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 Table of Contents  
Year : 2017  |  Volume : 14  |  Issue : 3  |  Page : 242-250

Cultural variation influences on the learning experience of international nursing students

1 Department of Community Health Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
2 Department of Pediatric Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt

Date of Submission29-Sep-2017
Date of Acceptance28-Jan-2018
Date of Web Publication1-Jun-2018

Correspondence Address:
Rabab El-Sayed Hassan El-Sayed
Pediatric Nursing Department, Faculty of Nursing, Mansoura University, El-Gomhoria St. 35516, Mansoura
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ENJ.ENJ_37_17

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Background Through their perspectives, various scholars have explored the academic and social challenges foreigner students face in their experience of learning. Understanding the positive impacts and the challenges of international nursing students can lead to a greater awareness of the obstacles and benefits that come from their scholarship experience. The current study aimed to recognize perspectives of Nigerian students about the influences of cultural variation on their learning process, and rating the students’ satisfaction with the nursing scholarship experience.
Method Both descriptive exploratory and grounded theory research designs were utilized to conduct the quantitative and qualitative parts of this study respectively. The study was conducted in the Faculty of Nursing, Mansoura University, Egypt. A purposive sample of all (n=51) first year Nigerian students who registered at the academic year 2013–2014 2nd semester and studying the course of research methodology-credit hours system were requested to participate in this descriptive cross-sectional study. Tools of data collection were included; self-administered, and semi-structured interview questionnaire, in addition to four points of Likert scale.
Results The study results revealed that communication barrier, combined use of local language, and different language barrier were cited by around three quarters of Nigerian students as cultural variation related obstacles that influenced teaching process as well as students’ learning. However, less than half of Nigerian students considered know about different cultural background as a motive in their process of learning.
Conclusion This study concluded that, cultural variation has both positive and negative influences on Nigerian nursing students’ learning experience. It is recommended that, recognition of Nigerian nursing students’ perspectives are needed to support their scholarship learning experience in a new environment of different culture.

Keywords: cultural variation, international students, learning process, nursing, scholarship experience

How to cite this article:
Abd El-Raaouf SE, El-Sayed RSH. Cultural variation influences on the learning experience of international nursing students. Egypt Nurs J 2017;14:242-50

How to cite this URL:
Abd El-Raaouf SE, El-Sayed RSH. Cultural variation influences on the learning experience of international nursing students. Egypt Nurs J [serial online] 2017 [cited 2020 Aug 8];14:242-50. Available from: http://www.enj.eg.net/text.asp?2017/14/3/242/233666

  Introduction Top

Culture is a learned, patterned behavioral response acquired over time that includes implicit versus explicit beliefs, attitudes, values, customs, norms, taboos, arts, and life ways accepted by a community of individuals. Culture is primarily learned and transmitted in the family and other social organizations, shared by the majority of the group, includes an individualized worldview, guides decision making, and facilitates self-worth and self-esteem (Armenakis and Kiefer, 2007; Lillis and Tian, 2010; Lu and Fan, 2015).

Cultural sensitivity is experienced when neutral language − both verbal and nonverbal − is used in a way that reflects sensitivity and appreciation for the diversity of another. It is conveyed when words, phrases, categorizations, etc. are intentionally avoided, especially when referring to any individual who may interpret them as impolite or offensive. Cultural sensitivity is expressed through behaviors that are considered polite and respectful by the other. Such behaviors may be expressed in the choice of words, use of distance, negotiating with established cultural norms of others, etc. (Armenakis and Kiefer, 2007; American Association of College of Nursing, 2008; American Association of Colleges of Nursing, 2011).

Multicultural education is the education that allows all students to reach their potential as learners. It respects diversity while teaching all students to become effective and participating members in the process of learning. It respects individuality while promoting respect for others. It emphasizes the contributions of the various groups (e.g. ethnic, sex, religious, and sexual orientation) that make up the population of this country. It focuses on how to learn rather than on learning specific information. It acknowledges that different students have different learning styles. It emphasizes understanding in terms of different perspectives rather than learning just the facts. It takes into consideration the learner and his or her relationship to the material. It recognizes that the measure of one’s learning is not only the new information or understandings that one has gained but also includes the extent to which the learner has changed relative to the material. It helps the students make sense out of their everyday life. It facilitates communication between students, their teachers and the rest of society. It encourages students to learn how to resolve conflicts in nonviolent ways, and finally, it promotes world peace and harmony. Developing a multicultural classroom means more than adopting a multicultural curriculum (Center for Mental Health in Schools at UCLA, 2008; Jenny, 2012).

Many universities utilize activities such as study abroad programs that send students to another country to participate in academic and cultural learning. Study abroad programs are highly effective in meeting the goals associated with international education regarding internalizing foreign concepts and experiencing foreign nations and cultures (Aggarwal and Goodell, 2015). In 2013, 4.3 million students were studying outside their home country (Organization for Economic Co-operation and Development [OECD], 2013). Bordia et al. (2015) note ‘despite their significant presence in abroad schools, the needs and learning experiences of international students have not been adequately met unless learning styles and preferences of students are considered or have been given a great deal while planning for the educational process of foreigner students’.

Learning styles are collectively defined as ‘the preferences students have for thinking, relating to others, and particular types of classroom environments and experiences’ (Grasha, 1990), as well as the ways in which an individual characteristically acquires, retains, and retrieves information (Claxton and Murrell, 1987). Previous studies indicated the beneficial effect of matching teaching and learning styles on students learning. A meta-analysis conducted by Lovelace (2005) reported that instruction matched with individual’s learning styles improved academic achievement and enhanced attitudes towards learning. In addition, Stevenson and Dunn (2001) suggested that student may learn more rapidly and effectively if preferred learning style was used. Therefore, it is imperative for educators to incorporate different learning styles in their teaching plan to accommodate students’ preferences and ultimately result in a better outcome (Cakiroglu, 2014). Many scholars argue that delivering knowledge in the students’ preferred learning styles can increase the motivation to learn (Nuzhat et al., 2011). Furthermore, Felder and Silverman (1988) claimed that learners who prefer a specific learning style could have difficulties if teaching styles differ from their preferred ones.

The influence of culture on beliefs about education, the value of education, and participation styles cannot be underestimated (Rosenberg et al., 2008). When cultural factors of one group or one individual interface with another culture, it is quite likely that some form of dissonance will occur. Such dissonance or discord offers the potential for misunderstanding, and in the learning environment, it frequently leads to less-than-successful learning experiences for those who are cultural outsiders and not uncommon to frustration, loss of motivation, and reduction in self-esteem and individual worth. It is extremely relevant then that educators have a clear understanding of the role cultural factors play in the learning process so that they may utilize that knowledge to create a culturally responsive learning environment that supports the success and achievement of all students (Perso, 2012). This occurs when educators recognize those strengths that students bring to school and make use of them to facilitate success for all learners.

Justification of the problem

Attracting more international students with their greater tuition fees is encouraged by the faculties and universities of the developing countries. One of the issues that relates to international students’ perceptions about the quality of higher education is with regards to the difficulties and problems they face while studying in colleges outside their home countries. Therefore, this study seeks to highlight the obstacles faced by Nigerian nursing students, as well as the benefits and what motivates their learning in a variant culture. Moreover, it is important to gain and understand their insights that reflect whether these individuals recommended the host institution to other students when they return to their home country through exploring the Nigerian students’ satisfaction with the overall scholarship experience. This paper discusses this in greater detail.

  Aim Top

The aims of this study were the following:
  • To get the perspectives of Nigerian students about the influences of cultural variation on their learning process.
  • To explore the Nigerian students’ satisfaction with their nursing scholarship experience in Mansoura University, Egypt.

Research questions

  • What are the perspectives of Nigerian nursing students about the influences of cultural variation on their learning process?
  • How do Nigerian students put cultural variation-related obstacles that affect the learning process into priority?
  • What are the cultural influences that affect Nigerian students’ satisfaction with overall nursing scholarship experience?

  Patients and method Top


Research design

A combination of descriptive exploratory research design was used to conduct the quantitative part of this study, and a qualitative approach based on grounded theory was developed for this research. It was a bottom-up approach where the study was taken from the perspective of the student rather than the researcher.


The study was conducted at Faculty of Nursing, Mansoura University, Egypt.


A purposive sample included all the Nigerian nursing students who were registered for the academic year 2013–2014 second semester and were studying the course of research methodology-credit hours system (n=51).

Data collection tools

Three tools were designed by the researchers in English language and were used to collect the required data as the following:

Tool I: a self-administered questionnaire

This tool included seven open-ended questions that related to the influences of cultural variation on Nigerian students’ learning and concerned with obstacles affecting learning, cultural differences motivating learning, and benefit from cultural differences in learning.

Tool II: a semistructured interview questionnaire

This tool included seven open-ended questions that are concerned with putting cultural variation-related problems and obstacles affecting learning, cultural differences that motivate learning, and benefits from cultural differences in learning in absolute into priorities. Through this tool, Nigerian students’ responses will be recorded through handwriting and also with a camcorder.

Tool III: four-points Likert scale (satisfaction rating scale)

It was composed of 10 statements for ratings of the Nigerian students’ satisfaction with overall scholarship experience. The respondents were required to indicate their agreement or disagreement with the scale items on a four-point Likert scale. If the traditional five-point scale was used, respondents had the tendency to select responses in the center of the scale. The responses for the four-point scale were strongly agree (4), agree (3), disagree (2), and strongly disagree (1).

  Methods Top

Preparatory phase

Ethical consideration

The Community Health Nursing and Pediatric Nursing Departments Committees approved to conduct this study. Approval was obtained from the Research Ethics Committee of Faculty of Nursing. All questionnaires were anonymous and considered confidential. All the Nigerian students were informed about the study at the beginning of the course. Nigerian students were informed that their participation at this study is voluntary, and their perspectives about the course would have no effect on their educational assessment.

Tool development

After reviewing the past and current literatures, the study tools were developed. The content validity of the study tools is assessed by a jury of five experts in the field of education, pediatric nursing, and community health nursing for its clarity and relevance. According to jury suggestions, minor modification was done in the sequence of one tool item. The developed tools were statistically tested for reliability and yielded a Cronbach’s α of 0.94.

Exploratory phase

Pilot study

It was conducted on 10% of total subject’s size to estimate time required to fulfill the tools and its applicability. Based on the findings of the pilot study, some modifications were made on the used English language terms. Students who participated in the pilot study were excluded from the study subjects.

Data collection technique

A cross-sectional study was conducted with 51 first-year Nigerian undergraduate nursing students undergoing a range of courses at a Faculty of Nursing that belongs to one of the Egyptian Universities to explore students’ perspectives about the difficulties and benefits related to studying in a variant culture and may affect their learning and overall scholarship experience.

The quantitative data were collected using the first tool’s sheet which was distributed among the Nigerian students at the end of the last lecture of research methodology course by credit hours system. The researchers instructed the students to fulfill the sheet anonymously. The researchers waited for 30–45 min, which was the required time to fulfill the tool, and then collected the sheets after students had been finished. Based on Nigerian students’ interviews, the second tool was used to collect qualitative data immediately after finishing the course. The researchers conducted semistructured interview for groups of volunteer Nigerian students; each group contained 3–5 students. The lengths of interviews were ∼1 h each, through which one of the researchers asked the questions and the other wrote the responses of the students. The interview was simultaneously recorded using a camcorder to ensure the conformity of responses (what was said by the students and what was written by the researcher during an interview) and complete missed words or statements, if missed during handwriting. Shortly before graduation, the third tool was used, and it explored international students’ satisfaction with overall scholarship experience and if they can influence other students to try the same learning experience when they return to their home country. The researchers distributed the sheets and instructed the students to anonymously rate each statement that described their opinion/experience through putting ‘a true like sign’ inside the box of four-point Likert scale items of strongly disagree, disagree, agree, and strongly disagree. The researchers wait for 15–20 min until the students finished and collected the scale sheets.

Statistical analysis

The collected data were revised, coded, tabulated, and analyzed using the statistical package for the social sciences (SPSS, version 21; IBM SPSS Statistics, Chicago, IL, USA). Descriptive statistics including frequency and percentage were calculated to characterize the study findings.

  Results Top

The results of the characteristics of Nigerian students reveal that more than half (56.9%) of them are male students and age from 25 to less than 30 years (52.9%), respectively, with mean age of 25.92±2.55 years. All of them are Muslims. Urban residence and single status of Nigerian students represents more than three-quarters (76.5%), and most (96.1%) students, respectively ([Table 1]).
Table 1 Characteristics of Nigerian students (n=51)

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The majority (86.3%) and more than three-quarters (78.4%) of Nigerian students state that there are cultural differences affecting the teaching process for foreigner students and their learning, respectively. All of the Nigerian students mentioned that there are obstacles affecting foreigner students’ learning. Moreover, most (94.1%) and the majority (88.2%) of Nigerian students viewed that cultural differences motivate and are beneficial for foreigner students’ learning, respectively ([Table 2]).
Table 2 Nigerian students’ perspectives related to learning in a different culture (n=51)

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[Table 3] illustrates that the highest percentages (77.3, 70, and 74.5%) of Nigerian students report that different language/communication barrier, combined use of local language, and different language barrier, respectively, are the priority among problems affecting teaching process, learning, and obstacles for foreigner students. Considering the learning motives and benefits for foreigner students’ priority reflections, conducive learning environment was reported by 47.9%, give a chance to know about different cultural background by 31.1%, and improve coping ability by 31.1% of the study sample.
Table 3 Priorities of reflections reported by Nigerian students related to learning in a variant culture

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[Table 4] shows that more than two-thirds (69.2%) and less than half (46.2%) of Nigerian students state that different language and poor interaction with native Arabic colleagues, respectively, were problems and obstacles affecting foreigner students’ learning. Furthermore, half (50.0%) and the vast majority (92.3%) of Nigerian students reveal that exposure to different new teaching methods and deal with a very supportive staff, respectively, are cultural differences that motivate and are beneficial for foreigner students’ learning.
Table 4 Ranking of Nigerian students’ reflections through focus group about learning in a variant culture (n=26)

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[Table 5] reveals that ‘agree’ occupied the highest percentages in ratings of the Nigerian students’ satisfaction with scholarship learning experience, which range from 19.6 to 56.9%, except for the items ‘I would rather describe the scholarship experience as compensatory’, ‘As a foreigner student, the provided scholarship programs met my learning expectations’, ‘I would recommend this scholarship to other younger students when return back to homeland’, and ‘I would like to take another chance of scholarship for postgraduate degree here’ where ‘strongly agree’ had the highest percentages at 43.1, 39.2, 35.3, and 60.8%, respectively. On the contrary, the highest percentage for ‘disagree’ 43.1% was reported the item of ‘I would describe the scholarship experience as being highly interesting than local studying in our home country’ with the median of 17.
Table 5 Ratings of the Nigerian students’ satisfaction with overall scholarship experience (n=51)

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  Discussion Top

Qualitative research could detect and analyze the underlying assumptions that guide students’ choices on whether and where to study abroad. Overall, more research and new theoretical frameworks are essential to understand the study abroad process. Certainly, the reasons for choosing to study abroad are very different from those for studying at a domestic university. According to Altbach (2004) and Lee (2010), the ‘push–pull’ model has often been used to describe challenges within the home country that ‘push’ a student to seek education elsewhere (e.g. lack of specialized fields and political repression) and the opportunities within the host country that ‘pull’ a student to a particular host country or institution (e.g. educational interests or concerns, higher quality of education, and better quality of life). Although this model has increased the understanding of the larger cultural, political, and economic factors that contribute to the global imbalance of student flows, the individual’s decision is only speculative.

Cultural differences are evident in many aspects of human behavior. Cultural factors influence beliefs, behavior, perceptions, and emotions, all of which have important implications on learning (Nieto and Booth, 2010), as it is ‘a set of learned behaviors, beliefs, attitudes and ideals that are characteristic of a particular society or population’ (Institute of International Education, 2011; Rice et al., 2012). A useful analogy of culture described by Wilson (2011) refers to culture as an inherited ‘lens’ through which the individual perceives and understands the world and as a result learns how to live within it.

Nigerian students’ prospective in the present study revealed that there were cultural problems and obstacles affecting teaching process of foreigner students and their learning (Brown and Aktas, 2011). In the same context, Kim (2011) asserted that, culture refers to a group of shared set of beliefs, norms, and values. Core beliefs of foreign language students are based on the learners’ direct personal experiences that are held firmly and are resistant to change. Chen and Lewis (2011) go with the study findings, as they stated that conflict arising from dissimilarity in beliefs about language teaching among learners and teachers can result in the disruption of their interpersonal communication, which has damaging effect on the learning process. Moreover, and from the researcher’s point of view, it is important for lecturers who acquired English as their second language to speak English with an excellent accent, as well as great emphasis is placed on the formal aspects of grammar to facilitate native English students’ understanding in the classroom.

In addition, Chow (2011) who found that the major sources of cultural conflict identified in interaction with students can be separated into two categories. One relates to the development of scientific concepts and to ways in which we see the world and try to understand it. He called these ‘conceptual conflicts’. The other category he called ‘behavioral conflicts’. These conflicts were related to interpersonal interactions and had to do with general expectations, attitudes, and behaviors.The study findings illustrated that different language/communication and poor communication were the obvious problems and obstacles affecting teaching process of Nigerian students and their learning, which reflected repeatedly in different ways and statements including combined use of local language and poor interaction with native Arabic colleagues. This was constant with Gay et al. (2012) who stated that cultural differences that are often associated with language differences are a barrier to effective communication. One’s culture affects one’s understanding of a word or sentence and even one’s perception of the world (Erichsen and Bolliger, 2011). To learn a language is not the same as understanding a culture, as even those who share a common native language may not share a common culture (Hendrickson et al., 2011).

The results of the present study showed that less than one-third, slightly more than one-third, and only one of Nigerian students reported that gives a chance to know about different cultural background, improves coping ability, and gives a chance to interact with people of different society, respectively, were learning motives and benefits for foreigner students. Otherwise, Kettle (2011) mentioned that universities, colleges, and nursing programs specifically are beginning to focus on increasing diversity as they seek to effectively prepare nursing students to serve diverse clients and communities. With worldwide expanding immigration, increasing globalization, and minority population growth, there is a need to enrich the diversity within the nursing profession to better meet the needs of our changing society.

In the same context, half, less than one third, and less than three fourths of Nigerian students reported that their learning has been motivated and utilized due to exposure to different new teaching methods, dealt with caring teachers, and took a chance to improve the academic level respectively. This was supported by Curtin et al. (2013) who stated that the diversity of students engaged in higher education continues to expand. Students come to colleges with varied ethnic and cultural backgrounds, from a multitude of training programs and institutions, and with differing learning styles.

Furthermore, Erichsen (2011) who illustrated that the concept of using a menu of teaching modalities is based on the premise that at least some content will be presented in a manner suited to every type of learner within a given classroom or course. Furthermore, one research study had focused on profiling learning types so that instructors have a better understanding of the cohort of students they are educating (Rivzi, 2011).

In the present study, agree occupied the highest percentages in ratings of the Nigerian students’ satisfaction with overall scholarship learning experience, which ranged from most to more than half of them related to six statements out of 10. This was in the same line with Brew and Ginns (2008) who conduct a large research at intensive university in Australia to discuss the relationship between faculty performance on a set of scholarly accomplishments in relation to teaching and learning from 2002 to 2004, and changes in students’ course experiences from 2001 to 2005. It provides evidence of the relationship between the scholarship of teaching and learning and students’ course experiences and demonstrates the effectiveness of institutional strategies to encourage the scholarship of teaching and learning.

Finally, internationalization should look beyond collecting large sums of money. Although international students’ enrollment is a significant marker of internationalization and is perhaps indicative of foreign students’ experiences at a particular institution, the more important concern should be the extent to which native students, administrators, and faculty members positively interact and properly deal with their international guest students. International students offer cultural knowledge and many skills that can certainly improve learning and scholarship in an increasingly global society.

Conclusion and recommendation

Based on the study findings, it was concluded that, cultural variation had negative influences on Nigerian nursing students’ learning experience, including language differences, which affect their communication and interaction with native Arabic teachers and colleagues. On the contrary, students reported ‘give a chance to know about different cultural background, improve coping ability, and give a chance to interact with people of different society’ as learning motives and benefits for foreigner students.

The recommendations from this study can be divided into three categories, which include recommendations for faculty and international students’ office, faculty members, and international students, as follows:
  1. For faculty and international students’ office:
    1. The on-faculty educational services should involve the native English international students into native Arabic language classes to improve their communication skills, which reduce both social and academic challenges.
    2. The international students’ office may arrange an orientation program for the students when they initially arrive to minimize their emotional challenges or fear of unknown.
    3. Acquaintance about cultural variations from the sides of both Nigerian students and the academic staff of host country is considered essential to improve the learning experiences of culturally and linguistically diverse nursing students.
  2. For faculty members:
    1. Teachers should be aware of the learning characteristics of the Nigerian students they serve to enhance their educational achievement.
    2. Teachers should become flexible and able to modify teaching strategies as well as modes of reflective learning or learning styles to suit/promote cultural infusion in their classrooms.
    3. Teachers must ensure that they treat all the students the same and to have high expectations from each one, so that they will all strive to reach their full potential.
    4. Teachers should emphasize the role of group collaboration that can enrich education environment of different culture students.
  3. For Nigerian students:
    1. Students should not hesitate to ask for help when needed.
    2. Nigerian students should be involved in the activities arranged by the International Student Office to build social networks, as well as improve language skills, and become familiar with the new environment.
    3. It is important to become aware of the cultural aspects before coming, especially regarding similarities and differences between their home culture and Egyptian culture, so they can set more realistic expectations.


They were limited number of relevant local references, because it is unfamiliar for higher education institutions of developing countries to admit international students to their graduate programs; however, the opposite is the most common.

Implication for further studies

Further studies of culturally and linguistically diverse nursing students in the clinical environment need to be conducted to examine influential aspects on acquiring the required clinical practices.

A longitudinal study all over the academic years of the students’ scholarship through developing follow-up interviews for each candidate based on what emerged obstacles from arrival time till graduation may be needed to configure an overview about different experiences and offer some solutions to overcome the possible challenges.


The researchers want to heartfully thank the Nigerian students who participated in this research work and openly shared their learning experience reflections for their co-operation, which had a great value to accomplish this study.[37]

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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