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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 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.
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.
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.
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.
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OBSERVANCE OF HOLIDAYS
People from all cultures celebrate civil and religious holidays. Nurses should familiarize themselves with major holidays for members of the cultural groups they serve. Information about these important celebrations is available from various sources, including religious organizations, hospital chaplains, and patients themselves. Routine health appointments, diagnostic tests, surgery, and other major procedures should be scheduled to avoid those holidays a patient identifies as significant. Efforts should also be made to accommodate patients and family or significant others, when not contraindicated, as they perform holiday rituals in the health care setting.
The cultural meanings associated with food vary widely but usually include one or more of the following: relief of hunger; promotion of health and healing; prevention of disease or illness; expression of caring for another; promotion of interpersonal closeness among individuals, families, groups, communities, or nations; and promotion of kinship and family alliances. Food may also be associated with solidification of social ties; celebration of life events (eg, birthdays, marriages, funerals); expression of gratitude or appreciation; recognition of achievement or accomplishment; validation of social, cultural, or religious ceremonial functions; facilitation of business negotiations; and expression of affluence, wealth, or social status. Culture determines which foods are served and when they are served, the number and frequency of meals, who eats with whom, and who is given the choicest portions. Culture also determines how foods are prepared and served; how they are eaten (with chopsticks, hands, or fork, knife, and spoon); and where people shop for their favorite food items (eg, ethnic grocery stores, specialty food markets). Religious practices may include fasting (eg, Mormons, Catholics, Buddhists, Jews, Muslims), abstaining from selected foods at particular times (eg, Catholics abstain from meat on Ash Wednesday and on Fridays during Lent), and considerations for medications (eg, Muslims may prefer to use non-pork-derived insulin). Practices may also include the ritualistic use of food and beverages (eg, Passover dinner, consumption of bread and wine during religious ceremonies). Many groups tend to feast, often in the company of family and friends, on selected holidays. For example, many Christians eat large dinners on Christmas and Easter and consume other traditional high-calorie, high-fat foods, such as seasonal cookies, pastries, and candies. These culturally-based dietary practices are especially significant in the care of patients with diabetes, hypertension, gastrointestinal disorders, and other conditions in which diet plays a key role in the treatment and health maintenance regimen.
Along with psychosocial adaptations, nurses must also consider the physiologic impact of culture on patient response to treatment, particularly medications. Data have been collected for many years regarding differences in the effect some medications have on persons of diverse ethnic or cultural origins. Genetic predispositions to different rates of metabolism cause some patients to be prone to overdose reactions to the “normal dose” of a medication, while other patients are likely to experience a greatly reduced benefit from the standard dose of the medication. An antihypertensive agent, for example, may work well for a white male client within a 4-week time span but may take much longer to work or not work at all for an African-American male patient with hypertension. General polymorphism—variation in response to medications resulting from patient age, gender, size, and body composition—has long been acknowledged by the health care community. Culturally competent medication administration requires that consideration of ethnicity and related factors such as values and beliefs regarding the use of herbal supplements, dietary intake, and genetic factors can affect the effectiveness of treatment and compliance with the treatment regimen.
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• Cultural Blind Spot
• Nursing Rituals
• Simultaneous Dual
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
Exploring Transcultural Communication
• Define ethnocentrism and explain how this barrier blocks transcultural
• Describe the different types of language barriers that can impede
• 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.
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.
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BARRIERS TO TRANSCULTURAL
There are eight important barriers to transcultural communication in nursing:
(1) lack of knowledge, (2) fear and distrust, (3) racism, (4) bias and ethnocentrism,
(5) stereotyping, (6) ritualistic behavior, (7) language barriers, and
(8) differences in perceptions and expectations.
Lack of Knowledge
The failure to understand cultural differences in values, behaviors, and communication
styles is a common stumbling block for nurses who work in transcultural
settings. Nurses who are not knowledgeable about cultural differences
risk misinterpreting patients’ attempts to communicate. As a result,
patients may not receive the proper care.
Remember that each culture dictates what is “normal” behavior when
sick; for example, Japanese patients might react with silent obedience to your
requests, white middle-class patients might wish to discuss their nursing care
CHAPTER 4 Transcultural Communication Stumbling Blocks n 65
with you, Italian patients might dramatically express their discomfort, while
an inner city youth might loudly demand your attention. Nurses who are
unaware of cultural differences may mistakenly expect all patients to communicate
in the same way, regardless of culture.
Furthermore, nurses who have not learned about which behaviors are
acceptable in different cultures may attribute a patient’s behavior (e.g.,
silence, withdrawal) to the wrong reason or cause—resulting in faulty assessment
Example: A nurse was teaching a prenatal class to a group of white,
Hispanic, and black adolescents. The nurse used some words that
Bonita, a Hispanic teenager, did not understand. Bonita asked the
nurse to explain what the words meant. The nurse, who wanted to
cover the rest of her lesson, told Bonita that she would talk with her
about the words after class. But when class was over, Bonita abruptly
left the room.
The nurse, who was not knowledgeable about Hispanic culture,
incorrectly assumed that Bonita had either forgotten that she was to
remain after class, or had decided that she had more important
things to do.
Had the nurse known more about the culture and behavioral
patterns of Hispanics, she would have realized that:
• Hispanics typically view nurses and teachers as authority figures and
expect them to initiate actions. Thus Bonita expected the nurse to call
her name and remind her to stay after class.
• Many Hispanic children receive a great deal of close supervision and
attention from adults. Bonita might have felt that she should not have
been made to wait until after class to receive answers to her questions.
• Hispanic children are raised to be respectful and quiet. Bonita overcame
her shyness when she asked the nurse a question. If the nurse
had known more about the behavioral patterns of Hispanic children,
she would have invited Bonita to ask her questions again at the end
of class. As Bonita did not receive a cue from the nurse that it was
all right to speak, she assumed it would be rude to raise her hand.
Thus, this nurse-instructor incorrectly attributed Bonita’s behavior
to forgetfulness or disrespect. Because the nurse did not understand
the culturally-based reasons for Bonita’s behavior, she missed
a valuable opportunity to expand Bonita’s grasp of prenatal care.
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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
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
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Transcultural Communication Stumbling Blocks assignments on time. Once people trust each other, they may finally
learn to genuinely like each other.
7. Like: For people to like each other, they must share many things in
common. To reach this final stage, individuals from diverse cultures
must be able to concentrate on the human qualities that bind people
together, rather than the differences that pull people apart.
This evolution of a relationship from fear to trust has been dramatized in
films. For instance The Defiant Ones starring Tony Curtis and Sidney Poitier is
the story of two escaped convicts—one white and one black—who are
chained together. At first the two men dislike and distrust each other.
However the men are forced to work together in order to survive. By the time
the film ends, the men have established a mutual trust and respect.
Racism in American nursing is a formidable barrier that strangles transcultural
communication between nurses and patients, and between nurses and
other health care providers. Because nursing is regarded as a “caring profession,”
nurses find it difficult to acknowledge that racism exists in the health
care workplace. Indeed, for most Euro-American nurses, discussions of racism
in American nursing are taboo (Barbee, 1993).
Barbee’s article points out that there are three types of racism:
1. Individual racism: Individuals are discriminated against because of
their visible biological characteristics; for example, black skin or the
epicanthic fold of the eyelid in Asians.
2. Cultural racism: An individual or institution claims that its cultural
heritage is superior to that of other individuals or institutions. For
example, during World War II, the Nazis claimed that their Aryan
genetic and cultural heritage was superior to the Jewish heritage.
They justified persecution of the Jews by convincing themselves that
the Jews were an inferior people.
3. Institutional racism: Institutions (universities, businesses, hospitals,
schools of nursing) manipulate or tolerate policies that unfairly
restrict the opportunities of certain races, cultures, or groups. For
example, at one time, black nurses were not allowed to join the
American Nurses Association (ANA). This policy prevented black
nurses from having a voice in the regulation of nursing practice and
Exploring Transcultural Communication
Because nurses perceive themselves as individuals who regard all people
as equal, most nurses (black and white) will talk about cultural diversity, but
avoid the word racism. Nevertheless, racism exists. For example, in a classic
study by Morgan in 1984, researchers found that Euro-American nursing students
perceived black patients more favorably than black people, and Euro-
American patients as more favorable than any other group.
At the institutional level, white students have been admitted more readily
to schools of nursing than black students. Racism is also a factor in the low
enrollment numbers of black students in baccalaureate nursing programs
compared to 2-year programs. Within the workforce, black nurses have complained
about not being promoted as readily as white nurses (see Chapter 14).
Also, black nurses have had difficulty publishing in Euro-American nursing
Racism will undermine the nursing profession for as long as nurses deny
its existence and refuse to talk about it openly and honestly. In the words of
Evelyn Barbee (1993):
One of the flaws in the profession is an unwillingness to recognize
that racism is endemic in nursing and health care. This unwillingness
results in a lack of discussion about racism and leads to responses
that exacerbate the problem.
Bias and Ethnocentrism
Whatever their cultural background, people have a tendency to be biased
toward their own cultural values, and to feel that their values are right and
the values of others are wrong or not as good. Many people are surprised to
discover that the values and actions they so admire in their own culture may
be looked upon with suspicion by people from other cultures, who are equally
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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
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
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.
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Cultural biases can distort your perception of other people’s values
and behavior, and thus damage your ability to communicate.
To overcome your biases, you must first acknowledge that they
A cultural stereotype is the unsubstantiated assumption that all people of a
certain racial and ethnic group are alike. For example: All Eskimos are
reserved, deliberate, and noncommittal. Certainly, some or even the majority
of Eskimos may be reserved, deliberate, and noncommittal, but it is cultural
CHAPTER 4 Transcultural Communication Stumbling Blocks n 71
stereotyping to state that all Eskimos have these traits. Stereotyping is particularly
destructive when negative traits or characteristics are imposed on all
members of a cultural group. For example, All Native Americans are at risk
While you must avoid negatively stereotyping patients from different cultural
groups, it is nevertheless important to learn about the representative
characteristics of different groups. This knowledge will help to smooth and
ease your interactions with patients from other cultures.
For example, if you know that Eskimos are raised to be reserved and noncommittal,
you will not be offended when Eskimo patients respond to your
assessment questions with silence or monosyllables. Conversely, if you are
aware that Italian patients tend to be more flamboyant as a group, you will
not be surprised when your Italian patients respond to their problems with
dramatic gestures and tears.
To avoid stereotyping, remember that patients are individuals
with unique experiences, and thus may not conform to many (or
any) of the characteristics ascribed to their cultural group. Thus,
some Eskimos may be outgoing and some Italians may be
Cultural blind spot syndrome is a form of stereotyping that is a problem
for many nurses and physicians. Cultural blind spot syndrome is the belief
that “Just because the client looks and behaves much the way you do, you
assume that there are no cultural differences or potential barriers to care”
(Buchwald, 1994). For example, white American nurses may assume that
white American patients believe in the same cultural values as they do. This
assumption is false. As you learned in Chapter 2, white Americans come from
many different ethnocultural backgrounds—Irish, Russian, German, Jewish,
and English to name but a few. In addition, white nurses and patients may
also belong to different subcultures that have different values. For example,
a white male patient of Italian descent who is gay will probably have somewhat
different values than a white Irish-American nurse who is married with
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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.
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 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
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
• 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
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Idioms, Slang, and Street Talk. Sometimes the language barrier—and the
type of interpreter needed—may not fit the conventional mold just discussed.
For example, if you are from a white middle-class background, you may find
yourself at a loss to understand the characteristic terms, idioms, or expressions
used by patients from English-speaking subcultures, be they ghetto
blacks, Appalachian hillfolk, or teenagers fluent only in the latest street slang.
For example, a nursing student from an upper class background failed to
understand the adolescent girls in a clinic until another nurse explained that
poppers, fizzers, and wa-was referred to prescribed medicines.
Black American speech is particularly rich in idioms. In her book Black
Talk: Words and Phrases From the Hood to the Amen Corner, Geneva Smitherman
(1994) explains that the word hood means the neighborhood where a
person has grown up and feels comfortable. The phrase Amen Corner refers
to the corner in a traditional black church where the older church members
(usually women) sit. These women, regarded as the watch dogs of Christ lead
the congregation in Amens.
Some black expressions that you may hear as you work with some black
patients in neighborhood clinics or hospitals have the following meanings
• Bad means excellent or good.
• BMT means black man talking. This term is used to express authority.
• Can’t kill nothing and won’t nothing die means having a difficult
• Get on the good foot means to correct what needs improving.
• Git out my face means stop confronting me.
• Glass house is a drug house.
• Come out of a bag means to behave differently than expected.
• Hard headed is a person who refuses to listen to reason.
• Hoodoo man is a person skilled in voodoo.
• The Nation refers to the Nation of Islam, a black Muslim group.
• Changes are personal problems; “He’s put me through a lot of
• Soul means the essence of life, passion, or emotion.
• What goes around, come around is a proverb that expresses the
black philosophy that what has happened in the past will occur
again, possibly in another form.
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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.
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When there are cultural, behavioral, and language differences
between nurses, patients, and patient’s families, there is a greater
probability that patients will misunderstand nursing care instructions.
To prevent conflicts and misunderstandings, make sure
that the message you send the patient is the same message that the
patient receives. When there is a language barrier, you will need
to work closely with an interpreter.
Another common area of conflict between nurses and patients from
diverse cultures involves the perception of health promotion and disease prevention.
For example, Hispanics—whose culture is based on honor and
pride—may be taught from childhood to bravely accept illness and pain as an
inevitable part of human existence. For this reason, traditional Hispanics may
see no reason to submit to mammograms or vaccinations (Sabatino, 1993). In
the words of the former Surgeon General, Antonia Novello:
Hispanics are fatalistic. We’ve been taught that you live, you suffer,
you die. That’s the way life is. The idea has never been presented
that if you take care of your health, if you go to the doctor early,
you won’t have to suffer pain or discomfort.
Expectations that patients have of nurses and physicians may also lead to
transcultural communication problems. For example, Japanese patients generally
look to their family members for the majority of their care, rather than
to nurses. Even physicians are not in charge; instead they are thought of as
skilled and sympathetic technicians whose job it is to help families cure the
patient (Rothenburger, 1990). Nurses or physicians need to recognize the
importance of the Japanese patient’s family as caregiver, and always communicate
with the family before making any important decisions concerning the
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TESTING YOUR KNOWLEDGE
Circle the correct answer.
1. Racism can be classified as
d. all of the above.
2. The belief that one’s culture and value system is better than that of
another culture is called
3. The statement: “All Asians honor the past” is an example of
d. Cultural Blind Spot Syndrome.
4. A nurse who fails to culturally assess a patient from the same culture is
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.
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A Florida State of Mind
Flrida the state and Florida the state of mind. These are two locations that offer the right fit for nurses in search of the perfect blend of career and lifestyle.
The first thing to consider is your profession. The fact that you chose a career in nursing says a lot about you.
Your dedication to serving others speaks to your selfless character and your giving spirit. But there are so many facets to the whole person that is you, dear nurse reader. And that is why the quality of your after-hours life is just as important as the quality of the time you spend "on the job”. Many nurses find a career in the Sunshine State to be the best of all worlds.
Central Florida boasts some of the country's top-rated Hospitals, recognized over a broad spectrum of healthcare specialties. Professionally, this is a great place to apply and grow your skills.
Central Florida is the perfect location to recharge, refresh and reinvigorate your spirit, while the region's top healthcare systems let you immerse yourself in the type of challenging nursing career that can reward you on a professional and personal level.
The Sunshine State is home to world-class entertainment, miles of beaches for sunbathing, exploration and discovery, and enough sporting, social and cultural outlets to keep your calendar as full as you want it to be.
There are edge-of-your-seat "thrill-tractions," some of the world's greatest golf challenges, and if family entertainment is your cup of tea, central Florida is THE mac-daddy teacup of them all, with Walt Disney World, Sea World, Busch Gardens and Universal Studios all either in your neighborhood, or within day-trip distance. World-class museums, Broadway-quality theaters, antique shops and restaurants to appeal to every conceivable taste, are in abundance throughout the state with unique communities like Lake Wales (where, on "Spook Hill," cars appear to defy the laws of physics), Tarpon Springs (its world-famous Sponge Docks are great for sightseeing, shopping and sampling the incredible array of Greek cuisine), historic Cassadaga, (known for its community of spiritualists), or St. Augustine, the oldest city in North America, visited in 1513 by Ponce de Leon in his search for the Fountain of Youth. And that's just scratching the surface...
You Want Beaches, We've Got World Class Beaches
North, East, South or West, no matter where you are on the Florida peninsula, you're virtually minutes away from great beaches.
In Palm Beach County, to the south, you can enjoy Fort Lauderdale or Miami, or chose the local flavor, smaller crowds and scenic dunes of Delray Beach.
On the Space Coast, on the Atlantic side of Central Florida, Sebastian Inlet offers opportunities to charter a fishing boat or fish from the pier, where impressive catches of snook, redfish and mackerel are common. Sebastian Inlet is also a great spot for nature-watchers. Bottle-nosed dolphins and manatees reward patient sightseers with their sometimes comic antics and serene presence. Annual surfing contests and sea turtle nesting areas bring nature lover and sports enthusiasts back here year after year.
Fort DeSoto State Park is near Tampa, on Florida's Gulf Coast. It boasts 900 acres of bike trails, beaches and nature walks. Regarded for its great shelling, Fort DeSoto State Park also offers pet owners a Leash-free Dog Beach so they can also enjoy the Florida sun with their best friends.
Golf, Fishing and Other Great Reasons to Celebrate Florida Outdoors
Whether you prefer your clubs in a golf bag, in a poker hand, or filled with bright lights and loud music, Florida can satisfy.
The Hard Rock Casino in Tampa offers Texas Hold 'Em, Slots and more games of chance. Golf courses like Isleworth, Bay Hill and the Ginn Reunion Resort, home of the Ginn Open, near Orlando, Calusa Pines in Naples, and Shell Point Gold Club in Fort Myers, are the tip of the golf course iceberg that is Florida. Pro tour-quality links dot the state from coast to coast and all points in between. It is a golfer's paradise where variety is par for the course.
Nightlife, dance clubs, improv comedy, the Daytona 500, jai alai, social and community organizations are all here, and there is enough variety to cater to virtually every taste and orientation.
Factor into this equation no state income tax, close proximity to both the east and west coasts, and prospects for substantial growth, and you have a formula for personal and professional satisfaction without equal.
If you are currently a nurse in Florida, there is a world outside your door for the discovery. If you are considering what next steps you want to take in your professional life, Central Florida may just be everything you've been looking for, and more. Florida is a great state, and a great state of mind.
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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.
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Are You a Filipino Registered Nurse?
Australia is currently one of the best destinations for Filipino registered nurses, not only because the "Registered Nurse” is an occupation in demand in Australia, but also because the opportunities to work in the USA or UK may not be available at this time. This is based on the advice that the USA is currently processing applications which date back to July 2006, and that the UK prefers registered nurses from members of the European Union. There are other work opportunities for nurses to work in the Asian region, however, they do not pay as much as employers in Australia.
First of all, you must be a registered Australian nurse to qualify for a working visa or permanent residence as a registered nurse in Australia.
Working visas to Australia for all occupations was discussed in a separate paper entitled, "Do You Qualify for a Working Visa?" Before you pay a single cent in any “offer for a working visa” you must verify with the Department of Immigration and Citizenship (DIAC) whether your proposed sponsoring employer has been approved as sponsor. You also need to determine whether the proposed position, task and workplace where you will be assigned, satisfy the current migration policy criteria.
Pitfalls of working visas
Many have fallen victim to “recruiters” who claim they are authorised to recruit for positions of Caregiver, Assistant in Nursing (AIN) or Residential Care Officer (RCO). Migration policy has changed over the years and continues to change. At present:
■“Assistant in Nursing” and “caregiver” are not in the list of qualifying occupations for working visa.
■A Residential Care Officer may no longer be assigned to work in nursing homes and care for the aged because, according to a recent case decided by the Policy Section of DIAC in Canberra, it is outside the RCO ASCO definition “ to provide care and supervision for children or disabled persons in group housing or government institutions”.
■A Disability Services Officer (DSO) may likewise no longer be allowed to provide personal care in nursing homes if DIAC is to strictly enforce the DSO ASCO definition” to provide education and community access to people with intellectual, physical, social and emotional disabilities”.
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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
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.
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Permanent Resident Visa Application while working Overseas
If you are currently working as registered nurse in the UK, USA, Ireland, Canada or New Zealand, you may be granted registration without having to undertake an English test and nursing competency test under certain conditions. After you obtain Australian registration you may qualify for permanent residence in Australia under certain conditions while you continue to work in the UK, USA, Ireland, Canada or New Zealand.
If your permanent resident visa is approved before your overseas contract expires,
you can still validate your respective visas by entering Australia with those included in your visa application. You may return to the UK, USA, Ireland, Canada or New Zealand to complete your employment contract the next day and your family members can either remain in Australia, or leave for the Philippines or elsewhere, provided each of you return to live in Australia within 5 years from visa grant.
Which Family Members Can You Bring?
You are allowed to include your entire family (spouse and dependent children below 25 years old) your widowed parent, single aunt or uncle
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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.
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We encounter a group of children coming home from school and they call "foto, por favor,” wanting to get their pictures taken and then laugh as they see their images played back. They do dances for us and stand outside the clinic with an iguana one of the men on our team found. One young boy laughs as it sits upon his arm. They take turns touching and exploring the little creature.
The following day we see many of the same in clinic. People come and are fitted for glasses and glow with huge smiles as they can finally read a book. It is so heartwarming to know we do so little that brings so much joy to these needy people. More Tylenol, anti fungals and antibiotics are dispensed. Many suffer from muscle pains and joint problems from the heavy labor they do, and the heavy rains and sweating promotes athlete's foot and genital fungal conditions. No word is received yet on the little one we sent to the hospital. Tomorrow will be our last day at clinic; hope we receive word then.
Today is our last day of clinic in El Tesoro and I already feel an emptiness creeping in. I smile at the many faces and say a silent prayer for each one. It has been a challenging week in many ways, taking us each to new heights, but it has been so rewarding to know we have made a difference. We have shown the people of El Tesoro that we are trustworthy and respectful of their culture and their ways. We have tried to teach new ways for health care and better health. We have been received well as a people that listen to and care about their loved ones, and for us that is a great achievement.
We receive word in the afternoon our little baby will survive. He is still in the hospital but expected home by the weekend. We all rejoice in that news. Even if there were nothing else the during the trip that was noteworthy, intervening in that little ones life and sending him off for the care his parents did not understand he needed, made it all worth it.
We are honored at lunch with the town president bringing in bottles of warm Pepsi for us to have with our meal. We each graciously accept our pop as they smile as we receive them. They give Andrew a large turtle they caught as a gift for his sons. We sit and eat our last meal together and realize the bond we have made. As the day ends, we tear down our little pharmacy, pack up our medical equipment, and say our goodbyes. Where there had been handshakes on Monday, we now give hugs. People are in the streets to wave us good bye, and as we leave, music plays from the local church as a farewell to their North American friends. We head home tired and elated as yet another rain begins.
Our total patient count for all clinics was 500 patients, some receiving needed medications, some receiving needed glasses, one receiving a new chance at life. It is hard to say farewell, but our work is completed. We will all go our separate ways, changed from the way we arrived, having had a glimpse into a world filled with poverty, grace and love given for the travelers that came to see them. Again, Guatemala, I feel your love and the pull on my heart to return once again another year.
I arrived back home in the United States, tired and weary but feeling a sense of completeness for how I had been able to use my God-given skills and talents as a nurse. It took me several days to re-acclimate to being home; I found myself hesitant to drink water from the faucet and not a bottle, or I would forget that I was using a white porcelain toilet and that it was okay to flush the paper.
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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.
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Nurse in Canada
Have you ever thought about nursing outside of your own country? If so, nursing in Canada may represent a great opportunity. NurseTogether contributor Sue Heacock RN, MBA, COHN-S provides information on the requirements to work there.
Here are some interesting facts about nursing in Canada:
■Canada's health care system has been publicly funded for 40 years.
■Registration of nurses in Canada is not done on a national level. To practice, you must be licensed or registered in the province or territory you will practice in.
■Taking the Canadian Registered Nurses Examination (CRNE) is part of the registration/ licensure process in all provinces other than Quebec.
What are the employment prospects in Canada?
■Like the United States, Canada has a nursing shortage. It is estimated that there will be a shortage of 22,000 to 35,000 nurses over the next 10 years in Canada.
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■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.
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■You can work and be considered a "Registered Nurse" on an interim permit. The interim permit is obtained from the nurses association in the particular province you are going to work as a nurse. The interim permit has a condition attached that you will take and pass the CRNE within a specific period of time. This time period, which varies from province to province, is between 4-8 months after arrival to take the exam for the first time. Should you not pass the exam, you have two retake opportunities within a specified time period. Again, this varies from province to province.
■You must have a work visa to go along with your interim permit.
When you pass the CRNE, you are fully registered and no longer considered "interim".
■You must apply directly to individual employers. The Canadian Hospital Association publishes a directory listing addresses for hospitals, health care centers, nursing homes, health associations, and health education programs. The directory may be available though a public library or the Canadian Consulate.
What is my status upon arrival in Canada to work?
■You and any family members issued visas are considered permanent residents. This status entitles you to all the rights of any other Canadian (except the rights to vote and run for public office).
■After three years in country you qualify for your Canadian passport.
What are the costs associated with gaining my Canadian nursing registration?
■The registration fee for the nursing board is approximately 200 Canadian dollars.
■The fee for the CRNE Exam is approximately 500 Canadian dollars.
Who do I contact for more information?
■Contact the Canadian Nurses Association for further information about nursing in Canada.
■You can also contact the "College of Nursing" in the particular province you wish to practice in to obtain further information.
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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!
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Nursing in Australia – A Great Work Life Balance
Thousands of nurses migrate every year looking for career development, a new challenge and the novelty of travel, variety and adventure. Australia has always been an attractive destination for both migrant nurses looking for a change in lifestyle, as well as for travellers just seeking nursing work to fund their journey. The tourist season in Australia runs from December to March, when the country is at its warmest. This is also a popular time for nurses wanting to go to Australia to stay and work on a working holiday visa. Understandably, nurses tend to head for the sun loving beach sprinkled east coast on the ‘Sydney to Cairns route’, working and travelling along the way, but overseas nurses can be found all over Australia any time of the year. They often choose longer stay visas, some even deciding to permanently migrate to Australia.
The range of nursing roles in Australia is diverse and this is due to the size of the country, its geography and the environment and the spread of the population. A nurse may need to fly out to run a clinic in a remote area to provide much needed nursing care in the ‘outback’, or one might choose to become a clinic nurse on a remote island in the Whitsundays. There are a variety of roles aside from the more usual hospital-based positions, including jobs in: community health, acute care, homeless teams, remote area nursing, flight nursing, outback placements, liaison services and nurse-run clinics, providing roles for everyone from Nurse Practitioners to general practice nurses.
As newcomers to the Australian health service, nurses face a number of challenges as they learn about new practices and frameworks, and behaviours that may be significantly different from the health care background they are from. Those that aren’t put off by the initial challenges do adapt to the environment and are successful in no time at all.
Nursing in Australia has many similarities to other westernised countries. Many who have made the leap also say that the experiences gained working in another country only served to broaden the scope of their nursing practice, even accelerating their career path and future job prospects.
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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.
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Nursing in Pakistan: Honorable or a Disgrace?
“You want to become a nurse? Why would you want to go into such a demeaning profession?” asked my uncle from Pakistan, who is a pathologist. That is the reaction I received from many family members that live there. I couldn’t help but wonder...why is nursing so disrespected in my country?
Pakistan is a third-world developing country and is a patriarchal society where men are the authority figures. Families play a big role in the career choice of women. In that society, nursing is considered to be a disrespectful profession. It holds absolutely no prestigious value and is regarded as a blue-collar profession. Most of the time, nursing is not allowed to be a career option for many middle and upper-class families. When it comes to nursing, many apprehensions exist, but the biggest one is coming into contact with the opposite sex. This aspect is completely disregarded when a woman chooses to become a doctor. Becoming a medical doctor is one of the most prestigious professions in the country. If you are a doctor, you will get respect and status, as a nurse you will not.
This view of nursing has caused Pakistan to face a huge shortage of nurses. The nurse to patient ratio that exists in Pakistan is 1:3175; the same ratio in the US is 1:102 (Hasnain, 2010). This has led to a plethora of problems. Since there is discouragement to enter the profession, the enrollment in nursing schools is extremely low. There is an alarming increase in the number of women that leave the nursing profession early on. This is due to the harassment they receive from patients, family members, and other health professionals in the home and work environment. One nurse who works at a prestigious hospital in Pakistan stated, “Harassment is a major issue, and in many cases no action is taken against the harasser, resulting in the feeling of insecurity for the victim.” Due to the lawlessness and corruption of the country, there is no justice for these women. On top of all this, the salary for a nurse in Pakistan is incredibly low. The average daily laborer in Pakistan earns $110-$160 per month, servants and the poor earn even less. A fresh medical doctor upon graduating makes approximately $700+ per month and the average nurse makes around $80-$190 per month. It is obvious why families do not want their women to enter this field; they have to deal with extremely low wages, a poor working environment, staffing issues, and harassment. The ones that do enjoy nursing often receive better opportunities in other countries, so they leave
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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.
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Cultural Competency in the Nursing Profession
Creating an environment that embraces diversity and equality not only attracts the most qualified nursing candidates, but an inclusive environment also helps to assure that the standards of nursing care include “cultural competency.” Cultural differences can affect patient assessment, teaching and patient outcomes, as well as overall patient compliance.
Lack of cultural competence is oftentimes a barrier to effective communication amongst interdisciplinary teams, which can often trickle down to patients and their families.
With the increase in global mobility of people, the patient population has become more ethnically diverse, while the nursing forces remain virtually unchanged. Nursing staff work with patients from different cultural backgrounds. Consequently, one of the challenges facing nurses is the provision of care to culturally diverse patients. Hospitals and health care agencies must accommodate these needs by initiating diversity management and leadership practices.
According to Cross, T., Bazron, B., Dennis, K., and Isaacs, M. (1989); these are the five essential elements that contribute to an institutions ability to become more culturally competent:
■Having the capacity for cultural self-assessment.
■Being conscious of the dynamics inherent when cultures interact.
■Having institutionalized cultural knowledge.
■Having developed adaptations of service delivery reflecting an understanding of cultural diversity.
A culturally competent organization incorporates these elements in the structures, policies and services it provides, and should be a part of its overall vision.
From all levels, the nursing workforce should reflect the diversity of the population that it serves. A more diverse workforce will push for better care of underserved groups. It’s important to note that that diversity, inclusion, and cultural awareness isn't just about race or ethnicity. We must always keep in mind socioeconomic status, gender, and disability in our awareness.
Becoming more inclusive is a shared responsibility between nurses and health care agencies. Becoming an “agent of change” within your facility can inspire awareness and affect attitudes and perceptions amongst your peers.