The Effects of Ethnic Differences Among International Nursing Students

thesis-statement-writing-help-300x223I made a thesis 3 months ago about “The Effects of Ethnic Differences Among International Nursing Students”. This is a simple research that I made it myself. I hope you find it amusing and help you to understand about the differences in cultures, other categories in society, and also what are the pros and cons.

 Enjoy reading it 🙂

 

CHAPTER 1

1.1 INTRODUCTION:

                Nursing students are extensively taught how to be compassionate, culturally sensitive, recognized and present broadminded in others, but seldom educated in how appropriately care for others and for themselves. Nursing students experience stressors that differ from students in other disciplines due to the nature of the programs and profession. The increasing diversity of the Trinity University of Asia is an evidenced by a recent report predicting that several years ago, racial and ethnic minorities will make up over half of the student population in the university. A culturally diverse workforce in nursing student is critically needed to meet the health care needs of this increasingly diverse population.

Nursing students taught how to provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent, and resolve conflicts and complaints in the academic of school and others. Nursing students broaden their understanding of the world by learning about other people’s world views, which determines how people perceive others, how they interact and relate to reality, how they process information.

            International nursing students constitute an increasingly relevant and important source of diversity in college/ university campuses. Attending a school enrolling substantial numbers of international students may advantage Filipino students in the marketplace, to the extent that the experience increases their culturally sensitivities and well-rounded in working with people from different backgrounds.

            Filipino society is more a developing country now that at any previous time. It is no surprise, then, that knowledgeable observers both inside and outside the academy say that an important goal of higher education is to equip culturally competent individuals with the ability to work effectively with people from different backgrounds. Up-and-coming approaches include creating learning environments that benefit and value diversity, as well as intentionally exposing students to multiple backgrounds and sometimes competing perspectives that challenge previously unexamined assumptions. Such challenges when imbedded in an appropriate pedagogy, can promote high levels of intellectual and personal growth and development. Diversity in college/ university campuses is not an idealistic goal; it is essential in order for nursing students to learn how to survive and work effectively with others who differ from themselves.

            Clinical experience was identified to be cause of ethical minorities. Students reported that lack of adequate support in the clinical setting and shortage of timely feedback regarding clinical skill sets contributed to both stress and anxiety levels. Relationships with school faculty and staff and academic concerns were also identified as factors and stressors to nursing students. Students also reported that what was taught in the classroom (Theoretical Foundations of Nursing) and in theory differed from what is seen in the clinical setting, identifying this as a source of ethical background issues. This cause for cultural insensitive or discrimination is one of the potentially exclusive to nursing.

            Cultural competency is dynamic and developmental, thus taking time to evolve as a newly international nursing student. A variety of cultural competency exist. One suggests that the student’s nurses see themselves as “becoming” rather than being culturally competent because culturally competency is developmental. Ethical differences among international nursing students frequently differ within a single social group or a group of student nurses. For an individual, nursing students, faculty members, and staff of the nursing school team alike, culture is a process through which ordinary activities such as greeting another person or selecting a school-mate take on an emotional tone and moral meaning beyond that which appears on the surface. Realize the need to develop cultural interventions and assessment skills that will allow to a successfully negotiate the various world views present in encounters with other people and different ethnicity. Most important, the core of this negotiation is compassionate care.

            This study explores the incentive offering for international nursing student experiences and the reasons students choose to participate. Students should prepare by learning cultural humility rather than cultural competency, and they should be more open-minded and oriented to the ethical responsibility implicit in caring for those in developing countries. Programs that are provide these experiences need to be evolve with an eye sustainability so the lives of those receiving care will be enriched after they meet the goal.

            Recruiting and retaining underrepresented ethical international nursing students continues to be an important component of this process but remains challenge for the nursing education community. Saint Luke’s College of Nursing agree that increasing the racial and ethnic diversity of international nursing students in Trinity University of Asia nursing programs is a high priority. By increasing recruitment and improvement retention and graduation rates of minority nursing students, nursing programs could facilitate increased ethical representation in the nursing school.

1.2 STATEMENT OF THE PROBLEM:

            This research aimed to assess the knowledge, behavior and practices of the ethical differences. A report of study encountered by international nursing students in their everyday routine or practices in Trinity University of Asia- Saint Luke’s College of Nursing.

Student Questionnaire

Instructions: Based on your personal experience, rate the question from 1 to 5 by checking.

#1 being I AGREE, #3 being NEUTRAL and #5 being STRONGLY DISAGREE.

  1. My initial experience in the Philippines as an international nursing student was a culture shock.
  2. When I first arrived, Filipinos were welcoming and understanding of my ethnic background.
  3. I made friends easily.
  4. My initial experience about the Philippines has changed.
  5. My teachers understood and respected the fact that I came from a different country.
  6. My friends and my teachers often excluded me from certain academic situations.
  7. On my nursing duties, my patients treated me the same as they treated the local student nurses.
  8. I do not regret coming to the Philippines.

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CHAPTER 2: RELATED LITERATURES

 2.1 ETHNIC DIFFERENCES:

An ethnic group or ethnicity is a category of people who identify with each other based on similarities such as common ancestral, language, social, cultural or national experiences. Unlike other social groups (wealth, age, hobbies), ethnicity is often an inherited status based on the society in which one lives. In some cases, it can be adopted if a person moves into another society. Membership of an ethnic group tends to be defined by a shared cultural heritage, ancestry, origin myth, history, homeland, language or dialect, symbolic systems such as religion, mythology and ritual, cuisine, dressing style, art, and physical appearance.

Race VS. Ethnicity:

            Race is associated with component of personal identity, whereas ethnicity is associated with culture. Race is a potent social reality and is selected by individual respondents from specified categories. Such as self-identification, social categorization and racial classifications diverge from strict classification by descent.

            Ethnicity is similar in concept to race. But while races have often been distinguished in the basis of physical characteristics (for example, skin color). Ethnicity is the term for the culture of people in a given geographic region, including language, heritage, ancestry, and so on.

Multi-Ethnicity:

Multi-ethnic can be a person which his or her mother is American and father is Brazilian, therefore, their nationality is half-American and half-Brazilian. Multi-ethic states can be the result of two opposite events, either the recent creation of state borders at variance with traditional tribal territories, or the recent immigration of ethnic minorities into a former nation state. Examples for the first case are found throughout Africa, where countries created during decolonization inherited arbitrary colonial borders, but also in European countries such as Belgium or United Kingdom. Examples for the second case are countries such as Germany or the Netherlands, which were ethnically homogeneous when they attained statehood but have received significant immigration during the second half of the 20th century. States such as the United Kingdom, France and Switzerland comprised distinct ethnic groups from their formation and have likewise experienced substantial immigration, resulting in what has been termed “multicultural” societies especially in large cities.

Culture Encounter:

A cultural encounter is an intervention that involves directly interacting with other different ethnicity from culturally diverse backgrounds. The use of caring, and culturally congruent relationship will lessen the likelihood of conflict when you engage in such encounters. A cultural encounter enables new forms of community and collective identity between you and others. Ethnic differences create a wide variety of responses and to send and receive both verbal and nonverbal communication accurately and appropriately. Interacting with other international nursing students from culturally diverse backgrounds in order to validate, refine and modify existing values, beliefs and develop cultural desire, awareness, skills and knowledge.

Research and study materials are organized into two sections:

  • an overview of educational, social and cultural impacts
  • a description and analysis of strategies that have been used to promote internationalization and increase intercultural understanding.

The Differences Between the Local and International Nursing Students:

  • Local or domestic nursing students are laid-back, quiet, easy, and timid; whereas international nursing students are more aggressive, lively, persistent and sometimes obnoxious.
  • In results of the research converge to indicate that the amount of cross-national interaction is generally low, that international nursing students expect and desire greater contact, and that interaction with domestic peers is generally associated with psychological, social and academic benefits for the international nursing student.
  • Local or domestic nursing students hold relatively favourable perceptions of international students, most investigations have concluded that domestic students are largely uninterested in initiating contact with their international peers.
  • International nursing students are eager to initiate to advance learning and new challenges.
  • International nursing students have a good and sarcastic sense of humor than local students. Although studies converge in the finding that the incidence of intercultural interactions is low, greater contact is expected and desired by international students.

Impact in the classroom:

The possible of international nursing students to change both the content and the process of education has received considerable attention in the literature where it has been argued that they bring an international perspective to classroom discussions and that they challenge and encourage teachers to consider new methods of instruction that are more consistent with their previous learning experiences. For example, teacher is speaking Tagalog in the class and there are at least two or three international students. Although there is an extensive literature on cross-cultural differences in educational expectations and practices and considerable research on cross-cultural differences in student behaviors, there has been little to no direct investigation of how these impact on the international classroom. Evidence suggests that for the most part educators (particularly those at all level) make few, if any, changes in either the process or content of academic activities. Clearly this is an area that deserves further attention.

Impact on the school institutions:

The positive and negative consequences of an increased international nursing students have been studied in a limited amount of research has been undertaken in the area. Benefits have been largely framed in terms of internationalizing educational environments while costs have been linked to heavy demands put on academic support services. In the first instance discussions are often rhetorical and infrequently based on empirical evidence; however, there is some suggestion that increasing cultural awareness may result from the presence of international nursing students. In the latter instance, research is available, though patchy, and largely limited to tertiary institutions. Studies generally find that international nursing students experience more problems than local nursing students and in some circumstances that they make greater use of health services and academic situations. The overall usage of support services is still relatively low, however, and no evidence has been located that indicates support services are strained by international students, at least those in tertiary institutions.

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Impact in the community/ outside the campus:

There is research that can provide some insight into the relationship between international nursing students and members of the host culture. These include studies of perceived discrimination and research on home stays. There are also some descriptive writings about community outreach programmed although these are rarely evaluated. The data that are available are uncertain as to whether international nursing students experience greater difficulty outside the campus, the more protective environments of their learning institutions. Very little is known about the integration of international nursing students into the larger community although some data suggest that home stays are a source of stress for international nursing students. Community outreach programmed have been developed and reported on in an ad hoc fashion, but systematic evaluations of these initiatives have not generally been undertaken.

Effects of ethnicity:

It is important to try to understand where and how ethnic differences impact on delivering the health cultural inequalities are to be reduced across the whole population. Ethnicity may impact on physiological need, health care need and access to it at many levels, acting through factors such as:

  • Differences in service uptake.
  • Communication issues.
  • Culture and attitudes.
  • Socio-economic factors.
  • Differences in disease prevalence.
  • These differences affect access to services and act as barriers to good culture care.

Communication issues: Language barriers

Academic provider and nursing students need to be able to communicate as freely as possible. In the Philippines, the clear majority of healthcare is delivered in the Tagalog and English language; amongst ethnic minority groups this may not be the first language or even a language of fluency. It is sometimes necessary to use interpreters. This can challenge the provision of the best care:

  • Patient confidentiality can be compromised.
  • Engagement and empathy may be harder for health professionals to communicate and for patients to recognize.
  • Interpretation or translation may not be faithful to the patient’s account or meaning.
  • Translation takes time and this may lead to superficial consulting.
  • Translation may cause embarrassment (for example, between parent and child).
  • There can be additional cost involved.

Additional problems of communication include:

  • Lack of interpreters and uncertainty over what language the patient speaks.
  • Lack of a shared understanding of academic issues and health issues.
  • Interpretation problems.
  • Difference in understanding of health, disease, and treatment.
  • Different expectations.
  • Unwilling to talk freely (for example: due to interpreter, due to fears of persecution).
  • Lack of time for complex problems in the normal time framed
  • Extra time needed to consult with an interpreter.

It is the responsibility of academic professionals to ensure that consultations are understood, and should do their best to use effective, professional translation services. It is good practice to compile a resource pack listing interpreter services which may be available locally.

2.2 ETHNIC BACKGROUNDS:

            Ethnic background means the person’s ethnic origins tends to be defined by a homeland, shared cultural heritage, religious group or their ancestors came from. Examples of different ethnic backgrounds include: Native American, Filipino, Persians, British, Jewish, Muslim, and many more. People may identify themselves with more than one ethnic group, although to allow data to be collected and analyzed on a large scale, ethnicity is often treated as a fixed characteristic.

Some ethnic difficulties include, but are not limited to, language difficulties, difficulties adjusting to the academic culture, misunderstanding, and complications in communication with faculty and peers; stress, anxiety, feeling of isolation, social experiences, culture shock, financial hardships, lack of appropriate accommodation, isolation and loneliness, and any adaption in their daily life. Many international students also faced the challenges from professors. For example, examined six international nursing students’ struggles in interacting with native speakers using ethnographic methods. Findings from this study showed that international students had to pretend to understand the conversational contents exchanged with native English speakers due to their limited language proficiency. At times, a low English proficiency level would result in a negative impression from a professor because the professor perceived that the international student was not well-prepared for class.

            In school of nursing, we have many international students came from different countries like America, Iran, Canada, Dubai and Nigeria. Each individual has different experiences and characteristic backgrounds.

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RESPONDENT’S DEMOGRAPHIC PROFILE:

NAME NATIONALITY YEAR LEVEL
Cydair Manansala British-Filipino 2nd year
Zim Eze Nigerian 3rd year
Safoura Tavakoli Persian 3rd year
Favour Ben Rabibi Nigerian 2nd year
Joy Heart Avong Nigerian 4th year
Blessing Chizimuzo Uzodimma Nigerian 3rd year
Chansong Kim Korean 4th year
April Mae Labrador (myself) Filipino-American 1st year

British-Filipino Ethnic Background:

  • Cydair Manansala- she is a well-rounded person and goal oriented. Her mother is pure Filipino and father is pure British. She is half- Filipino and half- British. She is from United Kingdom.

Nigerian Ethnic Background:

  • Favour Ben Rabibi- she is sweet and optimistic young lady. She is from Cross River State, Nigeria
  • Joy Heart Avong- she is very sweet. She is from Kaduna State, Nigeria; came from A’jemma tribe.
  • Blessing Chizimuzo Uzodimma- she is lovely lady. She is from Abuja, Nigeria.
  • Zim Eze- he is energetic and talented. He is from Nigeria.

Persian Ethnic Background:

  • Safoura Tavakoli- she is feisty and introvert. She came from Islamic country, Iran.

Korean Ethnic Background:

  • Chansong Kim- she is enthusiastic and friendly. She is from Seoul, South Korea.

Filipino-American Ethnic Background:

  • April Mae Labrador (myself)- I am multi-ethnicity. My mother is half-Spanish and my father is pure Filipino, therefore, I am 75% Filipino and 25% Spanish. I came from Orlando, Florida, USA.

 

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CHAPTER 3: METHODOLOGY

Research Design:

Qualitative case study approach was adopted because the purpose of this study was to understand in depth the issue of adaptation faced by international nursing students studying in a city in a central part of the Philippines island. Case study is the most applicable qualitative research method for the present study because it “concentrates on experiential knowledge of the case and close attention to the influence of its social, cultural, and other contexts”.

Data Collection:

Interview sessions were held at the Starbucks coffee shop and in the campus. Participants are very busy, some of them were interviewed through phone calls. Each interview lasted 15 minutes. Interviews were audiotaped or used survey questionnaire. The interview questions are related to international nursing students’ experiences since they came to study in the Philippines. We adopted the semi structured interview in this study; thus, each participant replied to the same research questions, and we can explore more information based on their responses. The rationale of using this approach is to understand the respondent’s point of view rather than generalize about behavior. The value of this type of interview allowed for opportunities to explore areas I had not previously considered. Interviews were conducted mainly in English. Interviews were transcribed immediately afterwards. Researcher’s reflection and notes were also prepared to compare with interview transcripts.

Date Analysis:

            Process of research and modeling data with the goal of discovering useful information, suggesting conclusions, and supporting decision-making.

Participants:

Eight participants were identified as international nursing students (including myself) who were studying in undergraduate and graduate programs in Trinity University of Asia- Saint Luke’s College of Nursing. Using convenience sampling, representativeness was limited in this study; however, to generate more representativeness some demographic variables were controlled. For example, participants were selected from different countries, such as, UK, USA, South Korea, Iran, and Nigeria.

Having a similar background helped researchers to establish the relationship with our participants. Based on the friendship with all participants, we consider ourselves as researchers from an insider perspective. We share similar identity, language, and experiential base with the participants. This insider role also allowed me to a more rapid and complete acceptance on each participant. The participants were typically more open with me in allowing for a greater depth of data to be gathered. Throughout my study, I have developed a close friendship with each participant. Demographics of the eight international nursing students and they were selected based on these criteria. (1) They enrolled in an undergraduate or graduate program in a university in the US. (2) The length of residence was less than 5 years in the Philippines. The length of residence may also influence the adjustment difficulties, so this study focused on students who newly arrived in this country. (3) Students had experiences taking language classes.

CHAPTER 4: PRESENTATION OF FINDINGS

 This chapter comprises the results and interpretation of the quantitative data collected from the research instruments given to the respondents.

4.1 RESPONDENT’S RESULT’S DISCUSSION:

  • The result show more than 50% (Agree) of respondent’s regard their first initial experience moving in to the Philippines as international nursing student is a culture shock. Most of their comments were they feel scared, worried, language barriers and stereotyping.
  • The result show more than 37.50% (Somewhat Disagree) of respondent’s regard their experience of not regretting being in the Philippines. Because, some of them learned how to speak different dialects, adapt the Filipino culture, graduating in school as an international nursing students, and able to enjoy the community both inside and outside the campus.
  • The result show more than 37.50% (Somewhat Agree) of respondent’s regard their experience of being treated differently in a positive way. Some of the made friends easily, had a good interpersonal and social relationship with different cultures, build rapport between the nursing students and faculty members, some of them feel recognize and avoid making assumptions.

4.2 THEORIES:

            The theory of this thesis topic is a significance of the theory of Madeleine Leininger, “Culture Care Diversity and Universality”. In the 1960s, she first begun to use the terms “transcultural nursing and ethno-nursing”. The concepts and their interrelationships provide the basis for the Sunrise Model of this theory. It presents a cognitive model, which when viewed from top down, moves from the cultural and social structure through individuals, families, groups, communities, and institutions in generic, professional, and nursing care systems to nursing care decisions and actions that are cultural care preserving, accommodating, and repatterning. The model also indicates care patterns, social sensitivity, and processes may be universal or diverse. Universal care indicates care patterns, values, beliefs, and behaviors that are common across cultures. Cultural care diversities represent those patterns and processes that are unique or specific to an individual, family, or cultural group.

            The Effects of Ethnic Differences among International Nursing Students research has been reported about cultures and subcultures experiences in the campuses. It provides direction on how to learn about the ethical differences from another and how to exhibit caring in relation to another’s cultural values. The theory has been used to guide, research, education, and nursing practice about and with a wide variety of cultural awareness.

The theory was initiated from clinical experiences recognizing that culture, a wholistic concept, was the missing link in nursing knowledge and practice. Through a creative process of concept explication, reformulation, and resynthesize, the theory of cultural care was set forth as a guide for the development of nursing knowledge. The concept of culture was derived from anthropology and the concept of care was derived from nursing.

Cultural congruent (nursing) care is defined as assistive, supportive, facilitative, or enabling acts or decisions that are tailor-made to fit with individual, group, or institutional cultural values, beliefs, and lifeways to provide or support meaningful, beneficial, and satisfying health care, or well-being services.

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4.3 DATA ANALYSIS (My own response):

            Based in my own experienced and understanding. Moving to a different country can be very a cultural shock. Some people may experience of feeling worried, discomfort, lack of confidence, anxiety, and emotional stress. Going back in the Philippines is very difficult and depressing because you missed your own friends, your lifestyle, and your most favorite things to do.

The lack of contact is disappointing given the desire for interaction expressed by international nursing students, the general awareness of other nationals as friendly that benefits of cultural interactions. There is strong evidence that greater contact with local students is associated with psychological, social, and academic adaptation. Having local friends and spending more free time with them are related to lower stress levels, less depression, greater life satisfaction, happiness and self-esteem. Satisfaction with other ethnic relations and with one’s social support network more broadly is also related to enhanced psychological well-being.

Research has shown that the presence of international nursing students, even in large numbers, is insufficient to promote cultural interactions, to establish intercultural friendships and to result in cultural diverse understanding. Rather, situations must be structured to foster these processes. Studies have also revealed that students, both local and international, perceive it is the responsibility of educational institutions to increase and enhance cultural interactions. Three strategies that have been used, evaluated, and proven to foster positive intercultural perceptions and relations are peer-pairing, cooperative learning and residential programmed.

Negative Experiences:

            When I first moved in the Philippines, my expectations were to create more friends but I did not. For most overseas students, they lack friends. Having true friends and somewhat similar like you is very rare. At first, I felt alone and depressed because I missed all my friends, making money, and working. Going back to school is a little difficult especially for my age (31 years old). It takes time to process and relearning all the experiences being as a Filipino-American nursing students. Back home in Florida, punctuality is very important but since I moved in the Philippines, I have learned to be more patient and adapt the culture. Self-disclosure may be difficult to others. Stress working with other local nursing students to address some academic problems and social relationship.

Positive Experiences:

            As time goes by, I made new friends inside and outside the campus. I kept myself preoccupied and being proactive by traveling different places, going for exercise, and spending more quality time with family. I have also learned how to be more sensitive and tried different exotic foods. Connection on social level is very helpful. Seek out and understand individual’s behavior. Being flexible regarding issues of control.

Positive outcomes include increased cultural knowledge, more interactions, and a greater number of networking through making new friendships. Those engaged in evaluations of such programmed have noted that their success depends upon the integration of intercultural activities across all areas of student life, skilled and committed support persons to implement the programmed and a high level of involvement from participating students.

            Interpersonal communication is essential for effective learning action inside and outside the campus. Develop a trusting relationship, express a level of caring, and communicate clearly with others and families. Good communication keeps people informed and engaged in decision making, provides cultural respect, and supports for those who have challenging emotional needs.

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 CHAPTER 5: CONCLUSION AND ASSUMPTION

Studying and living in overseas appears to be a positive experience for undergraduate international nursing students, with high levels of positive feelings and satisfaction and low levels of stress, physical complaints, psychological problems, and relationship issues, particularly when compared with local university nursing students. Though issues related to accommodation, finance, language, culture, and distance from home, family, and friends, may pose initial problems in adaptation, most of the students appeared to have adapted quite well after the initial transitional period. Besides the use of good coping skills and a good network of social support, such adaptation was facilitated by the good weather, local culture and history, the hospitality of the Filipino people, the widespread use of English dialect, access of services and facilities at Trinity University of Asia- Saint Luke’s College of Nursing, and friendly staff amongst others. Overall, undergraduate international nursing students in Trinity University of Asia reported being happy and satisfied with their decision to come to study in the Philippines and felt that this experience helped them both on a professional and a personal level. This study however, is based on a relatively small sample of students and the findings and conclusions need to be treated with caution. Due to the small sample size, it was also not always possible to compare the means of the various dependent variables by age, gender, language, or country of origin. The participants were mainly transfer and exchange undergraduate nursing students. A larger scale, more comprehensive study of the academic and social experience of all international nursing students at the Trinity University of Asia, including qualitative data, would provide a more robust portrait of studying and living in the Philippines, and consequently lead to an improvement of the services and facilities for international nursing students at the university.

Using qualitative research methods, this research explored international nursing students’ academic, social, and cultural adaption. To maintain the generalization, this study report includes international students from different countries. The findings indicated that international nursing students often face a series of transitional dilemma when they come to study in the Philippines at universities and colleges. On the other hand, these challenges also motivate international nursing students to develop strategies to solve problems. When they become autonomous learners, they develop new learning strategies to deal with difficulties. The adjustment and adaption takes time and effort, and it needs a lot of support from different aspects. The university is usually the first place where resources can be provided; thus, the university needs to focus on the challenges faced by international nursing students and provide more adequate support for them.

The goal of ethnical differences among international nursing student is to obtain accurate information from everyone that allows you to formulate a mutually acceptable and cultural relevant of this study report. Nursing students need skills to perform a proper cultural assessment of individuals, groups, and communities as to their cultural beliefs, values, and practices. Using cultural care will help the nursing students better understand the complex factors that influence their cultural world view. It helps to assess, interpret, and describe the needs that are significant to their care. Understanding the ethnic mix of a population can improve healthcare delivery by helping to focus resources such as screening programmed, education and resource allocation.

As an international nursing students, we can bridge cultural gaps to provide meaningful and supportive care pertaining to interaction such as social groups, cultural awareness, improving health literacy, promote teaching and cultural desire in communicating others. Acknowledge and discuss cultural differences and similarities, spiritual and cultural may help lessen depression and anxiety. Having interpersonal relationship also connect on a personal and social level. Helps to overcome barriers by providing resources and availability for help. Being a good student nurse, we must learn how to be more open-minded and more cultural sensitive who are different from us. It shows empathy, cultured, respect, and moral values. Forming conclusions about the needs of an international nursing students and local nursing students requires diverse ethnic background, integrated cultural practices and an outreach programmed.

Ethnic differences will teach you that the unexpected is rarely as bad as you think. Often, they are just small obstacles that can easily be overcome. Eventually, you become accustomed to uncertainty and the unexpected challenges that come your way. In fact, you will start embracing them and learn how to overcome those challenges. Nothing is more eye-opening than surrounding yourself with another culture that chooses to live their life completely different from yours.

CHAPTER 6: BIBLIOGRAPHY/ REFERENCES

  1. Thesis: Trinity University of Asia- Saint Luke’s College of Nursing

“Assessment of the Knowledge, Attitude, and Practices of Traffic Enforces in their Occupational Health Hazards”

Batch Leviticus: 3NU01- Group #1

July 2016

  1. “A Comparison of International Student and American Student Engagement in Effective Educational Practices”, by Chun-Mei Zhao (Research Analyst)
  2. Ethical outline and guidelines- ncbi.nlm.nih.gov
  3. Ethical differences and background- wikipedia.com
  4. “Fundamentals of Nursing”, by Potter and Perry (9th Edition-Book)
  5. “Nursing Theories”, by Julia B. George, RN, PhD (5th Edition-Book)

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