title: Clinical learning environment and supervision of international nursing students: A cross-sectional study.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland. Electronic address: kristina.mikkonen@oulu.fi.
authors.forename: Kristina
authors.initials: K
authors.lastname: Mikkonen
authors.affiliation: Research Unit of Nursing Science and Health Management, Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: Satu
authors.initials: S
authors.lastname: Elo
authors.affiliation: Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: Jouko
authors.initials: J
authors.lastname: Miettunen
authors.affiliation: Department of Nursing Science, University of Turku, Oulu, Finland.
authors.forename: Mikko
authors.initials: M
authors.lastname: Saarikoski
authors.affiliation: Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
authors.forename: Maria
authors.initials: M
authors.lastname: Kääriäinen
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D018864:Cultural Diversity; D004508:Education, Nursing, Baccalaureate / Q000379:methods; D005181:Faculty, Nursing / Q000523:psychology; D005260:Female; D005387:Finland; D006801:Humans; D007802:Language; D008297:Male; D064700:Nurses, International / Q000523:psychology*; D018794:Problem-Based Learning; D013338:Students, Nursing / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Clinical facilitator; Clinical learning environment; Cultural and linguistic diversity; Internationalism; Nurse teacher; Nursing students; Supervision