Caring for terminally ill Muslim patients: Lived experiences of non-Muslim nurses

Intersectional employee voice inequalities and culture care theory: the case of migrant palliative care nurses in Saudi Arabia

PURPOSE

This narrative literature review examines intersectional employee voice inequalities in a non-Western, high power distance context to develop a multilevel conceptual framework.

DESIGN/METHODOLOGY/APPROACH

The authors use Leininger's (1997, 2002) culture care model to explore multilevel influences on intersectional voice inequalities. The article applies insights from a review of 31 studies to the specific challenges of migrant palliative care (PC) nurses in Saudi Arabia.

FINDINGS

The themes identified in the review indicate how better transcultural communications might mitigate voice inequalities that influence migrant employee wellbeing and intentions to quit which result from cultural incongruities.

ORIGINALITY/VALUE

The impact of national culture differences and intersectional inequalities on employee voice has largely been ignored in academic research. This paper offers unique insights drawing on culture care theory into intersectional voice challenges from a non-Western perspective in the underresearched setting of Saudi Arabia which is mid-way through a national transformation program. It starkly contrasts policy ambitions for advancing healthcare with discriminatory practices based on conservative attitudes which stifle migrant worker voices.

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.

Understanding person-centered care within a complex social context: A qualitative study of Saudi Arabian acute care nursing

Policy reforms implemented in Saudi Arabia in recent years aim to modernize the culture and infrastructure of healthcare delivery and are expected to integrate person- and patient-centered care principles throughout the national healthcare system. However, in a complex multicultural environment where most nurses are international migrant workers, unique challenges emerge that frame the delivery of care. Better understanding is needed about what nurses perceive to be high-quality, person-centered care in Saudi Arabia and how they manage to enact it in practice. Semi-structured interviews were conducted with 21 nurses working in two tertiary hospitals in Riyadh, the capital city. Participants included Saudi citizens (n = 9) and expatriates (n = 12) who were asked to describe their perceptions of quality nursing care and explain the obstacles that they encounter in providing such care. Nurses reported extensive efforts to achieve individualized, empathetic, developmentally appropriate care. Their descriptions of care aligned with principles of patient-centeredness in care but were not separable from challenges at the patient, organizational, and regional levels, including staffing and supplies shortages, gaps in regional care coordination, inadequate language translation services, variability in cultural beliefs about healthcare communication, and overt discrimination against expatriate workers. Nurses reported creative strategies to achieve professional nursing values while navigating a dynamic landscape of constraints. The findings add to literature suggesting that person-centeredness in care cannot be understood outside the social and organizational conditions that shape it.

Palliative Care Practices and Knowledge of Home Care Nurses in Saudi Arabia: A Cross-Sectional Study

Palliative Care (PC) is an interdisciplinary specialty focused on relieving symptoms and optimizing quality of life for people living with serious illnesses and their families. A great need for PC exists in Saudi Arabia due to its aging population and prevalence of cancer and other chronic diseases. Home healthcare can make PC more accessible to patients, but clinicians must be equipped with the PC knowledge and skills to perform their roles. This study was a descriptive, correlational examination of PC practices and knowledge of home care nurses recruited from military hospitals in Saudi Arabia. We surveyed participants using the Palliative Care Quiz for Nursing (PCQN) and the Modified Global Home Health Nursing Care Assessment Questionnaire. The mean PCQN score was 8.40, indicating low levels of PC knowledge. A nurses' demographic and physical, spiritual, religious, cultural, linguistic, ethical, and legal aspects of care revealed significant associations. Given the low levels of PC knowledge and skills, we recommend focusing on education, training, and research. Universities should review their curriculum to ensure PC content. Hospitals should provide training programs focused on all aspects of PC, specifically emotional and spiritual, without limiting training to physical aspects of care. Future research is also needed to inform policy in this area.

Family members' participation in palliative inpatient care: An integrative review

AIM

To analyse how family members participate in hospital inpatient palliative care, and how their participation could be supported.

METHODS

This review followed a methodology outlined in the literature for integrative reviews. A literature search supplemented by a manual search was conducted on four electronic databases during 2020 to 2021: PubMed, CINAHL, PsycINFO, and Cochrane Library. A critical appraisal of the included studies was performed, and data were analysed using inductive content analysis.

RESULTS

The literature search resulted in 4990 articles, of which 14 articles were included in this review. Four main categories were identified concerning the participation of family members in hospital inpatient palliative care: participation in the physical care, provision of emotional support, promoting good patient care, and support provided by healthcare professionals for family members' participation. Family members' participation can be supported in different ways, including active communication and adequate information.

CONCLUSION

Family members' participation in hospital inpatient palliative care has been an important part of palliative care in hospital settings. Family members should be offered the opportunity to participate in patient care, and their presence in the hospital should be accommodated. Research on the topic is still scarce, and future research is needed from different perspectives, including intervention research.

Participation in inpatient care from the perspective of family members of palliative care patients

BACKGROUND

The participation of family members in inpatient palliative care has been shown to be meaningful; it contributes to the wellbeing of the patient. Even so, little is known about the perspectives of family members regarding their participation in this type of care.

AIM

The aim of this study was to describe participation in inpatient care from the perspective of family members of palliative care patients.

METHOD

This study involved semi-structured individual interviews with family members (n=19) of patients receiving inpatient palliative care, as well as inductive thematic analysis.

FINDINGS

Four main themes describing the family members' perspectives of their participation in inpatient palliative care were identified: family members attending to everyday activities, importance of participation to family members, family members providing emotional support to patients and the role of family members in discussions and decision-making processes concerning patient care.

CONCLUSION

Family members participate in inpatient palliative care in different ways. Participation was experienced as important to patients and family members, and some family members felt that participation may have supported their coping process.

The Role of Islamic Beliefs in Facilitating Acceptance of Cancer Diagnosis

Although survival rates for patients with cancer have increased, this disease continues to affect couples significantly. Religion and culture seem to be part of the therapeutic process for people with cancer. Despite the abundance of the Arab Muslim community in Western countries, there is a lack of documented data on Arab Muslim couples experiencing cancer. A simple exploratory qualitative study was conducted through semi-structured interviews on six married couples (n = 12) identifying with the Arab Muslim culture and being affected by cancer. An iterative data analysis was performed. Results were reported under the following themes: accepting illness through coping strategies provided by Muslim religious beliefs and practices, experiencing problems with the expression of needs and feelings within the couple, experiencing closeness within the family, and experiencing illness in the hospital setting as Muslims. Our results show that Islamic beliefs can facilitate acceptance of a cancer diagnosis. It is also noted that religion seems to unite spouses in supporting each other and maintaining hope in a difficult context. Communication issues may persist between a couple due to stressors related to cancer. The results of this study could raise awareness about the importance of exploring religious and spiritual beliefs when supporting couples affected by cancer.

The use of Husserl's phenomenology in nursing research: A discussion paper

AIMS

To discuss how Husserl's descriptive phenomenology, as a philosophy and approach, has been used and reported in researching the experiences of others, using the topic of foreign-trained nurses.

DESIGN

Discussion paper.

DATA SOURCES

A systematic search of MEDLINE (PubMed), CINAHL, SCOPUS, British Nursing Database and PsycInfo was carried out in December 2021. The inclusion criteria were peer-reviewed phenomenological research articles, grounded by Husserl's philosophy, conducted among foreign-trained nurses and published in English from 2000 to 2021.

FINDINGS

Two main themes were the outcome of critically reviewing relevant selected literature, 'referring to the original philosophy is not enough' and 'phenomenological findings need to be phenomenological'. These findings confirm some arguments about nurse researchers' discrepant use of phenomenology in their studies, including the proper application of phenomenological notions on the ground.

IMPLICATION FOR NURSING

Nurse researchers need to clearly distinguish between phenomenology and other qualitative research approaches and consider the uniqueness of philosophical underpinnings that are essential in Husserl's phenomenology, which also need to be clearly applied and reflected in their studies.

CONCLUSION

There are continually existing discrepancies and variations in using phenomenology by nurse researchers. These variations were uniquely evident when nurse researchers could not provide enough philosophical grounds and assumptions to their studies and underestimated the need to keep up with the various applications of Husserl's phenomenological notions, including the proper practice of phenomenological attitude. Therefore, it is recommended that nurse researchers should opt for different, less complex qualitative approaches if they do not adequately prepare and understand what constitutes phenomenology and the particulars of Husserl's philosophy.

IMPACT

What problem did the study address? Phenomenology remains popular in nursing. However, it can confuse nurse researchers and may result in an improper understanding of its core concepts. The use of phenomenology in nursing has been criticized over the years with nurse researchers being accused of conducting phenomenological research inconsistent with the original philosophy. What were the main findings? Using phenomenology by nurse researchers is various and includes some discrepancies. This variation is caused by not complying with essential philosophical grounds and underestimating proper applications of Husserl's phenomenological notions. Where and on whom will the research have impact? Outcomes of this paper illustrate examples of proper and improper uses of Husserl's phenomenology in nursing research, including critical considerations, which can guide nurse researchers aiming to conduct descriptive phenomenological research. Additionally, nurse lecturers can utilize this paper to show and emphasize the importance of philosophical grounds in phenomenology.

NO PATIENT OR PUBLIC CONTRIBUTION

Due to the nature of this discussion paper addressing philosophical and methodological aspects using examples from the literature, no direct patient or public contribution was required.

Russian nurses' readiness for transcultural care of palliative patients

Palliative care involves an approach aimed at improving the quality of life of patients and their families, who are forced to cope with the problems associated with life-threatening diseases. This definition includes a growing group of patients around the world. It requires an extension of the definition of patients in need of palliative care in countries such as Russia and a significant improvement in the work of nursing personnel with these patients. This study aims to determine the level of preparedness of nursing personnel for specialized care (transcultural care) and the quality of care provided to palliative patients. The presented findings of the study demonstrate the relevance of developing transcultural competence, which enables significant improvement in the quality of life of palliative patients. The analysis of medical workers' assessment of the level of specific training and their intercultural preparedness was conducted based on hospices (Moscow). A survey was conducted among 113 medical workers of the middle level of education aged between 28 and 56 (average of 44.2 years) and experience in palliative care ranged from 3 to 18 years (average of 9.5 years). The Intercultural Readiness Check (IRC) test, widely used to assess nursing staff worldwide, was used for the survey to determine the level of readiness for transcultural care. A strong correlation was found between a number of the test scales and measures of participants' age and experience. The presented material demonstrates the realization of an interdisciplinary approach to the issues of specific training of nursing personnel in the field of "transcultural care" in providing palliative care to incurable patients.

Hospital Nurses' Experiences of Providing Care for Muslim Patients in the United States

INTRODUCTION

Understanding a patient's culture is imperative to providing holistic patient care. The purpose of the study is to describe and explore the lived experiences of non-Muslim hospital-employed registered nurses providing care for Muslim patients in the United States.

METHOD

This study used a qualitative exploratory research design based on semi-structured interviews utilizing Husserlian phenomenology. A snowball technique was used to recruit the participants.

RESULTS

Ten nurses who cared for hospitalized Muslim patients were interviewed and three major themes emerged from the participants' narratives: Nurse-Patient Relationship, Nurses' Knowledge and Western Health Care Systems, and Family Influence.

DISCUSSION

Muslim patients have cultural expectations and differences that may not be anticipated by nurses, which affects nurses' experiences when providing care. As the Muslim population continues to grow in the United States, there is a need for increased education on culturally congruent care to assure the highest quality of nursing care.

Challenges for palliative care professionals in providing spiritual care to patients from religious or cultural minority groups: a scoping review of the literature

In light of the increasing number of people living into advanced age and the intensification of migration flows, care provision to multi-cultural and religious patient populations has become an important concern for many palliative care professionals. The current scoping review aims to explore the main barriers to spiritual care provision for minority groups and identify some strategies to overcome such obstacles. The review draws some general recommendations for researchers, policymakers and clinicians. First, more empirical research on different patient groups is needed; studies should target not only nurses, but also other healthcare providers, to ensure that practice adequately reflects the multidisciplinary nature of palliative care. Secondly, training and education should be offered in various forms and at different levels, as well as go beyond factual knowledge about the beliefs and practices of various religions.

Culture, religion, language and the assessment and management of children's pain by expatriate nurses in Saudi Arabia: A qualitative study

PURPOSE

Unrelieved pain among hospitalized children is a common problem that affects all aspects of children's health and their quality of life. Cultural and language differences between nurses and patients have been shown to impact the quality and safety of nursing care and management for children with pain. The aim of this study was to identify the cultural factors, barriers, and facilitators impacting the assessment and management of children's pain by expatriate nurses in Saudi Arabia.

DESIGN AND METHODS

A qualitative descriptive design was employed in this study. A sample of 16 nurses was conveniently recruited and interviewed through face-to-face semistructured interviews. Each interview lasted between 30 and 60 min and was audio-recorded. Content analysis was used to analyze the transcripts. Transcripts were carefully read, significant statements were highlighted, coded, categorized, and clustered thematically.

RESULTS

Three main themes were identified, namely, (I) low priority of children's pain, (II) culture and religious challenges, and (III) communication challenges.

PRACTICE IMPLICATIONS

Cultural and language differences described by expatriate nurses hindered their care of children with pain. A systematic education for expatriate nurses, children, and families is urgently needed to enhance inter/cross-cultural understandings and improve childcare in Saudi Arabia. This study identifies the unique challenges faced by expatriate nurses in Saudi Arabia. The findings reveal how a lack of knowledge about cultural values and beliefs can lead to misunderstandings and conflicts between nurses, children, and families and can have an impact on childcare and pain. It also highlights the need to improve pain management practices in multicultural healthcare settings, similar to those of Saudi Arabia and neighboring Arab nations, and across the globe.

A quantitative study of nurses perception to advance directive in selected private and public secondary healthcare facilities in Ibadan, Nigeria

Objectives

The study evaluated nurses’ perceptions on the benefits, drawbacks, and their roles in initiating and implementing advance directives (AD) at private and public secondary healthcare units.

Methods

The study adopted a cross-sectional, comparative-descriptive research design and was anchored on the structural functional theory. A total of 401 nurses (131 private and 270 public) were chosen on purpose. The data was collected between January and March 2018 among nurses at the selected hospitals. Analysis was done via SPSSv28.0.1.0.

Results

Compared to nurses working in private healthcare facilities (72.5%), the majority of nurses at the public healthcare facilities (75.2%) indicated a more favorable opinion of AD’s benefits and (61.9%) felt they had a substantial involvement in the development and execution of AD than their private counterpart (56.5%). Similarly, 60.7% of nurses employed by the government agreed that AD has some disadvantages compared to those employed by the private sector (58.8%). Significantly, Christian nurses are 0.53 times less likely than Muslims to contest AD’s benefits; 0.78 times less likely than Muslim to disagree that AD has flaws; and 1.30 times more likely than Muslim nurses to deny they contributed to the development and execution of AD, though not significant.

Conclusion

Making decisions at the end-of-life can be challenging, thus AD should be supported across the board in the healthcare industry. Nurses should be trained on their role in developing and implementing AD, as well as on its advantages and how to deal with its challenges.

Adult patient communication experiences with nurses in cancer care settings: a qualitative study

Background

The patient communication experience is an important outcome measure that guides quality improvements in healthcare settings specifically in cancer care. Therefore, this study aimed to explore the patient’s communication experiences with nurses in cancer care settings.

Methods

Semi-structured face to face interviews were conducted with 21 participants who received cancer care at two Saudi Arabian tertiary healthcare facilities between Aug 2019 to Dec 2019. The study used a qualitative descriptive design. The interviews were audio-recorded and transcribed verbatim. Thematic analysis was used to analyse the data using six stages of Braun and Clarke.

Results

Four major themes were identified and a total of eleven sub-themes. The major themes were; (1) The importance of patient-nurse relationships, (2) Providing appropriate information to patients, (3) Responding to patients emotional needs and (4) Verbal communication between nurses and cancer patients.

Conclusions

Some participants felt that their communication with nurses was limited, but generally, most felt that communication was acceptable irrespective of barriers such as language, culture, religion, gender, workload and healthcare preferences. Participants drew a comparison between Saudi and non-Saudi nurses as well as between nurses and doctors communication skills. They felt that Saudi nurses had good communication skills, but non-Saudi nurses were more competent in some aspects such as kindness, politeness, respectful and non-verbal communication. They also felt that doctors were more accurate in their information than nurses.

Clinician End-of-Life Experiences With Pediatric Muslim Patients at a US Quaternary Care Center

CONTEXT

A small, growing body of data exist discussing the experiences of Muslim patients with the palliative care system, both in the United States and abroad, as well as providers' experiences with Muslim patients. However, no studies evaluate clinician experiences with Muslim patients in the United States, and none address the unique dynamics of pediatric clinician experiences with Muslim patients and their families in the EOL setting.

OBJECTIVES

The purpose of this study is to perform a thematic analysis of clinician experiences with pediatric Muslim patients and families at the end of life.

METHODS

This was a qualitative study of pediatric clinicians at Duke University Medical Center in the Pediatric Intensive Care Unit, Pediatric Cardiac Intensive Care Unit, and Pediatric Bone Marrow Unit from August 2018 to February 2019. We conducted semistructured interviews with nurses, attending physicians, and social workers to assess participants' experiences caring for Muslim patients and families. We analyzed interview transcripts using descriptive content analysis with NVivo10.

RESULTS

We interviewed 16 clinicians at Duke University Medical Center Pediatric Intensive Care Unit, Pediatric Cardiac Intensive Care Unit, and Pediatric Bone Marrow Unit. Five physicians, five social workers, and six nurses were interviewed. The majority of providers were female, Caucasian, and Christian in an institution where Muslim patients are a significant minority. Several themes emerged highlighting language barriers, difficulty engaging with Muslim families, variations in approach to care and communication, discomfort with gender roles, moral distress with unrelatable decision-making, and external pressures on patient decision-making.

CONCLUSION

A thematic analysis of pediatric clinicians at a quaternary care center in the Southern United States yielded several prominent themes. Many clinicians recognize they likely provide disparate care to minority patients for a variety of reasons encompassing the above barriers. As we work to care for an increasingly diverse patient population, more research into barriers to care and effective educational methods is needed.

Home-Based Palliative Care and Home Health Care in Saudi Arabia: An Integrative Literature Review

Aging populations and a rising disease burden have increased the need for palliative care (PC). Despite the growing demand for PC, only 14% of patients worldwide receive this service. Home-based PC is necessary because many people prefer to receive care and die at home. Nurses are well equipped to address diverse health care needs in the community and are critical to successful delivery of home-based PC. The purpose of this review is to synthesize and analyze literature relevant to home-based PC in Saudi Arabia with an emphasis on nursing. This purpose required us to examine literature in two areas: PC and home health care (HHC). We identified studies through database searches. We found 24 studies published between 2005 and 2021 that met quality and inclusion criteria. Although PC and HHC are associated with positive outcomes, lack of nurses’ knowledge and awareness of PC and the underdevelopment of HHC in Saudi Arabia have contributed to underuse of these services. Nurses are vital to the functioning of interdisciplinary teams and effective interfacing with patients, caregivers, and families. Education and training of nurses in Saudi Arabia is essential to promoting access to PC and HHC and the development of home-based PC in the kingdom.

Entering forbidden territory - Value conflicts of female Muslim student nurses providing personal care to male patients: A qualitative study

BACKGROUND

Saudi Arabia is now facing a critical nursing shortage and is under considerable pressure to recruit more local nurses. However, attracting Saudi Arabian women into the nursing profession has traditionally been difficult due to religious and cultural barriers.

OBJECTIVES

The study was designed to provide insights into the research participants' experiences or awareness of conflicts between professional nursing values and the dominant religious and cultural values of Saudi Arabia.

DESIGN

The research took the form of a qualitative case study.

SETTING

The study was conducted at a leading university in Saudi Arabia.

PARTICIPANTS

The participants consisted of 24 female Muslim student nurses from the second and fourth years of study of the BSc Nursing degree and six female Muslim College of Nursing faculty members from the same university.

METHODS

Data collection methods consisted of individual interviews and focus groups, and thematic analysis was used to analyse the data. The study used a theoretical framework based on Rokeach's (1973, 1979) theories of values and value change.

RESULTS

All student participants were found to be experiencing conflicts between the nursing requirement to provide personal care to male patients, and their religious and cultural values relating to personal modesty. Faculty participants were aware of the presence of this value conflict, but it was not being formally acknowledged or addressed at the case study institution. The lack of official practice or policy guidance was found to be reinforcing the potential for the value conflict. Participants regarded religious values as fixed and mandatory, but cultural values as subject to change.

CONCLUSIONS

It was concluded that awareness-raising initiatives and open discussion of value conflicts should be conducted by the university to help realign the participants' culturally influenced values with the requirements of nursing. The available Islamic guidance should also be used to clarify the institution's official position on the provision of personal care to male patients by Muslim female nurses and improve understanding of the nursing tasks acceptable within Islam.

"I Need Presence and a Listening Ear": Perspectives of Spirituality and Spiritual Care Among Healthcare Providers in a Hospice Setting in Pakistan

This paper aims to describe how healthcare providers perceived spirituality and spiritual care while caring for dying patients and their families in a hospice setting in Karachi, Pakistan. Using a qualitative interpretive description design, individual in-depth interviews were conducted among healthcare providers. Thematic analysis approach was used for data analysis. Spirituality and spiritual care were perceived as shared human connections, relating to each other, acts of compassion, showing mutual respect while maintaining dignity in care and empowering patients and families. Developing spiritual competency, self-awareness, training and education, and self-care strategies for healthcare providers are essential components promoting spiritual care in a hospice setting.

Transcultural Nurses' Caring for Pilgrims for the First Time During Hajj Season in Saudi Arabia

The Kingdom of Saudi Arabia invests tremendous governmental resources to support the annual Hajj season, including providing free world-class healthcare for all visiting pilgrims. Nurses from around the Kingdom are encouraged to work at Makkah during this period. These nurses come from different cultural backgrounds and provide care for pilgrims from around the world. The study utlized descriptive phenomenology design. A total of 11 transcultural nurses were interviewed. A thematic analysis was performed to understand the lived experience of the transcultural nurses participating in the Hajj for the first time. Five themes emerged. These included serving with satisfaction; a supportive and fair system; professional and personal values; difference, and difficulties and problems. This is the first study of transcultural nurses' experiences of providing nursing care to pilgrims during the Hajj. The results highlight transcultural nurses' perceptions of the benefits and challenges of providing care during the Hajj and potential strategies to improve preparation and care quality.

Preferences and Experiences of Muslim Patients and Their Families in Muslim-Majority Countries for End-of-Life Care: A Systematic Review and Thematic Analysis

BACKGROUND

Care for people with progressive illness should be person centered and account for their cultural values and spiritual beliefs. There are an estimated 1.7 billion Muslims worldwide, largely living in low-income and middle-income countries.

AIMS

This study aimed to identify, appraise, and integrate the evidence for the experiences and preferences of Muslim patients and/or families for end-of-life care in Muslim-majority countries.

DESIGN

Systematic review.

DATA SOURCES

PsychINFO, MEDLINE, Embase, Global Health, CINAHL, Cochrane Library and Registry of Clinical Trials, PubMed, Applied Social Sciences Index and Abstracts (ASSIA), Social Services Abstracts, Sociological Abstracts, Social Policy & Practice, and Scopus were searched until December 2018. Handsearching was performed, and gray literature was included. Qualitative studies analyzed using thematic analysis and quantitative component provided triangulation.

RESULTS

The initial search yielded n = 5098 articles, of which n = 30 met the inclusion criteria. A total of 5342 participants (4345 patients; 81.3%) were included; 97.6% had advanced cancer. Most (n = 22) studies were quantitative. Three themes and subthemes from qualitative studies were identified using thematic analysis: selflessness (burden to others and caregiver responsibilities), ambivalence (hope and hopelessness), and strong beliefs in Islam (beliefs in death and afterlife and closeness to Allah). Qualitative studies reported triangulation; demonstrating conflicts in diagnosis disclosure and total pain burden experienced by both patients and families.

CONCLUSION

Despite the scarce evidence of relatively low quality, the analysis revealed core themes. To achieve palliative care for all in line with the total pain model, beliefs must be identified and understood in relation to decision-making processes and practices.

Telling their story: A qualitative descriptive study of the lived experience of expatriate palliative care nurses in the United Arab Emirates

PURPOSE

To explore the experiences of expatriate nurses caring for Muslim patients near end-of-life in a palliative care unit in the United Arab Emirates.

METHODS

A qualitative descriptive study, with data collected through semi structured individual interviews with nine expatriate nurses working in a palliative care unit in one hospital in the United Arab Emirates. Thematic analysis of the data transcripts used a structured inductive approach.

RESULTS

Analysis of the interview transcripts yielded three themes. First, language was a significant barrier in end-of-life care but was transcended when nurses practiced authentically, using presence, empathetic touch and spiritual care. Secondly, relationships between nurses, patients and families were strengthened over time, which was not always possible due to late presentation in the palliative care unit. Finally, nurses were continually in discussions with physicians, families and other nurses, co-creating the meaning of new information and experiences within the hospital policy context.

CONCLUSION

For expatriate nurses, palliative nursing in a Muslim middle eastern country is complex, requiring nurses to be creative in their communication to co-create meaning in an emotionally intensive environment. Like other palliative care settings, time can strengthen relationships with patients and their families, but local cultural norms often meant that patients came to palliative care late in their disease trajectory. Preparing expatriate nurses for work in specialist palliative care settings requires skill development in advanced communication and spiritual practices, as well as principles of palliative care and tenets of Muslim culture.

Barriers to nurse-patient communication in Saudi Arabia: an integrative review

Background

Effective nurse–patient communication is important in improving quality of health care. However, there are several barriers to nurse–patient communication in Saudi Arabia. This is attributed to the increasing number of non-Saudi expatriate nurses providing health care to patients. In particular, there are differences in culture, religion and language among non-Saudi nurses and patients. This integrative review aims to identify and synthesize quantitative and qualitative evidence on the current practice in nurse–patient communication in Saudi Arabia and its effect on service users’ quality of care, safety and satisfaction.

Methods

An integrative review based on Whittemore and Knafl’s approach (Whittemore and Knafl, J Adv Nurs 52:546–553, 2005) was used to conduct the review. Peer-reviewed articles containing any of a series of specific key terms were identified from sources such as CINAHL, EMBASE, Medline, PubMed and PsychINFO. The review included studies that focused on nurse–patient communication issues, communication barriers, and cultural and language issues. The search was limited to papers about the Saudi Arabian health system published in English and Arabic languages between 2000 and 2018. A data extraction form was developed to extract information from included articles.

Results

Twenty papers were included in the review (Table 1). Ten papers employed quantitative methods, eight papers used qualitative methods and two used mixed methods. The review revealed two major themes: ‘current communication practices’ and ‘the effect of communication on patients’. Some of the communication practices rely on non-verbal methods due to a lack of a common language, which often results in the meaning of the communication being misinterpreted. Many non-Saudi nurses have limited knowledge about Saudi culture and experience difficulty in understanding, and in some cases respecting, the cultural and religious practices of patients. Further, limited nurse–patient communication impacts negatively on the nurse–patient relationship, which can affect patient safety and lead to poor patient satisfaction.

Conclusions

Current nurse–patient communication practices do not meet the needs of Saudi patients due to cultural, religious and language differences between nurses and patients. The barriers to effective nurse–patient communication adversely effects patient safety and patient satisfaction. Further research from the perspective of the patient and family is needed.

Provision of renal care for patients with end stage kidney disease in persistent vegetative state, in United Arab Emirates: a national survey of renal physicians

Patients with end stage kidney disease (ESKD) with severely impaired cognitive function have no survival benefit from dialysis. We therefore undertook a survey to explore the renal physicians' practices of withholding and withdrawal of dialysis treatment in vegetative state patients in the United Arab Emirates (UAE). A cross sectional survey of 29 nephrology practices in UAE exploring physicians' practices in making decisions of withholding and withdrawal of dialysis treatment during provision end-of-life care for patients in persistent vegetative state (PVS).The majority of participants practice in governmental non-for-profit dialysis units (79%), and think they are well prepared to make decision with patients and family on issues of dialysis withdrawal and withholding (69%). If a chronic dialysis patient became permanently unconscious only few respondents (17%) indicated probability of stopping dialysis. On the other hand, more respondents (48%) reported that dialysis is likely to be withheld in PVS patients who develop kidney failure. In high risk or poor prognosis ESKD patients and given how likely they would consider each option independently, respondents reported they are likely to consider time-limited dialysis in 78% of the time followed by stopping (46%) or forgoing (27%) dialysis. Majority of the participants perceived that their decisions in providing renal care for PVS patients in UAE were influenced by the family sociocultural beliefs (76% of participants), the current hospital policies (72% of participants), and by Islamic beliefs (66% of participants). Only few perceived access to palliative care (30%) and treatment cost (17%) to have an impact on their decision making.Decisions of initiation and continuation of dialysis treatment to ESKD patients in PVS are prevalent among nephrology practices in UAE. Development of local guidelines based on the societal values along with early integration of palliative kidney failure management care would be required to improve the quality of provision of end-of-life renal care in UAE.

ABBREVIATIONS

ESKD: stage kidney disease; UAE: United Arab Emirates; PVS: persistent vegetative state; RPA: Renal Physicians Association; ASN: American Society of Nephrology; EMAN: Emirates Medical Association Nephrology Society; CPR: cardiopulmonary resuscitation.