Scholarly article on topic 'Chinese nursing students' culture-related learning styles and behaviours: A discussion paper'

Chinese nursing students' culture-related learning styles and behaviours: A discussion paper Academic research paper on "Economics and business"

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Abstract of research paper on Economics and business, author of scientific article — Carol Chunfeng Wang, Kenneth Mark Greenwood

Abstract Globalisation requires that nursing education focuses on culturally competent care. International students studying in Australia present a valuable resource for cultural learning, yet internationalisation presents opportunities and challenges for both lecturers and students. This paper explores Chinese nursing students, the single largest group of international students in Australia, their communication behaviour, patterns and learning styles at Australian universities from cultural and psychosocial perspectives. Our aim is to provide insight for educators in Western countries to better understand this particular ethnic group and help Chinese nursing students overcome learning difficulties and develop their potential learning capabilities. We further recommend coping strategies to help international Chinese nursing students' learning.

Academic research paper on topic "Chinese nursing students' culture-related learning styles and behaviours: A discussion paper"



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Chinese nursing students' culture-related learning ^ styles and behaviours: A discussion paper


Carol Chunfeng Wang a'*, Kenneth Mark Greenwood b

a School of Nursing and Midwifery, Edith Cowan University, Perth, Australia b Faculty of Health, Engineering and Science, Edith Cowan University, Perth, Australia



Article history: Received 23 April 2015 Received in revised form 23 May 2015 Accepted 30 July 2015 Available online 14 August 2015


Chinese nursing students International students International education

Globalisation requires that nursing education focuses on culturally competent care. International students studying in Australia present a valuable resource for cultural learning, yet internationalisation presents opportunities and challenges for both lecturers and students. This paper explores Chinese nursing students, the single largest group of international students in Australia, their communication behaviour, patterns and learning styles at Australian universities from cultural and psychosocial perspectives. Our aim is to provide insight for educators in Western countries to better understand this particular ethnic group and help Chinese nursing students overcome learning difficulties and develop their potential learning capabilities. We further recommend coping strategies to help international Chinese nursing students' learning.

Copyright © 2015, Chinese Nursing Association. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (http://

1. Introduction

The numbers of international students attending Australian universities make international education a significant industry and an important international exchange program. The growth in the number of international students is considered economically beneficial, but also beneficial for building alliances, sharing knowledge, enhancing Australian influence, increasing cultural awareness, and for preparing a workforce for the global environment [1—7]. This discussion paper will examine the literature to assist Australian university educators in understanding the perspective of Chinese nursing students studying in Australia. This discussion is

partially in response to the importance of international students' teaching and learning experiences, which has received considerable attention in educational research [8]. We focus on the students' culture-related learning styles and behaviours, particularly in the area of nursing and nursing education.

As a culturally diverse country, 26% of Australia's population was born overseas [9]. There is a significant number of international Chinese students who choose to study at Australian universities [6] and China is the country of origin for the single largest group of international students at many educational institutions [10,11]. According to the Australian Department of Education, Chinese students were the largest

* Corresponding author.

E-mail address: (C.C. Wang). Peer review under responsibility of Chinese Nursing Association.

2352-0132/Copyright © 2015, Chinese Nursing Association. Production and hosting by Elsevier (Singapore) Pte Ltd. This is an open access article under the CC BY-NC-ND license (

single international student group overall, and similarly, comprised the largest number of international nursing students in 2011 and 2012 [9]. To support culturally competent care, the Australian government has encouraged the employment of health care professionals with multicultural experiences and backgrounds [12], and the significant number of international students enrolling at Australian universities in health-related programs is a potential source of employees [4,7]. Therefore, providing a positive learning experience for international students is also an important recruitment strategy in achieving the nation's future healthcare needs.

Unfortunately, the majority of literature has identified a range of challenges for international students in assimilating and learning within their host countries, including Australia. These issues include English language proficiency, cultural barriers, social conflict, different learning styles, unexpected academic demands, perceived racism, homesickness, and financial hardship [6,13-18]. However, most of the literature has attributed these obstacles to a deficit approach, emphasising the hindrances in international students' learning and experiences, yet potentially overlooking the value of their education to both the students themselves and their host nations [19,20].

The learning experiences of different international student cohorts can vary greatly [21]. Therefore, both cultural and study discipline-based research into specific groups is highly relevant. While this paper will address issues of broad relevance to international students, we specifically focus on nursing students from mainland China. This cohort of students contributes to the highest proportion of international students studying in Australia as a whole and also within nursing programmes [9].

Lecturers accustomed to Western-based student behaviours may perceive the behaviour and personality of Chinese nursing students at Australian universities differently. Little research has been performed to better understand Chinese students' communication behaviour, patterns and learning styles from both cultural and psychosocial perspectives, or how they may impact their study abroad [11,22]. As we discuss, the learning styles of Chinese students have been profoundly shaped by Confucian philosophy and Chinese cultural values. Understanding how Chinese students' minds operate, their cultural values and why certain learning styles are preferred by these students will potentially improve their teaching and learning experiences. To gain a better understanding, the remainder of the paper will address the major frameworks that inform Chinese students' thinking, perceptions and learning approaches. Our aim is to provide insight for educators in Western countries to better understand this subject and help Chinese nursing students overcome learning difficulties and develop their potential learning capabilities.

2. When the west meets the east

Among the many frameworks of cultural variability, collectivism versus individualism [23] and high-context versus low-context communication [24] are two main Western cultural explanatory dimensions that apply to Chinese culture [25-27]. In addition, Chinese culture has been profoundly shaped by

the influential power of Confucian philosophy, and hence, these aspects will be included within our discussion.

2.1. Collectivism versus individualism

Individuals in collective cultures are "primarily motivated by the duties and goals of the members of these collectives over their own personal goals" [23]. Chinese culture is predominantly collectivistic. Reid stated that "within the Confucian tradition, students learn through co-operation, by working for the common good, by supporting each other and by not elevating themselves above others" [28]. This co-operative value requires Chinese students to help each other, with each member having a strong sense of duty towards other group members. Firstyear or junior students will often refer to more senior students as 'big brother' or 'big sister', both as a mark of respect and acknowledgement of their commitment to the group.

In contrast, individualism is defined as "a social pattern that consists of loosely linked individuals who view themselves as independent of collectives: are primarily motivated by their own preferences, needs, rights, and the contracts they have established with others; give priority to their personal goals over the goals of others; and emphasize rational analyses of the advantages and disadvantages to associating with others" [23]. Australia is an example of an individualistic culture whereby students are expected to largely work independently and take responsibility for their learning.

Triandis' [23] framework of collectivism versus individualism causes conflict for Chinese students studying in a Western-based individualistic culture. For example, their culture-based behaviours, such as respect for authority figures and preserving harmony, can present a challenge when these ideals conflict with the host educational institution's expectations. Thus, Chinese students are often perceived by Western lecturers and peers as passive, quiet in class, non-confrontational, do not asking questions, lack of critical thinking, lack of independent learning, and lack of assertiveness.

2.2. High-context versus low-context cultures

According to Hall, "culture is communication and communication is culture" [24]. In high-context cultures such as China, communication is indirect and implicit. Communication is internalised and is dependent on physical and psychosocial contexts. However, in low-context cultures such as Australia, communication is explicit, direct, open and straightforward. Hall believed that "culture determines what an individual takes in and leaves out in terms of information processing" [26], and further suggested that collectivism (China) is a high-context culture whereas individualism (Australia) tends to be a low-context culture.

Hall's ideas concerning high-context and low-context cultures provide an explanatory framework for understanding Chinese nursing students' communication behaviour patterns and styles. For example, Chinese students will not engage in discourse before they are certain of the related implications. Even though they have the desire to enter into discourse, they may undergo a complex thought process while remaining

silent; until they feel comfortable that they do not run the risk of losing face in the presence of significant others. Consequently, Chinese nursing students often take much time to decide whether to approach a lecturer to ask a question, or may provide no response to a question in class. The challenge is not that the student does not understand, but that they are not confident that their response will be sufficiently complete, thus embarrassing themselves and their teachers.

In addition to avoiding 'losing face', language disfluency is a major barrier for these students to speak up in the classroom. Chinese nursing students need to be familiar with medical or nursing terms, which are usually difficult to correctly pronounce. Before they can handle these pronunciations, they may not ask questions in the classroom because they are afraid to waste other students' time as the teachers may take more time to understand their questions.

2.3. Confucian values

Confucius insisted that all leaders must rule with good will and justice, and that people should follow and respect their leaders in return. He believed that the only way forward in a hierarchical Chinese society was to develop a morally motivated system. According to Oh [29], the key emphases of Confucian values on the family are expressed as five constant virtues and parallel cardinal relationships, as follows:

As cited in Chan [30], Kirkbride and Tang (1992) stated that "Confucianism emphasises the value of harmony, urging individuals to adapt to the collectivity, to control their emotions, to avoid conflict, and to maintain inner harmony".

Respecting parents at home, teachers at school and university, leaders at work [31], being anxious about preserving harmony, saving face, avoiding bringing shame to one's self and one's family all contribute to the teaching and learning styles preferred by Chinese nursing students, such as being quiet in class, tending to agree easily, being non-confrontational, using rote memorisation, and preferring instructive learning methods. These not only conflict with certain Western learning approaches, but they also impact how these students adapt to the need to be forthright and appear confident in the clinical environment.

3. Culture-based behaviours, patterns and styles

Several studies have confirmed that communication behaviours are largely determined by culture [32—34]. The collec-tivistic culture in China is derived from Confucianism, which has long been entrenched in Chinese culture. With

Confucianism values, Chinese nursing students often present certain characteristics in their communication patterns, as outlined below.

3.1. Face saving

'Face' is a psychosocial concept ingrained in Chinese communication behaviours. 'Face', the public image, brings reputation to one's self and family. An individual's success and shame would not only be attributed to the individual, but to the entire family [32]. Direct confrontations are avoided at all times to save face. This concept explains why Chinese nursing students give the impression of being passive, respectful, agreeable and well mannered. Therefore, a Chinese student's classroom behaviour would be an attempt to save face and prevent embarrassment or offence to others.

As cited in Guan and Jones [35], Chinese cultural values and roles, such as face, harmony, humbleness, and respect for authority, lead to students having different learning styles such as being 'quiet in class', and 'preferring not to be questioned by the lecturer'. Debating in class and questioning the teacher are considered inappropriate behaviour and would lead to 'loss of face' for the Chinese student.

3.2. Respect of teachers

From the Confucian perspective and the tradition of absolute respect for one's parents and the love of learning and knowledge, teachers are the 'fountains of knowledge', 'truth holders', 'moral exemplars' and 'parents outside the home', and therefore should be highly respected. Chinese teachers and students form a much 'closer' relationship compared to Western teachers and students. In turn, teachers have enormous authority, power, and influence. As authority figures, Chinese teachers command respect from their students, and asking questions is often seen as a challenge to the teacher, resulting in a loss of face for the teacher and the student [36]. Confucius said, "when I walk along with two others, they may serve me as teachers. I will select their good qualities and follow them, their bad qualities and avoid them" [32]. Chinese students often model their teachers' behaviours; thus, Chinese nursing students often follow their teachers' instructions without question.

3.3. Quiet in class

Chinese nursing students' 'quietness' is often perceived by their Western lecturers and peers as being 'shy', having 'no learning needs', 'being unable to answer a question', 'having no views at all', having the 'inability to form an opinion' or indicating a lack of 'critical thinking skills' [26]. In reality, Chinese students do not ask questions in class to avoid bringing embarrassment by asking 'foolish' questions in public or to avoid a possible situation where the lecturer would lose face by being unable to answer a question. Chinese students aim to live in harmony, modesty and humility, suppressing individual needs based on their collective responsibilities to their families and groups. These values explain why Chinese nursing students are 'quiet' in class. Debating in class and displaying individualism do not have a

Constant Virtues Cardinal relationships

Filial piety Father and son

Faithfulness Husband and wife

Brotherhood Elder and younger brother

Loyalty Monarch and subject

Sincerity Between friends

place in Chinese culture [32]. Confucian values dominate the individual's perception and ways of learning. Wen and Richard [36] argued that Chinese students quietness in class is not solely an English language issue and that it is deeply rooted in Chinese philosophy. Wen and Richard believed that other-directed self (i.e. one's behaviour is directed by external norms rather than by one's own scale of values) and a submissive way of learning are two aspects governing this phenomenon.

3.4. Other-directed self

According to Confucius, the self does not exist as a single entity. Its existence is related to the family, the community, the nation and the world. Chinese culture emphasises that when conducting oneself in different situations, one needs to be aware of how others interpret one's behaviour in these situations and one's relationships with others. Chinese people often attach themselves from their obligation to others; 'guanxi' (connections with others) is a very complex and stressful phenomenon in Chinese society. They are relaxed when they are with friends, but become very cautious of their thoughts and actions in public to avoid disapproval. Hence, in decision-making situations on a team, the Chinese student's cultural requirement to respect the other party's opinion overrides the need to express one's own, and their tendency to cooperate could be interpreted as dependence.

Instead of asking the lecturer a direct question during class, Chinese nursing students often have troubled thoughts for days, such as, "Should I ask my lecturer this question? What will my lecturer think of me? How will others evaluate me? How will others respond?" This is elaborated by Yang [37]: submission to social expectations, and worry about external opinions in an attempt to achieve one or more of the purposes of reward attainment, harmony maintenance, impression management, face protection, social acceptance, and avoidance of punishment, embarrassment, conflict, rejection, ridicule and retaliation in a social situation.

Wen and Richard [36] stated that having the desire to communicate does not necessarily imply a willingness to communicate. Similarly, Chinese nursing students are generally quiet, slow to respond and reluctant to communicate, but this does not suggest that they do not have the internal desire or motive to interact with others. Chinese nursing students in Australia are often overwhelmed by their traditional social orientation and will not run the risk of losing face in the presence of significant others; they will only engage in speaking when they feel comfortable.

As China opens her door to the world, younger people have changed their beliefs and behaviours regarding their education. An increasing number of Chinese students are willing to ask questions in classrooms and not consider others' responses. It may take some time for Chinese nursing students to freely ask questions in the classroom, but after the first year of study, they are often more open and active in the classroom.

3.5. "Yes"

A response of "yes" accompanied by nodding and smiling often only means "I heard you" in Chinese culture, and it does

not automatically suggest agreement or consent from Chinese nursing students. Because Chinese nursing students do not want to offend others by saying "no," they often offer this culturally programmed response. Coupled with limited English proficiency, this often compounds a confusing situation where the Western lecturer is challenged to understand whether the Chinese students comprehend the information or are simply being courteous.

3.6. Will power

Chinese culture emphasizes the importance of education. Chinese nursing students often work very hard for their education. Ho (1981), cited in Ngwainmbi [25], suggested that learning and education are the most effective ways to improve one's social, economic and personal situation in China and a means to achieve a higher status in society. Examination systems in China are the primary method for individuals to gain status and success in their career [32]. Confucian value emphasizes 'will power' in the learning process and suggests that everyone can achieve education and perfection when they are motivated and make an effort. Even a weak learner who is persistent will eventually succeed. Chinese consider success is the consequence of hard work.

3.7. Rote learning & memorization

It is universally assumed that Chinese schooling is 'paternalistic' with learning achieved via rote memorization [38], that it is dictatorial and critical [25], primarily uses instructive methods [39], and is completely different from the Western style of teaching (learner-centred) [10]. Considerable evidence suggests that a student's learning methods and preferences are culturally determined [32-34], and this potentially conflicts with the host institution's teaching approaches. Conversely, Cooper [40] suggested that while surface approaches to learning can be associated with mechanical rote learning, the Chinese tradition of memorisation through repetition can be used to deepen understanding and achieve high levels of academic performance. As such, memorisation should not be treated as rote learning or as unessential.

3.8. Insider effect

Chinese culture tends to divide people into two groups: 'insiders' who are intimately related families and friends, and 'outsiders', who are strangers. The Chinese keep a certain distance from outsiders and their cultures. This 'keep-away' attitude is quite common in some Chinese people who have lived in a foreign community for over a decade and have never had close contact with native speakers. This attitude is also seen in many places such as Chinatown, where the Chinese "remain faithful to Chinese food and Chinese customs and live in Chinese circles" [36]. For Chinese people, their inner feelings should only be disclosed to intimate friends and family.

Chinese students have found it more difficult to make friends with local students compared to other international students. According to Wang and Cross (2005), as cited in Campbell and Zeng [21], Chinese international students in

Australia are not always capable of integrating themselves with their local communities or the methods of academic or social inquiry. Campbell and Zeng [21] found that Chinese students relied on their co-national friends in the host country and their family and friends in China as their primary coping strategy.

4. Coping strategies

4.1. Two-ways of learning

Learning styles are influenced by culture. To enhance Chinese nursing students' learning outcomes and the quality of their educational experiences whilst studying in Australia and to develop a 'culturally sensitive pedagogy', there is a clear need to learn about Chinese students and their cultures, adjusting our own expectations, teaching styles, increasing our self-awareness and assuming an open, tolerant, empathetic attitude toward different approaches of doing things. For example, teachers should avoid using colloquialisms, slang or their own culture-based metaphors, and encourage students to ask questions. They should avoid asking students questions in public and approach them in a sensitive manner. To achieve mutual understanding, we need to make a conscious effort to understand the Chinese culture.

4.2. Collaborative learning

Flowerdew [41] suggested that "collaborative learning strategies have been found to foster the adoption of a deep approach to learning, and the use of high-level cognitive strategies" [41]. Flowerdew [41] further advocated for group work is a useful teaching tool for Chinese nursing students, as it portrays the Confucianism value of co-operation and it counterbalances the Confucianism value of 'saving face'.

In a group activity, it is important that lecturers and tutors allow students the opportunity to first define their roles, provide clear instructions, and allow time to think about the topics. Although these students are quiet in class, it does not mean they refuse to participate. Instead, they may be troubled with their traditional social orientations, such as issues with status, face, and shame, which may limit open discussions, which may require more probing and encouragement from lecturers and tutors. Lecturers and tutors should be sensitive to such 'restraints' on Chinese nursing students' behaviour and should be instrumental in shaping students' learning.

Teachers should be mindful when using training techniques such as case studies, role-play and games. These approaches can be challenging for nursing students who are not accustomed to open discussions and expressing opinions. Perhaps these methods could be slowly introduced with clear instructions and sufficient preparation time.

4.3. Diligence and self-determination in learning

Lecturers and tutors often spend less time motivating highly determined Chinese nursing students. This has been elaborated by Wang and Greenwood [31]:

Chinese students are taught to exert diligence and persistence in their study ... They are pushed to work extremely hard and trained to be very self-disciplined by both their parents and their teachers. The purpose of Chinese students being very self-disciplined and engaging all their energy in their study is to be successful in the 'exam war' and get a good job after graduation. The success in their studies and work would win 'face' for their family and enhance the family's status.

Teachers using Western approaches must be sympathetic to distinct approaches of learning and understanding by this unique ethnic student group, and the teaching materials used should be designed to better appeal to them.

5. Conclusions

There is very little research into Chinese nursing students, the largest single group of international students in Australia (2012), and their learning culture. Much of this research has described the Chinese learning style as a deficit and 'inferior'. No single learning culture is superior to another. Chinese learning styles are far more subtle and complex than Westerners often perceive them. Common assumptions of Chinese learning styles such as memorisation, rote learning and surface learning need to be re-evaluated. Future research in these areas would be beneficial.

Teaching international students demands considerable attention in educational research. The aim to provide positive learning outcomes and quality educational experiences through a better understanding of Chinese learning styles could benefit Chinese nursing students and their teachers at Australian universities.

Globalisation has implications for nursing education, research and clinical practice [42]. Coupled with the global nursing shortage, nursing education development to support a safe effective nursing workforce has drawn increasing attention [43-45]. The insight gained from this discussion paper could help educators in Western countries better understand their Chinese nursing students. Teaching and learning of international students, particularly Chinese nursing students, could improve their learning success, allowing them to contribute to culturally competent care and make nursing exchange programs possible on a global scale.


[1] Australian Education International. New AE: a discussion starter. Canberra: Australian Government; 2010.

[2] Bhandari R, Blumenthal P. International students and global mobility in higher education: national trends and new directions. New York: Palgrave Macmillan; 2010.

[3] Caluya G, Probyn E, Vyas S. "Affective eduscapes": the case of Indian students within Australian international higher education. Camb J Educ 2011;41(1):85-99.

[4] Hellsten M, Prescott A. Learning at university: the international student experience. Int Educ J 2004;5(3):344-51.

[5] Sovic S, Blythman M. International students negotiating higher education: critical perspectives. Hoboken: Routledge; 2012.

[6] Wang CW, Singh C, Bird B, Ives G. The learning experiences of Taiwanese nursing students studying in Australia. J Transcult Nurs 2008;19(2):140-50.

[7] Yen WJ. Taiwanese students' perspectives on their educational experiences in the United States. Int Educ J 2010;5(3):294-307.

[8] Dolby N, Rahman A. Research in international education. Rev Educ Res 2008;78(3):676-726.

[9] Australian Education International: International Student Enrolments in Nursing. Austrlia: AEI; 2012.

[10] Jin L, Cortazzi M. Researching chinese learners: skills, perceptions and intercultural adaptations. Basingstoke: Palgrave Macmillan; 2011.

[11] Wang CC, Andre K, Greenwood KM. Chinese students studying at Australian universities with specific reference to nursing students: a narrative literature review. Nurse Educ Today 2015;35(4):609-19.

[12] Ohr SO, Parker V, Jeong S, Joyce T. Migration of nurses in Australia : where and why? Aust J Prim Health 2010;16(1):17-24.

[13] Bonazzo C, Wong YJ. Japanese international female students' experience of discrimination, prejudice, and stereotypes. Coll Student J 2007;41(3):631-9.

[14] Gunawardena H, Wilson R. International students at university: understanding the student experience. Bern: Peter Lang; 2012.

[15] Olivas M, Li CS. Understanding stressors of international students in higher education: what college counselors and personnel need to know? J Instr Psychol 2006;33(3):217-22.

[16] Trice AG. Faculty perspectives regarding graduate international students' isolation from host national students. Int Educ J 2007;8(1):108-17.

[17] Vandermensbrugghe J. The unbearable vagueness of critical thinking in the context of the anglo-Saxonisation of education. Int Educ J 2004;5(3):417-22.

[18] Wong J. Are the learning styles of Asian international students culturally or contextually based? Int Educ J 2010;4(4):154-66.

[19] Singh M. Using Chinese knowledge in internationalising research education: Jacques Ranciere, an ignorant supervisor and doctoral students from China. Glob Soc Educ 2009;7(2):185-201.

[20] Turner Y, Robson S. Internationalizing the university. Bloomsbury Publishing; 2008.

[21] Campbell N, Zeng J. Living in the West: a study of Chinese international students' adaptation. Commun J N. Z 2006;7(1):1-31.

[22] Wang CC, Geale SK. The power of story: narrative inquiry as a methodology in nursing research. Int J Nurs Sci 2015;2(2):195-8.

[23] Triandis HC. Individualism & collectivism. Westview Press; 1995.

[24] Hall ET. Beyond culture. New York: Anchor; 1976.

[25] Ngwainmbi EK. Communication in the Chinese classroom. Education 2004;125(1):63-76.

[26] Scheele TH, Pruitt R, Johnson A, Xu Y. What do we know about educating Asian ESL nursing students? A literature review. Nurs Educ Perspect 2011;32(4):244-9.

[27] Xu Y, Lippold K, Gilligan A, Posey-Goodwin P, Broome B. A model for enhancing intercultural communication in nursing education. Home Health Care Manag Pract 2004;17(1):28-37.

[28] Reid JM. Learning styles in the ESL/EFL classroom. Heinle & Heinle Publishers; 1995.

[29] Oh TK. Understanding managerial values and behaviour among the gang of four: South Korea, Taiwan, Singapore and Hong Kong. J Manag Dev 1991;10(2):46-56.

[30] Chan S. The Chinese learner-a question of style. Education+ Train 1999;41(6/7):294-305.

[31] Wang X, Greenwood KM. Chinese students' perceptions of their creativity and their perceptions of Western students' creativity. Educ Psychol 2013;33(5):628-43.

[32] Chou MJ, Tu YC, Huang KP. Confucianism and character education: a Chinese view. J Soc Sci 2013;9(2):59-66.

[33] Scollon R, Scollon SW, Jones RH. Intercultural communication: a discourse approach. Malden, MA: Wiley-Blackwell; 2012.

[34] Davidhizar DNS. Intercultural communication in nursing education: when Asian students and American faculty converge. J Nurs Educ 2005;44(5):209-15.

[35] Guan X, Jones G. Unlearning and relearning: Chinese Students in a New Zealand first year undergraduate class. N. Z J Teachers' Work 2011;8(2):208-19.

[36] Wen WP, Clement R. A chinese Conceptualisation of willingness to communicate in ESL. Lang Cult Curric 2003;16(1):18-38.

[37] Yang KS. Social orientation and individual modernity among Chinese students in Taiwan. J Soc Psychol 1981;113(2):159-70.

[38] Sanner S, Wilson A. The experiences of students with English as a second language in a baccalaureate nursing program. Nurse Educ Today 2008;28(7):807-13.

[39] Charlesworth ZM. Learning styles across cultures: suggestions for educators. Educ Train 2008;50(2):115-27.

[40] Cooper BJ. The enigma of the Chinese learner. Account Educ 2004;13(3):289-310.

[41] Flowerdew LA. Cultural perspective on group work. ELT J 1998;52(4):323-9.

[42] Davidson PM, Daly J, Meleis A, Douglas M. Globalisation as we enter the 21st century: reflections and directions for nursing education, science, research and clinical practice. Contemp Nurse A J Aust Nurs Prof 2003;15(3):162-74.

[43] Wong FK, Zhao Y. Nursing education in China: past, present and future. J Nurs Manag 2012;20(1):38-44.

[44] Gao LL, Chan SWC, Cheng BS. The past, present and future of nursing education in the People's Republic of China: a discussion paper. J Adv Nurs 2012;68(6):1429-38.

[45] Li Z. Problems and challenges in graduate education of nursing in China. J Nurs Adm 2006;6(3):12-5.