What Did Students Of Ethnic And Racial Minority Background Face
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Exploring the experiences of being an ethnic minority student within undergraduate nurse education: a qualitative study
BMC Nursing volume xviii, Commodity number:63 (2019) Cite this article
Abstract
Background
Students studying in a country where another language is spoken face multiple challenges including their ability to fully integrate with peers and academic pressures in trying to obtain an undergraduate nursing caste. The aim of the written report was to explore the lived experiences of students, from varying cultural and ethnic backgrounds, undertaking an undergraduate nursing degree.
Methods
The report adopted a qualitative pattern and viii individual semi-structured interviews were conducted. The interviews were analysed using manifest content assay co-ordinate to Graneheim and Lundman.
Results
Students reported feelings of isolation and the lack of opportunities to integrate with native students within academia and practice. The demand for personal back up was a crucial gene that was independent of gender and students reported challenges related to both language and culture during the programme.
Conclusions
Suggestions arising from this report includes appropriate support systems within academia and practice. Information technology is imperative that universities and practice settings promote and integrate cultural awareness within academia and practise in meeting the needs of students and providing culturally appropriate nursing intendance, thereby providing opportunities for all students to become competent and professional person practitioners.
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Background
Europe is condign increasingly multi-cultural and with globalisation, there is an increasing number of students from multiple ethnic and cultural backgrounds studying different courses inside college education. A common assumption in higher education is that bookish integration of international students, that is the extent to which students adjust to the academic fashion-of-life [ane], is not well-aligned. A big number of studies take addressed pupil retention or persistence in college didactics. For case, the interaction student attrition model of Tinto [1, ii] considers that students accept a multifariousness of educational experiences, skills and competencies, family and community backgrounds and values before entering into higher didactics. At an private and social level, this volition influence how a student integrate into their studies at universities. Tinto [2] identified that students need to persist in their didactics to graduate, demonstrating academic integration and also demand to actively participate in student culture within and exterior of the learning environs.
This paper has a focus on undergraduate nurse education in Norway, where students from an international groundwork report with native students and Norwegian is their 2d linguistic communication. The literature indicates that students from an ethnic minority and international groundwork face up challenges in their encounters inside undergraduate nursing educational systems [iii,iv,v,6,7,8,9]. Challenges related to social expectations are some of the cardinal factors that may influence how international students may experience almost their study state of affairs [iii,4,5,6,vii,8,9]. Learning a new language and dissimilar means of academic writing is hard and may impact or impede academic performance. Coupled with that, indigenous minority students also reported facing discrimination and maintaining their cultural identity [half dozen,seven,8, 10, 11]. Additionally, these particular students may also face a sense of belonging [ix].
It is reported within the literature that ethnic minority students may face bigotry at both an institutional and private level [9, 11, 12]. Furthermore, ethnic minority students identified encountering negative experiences in clinical practice with the employ of terminology and understanding patient questions [12]. Sedgwick et al. [12] identified that ethnic minority students experienced discrimination both inside the academic and practice settings and there are implications. For example, there are legal statutes to protect individuals within society, and people should not exist discriminated based on their gender, religion, race, and sexuality or for having a disability [13]. The literature indicates that from a European perspective, nurse education continues to reflect the values and orientation of the Euro-axial mainstream. Therefore, the inclusion of multi-culturalism and multifariousness within the nursing curriculum will need to be fully realised and acknowledged.
In 2017, 22,5% of undergraduate nursing students studying at universities and university colleges in Norway, were from an international background [14]. In Norway, an undergraduate nursing programme has a duration of 3 years consisting of academic and practice hours. Students must compete on equal terms for entry onto the plan and instruction is delivered in Norwegian. International students must demonstrate proficiencies in the Norwegian language past undertaking and passing a test, verbal and writing and are held to the highest standards. In 2017, at one item academy, eleven% of the students were from an ethnic minority background mainly Asia and Africa [14]. These students are integrated into the undergraduate nursing program with native students.
Migration often brings many social, cultural, and psychological losses, which may cause an individual to see feelings of isolation when settled in another country with different cultural norms and values. Consequently, there may be difficulties faced in trying to adjust and feel a office of guild. With this in mind, it is imperative that ethnic minority students are given due consideration and experience a positive teaching and learning environment to promote integration [10, 11]. Additionally, a lack of office models amongst family, friends and within the academic and practice environs is another factor that tin can impact indigenous minority students' experiences, leading to feelings of vulnerability more and then than other native students [5, 15]. More than research is needed among this particular group of students, and then that their experiences can be captured and better understood [12]. Therefore, college education institutions have a responsibility in enabling all students, irrespective of backgrounds or cultural identity to attain their total potential [3]. There are only a few studies that have been conducted from a Scandinavian perspective about ethnic minority undergraduate nursing students' experiences within undergraduate nurse pedagogy. Therefore, the aim of this study was to explore the lived experiences of students from varying cultural and ethnic backgrounds undertaking an undergraduate nursing caste.
Methods
Pattern
This study adopted a qualitative blueprint, using individual semi-structured interviews with 8 ethnic minority undergraduate nursing students from this university in Norway during 2017. A qualitative approach was chosen to gain in-depth insights and further understanding into the students' subjective experiences and social context in their natural setting [16] using a loose topic guide to allow students the liberty to elaborate and guide the discussion.
Recruitment and sample
The inclusion criteria were undergraduate nursing students with migrant status living in Norway and undertaking an undergraduate nursing degree at 1 university. There is i intake of students per yr and students were recruited from the third yr of their study over ii intakes. The intention was to recruit students from the third year in the programme who were near completion to explore differences or similarities in their journeying. The rationale for including third year students was the length of time on the programme and the ability to provide a wider perspective. Students who fulfilled the inclusion criteria (due north = 11) were invited by the coordinators of the nursing available programme to participate in the study, which is purposive sampling. Information was provided near the study by the coordinators and 8 of the eleven students contacted agreed to participate in the study. Students were informed that they were not obligated to participate in the study to prevent co-coercion. Participants were born in different countries ranging from Asia and Africa, respectively. Participants had been living in Kingdom of norway from 6 to 25 years, respectively, and consisted of five women and three men aged between 22 and 37 and had all Norwegian citizenship. All participants were considered every bit mature students given the age range.
Data collection
Eight individual semi-structured interviews lasting 25 to 45 min were conducted by the beginning author. The interviews were conducted in a individual room at the local university campus and audio recorded with consent. Employing contiguous dialogue and a loose topic guide, participants were free to move the interview in any direction to best describe their experiences of being an indigenous minority student inside the academic and practise environs. Afterward obtaining demographic data including age, gender, country of birth, and length of time each individual had lived in Kingdom of norway open-ended questions were then asked: "Can yous tell me about your experiences of being a educatee in this nursing program?" Probing questions including, "What exercise you lot mean?" and "Can you tell me a lilliputian more about …?" were asked to gain farther in-sight and depth of conversation. A topic guide was used equally a checklist to get the participants' experiences elucidated effectually lectures, pupil life at campus, working in groups with other students, practice placements within the hospital and community settings. Interviews were transcribed verbatim.
Assay
The transcribed interviews were analysed using manifest qualitative content analysis according to Graneheim and Lundman [17]. The steps in the manifest analysis were as follows: (1) individual interviews were read several times to achieve a sense of the entire picture; (2) a number of 230 meaning units were then selected (based on each participant's experiences of being an ethnic minority student in an undergraduate nursing programme); (3) each meaning unit of measurement was condensed; (4) the condensed meaning units were abstracted and labelled with a code; and (5) a number of xxx codes derived from the information were gathered and sorted into three categories (vi). Iii of the authors discussed the assay and verified the obtained codes and categories. In the analysis, the authors used their insider knowledge as nurses and nurse educators to make sense of the data. A applied example of the analysis procedure is displayed in Table 1 below.
Results
Feeling isolated
Well-nigh participants identified and spoke well-nigh their experiences and feelings of isolation during their years within the nursing program. This was significant and was linked to more engagement in grouping work at the academy: "I don't have bad feelings in the classroom, but when nosotros work in groups, I feel isolated" (Participant 6). Participants reported that conversations in groups sometimes were conveyed in ways that they did not understand: "I went to the group where I was placed, and nosotros started to speak well-nigh the lesson for the day. After a cursory time, one of the students said: Bye, we are meeting adjacent Mon. I hadn't catch what we had agreed" (Participant 3). Even though indigenous minority students tried very hard to be a part of the group through the programme, most of them felt that they did not fully grasp the language and that the Norwegian students did non modify their language to accommodate for this.
While some of the participants experienced greater degrees of isolation, other felt less: "In my grouping we are on Facebook. In that location I tin ask them about questions I have due to this topic" (Participant 5). Only 1 of the female participants expressed that her knowledge was appreciated within the grouping and felt valued every bit a member: "They e'er told me that I was very clever, and they supported me and said that: We heed to you, while we practise the writing work. Nosotros're kidding in a way and I utilize to say that they had to cope with my orthography and that worked!" (Participant 7).
Native students sometimes organise and agree social events in the evenings. At break times, native students get together, and some participants reported feeling like outsiders and noted that interruption times within academia were uncomfortable points during the mean solar day. Students reported that they had attempted to interact with native students on several occasions but found information technology difficult to feel a sense of belonging with native peers: "I had decided from the start that I should get contact with Norwegian students, but I see that I don't catch it" (Participant i). Near participants reported that after iii years, they could not identify one native students on the programme as a friend. Additionally, those who had been in Norway since childhood had too establish information technology difficult to make friends throughout their years at school. Each participant addressed their loneliness in their ain mode, by getting together as a group inside the wider grouping of students: "I established a group for all the students at the programme coming from another culture. Nosotros run across one time in a month for exchange experiences and help each other" (Participant eight).
Educatee support
All participants reported that they did non know anyone outside the university who could back up them in a largely unknown earth, as represented by the university and the undergraduate nursing program. Six of the participants reported facing difficulties in making the transition from loftier school to university. At the start of the programme well-nigh participants noted that some native students knew private students beforehand, such as those from their own families or other individuals whom they could talk to about the reality of beingness a university educatee. For example, some native students were able to speak with someone who had previous experience as a nurse or had completed a degree. The participants missed this opportunity: "Nobody in my family has higher pedagogy. I didn't know anything almost either student life at the academy or being a pupil in exercise in the Norwegian Health Intendance Services. I have to find it out of my own" (Participant 5).
All participants, irrespective of gender, expressed a need for interpersonal support from nurse educators inside the academic sector. Participants reported that during the duration of the nursing programme, it would take been beneficial if they had been given a mentor: "I should wish I had someone who could guide me through the programme, a person I could ask all those stupid questions I had" (Participant iv). Only one male person participant reported having a native student that followed him up from the first of the program until the terminal commitment of student'south bachelor'south thesis: "I run into [the name of the person] at the beginning of the programme and [the name of the person] has helped and encouraged me and…has meant a lot for me! …e'er saying: Yous can do this!" (Participant 2).
Participants reported student support in clinical practice equally challenging, both inside the hospital and community settings. They described a plethora of emotions including fearfulness, anxiety, curiosity and happiness. However, participants recounted a number of negative encounters within the clinical surface area, and in particular those placed within the hospital setting. These included supervisors referring to native students by proper name just addressing ethnic minority students not by their names but equally students. Some other example reported was supervisors speaking negatively near ethnic minority students with colleagues in their presence: "My supervisor talked about me to another nurse, while I was standing adjacent to her. She was speaking in a way as I didn't exist!" (Participant 8). Some participants perceived a few supervisors in do as being unfriendly and stated that they tried to avert them. Conversely, some participants communicated working closely with nurse supervisors, not considering they needed to, but because they felt it was a necessary step to pass clinical practice: "I felt I had to be close to my nurse if I should pass through hospital practise" (Participant 3). Nonetheless, other expressed that they had a good human relationship with their supervisors: "From the start time it functioned in a good way between my nurse supervisor and me" (Participant 4).
Most participants conveyed marvel linked to starting clinical practice. They related working with patients as very interesting and narrated that it was easy to establish a proficient relationship with most patients. Yet, some participants reported a few negative encounters with patients, who requested reassignment every bit they did not desire care delivery from an ethnic minority student: "I had responsibility for a patient to clarify him for leaving the hospital, merely the problem was that the patient didn't desire me to do that and I felt it was because of my skin colour. My supervisor was whining at me and she felt that I used more time than I should on this work" (Participant 5).
Challenges with linguistic communication and culture
Seven participants reported academic writing equally very challenging and felt they possessed rudimentary language skills. Three of them also mentioned that they had practiced marks in loftier school, but information technology was difficult for them to maintain the same high grades in university when compared with the grades achieved amid native students: "It is more hard for me to go proficient marks than it is for them. I was very clever at high school!" (Participant 6). Due to their language-related challenges, participants wished for more academic support for most of the compulsory written assignments in their university programme.
Participants described additional responsibilities that they had outside of university life. This ranged from taking intendance of family members including parents, which they thought native students did non need to do. Participants described conflicts every bit they had to rest the commitments of existence a academy student and family unit responsibilities and duties expected from them culturally. This led to some participants feeling torn between wanting to take care of their families and wanting to experience a similar sense of independence that was experienced past the native students: "I have taken care for my mom and she don't have a good health. When I apply time with my fellow students, I know that she misses me and desire me dorsum abode" (Participant 7).
Discussion
The aim of this report was to explore the lived experiences of students from varying cultural and indigenous backgrounds undertaking an undergraduate nursing degree. The findings identified that participants faced discrimination in practice and felt isolated mostly. Additionally, all participants spoke of their desire to integrate and build relationships with native students. This is supported past With and Fulton [5] who reported similar findings and identified that ethnic minority students demand to develop relationships with their peers throughout the course of their education. The findings from this report is a clear indication of the need for native students, nurse educators in practice and academia to requite due regard to multi-culturalism and its significance in moving forrard. All students can acquire from each other and integration would allow for peer learning and diversity to exist addressed. Given the changing nature of higher teaching and globalisation, there is a concerted need for systematic policies and procedures in place that values diversity, equity and educatee progression and not just seen as a tick box practise.
All participants experienced isolation, despite living in Norway for a number of years. Reasons identified by participants were cultural diversity and different ways of living, as some mentioned family commitments and cultural expectations. Therefore, it is imperative that cultural diversity is acknowledged and developed within the curriculum to truly create an inclusive environment within academia and practice. This requires a consistent approach and action plan, evaluated annually to address concerns and identify best practice. Nursing values as empathy and caring is a requirement of a professional nurse and this should also relate to colleagues and this will demand to exist made explicit to all students irrespective of background to culture [7]. This may be ane way in getting ethnic minority and native students to integrate more than and reduce feelings of isolation, thereby creating a sense of belonging. This is important for delivering culturally competent nursing intendance within a multicultural society. Furthermore, building relationships is closely concerned with communication betwixt people, as in previous studies by Mattila et al. [eight] and Pitkäjärvi et al. [18], who found that linguistic communication barriers increases students' risk of isolation. Struggling with different accents may hinder confidence in communicating finer and could further compound the way that ethnic minority students are perceived past native students [6]. One way in which confidence and communication can exist improved amid this particular group of students is to provide opportunities to attend an advanced language course earlier starting the programme. Since linguistic communication difficulties will influence both the relationship and confidence of students, the utilise of additional language skills is vital in preparing and enhancing student learning. Participants reported that social events held outside of academy and break times did not assistance interaction with native students. These finding are similar to White and Fulton [5] and resulted in the ethnic minority students establishing their own group for peer back up. It is evident that academia and practice will need to collaborate further in ensuring the needs of this particular group of students are identified and met. Additionally, the curriculum volition need to exist further developed to ensure that student attainment is comparable for ethnic minority students.
Cooperating with nurse supervisors was hard for some participants and participants within this study alluded to facing discrimination and racism in clinical practice and existence poorly treated based on their ethnicity. This was farther compounded by a few patients who requested to be cared for by natives rather than an ethnic minority student. Orduňa [19] found like results among African American students and reported that some patients requested reassignment because they did not want intendance delivery from that particular group of students. These findings illuminate that farther cooperation between clinical do and the university is vitally important in addressing students concerns and complaints of discrimination. Bigotry is against the police force and policies should be utilised effectively to transport a message that information technology is not acceptable and educators both within academia and practice should undertake staff development including unconscious bias training. White and Fulton [five] reported that indigenous minority students were more than likely to confront discrimination from nurse supervisors in clinical do and Gardner [7] constitute that ethnic minority students were more likely to exist excluded or overlooked. This can also exist a problem for native Norwegian students. As reported by Sedgwick et al. [12], the participants in this study tried to avert nurse supervisors they perceived as beingness unfriendly. This can be detrimental on student morale and operation. Students need to feel respected, encouraged and treated with nobility [6]. Inappropriate behaviour should exist challenged and addressed to truly promote a more inclusive working environment for ethnic minority students. The findings of this study identified other factors that were negative for ethnic minority students including lack of peer support and a deficit of office models, which appeared to amplify the challenges they faced [five, 15, 20]. This tin also be a problem for native Norwegian students. The knock-on effect for ethnic minority students is to see role models they tin aspire to and to enlighten native students on becoming more diverse in their outlook. Skisland et al. [21] also found that supervisors in clinical do requested closer cooperation with the university in improving supervision of ethnic minority students. One way to promote inclusivity is for higher education institutions and practice settings to employ individuals from various backgrounds, which is in keeping with globalisation and the diverse growing population inside Kingdom of norway.
Implications for nursing education practise
The findings from this study have implications for undergraduate programmes in Norway from an institutional perspective in providing and approaching diverseness and inclusivity in a more productive and systematic style. In moving forward, diversity training should be mandatory for staff within academia and practice. This would get some way in promoting and enhancing diversity and inclusivity. Additionally, the curriculum will demand to exist adult to promote inclusivity and equity, taking into account private learning needs of students from all backgrounds. Establishing a mentoring programme or buddy system for ethnic minority students may go some mode in alleviating some of the challenges identified by participants inside this study. Receiving additional support from academics and peers will be invaluable in enhancing confidence and promoting integration. This is where the role of having a personal academic tutor may be invaluable in providing one-to-one support for students. Furthermore, the cooperation between universities and clinical practices should be more aligned to ensure that students are treated fairly and with respect irrespective of their cultural background.
Strengths and limitations
The trustworthiness of the study was ensured by the fact that a) all participants were encouraged to speak freely about their experiences; b) all the steps in the assay [17] were strictly followed; c) three of the authors participated in the coding of the information and d) the students' voices were heard and accounted for using quotations. Moreover, the findings were linked with those from other international studies [4, ten,11,12, xviii, 20], which bolsters the integrity of the current study. Thus, this report has demonstrated that participants experienced similar challenges every bit indigenous minority students' in other western countries. Whilst the sample size is minor, the findings may resonate to other undergraduate nursing programmes, but as with other qualitative research, it is up to the reader to decide on the level of transferability [16, 17].
1 limitation in the present written report was the sample size as but eight students were recruited. Despite the small sample size, rich data were obtained, and saturation was achieved. The topic guide was not pilot tested due to time constraints and this could be another limitation. Some other limitation could exist that it was difficult for participants to exist completely honest with the teacher about their experiences of existence a nursing student. The first author had met a few of the participants during their second year in applied studies. When information was provided about the study, students were informed that participation was voluntary. A year had elapsed when the interviews were performed, and iii students chose not to participate. Further research is needed to develop a comprehensive nursing teaching programme where all students are given the same opportunities in condign healthcare professionals that values variety and inclusion. It would be useful to bear this study in other European countries such equally the United Kingdom to gain a European perspective.
Decision
Most participants in the written report faced many challenges with language, civilisation and isolation throughout the undergraduate plan in nursing as documented inside the findings and discussion. The findings indicate that it is important for indigenous minority nursing students to accept social back up and be surrounded past a strong network and part models. It is considered specially important that nursing educational programmes incorporate intercultural knowledge and guidance into their piece of work with the students.
Universities will need to promote multi-culturalism for all students and staff as function of the education process, every bit this is significant in nursing care commitment. Further collaboration and training is required within academia and practise and is imperative in ensuring that all students go a quality education and the private needs of ethnic minority students are met. Nurse educators in practice will need to piece of work inside the law and educate patients in preventing discrimination and infirmary policies should be very clear in these matters. The number of ethnic minority students will increase as volition the patient population and coming together the needs of these individuals will need to exist a priority.
Availability of data and materials
The interview data volition not be shared since the participants are guaranteed full anonymity.
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Acknowledgements
We wish to thank all the informants who participated.
Funding
The Faculty of Wellness and Sport Sciences, Academy of Agder, Kingdom of norway supported the study.
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Contributions
SF, AFT, AV-SS and U.s. designed the study; SF performed and analysed the interviews; SF, MPM, AFT, AV-SS and US discussed the analysis; SF, MPM and US drafted the article; all authors revised information technology critically and all authors read and approved the last version.
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Ideals approval and consent to participate
The study was designed in accordance with the tenets of the Announcement of Helsinki [22]; this investigation was part of a larger project that was focused on minority-language-speaking nursing students, from students', academics', and nurse supervisors' perspectives. Blessing was obtained from the Norwegian Heart for Research Data (project number: 52027) regarding the collection, handling, storage, and anonymization of information. The students were informed both verbally and in written format nearly the study. They were likewise informed that their participation was voluntary and that they had the possibility to withdraw without providing a reason and without any consequences for further educational progress. All the students provided their written consent to participate.
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Flateland, S.M., Pryce-Miller, Yard., Skisland, A.VS. et al. Exploring the experiences of existence an ethnic minority pupil within undergraduate nurse education: a qualitative study. BMC Nurs 18, 63 (2019). https://doi.org/10.1186/s12912-019-0389-0
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DOI : https://doi.org/10.1186/s12912-019-0389-0
Keywords
- Bachelor's degree in nursing
- Content assay
- Culture
- Isolation
- Nursing students
What Did Students Of Ethnic And Racial Minority Background Face,
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