Culturally Competent for Nurses: A Challenge for Asian Economics Community (AEC)

Abstract
Nurses globally are too focus and getting used to in providing care to their clients from
the same country and society. The upcoming AEC in 2015 is an awareness for all nurses in
ASEAN Community to be prepared for the flows of the clients into their care settings from
different countries, especially among the 10 in ASEAN. The significant issue is that the diversity
of the population will be challenged nurses in transcultural nursing. In providing care effectively
to the foreign patients, nurses need to be aware of clients culture, values, lifestyle and customs
no matter where the patients come from, therefore, the cultural competent in nursing becomes
crucial at this stage. The top three Southeast Asian countries for medical tourism are Malaysia,
Singapore and Thailand. The objectives of this paper is to 1) identify the medical tourism in
present situation. 2) to study about the concepts of cultural competent in nursing and 3) to study
the roles of nurse administrators for transcultural nursing.
Background and Significance
Worldwide, medical tourism is a significant business and the number of clients is
increasing every year. According to GOASEAN, 2015, medical tourism information provider,
Patients Beyond Borders estimated the industry to be worth up to US$55 billion with over 11
million travellers worldwide crossing international borders to seek medical care in 2014. The
four popular reasons why people travel overseas to seek healthcare are: 1) competitive costs for
high-quality healthcare. 2) specialized medical treatments that are not readily available in their
country. 3) long waiting lists back home and 4) privacy from friends and family. The average
savings for the top three Southeast Asian countries for medical tourism are Malaysia: 65-80%,
Singapore: 25-40% and Thailand: 50-75%.

The Asian medical tourism industry is nearly a $15 Billion, which accounts for roughly 5
million patients. In 2012 an estimated 1.6 million Americans travelled outside their country for
medical treatment, and they headed to India, Thailand, and Singapore about 90% of the time
when considering medical tourism in Asia. It has been reported that 19 million tourists visited
Thailand in 2011, and 500,000 of them were there for medical treatment. In Singapore, there are
10.2 million tourists, and about 200,000 of them were seeking healthcare. On the other hand,
affluent Asians tend to travel to Western countries to seek medical attention, considering medical
practices in those countries are more advanced and have higher standards (Sahil & Mohan,
2015).
Patients from the Middle East, Cambodia, Laos, and Vietnam were rapidly followed by
European clients. Today, thousands of Americans and Canadians also head to Bangkok or
Phuket, mostly to save on elective surgeries with lower costs that more than compensate for the
uncomfortably long flight (PBB, 2015).
In relevant to what had mentioned above, the transcultural nursing is very important and
nurse administrators must be aware and put cultural competent in nursing into practice in order
to promote high quality of care. Transcultural nursing is a significant part of healthcare in this
era. The increasing of diversity of the population moving across from one to another country in
ASEAN Community positions a weighty challenge to nurses provides care to the clients
holistically and individually. Therefore nurses need to identify and gain cultural differences in
healthcare, lifestyle, customs, values and beliefs. Nurses in ASEAN Community must obtain
important knowledge and skills in transcultural nursing. Nurses who have culturally competent
can helps to increase patient satisfaction and positive outcomes. This paper discusses the
importance of transcultural nursing and cultural competent which the roles of nurse

administrators in ASEAN Community. It is very important that the nurse administrators in

ASEAN Community are able to identify factors that contribute to the transcultural nursing so
that they can promote culturally competent nursing care. The requirement for transcultural
nursing will need to be remained as an important part in healthcare. All nurses worldwide need to
promote transcultural nursing in nursing practice.
Objectives of this paper
The objectives of this paper are: to 1) identify the medical tourism in present situation. 2)
to study about the concepts of cultural competent in nursing and 3) to study the roles of nurse
administrators for transcultural nursing.
Literature review
Madeleine Leininger is considered as the founder of the theory of transcultural nursing.
Transcultural nursing theory is also known as Culture Care theory. Theoretical framework is
depicted in her model called the Sunrise Model (1997). Nurses may encounter patients from
numerous cultures in daily practice. It is unlikely that nurses would know about the culturallybased, health-related beliefs and practices of all persons. However, nurses can gain knowledge
and skills in cross-cultural communication to help them provide individualized care that is based
on cultural practices.
In 1995, Leininger defined transcultural nursing as: a substantive area of study and
practice focused on comparative cultural care (caring) values, beliefs, and practices of
individuals or groups of similar or different cultures with the goal of providing culture-specific
and universal nursing care practices in promoting health or well-being or to help people to face
unfavorable human conditions, illness, or death in culturally meaningful ways (p. 58).

There are Six domains of sunrise model by Leininger consist of: 1) Culture values and life
ways. 2) Religious, philosophical, and spiritual beliefs. 3) Economic factors. 4) Educational
factors. 5) Technological factors. 6) Kinship and social ties and political and legal factors.
And Three Modalities for guiding nursing care judgments, decisions, or actions to provide
appropriate, beneficial and meaningful care: (1) cultural preservation or maintenance (2) cultural
care accommodation or negotiation (3) cultural care repatterning /restructuring.
Definition of Cultural Competence According to the Williams & Haynes (2007), Cultural
competence refers to a set of congruent attitudes, practices, policies, and structures that come
together in a system or agency to enable professionals to work more effectively with members of
culturally distinct groups in a manner that values and respects the culture and worldview of those
groups. Hanley (1999) defined cultural competency as the ability to work effectively across
cultures in a way that acknowledges and respects the culture of the person or organization being
served. Cultural competence is defined as a set of congruent behaviors, attitudes, and policies
that come together in a system, agency, or among professionals and enables that system, agency,
or those professionals to work effectively in cross-cultural situations (Cross T., et al, 1989).
Operationally defined, cultural competence is the integration and transformation of knowledge
about individuals and groups of people into specific standards, policies, practices, and attitudes
used in appropriate cultural settings to increase the quality of services; thereby producing better
outcomes (Davis, K. 1997). According to the Cultural Competencies for Health and Social
Service Organizations, there are three main components to becoming culturally competent. These
three main components are found in many models of cultural competence and in many different
professions such as nursing, counselling and psychology, as well as at an organizational level
(e.g., community care organizations): 1) Cultural awareness: a sensitivity and understanding of
ones own cultural identity as it manifests itself though our beliefs, values and practices as well

as our biases. 2) Cultural knowledge: having knowledge of other cultures beliefs, values and
practices, which allow for an understanding of different worldviews. 3) Cultural skills: having
the skills to interact effectively with diverse cultures (Sue et al., 1998; Kim-Godwin et al., 2001;
Campinha-Bacote, 1998; Rodriguez, 2003).
Discussion
The role of nursing administrator toward AEC: (1). To provide good training and education
the health care organization leader/manager should: a) Provide orientation and annual in-service
training in cultural competence for all levels of staff, including all management, professional,
and auxiliary staff in any department with patient contact. b) Provide classes to increase staffs
cultural knowledge about the ethnically diverse patients who receive health services in the
facility. c) Provide classes to enhance nurses skills in cross-cultural assessment and
communication skills. d) Use a variety of modalities to teach cultural competency, such as
workshops, conferences, online training, films, and immersion experiences. e) Partner with
transcultural experts to provide staff with continuing education courses, consultation, and
practice skills for culturally. (2). Nursing administrator have to more advance in evidence- based
with multi- cultural issue , to reach that competence they should: a) Provide nursing staff with
resources for improving library search and research critique skills of the staff in long term. b)
Establish journal clubs to review current literature about the most common cultural groups
served to ensure evidence-based practice. c) Develop Advanced Practice Nurse (APN)
consultants to facilitate implementation of evidence-based cross-cultural practice. d) Consult
with local faculty for expertise in research process and study design. e) Collaborate with
colleagues to establish a national agenda of priorities for transcultural nursing research. f)
Develop interdisciplinary teams of researchers to collaborate on quality improvement projects or

research studies and to apply for funding. g) Conduct research through networks with high
proportions of patients from diverse populations. g) Collaborate with national and international
colleagues to design and implement large-scale intervention studies of cultural phenomena. h)
Host workshops and conferences to disseminate evidence on effective approaches to culturally
congruent nursing practice.
Conclusion
Transcultural nursing is essential in daily nursing practice. The ever-growing number of
patients (foreign patients) from various cultural backgrounds creates a major challenge for nurses
to provide individualized and holistic care based on each patients cultural needs. This requires
nurses to understand cultural differences in healthcare values, beliefs, and customs. Nurses must
be open-minded and have a positive interest as well as a sincere desire to learn other cultural
ways.
Transcultural knowledge is important for nurses to acquire in order for them to become
sensitive to the needs of patients specially in communication from various cultures especially as
societies become increasingly global and complex. Since nurses have the most intimate contact
with patients and are responsible for formulating care plans that help meet the individual needs
of patients, it is a necessity for nurses to understand, appreciate, and respond to the patients
cultural preferences.
The most effective way to accomplish this is for nurses to increase their awareness of
cultural differences and become knowledgeable about the cultural preferences of their patients
under their care. This highlights the need for nursing education to include transcultural nursing in
the curriculum. It should instill in nursing students an appreciation for cultural differences in
healthcare values, beliefs and customs.

The curriculum and competency in transcultural nursing should also teach the knowledge
and skills needed to provide culturally competent nursing care. Furthermore, hospitals and other
health care facilities should offer nurses frequent in-service programs on cultural competency in
order to increase their level of confidence and knowledge of transcultural skills. Hence, it was
then established that having cross-cultural nursing knowledge would enable the Nurse to interact
effectively with the individual preferences of each culturally influenced health behaviours to
prevent misunderstanding and to enable the nurse to provide suitable care in a culturally diverse
health care setting.
The cultural competence needs to be integrated into nursing education, both school and
hospital setting. Nurse administrators must be valued and aware of its important to meet the
professionalism of nurses, patients satisfaction and nurse job satisfaction. Cultural competency
need to be integrated with evidence-based practice and it should be an ongoing process
supplemented by focused reflection and feedback. To achieve an adequate level of competence,
more studies are needed to determine how a program starting at basic staff nurses and continuing
into clinical practice by put together most effectively, and what teaching and training techniques
for the best results in order to prepare professional nurse for upcoming AEC in the end of 2015.
In summary, nurses who understand and value the practice of culturally competent care
are able to effect positive changes in healthcare practices for clients of designated cultures.
Sharing a cultural identity requires a knowledge of transcultural nursing concepts and principles,
along with an awareness of current research findings. Culturally competent nursing care can only
occur when client beliefs and values are thoughtfully and skillfully incorporated into nursing
care plans. Caring is the core of nursing. Culturally competent nursing guides the nurse to
provide optimal holistic, culturally based care. These practices also help the client to care for

himself and others within a familiar, supportive, and meaningful cultural context. Continual
improvement and expansion of modern technologies and other nursing and general science
knowledge are integrated into practice if they are appropriate. Today nurses are faced daily with
unprecedented cultural diversity because of the increasing number of immigrants and refugees.
Commitment to learning and practicing culturally competent care offers great satisfaction and
many other rewards to those who can provide holistic supportive care to all patients (Leininger
2002, 1991).

References
Goasean (2015). ASEAN a top destination for medical tourism. Retrieved on November 9th
2015 via http://www.goasean.com/stories/asean-a-top-destination-for-medical-tourism.
Sahil, K., and Mohan. (2015). Industry in the ASEAN 2015 integration A coopetion framework
for St. Lukes medical center and Biopolis of Singapore. Retrieved on November 9th
2015 via https://aimwebmarketing100.files.wordpress.com/2014/07/katarya-mayanksantra.pdf.
Patients Beyond Borders (PBB). (2015). Thailand. Retrieved on November 9th 2015 via
http://www.patientsbeyondborders.com/thailand.