PROGRAM PROPOSAL
Transcultural Nursing in the Middle East
A Program Proposal
A Paper Submitted
In Partial Fulfillment of the Requirements in
ADVANCED ADULT HEALTH NURSING I
Submitted by:
Roger Dela Pena
Kassandra Lizze T. Cruz
Christian John M. Bingayan
Submitted to:
Melanie Reboldera-Adolfo, RN, MSN
Graduate School
St. Paul University Philippines
July 15, 2015
PROGRAM PROPOSAL
I.
Background/Situational Analysis
In an ever-changing world, society tends to become increasingly diverse. With constant
internal and environmental stimuli, such behaviors, values, beliefs and norms develop overtime
which creates a mark in the mind of every individual and is observed through social practices,
religious structures and artistic expression. The end result of such change is what we recognize
now as culture. Culture directs an individual thinking, doing and being. Within the context of
nursing practice, cultural backgrounds can influence views on healthcare and healthcare
outcomes. Due to the recurrent concerns regarding the challenges encountered in the care for
culturally diverse patients, transcultural care has become an important aspect of health care.
Nowadays, the goal of the medical system is to provide optimal and holistic care for all patients
to be culturally competent is an ingredient in order to accomplish quality care and health
outcomes. The need for clinicians to become more sensitive to cultural differences and gain an
understanding of transcultural concept has been repeatedly stressed by Leininger (1988). The
practice of transcultural nursing addresses the cultural dynamics that influences the nurse client
relationship. Because of its focus on this specific aspect of nursing a theory was needed to study
and explain outcomes of this type of care.
With fewer jobs and less opportunities for nurses in the Philippines, many nurses have the
desire to work overseas where the salary is higher and they feel compensated for their hard work.
Some nurses decided to move to other countries to work. Nurses who wished to practice their
profession in other countries are unfortunately forced to stay behind due to regression. Middle
East countries such as Saudi Arabia and United Arab Emirates are also popular destinations for
nurses. Some chose to work in these countries because they do not want to take the licensure and
English competency exams needed to be able to work in the US, Canada and the United
PROGRAM PROPOSAL
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.
The World Health Organization (W.H.O.) has cited the Philippines as the largest exporter
of nurses to foreign countries. Filipino nurses can be found everywhere around the world -- in
the big cities of United States and Ireland, in urbanized centers of Europe and Asia, in the far
corners of Africa and South America, in remote desert clinics and state-of-the-art hospitals in the
Middle East. In 2013, Saudi Arabia was the top destination of Filipinos with 8513 nurses
deployed. The second top destination, UAE lags behind with the only a mere 473 nurses
deployed according from the POEA. Neighboring countries such as Oman, Qatar, Kuwait and
Bahrain have immensely increased its demand for health facilities as well as the growing
population in the region. The influx of nurses has tremendously changed the landscape of
healthcare in the region. The GCC (Gulf cooperation Council) with its six member countries
Saudi Arabia, UAE, Qatar, Kuwait, Oman and Bahrain are in constant move of hiring Philippine
Registered nurse a record high in the past years. The changing landscape of healthcare the
constantly evolving disease pattern and the demand for highly trained and specialized nurse is
more and more becoming advent. Practicing nurses in the Middle-East is confronted with
challenges involving educational preparedness, required competencies as well as the ability to
adapt in to a new environment which is entirely different in terms of religion and cultural
practices. Nurses in the field must at the time of entry are equipped with the knowledge relevant
to education and years of experience, the level of competency should on its utmost cater to the
requirements of the facility they are assigned and more importantly be knowledgeable of the
cultural and religious aspect of the care being given to the patient.
PROGRAM PROPOSAL
II.
Nursing Theory
Transcultural theory by Madeline Leininger (The Sunrise Model)
Madeleine Leininger developed her theory of transcultural theory by defining the ways
on how people of different cultures can see their nursing world and focusing on the peoples
general beliefs and practices. Her belief that different cultures have both practices that are
specific to ones culture and prevailing patterns are common across cultures. Madeleine Leininger
gave three types of nursing actions that are culturally- based and consistent with the needs and
values of the client. These are: (1). cultural care preservation/ maintenance (2).cultural care
PROGRAM PROPOSAL
accommodation/negotiation (3).cultural care repatterning/restructuring. These three models of
action can lead to: deliverance of nursing care that best fits with the clients culture, reduce
cultural stress and reduce chances of conflict between the client and nurse.
Transcultural theory in nursing a humanistic and scientific area of formal study and
practice in nursing which is focused upon differences and similarities among cultures with
respect to human care, health and illness based upon the peoples cultural values, beliefs and
practices to use this knowledge to provide nursing care to people based on specific cultures.
Goals of Trascultural Nursing
1. To give nursing care that is suitable to the clients culture.
2. To provide universal nursing care practices for the health and well being of the patient.
3. To help people in facing illness or death in culturally meaningful ways.
Application of the theory
Education the addition of culture and relative care in the nursing curriculum began
in 1966 at the University of Colorado where Leininger was a professor of Nursing
and Anthropology. Nowadays, with the sensitive public awareness of healthcare costs,
different cultures and human rights, there is superior demand for the transcultural
people who are trained to protect the quality of care and to prevent improper care.
Research a lot of nurses today are using Leininger culture theory worldwide. This
theory is the only one in nursing focused on culture and care with a research
technique called ethnonursing to examine this theory.
PROGRAM PROPOSAL
Ethnonursing a research method for describing, documenting and explaining
nursing care phenomena by the study of the beliefs, values and practices concerning
nursing care that belongs to a specific culture.
Practice to develop understanding, respect and appreciation for the individuality and
diversity of patients beliefs, values, spirituality and culture regarding illness, its
meaning, cause, treatment and outcome. To encourage in developing and maintaining
program of physical, emotional and spiritual self- care introduce therapies.
Critique of the Theory
Simplicity- wide in scope, comprehensive in nature, applicable worldwide
Generality- does not demonstrate its criterion of generality, qualitativelyoriented theory, broad comprehensive and worldwide in scope.
Significance of the Theory
This theory focuses on the differences and similarities among cultures with
respect to human care, health and illness. It supports specific care that is humanistic,
holistic and respectful of diverse values, beliefs and practices.
III.
Related Literature
PROGRAM PROPOSAL
Leininger (1978) describes culture shock as a state of being disoriented or
unable to respond to a different cultural environment because of its sudden
strangeness, unfamiliarity and incompatibility to the persons perceptions and
expectations. This can be experienced when a health care professional enters a new
health care subculture. It can provoke psychological crises, social dysfunction and, of
course, is experienced in varying degrees if in an unfamiliar setting. How any
individual reacts will depend on a variety of factors, which include previous
experiences with other cultures.
Culture shock should be seen as normal reaction but it may not be recognized
properly and, as a result, people dont respond or get the right help for the problems
that develop. According to Winkelman (2002), this is a concept that often gets
overlooked. If we dont pay attention, it can have very serious effects on our own
health and well-being.
Working in a completely different setup leads to various challenges in which
dealing with cultural shock is one of them. Culture is a combination of set patterns of
learned behavior that is the typical features of any members of any given society.
Culture refers to the total way of life of particular groups of people. It includes
everything that a group of people thinks, says, does and makes its systems of
attitudes and feelings. Culture is learned and transmitted from generation to
generation". Further mentioned in a seminal study that culture is combined setup of
mind which creates values, attitudes and behaviors. In that cultural shock occurs in
those people who come to different kind of environment and feels disoriented
psychologically. It generally occurs due to lack of social dealings, familiar customs,
PROGRAM PROPOSAL
signs and symptom what person used to have is being taken away. In that case person
feels like child again and show inability to judge between right and wrong things. An
individual usually start his approach with excitement in foreign countries but that is
often
followed
by
disappointment
which
can
lead
to
cultural
shock.
Cultural shock is considered as the major barrier for foreign health care
professionals to settle in a foreign country. Cultural shock is the emotional and
psychological factor that leads to confusion, uncertainty, clashes and certain
unidentified reaction that effect person observation and their interaction skill in
completely different cultures. Managing themselves in a different community, with
different languages and customs is a serious thing for any foreign worker; in order not
to achieve these, person could face depression, frustration and homesickness. Various
other factors that also affect cultural shock are lack of proper training, demographic
characteristics, organization support and different sort of technical competence.
Several works has been done on this topic but still the information is not sufficient
enough which help to live in diverse cultures, this definitely demand for learning
environment to develop competences with multicultural environment. The World
Conference on Higher Education has mentioned the need for exchanging the staff and
students in order to gain better understanding about each culture to make a cultural
competence
health
care.
Further it is stated that differences due to cultural shock could impact on persons
motivational factors and orientation at works. Another study mentioned that cultural
PROGRAM PROPOSAL
shock generally occurs due to cultural myopia- lack of experience and unsolved
cultural issues.
Dealing with these are not the only problems for foreign health professionals but
other such as no value or acceptance of their knowledge or qualifications in another
country. This resulted as the cancellation of their license or denying their access to
related field. To do more harassments and in order to achieve their standard, the
foreign health workers have to prove them by attaining more education programs for
better credentials, this could limit the stay of foreign health care professionals for
long term specially nurses and doctors.
IV.
Program Description
Most Filipino nurses choose to work abroad to have a better lifestyle, good
income, more opportunities but experienced culture shock. Culture shock is defined
as personal disorientation a person may feel when experiencing an unfamiliar way of
life due to immigration or a visit to a new country or simply travel to another way of
life. Most common problems include information overload, language barrier,
generation gap, technology gap, skill interdependence, formulation dependency,
homesickness, boredom, response ability and discrimination. There is no true way to
entirely prevent culture shock as individuals on any society are personally by cultural
contrast differently.
PROGRAM PROPOSAL
10
Purpose of the Program: The program aims to educate nurses (especially first
timer) going to the Middle East regarding the countrys culture, standards and practices to
help them render culturally congruent care to their patients.
Target Participants: The target participants of the program being proposed at
least 30 nurses that will come from different recruitment agencies in the region; who are
nearly deploy to work in MiddleEast countries. Nurses who dont belong to an agency
or those nurses who only wants to gain knowledge/ background about the topic are
welcome to join the seminar.
Resource Speaker: The guest speaker that will be invited is a registered nurse
who worked in one of the countries in the Middle East for a couple of years and is
equipped with knowledge about the countrys culture, views and beliefs. The guest
speaker will also demonstrate how to provide culturally congruent care to the foreign
clients.
V.
Goals and Objectives of the Program
A. Goals
PROGRAM PROPOSAL
11
1. To advance cultural competence for nurses worldwide.
2. To develop strategies for advocating social change for culturally competent
care
B. Objectives
At the end of the seminar the participants met the following objectives:
1. To define and discuss transcultural nursing and related major concepts.
2. To identify approaches and strategies for the effective teaching/learning
of transcultural nursing to achieve to the optimum level in a transcultural learning
situation.
3. To evaluate the knowledge of nurses working overseas on transcultural
care nursing.
4. To discuss the human rights of diverse culture.
5. To identify transcultural nursing practices that reflect ethnocentrism,
cultural biases, prejudices and other problems that limit the quality of nursing care
to people of specific cultures.
6. To provide knowledge in the field of transcultural nursing to guide
nurses thinking and actions.
VI.
Work Plan
PROGRAM PROPOSAL
12
After the finalization of the proposal, there will be coordination to the different
recruitment agencies in the region, to resource speaker and other establishments to be part
of the program. A request letter will be distributed to have their permissions and
approvals regarding the proposal. Invitations to the seminar will be through distribution
of pamphlets, brochures, leaflets and or through posting in social media (e.g facebook,
twitter etc.), also invite by friends can do. The program will be a six-hour seminar and
will include series of discussions and a time will be allotted for open forum to allow the
participants to ask questions. The activity will be held once a week for one month. The
guest speaker will provide the necessary information through power point and video
presentations and through sharing experiences about rendering care to the foreign clients.
This seminar is already coordinated with the different recruitment agencies in the region
and they are willing to inform all their interested applicants.
PROGRAM PROPOSAL
13
PROGRAM PROPOSAL
SCHEDULE
ACTIVITY
1st meeting
(August
Six
8,
2nd -4TH
meeting
( August 15,
22, 29 ,2015)
EXPECTED
OUTCOME
After the session,
PERSONS
RESPONSIBLE
Guest Speaker
to
nurses will be
Participants
and
able to orient
hours
seminar
orient
2015)
14
educate nurses
enough
going to Middle
knowledge and
East
understanding on
countries
regarding
cultures, beliefs,
cultures,
politics, standards
beliefs, politics
and practices of
standards
Middle- East
and
MATERIALS
NEEDED
Power
point
presentation
Audio/Visual aids
Seminar Kit
EVALUATION
Participants may
ask questions
regarding the topic
discussed.
Give feedbacks to
the topic given
The participants
will be evaluated
through questions
and writing what
knowledge they
attain from the
topic.
Participants may
suggest
other
topics
to
be
discuss to gain
more knowledge
and understanding
about transcultural
nursing concepts
practices
countries.
Six hours
After the session,
seminar to
nurses will be
educate
able to acquire
thoroughly
more knowledge
nurses going to
and understanding
they learned from
Middle East
on cultures,
the seminar as a
countries
standards and
whole.
regarding
practices of
cultures,
Middle East
standards and
countries.
practices
Awarding
ceremony
( distribution of
certificates,
tokens to the
participants and
to resource
speaker)
Guest Speaker
Power point
The
presentation
will be evaluated
Participants
participants
through questions
Video presentation
and writing what
PROGRAM PROPOSAL
15
SEMINAR ON TRANSCULTURAL NURSING IN THE MIDDLE EAST: A ROAD TO
EFFECTIVE and SAFE NURSING PRATICE AND COMPETENCY.
HOTEL CARMELITA, TUGUEGARAO CITY (venue)
August 8,15,22,29, 2015 (8:30 AM 4:00 PM)
8:30 am 9:00 am
Facilitators________________________________________ Registration
9:00 am -9:05 am
Facilitators_________________________________________ Opening Prayer
9:05 am 9:20 am________________________________________
Levelling of Expectations
9:20 am 9:30 am
Facilitators________________________________________ Introduction on the Topic
9:30 am 9:35 am
Facilitators_________________________________________Introduction to the Guest Speaker
9:35 am - 10:30 am________________________________________ Lecture: Common culture and standards in
Middle East( Guest Speaker)
10:30 am- 10:45 am_________________________________________ AM SNACKS
10:45 am -12:00 pm________________________________________Lecture: Common culture and standards in
Middle East(Guest Speaker)
12:00 pm 1:00 pm_________________________________________ Lunch Break
1:00 pm -2:30 pm___________________________________________ Lecture: Ways How to avoid and over
come Culture Shock(Guest Speaker)
2:30 pm 2:45 pm__________________________________________ PM Break
2:45 pm 3:45 pm__________________________________________ Open forum
(Guest Speaker and Participants)
3:45 pm -4:00 pm__________________________________________ Giving of Certificates and Closing Remarks
(Facilitators)
PROGRAM PROPOSAL
VII.
16
BUDGET PROPOSAL
The venue will be used of the said seminar is Hotel Carmelita - Conference Hall. It will be a sixhour seminar and will include series of discussions period from 8:30am to 4pm. The activity will
be held once a week for one month, in which, different recruitment agencies in Region II are the
chosen partner in providing the seminar to the aspiring nurses going to work in the Middle-East.
The participants will be accommodated; they will be given orientation regarding the seminar
what to expect and benefits to them. Per seminar is composed of at least 30 participants from
recruitment agencies or nurses who dont belong also welcome to join. Furthermore, there will
be 1 speaker and 3 facilitators. Lastly, this is inclusive of hand outs, snack, and lunch, certificates
and tokens to participants and resource speaker. The registration fee of the said seminar is PHP
450. 00 only per session.
PARTICULARS
(FACILITATORS)
VENUE
(HOTEL
CARMELITA)
AM SNACKS
QUANTITY
COST
TOTAL AMOUNT
300/HOUR
PHP 1,800.00
70/head
PHP 210.00
LUNCH
150/ head
PHP 450.00
PM SNACKS
70/ head
PHP 210.00
CERTIFICATES
10/ FACILITATOR
PHP 30.00
TOTAL
PHP 2,700.00
PROGRAM PROPOSAL
17
PARTICULARS
(SPEAKER)
AM SNACKS
QUANTITY
COST
TOTAL AMOUNT
PHP 100.00
PHP 100.00
LUNCH
PHP 150.00
PHP 150.00
PM SNACKS
PHP 100.00
PHP 100.00
TOKEN/
CERTIFICATE
HONORARIUM
PHP 300.00
PHP 300.00
PHP 300.00/HOUR
PHP 1,800.00
TOTAL
PHP 2,450.00
PARTICULARS
(PARTICIPANTS)
SEMINAR KIT
PENCIL
BALLPEN
NOTEBOOK
NO.
OF COST
PARTICIPANTS
TOTAL AMOUNT
30
PHP 30.00/HEAD
PHP 900.00
30
PHP 5/HEAD
PHP 150.OO
30
PHP 70/ HEAD
PHP 2,100.00
LUNCH
30
PHP 150/HEAD
PHP 4,500.00
PM SNACKS
30
PHP 70/HEAD
PHP 2,100.00
CERTIFICATES
30
PHP 10/HEAD
PHP 300.00
TOTAL
PHP 10,050.00
BROCHURES,
LEAFLETS,
PAMPHLETS
AM SNACKS
GRAND TOTAL: PHP 15,200.00
REGISTRATION FEE: PHP 450.00/ SEMINAR
PROGRAM PROPOSAL
18
SEMINAR ON TRANSCULTURAL NURSING IN THEMIDDLE EAST, A ROAD TO
EFFECTIVE AND SAFE NURSING PRATICE AND COMPETENCY
HOTEL ROMA, TUGUEGARAO CITY
JUNE 20, 2015 (8:30 AM 4:00 PM)
8:30 am 9:00 am
Facilitators________________________________________ Registration
9:00 am -9:05 am
Facilitators_________________________________________ Opening Prayer
9:05 am 9:20 am________________________________________
Levelling of Expectations
9:20 am 9:30 am
Facilitators________________________________________ Introduction on the Topic
9:30 am 9:35 am
Speaker
Facilitators_________________________________________Introduction to the Guest
9:35 am - 10:30 am________________________________________ Lecture: Common culture and
standards in
Speaker)
Middle East( Guest
10:30 am- 10:45 am_________________________________________ AM SNACKS
10:45 am -12:00 pm________________________________________Lecture: Common culture and
standards in
Middle East(Guest
Speaker)
12:00 pm 1:00 pm_________________________________________ Lunch Break
1:00 pm -2:30 pm___________________________________________ Lecture: Ways How to avoid
and over
Speaker)
come Culture Shock(Guest
2:30 pm 2:45 pm__________________________________________ PM Break
2:45 pm 3:45 pm__________________________________________ Open forum
Participants)
(Guest Speaker and
PROGRAM PROPOSAL
19
3:45 pm -4:00 pm__________________________________________ Giving of Certificates and
Closing Remarks
(Facilitators)
References
Guru, R. Effects of cultural shock on foreign health care professionals: An analysis of
key factors. Retrieved from http://www.scopemed.org/?mno=18976&html=1
Canadian Health Care System. Culture Shock. Retrieved from
http://www.healthpei.ca/nursingeducation/index.php3?number=1044297&lang=E
Nursing 2015 Journal. Understanding Transcultural Nursing. Retrieved from
http://journals.lww.com/nursing/Fulltext/2005/01001/Understanding_Transcultura
l_Nursing.2.aspx
