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Breaking the trap

The growth in numbers of culturally and linguistically diverse students entering nursing programs in Australia presents challenges for academic and clinical staff. And most importantly the students themselves, writes Annie May.

There are many reasons why overseas qualified nurses decide to study in Australian universities. Completion of a bachelor of nursing degree at an Australian university is considered to be one way for overseas nurses to gain registration and residency, while others return to their country of origin with heightened career prospects and the capacity to share their knowledge and skills.

In 2007, overseas qualified nurses (OQNs) from culturally and linguistically diverse (CALD) backgrounds comprised approximately 18 per cent of the 7379 students who commenced nursing programs. Research also shows the majority of CALD students in pre-registration nursing courses remain in Australia after the completion of their studies and make a significant contribution to the nursing workforce.

But while Australia has long been, and continues to be, a popular place for students from diverse cultures to study nursing and midwifery, these students face many challenges.

Sarah Jeong is only too aware of these challenges. The now senior lecturer at the University of Newcastle’s School of Nursing and Midwifery was an overseas student when she did her BN degree at the same university in the mid-90s. Her experiences have led her to be somewhat of an advocate for international students.

“I came here as an international student and met some wonderful lecturers who were very supporting. I also met the opposite, who didn’t help me at all,” she told Nursing Review.
It was her experiences as a student that led her to lead a study investigating the experiences of CALD students and the clinical and academic staff that support them both in clinical and university settings.

What she found was CALD students studying in Australian universities experience a range of issues that negatively impact their learning. These include cultural differences, language problems, lack of cultural responsiveness from their university, a mismatch in expectations of teaching and learning, loneliness and social isolation.

“Despite the strategies implemented to address the concerns of CALD students, many Australian universities remain ethnocentric and CALD students’ complaints of poor quality education are increasing,” said Jeong. Academic and clinical staff are also rarely offered additional instruction in teaching CALD nursing students.

As part of the study, which findings were published in the recent issue of Nurse Education Today, 106 CALD nursing students enrolled in the University of Newcastle were interviewed. The countries represented included China, South Korea, and a range of other countries.
Academic staff and clinical facilitators who had taught CALD students were also invited to participate in the study.

Data was collected between August and October 2008 through four focus group interviews. There were two focus groups of CALD students, one of clinical facilitators, and one of academic staff.

Four key issues were common to all participants: English language competence; feelings of isolation; limited opportunities for learning; and inadequate university support.

The issue of English language competence was raised by all participants in the study. For the CALD students for whom English is a second language the issue of English competence was raised in relation to feelings of frustration, panic and embarrassment because of their inability to understand the language used in tutorials, lectures and in the clinical environment.

However, participants also felt that it was a reciprocal issue:

One CALD student said: “I have a feeling [is] that maybe our English is difficult for them to understand, but the way you speak your English, it is difficult for us.”

Students also expressed feelings of rejection because of their lack of English competence:

“Somebody will say you are not communicating well with your English... you (I) will try and communicate...but [the clinical facilitator thinks]… I can’t communicate! You know it is very frustrating...it is like she (clinical facilitator) doesn’t want to listen because I wouldn’t speak really well,” said another student.

“Despite the reported negative feelings and emotions, the students were resilient and discussed their effort to take responsibility and move forward,” said Jeong.

Academic and clinical staff also reported difficulties in communication with CALD students. They noted a lack of verbal and written English proficiency among CALD students both in academic learning environments and clinical settings. Some queried how these students were allowed to commence the nursing program when their English Language skills seemed to put them at risk of failing their courses:

“They come in with the English language barrier or disadvantage and I guess that’s not fair. They (university) are setting them up to fail,” said a clinical staff member.

Isolation was a common theme and experienced by all CALD students who participated. It included the issues of social isolation, rejection and discrimination. This was an area of concern to academics. Social isolation of CALD students who resided at the university was identified by the academics from conversations they had with them. Some CALD students reported an insular university experience which caused difficulties in developing relationships with the surrounding communities. Said one academic staff: “Some of the [international] students you talk to say ‘I live on university campus and I go to my room, I come to my class, I go to the library, I go to my room’, and how can they [international students] emotionally survive that.”

Social isolation of CALD students was exacerbated by the rejection and discrimination they experienced from domestic students.

Jeong said discrimination was evident particularly in relation to group work activities and assessment items. Academics noted that domestic students sometimes requested not to work with CALD students on group work projects.

CALD students felt that social isolation was a major issue and believed that if future students could engage with others then the stress associated with this isolation may lessen: “You have to develop a good relationship with locals otherwise you might (as well) stay in China... you are bringing your mind from China here,” said a student.

One way, according to the CALD students, to lessen the challenges they encountered during the orientation and enrolment period is by having a more structured and supportive approach especially from someone who had experienced the same challenges.

A fundamental issue that had a negative impact on CALD students’ learning was their perception of limited learning opportunities,” Jeong said.

“This derived from the additional time that it took to facilitate the learning of CALD students and the allocation of inconsistent and inexperienced mentors. Time was acknowledged by CALD students, clinicians and academics as a major constraint in adequately supporting CALD students in both the academic and clinical settings.” Time was also perceived by academics as a fundamental issue. Academics felt that they did not have the time to provide CALD students with the individualised support they needed.

As one academic admitted during the focus group: “It is time and when you are working 12 hour days as it is, just keeping up with everything we are trying to do, [I] have not got the time to provide any more [academic support to international students].”

When participants were asked how learning could be improved all agreed that a designated and specialised mentor for the CALD students could assist them with communication during the often stressful placement experiences.

Academics and clinicians believed that by educating selected mentors on the needs of CALD students in the clinical setting and using these mentors specifically with CALD students either for the length of the placement or in the initial days of placement, students may have a better experience.

Participants felt that the university support for CALD students was inadequate, Jeong said. Academics also felt that they did not have adequate knowledge of the support services that were available to CALD student.

“Despite the problems encountered academics and clinical facilitators all recognised the value of engaging with CALD students, including, the sharing of global experience with domestic students, and the job satisfaction that comes from assisting the determined and focused CALD students.
“The provision of support for CALD students is a significant issue which can directly impact on the students’ learning experience.”

One key strategy to improve the experiemce put forward was the appointment in universities of a designated person who is given time to support CALD students, who can act as an advocate for CALD students, and who is able to educate academics and clinical facilitators on the most effective and appropriate teaching and learning strategies.

As a result of this project a number of initiatives have been introduced at the University of Newcastle to better support CALD students.

A list of support services provided by the university to CALD students has been developed, is regularly updated and sent to all staff involved with teaching CALD students. The School of Nursing has established a student mentor program, which encourages third year students (international or domestic) to act as mentors to assist commencing CALD students.

An academic from a CALD background has also been appointed as the school’s International Student Liaison Officer. This staff member acts as an advocate for CALD students and supports teaching staff to enhance their understanding of the educational and cultural needs of CALD students.

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