Caring for ethnic minority patients: a mixed method study of nurses' self-assessment of cultural competency

Norwegian nursing students' experience of international clinical placement abroad: A qualitative study

BACKGROUND

For several years, the Norwegian government's goal has been that half of those who complete a degree in Norwegian higher education, should have had a study period abroad. This also applies to undergraduate nursing students. Nurse education programs in Norway often offer clinical practice abroad in order for their students to gain experience from another country's health care system. There is a knowledge gap in the literature on how Norwegian nursing students' experience their study period and internships abroad.

OBJECTIVE

The aim of the study was to explore Norwegian undergraduate nursing students' experiences of their clinical practice abroad.

DESIGN

A descriptive and exploratory qualitative study.

SETTING AND PARTICIPANTS

Nursing students were recruited from one specialized university in Norway. Nine students were interviewed.

METHOD

Three focus groups were conducted via the online platform Zoom with nursing students who had their clinical practice abroad during their bachelor's degree. The interviews were conducted in June 2020. The collected data were analyzed using thematic reflective analysis inspired by Braun and Clarke.

RESULTS

Four themes were developed from the analysis: 1) Motivation for studying abroad, 2) Professional and personal development, 3) Different nursing role and 4) Different supervisor role.

CONCLUSION

Students provided valuable insight from their experiences of studying abroad. The study highlights that there were other learning opportunities abroad than in Norway, but that the learning approach was somehow different and that it made the students take more initiative thus becoming more independent. The nursing role was different from what they were used to in Norway. In general, the Norwegian students experienced the nurse role abroad as more medical oriented. In addition, in countries like India, Spain and Cuba the family was taking a greater part of the care of people's basic needs.

Perceptions of nurses on the scope of culturally competent care in critical care: A qualitative study

BACKGROUND

The cultural competence of nurses is crucial in providing nursing care for patients from different cultures. The absence of cultural competence can negatively impact the entire course of care; however, implementing cultural competence in critical care unit can be complicated.

AIM

This study aimed to determine nurses' perceptions regarding cultural competence in critical care units.

STUDY DESIGN

This study used a qualitative design with semi-structured interviews with nurses (n = 10) working in critical unites. Data were collected from February to June 2022 and then categorized and evaluated. Atlas.ti was used for the inductive thematic content analysis.

RESULTS

Three key areas identified were as follows: (1) nurses and culturally competent care in critical care, (2) cultural challenges in practice and (3) suggestions for improving culturally competent care. The participants expressed that culturally competent care in critical care units has specific limitations because of the nature of the intensive care units (ICUs). Additional learning included opportunities to improve culturally competent care, such as raising cultural awareness, developing language skills and promoting culturally competent care.

CONCLUSIONS

Providing culturally competent care in critical care units is an understudied area. Identifying barriers and cultural challenges is one strategy nurses can use to improve culturally competent ICU care.

RELEVANCE TO CLINICAL PRACTICE

Creating cultural awareness by training nurses in their own culture, in cultural diversity, and in overcoming prejudices and stereotypes is an essential step towards increasing cultural competence. Understanding nurses' perceptions on this topic can provide valuable insights into the challenges and opportunities for providing culturally sensitive care in a critical care setting.

Checking the Pulse of Holistic and Culturally Competent Nursing Practice in Pennsylvania

Traditionally, underrepresented racial and ethnic groups experience marginalization, leading to inequities and disparities in health and health care. A holistic approach to care delivery can help providers meet a culturally diverse patient population's unique healing needs. A systematic assessment of nurses' cultural competency practice was conducted in Pennsylvania to reveal opportunities and provide direction for holistic, culturally competent health care services. This exploratory cross-sectional descriptive study used the Cultural Competence Education and Awareness Survey (CCEAS) to examine cultural competence practices of registered nurses employed in the state of Pennsylvania. A total of 1246 registered nurses completed the survey. Respondents expressed a strong desire for cultural competency. Education and organizational infrastructure to facilitate cultural competency could be improved. Health care leaders and policy makers at all levels should explore opportunities to strengthen nurses' culturally competent practices through ongoing professional-development activities and enhanced organizational infrastructure.

Beyond challenges and enrichment: a qualitative account of cross-cultural experiences of nursing patients with an ethnic minority background in Norway

BACKGROUND

Substantial mass migrations to the Scandinavian countries have made them heterogeneous and multicultural societies. Migration has also influenced the workforce, especially the healthcare system that has had to accommodate a culturally diverse population. This qualitative study aimed to explore nurses' experiences in caring for patients with an ethnic minority background.

METHODS

Focus group interviews with a total of 21 nurses were conducted. Thematic analysis was performed on the transcribed and translated interviews.

RESULTS

The findings of this study revealed three major themes: various experiences concerning language barriers and the use of interpreters, the impact of religious and cultural values, and caring for patients with an ethnic minority background is professionally interesting but demanding.

CONCLUSIONS

Caring for culturally diverse patients offers both challenges and opportunities to enhance cultural competence and cultural sensitivity among nurses. Various culturally divergent needs of patients such as family visits, food preferences, expression of pain, and gender sensitivity are interlinked and depend on effective communication during encounters with nurses and the healthcare system at large.

Development and validation of cultural competence assessment tool for healthcare professionals, India

Culture influences an individual's perception of "health" and "sickness". Therefore, cultural competence assessment of healthcare professionals is very important. Existing assessment scales have limited application in India due to the nation's rich cultural diversity and heterogeneous healthcare streams. This study was undertaken to develop and validate a cultural competence assessment tool for healthcare professionals in India. A cross-sectional study using convenience sampling was conducted following all standard steps among 290 healthcare professionals in India. Item reduction was followed by estimation of validity and reliability. Responses were recorded on a five-point Likert scale, ranging from strongly disagree to strongly agree. The resultant tool, named Cultural Competence Assessment Tool-India (CCT-I) showed an acceptable internal consistency (Cronbach's alpha =0.734). Inter-rater agreement was 81.43%. Face, content, and construct validity were demonstrated. There was no statistically significant difference in cultural competence between the healthcare streams based on years of clinical experience. There was statistically significant difference between streams of healthcare (p-value =0.009) and also between dentistry and Ayurveda groups (p-value = 0.003). This comprehensive tool can be used as the first step toward designing cultural competence training of healthcare manpower and the establishment of culturally sensitive healthcare organizations.

Navigating the care between two distinct cultures: a qualitative study of the experiences of Arabic-speaking immigrants in Norwegian hospitals

Background

During the past decades, there has been an increase in the number of immigrants to European and Scandinavian countries. This has challenged the health-care systems, which cater to the needs of patients despite their cultural and linguistic barriers, in these countries. Most studies on this topic have focused on the perspectives of health-care providers in delivering their service. The purpose of this qualitative study was to explore how hospitalized Arabic-speaking patients experienced their interaction with the Norwegian health-care system.

Methods

In-depth interviews with 20 participants and researcher’s participant observation were conducted to explore the idiosyncratic details and ascribed meanings that foreign-born patients attach to their everyday experience of the Norwegian health-care system. Thematic analysis was performed on the transcribed and translated versions of the in-depth interviews.

Results

The findings of this study indicated three interrelated core themes. Firstly, there exist challenges in understanding and being understood because of linguistic and cultural differences of newly migrated patients. Secondly, some patients missed the holistic and direct care available in their home countries. Finally, patients were satisfied with the Norwegian health-care system because of its compassion, care, and respect toward them as well as advanced health-care equipment.

Conclusion

Arabic-speaking patients in Norwegian hospitals experienced long waiting times and linguistic problems. Hence, a better and specialized interpreter service may resolve problems emanating from communication within the system and the subsequent delays in treatment. Compassionate care and the feeling of respect and love is the core strength of the Norwegian system as perceived by the patients.

Challenges and approaches to transcultural care: An integrative review of nurses' and nursing students' experiences

BACKGROUND

Provision of transcultural care is an essential nursing competency. It is important to comprehensively understand the challenges nurses and nursing students face while striving to provide transcultural care in clinical settings.

PURPOSE

The purpose of this review was to develop a comprehensive understanding of nurses' and nursing students' challenges and approaches to the provision of transcultural care to people with diverse ethnicities.

METHODS

An integrative review was conducted. Literature was searched within five databases, and 30 studies published from January 2010 to January 2021 were reviewed and appraised using mixed methods critical appraisal tool. Literature summary tables and inductive approaches were used for data extraction and synthesis.

RESULTS

The challenges to the provision of transcultural care were intrapersonal struggle, cultural conflicts, varied expressions of pain and suffering, and navigation of personal and organizational constraints. Addressing these challenges required nurses and students to practice self-criticism and tolerate differences, develop interpersonal and psychological skills, and collaborate with peers and patients' families.

CONCLUSIONS

Provision of transcultural care is a complex task for nurses and students because of different interpretation of personal and organizational factors. Health care institutions should proactively provide resources to nurses and students to strengthen their interpersonal and psychological skills to provide effective transcultural care.

Migration health research in Norway: a scoping review

Aims: To provide an overview of published research on migration and health conducted in Norway and identify gaps in the research field. Methods: Applying a scoping review methodology, we searched Medline for articles on migration health in Norway published between 2008 and 2020, and assessed them according to research topic, methodology, user-involvement and characteristics of the populations studied (country or area of origin, type of migrant/immigrant status). Results: Of the 707 articles retrieved, 303 met the inclusion criteria. Most studies (77%) were within the clinical disciplines reproductive health, mental health, infectious diseases and cardiovascular diseases, or on socio-cultural aspects and the use of healthcare services. One third of the papers (36%) pulled participants from various geographic backgrounds together or did not specify the geographic background. Among those who did so, participants were mostly from The Middle East, South and Southeast Asia and sub-Saharan Africa. Only 14% of the articles specified the type of migrant/immigrant status and those included refugees, asylum seekers and undocumented migrants. A total of 80% of the papers used quantitative methods, of which 15 described an intervention; 15 papers (5%) described different types of user-involvement. Conclusions: Our findings suggest gaps in research related to migrant subgroups, such as those from Eastern-Europe and labour and family reunification migrants. Future studies should further investigate the self-identified health needs of different migrant groups, and might also benefit from a methodological shift towards more intervention studies and participatory approaches.

Healthcare professionals' social distance towards immigrant patients: A descriptive cross-sectional study

OBJECTIVE

This study aimed to determine the attitudes, beliefs, experiences, and the level of social distance among healthcare professionals who provide healthcare to refugee patients.

DESIGN

Descriptive cross-sectional study.

PLACE AND DURATION OF STUDY

The researchers obtained the ethical approval of the study from the Non-Interventional Ethical Committee of Sakarya University Faculty of Medicine on 23/11/2018. The study was carried out between December 2018 and February 2019 at Sakarya University Research and Training Hospital.

METHODOLOGY

A total of 1484 healthcare professionals work at clinics which are likely to offer care to refugee patients. Descriptive analyses were performed for the study. The data were collected by a questionnaire created by the researchers in light of related literature to investigate the sociodemographic characteristics of the participants and their work-related descriptive characteristics (such as, experience, beliefs, etc.) which may affect their attitudes while providing healthcare to refugee patients. The form was prepared by the researchers based on the literature knowledge. For determining the level of social distance towards refugee patients, Arkar's²⁸ social distance scale was used.

RESULTS

Health professionals show a serious level of social distance towards refugee patients due to various difficulties but mainly because of the language barrier.

CONCLUSION

Healthcare professionals have great social distance to refugee patients. Moreover, they can continue their professional attitudes towards patients in emotional terms.

Development and Validation of the Humanistic Practice Ability of Nursing Scale

PURPOSE

The purpose of this study was to develop a Humanistic Practice Ability of Nursing (HPAN) scale adapted to China and validate its psychometric properties.

METHODS

The original HPAN scale was revised through a literature review. Sixteen experts who met the inclusion criteria were consulted 2 rounds by the Delphi method. According to their suggestions and opinions, the structure, content, and semantics of each item of HPAN were modified, and a HPAN scale was preliminarily developed. The HPAN scale was validated through item analysis, exploratory factor analysis, convergent validity, and reliability. The data came from 406 first-class hospital nurses.

RESULTS

A 5-dimension, 29-item HPAN scale demonstrated satisfactory fit with significant factor loadings. The split-half reliability coefficient of the scale was .98, the split-half reliability coefficient of each dimension was .86-.99, Cronbach's α coefficient was .96, and the Cronbach's α coefficient of each dimension was .87-.98. The model fit of the scale was good, and the items of the scale showed convergent and discriminant validity.

CONCLUSION

The HPAN scale indicated that the reliability and validity were good. It is easy to imply factors of HPAN. This scale can be used to assess the HPAN.

Clinical mentors' experiences of their intercultural communication competence in mentoring culturally and linguistically diverse nursing students: A qualitative study

BACKGROUND

Intercultural communication has become increasingly important in nursing due to the cross-border mobility of patients, health professionals and students. Development of cultural competence continues to be a challenge, particularly among professionals such as educators or healthcare providers who work in professions requiring communication across cultural boundaries. Despite challenges in nursing education related to cultural diversity, competence in intercultural communication has been proven to empower students and to help them grow professionally.

OBJECTIVES

The aim of this study was to describe clinical mentors' experiences of their intercultural communication competence in mentoring culturally and linguistically diverse nursing students during completion of their clinical practice.

DESIGN

Qualitative study design.

PARTICIPANTS

The participants were 12 nurses who had previously mentored at least two culturally and linguistically diverse nursing students.

METHODS

Data were collected during spring 2016 using semi-structured interviews of 12 mentors working in specialized nursing care at one hospital located in central Finland. Data were analyzed using deductive-inductive content analysis. The main concepts of the Integrated Model of Intercultural Communication Competence were used during the semi-structured theme interviews and during analysis. These concepts include empathy, motivation, global attitude, intercultural experience and interaction involvement.

RESULTS

Mentors stated that empathy motivates them in the development of intercultural communication. Mentors experienced a lack of resources and support from their superiors, which caused psychological and ethical strain and reduced mentors' motivation. Mentors openly admitted that they had experienced fear towards unknown cultures, but that this fear was reduced through positive mentoring experiences and cultural encounters.

CONCLUSIONS

Continuous education on intercultural communication competence could succeed to further develop clinical mentors' mentoring expertise, which could have the potential to greatly benefit students, patients and staff. Such education could be designed, implemented and measured for its effect in collaboration between health care organizations and higher educational institutions.

Hospital food: When nurses' and ethnic minority patients' understanding of Islamic dietary needs differ

AIM

The aim of this study was to investigate how medical unit nurses assess their knowledge about Muslim patients' dietary preferences and needs and Muslim patients' needs regarding food.

DESIGN

Mixed-method design.

METHODS

Two-part study. Part 1: Two focus group interviews and a survey answered by medical unit nurses. Part 2: In-depth interviews with ten immigrant patients (eight Asians and two Africans). Hermeneutic analysis of qualitative data and SPSS were used for descriptive analysis of the quantitative data.

RESULTS

The nurses' knowledge about acceptable and prohibited food within Islam appears to be simplistic and Muslim patients tended to be perceived as a homogenous group. Patients' distrust about the preparation and content of the food served may result in insufficient nutritional intake. Serving food that is acceptable to individual patients requires insight and is an essential part of culturally sensitive nursing care.

Nurses' Experiences of Establishing Meaningful and Effective Relationships With American Indian Patients in the Cancer Care Setting

Introduction

The establishment of caring relationships with racial and ethnic minority populations is challenging for many cancer care nurses. Nurses serving American Indian (AI) patients frequently encounter population-specific issues, yet their experiences are largely unknown.

Objective

The purpose of this study was to describe the meaning of the AI patient-cancer care nurse relationship from nurses' perspectives. The study included three objectives: (a) to describe the immediate experiences of nurses that have engaged in cancer care relationships with AI patients, (b) to identify the underlying structures of the AI patient-cancer care nurse relationship as described by nurses, and (c) to interpret the meaning of the patient-nurse relationship within the context of AI cancer care experiences.

Methods

This was an interpretive phenomenological study using a hermeneutical process for data collection and analysis of multiple, exploratory interviews. Thematic reduction was completed to explicate the fundamental structures of this particular relationship. Reduction of individually situated themes resulted in seven shared meta-themes including from task to connection; unnerving messaging; we are one; the freedom of unconditional acceptance; attuning and opening; atoning for the past, one moment at a time; and humanizing the inhumane.

Results

Nine cancer care nurses participated. Reconstitution of data and reflective writing suggested that the essential meaning of the AI patient-cancer care nurse relationship was expressed in contradictory yet simultaneous patterns for nurses. Nurses sought synchronicity with their AI patients despite their contextual differences and similarities, yet most lacked adequate cultural safety training. Being in relationship provided nurses great purpose within the universal human context of caring.

Conclusions

Results contribute to the development of interventions designed to improve both the AI cancer care experience and the support and training of nurses. The mutually dependent nature of the patient-nurse relationship implies that strengthening and improving support for one entity may in turn positively impact the other.

Contested discourses and culture sensitivity: Norwegian nursing students' experience of clinical placement in Nicaragua

Aim

The purpose of this study was to gain understanding of Norwegian students' practical experience of “culture sensitivity.”

Design

Using focus‐group interviews and individual written assignments, we draw on a Foucauldian‐inspired approach to analyse nursing students' narratives about their clinical placement in Nicaragua.

Method

Seven third‐year bachelor nursing students enrolled in a clinical placement programme on the Caribbean coast in Nicaragua and participated in focus‐group interviews. Interviews were conducted prior to their departure to Nicaragua and after their return to Norway. Other sources of data included learning objectives for clinical placement, written individual assignments with students' reflections about their experiences and achievement of learning objectives.

Results

Students expressed gradually increased awareness about the nursing discourses and power relations shaping clinical encounters throughout their learning trajectory in clinical placement. They became more aware of the politics of nursing practices through their experiences of clashes between different nursing discourses.

Perceptions of the critical cultural competence of registered nurses in Canada

BACKGROUND

Cultural diversity often leads to misunderstandings, clashes, conflicts, ethnocentrism, discrimination, and stereotyping due to the frequent intersection of many variables, such as differences in traditions, behaviours, ethical and moral perspectives, conceptions of health and illness, and language barriers. The root of the issue is related to the way people conceptualise differences and the unique cultural and historical circumstances that have shaped different groups' heritages. In this study, therefore, we aimed to investigate the perceptions of critical cultural competence (CCC) of registered nurses working in various hospitals across the province of British Columbia, Canada.

METHOD

Data were collected using Almutairi's Critical Cultural Competence Scale (CCC Scale) with a random sample of 170 registered nurses. This scale measures four essential multidimensional components of the CCC model: critical awareness, critical knowledge, critical skills, and critical empowerment. Data were analysed using descriptive and inferential statistics (Kruskal-Wallis test).

RESULTS

The data revealed that participants' perceptions of CCC were positive with a mean score of 5.22 out of 7.00 for the total number of items (n = 43) and a standard deviation of 0.54. The mean scores for the CCC subscales ranged from 4.76 (for critical skills) to 5.42 (for critical empowerment). The results indicated a statistical difference in CCC perceptions based on participants' age and country of birth with p = 0.05 < 0.05 and 0.029 < 0.05, respectively.

CONCLUSION

Nurses' age (experience) and country of birth may influence their perceptions of CCC as gaining cultural competence requires exposure to caring for patients from various cultures and countries, and is associated with cultural knowledge and awareness. Therefore, this finding reveals that healthcare organizations must provide ongoing cultural education programs to increase their nursing staff's level of cultural competence so they are better able to deal with the difficulties that might arise during cross-cultural interactions.

The impact of short term clinical placement in a developing country on nursing students: A qualitative descriptive study

BACKGROUND

Offering nursing students' international clinical placement during the educational program is one response to meet the need of cultural competence among nurses. This paper provides insight into the impact of clinical placement, in a developing country, on third year nursing students. In the study we investigated how short term international clinical placement impacted Norwegian nursing students' development of cultural competency.

DESIGN AND METHODS

In this study we utilised a qualitative descriptive design and used individual interviews with eighteen Norwegian nursing students who had all participated in an international clinical placement. The data were analysed using the principles of systematic text condensation.

RESULTS

In spite the international clinical placement only was four weeks, the findings suggested that real life experience culturally awakened the students and forced an ongoing process developing cultural competence. However, it is important to give students time to reflection.

CONCLUSIONS

Although increased cultural awareness and a growing cultural competence was identified by the students undertaking international clinical placement, further research is required. It is important to investigate the best methods to support the students' reflection such that the experiences lead to learning.

‘Disse smertene plager min sjel’: En kvalitativ intervjustudie av iranske kvinner i Norge

Aim

To learn about Iranian women’s experience with chronic pain and Norwegian nurses’ nursing care.

Background

Chronic pain is aggravated by social, economic and political strain causing serious accompanying psychological symptoms. Iran women’s position is characterized by social and political discrimination and inequity. Women are expected to be homemakers and obey their male family members.

Method

Semi-structured in-depth interviews with five female Iranian refugees aged 39–55 years who had lived 10 or more years in Norway. Hermeneutic analysis. Informed consent was given by all respondents.

Findings

Culturally-based duties and expectation aggravate their pain, anxiety, depression and insomnia. This may result in aggressiveness, bitterness, concentration problems, fatigue, heartaches, and a feeling of inadequacy. They are lonely and miss homeland, family and friends. Their losses make the pain worse. Norwegian nurses are seen as unbelieving regarding their pain, which make them take pain medication brought from home rather than ask for analgesics.

Conclusion

Traditional roles and expectations, limited social network, and longing for homeland, friends, and family aggravate these women’s chronic pain and make them vulnerable.