University of Oulu

Kristina Mikkonen, Satu Elo, Jouko Miettunen, Mikko Saarikoski, Maria Kääriäinen, Clinical learning environment and supervision of international nursing students: A cross-sectional study, Nurse Education Today, Volume 52, 2017, Pages 73-80, ISSN 0260-6917,

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

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Author: Mikkonen, Kristina1; Elo, Satu2,3; Miettunen, Jouko4,5;
Organizations: 1Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland
2Research Unit of Nursing Science and Health Management, Medical Research Center Oulu, Oulu
3University Hospital and University of Oulu, Oulu, Finland
4Center for Life Course Health Research, University of Oulu, Oulu, Finland
5Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
6Department of Nursing Science, University of Turku, Oulu, Finland
Format: article
Version: submitted version
Access: open
Online Access: PDF Full Text (PDF, 1.7 MB)
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Language: English
Published: Elsevier, 2017
Publish Date: 2019-06-14


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.

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Series: Nurse education today
ISSN: 0260-6917
ISSN-E: 1532-2793
ISSN-L: 0260-6917
Volume: 52
Pages: 73 - 80
DOI: 10.1016/j.nedt.2017.02.017
Type of Publication: A1 Journal article – refereed
Field of Science: 316 Nursing
Funding: We acknowledge Oulu University Scholarship Foundation for providing financial support for the cost of data collection.
Copyright information: © 2017 Elsevier Ltd. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license