CAPITULO III: Fundamentación teórica
3.3 Desarrollo y enseñanza de la primera y segunda lengua
3.3.1 Desarrollo y enseñanza de la lengua materna
One of the importance of any research is to provide a new knowledge or confirm the existing knowledge. Similarly, the research provides insights for the scholars, practitioners and policy makers (Creswell 2009; Eriksson and Kovalainen 2008; Yin 2003). Therefore, this chapters concludes the thesis. It presents how the thesis relates to previous studies, and how it answered its research questions and achieved goals. It also outlines its recommendations of the findings and it limitations.
7.1 Discussion
The data analysis and findings show that the nursing competence are associated with the skills and personality that can make the nurses perform their assigned tasks. For example, the scholars from the analysis, such as Jirwe et al (2010, 2009), Seeleman et al (2009) and Calvillo et al (2009), explain that the cultural knowledge enables the nurses to be aware of as well as respect the patients’ cultural influences. The scholars also emphasize that the nurses should know that the cultural background of elderly immigrant plays significant roles on their reasoning, responding and attitude. This competence proves the argument of Zhang et al (2001) that competence is associated with the skills and attitudes. Similarly, this competence confirms the work of Alfaro- LeFevre (1994) that it consists of theoretical and practical skills.
As the cultural knowledge appears to be the first and most mentioned competence among the analyzed articles, it can be agreed that the claims of Zhang et al (2001) and Alfaro-LeFevre (1994) seem to be right that the scholars focused so much about the cultural knowledge in the nursing competences than any other skills. Meanwhile, the current findings show that several scholars focused on the other skills such as clinical knowledge, medical knowledge and use of medical equipment. This support the emphasis of McFarland and Wehbe-Alamah (2018), Flinkman et al (2016) and Plöthner et al (2016) about the necessity of the nurses to know and understand the use of medicines and their effects on the different people (especially on the immigrants who might have not long medical records).
Furthermore, the communication competence was discussed by the previous studies, but this thesis found that the intercultural communication is as essential as cultural knowledge. The analyzed articles state that both native and immigrant nurses should acquire communication skills as it is suggested by Söderman and Rosendahl (2016), Jirwe et al (2010), Plaza del Pino et al (2013) and Tavallali et al (2013). Although some scholars, which include Zhang et al (2001) and Alfaro-LeFevre (1994), mention that the communication skill is highly needed by the nurses, this thesis found that verbal and non-verbal communication competence are necessary for the both native and immigrant nurses. The thesis found that the competence creates and maintains mutual relationship between the nurses and their patients (elderly immigrants). The thesis also notes that the communication competence promotes conducive working environment for the nurse and good end-of-life living experience for the patients. Flexibility is a new finding that was not deeply discussed in the previous work as an important competence. The analyzed articles, such as Jirwe et al (2009) and Seeleman et al (2009), argue that the nurses should be flexible and ready to adapt as well as respond to unexpected situations. The narratives of one of the authors of this thesis confirmed that the elderly care requires some flexibility because this type of patients is like children; they are fragile and unpredictable. The author also recalled that many unexpected situations are happening everyday. Thus, it can be agreed that being flexible is an important competence.
The use of tools and medical equipment is officially expected from the nurses. Meanwhile the result of the thesis shows that some technical training is needed for some equipment such as radiography (e.g. Fatahi et al. 2010). The narratives of some analyzed work and one of the author thesis support that the nurses should not feel shy to learn how to use different equipment and newly high technology devices. The thesis notes that further training to acquire this competence is highly recommended, especially for elderly nurses.
The open-mindedness and positive attitude are recommended and emphasized by the analyzed articles. This competence is also noted in the narratives of some scholarly works which include Ogbonnaya et al (2019), Sagbakken et al (2018), Westerbotn et al (2015) and Pavlish et al (2010). The narratives of one of the authors affirmed that the competence is very essential for the nurses. The author pinpoints that this competence would enable the nurses to be developed professionally.
In summary, the findings of the thesis are related to the previous studies as well as narratives of the authors and other scholarly articles. Although the cultural knowledge appears to be the main focus of the scholars, there are some competence such as use of tools and flexibility competence.
7.2 Conclusion
The primary purpose of this thesis was to investigate the nursing competences from analytic point of view. The thesis aimed to synthesize the scholarly articles and deduce the most important nursing skills. Similarly, the thesis tried to propose recommendations on how the nursing competence would be improved. In respect to these objectives, the thesis employed qualitative research method by searching, selecting and analyzing scholarly articles. The thesis employed thematic content analysis tool to synthesize 40 articles which they were published between 2009 and 2019.
The thesis found in its analysis that there is cultural knowledge, communication skill, and medical knowledge competences are essential for the nurses. The thesis found that flexibility, use of tools, and open-mindedness and positive attitude are also important competence of nurses. The thesis notes that these competences can be acquired by both native and immigrant nurses. The thesis explained how each competence can be acquired and used by the native and immigrant nurses. Furthermore, the thesis presented and discussed general competences which include leadership and following of instruction.
The explanations of thesis make the competence easy to understand and insightful for the policy makers, especially in the development of curriculum as Repo at al (2017), Singleton (2017), Kalengayi et al (2012), Samarasinghe et al (2010) and Fatahi et al (2010) suggested. Therefore, it can be concluded that the goal “to provide knowledge
for nursing students on how to give care to elderly immigrants” is achieved.
Similarly, the thesis presented simple explanations on how each competence is relevant to the native and immigrant nurses separately. These explanations provide guidance for the nursing students. It guides the nursing students to focus on the competences they might need to improve and how they can improve them. It also guides working nurses on how to improve some competences that they have not yet
considered as their weakness. Therefore, it can be concluded that the thesis achieved this goal: to improve multicultural skill for nursing students.
This thesis examined two research questions. The first research was answered from the findings of the thesis. The findings, that were discussed in the chapter 5, show that the research question: what is the necessary knowledge that nursing students
should have in giving care to immigrant elderly people? was answered. The
chapter presents necessary knowledge for the nursing students, either natives or immigrants, that are going to provide care for the elderly patients. The knowledge is highly needed as it was called by Repo et al (2017). Similarly, the section 5.4. answered this question: how can the knowledge of the nursing students be
evaluated? by presenting how the nursing competences can be assessed. The section
enlightened the policy makers and curriculum developers on the key categories for nursing students’ evaluation. Thus, it can be concluded that thesis answered its research questions.
7.3 Limitations
This thesis is a narrative literature-based research. It focused on certain period of time and certain literature. Hence, it has some limitations. The first limitation is that selected articles might not be very comprehensive because some literary materials, such as conferences papers, books and book chapters, policy documents and practitioner reports, were excluded. These excluded materials might have important information that might be relevant for thesis.
Another limitation is that the number of years. The thesis focused on the articles that were published between 2009 and 2019. There is possibility that some important articles were published early, and they contained relevant information for the thesis, but they were excluded. For instance, Zhang et al (2001) is an earlier article about the thesis topic and it contains relevant information. This article was analyzed for the thesis because of its year of publication.
The thesis seems to have practical implication. Meanwhile, it is not an empirical research. Thus, this is a limitation. The thesis might have more practical implication if it could be done empirically.
However, the above-mentioned limitations do not render this thesis useless or valueless. The limitations make the thesis to be useful for future studies. For instances, there can be a future study that considers all different literary materials and longer period. There can be also a future study that use empirical approach to investigate the necessary nursing competence. Additionally, there can be a future study that considers a specific nursing competence, like medical and clinical knowledge.
7.4 Recommendations
There is a speculation that a new nursing curriculum will be in use from next year academic session (that is, 2020/2021). The new curriculum requires the nursing students to do an examination before becoming a registered nurse. Thus, NCS questions can be added to the examination to know how the upcoming nurse is prepared for diverse or multicultural healthcare working environment in Finland. Similarly, the examination may contain some questions that relate to identified nursing competence from this thesis.
Furthermore, the identified nursing competence of this thesis can be used to assess preparation for nursing profession. The simulation and nursing student’s performance can be known during the sessions because simulation shows the level of understanding of each student. Likewise, pharmacotherapy knowledge can be checked during the simulation as well as the nursing student’s flexibility and productivity even though the simulation environment is not real, however ability to participate and show skill levels denote nursing student’s interest and passion for the profession. Therefore, using the finding of the thesis is recommended.
REFERENCES
Agee, J. (2009) Developing qualitative research questions: a reflective process, International
Journal of Qualitative Studies in Education, Vol. 22 (4), 431–447.
Alfaro-LeFevre, R. (1994) Applying Nursing Process: A Step-by-Step Guide 3rd edn. Lippincott, Philadelphia, PA
Allen, J., Brown, L., Duff, C., Nesbitt, P., & Hepner, A. (2013) Development and evaluation of a teaching and learning approach in cross-cultural care and antidiscrimination in university nursing students, Nurse Education Today, 33(12), 1592–1598.
Alpers, L.-M. (2016) Distrust and patients in intercultural healthcare: A qualitative interview study. Nursing Ethics, 25(3), 313–323.
Alpers, L.-M., & Hanssen, I. (2014) Caring for ethnic minority patients: A mixed method study of nurses’ self-assessment of cultural competency. Nurse Education Today, 34(6), 999–1004. Anttonen, A. & Haïkïö, L. (2011) Care ‘going market’: Finnish elderly-care policies in transition, NJSR – Nordic Journal of Social Research, Special Issue.
Backhaus, P. (2009) Politeness in institutional elderly care in Japan: A cross-cultural comparison, Journal of Politeness Research, 5, 53-71
Bing-Jonsson, P. C., Hofoss, D., Kirkevold, M., Bjørk, I. T. and Foss, C. (2016) Sufficient competence in community elderly care? Results from a competence measurement of nursing staff, BMC Nursing, 15 (5), 1-11.
Blomberg, K., James, I., Kihlgren, A. (2013). Meanings Over Time of Working as a Nurse in Elderly Care. Open Nursing Journal. 2013; 7: 107–113. Referred 7.2.2020. Available online at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772566/
Boote, D.N. & Beile, P. (2005) Scholars before researchers: On the centrality of the dissertation literature review in research preparation, Educational Researcher 34 (6), 3-15
Bourgeault, I. L., Atanackovic, J., Rashid, A., & Parpia, R. (2010) Relations between Immigrant Care Workers and Older Persons in Home and Long-Term Care, Canadian Journal on Aging /
La Revue Canadienne Du Vieillissement, 29(01), 109.
Braun, V., & Clarke, V. (2006) Using Thematic Analysis in Psychology. Qualitative Research in
Psychology, 3(2): 77-101.
Cacabelos, R. (2018) Pharmacogenomics of Alzheimer’s and Parkinson’s diseases.
Calvillo, E., Clark, Ballantyne, J.E., Pacquiao, D., Purnell, L. D., & Villarruel, A. M. (2009) Cultural competency in baccalaureate nursing education, Journal of Transcultural Nursing, 20 (2), 137–145.
Caraco, Y., Blotnick, S., & Muszkat, M. (2008) CYP2C9 genotype-guided warfarin prescribing enhances the efficacy and safety of anticoagulation: a prospective randomized controlled study.
Clin Pharmacol Ther, 83, 460-70.
Cicolini, G., Pelle, C. D., Comparcini, D, Tomietto, M., Cerratti, F., Schim, S. M., Di Giovanni, P., & Simonetti, V. (2015) Cultural Competence Among Italian Nurses: A Multicentric Survey,
Journal of Nursing Scholarship, 47 (6),536–543
Creswell, J. W. (2009). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches, 3rd Ed. Publication Inc., London.
Daneshi, N., Holliday, E, Hangcock, S., Schneider, J., Scott, R-J, Attia, J., Milward, E-A. (2017). Prevalence of clinically actionable genotypes and medication exposure of older adults in the community.US National Library of Medicine. 10:17–27
Dauvrin, M., & Lorant, V. (2015) Leadership and Cultural Competence of Healthcare Professionals. Nursing Research, 64(3), 200–210.
Debesay, J., Harsløf, I., Rechel, B., & Vike, H. (2014) Facing diversity under institutional constraints: challenging situations for community nurses when providing care to ethnic minority patients. Journal of Advanced Nursing , 70(9), 2107-2116.
Dubus, N., (2010) “I feel like her daughter not her mother”: Ethnographic trans-cultural perspective of the experiences of aging for a group of Southeast Asian refugees in the United States. Journal of Aging Studies, 24; 204–211
Elstad, J. I & VabØ, M. (2008) Job stress, sickness absence and sickness presenteeism in Nordic elderly care, Scandinavian Journal of Public Health, 2008; 000: 1–8
Ellis, T. J. & Levy, Y. (2009) Towards a Guide for Novice Researchers on Research Methodology: Review and Proposed Methods, Issue s in Informing Science and Information
Technology, Volume 6, http://iisit.org/Vol6/IISITv6p323-337Ellis663.pdf
Epilepsy Foundation (2009), issue 2. Referred 7.2.2020. Available online at:
https://mail.google.com/mail/u/0/#inbox?projector=1
Eriksson, P., & Kovalainen, A. (2008) Qualitative Methods in Business Research. London: Sage Publications Ltd.
Evans, N., Meñaca, A., Koffman, J., Harding, R., Higginson, I. J., Pool, R., & Gysels, on behalf of PRISMA, M. (2012), Cultural Competence in End-of-Life Care: Terms, Definitions, and Conceptual Models from the British Literature. Journal of Palliative Medicine, 15(7), 812–820. Fatahi, N., Mattsson, B., Lundgren, S. M., & Hellström, M. (2010) Nurse radiographers’ experiences of communication with patients who do not speak the native language. Journal of
Advanced Nursing, 66(4), 774–783.
Finland Population Research Institute (Väestoliito, 2020) Migration in Finland. Consulted on:
https://www.vaestoliitto.fi/in_english/population_research_institute/facts-and-figures/migration- in-finland/
Finlex (2016) Laki ikääntyneen väestön toimintakyvyn tukemisesta sekä iäkkäiden sosiaali- ja terveyspalveluista. Referred on 19.5.2020. Available online at:
https://www.finlex.fi/fi/laki/ajantasa/2012/20120980
Flinkman, M, Leino-Kilpi, H., Numminen, O, Yeon, Y., Kuokkanen, L., Meretoja,R. (2006) Nursing Competence scale: A systematic and psychometric review. Referred 7.2.2020. Available online at: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jan.13183
Golafshani, N. (2003) Understanding Reliability and Validity in Qualitative Research, The
Qualitative Report, 8 (4), 597-607.
Hafsteinsdottir, T., Jonsdottir, H., Kirkevold, M, Leino-Kilpi, H., Lomborg, K., Rahm Hallberg, I. (2019) Leadership in Nursing: experiences from the European Nordic Countries. Spriger Nature Switzerland
Heikkinen, S.J, Lumme-Sandt, K, ( 2014 ) Ikääntyvä maahanmuuttaja kuntien kotouttamisohjelmissa ja vanhuspoliittisissa ohjelmissa, Gerontologia 28(3), 2014. Referred 7.2.2016. Available online at: https://elakelaiset.fi/wp-content/uploads/Artikkeli_Sari- Heikkinen.pdf
Hietapakka, L., Elovainio, M., Wesolovska, K. et al. (2018) The association between cross- cultural competence and well-being among registered native and foreign-born nurses in Finland BMC Health service Research, PLoS One, 13(12).
Hietapakka, L., Elovainio, M., Wesolovska, K. et al. (2019) Testing the psychometric properties of the Finnish version of the cross-cultural competence instrument of healthcare professionals (CCCHP), BMC Health service Research, 19(1):294
Hovland, O., Johannessen, B. (2018) Nursing students develop cultural competence during student exchanges in Tanzania. Norwegian Journal of Clinical Nursing / Sykepleien Forskning, 1/4/2019; 1-17.
Johnstone, M- J., Hutchinson, A.M, Redley, B., and Rawson, H. (2016) Nursing Roles and Strategies in End-ofLife Decision Making Concerning Elderly Immigrants Admitted to Acute Care Hospitals: An Australian Study, Journal of Transcultural Nursing, 27(5) 471 –479
Jirwe, M., Gerrish, K., Keeney, S. and Emami, A. (2009) Identifying the core components of cultural competence: findings from a Delphi study, Journal of Clinical Nursing, 18, 2622–2634. Jirwe, M., Gerrish, K. & Emami A. (2010) Student nurses' experiences of communication in cross-cultural care encounters. Scand J Caring Sci., 24: 436-444.
Kallakorpi, S, Haatainen, K., Kankkunen, P. (2018) Psychiatric nursing care experiences of immigrant patients: A Focused ethnographic study. International Journal of Mental health
Nursing, 28 (1)
Kalengayi, F.K.N., Hurtig, A., Ahlm, C. et al (2012) “It is a challenge to do it the right way”: an interpretive description of caregivers’ experiences in caring for migrant patients in Northern Sweden. BMC Health Serv Res, 12, 433
Kim, Y. S., Baek, H. C., & Wynd, C. A. (2010) Factors Influencing Professionalism in Nursing Among Korean American Registered Nurses, Journal of Professional Nursing, 26(4), 242–249. Last, J. (Editor) (2001) International Epidemiological Association: A dictionary of epidemiology (4th Ed) USA: New York: Oxford University Press
Lääketieteellinen Aikakauskirja Duodecim 2008;124(11):1289-93. Referred 7.2.2020. Available online at: https://www-terveysportti-fi.ezproxy.turkuamk.fi/dtk/ltk/koti
Knecht, J.,Fontana, J.S., Fischer, B., Spitz, K.R., Tetreault, J. N. (2019) An Investigation of the Development of Cultural Competence in Baccalaureate Nursing Students: A Mixed-Methods Study, Journal of Cultural Diversity,26(3): 89-95.
McClimens, A., Brewster, J., & Lewis, R. (2014) Recognising and respecting patients’ cultural diversity. Nursing Standard, 28(28), 45–52.
McFarland, M. & Wehbe-Alamah, H. (2018) Leininger’s Transcultural Nursing. Concepts, theories, research & Practice, Fourth Edition, Mc Graw Hill Education. New York.
Meretoja, R., Isoaho, H. & Leino-Kilpi, H. (2004a) Nurse Competence Scale: development and psychometric testing. Journal of Advanced Nursing, 47, 124–133.
Ministry of Economic Affairs and employment in Finland. Referred 23.1.2020. Available online at: https://tem.fi/en/article/-/asset_publisher/maahanmuuttajien-onnistunut-kotoutuminen-on- monen-tekijan-summa
Munkejord, C.M, Tingvold, L. (2019) Staff perceptions of competence in a multicultural nursing home in Norway, Social Science & Medicine. 32; 230-237
Nielsen, B., & Birkelund, R. (2009) Minority ethnic patients in the Danish healthcare system - a qualitative study of nurses’ experiences when meeting minority ethnic patients. Scandinavian
Journal of Caring Sciences, 23(3), 431–437.
Numminen, O., Meretoja, R., Isoaho, H., & Leino-Kilpi, H. (2013) Professional competence of practising nurses. Journal of Clinical Nursing, 22(9-10), 1411–1423.
Ogbonnaya, O., Watson D. P., Hendrie H.C. (2019) Understanding the healthcare experiences and needs of African immigrants in the United States: a scoping review. BMC Public Health 20:27
Pavlish, C-L, Noor, S, Brandt, J. (2010) Somali Immigrant Women and the American Health Care System: Discordant Beliefs, Divergent Expectations, and Silent Worries US National Library of Medicine, Soc Sci Med. 71(2): 353–361.
Plaza del Pino, F.J., Soriano, E. & Higginbottom, G.M. (2013) . Sociocultural and linguistic boundaries influencing intercultural communication between nurses and Moroccan patients in southern Spain: a focused ethnography. BMC Nursing, 12, 14.
Plöthner, M, Rippentrop, D., Hartman, J-P., Frank, M. (2016) Cost-Effectiveness of Pharmacogenomic and Pharmacogenetic Test-Guided Personalized Therapies: A Systematic Review of the Approved Active Substances for Personalized Medicine in Germany. US National
Library of Medicine. 33(9), 1461–1480.
Raaska, K., Neuvonen, P., Backman, J. (2008) CYP2D6-geenitesti masennuslääkityksen yhteydessä.
Rask, S.(2018). Diversity and Health in the Population : Findings on Russian, Somali and Kurdish origin populations in Finland. Väitöskirja. Pysyväiosoite: Referred 7.2.2020. Available online at: https://helda.helsinki.fi/handle/10138/233970
Repo, H., Vahlberg, T., Salminen, L., Papadopoulos, I., & Leino-Kilpi, H. (2017) The Cultural Competence of Graduating Nursing Students. Journal of Transcultural Nursing, 28(1), 98–107 Rojon, C. - Saunders, M. N. K. (2012) Formulating a convincing rationale for a research study. Referred 24 December, 2019. Aavailable online at :
http://epubs.surrey.ac.uk/135497/3/Saunders_Formulating.pdf
Sagbakken, M, Storstein, S., Nielsen, R. (2018) Dementia and immigrant groups: a qualitative study of challenges related to identifying, assessing, and diagnosing dementia in Norway. BMC
Health Service Research
Samarasinghe, K., Fridlund, B., & Arvidsson, B. (2010) Primary health care nurses’ promotion of involuntary migrant families’ health. International Nursing Review, 57(2), 224–231.
Seeleman, C., Suurmond, J. & Stronks, K. (2009) Cultural competence: a conceptual framework for teaching and learning, Medical Education, 43: 229–237
Singleton, J. (2017) An Enhanced Cultural Competence Curriculum and Changes in Transcultural Self-Efficacy in Doctor of Nursing Practice Students. Journal of Transcultural
Nursing. 28(5): 516-522
Starr, S., & Wallace, D. C. (2009) Self-Reported Cultural Competence of Public Health Nurses in a Southeastern U.S. Public Health Department, Public Health Nursing, 26(1), 48–57
Statistics of Finland, 2018. Person’s with Foreign Background. Referred 23.1.2020. Available online at:
https://www.stat.fi/tup/maahanmuutto/maahanmuuttajat-
vaestossa/ulkomaalaistaustaiset_en.html#tab1483972363209_2
Steward, B. (2004) Writing a Literature Review, British Journal of Occupational Therapy, 67(11): 495 – 499.
Suh, E. E., Kagan, S., & Strump, N. (2009) Cultural Competence in Qualitative Interview Methods with Asian Immigrants. Journal of Transcultural Nursing, 20(2), 194–201.
Söderman, M., & Rosendahl, S. P. (2016) Caring for Ethnic Older People Living with Dementia – Experiences of Nursing Staff. Journal of Cross-Cultural Gerontology, 31(3), 311–326.