An Exploration of the Perceptions of Nurse Lecturers, Student Nurses and Clinical Mentors of the Utility of Student Nurses Undertaking International Clinical Experience

  • Desmond Cornes

Student thesis: Doctoral ThesisProfessional Doctorate (ProfD)


Universities and nursing programmes are faced with the challenge of how to create learning opportunities which address the continued momentum towards the internationalisation of society and its health care needs. International clinical immersion experiences have been one way of achieving this. However, in times of resource constraint and emerging views that the proposed benefits of such an exchange and the enhanced skills attributed to the exchange experience can be achieved by alternative means and are not necessarily transferred back to local clinical contexts, raises the question of their utility. This dilemma reflects the aim of my study which was to identify and critically analyse how three groups of nurses; students, nurse lecturers and clinical mentors, perceived the utility of
undergraduate student nurses undertaking an international clinical practice immersion experience with a view to informing the internationalisation of the nursing curricula.

This phenomenological study underpinned by the philosophical hermeneutics of Gadamer (1975) employed individual, face-to-face, unstructured but focussed interviews to elicit the perceptions of academic staff, undergraduate nursing students who have had an international clinical exchange and clinical mentors on this issue. Each distinct group comprised eight participants (n=3x8=24). Their plausible insights into these phenomena will be used to inform curricular design for undergraduate nursing programmes and to develop strategies to maximise any derived benefits into the students' clinical practice on return. Data analysis was done using the method developed by Fleming et al (2003).

The results showed that students were positive and enthusiastic about their exchange experience, academics saw it as a great learning opportunity and clinical mentors were for the most part indifferent to the student's international experience. This lack of recognition that they had been abroad and overcome significant challenges undertaking an international placement was an area of particular sensitivity for students. It was evident from the data that value was attached to international placements by academics and clinical mentors in the absence of any in-depth knowledge, awareness or experience of international exchange. Importantly however was the fact that these values could be changed by information about, and the opportunity to discuss the concept. Significantly
members of all three groups expressed doubt about the ability of the students to transfer the developed skills back to their clinical practice at home. The reality for most students was that they were not encouraged to practice the skills they had developed abroad partly because of traditional ways of allocating duties in which the students international experience was not taken into account and partly because of preconceived ideas about students level of competence based on the stage of their programme. Students who also perceived that they might get a negative reaction to their experience ameliorated their behaviour to ensure they 'fitted in' and or 'passed their placement'. In this regard how the student communicated about their international experience and their relationship with their clinical mentor was of paramount importance in effecting their learning experience.

The study also demonstrated that the uniqueness of the clinical exchange as a learning experience was in being immersed in the culture and the vulnerability the student felt in overcoming the associated challenges. For this reason students' who did not exchange could not get the same experience using alternative pedagogical approaches and educational technologies; however these strategies are useful for students who do not exchange and in meeting curricular requirements for validated nursing programmes. It became obvious however that students' who exchanged were unable to articulate beyond a superficial level what they had actually learned and academics were unable to specify the unique learning outcomes which would reflect the international element of the experience and differentiate it from the learning outcomes a student would be expected to achieve if they had not exchanged. There was also a strong argument that a student would not have to go abroad to develop the personal and professional growth associated with international clinical exchanges. In reality it was expected that students who did not exchange would develop the same knowledge and skills and maturity by the end of their undergraduate nursing programme. In this domain no academics or clinical mentors involved in this study felt it was possible to differentiate between those students who had exchanged and those who had not by formal or informal assessment. For this reason it was the view of clinical mentors that an international experience would not necessarily help them secure their first permanent position as a trained nurse.

With respect to internationalisation of the curriculum it was evident that whereas the principle of international exchange was accepted by each of the three groups of participants there was a dearth of appreciation of what that meant in terms of an internationalised curriculum. Students and clinical mentors showed little interest in the concept while academics although more knowledgeable perceived it to be a top down initiative associated with a marketing strategy which they were not particularly interested in or were not involved with either through choice or other commitments. However the need to facilitate more students going abroad was recognised while the need to have a planned approach to exchange focussing on learning needs rather than the practicalities of the exchange was highlighted.

The findings from this study suggest that students do undergo substantial personal and professional growth as a result of an international exchange experience. The challenge now is to enhance the knowledge about this experience and the value attached to it by the wider nursing community and to improve the transferability of the enhanced skills and qualities developed by the student to home clinical contexts. This study suggests that the following recommendations will contribute to that goal.

It is imperative that academics that are interested, motivated and knowledgeable about student exchange take the lead and ensure that potential advantages of exchange are advertised, known and understood. In this regard the opportunity to discuss the concept face-to face is likely to be more successful in changing attitudes and the targeting of clinical mentors more productive. Clearly appropriate learning outcomes which capture the uniqueness of the international exchange should be developed while for those students who do not exchange it is imperative to continue to develop and utilise alternative teaching strategies and use of technologies and clinical placements to provide alternative means of achieving concomitant personal and professional growth. However for those who exchange there is a need for the development of a planned approach to student exchange which is focussed on student learning rather than on the planned process of arranging the exchange. This process should include briefing, support during the exchange, reflection on return and importantly preparing the student for their return to home clinical environments particularly in reference to communication and interpersonal skills. With respect to the latter clinical mentors are crucial in the ability of the student to transfer and further practice and develop the skills which are developed abroad. It would seem appropriate therefore to include wider discussion of international exchange and the experiences and expectations of students on their return within mentorship programmes and updates. Similarly it would be wise to increase the opportunities for more academics, clinical mentors and students to be involved in all stages of curriculum development. This tripartite involvement would have the added benefit for not only contributing to a more internationalised curriculum but in helping to utilise more fully the perceived benefits of the student immersion experience.

These findings and recommendations have compelling implications for nurse education, practice and research.
Date of Award2016
Original languageEnglish
Awarding Institution
  • Glasgow Caledonian University
SupervisorFrank Crossan (Supervisor) & Jo Booth (Supervisor)

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