{"id":{"repo_id":"oxford-brookes","oai_identifier":"tle:fcf156ed-4460-4232-b6cf-35ef5843af41:d6bd9758-527a-46cd-bfe2-c433766e8fca:1"},"canonical_url":"https://search.dev.ndltd.org/etd/oxford-brookes/tle:fcf156ed-4460-4232-b6cf-35ef5843af41:d6bd9758-527a-46cd-bfe2-c433766e8fca:1","repository":{"repo_id":"oxford-brookes","name":"Oxford Brookes University","base_url":"https://radar.brookes.ac.uk/radar/oai"},"display":{"title":"An appreciative inquiry into the integration of internationally educated nurses (IEN) in England : perspectives from IENs and home- educated nurses (HENs)","abstract":"Background: Internationally educated nurses (IENs) play a vital role in sustaining the English healthcare system (EHS), contributing clinical expertise, cultural diversity, and workforce resilience. However, the processes through which IENs are integrated into practice remain uneven and underexplored. Existing literature has mainly focused on individual adaptation and deficit-based framings, often overlooking relational dynamics, organisational responsibilities, and the perspectives of home-educated nurses (HENs). This study explores IEN integration as a relational, organisational, and systemic process, informed by the experiences of both IENs and HENs within the EHS. Method: In this qualitative study, fifty-five participants (n = 40 IENs and n = 15 HENs) were recruited from five NHS Trusts in England and professional networks using purposive and snowball sampling. Data was collected through semi-structured interviews. Data were analysed using the Framework Method (Gale et al., 2013). Bronfenbrenner's Ecological Systems Theory (BEST) (1979) provided the primary interpretive framework. The original five-level structure was retained for findings presentation, and an adapted three-level version, micro, meso, and macro, with time and place as cross-cutting enablers, was applied in the discussion. An Adapted Appreciative Inquiry (AAI) orientation informed the study's strengths-based framing and approach to participant engagement. Findings: The integration into EHS was experienced as a non-linear, dynamic, relational, and multi-level process shaped by interactions across ecological systems. Four interconnected themes were identified. Theme 1, Building connections through language, communication, and cultural exchange (microsystem), Theme 2, Thriving through professional support and learning (mesosystem), Theme 3, Enhancing equity, ethics, and opportunity in practice (exosystem and macrosystem), and Theme 4, Thriving, belonging, and living beyond the workplace (macrosystem and chronosystem). Variations in integration experiences were evident across settings. Consistent relational and organisational support was associated with more positive and sustained integration, and inconsistency was linked to delayed progression, marginalisation, and emotional strain. Conclusion: Integration of IENs is not a one-time transition or an individual responsibility, but a negotiated, co-produced process shaped by relationships, organisational practices, and wider structural contexts. Integration was most effective where inclusive leadership, coherent induction and mentorship structures, and equitable organisational cultures aligned to recognise IENs’ expertise and support their professional growth. Where such alignment was lacking, integration was experienced as fragmented and less sustainable. By advancing an ecological, strengths-based understanding of integration, this study highlights the need for shared responsibility across policy, organisational, and team levels, and offers evidence-informed implications for workforce planning, professional development, and inclusive practice within the EHS.","abstract_html":"Background: Internationally educated nurses (IENs) play a vital role in sustaining the English healthcare system (EHS), contributing clinical expertise, cultural diversity, and workforce resilience. However, the processes through which IENs are integrated into practice remain uneven and underexplored. Existing literature has mainly focused on individual adaptation and deficit-based framings, often overlooking relational dynamics, organisational responsibilities, and the perspectives of home-educated nurses (HENs). This study explores IEN integration as a relational, organisational, and systemic process, informed by the experiences of both IENs and HENs within the EHS. Method: In this qualitative study, fifty-five participants (n = 40 IENs and n = 15 HENs) were recruited from five NHS Trusts in England and professional networks using purposive and snowball sampling. Data was collected through semi-structured interviews. Data were analysed using the Framework Method (Gale et al., 2013). Bronfenbrenner's Ecological Systems Theory (BEST) (1979) provided the primary interpretive framework. The original five-level structure was retained for findings presentation, and an adapted three-level version, micro, meso, and macro, with time and place as cross-cutting enablers, was applied in the discussion. An Adapted Appreciative Inquiry (AAI) orientation informed the study's strengths-based framing and approach to participant engagement. Findings: The integration into EHS was experienced as a non-linear, dynamic, relational, and multi-level process shaped by interactions across ecological systems. Four interconnected themes were identified. Theme 1, Building connections through language, communication, and cultural exchange (microsystem), Theme 2, Thriving through professional support and learning (mesosystem), Theme 3, Enhancing equity, ethics, and opportunity in practice (exosystem and macrosystem), and Theme 4, Thriving, belonging, and living beyond the workplace (macrosystem and chronosystem). Variations in integration experiences were evident across settings. Consistent relational and organisational support was associated with more positive and sustained integration, and inconsistency was linked to delayed progression, marginalisation, and emotional strain. Conclusion: Integration of IENs is not a one-time transition or an individual responsibility, but a negotiated, co-produced process shaped by relationships, organisational practices, and wider structural contexts. Integration was most effective where inclusive leadership, coherent induction and mentorship structures, and equitable organisational cultures aligned to recognise IENs’ expertise and support their professional growth. Where such alignment was lacking, integration was experienced as fragmented and less sustainable. By advancing an ecological, strengths-based understanding of integration, this study highlights the need for shared responsibility across policy, organisational, and team levels, and offers evidence-informed implications for workforce planning, professional development, and inclusive practice within the EHS.","abstract_has_math":false,"creators":["Rajpoot, Aasia"],"institution":"Oxford Brookes University","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Henshall, Cathy","Alexis, Obrey","Merriman, Clair","Rafferty, Anne-Marie"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":null,"date_issued":"","date_published":null,"updated_at":"2026-07-24T03:41:51Z","subjects":[],"languages":["en"],"rights":["All rights reserved"],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://doi.org/10.24384/p4a2-1c48","outbound_label":"DOI","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Rajpoot, Aasia","Henshall, Cathy","Alexis, Obrey","Merriman, Clair","Rafferty, Anne-Marie"]},{"key":"dc:creator","label":"Author","values":["Rajpoot, Aasia"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:publisher","label":"Institution","values":["Oxford Brookes University"]},{"key":"dc:type","label":"Dc Type","values":["thesis"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["en"]},{"key":"dc:rights","label":"Dc Rights","values":["All rights reserved"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["https://doi.org/10.24384/p4a2-1c48","https://radar.brookes.ac.uk/radar/file/fcf156ed-4460-4232-b6cf-35ef5843af41/1/Rajpoot2026Integration.pdf"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["Background: Internationally educated nurses (IENs) play a vital role in sustaining the English healthcare system (EHS), contributing clinical expertise, cultural diversity, and workforce resilience. However, the processes through which IENs are integrated into practice remain uneven and underexplored. Existing literature has mainly focused on individual adaptation and deficit-based framings, often overlooking relational dynamics, organisational responsibilities, and the perspectives of home-educated nurses (HENs). This study explores IEN integration as a relational, organisational, and systemic process, informed by the experiences of both IENs and HENs within the EHS. Method: In this qualitative study, fifty-five participants (n = 40 IENs and n = 15 HENs) were recruited from five NHS Trusts in England and professional networks using purposive and snowball sampling. Data was collected through semi-structured interviews. Data were analysed using the Framework Method (Gale et al., 2013). Bronfenbrenner's Ecological Systems Theory (BEST) (1979) provided the primary interpretive framework. The original five-level structure was retained for findings presentation, and an adapted three-level version, micro, meso, and macro, with time and place as cross-cutting enablers, was applied in the discussion. An Adapted Appreciative Inquiry (AAI) orientation informed the study's strengths-based framing and approach to participant engagement. Findings: The integration into EHS was experienced as a non-linear, dynamic, relational, and multi-level process shaped by interactions across ecological systems. Four interconnected themes were identified. Theme 1, Building connections through language, communication, and cultural exchange (microsystem), Theme 2, Thriving through professional support and learning (mesosystem), Theme 3, Enhancing equity, ethics, and opportunity in practice (exosystem and macrosystem), and Theme 4, Thriving, belonging, and living beyond the workplace (macrosystem and chronosystem). Variations in integration experiences were evident across settings. Consistent relational and organisational support was associated with more positive and sustained integration, and inconsistency was linked to delayed progression, marginalisation, and emotional strain. Conclusion: Integration of IENs is not a one-time transition or an individual responsibility, but a negotiated, co-produced process shaped by relationships, organisational practices, and wider structural contexts. Integration was most effective where inclusive leadership, coherent induction and mentorship structures, and equitable organisational cultures aligned to recognise IENs’ expertise and support their professional growth. Where such alignment was lacking, integration was experienced as fragmented and less sustainable. By advancing an ecological, strengths-based understanding of integration, this study highlights the need for shared responsibility across policy, organisational, and team levels, and offers evidence-informed implications for workforce planning, professional development, and inclusive practice within the EHS."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["An appreciative inquiry into the integration of internationally educated nurses (IEN) in England : perspectives from IENs and home- educated nurses (HENs)"]}]}],"canonical_facts":{"dc:contributor":["Rajpoot, Aasia","Henshall, Cathy","Alexis, Obrey","Merriman, Clair","Rafferty, Anne-Marie"],"dc:creator":["Rajpoot, Aasia"],"dc:description":["Background: Internationally educated nurses (IENs) play a vital role in sustaining the English healthcare system (EHS), contributing clinical expertise, cultural diversity, and workforce resilience. However, the processes through which IENs are integrated into practice remain uneven and underexplored. Existing literature has mainly focused on individual adaptation and deficit-based framings, often overlooking relational dynamics, organisational responsibilities, and the perspectives of home-educated nurses (HENs). This study explores IEN integration as a relational, organisational, and systemic process, informed by the experiences of both IENs and HENs within the EHS. Method: In this qualitative study, fifty-five participants (n = 40 IENs and n = 15 HENs) were recruited from five NHS Trusts in England and professional networks using purposive and snowball sampling. Data was collected through semi-structured interviews. Data were analysed using the Framework Method (Gale et al., 2013). Bronfenbrenner's Ecological Systems Theory (BEST) (1979) provided the primary interpretive framework. The original five-level structure was retained for findings presentation, and an adapted three-level version, micro, meso, and macro, with time and place as cross-cutting enablers, was applied in the discussion. An Adapted Appreciative Inquiry (AAI) orientation informed the study's strengths-based framing and approach to participant engagement. Findings: The integration into EHS was experienced as a non-linear, dynamic, relational, and multi-level process shaped by interactions across ecological systems. Four interconnected themes were identified. Theme 1, Building connections through language, communication, and cultural exchange (microsystem), Theme 2, Thriving through professional support and learning (mesosystem), Theme 3, Enhancing equity, ethics, and opportunity in practice (exosystem and macrosystem), and Theme 4, Thriving, belonging, and living beyond the workplace (macrosystem and chronosystem). Variations in integration experiences were evident across settings. Consistent relational and organisational support was associated with more positive and sustained integration, and inconsistency was linked to delayed progression, marginalisation, and emotional strain. Conclusion: Integration of IENs is not a one-time transition or an individual responsibility, but a negotiated, co-produced process shaped by relationships, organisational practices, and wider structural contexts. Integration was most effective where inclusive leadership, coherent induction and mentorship structures, and equitable organisational cultures aligned to recognise IENs’ expertise and support their professional growth. Where such alignment was lacking, integration was experienced as fragmented and less sustainable. By advancing an ecological, strengths-based understanding of integration, this study highlights the need for shared responsibility across policy, organisational, and team levels, and offers evidence-informed implications for workforce planning, professional development, and inclusive practice within the EHS."],"dc:format":["application/pdf"],"dc:identifier":["https://doi.org/10.24384/p4a2-1c48","https://radar.brookes.ac.uk/radar/file/fcf156ed-4460-4232-b6cf-35ef5843af41/1/Rajpoot2026Integration.pdf"],"dc:language":["en"],"dc:publisher":["Oxford Brookes University"],"dc:rights":["All rights reserved"],"dc:title":["An appreciative inquiry into the integration of internationally educated nurses (IEN) in England : perspectives from IENs and home- educated nurses (HENs)"],"dc:type":["thesis"]},"updated_at":"2026-07-24T03:41:51Z"}