Table 2 Data extraction and synthesis
From: A meta-synthesis of the transitioning experiences and career progression of migrant African nurses
Author/ year/ setting | Study aim | Study design/ participants | Verbatim quotes | Subthemes | Themes |
|---|---|---|---|---|---|
Aboderin, 2007 [47] United Kingdom | To presents evidence on the contexts, circumstances and perspectives of Nigerian trained nurses working in the UK and examine their relationships to globalization by building on prior analyses that use Bauman's concepts of ‘global’ and ‘local’ perspectives | Exploratory qualitative study Nigerian trained registered nurses working in the independent nursing home sector in England (n = 25) and registered nurses, nursing tutors and returnee migrants in Nigeria (n = 7) | If the economy were improved in Nigeria, we wouldn't leave our country, you understand me? That is why we came here…to adapt ourselves to the situation and then to endure. After endurance we go back home In a nursing home, you do…maybe 30% of what a nurse actually does. And it is the same every day…but…at the hospital, you meet challenges…and you do what you have been trained to do Those white…carers. They tell me ‘I have changed this man, can you change the pad’. Do you get it? I tell them ‘you as the carer are not supposed to tell me that, I am supposed to tell you that I have changed [X], can you change the pad Well, at the end of the day, they are white and they will side with the carers I am here for a purpose I…will go when I am ready to go I know but if that is the sacrifice I have to make I am ready to do it | Survival strategy Navigating a new culture Standing up for oneself Prejudices Survival strategy Survival strategy | Navigating reality shock Navigating reality shock Finding one’s feet Discrimination and limited opportunities for promotion |
Alexis et al., 2007 [48] United Kingdom | To explore, describe and develop a greater understanding of the experiences of overseas black and minority ethnic nurses in the National Health Service (NHS) in the south of England | Phenomenological study Non-white participants originated from Asia, Africa and the Caribbean | Some relatives would by-pass me and look for a white nurse to enquire about their family member although I am the one caring for that patient We are just careful of what we have to say you know what I mean. They are permanent here and no matter what happens they can stay here but we are temporary nurses here and if we say something that they don't like we could be thrown out of the country | Preference for White over Black Prejudice/ navigating a new culture | Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion |
Henry, 2007 [49] United Kingdom | To explore the perceptions of career progression in the NHS of a group of midwives and nurses trained in Ghana and working in the UK | Qualitative case study Older Ghanaian nurses | she got it (promotion) because the questions they asked and everything, it's her natural language, that's her natural expression … for the African you have to prod … because that is the way we do things, you know. So the panel who are not used to the Africans, their way of life, or mannerisms, they say that we are thick, we cannot perform. But we can perform, we've got it all here, but sometimes it's the expression to make the panel understand us or to impress them … (she) looked at the job specification and then she started telling me ‘you know this, this, this’ … but the way she put it was not how I would have put it … she knew the buzz words she knew the words the people, the panel want they tell us to sell ourselves, but then what are we saying to sell ourselves? What should we say to sell ourselves? (It) is our downfall because we don't know what to say and this is a time that we need help. How do you sell yourself … We need somebody to tell us that this is how the panel want it and then we will say it because we've got it there. But it's not forthcoming It's not information I do not have, it's how to structure the information … how to make it sensible to me and to understand it and to be able to deliver it in the acceptable way. That is all we need … But that is what we don't get, but that is why, especially the African group of midwives and nurses, we don't move forward you hear the manager or some senior member of staff call a colleague who is also going for the interview, they go to office for a long time and they come back they are doing this (and) that … (but) nobody even asks me …’'have you prepared or is somebody helping you prepare for the interview?’’ No-one, no senior member of staff ever called me or asked me ‘they would call people to their offices and show them, tell them everything’ what was happening at the time was that they would help other people because I witnessed so many other things in that they would call some people Just before the interview I asked (the manager) if I could come for coaching, she said ‘‘no, no I may be on the panel so I won't be able to help you’’ so the day before the interview all she could do was just help me with how to use the projector … but the manager called my colleague to her office and rang personnel, got her an application, helped her to apply for a G grade I didn't get that kind of help. I would go to them and then … present myself and ask them what they think about the issues that were going to be interviewed on and then I tell them how I think it is. I tell them my version and they tell me it is alright. So I go away thinking that what I know is alright and is enough to go through the interview. So I go to the interview I get asked the questions and I tell them what I know and then it's like I make a fool of myself I've seen it and I've heard about it. I've seen it and I've sensed it. That this is what they do, they make arrangements with them, they go, they show them structure, ‘‘this is what you say, this is what you say, this is what you say’’. Now we don't get that sort of help. That's why we go for interviews and we don't pass We are afraid to make noise. That is what a lot of the black and ethnic minority staff are going through because they will be victimised … you will be victimised in such a way that nothing will move on for you. You will be noted as a trouble-maker and because of that people would rather suffer in silence (and) get their daily bread … we are not only looking after ourselves and our immediate dependents, we also have an extended family and we need to view that, who needs an enemy at your job place | Lack of recognition/ prejudice Prejudice Limited opportunities for workplace promotion Prejudice/ limited opportunities for workplace promotion Discrimination Discrimination Discrimination/ limited opportunities for workplace promotion Navigating a new culture | Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Navigating reality shock |
Iheduru-Anderson & Wahi, 2018 [50] United States of America | To characterize the facilitators and barriers to transition of Nigerian IENs (NIENs) to the United States health care setting | Descriptive phenomenology Six Nigerian nurses (all females) with an average duration of stay in the United States at the time of the study of 14.5 years, and an average age of 39 years The average number of years they spent as RNs was 18, and average years of experience as nurses in the United States was 11 | I was afraid to ask questions... I was kind of scared, I didn’t know the right thing to do. I was just dying inside and getting frustrated They did not even give me a chance, they judged my competency and knowledge based on my accent and skin color The nurses I worked with there were horrible. They were insensitive, they acted like they did not want me there.... They gang up on me and they were always reporting me to the manager, for no apparent reason.... Overall, it was a hostile environment They did not accept me in that place. You can’t just exclude the foreign trained nurses and judge them by the language, that they had an accent... [The patient] said, “Could you please get someone who speaks English because I am not even sure where you got your nursing license [In my previous job] they offer no support, even the preceptors. But in my second job, they gave me a good orientation, and I had support from another staff member who went out of her way to really give me more, and I was comfortable asking questions and she really helped me out and that made it more comfortable for me to work in that place Hard work, determination. I am not a quitter, I still have an accent but I have learned to speak so they can understand me better My nursing in Nigeria really prepared me well for my nursing practice in the US. They really did prepare me well to function as a nurse anywhere. I passed my board exams with no problems I had people I already knew that were working there. You know, other foreign educated nurses from Nigeria. I took the second job based on their conviction and assurance. They supported me all the way. I think because of them I am practicing as a nurse today. Having the other nurses from West Africa made a huge difference. I felt like I belong You just have to work hard in life and you can make it. Don’t give up... Don’t let other people issues get in your way. When all is said and done, we are better off here than at home [in Nigeria]. There is so much you can do here [in the US] as a nurse. So many places you can work. There are lots of options and opportunities for nurses here than back home. So it is better here I like the specialties here because, you specialize in one thing, this is your area and you know it well. That’s better than being everywhere. I prefer the specialties I will tell other Nigerian nurses the same thing, you will get used to it, just don’t let it bother you, don’t let them break you. It is just a phase, we all go through Because of all the bad experiences I had when I first started nursing in the country, what I can say is that I have grown professionally and otherwise... So to think of the impact it has made on me as a person, it has allowed me to understand what their perception of me is, and their perception of me as a professional nurse I believe a transitional program [would help], where foreign trained nurses can do like a three to six months training in a hospital | Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture/ prejudice Survival strategy and support amidst shock Experiencing growth Experiencing growth Support amidst shock Experiencing growth Experiencing growth Experiencing growth Experiencing growth Support amidst the shock | Navigating reality shock Navigating reality shock Navigating reality shock Discrimination and limited opportunities for promotion Navigating reality shock Finding one’s feet Navigating reality shock Finding one’s feet Navigating reality shock |
Jose, 2011 [51] United States of America | To elicit and describe the lived experiences of internationally educated nurses (IENs) who work in a multi-hospital medical centre in the urban USA | Phenomenology IENs who had migrated from the countries of the Philippines, Nigeria and India to the USA | ‘You know. The idea was once you get to America, you can make it. [without] any hindrances or difficulties’ ‘I feel if the families are there, they show love and concern by doing things for the patient and making him ready to go home’ ‘I had to learn to say things in a way they will understand’ I love the profession. I think America is a good place for me to do a better job and to expand in my education and practice’ ‘It's just that it's hard to come, pick up the language, the culture, in a short time. You've got to go slow. We are good nurses with lots of potential, but it's just that everything's overwhelming [in the beginning]’ | Navigating a new culture Support Experiencing growth Navigating a new culture | Navigating reality shock Navigating reality shock Finding one’s feet Navigating reality shock |
Larsen, 2007 [52] United Kingdom | To examine empirically and in-depth how discriminatory attitudes and practices are experienced by overseas nurses and how the discrimination may affect their well-being and career progression | Phenomenology Two migrant nurses | We felt what we were being trained for was really not nursing, not the kind of thing we were going to go into after[wards]. It was more carers’ work, like an extra hand. We're actually paid as well and rota'd with the carers [W]e were working as carers with them [the carers]. The next thing people expected a lot more from you. You get attitudes which isn't very nice towards your work and everything. … you know that negative attitude, like ‘who's done this?’ and ‘who's whatever’ and ‘these are the nurses’ and that kind of thing [N]ot accepting you as you are, that's how I felt about it. It was like, ‘these Black nurses, what do they know? Are they really nurses professionally or what?’ NHS now, things are different, they are not so bad as they were in the nursing home. But, you see, some of the things, you say to yourself: ‘what's happening here, what's this all about?’… A visitor comes, someone who's not knowledgeable, instead of talking to the staff nurse, who's there, about the patient, they'd rather talk to the student nurse, because [she is] White and you are Black. …You get that sort of thing on and off from different groups of people. It could be the patient or the visitor. It could be colleagues He was telling me that ‘if you don't finish your two years, you have to stay here for two years or you go back to your country.’… And I was the only coloured person where I was working. My first problem I had with the Matron was a clinical issue, was a nursing issue. The way we were trained [in Nigeria], the medical language, we knew everything. But [in Britain] they don't seem to understand anything. So when you say something they say ‘you know too much’ or ‘you are arrogant’. … She was sending this carer and trained nurses after me. When I'm on nights, I'm meant to start the medication at 10 o'clock. By 9 o'clock someone's coming in and telling me to give the medication. I'm telling ‘it is not yet time for me to start’. Even the people working there said ‘how did you get yourself registered?’. When they asked me several times I said ‘I stole it, can you please call the police’ Of course! The discrimination started from that salary. A carer who cannot be earning more than that, then it's discrimination. Apart from that, they were looking for every fault. They would phone the matron by 9·30 to say I hadn't started the medication. The matron would drive eight miles to come and spy. At night, in narrow roads! Eight miles! Before she got there I must have started something. She'd walk in and go round. I got to know that they were actually setting traps Yes, they didn't want me around. There was a time they sent a letter to the health authority, unfounded allegations. The reply came and they said ‘these are internal things, not professional’ From being very, a very confident person and like somebody who's outspoken and going to say what's going to be said, I sort of drew in, into a shell, just to protect myself. You know what I mean? You really don't know where you stand, you've made your choice, you want to go on with what you've done, you weigh the pros and cons. If I really do start questioning and all that, ‘oh this nurse, she's like that’ but you want things to be done in the right way. You are not really sure who to go to. And who to trust… Actually, it's knocked my confidence outright. I don't think I've gained my confidence at all up to now. I don't think so I've struggled since I came up to now. I made some personality changes and have adapted. I will leave it at that. I'm comfortable, I don't want to create any problems. I think for the time being I'll leave it as it is. That's how I feel about it I'll leave it like that for the time being. I'm contented with what I have. If I become an E grade nurse I'll have extra responsibilities. I'm not ready for that at all. The experience I've had I do want my career to develop, but at the moment in time I still don't know what I shall do next. I don't know. I want to move out of the [specialist] ward and get another experience in another hospital. I would like [to]. [But] when you think of all the experience, getting to know new people, different attitudes again and all that. I don't think I can stand it again at the moment [I]f you talk about discrimination, you'll never move. If you come into [a] room yourself, nobody can discriminate against you. That is one thing I realised. So I don't count on it Because you'd be depressed. Because whatever they do, even if it is not discrimination, you would think ‘oh God, that again!’. You understand? Kind of misinterpretation of peoples’ actions and you would just be rejected every time Yes. It stops you, believe it or not. If I was thinking of discrimination before interviews then I will have decided within me that I will never apply there again. Then I will have been stopped. I did not think about that and I continued. And that's how I got this job \\Yes. If you know your stuff, there are people that will see that ‘this guy knows what he's talking about, his knowledge, experience’. … They are distractions. Even if you live in the midst of discrimination, if you want to move you [inaudible], but if you live and you focus on discrimination… because you always get it every day. Or you misinterpret everything to be it every day. Then you'll always be rejected and feeling sad. But if you look at ‘where do you go, this is where I'm headed’, get yourself focused | Navigating a new culture Prejudice/ discrimination Prejudice/ discrimination Prejudice/ discrimination Prejudice Discrimination Prejudice/ discrimination Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Limited opportunities for workplace promotion Experiencing growth Experiencing growth Experiencing growth Experiencing growth | Navigating reality shock Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Navigating reality shock Navigating reality shock Discrimination and limited opportunities for promotion Finding one’s feet Finding one’s feet Finding one’s feet Finding one’s feet |
Likupe, 2015 [26] United Kingdom | To explore experiences of racism, discrimination and equality of opportunity among black African nurses and their managers' perspective on these issues | Qualitative study Thirty nurses from Malawi, Kenya, Ghana, Nigeria, South Africa, Zambia, Zimbabwe and Cameroon, had been in the UK between two and five years and were all at staff nurse grade Nurses had experience ranging from five to 20 years in their countries of origin. Two nurses had been lecturers in their country of origin while the rest had been sisters and staff nurses | ‘Nobody recognises any black (nurse) no matter how intelligent you are. If you are intelligent they would rather prove you to be too confrontational. So I tell you I cannot hide, I told my manager last week I said I'm not happy’ ‘When the Indian nurses were recruited there was this thing (policy) about recruitment and retention so you find that the kind of treatment that they were given is that kind of treatment that would want to keep people where they are and then after a while it (the feeling that Indian nurses were recruited to be retained) all worn off and that's why they came up with this attitude that they are better than you because they were given the impression that they were needed more than you are’ ‘We had one Hungarian lady who was working with us but you won't believe this lady was treated differently. We were saying the work she was doing wasn't the right thing but she was treated like… you know because of the colour as if she knows what she is doing’ ‘With my senior colleagues there was of course that feeling that I was under scrutiny all the time and it took time for them to understand that I can do the same things they do just as well as they do’ ‘Some of the residents accepted me but some were not happy to be looked after by a black person and I was told by the manager that room 40,room 43 and room 18 you should not go there because they don't like to be looked after by a black person’ ‘Even relatives, they see that you are the nurse; they have seen your badge, because we have similar uniform with the health carers but you can still see the difference. If they are enquiring something about their relative, they will bypass you, even if you are the first person they see, they will go to the health carer and then the carer will say no you go to that one, that's when they will come’ ‘…someone had chest pain and we had to do an ECG and I did it because I know how to do it although there is a pack that you should have which I don't have. She (the ward manager) said what you did was wrong and you don't have the pack so don't do it again. I said okay. She called an Indian lady to do it and she said sister but I don't have a pack as well and the sister said go and do it. I said what you are doing is discrimination’ ‘The best word I can use is racism or discrimination, as long as you come from Africa you are not one of them, you are not a white person, you are looked down upon in every way, there is racism, even when you are in a meeting, like making a suggestion, they won't take it into account because to them you are black and you don't know anything, you know, that's the thing’ ‘I have been there more than a year now, but there was a white nurse who came to work there after finishing her training, she just worked for six months and now she has been promoted to E grade. And you can imagine what impact it has on us’ ‘There are times when I have asked to go for a course, like me and another person want to go for the same course, they will choose their own people. We should feel that we've got the same qualifications and we contribute the same skills like white nurses and I think they should put equal opportunities in practice otherwise its of no use’ | Lack of recognition Prejudice/ lack of recognition Prejudices Navigating a new culture Prejudices Preference for White over Black Discrimination Discrimination/ prejudices Discrimination/ prejudices/ limited workplace promotion Limited workplace promotion | Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Navigating reality shock Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion |
Likupe & Archibong, 2013 [27] United Kingdom | To explore Black African nurses’ experiences of equal opportunities, racism, and discrimination in four NHS trusts in northeastern England | Qualitative study Thirty nurses from sub-Saharan countries working in four NHS trusts; Thirty nurses from Malawi, Kenya, Ghana, Nigeria, South Africa, Zambia, Zimbabwe and Cameroon, had been in the UK between two and five years and were all at staff nurse grade Nurses had experience ranging from five to 20 years in their countries of origin. Two nurses had been lecturers in their country of origin while the rest had been sisters and staff nurses | It could be anybody from Hungary, the Philippines it could be someone, but because you are coming from Africa there’s lack of respect. We are all professionals trained and if someone comes to a ward and doesn’t know the ward, the way it works, obviously the person will ask some questions. Africans are treated not nicely at all We had one Hungarian lady who was working with us, but you won’t believe this lady was treated differently. At the end we say the work she was doing wasn’t the right thing. but she was treated like... you know, because of the color, as if she knows what she is doing It’s really bad. You feel pain that a colleague of yours from home is being told that they need to look for a job elsewhere because they are not catching up! When you know back home, you and me, what do we do? You have no doctor around, but you have to go through a hundred patients, IVs and everything, then how come the same person cannot function? Th ere has to be something wrong, and then it will affect the quality of work that they give out. Somewhere so I think they need to know that and they need to know that we are smart like anybody else I worked on this ward, the sister sat down with me at my appraisal and I said this is what I can do, I know how to do it, if you need documents, I can try to get them for you. She never believed [that I had those skills] It’s like that because we as Africans, we are not like Filipinos and Indians who are very gullible because we fi ght back, they don’t like that. And they term that as arrogant Here it’s the auxiliaries who run the wards, not managers, I tell you. If the auxiliaries don’t like you, you are fi nished. ‘Cos they say things to your manager and the manag-ers take them seriously. If I’m on night duty and my colleague goes on break, I should not get instructions from an auxiliary You could read about carers back home, you cannot really explain what carers are; you may not be using the word carer back home. We use the word ward assistant. And then in shift planning you have to come across that carer. But how do you explain who a carer is, but if you are here, where the textbook is written, you know who a carer is and you can really apply what you are reading to your environment I once gave an example to one of the nurses, I said you have been a nurse here for some time, if I take you home and just dump you in my ward, would you be able to perform the way you have been performing? She said no, you must be very courageous to come here. But, you see, instead of giving us support even to show us, but people look at us if you fail to operate a hoist [a device for lifting patients] I had some problems with them [auxilia-ries] but I just tell them I am the registered nurse, you are the auxiliary therefore you are under my instruction. I don’t care if I am Black or what, but I am the registered nurse Again, most of them don’t know where we are coming from and what we have learned. For those who have worked outside they have a lot of respect. When you work with them you can tell the diff erence from those who have always worked here. I think it depends on their exposure and their culture. Th ose who are exposed to other cultures are diff erent. Th ose who are not exposed, I guess, you can’t blame them Th e most diffi cult age group I would say are the elderly because those are the people who have never even seen the Blacks. Because in their time there were only Whites, it’s only now that there are a lot of Blacks around It was very strange because I didn’t know what to do. One of the residents became poorly and the care assistant told me so-and-so is poorly in room 18. When I went, she refused for me to get into the room, so I had to call the ward manager to come and sort her out and take her to hospital, so it was very difficult Someone had chest pain and we had to do an ECG [electrocardiogram] and I did it, because I know how to do it, although there is a pack that you should have which I don’t have. She said what you did was wrong and you don’t have the pack, so don’t do it again. She called an Indian lady to do it and she said, “Sister, but I don’t have a pack as well, and she said go and do it.” I said, “What you are doing is discrimination.” As long as you come from Africa, you are not one of them, you are not a White person, you are looked down upon in every way. Th ere is racism, even when you are in a meeting, like a suggestion, they won’t take it into account because to them you are Black and you don’t know anything I don’t bother telling anyone because I do not think that people can listen to me. You don’t have a sense of belonging | Prejudices Prejudices Prejudices Prejudices Navigating a new culture Standing up for oneself Prejudices Prejudices Prejudices/ preference for White over Black Discrimination Prejudices/ discrimination Navigating a new culture | Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Navigating reality shock Finding one’s feet Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Discrimination and limited opportunities for promotion Navigating reality shock |
Okougha & Tilki, 2010 [53] United Kingdom | To explore the experiences of nurses recruited from Ghana and Philippines by a London NHS Trust | Qualitative study Nurses recruited from Ghana and Philippines | ‘When I first came to England, I did not understand when a patient asked me where the “loo” was. The word “loo” is not used in my country, we use toilet.’ ‘But I fi nd out the hard way that speaking eye to eye with someone without even a blink is the British way of communication. This is usually taken that someone is a good listener or actually cares.’ ‘“Please” and “thank you” is a way of showing politeness in British culture though it is not something we do in our culture.’ ‘I can say something to my colleague and, if said in a polite way, there is no need to say “please”. Being polite does not rest in the word “please”. Some people even say “please” and it is an insult.’ ‘You listen to the intonation … In my dialect, please is built into the statement. I was brought up to ask for something in a certain way that demonstrates politeness.’ ‘You can sit [as opposed to stand] even if the director of nursing is talking to you.’ ‘When I started, my mentor was an older person professionally and in age. I called her sister. Her response was “don’t sister me”! I was shocked and said “Oh sister, it is diffi cult for me to call your name because where I come from it is an insult to just call someone older than you by fi rst name.’ ‘It is easier with colleagues but with patients I still call Mr or Mrs. In Ghana, fi rst names are not used to address or refer to older family members.’ ‘Back home, when you are addressing somebody older than you, you add a title to the name like mama, auntie, sister etc.’ ‘Coming from cultural backgrounds where your physical presence is a way of demonstrating care and concern, it is diffi cult to understand why a nurse should be chasing up relatives.’ ‘People who have parents and grandparents take care of them. But this is not the same here. We do not send our aged people to nursing homes.’ ‘Some will even go away on holiday and send a postcard! I can never do this to my mother. If my mother is sick, I cannot travel. You have to be there irrespective of how important your holiday may be.’ ‘When your relative is dying back home, you don’t go to the hospital. The staff deal with it. But here, immediately the patient’s condition changes, you call the family, the next of kin.’ ‘We [Ghanaians] are very close and, when somebody is dying, the grief that we have, you don’t want to go near. But here, they even want to spend time with the dead body before it goes to the mortuary.’ ‘Offering a cup of tea to someone who has just lost a loved one was a challenge initially.’ ‘We believe in the existence of God, so we approach things differently. Here, when you admit a patient, you ask is if they need a priest. Some want the priest to come, but the majority don’t believe in God. Back home in the hospital, we do a little prayer before we start our job for the day, but here it is not like that.’ | Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture Navigating a new culture | Navigating reality shock |