A Defining Moment: Malaysian Nurses' Perspectives of Trans-National Higher Education

Abstract Transnational Higher Education (TNHE) post-registration top-up nursing degree programmes are relatively new in Malaysia and their impact in clinical settings is unknown. This research interprets Malaysian nurses’ experiences of such programmes and their perspectives of the extent TNHE theoretical knowledge has been applied in clinical settings. The contextual framework was established by drawing on a range of relevant dominant discourses, i.e. TNHE, nurse education, continuous professional development, theory-practice link in nursing, and culture and its influences, including coping with and adjusting to new ways of learning. Hermeneutic phenomenology and the ethnographic principle of cultural interpretation were used to explore the views of eighteen Malaysian nurses from two UK and one Australian TNHE universities (determined by convenience and snowball sampling methods) to enable data saturation. Semi-structured interviews were conducted to enable the nurses’ voices to define, describe and evaluate their TNHE experiences that were focused on personal and professional development, implementation and reaction of others towards change. In addition to the interviews, three threads of my own personal, professional and researcher experiences were reflected upon, to provide the contextual lens to shape the research process and situate the work firmly in the practice context. Data was analysed using thematic analysis. Four pre-determined key areas drawn from the literature were investigated and eight new sub-themes emerged. Findings indicated nurses’ improved self-confidence, knowledge, questioning skills and professionalism. The extent to which TNHE theory was applied in clinical practice was unable to be determined due to conflicting perceptions, contradicting views and restricted number of nurse-led examples. The main contribution this thesis offers to practice is what the voices of nurses tell about their experiences in TNHE programmes and in applying the taught theory in clinical settings. This study indicates enhanced application of theoretical knowledge in practice for improved quality and culturally competent patient care is unlikely to occur under current TNHE arrangements. Nurses’ motives for enrolling were mainly to obtain the high status western degree and the extrinsic benefits of a financial incentive and promotion. However, drawing on their resilience, nurses developed self and professional perspective transformation. The research provides new insights to inform continuous professional education policy for nurses, employers and the Malaysian Nursing Board, and can assist TNHE provider institutions to improve their programme delivery