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“I Call It Health Science, Not Nursing”: Male International Students Balancing Nursing Career Aspirations With Cultural Expectations

PMCID: PMC12335640

PMID: 40304290

Abstract

Introduction: Male South Asian international nursing students in Australia navigate a complex interplay of cultural expectations, personal aspirations, and gender stereotypes. These students often encounter stigma and familial pressure due to their pursuit of a non-traditional career in nursing. Method: A qualitative descriptive design involving 11 participants was employed. Data were analyzed using a thematic analysis framework informed by principles of transnationalism, intersectionality, and identity work. Results: Participants strategically employed linguistic camouflage, referring to their studies as “health science” rather than “nursing.” Motivations for pursuing nursing included migration opportunities, economic considerations, and aspirations for personal freedom and self-acceptance. The term “nurse” carried significant cultural baggage. Discussion: This study reveals the strategic and pragmatic nature of these students’ career choices. Despite facing unique challenges, including navigating a hostile educational environment, participants demonstrated remarkable resilience. Findings underscore the need for culturally sensitive support programs, curriculum reforms that challenge gender stereotypes, and faculty training in cultural competence to promote inclusivity and empower these students.

Full Text

Culture, as a complex interplay of shared beliefs, values, and practices, significantly shapes the nursing profession. It influences the perceptions and experiences of those who enter the field and affects their career aspirations, educational journeys, and professional practice. This cultural tapestry is woven with threads of tradition, gender roles, and societal expectations, which can either empower or constrain individuals depending on their alignment with established norms (Rodríguez-Pérez et al., 2022). In nursing, where compassionate care intersects with scientific knowledge, culture acts as a potent force, shaping the very fabric of care (Burns et al., 2020; Cassidy, 2024). This dynamic is particularly evident in regions like South Asia, where cultural norms and societal expectations surrounding gender roles can significantly impact the professional landscape, especially within traditionally female-dominated fields like nursing (Baby, 2023).
South Asia encompasses countries such as Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka (Joshi, 2015), where nursing is viewed through the lens of gender roles and societal expectations (Baby, 2023; Darr et al., 2008). In this context, the cultural impact is particularly profound for male individuals who challenge the status quo by aspiring to a nursing career (Mohulatsi et al., 2024). Most South Asian societies are characterized by predominantly patriarchal structures, which are hierarchical social systems that often reinforce traditional gender roles (Bussolo et al., 2023). Within these structures, men are typically expected to be the primary breadwinners and occupy positions of authority, while women are often relegated to domestic roles (Sengar & Shah, 2024). This patriarchal context significantly shapes the perception of nursing, which is often regarded as a feminine profession closely tied to caregiving and subservience roles. These roles are often deemed incompatible with traditional notions of masculinity. In this context, masculinity refers to the socially constructed set of attributes, behaviors, and roles generally associated with men within a particular culture. Many South Asian societies often emphasize strength, dominance, stoicism, and breadwinning, contrasting with the perceived feminine qualities of nurturing and emotional expressiveness often associated with nursing (Qureshi et al., 2020). This cultural perception can create a formidable barrier for male students, forcing them to navigate a complex landscape of conflicting expectations and limited opportunities.
Despite these challenges in the South Asian context, Australia has witnessed a notable increase in the representation of men in the nursing profession, currently accounting for 12.1% of the nursing workforce (Australian Nursing and Midwifery Federation, 2024). This rise can be attributed, in part, to the greater social recognition of nursing in Australia, where nurses are consistently ranked as the most trusted profession (Morgan, 2021), combined with the attractive migration opportunities it offers (Migration Affairs, 2024). In addition, the gender pay gap in nursing, which often favors male nurses, serves as an additional pull factor for male international students (International Council of Nurses [ICN], 2022; Woo et al., 2022). Interestingly, a significant proportion of international students in Australia originate from South Asia, with Indians (17%) and Nepalis (8%) being among the most prominent groups (Department of Education, 2024). While these statistics do not specifically identify male students pursuing nursing, they reflect a broader trend of South Asian individuals seeking educational and professional opportunities in Australia. Considering nursing’s well-established route for migration and professional accreditation, coupled with the prospect of enhanced income potential, relatively low tuition costs for international students, and increased opportunities for social mobility, it presents a compelling career pathway for many individuals (Dos Santos et al., 2024; Ghimire & MacDonald, 2025). However, despite the influx of South Asian students, there remains a limited exploration of male South Asian nursing students in the existing literature and how they navigate the cultural complexities associated with nursing as a career choice.
Adapting to a new cultural context, particularly in Western societies with different gender norms and expectations surrounding nursing, could potentially lead to experiences of cultural dissonance for male South Asian international students. These students may find themselves grappling not only with the practical demands of navigating a new educational system and professional environment but also with the psychological and social complexities of reconciling their masculine identities with the traditionally perceived feminine nature of nursing. To manage these challenges, some students employ linguistic framing strategies, such as linguistic camouflage or maneuvering. Linguistic framing refers to how language shapes perceptions and influences how a particular topic or issue is understood. It involves carefully selecting words and phrases to create a specific narrative or frame of reference (Formanowicz & Hansen, 2022). In this context, camouflage refers to concealing one’s true intentions or identity to avoid negative social consequences (Cook et al., 2021). Maneuvering involves strategically navigating social situations, often employing indirect communication or actions, to achieve desired outcomes while minimizing potential conflict or disapproval (Zsuzsanna, 2018). While there is a growing body of research exploring the experiences of male nursing students in Western contexts (DeVito, 2016; Grimshaw et al., 2024; Petges & Sabio, 2020), the unique challenges encountered and the strategies employed by male South Asian international students remain largely unexplored. Specifically, there is a gap in understanding how these students’ experiences intersect with issues of sexuality, societal expectations, family prestige, and this includes the pressure to conform to heteronormative ideals. This gap in the literature obscures the complex interplay of cultural, social, and personal factors that shape their educational and professional journeys, particularly within the domain of transcultural nursing and the negotiation of masculine identities in a predominantly female profession. Furthermore, the existing literature has not adequately addressed the specific push and pull factors that motivate male South Asian students to pursue nursing in Australia, including the role of financial considerations, migration aspirations, and the desire for personal and professional growth. Thus, this study addresses this gap by asking: How do male South Asian international students studying nursing in Australia navigate the cultural complexities associated with their chosen profession, and what strategies do they employ to reconcile personal aspirations with societal expectations?
This study is grounded in the theoretical frameworks of intersectionality and identity work, providing a lens through which to understand the complex experiences of male South Asian international nursing students in Australia. Intersectionality, as proposed by Crenshaw (1989), recognizes that individuals hold multiple, interconnected social identities (e.g., gender, race, ethnicity, class, sexuality) that simultaneously shape their experiences and are shaped by systems of power and oppression. In the context of this study, intersectionality helps us understand how the participants’ identities as men, South Asians, international students, and aspiring nurses intersect to create unique challenges and opportunities. Identity work, as described by Caza et al. (2018), refers to the ongoing process by which individuals negotiate and construct their sense of self in relation to their social environment. This framework is particularly relevant for understanding how these students navigate the cultural complexities of their chosen profession, balancing their personal aspirations with societal expectations, both from their home cultures and the host culture. The concept of transnationalism is also relevant, as it acknowledges the experiences of individuals who maintain connections and identities across national borders (Belford & Lahiri-Roy, 2019). It provides a framework for understanding how these students negotiate their sense of belonging in their home and host countries. These theoretical perspectives informed the research questions, data collection, and analysis, guiding the exploration of how participants’ intersecting identities shape their experiences and strategies for navigating a traditionally female-dominated field in a new cultural context.
This project received ethics approval from the Monash University Human Research Ethics Committee (MUHREC), project ID 45088, following a full review of the research protocol. Recognizing that international students are considered vulnerable due to potential power imbalances and cultural factors (Deuchar, 2022), we took several measures to ensure their voluntary and informed participation. Initial verbal consent was secured to assess participant interest, followed by distributing a detailed Plain Language Statement Form (PLSF) outlining the study’s purpose, procedures, potential risks and benefits, and their right to withdraw at any time without penalty. Participants were given ample time to review the PLSF and ask any questions before providing written consent, which was obtained prior to the interview. To maintain anonymity, pseudonyms were used throughout the study, and any potentially identifying information was removed from the transcripts. Confidentiality was ensured by storing all data securely and limiting access to the research team only.
This study employed a qualitative descriptive design, chosen for its suitability in exploring the lived experiences and perceptions of male South Asian international nursing students in Australia. This methodological approach enabled the researchers to capture the richness and complexities of the participants’ narratives, preserving the authenticity and significance of their voices (Doyle et al., 2020). Qualitative description aligns well with the theoretical frameworks of intersectionality and identity work as it allows for an in-depth examination of how individuals’ social identities and their negotiations of these identities shape their experiences (Lambert & Lambert, 2012). Qualitative description distinguishes itself from other qualitative methodologies such as grounded theory, which seeks to formulate new theoretical frameworks, and phenomenology, which delves into the fundamental nature of lived experiences. Instead, qualitative description prioritizes a thorough and straightforward characterization of events, articulating them in accessible language to capture the essence of those occurrences effectively. This approach is particularly useful, as in this study, the goal is to understand a phenomenon that has not been extensively researched, where existing knowledge is limited and requires a detailed descriptive foundation. An inductive approach was used to explore how male South Asian international nursing students navigate cultural complexities and challenges within the nursing profession. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were adhered to throughout the research process to ensure rigor and transparency (Tong et al., 2007).
The study’s sample consists of male South Asian international students currently enrolled in their final semester of a bachelor in nursing program at an Australian university. Participants were recruited through a combination of purposive and snowball sampling techniques (Palinkas et al., 2015). Purposive sampling identified potential participants who met the inclusion criteria, while snowball sampling leveraged existing networks within the South Asian student community to identify additional participants. Recruitment presented challenges due to the sensitive nature of the research topic and the limited pool of potential participants who met all inclusion criteria. To overcome this, we utilized the first author’s (AG) established connections within the South Asian student community to foster trust and rapport with prospective participants, underscoring our commitment to confidentiality and anonymity. Preliminary communications were conducted via email, subsequently complemented by in-person meetings to provide a more comprehensive overview of the study’s objectives and methodologies.
Data were collected by the first author (AG) through semi-structured interviews designed to elicit detailed and nuanced narratives about participants’ thoughts, experiences, attitudes, and beliefs (DeJonckheere & Vaughn, 2019). The researchers had no prior relationship with the participants. After obtaining informed consent, each participant engaged in an interview that lasted approximately 40–60 minutes. The interview was conducted in the public library at a time suitable for the participants. The interview protocol explored the participants’ experiences navigating cultural complexities and challenges as male South Asian international nursing students in Australia. Key areas of exploration included their perceptions of nursing within their home cultures, their experiences of cultural dissonance and adaptation, strategies they employ to manage expectations from family and peers, and their overall sense of belonging within the nursing profession (Table 1).
Data analysis was conducted using Braun and Clarke (2023) thematic analysis framework. The analysis involved thoroughly examining the interview transcripts from the eleven participants. Several measures were implemented to enhance the trustworthiness of the data. Each interview was audio-recorded and transcribed verbatim by the first author. All participants were then invited to review a summary of their interview and the corresponding transcript to ensure accuracy and address any potential misunderstandings. This member-checking process further strengthened the credibility and authenticity of the findings.
The analysis aims to achieve both code and thematic saturation (Naeem et al., 2024; Rahimi & Khatooni, 2024). Code saturation was reached when no new codes emerged from the data, indicating that the coding framework comprehensively captured the range of concepts and ideas expressed by the participants. Thematic saturation was achieved when no new themes or sub-themes were identified, and further analysis did not yield any new insights or perspectives, suggesting that the themes adequately represented the overarching patterns and complexities within the data. While related, these processes are distinct. Code saturation focuses on the breadth of concepts captured, while thematic saturation focuses on the depth and comprehensiveness of the overarching narrative. Code saturation was determined after analyzing nine interviews, where no new codes emerged. Thematic saturation was confirmed after analyzing the eleventh interview, where no new themes or sub-themes were identified, and the existing themes were sufficiently rich and nuanced to explain the data. Table 2 provides a detailed overview of the data analysis process, illustrating the iterative movement from meaning units to codes, categories, sub-themes, and overarching themes. The table demonstrates how specific excerpts from the interviews (meaning units) were assigned codes that captured their essential meaning. These codes were then grouped into broader categories based on shared characteristics. Sub-themes emerged from the analysis of the categories, capturing the nuances of the participants’ experiences. Finally, the overarching themes were developed to represent the study’s key findings. For example, the initial code “linguistic camouflage” was later subsumed under the broader theme of “The ‘Health Science’ Facade: Navigating Cultural Stigma as Male Nursing Students,” which captured the strategic use of language to manage cultural expectations. Another example is the code “migration opportunity,” which contributed to the theme “Calculated Choices, Complex Journeys: Migration, Masculinity, and the Pursuit of Nursing Careers,” reflecting the pragmatic motivations behind the participants’ career choices. Table 2 provides a detailed overview of the data analysis process.
This qualitative study acknowledges the inherent subjectivity in interpretive research and emphasizes the importance of researcher reflexivity in ensuring the trustworthiness of the findings (Peddle, 2022). The research team, comprising experienced qualitative researchers with diverse backgrounds and expertise in cultural studies and nursing education, actively engaged in critical self-reflection throughout the research process. This reflexivity involved acknowledging and examining their own cultural backgrounds, assumptions, and potential biases, which could shape both the research process and the interpretation of data. The first author (AG) is from a South Asian background, is a former international student, and is a migrant nurse who identifies as male. The second author (YQ) is from an East Asian background, is a former international student, and is a migrant nurse.
Eleven male South Asian international students participated in this study. The participants were aged between 23 and 27 years. All were enrolled in the final semester of their bachelor in nursing program. While all participants shared the common experience of being South Asian international students pursuing a nursing career in Australia, their motivations for choosing nursing varied. For some, nursing was a first-choice career path driven by a genuine desire to care for others and contribute to health care. For others, nursing was a strategic pathway to migration and broader career opportunities in Australia. This diversity in motivation highlights the complex interplay of personal aspirations, cultural influences, and pragmatic considerations that shape these students’ educational and professional journeys. Table 3 provides a snapshot of the participants’ socio-demographic characteristics.
The strategic use of nursing as a pathway to migration and economic stability, a phenomenon well-documented in existing literature (Konlan et al., 2023; Smith et al., 2022; Villamin et al., 2023), takes on a new dimension when viewed through the lens of cultural dissonance and gendered expectations. While global nursing shortages and the demand for skilled health care professionals in developed countries undoubtedly drive this trend, this study reveals a compelling narrative of individual agency and calculated risk-taking among male South Asian international students. Their decision to pursue nursing, a profession often incongruent with their cultural norms and masculine ideals (Cho & Jang, 2021), highlights a fascinating paradox: they leverage a traditionally female-dominated field to achieve social mobility and economic security in a new country. This strategic maneuvering can be seen as a form of “cultural arbitrage,” wherein individuals capitalize on the discrepancies between their cultural capital and the opportunities available in a different context (Hu, 2023). This concept, borrowed from the field of economics, offers a fresh perspective on the motivations of these students, who effectively “trade” their cultural background and willingness to challenge norms for the potential rewards of migration and professional advancement.
The internal conflict experienced by these students as they balance personal aspirations with familial and societal expectations speaks to the enduring power of cultural norms and the complexities of challenging traditional gender roles. Their narratives highlight the emotional labor involved in navigating these complexities and the resilience they demonstrate in pursuing their chosen paths. This negotiation can be effectively understood through the lens of identity work, where individuals actively shape and reshape their identities in response to social pressures and personal desires (Caza et al., 2018). For instance, participants like Arun and Farhan actively redefined their professional identities by using the term “health science,” while Ruvin and Rohan viewed nursing as a stepping stone to more culturally accepted professions. Specifically, these students engage in a delicate balancing act, striving to maintain their sense of masculinity while embracing a profession often associated with femininity. This balancing act is further complicated by the transnational context, as these students are negotiating their identities across different cultural landscapes (Belford & Lahiri-Roy, 2019; Binah-Pollak & Yuan, 2022; Kasun et al., 2022). Moreover, the pursuit of personal freedom and self-acceptance, as evidenced by some participants’ desire to escape the constraints of their home countries, adds another layer of complexity to their identity work. This aligns with research highlighting the experiences of marginalized groups who use migration as a strategy for self-discovery and liberation (Usta & Ozbilgin, 2023). This study advances the discourse by revealing the diverse experiences within this group, including those who strategically choose nursing precisely because of its perceived inclusivity and acceptance of gender diversity, as seen in Kamal’s narrative but also reflected in the motivations of other participants who sought a more tolerant environment. This nuanced understanding challenges the simplistic notion of a singular “male nursing student experience” and highlights the intersectionality of gender, sexuality, and cultural identity. It also speaks to the potential of nursing to become a site of resistance and transformation, where individuals can challenge traditional norms and create spaces for greater inclusivity and self-expression.
Moreover, the findings raise critical questions about the limitations of linguistic camouflage and the urgent need for a broader societal shift in perceptions of nursing. While strategic reframing may offer a temporary shield against cultural judgment, it can also inadvertently perpetuate the very stereotypes it seeks to avoid. Challenging hegemonic masculinity, as Liu et al. (2022) argue, requires not only individual resistance but also a transformation of social structures and cultural norms. By resorting to linguistic camouflage, male South Asian nursing students may unintentionally reinforce the notion that nursing is inherently feminine and incompatible with masculine ideals. This aligns with research on the power of language to shape perceptions and reinforce stereotypes (Formanowicz & Hansen, 2022). Concealing their true profession can be seen as a form of “symbolic violence” (Schubert, 2012), where individuals internalize and reproduce the dominant cultural norms that marginalize them. Furthermore, existing recruitment strategies in health care, which often rely on mobilizing specific versions of masculinity to attract men to the profession (Cottingham, 2014), may inadvertently contribute to the problem. Instead of fundamentally challenging hegemonic masculinity, these approaches may simply co-opt it, presenting a narrow and potentially exclusionary vision of what it means to be a male nurse (Cottingham, 2019). Therefore, dismantling the deeply ingrained gendered stereotypes surrounding nursing requires a multi-pronged approach that encompasses both individual and collective action alongside institutional efforts to promote gender equality (Teresa-Morales et al., 2022). This necessitates a shift in cultural attitudes toward caregiving professions, particularly within South Asian communities, recognizing them as valuable and suitable for all genders. This shift also extends globally, as many high-income liberal democracies grapple with similar gendered expectations in health care, highlighting the need for a broader re-evaluation of caregiving professions across diverse cultural contexts (Milner et al., 2021). Achieving this transformation calls for a critical examination of the language used to describe nursing, the images used to represent it, and a conscious effort to dismantle the power dynamics that perpetuate its gendered construction. Creating truly inclusive spaces within nursing requires challenging individual biases and the broader societal norms and structures that reinforce them.
This study reveals a compelling paradox within the power dynamics of nursing education, particularly for male students from non-Western backgrounds. While nursing globally is a primarily female-dominated field, these men often experience a unique form of marginalization (Huang, 2024). They are simultaneously hypervisible, as their presence as men in a female-dominated field attracts attention and scrutiny, yet often remain invisible, with their unique perspectives and challenges being overlooked or dismissed (Raghavan et al., 2023; Yokoya et al., 2023). This experience of hypervisibility and invisibility creates complex challenges, particularly for students from South Asian backgrounds. Their experiences are shaped not only by gender but also by the intersection of their cultural identities and the dynamics of being an international student in a new cultural environment. For instance, their accents, cultural practices, or even their names can become markers of difference, leading to increased scrutiny or stereotyping. This aligns with research on the experiences of minority groups in predominantly white spaces, where individuals often report feeling both hypervisible and invisible, their presence simultaneously highlighted and ignored (Jackson et al., 2022; Subu et al., 2022). This paradoxical experience can be conceptualized as a form of “double consciousness” (Joseph & Golash-Boza, 2021), where individuals are forced to navigate their identity through the lens of both their own cultural background and the dominant societal norms. This concept, initially developed by Du Bois (1903) to describe the experiences of African Americans, provides a valuable framework for understanding how individuals from marginalized groups experience a sense of duality and are constantly aware of how the dominant culture perceives them. While previous research has explored the paradoxical position of male nurses in general (Evans, 1997; Kellett et al., 2014; Salvador & Alanazi, 2024), this study extends these findings by highlighting the specific experiences of South Asian male nursing students and linking their experiences to the concept of double consciousness. These students not only navigate the general challenges faced by men in a female-dominated profession but also the additional complexities of being international students from a distinct cultural background.
Furthermore, the study highlights the hostile environment that male students often perceive in nursing education. Some participants reported experiencing a hostile environment in their clinical placements, marked by subtle and overt forms of discrimination. For instance, Raj described an incident where a preceptor repeatedly criticized his accent, making him feel marginalized and excluded. This experience highlights the additional barriers faced by international students, who may be judged based on their communication style rather than their clinical competence. This finding is consistent with research that highlights the challenges faced by international students in health care settings, including language barriers, cultural misunderstandings, and discrimination (Oduwaye et al., 2023; Pandey et al., 2021). Furthermore, studies have documented gender bias and unsupportive behaviors from educators in nursing education, which create significant obstacles for male students (Hosseini et al., 2022). This interplay of factors underscores the need for a more nuanced and intersectional approach to understanding the experiences of male South Asian nursing students and other students from diverse linguistic and cultural backgrounds. Creating educational environments that are truly inclusive and supportive of all learners requires a commitment to addressing not only overt prejudice but also the subtle, often unintentional biases that can create barriers to success.

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"[{\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr51-10436596251337062\", \"bibr6-10436596251337062\", \"bibr8-10436596251337062\", \"bibr2-10436596251337062\"], \"section\": \"Introduction\", \"text\": \"Culture, as a complex interplay of shared beliefs, values, and practices, significantly shapes the nursing profession. It influences the perceptions and experiences of those who enter the field and affects their career aspirations, educational journeys, and professional practice. This cultural tapestry is woven with threads of tradition, gender roles, and societal expectations, which can either empower or constrain individuals depending on their alignment with established norms (Rodr\\u00edguez-P\\u00e9rez et al., 2022). In nursing, where compassionate care intersects with scientific knowledge, culture acts as a potent force, shaping the very fabric of care (Burns et al., 2020; Cassidy, 2024). This dynamic is particularly evident in regions like South Asia, where cultural norms and societal expectations surrounding gender roles can significantly impact the professional landscape, especially within traditionally female-dominated fields like nursing (Baby, 2023).\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr33-10436596251337062\", \"bibr2-10436596251337062\", \"bibr15-10436596251337062\", \"bibr41-10436596251337062\", \"bibr7-10436596251337062\", \"bibr55-10436596251337062\", \"bibr48-10436596251337062\"], \"section\": \"Introduction\", \"text\": \"South Asia encompasses countries such as Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka (Joshi, 2015), where nursing is viewed through the lens of gender roles and societal expectations (Baby, 2023; Darr et al., 2008). In this context, the cultural impact is particularly profound for male individuals who challenge the status quo by aspiring to a nursing career (Mohulatsi et al., 2024). Most South Asian societies are characterized by predominantly patriarchal structures, which are hierarchical social systems that often reinforce traditional gender roles (Bussolo et al., 2023). Within these structures, men are typically expected to be the primary breadwinners and occupy positions of authority, while women are often relegated to domestic roles (Sengar & Shah, 2024). This patriarchal context significantly shapes the perception of nursing, which is often regarded as a feminine profession closely tied to caregiving and subservience roles. These roles are often deemed incompatible with traditional notions of masculinity. In this context, masculinity refers to the socially constructed set of attributes, behaviors, and roles generally associated with men within a particular culture. Many South Asian societies often emphasize strength, dominance, stoicism, and breadwinning, contrasting with the perceived feminine qualities of nurturing and emotional expressiveness often associated with nursing (Qureshi et al., 2020). This cultural perception can create a formidable barrier for male students, forcing them to navigate a complex landscape of conflicting expectations and limited opportunities.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr1-10436596251337062\", \"bibr52-10436596251337062\", \"bibr39-10436596251337062\", \"bibr30-10436596251337062\", \"bibr62-10436596251337062\", \"bibr17-10436596251337062\", \"bibr20-10436596251337062\", \"bibr25-10436596251337062\"], \"section\": \"Introduction\", \"text\": \"Despite these challenges in the South Asian context, Australia has witnessed a notable increase in the representation of men in the nursing profession, currently accounting for 12.1% of the nursing workforce (Australian Nursing and Midwifery Federation, 2024). This rise can be attributed, in part, to the greater social recognition of nursing in Australia, where nurses are consistently ranked as the most trusted profession (Morgan, 2021), combined with the attractive migration opportunities it offers (Migration Affairs, 2024). In addition, the gender pay gap in nursing, which often favors male nurses, serves as an additional pull factor for male international students (International Council of Nurses [ICN], 2022; Woo et al., 2022). Interestingly, a significant proportion of international students in Australia originate from South Asia, with Indians (17%) and Nepalis (8%) being among the most prominent groups (Department of Education, 2024). While these statistics do not specifically identify male students pursuing nursing, they reflect a broader trend of South Asian individuals seeking educational and professional opportunities in Australia. Considering nursing\\u2019s well-established route for migration and professional accreditation, coupled with the prospect of enhanced income potential, relatively low tuition costs for international students, and increased opportunities for social mobility, it presents a compelling career pathway for many individuals (Dos Santos et al., 2024; Ghimire & MacDonald, 2025). However, despite the influx of South Asian students, there remains a limited exploration of male South Asian nursing students in the existing literature and how they navigate the cultural complexities associated with nursing as a career choice.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr24-10436596251337062\", \"bibr11-10436596251337062\", \"bibr64-10436596251337062\", \"bibr19-10436596251337062\", \"bibr26-10436596251337062\", \"bibr47-10436596251337062\"], \"section\": \"Introduction\", \"text\": \"Adapting to a new cultural context, particularly in Western societies with different gender norms and expectations surrounding nursing, could potentially lead to experiences of cultural dissonance for male South Asian international students. These students may find themselves grappling not only with the practical demands of navigating a new educational system and professional environment but also with the psychological and social complexities of reconciling their masculine identities with the traditionally perceived feminine nature of nursing. To manage these challenges, some students employ linguistic framing strategies, such as linguistic camouflage or maneuvering. Linguistic framing refers to how language shapes perceptions and influences how a particular topic or issue is understood. It involves carefully selecting words and phrases to create a specific narrative or frame of reference (Formanowicz & Hansen, 2022). In this context, camouflage refers to concealing one\\u2019s true intentions or identity to avoid negative social consequences (Cook et al., 2021). Maneuvering involves strategically navigating social situations, often employing indirect communication or actions, to achieve desired outcomes while minimizing potential conflict or disapproval (Zsuzsanna, 2018). While there is a growing body of research exploring the experiences of male nursing students in Western contexts (DeVito, 2016; Grimshaw et al., 2024; Petges & Sabio, 2020), the unique challenges encountered and the strategies employed by male South Asian international students remain largely unexplored. Specifically, there is a gap in understanding how these students\\u2019 experiences intersect with issues of sexuality, societal expectations, family prestige, and this includes the pressure to conform to heteronormative ideals. This gap in the literature obscures the complex interplay of cultural, social, and personal factors that shape their educational and professional journeys, particularly within the domain of transcultural nursing and the negotiation of masculine identities in a predominantly female profession. Furthermore, the existing literature has not adequately addressed the specific push and pull factors that motivate male South Asian students to pursue nursing in Australia, including the role of financial considerations, migration aspirations, and the desire for personal and professional growth. Thus, this study addresses this gap by asking: How do male South Asian international students studying nursing in Australia navigate the cultural complexities associated with their chosen profession, and what strategies do they employ to reconcile personal aspirations with societal expectations?\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr14-10436596251337062\", \"bibr9-10436596251337062\", \"bibr3-10436596251337062\"], \"section\": \"Theoretical Lens\", \"text\": \"This study is grounded in the theoretical frameworks of intersectionality and identity work, providing a lens through which to understand the complex experiences of male South Asian international nursing students in Australia. Intersectionality, as proposed by Crenshaw (1989), recognizes that individuals hold multiple, interconnected social identities (e.g., gender, race, ethnicity, class, sexuality) that simultaneously shape their experiences and are shaped by systems of power and oppression. In the context of this study, intersectionality helps us understand how the participants\\u2019 identities as men, South Asians, international students, and aspiring nurses intersect to create unique challenges and opportunities. Identity work, as described by Caza et al. (2018), refers to the ongoing process by which individuals negotiate and construct their sense of self in relation to their social environment. This framework is particularly relevant for understanding how these students navigate the cultural complexities of their chosen profession, balancing their personal aspirations with societal expectations, both from their home cultures and the host culture. The concept of transnationalism is also relevant, as it acknowledges the experiences of individuals who maintain connections and identities across national borders (Belford & Lahiri-Roy, 2019). It provides a framework for understanding how these students negotiate their sense of belonging in their home and host countries. These theoretical perspectives informed the research questions, data collection, and analysis, guiding the exploration of how participants\\u2019 intersecting identities shape their experiences and strategies for navigating a traditionally female-dominated field in a new cultural context.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr18-10436596251337062\"], \"section\": \"Ethical Consideration\", \"text\": \"This project received ethics approval from the Monash University Human Research Ethics Committee (MUHREC), project ID 45088, following a full review of the research protocol. Recognizing that international students are considered vulnerable due to potential power imbalances and cultural factors (Deuchar, 2022), we took several measures to ensure their voluntary and informed participation. Initial verbal consent was secured to assess participant interest, followed by distributing a detailed Plain Language Statement Form (PLSF) outlining the study\\u2019s purpose, procedures, potential risks and benefits, and their right to withdraw at any time without penalty. Participants were given ample time to review the PLSF and ask any questions before providing written consent, which was obtained prior to the interview. To maintain anonymity, pseudonyms were used throughout the study, and any potentially identifying information was removed from the transcripts. Confidentiality was ensured by storing all data securely and limiting access to the research team only.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr21-10436596251337062\", \"bibr37-10436596251337062\", \"bibr59-10436596251337062\"], \"section\": \"Study Design\", \"text\": \"This study employed a qualitative descriptive design, chosen for its suitability in exploring the lived experiences and perceptions of male South Asian international nursing students in Australia. This methodological approach enabled the researchers to capture the richness and complexities of the participants\\u2019 narratives, preserving the authenticity and significance of their voices (Doyle et al., 2020). Qualitative description aligns well with the theoretical frameworks of intersectionality and identity work as it allows for an in-depth examination of how individuals\\u2019 social identities and their negotiations of these identities shape their experiences (Lambert & Lambert, 2012). Qualitative description distinguishes itself from other qualitative methodologies such as grounded theory, which seeks to formulate new theoretical frameworks, and phenomenology, which delves into the fundamental nature of lived experiences. Instead, qualitative description prioritizes a thorough and straightforward characterization of events, articulating them in accessible language to capture the essence of those occurrences effectively. This approach is particularly useful, as in this study, the goal is to understand a phenomenon that has not been extensively researched, where existing knowledge is limited and requires a detailed descriptive foundation. An inductive approach was used to explore how male South Asian international nursing students navigate cultural complexities and challenges within the nursing profession. The Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were adhered to throughout the research process to ensure rigor and transparency (Tong et al., 2007).\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr44-10436596251337062\"], \"section\": \"Sample\", \"text\": \"The study\\u2019s sample consists of male South Asian international students currently enrolled in their final semester of a bachelor in nursing program at an Australian university. Participants were recruited through a combination of purposive and snowball sampling techniques (Palinkas et al., 2015). Purposive sampling identified potential participants who met the inclusion criteria, while snowball sampling leveraged existing networks within the South Asian student community to identify additional participants. Recruitment presented challenges due to the sensitive nature of the research topic and the limited pool of potential participants who met all inclusion criteria. To overcome this, we utilized the first author\\u2019s (AG) established connections within the South Asian student community to foster trust and rapport with prospective participants, underscoring our commitment to confidentiality and anonymity. Preliminary communications were conducted via email, subsequently complemented by in-person meetings to provide a more comprehensive overview of the study\\u2019s objectives and methodologies.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr16-10436596251337062\", \"table1-10436596251337062\"], \"section\": \"Data Collection\", \"text\": \"Data were collected by the first author (AG) through semi-structured interviews designed to elicit detailed and nuanced narratives about participants\\u2019 thoughts, experiences, attitudes, and beliefs (DeJonckheere & Vaughn, 2019). The researchers had no prior relationship with the participants. After obtaining informed consent, each participant engaged in an interview that lasted approximately 40\\u201360 minutes. The interview was conducted in the public library at a time suitable for the participants. The interview protocol explored the participants\\u2019 experiences navigating cultural complexities and challenges as male South Asian international nursing students in Australia. Key areas of exploration included their perceptions of nursing within their home cultures, their experiences of cultural dissonance and adaptation, strategies they employ to manage expectations from family and peers, and their overall sense of belonging within the nursing profession (Table 1).\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr5-10436596251337062\"], \"section\": \"Data Analysis\", \"text\": \"Data analysis was conducted using Braun and Clarke (2023) thematic analysis framework. The analysis involved thoroughly examining the interview transcripts from the eleven participants. Several measures were implemented to enhance the trustworthiness of the data. Each interview was audio-recorded and transcribed verbatim by the first author. All participants were then invited to review a summary of their interview and the corresponding transcript to ensure accuracy and address any potential misunderstandings. This member-checking process further strengthened the credibility and authenticity of the findings.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr42-10436596251337062\", \"bibr50-10436596251337062\", \"table2-10436596251337062\", \"table2-10436596251337062\"], \"section\": \"Data Analysis\", \"text\": \"The analysis aims to achieve both code and thematic saturation (Naeem et al., 2024; Rahimi & Khatooni, 2024). Code saturation was reached when no new codes emerged from the data, indicating that the coding framework comprehensively captured the range of concepts and ideas expressed by the participants. Thematic saturation was achieved when no new themes or sub-themes were identified, and further analysis did not yield any new insights or perspectives, suggesting that the themes adequately represented the overarching patterns and complexities within the data. While related, these processes are distinct. Code saturation focuses on the breadth of concepts captured, while thematic saturation focuses on the depth and comprehensiveness of the overarching narrative. Code saturation was determined after analyzing nine interviews, where no new codes emerged. Thematic saturation was confirmed after analyzing the eleventh interview, where no new themes or sub-themes were identified, and the existing themes were sufficiently rich and nuanced to explain the data. Table 2 provides a detailed overview of the data analysis process, illustrating the iterative movement from meaning units to codes, categories, sub-themes, and overarching themes. The table demonstrates how specific excerpts from the interviews (meaning units) were assigned codes that captured their essential meaning. These codes were then grouped into broader categories based on shared characteristics. Sub-themes emerged from the analysis of the categories, capturing the nuances of the participants\\u2019 experiences. Finally, the overarching themes were developed to represent the study\\u2019s key findings. For example, the initial code \\u201clinguistic camouflage\\u201d was later subsumed under the broader theme of \\u201cThe \\u2018Health Science\\u2019 Facade: Navigating Cultural Stigma as Male Nursing Students,\\u201d which captured the strategic use of language to manage cultural expectations. Another example is the code \\u201cmigration opportunity,\\u201d which contributed to the theme \\u201cCalculated Choices, Complex Journeys: Migration, Masculinity, and the Pursuit of Nursing Careers,\\u201d reflecting the pragmatic motivations behind the participants\\u2019 career choices. Table 2 provides a detailed overview of the data analysis process.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr46-10436596251337062\"], \"section\": \"Rigor and Reflexivity\", \"text\": \"This qualitative study acknowledges the inherent subjectivity in interpretive research and emphasizes the importance of researcher reflexivity in ensuring the trustworthiness of the findings (Peddle, 2022). The research team, comprising experienced qualitative researchers with diverse backgrounds and expertise in cultural studies and nursing education, actively engaged in critical self-reflection throughout the research process. This reflexivity involved acknowledging and examining their own cultural backgrounds, assumptions, and potential biases, which could shape both the research process and the interpretation of data. The first author (AG) is from a South Asian background, is a former international student, and is a migrant nurse who identifies as male. The second author (YQ) is from an East Asian background, is a former international student, and is a migrant nurse.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"table3-10436596251337062\"], \"section\": \"Participants Characteristics\", \"text\": \"Eleven male South Asian international students participated in this study. The participants were aged between 23 and 27 years. All were enrolled in the final semester of their bachelor in nursing program. While all participants shared the common experience of being South Asian international students pursuing a nursing career in Australia, their motivations for choosing nursing varied. For some, nursing was a first-choice career path driven by a genuine desire to care for others and contribute to health care. For others, nursing was a strategic pathway to migration and broader career opportunities in Australia. This diversity in motivation highlights the complex interplay of personal aspirations, cultural influences, and pragmatic considerations that shape these students\\u2019 educational and professional journeys. Table 3 provides a snapshot of the participants\\u2019 socio-demographic characteristics.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr36-10436596251337062\", \"bibr56-10436596251337062\", \"bibr61-10436596251337062\", \"bibr10-10436596251337062\", \"bibr28-10436596251337062\"], \"section\": \"Discussion\", \"text\": \"The strategic use of nursing as a pathway to migration and economic stability, a phenomenon well-documented in existing literature (Konlan et al., 2023; Smith et al., 2022; Villamin et al., 2023), takes on a new dimension when viewed through the lens of cultural dissonance and gendered expectations. While global nursing shortages and the demand for skilled health care professionals in developed countries undoubtedly drive this trend, this study reveals a compelling narrative of individual agency and calculated risk-taking among male South Asian international students. Their decision to pursue nursing, a profession often incongruent with their cultural norms and masculine ideals (Cho & Jang, 2021), highlights a fascinating paradox: they leverage a traditionally female-dominated field to achieve social mobility and economic security in a new country. This strategic maneuvering can be seen as a form of \\u201ccultural arbitrage,\\u201d wherein individuals capitalize on the discrepancies between their cultural capital and the opportunities available in a different context (Hu, 2023). This concept, borrowed from the field of economics, offers a fresh perspective on the motivations of these students, who effectively \\u201ctrade\\u201d their cultural background and willingness to challenge norms for the potential rewards of migration and professional advancement.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr9-10436596251337062\", \"bibr3-10436596251337062\", \"bibr4-10436596251337062\", \"bibr34-10436596251337062\", \"bibr60-10436596251337062\"], \"section\": \"Discussion\", \"text\": \"The internal conflict experienced by these students as they balance personal aspirations with familial and societal expectations speaks to the enduring power of cultural norms and the complexities of challenging traditional gender roles. Their narratives highlight the emotional labor involved in navigating these complexities and the resilience they demonstrate in pursuing their chosen paths. This negotiation can be effectively understood through the lens of identity work, where individuals actively shape and reshape their identities in response to social pressures and personal desires (Caza et al., 2018). For instance, participants like Arun and Farhan actively redefined their professional identities by using the term \\u201chealth science,\\u201d while Ruvin and Rohan viewed nursing as a stepping stone to more culturally accepted professions. Specifically, these students engage in a delicate balancing act, striving to maintain their sense of masculinity while embracing a profession often associated with femininity. This balancing act is further complicated by the transnational context, as these students are negotiating their identities across different cultural landscapes (Belford & Lahiri-Roy, 2019; Binah-Pollak & Yuan, 2022; Kasun et al., 2022). Moreover, the pursuit of personal freedom and self-acceptance, as evidenced by some participants\\u2019 desire to escape the constraints of their home countries, adds another layer of complexity to their identity work. This aligns with research highlighting the experiences of marginalized groups who use migration as a strategy for self-discovery and liberation (Usta & Ozbilgin, 2023). This study advances the discourse by revealing the diverse experiences within this group, including those who strategically choose nursing precisely because of its perceived inclusivity and acceptance of gender diversity, as seen in Kamal\\u2019s narrative but also reflected in the motivations of other participants who sought a more tolerant environment. This nuanced understanding challenges the simplistic notion of a singular \\u201cmale nursing student experience\\u201d and highlights the intersectionality of gender, sexuality, and cultural identity. It also speaks to the potential of nursing to become a site of resistance and transformation, where individuals can challenge traditional norms and create spaces for greater inclusivity and self-expression.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr38-10436596251337062\", \"bibr24-10436596251337062\", \"bibr54-10436596251337062\", \"bibr12-10436596251337062\", \"bibr13-10436596251337062\", \"bibr58-10436596251337062\", \"bibr40-10436596251337062\"], \"section\": \"Discussion\", \"text\": \"Moreover, the findings raise critical questions about the limitations of linguistic camouflage and the urgent need for a broader societal shift in perceptions of nursing. While strategic reframing may offer a temporary shield against cultural judgment, it can also inadvertently perpetuate the very stereotypes it seeks to avoid. Challenging hegemonic masculinity, as Liu et al. (2022) argue, requires not only individual resistance but also a transformation of social structures and cultural norms. By resorting to linguistic camouflage, male South Asian nursing students may unintentionally reinforce the notion that nursing is inherently feminine and incompatible with masculine ideals. This aligns with research on the power of language to shape perceptions and reinforce stereotypes (Formanowicz & Hansen, 2022). Concealing their true profession can be seen as a form of \\u201csymbolic violence\\u201d (Schubert, 2012), where individuals internalize and reproduce the dominant cultural norms that marginalize them. Furthermore, existing recruitment strategies in health care, which often rely on mobilizing specific versions of masculinity to attract men to the profession (Cottingham, 2014), may inadvertently contribute to the problem. Instead of fundamentally challenging hegemonic masculinity, these approaches may simply co-opt it, presenting a narrow and potentially exclusionary vision of what it means to be a male nurse (Cottingham, 2019). Therefore, dismantling the deeply ingrained gendered stereotypes surrounding nursing requires a multi-pronged approach that encompasses both individual and collective action alongside institutional efforts to promote gender equality (Teresa-Morales et al., 2022). This necessitates a shift in cultural attitudes toward caregiving professions, particularly within South Asian communities, recognizing them as valuable and suitable for all genders. This shift also extends globally, as many high-income liberal democracies grapple with similar gendered expectations in health care, highlighting the need for a broader re-evaluation of caregiving professions across diverse cultural contexts (Milner et al., 2021). Achieving this transformation calls for a critical examination of the language used to describe nursing, the images used to represent it, and a conscious effort to dismantle the power dynamics that perpetuate its gendered construction. Creating truly inclusive spaces within nursing requires challenging individual biases and the broader societal norms and structures that reinforce them.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr29-10436596251337062\", \"bibr49-10436596251337062\", \"bibr63-10436596251337062\", \"bibr31-10436596251337062\", \"bibr57-10436596251337062\", \"bibr32-10436596251337062\", \"bibr22-10436596251337062\", \"bibr23-10436596251337062\", \"bibr35-10436596251337062\", \"bibr53-10436596251337062\"], \"section\": \"Discussion\", \"text\": \"This study reveals a compelling paradox within the power dynamics of nursing education, particularly for male students from non-Western backgrounds. While nursing globally is a primarily female-dominated field, these men often experience a unique form of marginalization (Huang, 2024). They are simultaneously hypervisible, as their presence as men in a female-dominated field attracts attention and scrutiny, yet often remain invisible, with their unique perspectives and challenges being overlooked or dismissed (Raghavan et al., 2023; Yokoya et al., 2023). This experience of hypervisibility and invisibility creates complex challenges, particularly for students from South Asian backgrounds. Their experiences are shaped not only by gender but also by the intersection of their cultural identities and the dynamics of being an international student in a new cultural environment. For instance, their accents, cultural practices, or even their names can become markers of difference, leading to increased scrutiny or stereotyping. This aligns with research on the experiences of minority groups in predominantly white spaces, where individuals often report feeling both hypervisible and invisible, their presence simultaneously highlighted and ignored (Jackson et al., 2022; Subu et al., 2022). This paradoxical experience can be conceptualized as a form of \\u201cdouble consciousness\\u201d (Joseph & Golash-Boza, 2021), where individuals are forced to navigate their identity through the lens of both their own cultural background and the dominant societal norms. This concept, initially developed by Du Bois (1903) to describe the experiences of African Americans, provides a valuable framework for understanding how individuals from marginalized groups experience a sense of duality and are constantly aware of how the dominant culture perceives them. While previous research has explored the paradoxical position of male nurses in general (Evans, 1997; Kellett et al., 2014; Salvador & Alanazi, 2024), this study extends these findings by highlighting the specific experiences of South Asian male nursing students and linking their experiences to the concept of double consciousness. These students not only navigate the general challenges faced by men in a female-dominated profession but also the additional complexities of being international students from a distinct cultural background.\"}, {\"pmc\": \"PMC12335640\", \"pmid\": \"40304290\", \"reference_ids\": [\"bibr43-10436596251337062\", \"bibr45-10436596251337062\", \"bibr27-10436596251337062\"], \"section\": \"Discussion\", \"text\": \"Furthermore, the study highlights the hostile environment that male students often perceive in nursing education. Some participants reported experiencing a hostile environment in their clinical placements, marked by subtle and overt forms of discrimination. For instance, Raj described an incident where a preceptor repeatedly criticized his accent, making him feel marginalized and excluded. This experience highlights the additional barriers faced by international students, who may be judged based on their communication style rather than their clinical competence. This finding is consistent with research that highlights the challenges faced by international students in health care settings, including language barriers, cultural misunderstandings, and discrimination (Oduwaye et al., 2023; Pandey et al., 2021). Furthermore, studies have documented gender bias and unsupportive behaviors from educators in nursing education, which create significant obstacles for male students (Hosseini et al., 2022). This interplay of factors underscores the need for a more nuanced and intersectional approach to understanding the experiences of male South Asian nursing students and other students from diverse linguistic and cultural backgrounds. Creating educational environments that are truly inclusive and supportive of all learners requires a commitment to addressing not only overt prejudice but also the subtle, often unintentional biases that can create barriers to success.\"}]"

Metadata

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