Higher education institutions around the world embrace the inclusion of international students on their programmes. Specifically, there is increasing evidence of the value of internationalisation within nurse education (Wihlborg and Robson, 2018) and learning and working in a different country remains a valuable experience for students in preparing them for nursing in multicultural societies (Leung et al, 2020). A search of the literature has found that international students experience difficulties adapting to student life, mainly due to unfamiliar models of education (Kahn and Misiaszek, 2019), academic English and the technical language of health care (Crawford and Candlin, 2013), social isolation (Jeong et al, 2011) and loneliness (Alloh et al, 2018). This article explores the experiences of two Ghanaian students on an Erasmus+ international exchange initiative and those of their faculty staff, during a semester of study abroad in Ireland before and during the COVID-19 pandemic.
Background
Numerous benefits of studying abroad are reported in the literature, including the development of students' personally and professionally (Kelleher et al, 2016; Brown et al, 2018). This is relevant within a nursing context when preparing graduates to care for culturally diverse populations (Viken et al, 2018). The development of programmes such as the Erasmus+ International Credit Mobility (ICM), affords students the opportunity to spend a semester abroad. This involves institutions partnering and working together to engage in curriculum mapping to ensure educational requirements are covered, enabling students to make the most of the benefits that a semester abroad brings to student learning and development (Cairns, 2017; Marshall, 2017).
Erasmus+ (ICM) is the European Union's flagship education and training programme, which enables students to study abroad. Introduced in 2015, it expands the EU Erasmus student and staff mobility programme, and provides opportunities for staff and students to study, teach and train in countries outside Europe. Erasmus programmes aim to enhance the quality of European higher education in the context of broader education and training through promoting understanding between people, cultures and nations (Marshall, 2017). The programmes also contribute to the sustainable and inclusive development of higher education in partner countries (Cairns, 2017; European Commission, 2022).
This article describes the experiences of two Ghanaian undergraduate nursing students who came to a university in Ireland on an Erasmus+ ICM collaboration for a semester abroad, engaging with a BSc Nursing (General) programme and of faculty staff who taught and supported them. Reflection is considered a key function in the professionalisation of nursing and the improvement of nursing care practices (Mlinar Reljić et al, 2019).
Gibbs' Cycle of Reflection
Through using Gibbs' Cycle of Reflection (1988), the students framed their experiences, enabling them to make sense of them from a personal and professional perspective, while also generating points of learning for nurse educators to consider when supporting international students and those engaging in online learning in the future. The six points on the cycle are: description, feelings, evaluation, analysis, conclusions and action plan and students' and staff's experiences will be discussed under these headings.
Description
When the student authors arrived in Ireland in January 2020, they were excited to join the university orientation week, exploring their new home, meeting new people and experiencing a new way of learning. Things were going well as the students enjoyed settling in, finding their way around campus, attending classes, making friends and enjoying the beautiful scenery of Ireland. However, on 12 March 2020, the Irish government issued a directive closing the university campus. The university moved to online learning due to national COVID-19 restrictions. All education delivery, library services and other student support services moved online to virtual platforms and all examinations, including practical sessions, were replaced with online alternatives. Nationally, workplaces closed and travel was restricted with only access to supermarkets for food and essential services permitted. For the student authors, communication with lecturers and friends was still possible via email, Skype, Microsoft Teams and social media formats. However, the ability to experience university life on campus was suddenly cut short. Furthermore, in response to the coronavirus pandemic, the students' home country of Ghana closed its borders, preventing the students' return home at the predetermined time at the end of the semester in May. Thus they remained in Ireland for 3 months more than initially planned.
Feelings
The students were excited at the opportunity to study abroad, supported through Erasmus+ ICM funding, embracing the opportunity and working hard to settle in. The students were very happy to make the most of this opportunity to travel, experience different learning environments and meet new people from different backgrounds.
Paralleled with their excitement, they also felt anxious and nervous of ‘a new environment, new people, and a new academic system’. The students wondered whether they would be able to adapt to this new experience away from home and be able to engage in classes and succeed. Helping them through this were fellow housemates who were also international students going through similar experiences. Having the support of the university Erasmus+ team and nursing faculty members made them feel more comfortable. International students often face challenges in adapting to new environments and cultures; many experience feelings of isolation and being foreigners in a different culture. This may be further compounded by limitations in their ability to communicate with faculty and peers, especially where language barriers exist (Karkar-Esperat, 2018).
The students were beginning to settle in and enjoy their new environment when the arrival of COVID-19 changed their circumstances and plans. Feelings of excitement and enjoyment changed to concern and worry. Anxieties arose in relation to the transfer of their programme online. The students were apprehensive about this approach, as they had limited knowledge of using computers and the internet, and little experience of online learning. National restrictions on travel and movement between households left the students feeling sad at times, as they now had less physical contact and communication with friends and were also unable to travel around Ireland as they had planned during weekends and breaks.
Coinciding with anxieties in relation to their new mode of learning were the stark realities of the pandemic itself as the students realised they were far away from home and family, facing the possibility that they may contract COVID-19 themselves and become ill. On a positive note, the students referred to the ‘massive support’ received from their host university, which gave them a sense of security and helped to ease some of their fears. The students remained homesick, however, as they lacked regular communication with their families due to poor internet connectivity at home in Ghana. Knowing that they could not return home on their planned date took its toll as their return date approached. They found that the uncertainty surrounding their educational and personal experiences, and family life a during the pandemic was frightening.
Nursing faculty members were initially delighted to be hosting students from Ghana and supporting their collaborative relationship with the student's home university, which staff members had previously visited. With the support of the Erasmus+ team, faculty staff and the home students helped the Ghanaian students to settle in. Meetings were held with the students to support their academic transition to a new university, ensuring they understood their timetable, had access to clinical skills laboratories and relevant library facilities. Faculty staff also encouraged the students' personal development by directing them to take part in campus activities and join clubs and societies, meeting new people and enjoying the university experience. With the arrival of COVID-19, faculty staff had a heightened awareness of the students' anxieties and felt a moral responsibility to support them in these unprecedented times. Regular virtual calls, along with emails, continued during initial restrictions, moving to staff meeting students outdoors when restrictions eased.
Evaluation
The ‘semester abroad’ experience helped the students to develop both personally and professionally and the unforeseen change to online learning that accompanied COVID-19 restrictions, while initially considered negative, was later viewed positively by the students, adding to their lifetime experience. Before the university closure, seeing and experiencing a new way of learning, engaging in large lectures, smaller tutorials, having reliable internet access and visiting the library, which provided access to high-quality academic information and resources, were all new experiences that supported the students' learning on their academic journey. A welcome difference to home education were the smaller class sizes that the tutorials and clinical skills laboratories provided. The students felt smaller class sizes encouraged greater student engagement in their learning. The teaching and learning strategy and forms of assessment in the host university were different from the usual method of tests and examinations used in Ghana. These differences, related to the fact that the students' home university had more directional strategies and assessments whereas the host university promoted more student-led learning approaches and assessments, which students welcomed as part of their learning experience. However, at times the Ghanaian students found this approach challenging. This method required students to take ownership of their work and to be self-directed in their approach to learning, which were new skills to be developed.
The advent of the pandemic meant everyone had to adapt to unforeseen changes; this was heightened for international students who were already trying to adapt to a new environment. As the university closed and teaching moved from face-to-face to online this provided new opportunities for the student authors, helping them to build their online skills as well as adapt to challenging situations. As one student reflected ‘It has led me to become resilient’. Although the benefits of online learning were acknowledged, challenges were also identified. Hughes (2013) explained that the experience of international students working with online resources can be complex and their ability to use online information is affected by their level of literacy skills. International students may also be challenged by their unpreparedness and unfamiliarity as a result of a lack of sufficient technical knowledge and ability in sourcing information through databases, and their limited ability to evaluate and synthesise online information for their academic work (Hughes, 2013; Lowenthal et al, 2014).
One area recognised by the student authors as difficult in the transition online was finding the motivation to study and complete assignments in their campus accommodation. Communications from lecturers and fellow students during this time was only possible through email or virtual calls, thus they missed face-to-face contact. Owusu-Fordjour et al (2020) noted that distractions exist when studying from home and this can affect learning and comprehension. The flexibility of the learners’ schedule may reduce their motivation and their ability to remain focused (Karkar-Esperat, 2018). Self-discipline is a vital characteristic required for online or e-learning, which many students lack (Zhang et al, 2004; Karkar-Esperat, 2018). This was addressed by both students in their reflections, warranting focused consideration by faculty members when designing online content for all students in the future.
Participation in online learning, although unexpected, allowed the students to experience studying in a virtual environment, a new concept for them. Connecting for online lectures, accessing a virtual library, and working with other students online, helped improve knowledge and skills in using the internet and technology. The students realised that learning these skills would equip them well for the future.
National restrictions such as reduced travel to within a 5-mile radius and no house calls all affected student life. Student support staff, who were previously available on campus, were now only contactable by telephone or through virtual platforms. The Erasmus+ team and international office continued to provide support such as telephone calls, online activities such as exercise classes, online quizzes and movie nights to bring students who remained on campus together, albeit virtually. The Ghanaian students reflected on how they did not pay attention to their mental health, and rarely sought help in relation to their challenges. They often felt overwhelmed, which affected their ability to work effectively online and manage their time. Students' psychosocial wellbeing may be threatened by certain factors such as a new environment, culture shock, financial problems, and an altered sense of identity (Mesidor and Sly, 2016). These would be further exacerbated during a global pandemic. This may result in depression, loneliness and isolation (Wei et al, 2007). Faculty staff and the Erasmus+ team were conscious of this and continued to connect virtually and, when reduced restrictions allowed, made contact in person. This allowed for face-to-face communication, listening to the students' worries and helping them navigate their challenges with online learning and, later, in trying to book flights home.
Analysis
Although the arrival of the COVID-19 pandemic presented challenges in the academic forum in moving online, it also provided an excellent learning opportunity for the student authors. Although initially daunted by online delivery, navigating live and pre-recorded lectures and audio presentations helped the students to organise their timetable and balance time effectively between study and leisure. These skills will remain with the students in their personal and professional lives.
The relationship between students and the host university played a key role in ensuring students were able to adapt to the online delivery of their programme. Initially, challenges for the student authors centered around online delivery; however, as time progressed, the likelihood of not being able to travel home on the pre-arranged date became students' main concern. The host university Erasmus+ team and nursing faculty helped students to secure further accommodation, and living expenses and provided support services through phone and Zoom calls. This aspect of their experience helped the students' personal growth; improving self-confidence and their ability to co-operate with different people, especially in group living. Having twice-weekly Zoom meetings and email contact during restrictions and physical meetings with faculty when restrictions eased, helped students to comprehend their situation and ask questions as they arose. Knowing that they would be supported by staff in their decision-making processes in relation to academic queries and especially in relation to arranging transport home was invaluable to the students. On a personal and social level, the Erasmus+ experience was supported by faculty members who invited the students to their homes to meet their children, who were of similar ages, and to visit nearby scenic areas. This helped the students feel connected and supported during this unprecedented and daunting time.
Experiencing varied ways of life through interacting with different people has widened the students' perspective. For one Ghanaian student, being with other international students who were in similar situations greatly helped as they could relate to each other's situation. They drew closer to roommates and friends and helped to organised various indoor games and activities to keep them entertained. This was viewed not as an experience to regret but rather as an enjoyable and memorable one. However, the other student author felt they could not socialise effectively with housemates as they felt different and were intimidated by the housemates' ability to speak English freely. This student is not alone in these feelings, as noted by Crawford and Candlin (2013). However, with time, this student author settled into the their accommodation, developed friendships and felt more comfortable and this was reinforced by visits to faculty members' homes. Huffman et al (2020) also reported an increase in students' level of confidence, tolerance and respect for others and their ability to co-operate with people as time went on.
By engaging with and experiencing online learning, the students are much more aware of their limitations in critical thinking and writing skills. Teaching and learning strategies used in the host university encourage self-directed learning, working towards improving critical thinking, writing skills and how to explore academic resources. The students had previously not been exposed to this and while they initially struggled, an understanding of how to develop these skills increased. These were skills that the students might not have developed without the arrival of COVID-19.
Conclusions
This reflective account of faculty staff and two Ghanaian students on a semester abroad during the COVID-19 pandemic, although small in scale and descriptive, opens discussions on the challenges international students face on a semester abroad, which were further compounded during a pandemic. The merits and advantages of online learning are emphasised in the literature; however, the realities of navigating technology prove challenging for all students, especially international students who may have limited exposure to technology. Online learning requires a certain temperament and self-motivation to continuously engage over a semester. Support to use the technology is required by institutions, faculty and students when engaging with online platforms.
Although much of the Ghanaian students' experience of a semester abroad was unexpected and unplanned it has contributed to one of the most rewarding experiences in relation to education and friendships. Participating in the Erasmus+ study abroad programme has improved the students' ability to adapt to new environments and cultures and exposed them to different methods and strategies of teaching and learning, providing new opportunities for the students to engage in their future. Neither the students nor the faculty members could have envisioned the arrival of a global pandemic and the changes that accompanied this in relation to online education delivery. In hindsight, this strengthened the students' experience in preparing them for further education and life. For faculty members, it is noteworthy to acknowledge and recognise the support from the Erasmus+ team, individual faculty members, the students and the students' home university in Ghana, which cannot be underestimated. Successful past relations between the host and the home university allowed positive commitment in securing the students a positive experience.
Action plan
An Erasmus+ semester abroad offered many opportunities and learning experiences for the student authors. However, the arrival of the COVID-19 pandemic forced both students and faculty into uncharted waters. The students did not regret their experience even though COVID-19 changed their plans, as this different journey led to their development both personally and professionally. Personally, students realised the need to do things when they have the chance, for example taking the chance to travel to interesting places at the beginning of the semester rather than leaving it until the end and unfortunately missing out. One student described their initial experience as: ‘It seems all my plans were lost to the pandemic’. However, professionally, the students wish to continue with their learning using online platforms, improving their knowledge of the use of computers, information technology and exposure to the internet to help make use of future learning opportunities. Exposure to new cultures and working on improving communication skills is planned, along with growing their knowledge and perceptions of different cultures to help them relate more effectively with people from different backgrounds.
This experience has taught the students the importance of adapting and seeking out support when provided and the exposure to more student-led learning approaches has reinforced the students' feelings of responsibility to their future learning and their commitment to lifelong learning. In addition, the students, although initially forced to adapt to online learning, recognised that this was a new approach for them and embraced this as a valuable strategy. This different learning approach is one that faculty staff will continue in some way, even with the return of face-to-face classes.
Conclusion
The Ghanaian students can take pride in how they coped with both adapting to living and studying abroad, and doing this during an pandemic. They will take what they have learned into their future careers as nurses, making them more adaptable and resilient. Faculty members have also learned a great deal from the experience, both about the support that international students need and in the use of online learning approaches and will draw on these experiences when welcoming future international students.
KEY POINTS
- Internationalisation within nurse education programmes provides a valuable experience for students
- Internationalisation prepares students for working in a multicultural society and employment environment
- COVID-19 presented challenges for students in having to access education online but also presented learning opportunities
- Students can be resilient when there is an awareness of support to face challenges
CPD reflective questions
- What motivates you to learn online?
- What supports are you aware of that help your online learning?
- How would you engage in effective learning in a foreign country not in your native language?
- As a faculty member, are you aware of the support available to you in supporting international students on your programme/module?
- When designing online content for modules and programme have you given consideration to how the content will keep students engaged, maintaining their focus on learning?