[Academically educated nurses from third countries: Professional self-concept versus working life in Germany. A qualitative study using the example of migrant nurses from the Philippines]. / Akademisiertes Pflegefachpersonal aus Drittstaaten: Professionelles Selbstverständnis vs. berufliche Realität in Deutschland? Eine qualitative Studie am Beispiel migrierter philippinischer Pflegefachpersonen.

BACKGROUND: The recruitment of internationally educated nurses is gaining relevance in Germany in response to the growing shortage of nurses. Differences in nursing qualifications and practices between the country of origin and of destination can irritate the professional self-concept and hinder professional integration. PURPOSE: The study objective was to examine the development of the professional scope of action to unfold the professional self-concept of academically qualified nurses in Germany. METHODS: In accordance with the episodic interview, eight guided interviews were conducted with Filipino nurses who had migrated to Germany. Data was analyzed by thematic coding. RESULTS: The analysis shows two dimensions that impact the professional scope of action: perceived systemic constraints in the transition process and perspectives on professional development. The recruitment and recognition process is associated with high financial and time-related uncertainties and professional devaluation experiences. Migrant nurses experience both a loss of competence and a sense of foreignness in their nursing role in Germany. In order to regain professional scope of action, strategies of continuing education and focusing on more technology-intensive nursing care areas are pursued; only a minority can adapt their self-concept to the circumstances of nursing practice in Germany. DISCUSSION: The study results demonstrate the importance of paying attention to both the competence profile and the professional self-concept of academically educated nurses in order to offer migrant nurses professional career prospects in Germany. Especially in long-term care, this has proved to be a structural problem. CONCLUSION: To provide an attractive destination for international academically qualified nursing professionals in Germany, the ratification of international standards, the provision of transparent and independent information, utilization of existing nursing expertise as well as the establishment of career opportunities are recommended.

Policy Reform on the Qualification Pathway of Internationally Educated Nurses in Greenland and Its Relationship With the Danish System: A Qualitative Discourse Analysis.

The nursing profession in Greenland, particularly in rural and remote areas, faces challenges due to geographical limitation and a lack of interdisciplinary collaboration. The registration process and status of internationally educated nurses (IENs) in Greenland are unclear. This article aimed to analyze existing policies and propose recommendations for an independent registration process for IENs in Greenland. A qualitative discourse analysis was used to critically discuss existing policies and regulations governing nursing registration in Greenland. Relevant legislation, government reports, and official documents were reviewed. Legislative regulations protect the title of registered nurse in both Greenland and Denmark. To work in Greenland, an IEN must have a residence permit. With recent health agreements between Greenland and Denmark, both countries have streamlined the permit acquisition process for foreign healthcare professionals, making it more accessible. However, the process of acquiring a license to work as a registered nurse for IENs lacks clarity. Policy reform is needed to establish a group of diverse nurse experts under the National Board of Health responsible for the assessment and registration of IEN qualifications. There is also a need for a bridging education program or national licensure examination which could facilitate faster IEN recognition. Mutual recognition of nurse licenses between Greenland and Denmark should be established to ensure efficient healthcare delivery and maintain professional standards. Embracing IENs can address nursing shortages and improve healthcare services in Greenland.

"A different country, a different language, a different culture " Educational experiences of international nursing students studying in Turkey: A qualitative study.

AIM: This study was aimed at investigating the educational experiences of international nursing students in Turkey. BACKGROUND: Nursing education has now gained an international dimension, which creates an environment where students from different cultures come together. In Turkey, nursing education is expanding internationally due to the increasing number of international students. DESIGN: A descriptive- phenomenological qualitative study. METHODS: The study data were collected from nursing students who came to Turkey from 17 different countries between April 2023 and July 2023 to study at a nursing faculty in Turkey using a semi-structured interview form. Of these students, 27 constituted the study sample. The data collected were analyzed using the content analysis. The COREQ checklist was used in reporting the study. RESULTS: Four themes emerged: a) challenges, b) gains, c) support needs and d) recommendations. Among challenges reported by the participating students were language barriers, cultural adjustment issues and lack of social support. As for the gains of being a foreign student, they stated that they experienced intercultural interaction and improved their language skills, independence and self-confidence. In the study, the need for language support, provision of psychological assistance and cultural adaptation support for these students and the importance of practical recommendations such as mentoring programs and orientation trainings to improve their educational experience were emphasized. CONCLUSION: In conclusion, in this study, the importance of targeted strategies in nursing education in areas such as language support, psychological assistance and cultural adaptation was emphasized, which helps international students to have a successful educational experience. It was also concluded that mentoring programs and orientation trainings could enrich the educational processes of students by facilitating their adaptation to their new environment. This study is notable in the literature in that students from 17 diverse countries share the same program and the same prerequisites.

Nurses International Open Educational Resources for Global Impact.

The Nurses international Open Educational Resources (NI-OER) directly addresses the global shortage of nurse educators by providing an open-access English-language curriculum for a Bachelor of Science in Nursing program. The aim of the program is to provide educators in low- and middle-income countries with international standard content suitable for low-resource settings. The NI-OER include classroom lectures, references and learning resources, evaluation materials, and checklists for clinical practice. In order to meet local requirements, users can adapt the material according to the Creative Commons license. The development of evidence-based educator materials is a volunteer effort by two sponsoring organizations, Nurses International and the Bangladesh Health Project. Over time, additional resources and translations will be developed using communities of practice.

Transition-to-U.S. Practice Experiences of Internationally Educated Nurses: An Integrative Review.

Internationally educated nurses (IENs) are an important part of the U.S. nursing workforce. Optimizing their transition-to-practice (TTP) experiences in the United States is crucial for ensuring high-quality patient and IENs' outcomes. The purpose of this integrative review is to analyze and synthesize the current evidence surrounding IEN TTP experiences in the United States from 2000 to 2018 to inform improvements in TTP. Eighteen studies were included. TTP was defined through IENs' description of facilitators and barriers of the transition process and presented in seven themes. Two themes were facilitators: support from family and nursing colleagues, and perceptions of self-efficacy. The remaining five themes were barriers: (a) the stigma associated with educational preparation, (b) communication and language, (c) differences in culture, (d) differences in nursing practice, and (e) legal issues. Findings are important for improving TTP programs. Further research focusing on the outcomes of transition programs is needed to inform policymaking surrounding IEN recruitment and retention.

Nursing Student Engagement in Cultural Humility Through Global Health Service Learning: An Interpretive Phenomenological Approach.

Introduction: This study explored how global health service learning supported nursing student engagement in the process of cultural humility and how it shaped student understanding of themselves and their ability to develop supportive intercultural relationships. Methods: Written reflections were collected from eight second-year students while on a 9-day practicum in a low-resource Caribbean country. Six students participated in posttrip interviews. Thematic analysis was used to illuminate the students' lived experience. Results: Four student themes emerged: (1) overcoming challenges, (2) opening our eyes, (3) seeing difference as a strength, and (4) learning with and from each other. While participants were inherently ethnocentric, the process of cultural humility curbed their sense of superiority and enabled the development of supportive intercultural relationships with their hosts. Discussion: This global health service learning was an effective strategy to enhance student nurses' learning about themselves and intercultural relationships and to develop the attributes of cultural humility.

International Nursing Program Accreditation.

The Accreditation Commission for Education in Nursing (ACEN) is committed to being a supportive partner in strengthening the quality of nursing education for all levels of nursing programs domestically and internationally. With a longstanding history of accreditation dating back 66 years, the ACEN accredited its first international program in 2004 adding international accreditation to its repertoire. Recognizing geographic, cultural, and national differences, the ACEN common core of Standards and Criteria equip faculty with autonomy to embrace unique attributes of their programs regardless of location, culture, and nationality. Further, the ACEN review process fosters self-evaluation, peer review, and the promotion of educational equity, access, and mobility. As a result, the number of international nursing programs pursuing and attaining accreditation with the ACEN has increased thus validating the inclusiveness and relevance of the ACEN Standards and Criteria. The purpose of this article is to highlight ways in which ACEN Standards and Criteria apply to domestic and international nursing programs.

Improvement of the qualification system in Korea for foreign nurses eligible to take Korean nursing licensing examination

PURPOSE: We aimed to review and provide a quality improvement for the document utilized by the relevant Korean government body to verify and evaluate foreign university/college graduates' eligibility for nursing and qualification to take the Korean nursing licensing examination. METHODS: This was a descriptive study. We analyzed the current Korean qualification system for foreign graduates to Korean nursing licensing examination and the same system utilized in some other countries. Then, we created a draft of the reviewed qualification standards document based on the 2 prior analyses and their comparisons, and applied a questionnaire in an open hearing with 5 experts to enhance the draft's quality. Finally, we presented and discussed the final draft. RESULTS: The reviewed criteria of the qualification standards included confirming whether the foreign graduate's university has an accreditation provided by its relevant government body, the exclusion of foreign graduates' provision of several documents previously required, a minimum number of credits (1,000 hours) for their original course, a 3-year minimum enrollment period for their original course, and a mandatory reassessment of the foreign graduates' university recognition in a 5-year cycle. DISCUSSION: We believe that by creating a review draft that addresses the flaws of the current document utilized to determine the qualification for foreign graduates to take the Korean nursing licensing examination, we have simplified it for a better understanding of the application process. We hope that this draft will contribute to a more objective and equitable qualification process for foreign university nurse graduates in Korea.

Internationally qualified nurse communication-A qualitative cross country study.

AIMS AND OBJECTIVES: To compare the communication and practice experiences of migrant nurses in geographically distant, culturally dissimilar countries in Eastern and Western contexts. BACKGROUND: Considerable research has focused on the experience of acculturation of migrant nurses into geographically diverse locations. However, there remains scant comparative research which considers the ways in which migrant nurses interpret their experience through making "sense" of events encountered in their practice. DESIGN: An exploratory qualitative study was conducted using face-to-face interviews with 36 migrant nurses currently practising in New Zealand and 20 migrant nurses practising in the United Arab Emirates. METHODS: The same question schedule was used to explore influences on communication and practice in both settings. Thematic analysis and sensemaking theory guided coding and analysis of data. COREQ guidelines informed the reporting of qualitative data. RESULTS: Qualitative analysis resulted in five representative themes, three illustrating similarities across diverse cultures and two that demonstrate the differences migrant nurses require to navigate across contrasting cultural environments successfully. CONCLUSION: Cultural value-based differences in both locales caused both systemic and interpersonal sensemaking challenges for migrant nurses that emphasise the importance of orientation and education programmes for internationally qualified nurses. However, cultural conflicts also exist within groups. Orientation programmes should address culturally patterned responses among different groups of internationally qualified nurses. RELEVANCE TO CLINICAL PRACTICE: Findings demonstrate a need for migrant nurses to be willing to embrace ambiguity in order to acculturate into a collaborative team culture in each of the geographical locations in this study. As registered nurses (RNs) also carry their cultural imprint, orientation interventions targeting the cultural variations of nurses in less standardised orientation programmes may be more beneficial in enhancing acculturation and in turn, staff retention.

Graduate experiences with transnational nursing education: a qualitative enquiry.

PURPOSE: The purpose of this paper is to share insights, research findings and discuss key issues related to graduate experiences with transnational nursing education (TNE). DESIGN/METHODOLOGY/APPROACH: The authors used a qualitative approach and sampled national and international nurse graduates to identify challenges and best operating practices in cross-border nursing program facilitation. FINDINGS: This research paper has provided a platform for graduates to lend their voices to the promotion of effective cross-border nursing education delivery and suggests that although international collaborations endeavor to maintain high academic standards in TNE, there is still a need to re-engineer, revise and adapt curricular content, learning, teaching and assessment practices to aid the nursing student. RESEARCH LIMITATIONS/IMPLICATIONS: Identified challenges affecting the facilitation and delivery of cross-border nursing education programs can act as levers to improving service quality of present and future cross-border programs to the nursing student. This will assist future nursing students to recognize culture shock and embrace their decision to pursue nursing. PRACTICAL IMPLICATIONS: The experience of being involved in TNE for nursing students may not be that much different than students of other disciplines. While not able to be generalized to the entire population, the reports by the nursing students in this sample appear to be valuable and worthwhile to continue supporting and encouraging other TNE opportunities. ORIGINALITY/VALUE: This paper explores cross-border nursing education experiences from national and international perspectives. The authors were able to explore inherent TNE challenges from diverse population and cultural backgrounds.

Cross-border nursing education: questions, qualms and quality assurance.

PURPOSE: The purpose of this paper is to share insights, research findings and discuss key issues relating to quality practices and quality assurance in cross-border nursing education program development and implementation. DESIGN/METHODOLOGY/APPROACH: The authors used a qualitative, multiple case-study approach, by sampling local, national and international nursing education institutions, academia and nurse graduates to identify challenges and best operating practices in implementing and facilitating cross-border education. FINDINGS: The authors reveal that quality assurance affects cross-border nursing education program design, delivery and implementation. RESEARCH LIMITATIONS/IMPLICATIONS: Quality assurance plays an important role in cross-border nursing education, by enhancing the reputation and recognizing the effectiveness and capacity of the educational institution. These findings of this study can offer valuable insight to forthcoming as well as existing nursing education curriculum developers who plan to engage in national or international educational partnerships. PRACTICAL IMPLICATIONS: Quality assurance plays an important role in cross-border nursing education, by enhancing the reputation and recognizing the educational institution's effectiveness and capacity. The findings offer valuable insight into forthcoming and existing nursing education for curriculum developers who plan to engage in national or international educational partnerships. ORIGINALITY/VALUE: This paper explores inherent challenges in cross-border nursing education and maximized data collection opportunities by sampling participants from both national and international settings.

Learner-Centered Approaches in an International Nurse Training Program.

BACKGROUND: This study examines the appropriateness of using learner-centered teaching approaches with international nurses in New Zealand. A 12-week international nurse training program was designed by a large tertiary institution in New Zealand in response to the request of Shenzhen local hospital officials in China. Three groups of 30 Chinese nurses attended this program. METHOD: Responses from program participants were garnered through an online survey and a focus group interview. All qualitative data were analyzed using a thematic approach. RESULTS: The study results highlighted that a positive aspect of the program was the collaborative decision making invited by the program coordinator about the learning goals, topics, and content. Participants reported how the shift in power from a teacher-directed program to a learner-centric approach helped them to engage more fully in the program and achieve greater, more successful individual outcomes. CONCLUSION: This project demonstrated the feasibility of implementing an international nursing training program using a culturally appropriate learner-centric teaching approach. The findings suggest that a learner-centric teaching style effectively addresses the diverse professional needs and cultural backgrounds of international nursing practitioners. [J Contin Educ Nurs. 2019;50(4):183-188.].

Predicting international students' clinical and academic grades using two language tests (IELTS and C-test): A correlational research study.

Academic English tests are used to ascertain if international English as a Second Language nursing students have sufficient language skills to commence their nursing degrees, and later, if they have sufficient English for nursing registration. However, an academic English test may not be appropriate for clinical contexts. This study examines the relationship between two types of English test and the performance of forty-nine undergraduate international nursing students in both their first year of theory-centred academic topics and practice-centred clinical topics. An academic English test, called the International English Language Testing System (IELTS), and a general English proficiency/processing speed test using a variation of the cloze-test (C-test) format were administered at the commencement of the students' course of study. At the end of one year, grade percentages were collected. It was found that both the IELTS test and the C-test were significantly correlated to both types of topic, albeit with different patterns. The two English tests were also tested for similarities in the constructs they measured, with a significant overlap found. The implications are to rethink the way English tests are applied to entry in university degrees involving a clinical component and, by extension, to direct universities to rethink how nursing students are supported during their degree. The question is also raised about the practice of using academic English tests for professional nursing registration purposes. The benefits of the two testing approaches are also considered, particularly the large differences in monetary outlay and time found between the two tests, given their performance in explaining the variance in grade outcomes.

Current Data of Foreign-Educated Nurses in Italy and the Recognition of Their Professional Qualifications.

Up-to-date data on foreign-educated nurses (FENs) in Italy and the recognition of their professional qualifications are pivotal to boost international discussion, and to improve the engagement and involvement of multistakeholders in the nursing profession. Currently, FENs in Italy represent roughly 6% of the total number of registered nurses. FENs are predominantly females between 35 and 54 years old. This article discusses FENs' paths to achieve their professional qualification to practice in Italy. It also offers insights for regulators and stakeholders, such as the need to enlarge the scope of practice for nurses.

International Nursing: Needs Assessment for Training in Disaster Preparedness for Hospital Nurses: A Modified Delphi Study.

Despite high awareness of the need, opportunities for nurses to gain disaster experience or training are limited. In Korea, most disaster training is done in an undergraduate curriculum where there is very limited practice, and the educational topics are mostly focused on the field aspect of disaster events. The purpose of this study was to determine the need for such training for hospital nurses and to determine appropriate and relevant components of the training contents. A qualitative survey approach using the modified Delphi method was used to collect and analyze the data. The surveys were conducted in 3 rounds. After the results were analyzed from the third-round survey, the authors finalized the contents for a training program to prepare nurses for their roles during disasters. Through a structured needs analysis using a modified Delphi survey, the framework for the content development of disaster training curriculum for hospital nurses was developed.

Internationally educated nurses' descriptions of their access to structural empowerment while working in another country's health care context.

AIM: To examine internationally educated nurses' experiences of empowerment structures using Kanter's theory of structural empowerment. BACKGROUND: There has been an increase in the number of nurses working in other countries worldwide and concerns have been raised regarding their working conditions. METHOD: Semi-structured interviews were conducted with a purposive sample of 11 internationally educated nurses. Directed content analysis was used to analyse the data and Kanter's theory of empowerment was used as a framework. RESULTS: Access to information was generally good. Access to support for their relationship with their managers varied. Regarding access to resources, nurses unfamiliar with clinical leadership found team leadership challenging. Access to in-house learning opportunities were reported as good. Access to informal power was more common than access to formal power. CONCLUSIONS: The findings support Kanter's theory and demonstrate that internationally experienced nurses encountered varying degrees of access to empowering structures. Access to information and formal power was more general and related to the unit. Access to resources, support, opportunities and informal power were related to both the unit and the informants' specific situation as IENs. IMPLICATIONS FOR NURSING MANAGEMENT: Managers need to support IENs when having a team leadership role, facilitate encounters between IENs and ordinary staff, and establishing mentorship for IENs.

Immigrant nurses' perceptions on cultural differences-based job concerns: A phenomenological study in Shanghai China.

AIMS AND OBJECTIVES: To explore the experiences of immigrant nurses working in Shanghai, China. BACKGROUND: With the development of China, population growth has been accelerating. Simultaneously, the number of immigrant nurses in Shanghai has been increasing dramatically. Meanwhile, their turnover rate is abnormally high, primarily because of job concerns stemming from cultural differences. An understanding of immigrant nurses' job concerns caused by cultural differences can be used to help them to work more efficiently and cohesively. We aimed to investigate immigrant nurses' lived experiences regarding job concerns caused by cultural differences in Shanghai, China. METHODS: This is a phenomenological study. In-depth semi-structured interviews were conducted with fifteen immigrant nurses from January-July 2016. Data were collected using audio-taped face-to-face interviews; the narratives were then transcribed verbatim and analysed thematically. RESULTS: The following three major themes emerged from the data: "communication difficulties," "work adjustment difficulties" and "life adjustment difficulties." The eight sub-themes within these were as follows: (i) language barrier, (ii) inability to integrate oneself with the local culture, (iii) feelings of unfairness, (iv) difficulty asking for leave, (v) feeling stressed, (vi) not being acclimatised, (vii) feeling helpless and (viii) feeling guilt at being unable to take care of their family. CONCLUSION: It is important to implement appropriate training programmes on language and cultural adaptation for immigrant nurses. To enhance integrate immigrant nurses into Shanghai's society, more support needs to be provided. RELEVANCE TO CLINICAL PRACTICE: Administrators in hospitals should pay attention to immigrant nurses' job concerns that are caused by cultural differences and provide timely and effective assistance.

Development and testing of the CALDs and CLES+T scales for international nursing students' clinical learning environments.

AIM: The purpose of this study was to develop and test the psychometric properties of the new Cultural and Linguistic Diversity scale, which is designed to be used with the newly validated Clinical Learning Environment, Supervision and Nurse Teacher scale for assessing international nursing students' clinical learning environments. BACKGROUND: In various developed countries, clinical placements are known to present challenges in the professional development of international nursing students. DESIGN: A cross-sectional survey. METHODS: Data were collected from eight Finnish universities of applied sciences offering nursing degree courses taught in English during 2015-2016. All the relevant students (N = 664) were invited and 50% chose to participate. Of the total data submitted by the participants, 28% were used for scale validation. The construct validity of the two scales was tested by exploratory factor analysis, while their validity with respect to convergence and discriminability was assessed using Spearman's correlation. RESULTS: Construct validation of the Clinical Learning Environment, Supervision and Nurse Teacher scale yielded an eight-factor model with 34 items, while validation of the Cultural and Linguistic Diversity scale yielded a five-factor model with 21 items. CONCLUSION: A new scale was developed to improve evidence-based mentorship of international nursing students in clinical learning environments. The instrument will be useful to educators seeking to identify factors that affect the learning of international students.