crossing cultures: the lived experience of jordanian graduate students in nursing: a qualitative...

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International Journal of Nursing Studies 42 (2005) 657–663

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Crossing cultures: the lived experience of Jordanian graduatestudents in nursing: a qualitative study

Ellen K. DeLuca�

Nursing Department, School of Health Science and Human Performance, Lynchburg College,

1501 Lakeside Dr., Lynchburg, VA 24501, USA

Received 1 July 2004; received in revised form 17 September 2004; accepted 23 September 2004

Abstract

This qualitative phenomenologic study explores the meaning of crossing cultures as experienced by Jordanian

graduate students in nursing. Seven male and female students participated in conversations and journals regarding their

experiences in the academic, social and professional realms of an American culture at a private, mid-Atlantic university.

An analysis of the text revealed an overarching theme, ‘‘metamorphosis of self.’’ Events leading to the metamorphosis

included being chosen, experiencing a time full of memories, feeling bombarded with stimuli and ‘‘looking to do

something’’ as professional nurses in Jordan.

r 2004 Elsevier Ltd. All rights reserved.

Keywords: Jordanian nursing students; Jordan; Cross-cultural transition; Graduate nursing students

1. Introduction

This study emerged because encounters with Middle

Eastern students called me to question what it is like for

students from an Arab culture to be in an American

graduate program in nursing. To study lived experience

means that the researcher studies the world as it is

immediately experienced rather than as one theorizes

about it. Phenomenology aims to come to a deeper

understanding of the nature or meaning of an everyday

experience, answering the question, ‘‘What is this

experience like?’’ It seeks to define the essential essence

or nature of the experience (van Manen, 1990).

The researcher’s own personal experience often

frames the starting point for this type of research since

the researcher is integrally involved in the process of

interpretation. (Tesch, 1987; van Manen, 1990). Ques-

e front matter r 2004 Elsevier Ltd. All rights reserve

urstu.2004.09.017

544 8322.

ess: deluca@lynchburg.edu (E.K. DeLuca).

tions arise from a recognition of personal experience and

a sense of connection with the text of the research. van

Manen (1990) states:

In actual phenomenological descriptions one often

notices that the author uses the ‘‘I’’ form or the ‘‘we’’

form. This is not only to enhance the evocative value

of the truth experience expressed in this way but also

to show that the author recognizes both that one’s

own experiences are the possible experiences of

others and also that the experiences of others are

the possible experiences of oneself yp. 57–58

Therefore I will speak in the first person.

2. Glimpses of the phenomenon

The study of lived experience begins with the

awareness of glimpses of the phenomenon. The first

glimpse came when I had the opportunity to be the

d.

ARTICLE IN PRESSE.K. DeLuca / International Journal of Nursing Studies 42 (2005) 657–663658

advisor for 14 Jordanian graduate nursing students. I

became very involved in helping them with language

issues and cultural concerns as they registered and

prepared for classes. I observed that their anxiety related

to being new to the culture affected their ability to

integrate into the fabric of the university culture in a

mid-Atlantic city of the United States.

In order to learn more about the phenomenon, I

explored it by talking with two persons who had had the

experience of ‘‘crossing cultures’’ as nursing students.

This was in essence a pilot study that illuminated the

phenomenon and also helped me to predict the success

of my chosen methodologies. Participants were a

Jordanian graduate student whom I currently advised

and a former nursing student from India whom I had

taught in the past. She had graduated from a large

public mid-Atlantic university 4 years previously with a

BSN degree in nursing. In two conversations with each

of them I asked ‘‘What was this cross cultural experience

like for you?’’ I taped and transcribed these conversa-

tions. Their narratives provided a lens through which I

saw aspects of the phenomenon. Some initial themes

that these two persons revealed were loneliness, missing

family and friends, feeling in-between, anxiety, uncer-

tainty and losing self.

A review of the literature in nursing and in higher

education revealed suggestions about the nature of the

phenomenon of crossing cultures. The nursing and

higher education literature revealed important aspects

of the nature of crossing cultures. Abu-Saad and

Kayser-Jones (1982) and Bronner (1982), studying

Middle Eastern graduate students in nursing, found

that loneliness, financial problems and differences in

social customs and values, were among those issues most

frequently named by students. The work of these

researchers shows that the most challenging experience

students face is adjusting to a new language (Abu-Saad

and Kayser-Jones, 1982; Bronner, 1982). Other issues

cited were lack of awareness of the foreign culture by

faculty, a fast pace and program flexibility. Researchers

in higher education and nursing indicate that crossing

cultures is a complex experience fraught with serious

threats to students’ identity (Abu-Saad and Kayser-

Jones, 1982; Bronner, 1982; Hull, 1978; Tien, 1982).

These research findings confirmed experiences with

students and validated my notion that understanding the

experience of Jordanian Middle Eastern graduate

students in nursing was very significant. I witnessed

the struggles of these students to understand the English

language as spoken by Americans, cope with the fast

pace of learning and acclimate to what seemed to them

to be a ‘‘strange’’ culture at first. This led me to develop

a passion for understanding what it was like for them

and subsequently to find better ways of teaching that

would reduce students’ fear and frustration and help

them to enjoy their educational experience.

3. Research question

The glimpses I had received thus far propelled me to

explore the meaning of students’ lived experiences. van

Manen (1990) states that the research question should be

one that deeply concerns or animates us as researchers.

The phenomenologic question should not only be made

clear but should be ‘‘lived’’ by the researcher. The

researcher also pulls the reader into the question in such

a way that the reader cannot help but wonder about the

phenomenon (van Manen, 1990). Narratives of the two

students prior to starting the study allowed me to

wonder about this experience. These two persons

indicated that the experience of crossing cultures

happened on several levels simultaneously, which for

them made it very stressful. The areas they defined were

social, academic and clinical experiences with patients

and faculty. Therefore, the question for study was: What

is it like to be a Jordanian graduate student in nursing in

the contexts of a new culture, the university and

experiences in the realm of professional nursing?

4. Methodology

Each of the seven Jordanian students participated in

four or five conversations. van Manen (1990) describes

the hermeneutic interview as one in which the question

or the meaning of the phenomenon is always kept open.

There is then a collaborative relationship between the

subject and the researcher, both of whom usually

becoming committed to revealing the nature of the

phenomenon. For this reason, the researcher sets up a

series of interviews. The participants have an opportu-

nity to reflect on the deeper meanings or themes of their

experiences. In the initial conversations with students, I

asked that they come with a written reflection entitled,

‘‘What are some memorable experiences as a Jordanian

graduate student in nursing?’’ van Manen (1990)

recommends that journals and diaries are good sources

of text. From this starting point the students kept a

journal in which they wrote any memorable encounters

for them in the settings in which they lived as students,

nurses and persons. In my conversations with them, I

asked them to elaborate on their narrative stories and

experiences and questioned the meaning of what they

said. Conversations were audiotaped and analyzed for

themes based on van Manen’s (1990) approach. Each

conversation built on previous ones in that themes or

concepts revealed initially were explored in more depth

in subsequent conversations. This allowed for a deepen-

ing in the understanding of the meaning of ‘‘crossing

cultures’’ for these particular Jordanian Middle Eastern

students.

The study was approved by the institutional review

board for the university and students signed a consent

ARTICLE IN PRESSE.K. DeLuca / International Journal of Nursing Studies 42 (2005) 657–663 659

form to participate in the study. They were told that

they could end their participation at any time and that

the information they provided would be reported

anonymously.

In the process of studying the text represented in the

students’ journals, and written transcriptions of audio-

taped conversations, I employed a consultant with a

specialty in Arabic languages to give his interpretation

of certain aspects of the text. I found this useful because

he was able to validate some of my interpretations and

in some cases to expand my understanding of students’

language patterns. His Arabic cultural background and

linguistic expertise offered new meanings that I was able

to explore further.

5. Analysis

I analyzed the text by reflecting on it to find significant

themes, while also engaging in the process of writing and

rewriting. Themes are defined as the structures that

make up the lived experience (van Manen, 1990).

Approaches to the research must be chosen with a

mindfulness to context and the unique question that is

studied (van Manen, 1990). Therefore, I reviewed the

transcripts, student writing and my own field notes as a

whole to get a sense of overarching ideas; next, I

reviewed these in more detail. van Manen (1990)

suggests that human science research should not be

mechanical. The researcher attempts to analyze the text

to gain insight and deeper meaning based on what is

known about the context of the research and other

sources that clarify the phenomenon. While doing this I

reflected on the writings of Heidegger (1962) with an

interpretation by Dreyfus (1992). This provided philo-

sophical underpinning and clarity in the interpretation

of lived experience. I also used literary sources such as

poetry and novels that described the experience of

crossing cultures. Phenomenological literature was also

helpful in illuminating the meaning of ‘‘crossing

cultures.’’

Interpretation of themes was validated by two other

faculty members, one of whom was an expert in

phenomenological research. Students confirmed the

accuracy of themes and further explicated meaning

throughout the interview process.

6. Findings

An analysis of the text using van Manen’s (1990)

approach reveals one overarching theme, ‘‘metamor-

phosis.’’ Students all revealed that they perceived a

dramatic change in their personal development while

studying Oncology Nursing in a US Graduate Nursing

Program. This metamorphosis seems to happen in

stages. In the early phase, students experienced a time

of vivid memories. Further analysis and interpretation

of the text revealed that memory plays an important role

in student’s metamorphosis. The persons that they

already have become, through their lives in Jordan, is

contained in their memory which also holds within it the

seed of the evolving self that has been transplanted and

grows in this new place. Reflection on the entirety of the

text revealed that memory and metamorphosis were

inextricably linked. After their initial colorful interval,

students encountered a period of ‘‘bombardment,’’ in

which they experienced numerous cultural clashes as

well as learning challenges. When this resolved and the

metamorphosis was complete, students revealed that in

fact, a new identity had emerged. There was a

culmination experience in which they were able to enjoy

themselves socially, succeed academically and also be

aware of a professional identity. As this emerged, they

were ‘‘looking to do something’’ in Jordan, applying

what they had learned and planning to make adjust-

ments to their Jordanian culture.

7. Being chosen

The seven Jordanian students began their stories by

recalling how their sojourn into American scholarship

started in their own country of Jordan where they were

chosen from a very large group of applicants to receive

the honor of an education in the United States. One

prominent theme is that of ‘‘being chosen.’’ One student

recalls ‘‘It was such a nice memory and stressful at the

same time.’’ As they shared their memories, all of the

students recalled or wrote about the exhilarating

moments of being chosen for this journey and traveling

by plane with a group of 14 persons, most of whom were

new acquaintances.

8. A time full of memories

The vivid nature of the memories as well as the mix of

feelings became apparent in the students’ early experi-

ence of being in a new culture and university setting. The

consistent theme which students imparted was the

excitement they experienced initially as they began their

journey of crossing cultures. Yet this excitement and joy

blends with sadness and anxiety. Some of the anxiety

was about not knowing what to expect. The sadness that

students mention was also about missing families.

As new arrivals to the campus, students described

vivid memories of staying at a motel and searching the

neighborhood in large groups, looking for places to stay.

One student states, ‘‘It was nice, it was just three days

full of memories.’’ Aside from concerns about where to

live, students became immediately faced with navigating

ARTICLE IN PRESSE.K. DeLuca / International Journal of Nursing Studies 42 (2005) 657–663660

in the English language as it is spoken by Americans.

Here, a student recounts an initial impression:

I remember when we first arrived to the United States

in New York City. When I talked with the airport

guard, I noticed that Americans don’t ‘‘speak’’

English. They speak something else that I have never

known. I used to study English, to read books and to

write notes. But I have not practiced the language

with AmericansyWhen we first came here, we met

the faculty. They were welcoming us. I understood

less than twenty percent of their speech. I was happy

only because no one asked me a direct question.

For one student, fears around language were asso-

ciated with the attitudes of Americans that the student

might face. Many students, like this one, had good

language skills but were afraid to speak because of a fear

of making a mistake. There was also a fear of the

environment as violent, so students stayed close together

and traveled in groups for the first few weeks.

Students’ vivid recollections of coming to a new place,

experiencing a new language and associating a mix of

emotions created a very lucid portrait. The first few

weeks of this experience were etched powerfully in their

memories. Memory that continually renews itself tells us

who we are, because it encapsulates the self with a view

of past and present identities. These Jordanian students

came to know themselves through their experience of

time through memory, place, language, emotions and

sensations. The stories of these early memories marked

the beginning of their metamorphosis.

9. Bombardment

Descriptions of this period influenced me to name this

experience ‘‘bombardment.’’ Unlike the initial period,

which was colorful and captured easily with memory,

this is a time of instability and uncertainty as students

grapple with the challenges of a new language, mounting

academic demands and the social conflicts that a new

American culture presents. Time seems to move with

lightening speed.

Students described moments of uncertainty related to

their academic requirements, such as writing papers,

acquiring adequate computer skills and meeting expec-

tations of faculty. Students were unprepared for what

they considered a fast pace and heavy reading load.

While facing a myriad of academic issues, this time

period was clouded with personal concerns and difficul-

ties trusting strangers. This student reflects on this time

period:

We were like in a very big country, we knew nobody

in this place, we trusted nobodyyEven as a group

we [the Jordanians] weren’t trusting each other

because I hardly know these peopley..Maybe I

didn’t joke because I didn’t know them.

This student echoes the concerns that all of the students

verbalized. They admitted to feeling social uneasiness,

and because of a score of activities to complete just to

get settled, it was difficult to concentrate.

Another student remembers that while studying to

pass the Test of English as a Foreign Language

(TOEFL) there was a real lack of confidence about

English language skills. As the preparation continued to

pass the test, this student’s stress grew. In order to cope

with passing the test, the student remembers focusing on

almost nothing else but language. One strategy was

sitting close to Americans in restaurants and buses in

order to model their language style.

As students journey to find comfort with place and

identity, there were many struggles along the way. All

students yearned to feel socially comfortable, to laugh

and enjoy themselves, but this was very difficult,

especially at the outset. One student describes the

frustration around establishing friendships and a com-

fortable living situation.

I have never felt like the strangeness, you call that

being a stranger, or away, until this moment when I

moved to the cityy.I wanted a place to live here and

it was the hardest thing to find. It was helly.

During this time, most of the students experienced a

sense of discomfort with each other as well as an

unsettledness within themselves. This time of feeling like

a stranger seems to be a time to look inward and come

to terms with individual values and a recognition of

some essential aspects of self.

The majority of students awaited official acceptance

into the graduate program the following semester

pending the passing of the TOEFL. Students faced

considerable stress to ‘‘make the grade’’ first by passing

the TOEFL test and later by succeeding in their classes.

Half of the group did not pass the test and were unable

to progress. What began to surface for the students was

that they had found their own unique identity. But this

did not happen as they expected. The Jordanian group

did not become a family, but, much like their American

colleagues, seven very unique individuals emerged from

this bombardment period. Their friendships were

primarily with Americans or Middle Eastern students

outside of their original group.

10. Metamorphosis: ‘‘Looking to do something’’

As the student’s sojourn enters its last phase, they

noticed that the ‘‘fitting in,’’ which they struggled so

hard to achieve, no longer seemed so difficult. They also

observed that they were flowing more naturally into the

ARTICLE IN PRESSE.K. DeLuca / International Journal of Nursing Studies 42 (2005) 657–663 661

new place, having uniquely negotiated differences in

culture, language and place. At this point in the

culmination of their experience, their social and

intellectual worlds collided to create an experience that

they called ‘‘enjoying life.’’ One female student described

the experience of this identity change.

Now I enjoy it. I feel that it’s part of me now, part of

growing up to the level that whenever I go some-

where, if I have a point to make, I have to make

ityyBefore you just joined the group, but here [in

graduate school] you have to create your own

identity.

For another student, this new identity was strength-

ened by developing writing and research skills. The

student began to realize a potential in writing and

research. The student began picturing an academic

career in the future. This talent was fueled by work

with colleagues and an enthusiastic faculty mentor.

And here the thing is, I like the updated research.

And this is great, you know, you can find research in

many areas you are interested iny. For example,

now I’m getting Oncology Nursing Forum and I’m

getting the most updated research, yes, it’s wonder-

ful, I love it. So I can’t find these things in Jordan.

yI tell you the truth, I like the academic part.

Maybe it’s the most important part in my lifeyy

For this student, it was as if a whole new world had

emerged. This student became excited each time a new

milestone was reached, like completing a paper or

submitting an article for publication. By improving

abilities in writing and research, the student’s image as

one fascinated with science and research had newly

materialized.

Aside from developing confidence in academic

spheres, students seemed to develop an ethic of caring

and concern with which they planned to return to

Jordan. One fear for them was that they would be

unable to force the changes necessary to improve

prevention and cancer care to patients.

But all of us are excited now and we are looking to go

and do something and I hope they will give us what

we want to do; they will open the door for us and our

plans. Because, as you say, as you saw ity..all of our

success is not shamefulywe have to work on thaty.

This male student considers the tensions that could arise

among colleagues and professionals at home in Jordan.

Perhaps in order to fit in, the student must pretend that

the work in graduate school was not successful. The

student considers a way to show humility but at the

same time fight for changes in the current level of health

care and cancer care.

Another concern shared by all students, whose final

projects dealt mostly with patient and community

education about various cancers, was the notion of

secrecy which pervades a diagnosis of cancer in Jordan.

They explained that this secrecy is often supported by

the health team and families in Jordan. One student

argues that this secrecy, displayed by family members

and the health team, prevents them from helping the

patient to fight the disease.

The patients know. The patient knows that he has

cancer. But they are just like, trying to avoid the idea.

And they don’t want to face the reality, the family

are protecting him and say don’t tell him. But he

knows, so we have to be clear and give him some

options, maybe we’ll do something, we have a lot of

things to think about, his bills, the bank, like, all this

stuff, the bills, the bank, the body image thing, to

want to have a wig or something, I mean there’s a lot

to talk with the patient about. But when we are not

telling him he is taking chemotherapy, we are taking

everything.

Because people are afraid to say the word cancer, they

are not able to talk about it. They are not talking about

it, and it limits preventive interventions that could save

the lives of millions. When this student spoke about it, it

was with a great deal of passion. Being able to make

these changes upon return to their country was a topic

all the students felt strongly about.

As the students realized the end of their education and

contemplated what they had done here, a sense of

purpose emerged for them. They began to visualize their

roles as professional nurses in Jordan. They became

motivated to confront the difficulties that they would

face upon their return. Issues about which these seven

students cared deeply were related to helping persons in

their country understand how the maintenance of

certain historical practices increases the incidence of

cancer. All of these students focused their scholarship on

the preventive aspects of cancer as well as acute

interventions. As students faced the uncertain world

that they hoped to change, they tried to be realistic in

considering the limitations as well as the possibilities

that lie ahead.

11. Discussion

Seeing students through this phenomenological lens

revealed unique aspects of crossing cultures. Like other

studies noted in the literature, this research revealed that

students face ‘‘chaos’’ in the process of cultural

adaptation. Issues of language and culture had to be

faced before students were able to progress academically

in nursing. The phenomenological approach allowed me

ARTICLE IN PRESSE.K. DeLuca / International Journal of Nursing Studies 42 (2005) 657–663662

to see the students’ experiences of tremendous growth

over time. Student participants disclosed that they

experienced a transformation in identity: this became

manifest in professional and social spheres. Integrating

into the American culture was vital for the students’

integration into academic and clinical nursing environ-

ments.

It is clear from the experience of these students that

some specific curricular and administrative interventions

might have improved student adjustment and overall

success. These included allowing an extended time for

orientation to the social and academic environment and

limiting course content in the first semester. Recom-

mendations to lengthen orientation time need to be

stressed with the host country. In this case, these

government-funded students were expected to complete

the graduate degree within a 2-year time frame, similar

to full-time American students. This increased the

students’ anxiety and presented many challenges.

Schools of Nursing might also consider broadening

admission requirements to include other criteria besides

a language test such as the TOEFL. This would be

helpful in assessing communication abilities and other

necessary competencies for a graduate student in

nursing.

This study shows that a major responsibility for

faculty working with Jordanian and/or Middle Eastern

students is to frame a relevant curriculum, which

includes course content, and assignments, which enrich

students’ own cultural and environmental perspectives

around health. Improvements in curricula are likely to

occur as faculty develop greater understanding of

cultural and health care issues in Jordan or other

Middle Eastern countries. Conducting workshops or

regular dialogue sessions for faculty is an excellent

strategy for Schools of Nursing involved with these

students.

Jordanian students did complete scholarly projects

which had implications for health issues in Jordan; this

was a meaningful experience, as well as the ability to

select clinical experiences which enhanced a students’

chosen specialty in Jordan, such as home care, operating

room, preventive health and acute care. However, this

area might have been strengthened. Allowing students

opportunities for independent study courses and a wide

range of choices in the completion of paper and project

topics is optimal.

12. Conclusions

Faculty at this university often adopted time-consum-

ing strategies to help students succeed. Research on

factors that influence faculty teaching styles and/or

preferences for teaching Jordanian or Middle Eastern

would be illuminating.

Since acclimation to the environment was an issue,

further study focusing on student orientation and

student adjustment in the first year would be useful.

Current literature in this area is primarily quantitative;

qualitative and/or phenomenological research might

reveal new information applicable to Jordanian students

and others.

Research studies that explore the impact of admission

criteria for Jordanian and/or Middle Eastern students

would also be beneficial. Comparisons among a variety

of colleges and universities could be made with an eye to

criteria that lead to the highest graduation rates and

highest levels of student satisfaction.

Based on the current political environment, American

and Jordanian attitudes towards each others’ coun-

tries may have changed. Research studies exploring

both student and faculty attitudes would be construc-

tive. Replication of this study would no doubt

produce interesting findings. In addition, this study

could be implemented with a variety of schools and

international student groups. Findings would have

applicability for faculty teaching strategies and optimal

curricula. Such research could also highlight best

practices for admission, orientation and progression of

Jordanian students and other international student

groups.

Acknowledgments

The author wishes to thank Dr. Francine Hultgren,

dissertation advisor for this study at the University

of Maryland, College Park, Department of Edu-

cation Planning, Policy and Administration, Dr.

Anne Bishop, Dr. Jack Scudder, Dr. Kathy Neill,

Dr. Judy Baigis and Sister Carol Taylor for assistance

with manuscript development, and Dr. Caroline

Burnette for assistance with methodology. The author

also wants to thank Sigma Theta Tau for a Grant of

$3000, and the University of Maryland, College of

Education for a Grant of $500.00 tuition for multi-

cultural research.

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