Professional-Cultural Knowledge Sharing in Nursing-Hospital Settings: Zooming in Practices and Zooming out on Contextual Conditions

Abstract

The purpose of this research was to explore the professional-cultural knowledge sharing phenomenon between experienced expatriate nurses (EXPNs) and novice host-country national nurses (NHCNs) in hospital settings. The gaps in how professional-cultural knowledge is shared, along with how contextual conditions influence sharing practices are demonstrated in the literature review. In particular, the literature review revealed that less attention is paid to how knowledge integration of diverse types unfolds at an individual level through sharing practices. A lack of evidence regarding the influence of contextual conditions in the sharing of patterns in professional-cultural knowledge sharing was also revealed in the literature review. Based on a critical analysis of the relevant learning and competency development models derived from organisational learning, intercultural management, and nursing literature, a conceptual framework of the professional-cultural knowledge sharing phenomenon, which builds on the commonalities among the reviewed literature, was suggested. The suggested framework comprised five components: motivation, context awareness, repeated experimentation, reflection, and individual differences. The conceptual framework functioned as an anchor for this research that was referred to during the stages of data collection and interpretation. \nAn integrated research design was developed utilising a combination of a qualitative approach, subjectivist epistemology, and an interpretivist philosophical paradigm. An interpretivist case study design with embedded units informed by case study principles was deemed the most appropriate to explore the contemporary conditions and address the “how” and “why” research questions about sharing practices and the influence of contextual conditions. The interpretivist case adopted qualitative data collection that interweaved data generated from familiarisation with nursing hospital settings, interviews, observations, and a document review. The use of a flexible case study design enabled the researcher to explore a range of contextual themes concerning the phenomenon under research using multiple data sources. The research findings emerged based on the data analysis approach informed by the principles of iterative analysis, qualitative data analysis, and thematic analysis. The research findings showed that professional-cultural knowledge sharing comprises three reciprocal practices: developing shared meaning, engaging in the clinical competency development, and maintaining alignment that are influenced by five intertwined contextual conditions: individual differences, situational work conditions, front-line leaders’ practices, administrative policies and practices, and expatriate human resource policies and practices. \nDeveloping shared professional-cultural meaning represents the set of activities in which EXPNs and NHCNs jointly participate to form a cohesive identity that enables a common understanding of the nursing-hospital system that is embedded in the broader national culture to evolve. Engaging in a co-equal clinical competencies development represents the mutual behavioural practices through which EXPNs and NHCNs engage with clinical sites to enable the development of NHCNs clinical competencies. Maintaining alignment through interventional actions represents the mutual efforts of EXPNs and NHCNs to work seamlessly and achieve cohesion between the actual performed patient care activities and the espoused nursing hospital policies, standards, procedures, guidelines, and aspects of national culture. They also help EXPNs and NHCNs to face uncommon and critical situations, along with learning from actions undertaken by one another. A combination of contextual conditions influences the motivational status of EXPNs and NHCNs, which in turn is reflected in the degree of EXPN and NHCNs’ participation in professional-cultural knowledge sharing practices.\nThe current research addresses the research gaps identified in the literature and contributes to the management and knowledge streams of the literature in several ways. The primary contribution of this research is the development of a greater picture of the professional-cultural knowledge sharing phenomenon that combines the sharing practices that take place between EXPNs and NHCNs along with the contextual conditions implicated in the sharing patterns. The research provides insights into the implicated role of individual differences with identity issues caused by competency gap and national culture-based differences, along with the strategies utilised by EXPNs and NHCNs to navigate differences and mechanisms to develop shared meaning. The research provides a detailed account that illustrates the participatory roles of novices and masters in the professional competency development process along with the strategies employed to navigate the power differential. The research also provides an empirical illustration for maintaining alignment practices, as they consist of two distinct reciprocal modes: proactive coping and reactive coordinating. The research also contributes to an emerging stream of literature that sheds light on contextualisation in management research in general, and knowledge sharing specifically, in ways that go beyond the prescriptive treatment of context as demographic context (region, culture, industry). On the practical level, a context-based approach to professional-cultural knowledge sharing between EXPNs and NHCNs provides practical insights that might enhance the effectiveness of the utilising expatriation in developing the NHCNs’ capabilities.