Clinical learning environment and supervision of international nursing students: A cross-sectional study

Nurse Educ Today. 2017 May;52:73-80. doi: 10.1016/j.nedt.2017.02.017. Epub 2017 Feb 27.


Background: Previously, it has been shown that the clinical learning environment causes challenges for international nursing students, but there is a lack of empirical evidence relating to the background factors explaining and influencing the outcomes.

Objective: To describe international and national students' perceptions of their clinical learning environment and supervision, and explain the related background factors.

Design: An explorative cross-sectional design was used in a study conducted in eight universities of applied sciences in Finland during September 2015-May 2016.

Methods: All nursing students studying English language degree programs were invited to answer a self-administered questionnaire based on both the clinical learning environment, supervision and nurse teacher scale and Cultural and Linguistic Diversity scale with additional background questions. Participants (n=329) included international (n=231) and Finnish (n=98) nursing students. Binary logistic regression was used to identify background factors relating to the clinical learning environment and supervision.

Results: International students at a beginner level in Finnish perceived the pedagogical atmosphere as worse than native speakers. In comparison to native speakers, these international students generally needed greater support from the nurse teacher at their university. Students at an intermediate level in Finnish reported two times fewer negative encounters in cultural diversity at their clinical placement than the beginners.

Conclusion: To facilitate a successful learning experience, international nursing students require a sufficient level of competence in the native language when conducting clinical placements. Educational interventions in language education are required to test causal effects on students' success in the clinical learning environment.

Keywords: Clinical facilitator; Clinical learning environment; Cultural and linguistic diversity; Internationalism; Nurse teacher; Nursing students; Supervision.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Cultural Diversity*
  • Education, Nursing, Baccalaureate / methods
  • Faculty, Nursing / psychology
  • Female
  • Finland
  • Humans
  • Language*
  • Male
  • Nurses, International / psychology*
  • Problem-Based Learning
  • Students, Nursing / psychology*
  • Surveys and Questionnaires