A systematic review of the experiences of undergraduate nursing students choosing to study at an English speaking university outside their homeland.

Background: Increasingly overseas students are attending university nursing programs in English-speaking countries to gain additional tertiary qualifications that may not be available in their homeland and also to fill the international nursing shortfall. For these students, some common issues identified and affirmed in qualitative research papers include loneliness, discriminatory experiences, developing communication, and academic skills. This systematic review will help identify and synthesise current issues through exploring the existing literature, giving an insight into the lives of international nursing students. Given the large and increasing number of these students, it is important to acknowledge and improve learning and other outcomes for them.

Objectives: The objective of this systematic review was to determine the best available evidence in relation to the experiences of undergraduate nursing students choosing to study at an English speaking university outside their homeland.

Inclusion Criteria: This review sought high quality studies aimed at exploring the experience of undergraduate nursing students studying outside their homeland at an English speaking university. Both qualitative research studies and opinion-based text were considered for this review.

Search Strategy: An extensive search of the literature was conducted to identify research studies published between January 1990 and April 2011 in English and indexed in 37 major databases.

Methodological Quality: All included articles were assessed independently by two reviewers (RT and SP), using the appropriate critical appraisal tool from the Joanna Briggs Institute.

Data Collection: Data were extracted from included papers using appropriate standardised data extraction tools developed by the Joanna Briggs Institute.

Data Synthesis: Data from qualitative studies and textual and opinion papers were meta-synthesised separately using standardised instruments. Data synthesis of all included studies involved the pooling of findings and then grouping into categories on a basis of similarity of meaning. The categories were further aggregated into a set of statements representing synthesised findings as a coherent whole.

Results: A total of 19 studies were identified as of high quality and meeting the inclusion criteria. From these studies, 254 findings were extracted which were grouped into 13 categories and further aggregated into four synthesised findings.

Conclusions: The four major areas identified in this review in relation to the experiences of undergraduate nursing students studying outside their homeland at an English-speaking university include the need for support and encouragement, valuing and respecting difference, and the desire to succeed despite challenges and inclusion.

Implications For Practice: Recognising the unique needs of international nursing students, in the clinical, academic and social context, is critical to improve the experiences of this student cohort. Educational and support strategies and programs are needed to respond to these needs.

Implications For Research: The implications for research are substantial. Given the outcomes of this review, action and evaluative research is needed to explore, implement and evaluate support strategies for students from non-English speaking backgrounds studying nursing. Research in the areas of curriculum development, supporting students' clinical experiences, and university social and academic support programs is recommended.