Transcultural Nursing

 

Culturally Mediated Characteristics

 Nurses should be aware that patients act and behave in a variety of ways, in part because of the influence of culture on behaviors and attitudes. However, although certain attributes and attitudes are frequently associated with particular cultural groups, as described in the following pages, it is important to remember that not all people from the same cultural background share the same behaviors and views. Although the nurse who fails to consider a patient’s cultural preferences and beliefs is considered insensitive and possibly indifferent, the nurse who assumes that all members of any one culture act and behave in the same way runs the risk of stereotyping people. The best way to avoid stereotyping is to view each patient as an individual and to find out the patient’s cultural preferences.

 

SPACE AND DISTANCE

 People tend to regard the space in their immediate vicinity as an extension of themselves. The amount of space they need between themselves and others to feel comfortable is a culturally determined phenomenon. Because nurses and patients usually are not consciously aware of their personal space requirements, they frequently have difficulty understanding different behaviors in this regard. For example, one patient may perceive the nurse sitting close to him or her as an expression of warmth and care; another patient may perceive the nurse’s act as a threatening invasion of personal space. Research reveals that people from the United States, Canada, and Great Britain require the most personal space between themselves and others, whereas those from Latin America, Japan, and the Middle East need the least amount of space and feel comfortable standing close to others. If patients appear to position themselves too close or too far away, the nurse should consider cultural preferences for space and distance. Ideally, patients should be permitted to assume a position that is comfortable to them in terms of personal space and distance. Because a significant amount of communication during nursing care requires close physical contact, the nurse should be aware of these important cultural differences and consider them when delivering care.

 

EYE CONTACT

 Eye contact is also a culturally determined behavior. Although most nurses have been taught to maintain eye contact when speaking with patients, some people from certain cultural backgrounds may interpret this behavior differently. Some Asians, Native Americans, Indo-Chinese, Arabs, and Appalachians, for example, may consider direct eye contact impolite or aggressive, and they may avert their own eyes when talking with nurses and others whom they perceive to be in positions of authority. Some Native Americans stare at the floor during conversations, a cultural behavior conveying respect and indicating that the listener is paying close attention to the speaker. Some Hispanic patients maintain downcast eyes as a sign of appropriate deferential behavior toward others on the basis of age, gender, social position, economic status, and position of authority. Being aware that whether a person makes eye contact may be a result of the culture from which they come will help the nurse understand a patient’s behavior and provide an atmosphere in which the patient can feel comfortable.

 

TIME

 Attitudes about time vary widely among cultures and can be a barrier to effective communication  between nurses and patients. Views about punctuality and the use of time are culturally determined, as is the concept of waiting. Symbols of time, such as watches, sunrises, and sunsets, represent methods for measuring the duration and passage of time. For most health care providers, time and promptness are extremely important. For example, nurses frequently expect patients to arrive at an exact time for an appointment, despite the fact that the patient is often kept waiting by health care providers who are running late. Health care providers are likely to function according to an appointment system in which there are short intervals of perhaps only a few minutes. For patients from some cultures, however, time is a relative phenomenon, with little attention paid to the exact hour or minute. Some Hispanic people, for example, consider time in a wider frame of reference and make the primary distinction between day and night. Time may also be determined according to traditional times for meals, sleep, and other activities or events. For people from some cultures, the present is of the greatest importance, and time is viewed in broad ranges rather than in terms of a fixed hour. Being flexible in regard to schedules is the best way to accommodate these differences. Value differences also may influence a person’s sense of priority when it comes to time. For example, responding to a family matter may be more important to a patient than meeting a scheduled health care appointment. Allowing for these different views is essential in maintaining an effective nurse-patient relationship. Scolding or acting annoyed at a patient for being late undermines the patient’s confidence in the health care system and might result in further missed appointments or indifference to health care suggestions.

 

TOUCH

 The meaning people associate with touching is culturally determined to a great degree. In some cultures (eg, Hispanic, Arab), male health care providers may be prohibited from touching or examining certain parts of the female body. Similarly, it may be inappropriate for females to care for males. Among many Asian Americans, it is impolite to touch a person’s head because the spirit is believed to reside there. Therefore, assessment of the head or evaluation of a head injury requires alternative approaches. The patient’s culturally defined sense of modesty must also be considered when providing nursing care. For example, some Jewish and Islamic women believe that modesty requires covering their head, arms, and legs with clothing.

 

COMMUNICATION

 Many aspects of care may be influenced by the diverse cultural perspectives held by the health care providers, patient, family, or significant others. One example is the issue of informed consent and full disclosure. In general, a nurse may argue that patients have the right to full disclosure about their disease and prognosis and may feel that advocacy means working to provide that disclosure. Family members of some cultural backgrounds may believe it is their responsibility to protect and spare the patient, their loved one, the knowledge of a terminal illness. Similarly, patients may, in fact, not want to know about their condition and may expect their family members to “take the burden” of that knowledge and related decision-making. The nurse should not decide that the family or patient is simply wrong or that the patient must know all details of his or her illness. Similar concerns may be noted when patients refuse pain medication or treatment because of cultural beliefs regarding pain or belief in divine intervention or faith healing. Determining the most appropriate and ethical approach to patient care requires an exploration of the cultural aspects of these situations. Self-examination by the nurse and recognition of one’s own cultural bias and world view, as discussed earlier, will play a major part in helping the nurse to resolve cultural and ethical conflicts. The nurse must promote open dialogue and work with the patient, family, physician, and other health care providers to reach the culturally appropriate solution for the patient.

 

  

KEY TERMS


• Barriers

• Biased

• Cultural Blind Spot

Syndrome

• Dialects

• Ethnocentrism

• Idioms

• Nursing Rituals

• Racism

• Regionalisms

• Simultaneous Dual

Ethnocentrism

• Stereotype

OBJECTIVES

After completing this chapter, you should be able to:

• Identify barriers to effective transcultural communication

between patients and nurses.

• Describe the process by which people from diverse cultures go

from fearing each other to liking each other.

• Identify and describe the three types of racism that are found in

our society.

Exploring Transcultural Communication

• Define ethnocentrism and explain how this barrier blocks transcultural

communication.

• Describe the different types of language barriers that can impede

transcultural communication.

• Develop an awareness of the various dialects, regionalisms, and

idioms that distinguish the speech of people from different

races, ethnic groups, and regions.

• Identify ways in which differing perceptions and expectations

can complicate communications between nurses and patients

from diverse cultures.

INTRODUCTION

Communication between nurses and patients from different cultures is often

complicated by different values, beliefs, traditions, expectations, and languages.

As you work with patients from multicultural backgrounds, you will

find that these differences raise barriers to transcultural communication. This

chapter discusses communication barriers in terms of their underlying dynamics,

and their impact on nurses, patients, and nursing care. Chapter 8 describes

practical strategies for overcoming transcultural communication barriers in the

health care arena.

Exploring Transcultural Communication

Fear and Distrust

Fear, dislike, and distrust are emotions that all too often erupt when people

from diverse cultures first meet. Rothenburger (1990) has identified seven

stages of adjustment that individuals pass through during their initial encounters

with people of different cultures that they do not know or understand.

These stages are:

1. Fear: When first meeting someone from a different culture, many

people feel threatened. Each person perceives the other person as

different and, therefore, dangerous. Usually as people become better

acquainted with each other, the fear gradually dissipates, only to

be replaced by dislike.

2. Dislike: Dislike is a much milder emotion than fear. Group members

have a tendency to dislike people who behave or communicate differently

from what is considered “the norm” in that culture or group.

For example, a working class black person might dislike a middleclass

white person because white people tend to be less vocal and

expressive than many black people, and thus appear insincere and

weak.

3. Distrust: People from different cultures are often suspicious of each

others’ actions and motives because they lack information. For

example, a white nurse who does not realize the importance of family

in Vietnam, may be suspicious of the new Vietnamese nurse who

allows family members to participate in a patient’s care instead of

providing all of the care herself. Unfortunately, unless there is pressure

to change their attitudes, some people never do progress

beyond fear, dislike, and distrust to the next stage of acceptance.

4. Acceptance: Usually if two people from different cultures share

enough good experiences over a period of time, they will begin to

accept each other rather than resent each other.

5. Respect: If individuals from diverse cultures are open minded, they

will allow themselves to see and admire qualities in one another. For

example, a Japanese nurse who has been trained to defer to authority

might admire the white American nurse who challenges authority.

Acceptance and admiration, in turn, foster respect.

6. Trust: Once people from diverse cultures have spent enough quality

time together, they usually are able to trust each other. For example,

a white American nurse will eventually trust the foreign-born

nurse who consistently provides good patient care and finishes

COMMUNICATION CONSIDERATIONS

The belief that one’s own culture or traditions are better than

those of other cultures is called ethnocentrism. The person who

is ethnocentric tends to antagonize and alienate people from

other cultures.

Simultaneous dual ethnocentrism is a component of every nursepatient

relationship. Nurses are assessing, judging, evaluating, and reacting to

Transcultural Communication Stumbling

patients on the basis of their own cultural values, medicocentric points of

view, and expectations. Simultaneously, patients are using their cultural values

to judge and evaluate their nurses and the Western health care system. As

Lydia DeSantis (1994) points out:

The concept of a simultaneous dual ethnocentrism makes nurses

keenly aware that they, their patients, their colleagues, and everyone

else in the clinical setting are operating under the influence of personal

cultural rules, some of which are shared and some of which

are not.

Attitudes towards Western medicine constitute one of the biggest barriers

to transcultural communication between American nurses and patients.

American nurses tend to be heavily biased toward the Western biomedical

health care system because most of them have been educated in this system.

Indeed, many nurses feel that the biomedical system is the best (and even the

only) approach to patient care. They may view other health belief systems

with suspicion and even contempt, refusing to acknowledge that another

approach might have some merit. This ethnocentric attitude can alienate

patients from other cultures, who fully believe that their therapeutic interventions

also have merit. Here is an example of how simultaneous dual ethnocentrism

can severely damage the nurse-patient relationship.

Example: Juan Perez, a Mexican immigrant, was hospitalized with

a fever of unknown origin. A major conflict developed between the

head nurse and Mr. Perez’s family when the family insisted that a

curandero or folk healer visit the patient. When the curandero

appeared on the ward with various healing paraphernalia, the head

nurse demanded that the healer leave the patient’s room at once.

The nurse’s attitude so upset Mr. Perez that his family signed him out

of the hospital against consent. Had the nurse been willing to at least

acknowledge Mr. Perez’s health care beliefs, he would have been

more willing to accept her biomedical beliefs.

When white American nurses care for people from other cultures, they

may be biased not only toward their own health care system, but toward

other learned values—such as cleanliness—as well.

Example: During a clinic visit, a Caucasian nurse assessed that a

Native American child had severe impetigo. The nurse observed that

the child appeared dirty, and that the mother had not thoroughly

washed her hands. The nurse concluded that because the child was

dirty, the mother was not taking adequate care of her child.

Exploring Transcultural Communication

The nurse’s assessment was based on a value she learned while

studying nursing, that is, that cleanliness is essential and basic to

good health. Her observations translated into a value judgment

based on Western bias: “Cleanliness is good. Therefore, a good

mother always keeps her child clean.”

The mother perceived correctly from the nurse’s demeanor and

tone of voice that this authority figure from the dominant white culture

disapproved of her and her parenting skills. She also suspected

that the nurse was planning to impose her expectations concerning

cleanliness and child-rearing.

The Native American mother found herself nodding yes, but tuning

out the disapproving nurse’s instructions. The young mother

would have been much more inclined to listen had the nurse been

sensitive in her approach rather than dictatorial. The nurse could

have said: “I’m sure that you’ve noticed that your baby has a problem

with his skin. When did the problem start? What have you done

thus far for the itching? Has it helped? Let’s think about this problem

together and see what we can do.”

By admitting and overcoming her own rigid bias toward cleanliness,

the nurse would have conveyed that the child needed attention

without appearing to judge the mother’s standard of cleanliness

or her child care skills. As a result, the mother would have been

more inclined to listen to the nurse and follow through on her suggestions.

 

Ritualistic Behavior

A ritual is a set procedure for performing a task. In the past, students in

nurse’s training were taught to perform their duties in a ritualistic manner.

Even today, nursing rituals persist. Many nursing rituals are beneficial, such

as always performing certain safety checks when preparing and administering

medications. However, other rituals, such as always excluding family from the

bedside during treatments, are unnecessary and may upset patients and their

families. Unfortunately, many nurses are so in the habit of performing certain

rituals that they become deeply disturbed when these rituals are challenged.

COMMUNICATION CONSIDERATION

As you care for patients, ask yourself which nursing rituals are

really necessary and which rituals are outdated. If there is no scientific

or logical reason to follow a ritual, try to create a new routine

that will benefit you and your patient.

Language Barriers

Language provides the tools (words) that allow people to express their

thoughts and feelings. Thus, language barriers present a grave threat to transcultural

communication between nurses and patients. There are several types

of language barriers that impede communication in the United States. These

barriers include:

a. foreign languages,

b. different dialects and regionalisms, and

c. idioms and “street talk.”

Foreign Languages, Dialects, and Regionalisms. Even when nurses and

patients speak the same language, misunderstandings can arise. But when

patients come from countries or households where English is not the native

tongue, the resulting language barrier can bring communication to a halt, producing

frustration and conflict.

Unfortunately, it is not possible to be familiar with the hundreds of languages

and dialects spoken by patients from different countries and cultures.

As noted in Chapter 1, over 6,000 different languages and dialects are spoken

today. In addition, the number of people in the United States (all potential

patients) who speak languages other than English is growing.

 

Based on the 1990 census, individuals who spoke languages other than

English constituted approximately 10% of the population, or 25 million people.

According to a U.S. Education Department report on languages during the

1980s, the number of Spanish speakers increased 65% and speakers of Asian

languages rose 98%. The number of people 5 years old and older who spoke

languages other than English at home rose approximately 40% (Gannet,

1994). These statistics will be updated in the 2000 census.

Large communities of people who speak languages other than English are

flourishing in Southern California, Texas, New Mexico, and Arizona. In Los

Angeles alone, over 100 languages other than English are spoken. These languages

range from the familiar Spanish tongue to the more exotic language

of Gujarati, which is spoken in western India (Compton’s, 1995). Moreover,

there are many more communities throughout the country where different

languages and traditions are common.

As if coping with people who speak different languages is not enough,

nurses must also be aware that there are hundreds of dialects and regionalisms.

Webster’s Dictionary defines a dialect as the distinctive way a language

is spoken or written in a given locality or by a given group of individuals.

A regionalism is a word, phrase, pronunciation, or custom peculiar to

a given region. For example:

• There are three major Chinese dialects: Mandarin, Cantonese, and

Shanghainese.

• There are 600 Filipino languages and dialects, among which the

most common are Tagalog, Ilocano, Ilonggo, and Cebuano.

• Spanish is not divided into dialects, but there are some regional differences

in the use of particular words and phrases. The most recent

influx of migrant workers in California speak Mixtec, not Spanish.

• Ebonics, or African-American English, was first discussed in 1975 in

Ebonics: The True Language of Black Folks, a book by psychology

professor Robert L. Williams. Williams derived the word Ebonics

from ebony (for black) and phonics for “the scientific study of speech

sounds.” Williams pointed out that black people are often accused

of using bad English when actually they are speaking their own language

or dialect, which is based on standard English. In December

of 1996, the Oakland School Board in California officially recognized

Ebonics as a language or dialect. Concerned that the majority of

black students who spoke Ebonics were not doing well in school,

the Board passed a resolution calling for improved instruction in

standard English (Barnhart and Metcalf, 1997).

 

To communicate effectively with patients who are not proficient in

English, you will need an interpreter. A skilled interpreter can help you, your

patient, and your patient’s family overcome the anxiety and frustration produced

by language barriers. Chapter 9 describes methods for communicating

with patients with limited English proficiency, both with and without an

interpreter.

Conflicting Perceptions and Expectations

When people from different cultures try to communicate, their best efforts

may be thwarted by misunderstandings and even serious conflicts. In health

care situations, misunderstandings often arise when the nurse and patient

have different perceptions and expectations, and consequently misinterpret

each others’ messages.

Misunderstandings due to cultural differences commonly arise in situations

involving food and drink. Imagine that you are taking care of a postoperative

Vietnamese female patient who, as her culture dictates, is almost constantly

attended by her family. You want to clearly instruct family members

that they are not to give the patient anything to drink. As the family speaks

only Vietnamese, you motion that the patient is not to drink, and you explain

via an interpreter that the patient must not drink.

When you return from your lunch break you find your patient vomiting,

and you observe an empty bowl of soup on her table. Obviously the family

has ignored your instructions and fed the patient soup. If you angrily say “I

told you not to give her anything to drink!” your reaction would be that of

many nurses in this situation.

However, you later learn from the interpreter that the family knew that

they should not give the patient water, but they assumed that broth would be

beneficial. Vietnamese believe that the sick need to drink broth to rebuild

energy. Your intended message (do not drink anything) was not understood

by the patient’s family, and you failed to grasp the family’s perception of your

instructions (broth is not water, and therefore all right to drink). As a result,

the patient’s family gave her broth and you became frustrated.

 

 

TESTING YOUR KNOWLEDGE

Circle the correct answer.

1. Racism can be classified as

a. institutional.

b. individual.

c. cultural.

d. all of the above.

2. The belief that one’s culture and value system is better than that of

another culture is called

a. bias.

b. pride.

c. ethnocentrism.

d. stereotyping.

3. The statement: “All Asians honor the past” is an example of

a. ethnocentrism.

b. stereotyping.

c. racism.

d. Cultural Blind Spot Syndrome.

4. A nurse who fails to culturally assess a patient from the same culture is

guilty of

a. ethnocentrism.

b. stereotyping.

c. Cultural Blind Spot Syndrome.

d. lack of knowledge.

5. The nurse who always excludes the patient’s family from the bedside

when giving care is

a. protective of the patient.

b. ethnocentric.

c. ritualistic.

d. biased.

Australia: Do you need to consult a migration agent before lodging your visa application?


Completing the DIAC forms look simple enough, yet why do so many visa applications fail? The case officers at the Department of Immigration and Citizenship (DIAC) are only human and so mistakes happen. That is why review tribunals exist. In many cases of DIAC visa refusal, on appeal, tribunals reverse the DIAC decision. However, in some cases, the visa application should not have been lodged in the first place, and the related fees and consequent anxiety could have been avoided, if only a preliminary assessment has been carried out by a competent migration agent before the lodgement of visa application.

There are about 3,000 registered migration agents in Australia you may choose from to advice you in person, by phone or visa internet, on the success of your intended visa application. Some migration agents will charge an initial consultation fee, others will not. Some websites represent that the preliminary assessment is free, but many start charging you on an hourly basis after you complete your personal details.

Free initial consultation seldom works. Often, the client does not appreciate the value of the advice provided and will seek further advice where consultation is charged. Moreover, some migration agents may not dedicate sufficient time to investigate your most suitable option because of more urgent matters to attend to for their paying clients.

If the visa is important to you and your future, do not take any chances. Consult a registered migration agent for as low as $110.00 and obtain a preliminary assessment advice to determine:

■the basis for a visa grant, depending on your purpose and situation;

■option to apply for other visas, if any,

■whether you are likely to satisfy the criteria for the visa suited to your situation;

■plan of action, if any, to qualify you for visa grant in the future, if you do not readily qualify at this time;


If you are able to provide documents acceptable to DIAC to support your claim of meeting the criteria for a visa grant at the time of application, and at the time of decision, then you can rest assured that you would have a very good chance of successfully obtaining the visa.

But bear in mind that registered migration agents are required to observe the Migration Agent’s Code of Conduct. It is their obligation to act professionally in their client’s best interest. In fact, you can lodge a complaint with the Migration Agents’ Registration Authority (MARA) for misconduct, if your migration agent guarantees visa grant without sufficient basis or justification when consulted for preliminary assessment advice.

Incidentally, a set of forms and precedent letters of advice, tables and a summary of skills assessment requirements, for almost all occupations in the skills occupations list authored by this writer, has recently been published. This publication known as “Time-saving Immigration Practice Solutions (TIPS) on general skilled migration (GSM), or “TIPS on GSM Visas”, is the first immigration law precedents publication of Leappublishing. It is now available for the use of other migration agents. Hence, there is no longer a reason why a migration agent cannot provide a detailed preliminary assessment advice on GSM visas, using TIPS. Visit leappublishing.com.au and search for the word “visa” for details.



 

Nurse Registration in Australia


Currently, there is a plan to unify the requirements for Australian nursing competency assessment and registration

Until that time, nursing registration is through the nursing registration board of any of the Australian States and Territories. They vary in their registration process, costs and requirements.


Once registered as “registered nurse” in any state or territory of Australia, your tourist, non-working visa or student visa may be changed to a working visa for a period of one year up to four years under certain conditions, provided there is no visa condition of “no further stay” on your existing visa.


NSW Nurse Registration for Overseas Registered Nurses


Under

guidelines, the NSW Nursing Board will consider, among other matters:


o The rank or classification of your educational institution in the Country Education Profile of the country of your education

o your overseas registration

o your grades in your transcript of records

o your experience, if any


The NSW Nursing board will determine whether your qualifications meet certain standards:


· The standard of your educational institution must be comparable to the standard of an Australian tertiary institution and

· The level of your nursing degree must be comparable to the level of an Australian Bachelor degree not an Australian Diploma level; and

· The course content of your overseas Bachelor degree in Nursing must be comparable to the course content of the Australian Bachelor in Nursing degree.


If your qualifications meet the standard of an Australian Bachelors degree in Nursing you will be referred to complete the College of Nursing Assessment for registered nurses. If not, you may be referred for assessment as an “enrolled nurse”. If you pass the assessment, you will be eligible for registration as registered nurse or enrolled nurse as the case may be.


Registration as “enrolled nurse” will not qualify you for permanent resident visa because it is not listed in the Skilled Occupations List (SOL) but will qualify you to apply for a working visa.


The other two accredited pathways for registered nurse registration in New South Wales are:

■A three year Australian Bachelor in Nursing degree and

■A two-year graduate entry Bachelor in Nursing degree course at the University of Technology Sydney or University of Western Sydney.

In all cases, you will be required to pass an English test at varying levels, unless exempted.


 

Circle of Love: A Nurses' Experience in Guatemala


We are up early and off to our first day of clinic. El Tesoro is about an hours ride from Santa Lucia. We pass pineapple plants and banana trees as we travel. Off in the distance are formations of volcanoes. As we approach El Tesoro, the roads become very rocky, with drives over small creeks and other rough terrain in our little Mitsubishi minivans. We witness so much damage from Agatha; waters from the storm are still running rapidly. Our clinic is held in the community center, which is a cement block building with open wire fencing on two sides that provides a nice breeze in the extreme heat.

We are greeted by the community president and town board, as well as their "health minister.” We see 73 patients our first day and are observed closely by the town board and health minister, as we provide care and supply medicines as needed. Many patients we see have parasites due to the lack of clean running water and sub-standard sanitary conditions. We are very concerned over one child, a one and a half year old who arrives in the late afternoon. The child is very dehydrated, had sixteen loose stools during the day, and is not nursing. We give hydration packs, Tylenol elixir and care instructions to the parents who leave with their child wrapped in a towel, ice on his head, traveling on a motorbike towards home. They will return tomorrow for re-assessment of their son; we pray they do return. We continue on giving out many anti-fungal medications, multivitamins, antibiotics, and deworming meds. It begins to rain and we must head back to Santa Lucia - another Indiana Jones ride in the Mitsubishi van - as we end a good first day.


The following day we see 100 patients, all very gracious and grateful we are there. With smiles on their faces, they offer "gracias" to us as they make a point to shake each caregiver’s hand. Some give kisses on the cheek, despite the heat and heavy rains, and joy swells in our hearts to know the people trust us and are grateful for our care. A busload of patients comes in a small chicken bus from El Carmen. They are war refugees like the people of El Tesoro. They arrive late, and their numbers are many, but we stay late despite the rain to meet their needs. School children hang from the side fencing of the building to watch us as we work. They smile and call out "Senora" to learn our names. They giggle as we smile and say our names in Spanish, and some touch our hair because it is not dark like theirs. Smiles are universal, and hugs freely received. Our doctor removes a sebaceous cyst in clinic today and I am able to assist.


The parents come back again, riding on their motorbike in the heavy rains with their sick little boy. It is obvious the baby is much worse and mother states they were unable to give any hydration to the child overnight. The parents do not understand the seriousness of the child's condition. Andrew, another volunteer, meets with the town board so immediate transport can be made for this family to take their child to a nationale hospital. It is a two hour ride, and we pray the baby survives the trip. Andrew expresses his great concern for the child and the parents finally agree to hospitalize their son. We know that if he is not hospitalized, they will bury their child. We gather and pray for his safety. Godspeed, little one.


The next day we are again back at El Tesoro, no rains during the night which made travel easier, but we arrive late. Patients are seated outside of the community center and greet us with "Buenos dias” and smiles as we arrive. They are becoming more comfortable with us. We expand our boundaries a bit at lunch break and explore the land.


The homes are either cement block, corrugated sheet metal or wood. Roads are rocky and muddy. There are several makeshift stores across from the clinic where they sell bananas, candy and other snack items. Chickens and dogs are frequent guests in our clinic, and a man drives his cattle down the road. Sows are feeding under trees, as the local women do laundry and hang their clothes on fences or parts of the house. They greet us with waves and allow us to take pictures.


 

Filipino Nurses Working Abroad


With fewer jobs and less opportunities for nurses in the Philippines, many nurses and nursing students have a desire to work overseas where the salary is better and they feel compensated for their hard work. Some nurses decide to move to Canada for work, while others move to the United Kingdom, New Zealand, Australia, Middle East and other European countries. Nurses who wish to practice their profession in the United States are unfortunately forced to stay behind, due to retrogression. Many Filipino nurses are looking elsewhere for a brighter future, so let's review the opportunies abroad.

As mentioned, the United States is currently experiencing a shortage of nurses and the situation will worsen in upcoming years, since the baby boomers are retiring and nurses are needed to take over their positions. Foreign nurses are the answer to this shortfall. What is unfortunate, however, is that hospitals cannot easily bring in foreign educated nurses because of the US immigration laws. So how can this be resolved? Legislation is the key, but it is up to Congress and President Barack Obama who promised to bring about change for this problem. Let’s wait and see, since rumours are spreading that congress will act on pending bills that cover the nursing shortage and immigration.

In regards to nursing opportunities in Australia and New Zealand, nurses must have the financial power to pay the fees required to live and work in these countries. You need approximately Php 500,000.00 to cover all expenses including airfare, food, rent and school fees for the bridging program that you must undergo before engaging in full-time practice as a Registered Nurse. Not all Filipino nurses can afford to pay that amount of money. Many chose nursing as a profession because they believed it was the only way to improve their lives and the lives of their families. They did not expect that they would need thousands in order to work abroad. Fortunately though, with many agencies now offering fly now pay later schemes, many are now able to fulfill their dreams of living in these areas. Check out Nursing in Australia: FAQ's.

Middle East countries such as Saudi Arabia and the United Arab Emirates are also popular destinations for nurses. Some choose to work in these countries because they do not want to take the extra licensure and English competency exams needed to be able to work in the US, Canada, and the United Kingdom, while others use these countries as stepping stones for the western world. Salaries in these regions are very high and are considered top destinations by healthcare providers. You not only receive competitive salaries and benefits, but you also get to enjoy the luxurious wonders of areas such as the Emirates.

Wherever you decide you want to live and work as a nurse, you must also be very careful in selecting a recruitment agency. Many nurses have been victims of fraud by filling out contracts that were not fully implemented as agreed upon while in the Philippines. Nurses can check if the agency is accredited by the Philippine Overseas Employment Agency (POEA) or Overseas Workers Welfare Administration (OWWA). Know your rights and be sure to keep copies of your contract/employment agreement in case you are ever a victim of fraud.

Migration is tough - it involves preparation and awareness. Remember that your career will shape your future, so choose wisely when choosing a country and whether or not to migrate.



 

■Nurses most in demand are those with specialized skills, such as emergency room, critical care, and operating room experience. Canada is also seeking nurses willing to work in smaller or isolated communities.

What languages do I need to speak?

■Being bilingual in English and French is an asset, but not a requirement in most territories in Canada.


■Language proficiency is required to become registered or licensed in Canada.


■Candidates must know the French language to practice in Quebec.


■Candidates must show proficiency in either English or French in New Brunswick, Manitoba, and Ontario.


■In other provinces and territories of Canada (not mentioned above), English proficiency is required.

What do I need to do to practice?

■If you hold a diploma in nursing, individual provinces accept Diploma holders with a minimum of 1165 hours of nursing practice over the past 5 year period. 8 of 10 provinces accept diploma educated nurses. The exceptions are Ontario and New Brunswick; which both require a Bachelor in Nursing Degree.


 

Philippines: Options for Unemployed Nurses


Every year, nursing schools produce thousands of nurses in the Philippines; recent reports put the number of new nursing graduates at 40,000, however thousands of RNs are jobless due to the surplus in supply. Hospitals are full and nurses don’t know where to go, so what can you do to increase your chances of finding a job?


Here are some tips for those of you looking for work:

Join training programs in major hospitals.

Many hospitals run training programs for nurses in a variety of specialties such as Ward Nursing, Critical Care Nursing, Emergency Nursing, Maternal & Child Nursing, Dialysis Nursing and Operating Room Nursing. These programs are designed to enhance the skills of professional nurses. They are structured according to accepted standards of nursing and are organized by seasoned and highly experienced nurses in the clinical setting. Choose only hospitals that are known for their excellence and are considered training hospitals, so that you won’t waste your time, effort and money.

Volunteer for medical and surgical missions.

International and local charitable organizations conduct medical and surgical missions in various parts of the country all year round. These missions are great venues for skill development and enhancement, since most of the missions offer technical and educational sharing to empower the local counterparts that they visit. Nurses who join missions are carefully selected and screened to assure that they are clinically competent in their field, so neophyte nurses will surely learn from them.

Apply to as many hospitals as possible.

Competition in the market is tough. Submit your application letter, along with all of your credentials, to every the hospital in your area. Many applications are lined up for interviews as soon as there are vacancies. Be sure to leave a positive impression when you submit your applications to the Director of Nursing or Human Resources. Dress appropriately. Start acting like a professional as early as now!

Attend continuing education courses and seminars.

Build your career and resume actively. Nursing organizations and other entities conduct training courses and seminars, and new trends and advances in technology and in science are continuously being discovered. Equip yourself with the basic skills necessary, such as IV Therapy, Basic Life Support, Advanced Cardiac Life Support and Pediatric Advanced Life Support Training. These courses are highly essential for nurses to learn so that they can respond to specific emergency situations inside or outside of the hospital. Nurses need to continue to learn – learning does not stop when you graduate from nursing school! We must update our skills with new techniques and apply evidence-based concepts in our work. Prospective employers are impressed with nursing applicants who desire continuing education. You may also want to enrol in graduate school and earn your Master’s Degree in Nursing.

Search for jobs abroad through the internet.

Using the internet to search for a job is becoming increasingly popular and opens up the door to many more opportunities in the Middle East, Canada, Australia, Europe, other areas of Asia, and the UK. It should be noted, however, that the demand from countries such as the UK and US has dropped; quotas for visas in the US are filled for the time being and the UK is now looking more towards home-grown healthcare professionals. In addition, foreign employers do prefer nurses with a four-year nursing degree rather than a two-year degree, so it is important to consider advancing your education.

The hunt for a good paying nursing job can be difficult, but everyone has a chance if you follow these suggestions and remain proactive in your search.

Stay positive, nurses, we are built to survive!



 

States of Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, and Connecticut.


One of the many benefits of a career in nursing is the travel opportunity it can provide for those willing to temporarily (or permanently) relocate. One of the most popular destinations for nurses coming to the US is New England – comprised of the states of Maine, Vermont, New Hampshire, Massachusetts, Rhode Island, and Connecticut. Its rich history, scenic beauty and numerous healthcare facilities make it a desirable choice for many to leave home and pursue a new opportunity.

If you are one of many considering an assignment in New England, here a few things to consider that should help you make an informed choice:

· The weather: located in the Northeastern part of the US, New England experiences the “four seasons” – summer, fall, winter, and spring. Most nurses relocating here have the most difficulty adjusting to the cold and snow that frequents the region from November through March. Winter can be beautiful and fun there, but it’s best experienced when you are prepared – make sure you are willing to spend the money on proper clothing ; high quality winter coats, hats, gloves, and shoes are key to making the adjustment. Ask any New Englander and they will tell you that a good pair of winter boots can make all the difference between embracing winter and fighting it.

The geographic diversity: the ocean, mountains, woodlands, big cities, small towns – New England has it all. An assignment “near Boston” for instance can mean many things – you could find yourself in a small, quaint, cozy suburban town only 20 miles outside of Boston, which is completely different from life in the “big city” and may not be exciting enough for someone looking to live in a fast-paced social environment. Make sure you thoroughly understand your new location and its proximity to urban, suburban, and geographic surroundings.


The “cost of living”: New England is one of the more expensive areas in the US to live. Housing, food, and entertainment can all be very pricey. Make sure you budget enough money for these key areas when you are considering your compensation package – a higher hourly rate does not necessarily transfer to a higher rate of take home pay when you factor in the additional expenses.


Driving: public transportation in New England is mainly limited to urban areas (as is the case in much of the US). If your job and apartment are both located in a larger city, then buses and trains will probably get you where you need to go. If however, either are located away from a major urban area then you will need to think carefully about how you will get back and forth to work, as well as taking care of your personal travel needs. The safest bet is to assume you will need to lease or own a car so you can factor that in to your expenses.

New England can be a great place for nurses to work and live. Doing your homework before you pack your suitcase helps to ensure you get the maximum satisfaction out of your new surroundings.



 

Nigeria

 

I have been a registered Nurse in Nigeria for about 8 years now and it has been a mixed story. Most peolpe go into Nursing through the Nursing Schools. the collegiate system is yet to commence fully. After graduation from Nursing school, people now go for specialty programmes as they cannot get any good job unless they are double qualified.In most cases, they take up Midwifery, there are a lot of men in Psychiatry, then Peri-operative, Anesthesia, Pediatrics, Renal, Ophthalmology and Othorpedics. There are special no training yet for oncology, ICU, Disaster, Geriatrics,etc. like you have in USA, but Nurses must have brief experiences in these areas before graduating from Nursing schools. Career for Nurses down here is majorly hospital based, No facilities for Nursing homes and Home care sevices and thes are areas that Nurses can invest in.

Before A Nurse can work in Nigeria, he/she must be registered with Nursing and Midwifery Council of Nigeria (NMCM).

Nigerian Nurses do work hard but thy receive little as salary. They are like an anchor at hospitals here. All team members depend on them but most times the Doctors take the appreciation from everybody as the health system in Nigeria is centered arround Doctors. Its a bit frustrating.

Now, furthering education for Nurses is a problem as most of them spend a lot of time battling with job problems and poor renumetration versus the bad economy.There are also few Universities offering RN to BSN programmes in Nigeria and Of cause no ONLINE opportunities at all for Nurses here.So, majority of Nurses here needs help on that. If there are schools Overseas that can offer online courses for Nigerian Nurses, Infact it will be a BIG HELP.

These are why Nurses here opt to work overseas for Bettter opportunities. Most get duped in the process and the hardship continues.

Even now these countries are putting on stringent meassures for Nurses traveling overseas. More frustration!!

But let me tell you that NIgerian Nurses have all there training in English language and work with English Language, its now appalling for English proficiency to be used as a criteria for employing Nurses from this place for overseas placement, but who will blame these countries after all "a begger has no choice".

If fellow colleages world wide will help Nigerian Nurses to get more access to affordabel online studies or provide scholarship, Partner with experienced Nigerian Nurses to open up Nursing Homes and Home care facilities, then there will be a revolution In Nursing down here.The market is very open here. The Nigerian population is a strength just like China. The health industry here is open, its worthy of investment.