Students’ ability in delivering transcultural nursing linked to their place of origin: A cross-sectional study

Abstract

Objectives

This study aimed to identify the influence of each student's place of origin in delivering transcultural nursing.

Method

The study used a cross-sectional research design and quota sampling technique. A total of 98 nursing students at the apprenticeship semester from either extension or regular programs were involved in the study.

Results

The majority of the students has Javanese cultural background and come from different regions of Indonesia. Students from different regions were capable of applying transcultural nursing skills within the good ability category (72.4%). However, there was no relationship between their place of origin and their ability to apply transcultural nursing (p value = 0.388).

Conclusion

There was no relationship between students’ place of origin and the skill of transcultural nursing application. This study recommends further research on the difference of student cultural competency in delivering nursing care based on their place of origin.

Introduction

Indonesia is known as a country of many ethnic groups, housing 633 ethnic groups¹ across the archipelago. Diversity is also reflected in the cultural composition of nursing students in Universitas Indonesia. These heterogonous cultural backgrounds may cause the studentsunderstanding about the study subjects vary due to the cultural differences. Culture has a great influence on a person's values. These values will affect an individual's information processing and behavior.²

Transcultural nursing is a discipline that refers to nursing science and practice by taking into account individuals’ values and beliefs in performing certain cultural nursing practices.³ The purpose of transcultural nursing is to ensure that nurses are able to deliver nursing care according to either culturally specific or universal nursing practices. Through the application of transcultural nursing, nurses are expected to build their awareness and appreciation of cultural differences⁴ so that they can provide professional nursing care while retaining their understanding of cultural concepts.

A nurse is also an individual to begin with. In other words, they are also coming from certain cultural backgrounds that can possibly affect their values. This cultural value may become a problem when it comes to delivering nursing care for patients from a different cultural background. In this case, it would be wrong for the nurse to ignore the value while it is also not right to impose his/her values on the patient.⁵ For this reason, transcultural nursing is needed.

Transcultural nursing has been studied by nursing students in Universitas Indonesia. Students receive a course in transcultural nursing during the Basic Concept of Nursing (KDK) I class. The KDK I class is given to first semester students and is applied to the rest of the student's nursing courses. Topics studied in KDK I consist of the transcultural nursing concept, the application of transcultural nursing on the lifecycle of a human being, and the application of transcultural nursing in health care practices. After they have obtained an understanding of the subject, the nursing students are expected to deliver it in practice.

Knowledge on the application of transcultural nursing affects the psychological aspect of a nurse in providing nursing care. Purnell⁶ found that cultural differences between nurses and patients affect nurses’ performance in delivering transcultural nursing. This is also supported by research in Japan in 2004–2015, which revealed that culture shock still lingers in foreign workers even though they had already lived in Japan for 30 years.⁷

Research also exists on the problem of adaptation in students who come from different regions. In 2016 in India, it was found that there is a striking difference in the attitude of work of students based on their place of origin. This is influenced by the cultural background of their hometown.⁸ In Indonesia, a research was conducted at Padjajaran University on students coming from other regions. The result of the study reveals that those students showing the tendency to maintain the cultural values of their place of origin tended to gather with fellow students who come from the same region. This makes it difficult for them to adapt to the new environment.⁹

This study aimed to identify the relationship between students’ ability to deliver transcultural nursing and their place of origin conducted on nursing students of the Faculty of Nursing UI who are on their apprenticeship semester. The study takes into account students’ place of origin, their ethnic groups, their study program (regular or extension), and the difference in ability in delivering the transcultural nursing in regards to their place of origin.

Method

The design

The design of the study used a quantitative research. The research used cross-sectional approach or momentary behavioral observation. This study was conducted one time without doing any follow-up or intervention. The reason to use a cross-sectional design was because it was the intention of this research to identify the relationship between students’ ability to deliver transcultural nursing and their place of origin conducted on nursing students.

Population and study setting

The population of this study consisted of apprenticeship students coming respectively from the regular class of 2012 and the extension class of 2014. Ninety-eight students were involved as samples in the study, who were determined using quota sampling. Criteria for inclusion in the study consisted of being a 2016 professional student faculty of Nursing University of Indonesia who is registered and an active student. The study was conducted from November until June 2017 in the Faculty of Nursing Universitas Indonesia, Depok, West Java.

Variables

Only categorical data are included in this study, namely the stage of education, place of origin, and ethnicity. There are 2 types of variables, namely the independent variable and the dependent variable. The independent variable in this study is the level of a student's ability to deliver transcultural nursing. The dependent variable in this study is the place of origin groups.

Data collection

Data collection was done by using questionnaires. The questionnaire consists of two parts; the first part focuses on respondents’ demographic data, and the questions include the respondents’ initials, student ID number, place of origin, and ethnicity. The second section consists of questions on the application of transcultural nursing. The second part is composed of 35 statements that were taken from the cultural skill questionnaire from Enie Novieastari's dissertation (2013).¹⁰

Data analysis

As for bivariate analysis, the researcher used the chi-square test since both of variable in this research are categorical. As for the requirement of the frequency, none should be valued less than one and no more than 20% should be valued less than five.¹¹

Results

This study was conducted in April 2017. The results were as follows:

A. Student's distribution based on ethnicity

The results of this study described the characteristics of the involved students based on their ethnicity. It was found that the Javanese is the dominant ethnic group 1.8% or 41 people. The second largest ethnic group was the Sundanese consisting of 23 people or by 23.5%. Ethnic groups that are not listed on the questionnaire occupy the third position with 12 people or 12.2% which consist of 2 people of Palembang ethnicity, 2 people of Balinese ethnicity, 4 people of Lampung/Ulun Lampung, 1 person of Sasa, 1 person of Dayak, 1 person of Tetun, and 1 person of Alune.

B. Student's distribution based on the study program

In this study, students were divided into 2 study programs based on the educational program they chose in their undergraduate degree, namely regular and extension programs. Respondents of this study predominantly consist of regular program and numbered as many as 70 people or equal to 71.4% of the total share.

C. Students’ distribution based on place of origin

In this study, respondents came from various regions in Indonesia. The researchers grouped them into 4 major groups, namely from DKI Jakarta, West Java, Central and East Java, and other regional groups. The result showed that nearly an equal number of students come from DKI Jakarta compared to West Java. Thirty-five people or a 35.7% share of total respondents come from the Jakarta area and 31 people or 31.6% come from the West Java region. Twenty-four people come from regions not listed in the questionnaire, as follows: from Sumatra, 12 people; Bali, 2 people; Banten, 5 people; NTB 1 person; NTT, 1 person; Central Kalimantan, 1 person; and Maluku, 1 person.

D. The ability to deliver transcultural nursing

Most of the nursing students in this study were able to deliver transcultural nursing during their clinical apprenticeship as seen in the results, where 72.4% of the students are within the good ability category.

E. Differences in the ability to deliver transcultural nursing in regards to place of origins

Most students who have a good transcultural nursing ability in the study live in DKI Jakarta with a total share of 25.5%. The results of differences in the implementation of transcultural nursing in regards to the students’ place of origin are described in Table 1.

Table 1.

Faculty of Nursing UI apprenticeship students distribution based on the differences in the ability to deliver transcultural nursing in regards to place of origin.

Place of origin	Ability to deliver transcultural nursing		Total	p value
	Good (%)	Poor (%)
DKI Jakarta	25 (25.5%)	10 (10.2%)	35 (35.7%)	0.388
West Java	23 (23.6%)	8 (8.2%)	31 (31.6%)
Central and East Java	6 (6.1%)	2 (2.0%)	8 (8.2%)
Others	17 (17.3%)	7 (7.1%)	24 (24.5%)
Total	71 (72.4%)	27 (27.6%)	98 (100%)

Discussion

The results of this study indicated that there is no relationship between these 2 variables with p valued at 0.388 (α = 0.05). This can also be seen in the result of the research, which indicates that most students from many place of origin are within the good ability category.

The results of this study were different from Purnell's⁶ findings, which stated that differences in cultural backgrounds between nurses and patients can influence their performance in providing culturally sensitive nursing care. This can also be seen in a study in Japan in 2015, which found that Japanese nurses had difficulty in providing professional services to non-Japanese patients.¹² In the study, it was revealed that Japanese nurses had to struggle in providing nursing care to patients that were alien to them due to cultural differences. Hence, causing a lack of proper transcultural nursing application.

In 2008, 14 Japanese nurses worked in Australia for 3 months. After experiencing adaptations with different environments, these Japanese nurses were committed to join a research study to examine the development of transcultural nursing applications. The results indicated an increasing the ability, before and after they were exposed to different cultures.¹³ The study is in line with research conducted on 144 Norwegian nurses scattered in 18 different countries in Europe. As the result, the Norwegian nurses showed an improvement in their ability to appreciate patients coming from different cultures. In addition, their ability to deliver transcultural nursing has also increased.¹⁴ This suggests that the exposure to different cultures may affect nurses’ attitude in respecting cultural differences as well as their ability to deliver proper transcultural nursing.

This study also revealed that diverse places of origin do not hinder the students in applying proper transcultural nursing. It can be seen that students coming from regions outside DKI Jakarta and West Java have higher levels of transcultural nursing. Students who reside in DKI Jakarta and West Java have good transcultural nursing ability, with a category share of 71.4% and 74.2%, respectively. Students from Central Java and East Java have a good ability percentage of 75%. As for other regions, the good ability share is 76.9%. To further elaboration, these regions consist of Sumatra and Banten, with a good ability percentage of 66%, Bali 50%, and all students from NTB, NTT, Central Kalimantan, and Maluku are all within the good ability category.

Moving out of one's place of origin and being exposed to a different culture can enhance one's ability to appreciate cultural differences as supported by Schroeder's dissertation.¹⁵ In his dissertation, Schroeder revealed that undergraduates experiencing cultural differences tend to have a culturally sensitive attitude. This is due to the successful acculturation process within the students. Acculturation is a process of adaptation of a foreign culture into cultural elements within a community group. This adaptation occurs in individuals who move to a new community group.¹⁶ As for the students involved in this research, they have successfully gone through the acculturation process during their 5 years of education.

Schroeder also revealed that it is easier for undergraduates to apply the transcultural nursing concept because they will come into practice soon.¹⁵ As for the students, more than half of them are able to show a decent capability of transcultural nursing application, which indicates the successful of education program in the Faculty of Nursing UI for apprenticeship students.

This study shows that, although students come from different regional origins, it does not necessarily affect their ability to deliver transcultural nursing to patients. The majority of students in the study were able to deliver transcultural nursing in their apprentice ship there is no differences with students from regions outside the area; all of them are able to deliver good, culturally sensitive nursing practice. This indicates a successful acculturation and educational process in the students of the Faculty of Nursing UI.

The researcher suggests that the results of this study should be utilized as input for further research on other transcultural nursing subjects, for example to determine the difference of the ability to deliver transcultural nursing for nurses who come from various regions in an institution.

Conflict of interests

The authors declare no conflict of interest.

Acknowledgements

The study is supported by Hibah PITTA 2017 funded by DRPM Universitas Indonesia No. 376/UN2.R3.1/HKP.05.00/2017.