students who come from countries where their language and culture is not western. The findings revealed the complexity of the nature of learning that often remains hidden to clinical educators. The participants’ ideas about nursing were constructed through their own experience and culture, and therefore varied from the Australian norm. Therefore having ‘to do’ nursing as it was constructed, often placed participants in moral peril and at risk of damaged reputations. This presentation will highlight the learning journey of two international nursing students, explain cultural differences affecting learning to nurse that can be conceptualised globally, and reinforce the important role that social learning theory (Bandura, 1977) has in clinical practice learning.