Esther Olaleye BSc student, Bachelor of Healthcare, Nursing, Novia UAS

Supervisor: Anita Wikberg, RN, RM, PhD, Senior Lecturer, Novia UAS

Abstract

The beginning of professional life after graduation is with mixed feelings, the joy of completing studies, and the tension of what lies ahead in work life. It is naturally expected that it will be difficult. However, specific skills and personal readiness to make an impact and to be fulfilled as a worker can go a long way to help a newly graduated nurse to function in a multicultural setting. Primary concerns include cultural awareness, cultural sensitivity, cultural adaptation, cultural competence, language and communication barriers, individual motivation, and different professional realities. The coping strategies nurses can use when dealing with the challenge of cultural diversity in a multicultural setting are multi-dimensional. Personal motivation, language, and professional competence are key traits a graduate nurse must have to fit well in a multicultural setting.

Graduate nurses intending to work in a multicultural setting must appreciate how cultural competence and educational interventions can help nurture knowledge, understanding, commitment, and confidence in providing quality care for culturally diverse patients (O'Brien et al. (2021). They should understand that language insufficiency can affect their self-confidence and professional nursing practice. There should be measures to ensure that language learning and system support are implemented for an extended period.

1          Introduction

International or intercultural nursing is the movement of professionals like nurses from country to country to study or practice the nursing profession in a place other than their own. This nursing experience across global borders varies from nation to nation. According to Roth, Berger, Krug, Mahler, and Wensing (2021) shortage of qualified nurses is a problem of growing concern in many countries. Recruitment of internationally trained nurses has been used to address this shortage. Individual values and preferences from each background may not be relevant in the host country. Individuals' survival or success depends on a partial or total adaptation to the host country's system for effectiveness. This variety of professionals from different backgrounds with different cultural values and opinions immediately creates room for a multicultural setting.

A multicultural setting is where two or more cultures coexist to achieve a mutual goal. In this case, health professionals from different backgrounds work together to care for patients from different cultures. Multicultural teams provide diverse skill sets, and members' different experiences could, through effective leadership, be leveraged to improve organizational performance, says Abadir, Batsa, Neubert, and Halkias (2019). The nurse in this multi-faceted population will need strategies to work and coexist successfully in the host country. In a multicultural setting, ethnic, linguistic, and national factors interplay to create conflicts for the new member. 

Coping strategies are the means or methods individuals or groups employ to survive any challenging situation or circumstance. Karatuna, Jönsson, and Muhonen (2020) opined that emotion-focused and problem-focused coping strategies could be used to survive in a challenging multicultural setting. The core of healthcare is nursing care, focusing on managing, reducing, or ameliorating the suffering of sickness and disease. These healthcare services are primarily needed everywhere today, and the fact remains that there will always be moves across borders by nurses, either as students or graduate professionals. The coping strategies for a nurse in a new setting are a big challenge. According to Fathi and Simamora (2019), nurses can use religion, being positive, having society and family support, and proper planning as their coping strategies for effectiveness in a new environment.

The coping strategies

Whether finishing a degree or changing jobs, there are many challenges a graduate nurse is bound to face. These might include cultural adaptation, language barriers, changes in traditions and family values, parenting and marital stress, and economic hardship. Coping strategies are attitudes, actions, or thoughts that one can use to deal with these challenges. Also, it is the use of cognitive and behavioural tactics to reduce or overcome stressful conditions to adjust to changes that happen from time to time. In their research, Isa, Abdul-Manan, Mohd-Salleh, Abdul-Mumin, and Rahman (2019) noted that graduate nurses could develop and use different coping strategies for survival and adjustment in a multicultural setting for organizational progress and job satisfaction. Some of the strategies are more effective than others. Coping strategies help to build resilience and the courage to handle pressures, negative emotions, panic attacks, and mental stress. The effectiveness will depend on the concerned individual.

Cultural adaptation

Culture is part of our existence, and sometimes it is difficult to change. The difficulty is the stress a graduate nurse will face while working in a multicultural setting. Cultural adaptation has the attitude that can enable one to survive or thrive in a new environment. Bhowmik, Cheung, and Hue (2018) Noted an accumulation of stress from prejudice and discrimination, cultural differences, dressing, transport, food, and accommodation. Viken, Solum, and Lyberg (2018) opined that nurse graduates would need a break from their old selves to be adjusted to the multicultural setting and the new working condition. There will have to be some "learning and unlearning", "reaffirming and removing", letting go of some views and prejudices, and retaining some necessary personal values and opinions for survival. A nurse graduate should be culturally competent as cultural competence reduces racial and ethnic differences and improves healthcare quality, patient satisfaction, and positive health outcomes.

Language and communication barriers

Language and communication barriers are significant challenges for graduate nurses in a multicultural setting like Finland. The law is stated in section 6 of the Health Care Act. (1335/2010) that the patient has the right to receive healthcare in their mother tongue, which means an intending nurse must be able to speak either Finnish or Swedish, at least at the primary level. It becomes necessary for graduate nurses to learn the language to cope with the working environment. Understanding the language of the environment will enhance the nurse-client relationship. The patient also will be able to receive quality care, and the nurse can be more confident in discharging his/her professional duties. The challenge of learning a new language and expectations by the employee can create an atmosphere of worry and

anxiety, which makes interpersonal relationships and adjustment to the work environment difficult. Therefore, graduate nurses should make it a matter of priority to learn and understand the language before entering work life.

Emotion-focused coping strategies 

Nursing is seen as a physically and emotionally stressful profession. Nurses had high-stress levels in the workload and time pressure (Fathi & Simamora, (2019). Emotion-focused coping strategies have to do with the adjustment of feelings and emotions in response to a challenge. It involves regulating feelings and emotional responses to the problem instead of addressing it. It is rebranding the self, creating new meaning, and having some emotional adjustments to cope in the multicultural setting, recognizing personal emotions and the emotions of others around, and understanding how these emotions influence actions and reactions. According to Wesołowska, Hietapakka, Elovainio, Aalto, Kaihlanen, and Heponiemi (2018), graduate nurses from a collectivistic background who desire to work in an individualistic culture may need to suppress their emotions for the progress of their career and to ensure a length of stay. Emotions like anxiety and panic attacks require appropriate

responses to avoid taking wrong steps and adverse decisions. Some activities that can help to relieve emotional strain include talking, writing, mindful meditation, or any activity of interest. Another side to emotional coping strategies is receiving affective affirmation from external sources like expressions of love, trust, concern, or care by the new worker. 

Social support coping strategies

In a multicultural setting, social support is a new worker's help or assistance from one or more individuals. Social support strategies assist in coping while transiting from study to work life and the stress surrounding it. Social support is understanding and the experience of enjoying care from the social network in the work environment. A graduate nurse surrounded by adequate social support will have an improved ability to deal with stressful conditions and be emotionally stable. Therefore, a graduate nurse must be proactive and versatile in the use of technology. There must be the willingness to ask for help from colleagues and search for information on the internet. Social support coping strategies from an active social network include physical and practical assistance, making community resources available, giving time to listen, and motivating. Fathi and Simamora (2019) Revealed that an active social support network could enhance positive emotional and physical health and assist the new worker in dealing with the challenge in a multicultural setting. This coping strategy helps the graduate nurse retain physical and mental strength and foster a healthy work life.

 Meaning-making coping strategies

Meaning-making as a coping strategy describes how people interpret and make sense of life events. Graduate nurses must reflect on past experiences to make meaning of the present. This reflection will pave the way for easy adjustment to the multicultural setting. As a form of personal accountability, graduate nurses must reflect on past successes and failures and use them as a stepping-stone to a fruitful stay in the new setting. Meaning-making helps graduate nurses evaluate actions and have a sense of control over the circumstances surrounding them. It assists in keeping things in perspective. Moreover, to connect the past with the present and channel a better future, the graduate nurse must connect with the environment and take each challenge as they come.

They will face different professional realities.

The graduate nurse may experience an unexpected and unfamiliar nursing practice which can result in occupational stress, as noted by Gu, Tan, and Zhao (2019). Although nursing may be considered universal, nurses should be prepared for a new nursing practice culture. Professional realities, team dynamics, models of nursing, and population health appeared to

shape the experiences of international nurses working in new environments O'Brien, O'Donnell, Murphy, O'Brien, and Markey (2021). During clinical training, student nurses should develop transferable skills that will help them adjust appropriately in their work life. Transitioning from study to work-life may create work-related stress, role uncertainty, and difficulties in decision-making. The graduate nurse may face challenges adjusting to the healthcare providers and the healthcare system. Viken et al. (2018) noted that though nursing principles were similar, nursing practice differed from place to place. Some in-house training may also be needed to care for specific populations, for example, elderly care. Expectations of critical thinking may present challenges for the graduate nurse as practice expectations differ from the work-life experience. In a team of several nurses, responsibility and decision-making are done jointly. At the beginning of the work-life, some nurses may feel devalued and reduce their personal and professional confidence, affecting how they interact with colleagues and patients and carry out their daily tasks.

2         Conclusions

Graduate nurses intending to work in a multicultural setting must appreciate how cultural competence and educational interventions can help nurture knowledge, understanding, commitment, and confidence in providing quality care for culturally diverse patients (O'Brien et al. (2021). They should understand that language insufficiency can affect their self-confidence and professional nursing practice. There should be measures to ensure that language learning and system support are implemented for an extended period.

Some benefits of multiculturalism are that the nurse will enjoy open-mindedness and the ability to dissolve ethnocentrism and stereotypes. Working together in the same setting will mean some adaptations will be necessary. In a culturally diverse setting, workers will be challenged to develop their talents and skills by learning directly from various colleagues. Problem-solving skills are better sharpened in a diverse setting with increased happiness and productivity. The chance to become a multi-tasker and a linguist is high when as a new worker, one is personally motivated. A basic understanding of the environment and written and spoken language is essential. Cultural adaptation is very crucial, which will rapidly enhance language skills. Careful consideration of the coping strategies discussed above will help a new graduate to thrive positively in a new setting.

References 

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