World Health

The Experiences of Western Expatriate Nursing

Educators Teaching in Eastern Asia
Carolyn S. Melby, Joan E. Dodgson, Marie Tarrant

Purpose: To describe the lived experience of English-speaking Western nurse educators teach-
ing in East Asian countries.
Design: The study design was an application of existential phenomenological approach to
qualitative data collection and analysis. Eight expatriate nurse educators who had taught
more than 2 years in an East Asian country were interviewed about their experiences
between January 2004 and November 2005.
Methods: Narrative data were analyzed using a phenomenological approach aimed at dis-
tilling the experience of the educators. Each member of the research team analyzed the
data, then through group discussions a consensus was reached, paying close attention to
developing clear understandings of language nuances and maintaining the participants’
voices.
Findings: Four themes emerged from the data: (a) differing expectations, (b) the cost of the
expatriate experience, (c) bridging pedagogies, and (d) adapting and finding purpose. The
tacit meanings of cultural differences affecting participants’ experiences are presented.
Conclusions: The ways that a collectivist-oriented culture may affect nurse educators coming
from a Western individualist worldview needs to continue to be researched to develop better
mutual understandings that will lead to culturally collaborative models of nursing practice,
education and research.

Clinical Relevance: Nurses providing direct care and nurse educators who work with people
from cultures other than their own will find the discussion of cross-cultural misunderstand-
ings useful.

[Key words: education, international, cross-cultural, phenomenology]

JOURNAL OF NURSING SCHOLARSHIP, 2008; 40:2, 176–183. 

C 2008 SIGMA THETA TAU INTERNATIONAL.

* * *

U
niversity education as requisite entry to practice
in nursing is developing as a global phenomena.
Throughout Asia, government and university ad-
ministrators have been eagerly offering economic incen-
tives to upgrade nursing to professional status. As a re-
sult, many universities in China, Japan, and East Asia have
recruited English-speaking Western nurse educators to fa-
cilitate growth and development of the nursing profession
(McAuliffe & Cohen, 2005).
Western nurse educators are stepping into university fac-
ulty roles abroad with little experience or preparation for
cross-cultural immersion and teaching. Although cultural
competency has been routinely emphasized within nursing,
the demands related to cultural competency change when
professionals are working immersed in another country. The
nature and intensity of this experience is different from
working with multicultural groups within one’s own society.
In East Asia, often the countries recruiting Western nurses
have a more monocultural society than found in the educa-
tors’ country of origin.
Teaching is relationship based and context dependent.
Cultural values exist within the experience of teaching
and learning, and affecting perceptions, relationships, and
Carolyn S. Melby, PhD, APRN, BC, CCH, Iota & Tau Nu, Professor, Na-
tional College of Nursing, Tokyo, Japan; Joan E. Dodgson, RN, MPH,
PhD, Gamma Psi at Large, Associate Professor & Director, Center for
the Advancement of Health Disparities Research, School of Nursing &
Dental Hygiene, University of Hawai’i at Manoa, Honolulu, HI; Marie Tar-
rant, RN, MPH, PhD, Assistant Professor, School of Nursing, University
of Hong Kong, Hong Kong, China. Funding was provided by National Col-
lege of Nursing, Kiyose Shi, Tokyo, Japan, and School of Nursing and
Dental Hygiene, University of Hawai’i, Honolulu, HI, USA. Correspondence
to Dr. Dodgson, Center for the Advancement of Health Disparities Re-
search, School of Nursing & Dental Hygiene, 2528 McCarthy Mall, 435
Webster Hall, University of HI at Manoa, Honolulu, HI, USA. E-mail: dodg-
son@hawaii.edu
Accepted for publication November 27, 2008.

176 Second Quarter 2008 Journal of Nursing Scholarship


interpretations of meaning (Thomas & Pollio, 2002). Re-
searchers have studied the experience of Western nursing stu-
dents during educational experiences in Asia (Duffy, Farmer,
Ravert, & Huittinen, 2005; Wallace, 2007), Western nurses
practicing in Asia and other countries (Button, Green, Teng-
nah, Johansson, & Baker, 2005; Parfitt, 1999), and a few
have quantitatively studied the roles of university-based
nurse educators abroad (Furuta, Petrini, & Davis, 2003;
McAuliffe & Cohen, 2005) or specific international collab-
orations (Zheng, Hinshaw, Yu, Guo, & Oakley, 2001). A
dearth of literature exists related to understanding the na-
ture of cross-cultural issues arising for Western nurse ed-
ucators who work within Confucian-based Asian cultures.
The purpose of this study is to understand the experience of
culturally Western English-speaking nurse educators teach-
ing in East Asian universities. It is an attempt to add to the
body of knowledge related to a global nursing education
perspective.
Background
Asian universities have been importing nurse educators
from English-speaking counties for decades, a process that
shows no signs of slowing (Lusk & Lash, 2002). Lash, Lusk,
and Nelson (2000) surveyed activities of American nursing
scholars (N=247) working internationally between 1985
and 1995. About one fourth of their sample was working
in Asia. They reported a three-fold increase in international
activity during that decade and a substantial increase in in-
ternational nursing scholarship. The U.S. scholars partici-
pated in development of undergraduate and graduate nurs-
ing programs, particularly with issues relating to research
methodology, faculty development, and curriculum (Lusk
Table. A Comparison of Worldviews: Eastern Collectivism and Western Individualisma
Key aspects of culture Eastern collectivism
Understanding the self The self is defined through group affiliations and relationships.
The self within society One has the obligation to work harmoniously within a family and
societal context by respecting the primacy of group goals.
Nature of truth Defined within the context of specific circumstances based on
retaining dignity and respect (saving face) of group members
and the overall good of the group.
Most important values Group harmony is more important than individual needs.
Respect for status (hierarchy) and the group decision-making
process.
Moderation ‘the Middle Way’ in all things (individual seeks not
to stand out within a group).
Hard work is normal and expected.
Expected role of the teacher Teacher-centered approach .
Effective learning strategies Lecture format, little classroom dialog, contextual learner,
& group achievement.
Note. a Adapted from Nisbett, (2003); Po-Wah, (2004); Slethaug, (2007); Watkins & Biggs, (2001). This table shows generalized information, which does not necessarily
represent specific individuals, and is by its nature an oversimplification of complex socio-cultural contexts.
Western Nurse Educators in Asia
& Lash, 2002). Furuta et al. (2003) surveyed North Ameri-
can nurse educators (N = 12) in Japan and found that most
were older women with doctoral degrees who had a lot of
experience in teaching and foreign travel and were accus-
tomed to being in control of their lives. Finding themselves
marginalized by their lack of knowledge of the Japanese
language and customs was a new and difficult experience.
“The customary knowledge and competence about every-
day culture became inoperative at work and for common
activities, such as reading academic reports or shopping
for groceries. . .. The everyday world became problematic”
(p. 146). Participants believed they had experienced personal
growth; however, neither their pedagogy nor their teaching
experiences were captured in detail.
Philosophers, social scientists, and non-nursing ed-
ucators, who specialize in cross-cultural comparisons,
have identified and described the perspectives inherent in
Confucian-based Asian and Western worldviews resulting
in very different societal norms and expectations (Bond,
1991; Hall & Ames, 1998; Watkins & Biggs, 2001). These
differences are profound and include basic understand-
ings of what constitutes the self in relation to society and
what constitutes truth and cultural values. Describing the
complexities of these differences is beyond the scope of
this paper and has been published elsewhere (Bond, 1991;
Hall & Ames, 1998; Nisbett, 2003; Po-Wah, 2004). How-
ever, these differences are central to understanding the
experiences of the participants in this study. Therefore,
a summary of key differences between the communitar-
ian Confucian-based Asian and Judeo-Christian individu-
alist Western worldviews is shown in the Table with the
understanding that complex cultural contexts have been
simplified.
Western individualism
The individual self is autonomous with an expectation of
self-determination.
Respect for and expectation of individual decision-making.
Perceived as an objective reality based on facts.
Individuals have the right to their own values.
Individual decision-making & disagreements are natural with a
group.
Respect is earned, usually not a given.
Excelling and standing out among many is good
Hard work should be rewarded.
Student-centered approach.
Active learning, questioning encouraged, linear learning, & individual
achievement.
Journal of Nursing Scholarship Second Quarter 2008 177
Western Nurse Educators in Asia
Expatriate nurse educators, because of the scope of their
positions, bear greater responsibility, than does one nurse
practicing in a foreign country. A greater need exists for
an educator to reveal their cultural assumptions and eth-
nocentric behaviors (Watkins & Biggs, 2001). In nursing,
little research has been done to study the ways that this oc-
curs. Central to this study is the ways in which educators,
no longer having familiar background meanings and en-
vironmental contexts, make meaning of their experiences.
The aim of this study was to describe the experience of
western nurse educators working in Confucian-based Asian
counties.
Methods
Phenomenology is both a school of philosophy and a
research method used in the human sciences. The philos-
ophy is the conceptual framework and the method is the
application of these concepts in a real world situation. Be-
cause different schools of thought exist within philosophy
about phenomenology, it is essential for researchers to be
clear about their underlying concept.
Conceptual Approach
Merleau-Ponty (1945/2001) embraced the notion of in-
terconnectedness among people, unlike many of his peers
and because of this stance he has appeal for nurse researchers
whose work most often is concerned with relationships
(Thomas, 2005). An individual “is thrown into a partic-
ular life world complete with background meanings and
practices that are shaped by one’s concerns, relationships,
culture, language and practices” (Chan, 2005). Meaning is
inherently existential and created through individuals within
their contexts through their “lived-experience” by (Merleau-
Ponty, 1945).
The lived-experience is context-bound and best under-
stood by a person’s perceptions (Benner, 1994b). Perceptions
are built upon one’s contextual experiences and come about
through an awareness of one’s existential context (Benner,
1994b; Munhall, 2007). An underlying assumption of our
approach based on the works of Merleau-Ponty (1945) is
that the situated individual co-creates and is created by tem-
poral, environmental, and historical contexts.
Design
Fundamental to the phenomenological methodology of
this study is the understanding that the researcher can not be
taken out of the research process by bracketing or other at-
tempts to distance one’s self from the process of the research
(Dreyfus, 1994). Participants and researchers co-create the
data (Benner, 1994b). The researchers are three Caucasian
nurse educators, who have worked in countries other than
their own for 3 to 10 years. This study grew out of their per-
sonal experiences and their observations of other Western
nursing educators, as they struggled to make meaning out
of their experiences teaching cross-culturally.
178 Second Quarter 2008 Journal of Nursing Scholarship
Another basic assumption of this methodology is that
“the world can never be spelled out completely” (Benner,
1994a, p. 100) because of its contextual and ever-
changing nature. This study is inherently temporally
bound and specifically focused on the experience of the
participants.
Sample
Snowball sampling was used to recruit a sample of eight
nursing educators. Sample selection criteria were: (a) native
of North America, Australia, or the United Kingdom; (b)
received doctoral degree in North America, Australia, or the
United Kingdom; and (c) had or have their first expatriate
faculty position at an Asian university for a minimum of
2 years but no more than 5 years. Expatriate nurse educators
who have made a career of working in countries other than
their own were excluded, because they most likely would
have very different perceptions than those working for less
than 5 years. The aim of this study was to understand the
experiences of those educators who were relatively new to
working within another culture.
Ethical approval to conduct this study was obtained
from the university’s institutional review board before re-
cruiting participants. A member of the research team con-
tacted potential participants. All nurse educators who were
contacted agreed to participate and informed consent was
obtained before data was collected.
Procedures
Interviews took place in a location of the participants’
choosing. Nurse educators were located in varied countries
as a result interviews were conducted in Japan, Hong Kong,
Thailand, and the United States. Two members of the re-
search team conducted the interviews, using a global ques-
tion (i.e., “Tell me about the experience of being a nurse
educator in a country other than your own?”) and possible
prompts that had been collaboratively developed with team
members. The interviews focused on the participants’ expe-
riences of teaching within the unfamiliar context in which
they lived. The length of the interviews varied from 1 to
2 hours. Most participants were interviewed once; however,
clarifications were sought throughout the analysis. Rigor
was facilitated by collaboration and by actively maintaining
an audit trail of decision-making during data collection and
analysis.
Interviews were tape-recorded and transcribed. All iden-
tifying information was removed from the transcripts and an
identification code assigned. The PI kept the consent forms
and code list identifying the participants in a locked file in
her locked office. A member of the research team checked
each transcript for accuracy before analysis.
Analysis
Data were analyzed following the completion of data
collection using an across-case analysis strategy. Benner
(1994) cautions, “The threat that the interviewer will shape

what is remembered or considered salient is ever-present”
(p. 111). To decrease this possibility, all three researchers
separately analyzed the data using a process of existen-
tial and phenomenological contextual processing as de-
scribed by Munhall (2007). Following this initial analysis,
researchers met several times to discuss and reflect on their
analyses. Meaning units were identified jointly by consensus.
Participants were contacted for clarification as needed, pay-
ing close attention to developing clear understandings of lan-
guage nuances and to maintaining the participants’ voices.
This iterative process was used among the researchers, par-
ticipants, and the literature as the analysis progressed. A
consensus was reached on the thematic content. We believed
that the consensus process was particularly important in this
study to remain as close to the experiences of the participants
as possible and to decrease the effects of each of our experi-
ences on the findings, as all of us had experiences similar to
our participants (Benner, 1994a).
Findings
Characteristics of the eight (expatriate) educators were:
seven women and one man, five were single and three
were married, none were currently raising children, al-
though five had done so previously, and all were Caucasian.
Their ages ranged from 39 to 65 years with a mean of
56.87 (SD=8.35). Countries of origin were United States
(n=5), Canada (n=1), Australia (n=1) and Great Britain
(n=1). The countries these educators were or had been
working in were Hong Kong SAR China (n=4), Japan
(n=3), and Thailand (n=1).
Four themes from the data were (a) differing expecta-
tions, (b) costs of the expatriate experience, (c) bridging ped-
agogies, and (d) adapting and finding purpose. Each theme
was defined and described with close attention to maintain-
ing voices of the participants.
Differing Expectations
Differing expectations was the difference between ex-
pectations and reality experienced by these educators. All
expatriate educators found that living in a cultural environ-
ment other than their own was challenging in unanticipated
ways. “I was familiar with Asian cultures but it isn’t the
same as living here . . . I had to try to get inside the culture
and that is really hard.”
Educators found that they did not understand what their
faculties expected of them. “I really didn’t know what they
wanted of me. . .. What did they really want from us?” Ten-
sions arose from these ambiguities causing varying amounts
of distress. According to one participant:
It has challenged me in every way imaginable. I thought that I wasn’t
that ethnocentric because I had worked with other cultures in the
US. I found that because they have a different ethical system and
a different pedagogy, their teaching methods were different; those
things sorely challenged me, and I was very frustrated. It took me
a good year to not hate being here.
Western Nurse Educators in Asia
They often framed the differences between their
expectations and those of others using their own cultural
perspective, which led to experiencing additional misunder-
standings. One example of an educator’s culture-bound un-
derstanding of truth was “they feel it’s very important for
everyone to feel good about themselves and to be part of the
group, so the result is they really do lie a lot.” Most expatri-
ate educators found that they had little preparation for the
differences they encountered in educational structures, while
local faculty were not aware of their dilemma. Some educa-
tors believed strongly that one of their responsibilities was
to increase awareness of these cultural differences among
colleagues “What is most difficult here is helping students
and faculty to understand that other people do not see the
world the way they do.” Another educator expresses it this
way,
I mean I don’t care how compassionate you are in the end, you have
to do and accept things that aren’t . . . were basically unacceptable
to you . . . and if you can’t then you aren’t going to be happy. So it
takes a special kind of person to make adjustments, fine tune into
another culture, and find happiness at the same time.
Costs of the Expatriate Experience
The second theme, the costs of the expatriate experience,
was defined as the perceived emotional, physical, moral, and
spiritual expenditure. Feeling bewildered and confused these
educators often could not sort out what was going on. “I
really didn’t know what was going on and at the beginning I
thought that maybe there were a lot of things going on that
I didn’t know about. Now I am wondering if those things
actually go on.” Searching for cultural cues became very
important in terms of learning how to interact. Giving up
control was a general issue for all participants coping with
the rather rigid social hierarchy. One participant put it this
way:
I am used to being in-charge of a lot of things. I like to do things in
advance; I am not a last-minute person. I like to know that things
are set and not have to over-look and see what shows up kind of
thing. That’s just not me . . . and I had to give that up because I
couldn’t mange it here.
Many educators talked about the personal costs asso-
ciated with their move and their day-to-day life, especially
where the value system and the way of operating in the world
seemed strange. Feeling confused and overwhelmed, many
participants spoke about becoming depressed, wondering
if they would ever understand how to negotiate their role
as educators: “Contemplating suicide was probable at one
time because I left everything to come and do this course
and waited so long and invested so much.” Another edu-
cator said, “It was overwhelming because I had no idea of
how totally a different experience it was going to be.”
Many educators spoke of the extra work of living within
a culture other than one’s own. Many discussed how in their
day-to-day life they had many problems that had to go un-
solved, their needs unmet. A participant explained, “There
was nothing there for guidance, there was nothing there for
Journal of Nursing Scholarship Second Quarter 2008 179
Western Nurse Educators in Asia
anything. I had no help with unpacking, my salary, I had
no help with anything.” Another said, “I kept asking for
advice . . . but never got any.” Decisions were made daily
based on the energy expenditure required and difficulties
in communicating. A participant explained how she coped
with these issues; “You need to know what you really can
get along without.” Exhaustion was a major issue for some
educators, which was overcome with time and increasing
familiarity with the new culture, but others found moving
beyond fatigue much more difficult.
Absolutely there is burnout; you just get tired from being away from
everything that is familiar and being away from your family. . .. I
am learning the language but I am far from being fluent . . . and all
these things make life . . . make it hard work every single day.
The work required to maintain daily life was in-
escapable, to alleviate the continual stress of this situation,
participants spoke about returning home “to get your en-
gines cleaned up and filled up, then you are ready to go
again.”
Bridging Pedagogies
Bridging pedagogies encompasses the notion that the
usual methods of teaching and evaluation of students and
self in the teacher role were perceived as unavailable or
nonfunctioning by participants. The frustration and struggle
that expatriate educators had in trying to understand educa-
tional systems very different from those they had previously
experienced was pervasive.
I didn’t even know what they [students] did in the hospital because
the clinical instructors were native speakers and if I went into the
hospital I still wouldn’t know what they did in the hospital. So it
was sort of teaching blind.
The roles of teacher and student were perceived by par-
ticipants as very different in the Asian countries. “I don’t
know what they [students] are learning.” Participants strug-
gled to understand their role. One said,
I think the most challenging aspect was understanding the stu-
dent[s] and where they were coming from. What is their level of
knowledge, how do they learn? What can I do to facilitate their
learning? What do they expect of me? And so I had to learn a lot
about the culture in order to be able to understand the students
at all.
Another educator said,
How to work in the system that existed was difficult. As well as
trying to understand if I was at all meeting the needs of the students
because they didn’t speak English that well and they were so quiet
and respectful that I couldn’t get a grasp on whether they really
understood what I said. Certainly, in class there was no (verbal or
nonverbal) feedback so that wasn’t a gauge. And so basically, I had
to wait until the end of the year when they had their comprehensive
exam to understand if they understood what I had taught them.
Many expatriate educators were uncomfortable with
the cultural norm of according teachers high social status
180 Second Quarter 2008 Journal of Nursing Scholarship
with the inherent high level of deference. “The largest chal-
lenge I have had is trying to break down the sense of rever-
ence for the professor and the view that the professor is the
holder of all knowledge.”
These educators discussed ethical issues that arose for
them while trying to fit their understanding of teaching and
learning into that of their host institutions. A major reoccur-
ring issue raised was the difficulties identifying weak stu-
dents, because the other students helped them so that the
whole group was successful. Similarly, issues concerning pla-
giarism were frequently mentioned. One educator described
her approach to this issue:
I wouldn’t ever approach [students] by saying “Oh my you are
plagiarizing.” Plagiarism is acceptable in most Asian cultures and
for reasons that make sense to them. They value things differently.
I think I’ve really learned to accept what they value from their own
culture, from their own history and traditions so I don’t have to
say you are wrong. I can let a process begin and let them begin to
learn why we see certain ethical standards as important.
Deciding what to teach was an issue given the roles that
nurses have within specific countries. The issue was framed
by one educator as, “Is it right to teach students what they
cannot practice?” Another educator elaborated further:
I think it is a pedagogical dilemma about what to teach to move the
profession along wherever it is in a particular county to the next
step. You know, do you bring it along to the next step by teaching
the global standard or do you bring it to the next step by teaching
the next step – how do you do that?”
Adapting and Finding Purpose
The fourth theme was adapting and finding purpose,
which was the way these expatriate educators were able to
adjust their thinking or actions to meet personal needs and to
make meaning of their situation. All participants expressed
a need to believe that their work was useful and meaning-
ful. “Being a role model is extremely important, and I think,
might be my most valuable role.” Reflecting on her experi-
ences, another educator spoke of role change over time.
There have been surprises . . . lots of surprises, unanticipated things.
But most of them haven’t been unpleasant or insurmountable.
When I first came, I wasn’t sure they knew what to do with me
and that surprised me. I didn’t feel like they were using me to the
utmost. And I kept saying, I am available . . . now I feel like I am
being used a great deal.
All participants spoke about how their experiences had
changed them. “I am not sure how they make the decision
sometimes . . . I knew some little things about the culture,
but to really understand what I would be doing, it was
an act of faith.” Another speaks to learning about one’s
ethnocentrism,
You can’t help but learn your biases when you are so immersed
in another culture. And you learn a lot about what you take for
granted. For example, you take for granted that people under-
stand you in certain ways and of course, they don’t, so you have to
try to be resourceful and think about how you could get them to
understand.

Discussion
A conceptual approach that indicates the deep cultural
differences between Eastern collectivist (e.g., Confucian-
based Buddhist) and Western individualist (e.g., Judeo-
Christian) philosophies framed this study. The differences
between collectivist and individualist worldviews has been
widely discussed in the literature (Nisbett, 2003; Slethaug,
2007). However even if the participants had a cognitive
recognition of these differences before their cross-cultural
teaching experience, the effects of total immersion in a
collectivist culture is much more than a cognitive experi-
ence. The fundamental ways of thinking, doing and under-
standing are very different (Nisbett, 2003; Slethaug, 2007).
Through interviews with Western expatriate nurse edu-
cators, some issues experienced during teaching in Asian
countries were identified. Although the educators’ countries
of origin and host countries were diverse, many similari-
ties existed. Perhaps this reflects their shared individualist
perspective.
Cultural competencies were familiar concepts to the ed-
ucators, who all had lived in multicultural societies. Their
familiarity with these concepts did not really prepare them
for the total immersion in cultures that were basically mono-
cultural and that were so inherently different. The differing
expectations and costs of the expatriate experience themes
reflect the disconnections and confusion experienced, previ-
ously described by some as “culture shock” (Storti, 2001).
This phenomenon has been recognized for over 50 years,
as a series of common cognitive and emotional reactions to
transcultural immersion (Storti, 2001) to the point that is of-
ten expected. The unanticipated challenges evoked a variety
of emotional responses from educators (e.g., anger, depres-
sion, confusion), which became tempered over time. Many
authors have described stages of culture shock, which re-
solve with the expatriate accepting and effectively working
within the host culture. The themes, bridging pedagogies and
adapting and finding purpose, are focused on ways that par-
ticipants were able to use their previous experience and the
new knowledge they were constantly obtaining to be more
effective in their faculty role. While a continuum of experi-
ence emerged from our data reflecting culture shock, which
ranged from initial emotional responses to adaptive strate-
gies, the focus of the interview process was the experience
of teaching cross-culturally, not the individual’s process of
adaptation to the host culture.
Asian cultures have been called “high-context,” while
Western cultures have been called “low-context” referring
to the extent that unspoken embedded cultural understand-
ings are needed to function within the culture (Hall, 1981).
As outsiders, expatriates coming from a low-context culture
into a high context culture will feel that there is a lot left un-
said and that unstated expectations for their behavior exist
(Slethaug, 2007). Examples of this situation were found in
the differing expectations theme. One example of this situ-
ation occurred with educators’ expectations of having sup-
port or recognition of their situation by their host faculty,
Western Nurse Educators in Asia
but receiving none. The lack of support or help in sorting
out what was expected of them in the performance of their
job was seen as making the job more difficult. As a result,
some expatriate educators felt the need to establish some un-
derstanding of their differing cultural perspective with their
host colleagues. Within their host cultures drawing atten-
tion to an individual’s struggles is not consistent with the
focus on group goals, maintaining harmony, and respecting
personal boundaries (Nisbett, 2003). Crigger, Branigan and
Baird (2006) suggest that this type of misinterpretation oc-
curs when one has insufficient information or faulty percep-
tions about a culture. Lei, Liang, and Krieger (2004) discuss
the stress experienced by expatriates living and working in
China. They suggest that the current preventive strategy of
using cross-cultural training programs is the best alternative;
although, they point out that no empirical evidence supports
this as an effective intervention.
Other than reading for their own interests, partic-
ipants did not attend any culture-specific training pro-
grams. Immediately upon arrival at the host university, these
educators had to begin their teaching and other faculty ac-
tivities. This adds an additional layer on top of the cul-
ture shock, because immediate performance was expected.
Participants expressed costs of the expatriate experience in
many ways. The work of daily living as well as the demands
of the job was often spoken of as being exhausting emo-
tionally and physically. Fatigue was a frequent experience.
A few researchers have examined health issues related to the
chronic stress of living in a foreign environment (Rogers &
Reilly, 2000), however, the personal costs involved in this
type of an immersion experience has not been addressed in
the nursing literature. Perhaps some of these costs might
have been less intense if mediated by a more in-depth under-
standing of the host culture (Crigger et al., 2006; Nisbett,
2003; Slethaug, 2007). Crigger et al. (2006) suggest replac-
ing the concept of cultural competence, which implies one
reaches this as a destination, with the concept of cultural
collaboration that implies ongoing mutuality between equal
partners.
Nussbaum (1977) refers to trying to explain others from
one’s own personal worldview as descriptive chauvinism.
She has also called the belief that one’s culture is supe-
rior to another normative chauvinism. Of course, each ed-
ucator brought to their cross-cultural teaching experience
their own cultural biases and values. Value-laden ethnocen-
tric issues or descriptive chauvinism arose throughout the
findings. For one educator, who stood rigidly within her
cultural definition of truth; no room for alternative pos-
sibilities existed. This example highlights a major diffi-
culty in cross-cultural communication, misunderstandings
related to different worldviews (Qiu, 2004). Alternatively,
the educator who discussed her approach to dealing with
plagiarism presented a more culturally collaborative ap-
proach. She was able to view the situation from both her
own perspective and that of the students, then work gen-
tly toward her goal. As nursing continues toward global-
ization, more work needs to be done that acknowledges
Journal of Nursing Scholarship Second Quarter 2008 181
Western Nurse Educators in Asia
these differences, yet finds common ground through mutual
understandings.
Within the theme, bridging pedagogies, many partic-
ipants were uncomfortable with the teacher-oriented ap-
proach used in Asian universities. Coming from a more
student-centered educational culture, many participants at-
tempted to break down the deference accorded to the
teacher’s point of view. The need for the familiar social struc-
ture and the drive to establish it was a very ethnocentric
approach with an embedded attitude of incorrectness of the
“other” system, an example of normative chauvinism (Nuss-
baum, 1977). Participants often cited the value of exposing
students to a different way of doing things as the rationale
for their actions. Watkins and Biggs (2001), who have re-
searched educational practices in Asia for many years, state
that,
Generally the educational environments in East Asian countries is
the antithesis of what has been identified as a good environment in
Western research. . .. Western observers frequently complain that
Asian students are prone to use rote-based, low-level, cogitative
strategies. . .. These perceptions are reinforced by classroom behav-
ior, which is seen as passive and compliant. (p. 46)
However, their research shows that despite these per-
ceived deficits, “students achieve at considerably higher
levels that their Western counterparts” beginning in mid-
dle school and continuing throughout university education
(Watkins & Biggs, 2001, p. 48). Their findings show that
the learning strategies used by Asian teachers and students
are much more sophisticated than was previously thought.
Understanding the implications of their extensive research
in cross-cultural education is essential for expatriate nurse
educators working in Confucian-based cultures. Expatriate
nurse educators are in a position to delve deeper into these
issues and add to an international dialog on cross-cultural
education, but first out-dated notions of Western hegemony
(normative chauvinism) must be recognized.
Another pedagogical concern raised by participants was
what they should be teaching to meet students’ needs.
Healthcare systems and the roles of nurses within those sys-
tems vary considerably from one country to the next. The
ethical dilemma well articulated by one participant was fo-
cused on the gap between established standards of care and
the scope of practice for nurses in the host country. If nurses
are unable to perform nursing care according to the inter-
national standard of care, because of limitations placed on
them by their regulatory bodies or their institution, should
they be taught according to known standards of care or
local standards of care? Several perspectives must be con-
sidered in addressing this issue. First, the educator has the
duty to prepare students to take on their nursing role after
graduation. Students must have sufficient knowledge and
practice to work within the existing healthcare system. Sec-
ond, is there really an international standard of care? The
International Council of Nurses (ICN) among others has
been working to develop global standards of care applica-
182 Second Quarter 2008 Journal of Nursing Scholarship
ble to all nurses. Standards need to be broad enough to en-
compass both technology-limited and technology-intensive
situations. The healthcare systems in which the students
of some educators worked were not technology-intensive
and by international standards had high quality healthcare
systems.
Last, the development of graduate nursing programs
and resultant advance practice roles has progressed at a
slower speed in these host countries than in Western coun-
tries. The participants’ understandings of standards of care
were driving their concerns. They wanted to educate for
change, hoping that they could affect the future direction of
nursing in their host countries. The role of nurses within
a society has been linked to the status of women. The
hierarchy within Confucian-based cultures has been male
dominated and is changing very slowly (Chen, 2001). Im-
proving the standard of care is a worthy goal; nursing edu-
cators can be more effective in doing so if they are able to
work within several professional venues (i.e., professional
organizations, conferences). Perhaps participants could have
facilitated change more effectively had they been able to
speak the native language. The changes that are occurring
in nurses’ roles in host countries are coming from within
existing professional organizations, regulating bodies, and
advocacy groups along with the universities (Chao, 1995;
Pang et al., 2004). It is difficult to determine if the presence
of expatriate nurse educators may have been a catalyst for
some of these changes.
Crigger et al. (2006) explain that complexities inherent
in any culture are often over-generalized and simplified by
the outsider, who fails to realize that all cultures are plu-
ralistic having a history and a present that is dynamically
changing. The limitations of this study include the method-
ological necessity to aggregate data in a manner that may
oversimplify the complexities of experience. Basic general-
izations about collectivist and individualist cultures have
been used in describing experiences and differences, real-
izing that each participant’s experience was complex and
multifaceted. Each of the authors has been an expatriate
nurse educator and worked in a collectivist culture. This is
a strength as we bring an emic view and it is possible that
it may also have been a limitation, restricting the results in
some unknown way.
Conclusions
Although the benefits of cross-cultural experiences can
be immense for faculty and students, the experience can
be challenging in unexpected ways that require personal
growth and reflection. The ways that a collectivist-oriented
culture may affect nurse educators coming from a Western
individualist worldview needs further research to develop
better mutual understandings that will lead to culturally col-
laborative models of international nursing practice, educa-
tion, and research.

Clinical Resources
• International Council of Nurses at http://www.icn.ch
• Transcultural Nursing Society at http://www.tcns.org
• Confucian understandings at http://www.sacred-
texts.com/cfu/
• The differences between high and low con-
text cultures at http://www.culture-at-work.com/
highlow.html
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