ANTIAGREGACIÓN SIMPLE EN LA CIRUGÍA CORONARIA

Australian permanent residency status before or after course completion (Graduate Careers Australia, 2007). In the 2010 Graduate Destination Survey, which is conducted annually by Graduate Careers Australia, 73% of former international nursing students remained as residents in Australia and were available for work four months following graduation (Hawthorne, 2010). Therefore, international nursing students are viewed as a valuable investment that is likely to return committed service to the Australian health care system (Department of Education and Training, 2014). With the current workforce shortages, the Australian health care system has become increasingly reliant on these locally trained international graduates (Konno, 2006; Productivity Commission, 2005).

Acculturation is an important concept in transcultural nursing because it

Australian culture more broadly (Sam & Ward, 2006) and the nursing culture specifically (Buscemi, 2011; Leininger, 1995; Michell, Del Fabbro & Shaw, 2017), including variations in professional values and orientations (Shaw & Degazon, 2008). Nurses professional socialisation was first described by Simpson (1979) as consisting of three analytically distinct dimensions of variables: education or the imparting of

occupational knowledge and skills; development of occupational orientations; and forming personal relatedness to the occupation. The first two dimensions are considered mainly cognitive, the third motivational (Waugaman & Lu, 1999). In contrast, Lurie (1981) breaks down socialization into two components: that which is acquired during pre-practice education, and that which is received during employment. Lurie (1981) describe three sociological approaches to professional socialization; one which stresses an indirect learning of attitudes, values, and behaviors beyond direct academic learning and training, one which stresses the effect of situational factors in the work setting, and another which views professional socialization as the result of an interactive process of breaking down a person’s identity in order to build up a new identity that includes a new profession. Current research (e.g. Crigger & Godfrey, 2014; Noll, 2014) builds on these more simplified schemas to embrace a deeper sociological and psychological understanding of the challenges newcomers encounter in the process of professional socialisation. Noll (2014) describes the process as occurring on a continuum; from compliance (i.e., following taught protocols and methods as is) to cooperative (i.e., finding solutions together) to directive (i.e., taking lead with input from others) to doing what works (i.e., creatively deviating from taught methods) and finally, to commanding (i.e., taking control/charge and refusing taught methods without involvement of clients or others, respectively). Crigger and Godfrey (2014) emphasize that the social

socialisation beginning in undergraduate and continuing over ones careers and where ethics is the foundation of everyday practice.

While attracting international students into nursing programmes and then into the local nursing workforce helps to alleviate Australia’s nursing workforce shortage, these migrant nurses must acculturate to the Australian environment if they want to become successful members of society and the nursing profession in Australia (Eggert, 2005, Takeno, 2010; Zhou, 2014; Zhou, Windsor, Coyer & Theobald, 2010). However, many of them experience significant problems in adjusting to both their professional and personal life in Australia (Ng Chok, Mannix, Dickson & Wilkes, 2017; Omeri & Atkins, 2002; Shakya & Horsfall, 2000; Stankiewicz & O’Connor, 2014).

A host of factors that affect the retention of overseas nurses in the workforce have been reported in the literature, encompassing the themes of language, perceptions of ethnocentrism (i.e., nursing education reflects Western cultural beliefs, values and orientations) and lack of orientation to the Australian nursing environment (Ng Chok et al., 2017; Omeri & Atkins, 2002; Shakya & Horsfall, 2000; Stankiewicz & O’Connor, 2014). Negotiating these issues is considered crucial for the successful transition of students from other countries to Australia and for their professional socialisation, as cultural values and beliefs can affect job satisfaction and long-term retention in the workforce (Omeri, 2006).

The successful transition of nursing students from collectivist cultures into an individualist culture involves a twofold process: acculturation (i.e., modifying existing values and internalising new values) and professional socialisation (i.e., adoption of the professional values associated with nursing) (Farenwald et al., 2005). Research has found that for international nurses in Israel, immigrant status (years in Israel) was significantly correlated to continuous commitment, whereby nurses born in Israel had

significantly lower intention to remain in nursing than those who had immigrated to the country (Glazer & De La Rosa, 2008). Further, the number of Filipino nurses in the United States who had a moderate level of job satisfaction was positively correlated to a level of acculturation that was closer to American rather than to Filipino culture (Ea, Griffin, L’Eplattenier, & Fitzpatrick, 2008). In contrast, Australian research conducted by Zheng, Everett, Glew and Salamonson (2014) examined the retention of first-year domestic nursing students and international nursing students who had English as a second language. Their results showed that the attrition rate of domestic students was nearly twice that of international students. The researchers concluded that acculturation itself is not sufficient to ensure a successful transition into the academic environment in either international or domestic nursing students. Further examination of the emerging issues for ethnically and culturally diverse nursing students in local undergraduate programmes, including the background factors, may help ensure that these students transition into the nursing culture smoothly and are retained in the local Australian workforce.

In this section of the literature review, the significance of culture has been explored as it relates to the nursing profession. The research of Hofstede and Hofstede (2005) and Triandis (1996) has been examined briefly, in light of their contributions to understanding the importance of the IC dimension to the construct of culture. The notion of acculturation that is specifically relevant in an increasingly ethnically and culturally diverse student body and increasing international nursing enrolments has been discussed. The culture of nursing and the professional socialisation of nurses have been discussed in relation to the process of transitioning into the nursing workforce. The implications for the present investigation have been reviewed particularly in relation to the need for understanding how cultural orientation intersects with nursing culture.