Language support to nursing students through CareEP project

1 Introduction

Internationally educated nurses have been migrating across the Organization for Economic Cooperation and Development (OECD) countries at an increasing rate since the turn of millennium. As of the latest available data, there is a discernible trend in the recruitment of nurses with foreign background throughout the OECD countries (OECD, 2019). This figure has doubled between 2000 and 2015, elevating the proportion of the international nurses in OECD countries from approximately 11% to 16% (Socha-Dietrich & Dumont, 2021). Simultaneously, the shortage of nurses in the global scenario has also prompted a surge in the admission of nursing students, leading to a notable increase in the enrollment of international students within nursing education. Ministry of Social Affairs and Health (2023), in Finland estimates that by 2030, 10% of nurses will be of foreign background having Finnish as a second language (Yle news, 2022). This emphasizes the increasing need for cultural and language awareness, not only in the health care sector but also across the entire society.

Our Culture and language-aware nursing in South Ostrobothnia “CareEP project”, spanning from 1.2.2023 to 31.1.2026, was started in February 2023. The work packages of the project are primarily focused on supporting nursing students in language learning and their clinical nurse supervisors in clinical nursing placements. The models to be developed within the project will support training and facilitate language skills acquisition among nurses trained both within the country and outside EU/EEA countries. A pivotal part of the project is to develop a career path model for nurses with foreign backgrounds, meaning nurses with Finnish as a second language. One aspect of the career pathway model involves informing and guiding clinical nurse supervisors to integrate culture and language awareness when supervising international nursing students. These international students are on the path of language learning with limited Finnish language skills. Integrating culture and language awareness into nursing supervision fosters a supportive environment. It enhances students’ language skills, promotes professional development, and reduces communication barriers, ensuring effective patient care for diverse cultural backgrounds.

2 Since the launch of the Project

Since the spring 2023, the RDI expert for the CareEP project has been working with international nursing students at SeAMK from different study groups. One of the goals of the project is to provide guidance for nursing students with foreign backgrounds and qualified nurses from EU/ETA countries who are already here. The guidance was provided to the nursing students in terms of professional language learning through “Hoida suomeksi työpaja.” The long-term goal of the CareEP project is to foster long-term integration and improve employment prospects for nurses with foreign backgrounds in the Southern Ostrobothnia region.

In the first phase, the targeted nursing students were top-up nursing students, meaning they have an earlier nursing degree, but their study duration at SeAMK is 1,5-2 years with 210 European Credit Transfer and Accumulation System (ECTS). The mentor was focused on mentoring the international students with professional Finnish since there was no regulated, predefined model for this mentorship and guidance. The students enrolled in the top-up nursing program have earlier nursing degrees from their home countries. They were already adept nursing experts with a good background in nursing theories and years of nursing work experience in medical and surgical nursing, palliative care, plastic surgery, mental health nursing, and pediatric and geriatric care. From the critical observation, it was noted that this qualified nursing workforce only needed professional Finnish language skills, which are needed in Finnish working life.

The language workshop equipped them with a theoretical foundation on various aspects of Finnish society and nursing work culture. In addition to that, students learned essential professional clinical skills and set up an ethical foundation that is necessary for work life. Given the variations in healthcare systems, education, and cultural contexts between the Philippines and Europe, the language workshop aimed to prepare the students for these differences and adapt to Finnish society. The language workshop supported them to understand the social and healthcare environment in Finland, understand the care pathway, including customer-oriented nursing care, clinical nursing skills, and the ability to navigate daily situations using professional Finnish language skills.

Implemented in both Finnish and English, the language workshop serves as a conduit for students to grasp the nursing vocabulary employed within healthcare organizations. This approach helped an early acquisition of nursing terminologies and vocabulary. However, the workshop extends beyond linguistic ability, it integrates the application of nursing principles into students’ daily practices. The emphasis on evidence-based nursing expertise occurs across diverse learning and care settings, empowering students to effectively engage with patients of different conditions such as acute, surgical etc. This integrated approach not only promotes health and well-being of the patients but also equips students with the ability to treat illnesses while concurrently mastering Finnish nursing terminologies. On the other hand, the clinical placement of the student is also diverse.

3 Learning professional language during Hoida suomeksi työpaja

Learning a new language is always time consuming and achieving academic proficiency in the host country’s language is even more demanding (Harju-Autti et al., 2021). Finnish language is the main challenge for international students in finding employment in Finland. As part of our CareEP –Project, we set out to solve these challenges faced by our nursing students. We focus on providing comprehensive support for professional language learning throughout their clinical training and overall study period, aiming to facilitate their seamless integration into Finnish society even during their study period. Most of the students with 120 or more than 120 ECTS are liable to work as a practical nurse.

In the “Hoida suomeksi työpaja”, the mentor develops a wide range of nursing learning materials in Finnish language to support the students´ Finnish language learning that are relevant in the nursing work life. Finnish working community and the clinical placement supervisor also play a key role in facilitating the successful integration of the nursing students during their clinical placements. Although the interaction situations and typical nursing vocabulary vary across sectors and workplaces, the language tools provided through the language workshop show promise for applicability in the professional environment. Further implementation, keen observation, experience of the nursing students and assessment are needed to determine its effectiveness. The language-aware guidance and the idea of learners’ self-reflection, motivation and behaviors are also central to the language learning process. Motivational factors make learners more receptive to new information. It is essentially important that the student is motivated and takes ownership of the language development goals (Seven, 2020).

In the beginning, there were several groups guidance for the top up nursing students. This included various meetings between the mentor and the student group focusing exclusively on professional language learning using nurse patient cases. For nursing students from multimodal group, the language workshop was conducted individually due to the time constraint and different life dimensions of the students. The first meeting was at the beginning of the clinical placement to discuss the student’s language skills, strengths and needs for development and support. These kinds of workshops were at least conducted five times, where the mentor and the student practice the Finnish nursing vocabulary used in various patient cases.

• Nurse patients’ interaction situations through patients’ cases, practicing the dialogues, practice on pronunciation that are needed in the clinical placement.
• Vocabulary typically needed in nursing.
• Nursing procedures, preparations
• Basic comprehension on general wellbeing of the patient.
• Asking about food preferences.

The healthcare organization and nurse supervisors also play a vital role in supporting the students in the rules of language use and how to support the student in learning the language, yet the language agreement was not implemented during these phases.

4 In clinical placements

The mentor visited the clinical practical placements as per the need of the student. The students had their own teacher supervisor from school and clinical nurse supervisor from the clinical placements. Most of the students with beginners’ Finnish language skill had difficulty in understanding the patient report and in documentation. In these situations, the mentor provides guidance in understanding the patient cases such as, why the patient is in the care unit, need for medical care, nursing care plan, nursing intervention, procedures, medications, and report writing as well as giving oral reports. These were the general challenges faced by the students, however the nursing students learnt other clinical skills by observing and shadowing their clinical supervisors.

Through the work packages of CareEP, we support nursing students and their clinical nursing supervisors in clinical nursing placements. Gradually, nursing students were introduced to professional Finnish languages and Finnish working life. Through the language workshop, we provided a range of informative nursing courses in Finnish languages that are focused on nursing and medical terminologies, patient communication, disease specific case study, nurse-patient dialogues supporting nursing students later in their clinical placement. Through the language workshop, nursing students not only learn professional vocabulary, but they also learn to speak with patients which promotes language acquisition. Finnish language proficiency is crucial for communication with colleagues, patients, and relatives (Mikkonen et al., 2016).

The mentor should actively collaborate with the nurse supervisors of the healthcare organization to promote and develop language awareness and understanding of the language learning process in the clinical placement of the nursing student. In my personal observations, international nursing students arriving from diverse countries to study and work in the Finnish health care sector significantly increase the multicultural competence of the work community as the sharing of the knowledge and skills mix from various cultural background happens, however, it is worth noting that the insufficient proficiency in the Finnish language tends to overshadow the nursing skills of these students. Kamau et al. (2023) in his research also stated the fact that nursing students from international background often lack language learning support from the organizations along with other proper orientation periods and mentorship support either during the clinical placement or during the induction phase. Hence, there is need for increased interaction not only with the clinical supervisor but whole nursing unit to address this linguistic gap and further enrich the learning experience for nursing students in clinical placements.

The article has been prepared as part of the CareEP project, Culture and Language-Aware Nursing in South Ostrobothnia, and we would like to thank the European Social Fund for funding the project and this article.

For more information, visit https://projektit.seamk.fi/hyvinvointi-ja-luovuus/careep/

The article was prepared as part of the Kulttuuri- ja kielitietoinen hoitotyö Etelä-Pohjanmaalla, the CareEP project, and we would like to thank the European Social Fund for funding the project and this article.

Binu Acharya
Expert, RDI
CareEP- hanke
SeAMK

Reference

Gea‐Caballero, V., Castro‐Sánchez, E., Díaz‐Herrera, M. Á., Sarabia‐Cobo, C., Juárez‐Vela, R., & Zabaleta‐Del Olmo, E. (2019). Motivations, Beliefs, and Expectations of Spanish Nurses Planning Migration for Economic Reasons: A Cross‐Sectional, Web‐Based Survey. Journal of nursing scholarship, 51(2), 178-186. https://doi.org/10.1111/jnu.12455

Harju-Autti, R., Mäkinen, M., & Rättyä, K. (2022). ‘Things should be explained so that the students understand them’: Adolescent immigrant students’ perspectives on learning the language of schooling in Finland. International journal of bilingual education and bilingualism, 25(8), 2949-2961. https://doi.org/10.1080/13670050.2021.1995696

Kamau, S., Oikarainen, A., Juntunen, M., Koskenranta, M., Kuivila, H., Tomietto, M., & Mikkonen, K. (2023). Nurse educators’ views of integrating culturally and linguistically diverse future registered nurses into healthcare settings: A qualitative descriptive study. Journal of advanced nursing, 79(9), 3412-3425. https://doi.org/10.1111/jan.15683

Mikkonen, K., Elo, S., Tuomikoski, A., & Kääriäinen, M. (2016). Mentor experiences of international healthcare students’ learning in a clinical environment: A systematic review. Nurse education today, 40, 87. https://doi.org/10.1016/j.nedt.2016.02.013

Nortvedt, L., Lohne, V., & Dahl, K. (2020). A courageous journey: Experiences of migrant Philippine nurses in Norway. Journal of clinical nursing, 29(3-4), 468-479. https://doi.org/10.1111/jocn.15107

OECD (2019), Recent Trends in International Migration of Doctors, Nurses and Medical Students, OECD Publishing, Paris, https://doi.org/10.1787/5571ef48-en.

Seven, M. A. (2020). Motivation in Language Learning and Teaching. African Educational Research Journal, 8, 62. https://files.eric.ed.gov/fulltext/EJ1274645.pdf

Socha-Dietrich, K., & Dumont, J. (2021). International migration and movement of nursing personnel to and within OECD countries – 2000 to 2018: Developments in countries of destination and impact on countries of origin (OECD Health Working Papers, No. 125). OECD Publishing, Paris. https://doi.org/10.1787/b286a957-en

Yle News. (27.11.2022). Finland needs 20,000 foreign health and social care workers, but few have arrived lately. https://yle.fi/a/3-12681978.