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Adaptation of Kenyan-Born Registered Nurses Into the American Healthcare System Emily Tangwar Gardner-Webb University

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Adaptation of Kenyan-Born Registered Nurses Into the American Healthcare System Emily Tangwar Gardner-Webb University Gardner-Webb University Digital Commons @ Gardner-Webb University Nursing Theses and Capstone Projects Hunt School of Nursing 2014 Adaptation of Kenyan-Born Registered Nurses into the American Healthcare System Emily Tangwar Gardner-Webb University Follow this and additional works at: https://digitalcommons.gardner-webb.edu/nursing_etd Part of the Occupational and Environmental Health Nursing Commons Recommended Citation Tangwar, Emily, "Adaptation of Kenyan-Born Registered Nurses into the American Healthcare System" (2014). Nursing Theses and Capstone Projects. 38. https://digitalcommons.gardner-webb.edu/nursing_etd/38 This Thesis is brought to you for free and open access by the Hunt School of Nursing at Digital Commons @ Gardner-Webb University. It has been accepted for inclusion in Nursing Theses and Capstone Projects by an authorized administrator of Digital Commons @ Gardner-Webb University. For more information, please see Copyright and Publishing Info. Adaptation of Kenyan-Born Registered Nurses into the American Healthcare System by Emily Tangwar A thesis submitted to the faculty of Gardner-Webb University School of Nursing in partial fulfillment of the requirements for the Master of Science in Nursing Degree Boiling Springs, North Carolina 2014 Submitted by: Approved by: ________________________ ______________________________ Emily Tangwar Dr. Candice Rome ________________________ ______________________________ Date Date Abstract Kenyan-born nurses (KBNs) continue to be an important part of the nursing workforce in the United States of America (USA). They bring their skills, knowledge, and experience to their new areas of nursing practice. Even though it may be challenging to adapt, Kenyan Nurse’s skills, knowledge, and experiences may be enhanced by successfully integrating them in the American healthcare system. Some of these challenges include socio-cultural difference; structure of healthcare systems; technology; language such as abbreviations, expressions, and phrases; and new environment. This study will be conducted using a quantitative research method and purposeful survey of 20 KBNs using Cross Cultural Adaptability Inventory (CCAI) tool. By focusing on KBNs working in the US, this study will help US hospitals and nursing employers to better understand the transition process of KBNs. Transitioning programs bridges the practices gaps between KBNs to their new setting. This study will examine how KBNs adapt to the American healthcare culture. Keywords: foreign nurses, experiences, transition, adaptation, nurse migration, orientation. ii Dedication To unquenched loving memory of my father, Joseph Kimaru araap Tangwar, whose solace lives among us, denied the joy of beholding it, succumbed to illness in my teenage. To my loving mother, Magdalyne Jerobon Tangwar whose strength in heart has helped me weather the storms of life! whose earnest prayers keep me going… To my loving husband, Ezekiel Kiprono araap Koech The love of my youth who has remained on his knees to keep me on my feet my fervent inspiration and always and forever smiling! To my son, Kipleel Rono The jewel of my life To my brothers and sisters our bonded love of one another To my village, Kerita-Kapkoigaa-Kosyin That raised me To my teachers, mentors and professors, and institutions who bestowed knowledge and understanding in academia To all and sundry those who will derive something from this Thesis and from me I praise God of Isaac and Jacob who gave me peace within and assurance of health abundant To Him I ascribe Glory, Honor, Power and Majesty iii Acknowledgments I humbly acknowledge Dr. Frances Sparti and Dr. Candice Rome, for leading the way. I thank the nurses who took part in this study and to the international students, who have shared their world experiences with me and the patients who have shared their lives with me iv © Emily Tangwar 2014 All Rights Reserved v TABLE OF CONTENTS CHAPTER I: INTRODUCTION Problem Statement .........................................................................................................2 Significance....................................................................................................................3 Purpose ...........................................................................................................................4 Research Questions ........................................................................................................4 Conceptual Framework ..................................................................................................4 Definition of Terms........................................................................................................7 Summary ........................................................................................................................7 CHAPTER II: RESEARCH BASED EVIDENCE Review of Literature .....................................................................................................8 Summary ......................................................................................................................14 CHAPTER III: METHODOLOGY Implementation ............................................................................................................15 Setting ..........................................................................................................................16 Sample..........................................................................................................................16 Design ..........................................................................................................................16 Protection of Human Subjects .....................................................................................17 Instruments ...................................................................................................................17 Data Collection ............................................................................................................19 Data Analysis ...............................................................................................................20 Summary ......................................................................................................................21 CHAPTER IV: RESULTS Sample Characteristics .................................................................................................22 Major Findings .............................................................................................................23 vi Summary ......................................................................................................................32 CHAPTER V: DISCUSSION Implication of Findings ................................................................................................34 Application to Conceptual Framework ........................................................................35 Limitations ...................................................................................................................37 Implications for Nursing ..............................................................................................38 Recommendations ........................................................................................................39 Conclusion ...................................................................................................................39 REFERENCES ..................................................................................................................40 APPENDICES Appendix A: Demographic Questionnaire...................................................................44 Appendix B: Consent Form .........................................................................................45 vii List of Figures Figure 1: The Sunrise Model .................................................................................................5 viii List of Tables Table 1: Demographic Characteristics of Respondents .....................................................24 Table 2: Details of US Experience.....................................................................................25 Table 3: Details of US Experience.....................................................................................26 Table 4: Mean Scores of Cross-Cultural Adaptability of KBN Based on Orientation Time Frame ........................................................................................................................27 Table 5: Results of ANOVA on Interaction Between Orientation Time and Cross- Cultural Adaptability .........................................................................................................29 Table 6: T-test and Sample Statistics .................................................................................31 ix 1 CHAPTER I Introduction Nursing shortages have become an increasing challenge in both developed and developing countries, leading a negative impact on the health and wellbeing of the global population (Buchan, 2004). To meet the growing needs resulting from this shortage, employers have been forced to recruit foreign educated nurses. As a result, nurses are migrating in growing numbers from developing countries to developed countries like the United States, Europe, and Canada. The phenomenon of nurse migration has a long tradition and continues to be a growing global sensation with major implications on the nursing profession worldwide (Likupe, 2006). This nursing shortage within the
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