The (un)-certainties of district nurses in the context of cultural diversity

Cultural Competence of Turkish Nurses and Nursing Students: An Integrative Literature Review

INTRODUCTION

Turkish population is characterized by its great cultural diversity, thus, Turkish nurses and nursing students often interact with patients of different cultural backgrounds from theirs. Cultural competence is needed to provide qualified contemporary nursing care. This study aimed to explore the literature on the cultural competence of Turkish nurses and nursing students.

METHODOLOGY

The Whittemore and Knafl review methodology was used to extract, summarize, and synthesize data of 15 primary research articles published between January 2011 and January 2021. The search was done in the Turkish Academic Network and Information Center-ULAKBIM (PubMed, TRDizin, DergiPark).

RESULTS

Three themes were identified: cultural competence, cultural-related problems, and importance of training on transcultural nursing.

DISCUSSION

Appropriate educational courses on transcultural nursing should be implemented in Turkish nursing schools as well as in continuing education programs for Turkish nurses.

'The Elephant on the Table': Religious and Ethnic Diversity in Home Health Services

Healthcare services are increasingly being provided in the home. At the same time, these home contexts are changing as global migration has brought unprecedented diversity both in the recipients of care, and home health workers. In this paper, we present findings of a Canadian study that examined the negotiation of religious and ethnic plurality in home health. Qualitative analysis of the data from interviews and observations with 46 participants-clients, administrators, home healthcare workers-revealed how religion is expressed and 'managed' in home health services.

The Role of the Social Network in Access to Psychosocial Services for Migrant Elderly-A Qualitative Study

Background: Despite high prevalence of mental problems among elderly migrants in The Netherlands, the use of psychosocial care services by this group is low. Scientific evidence points at the crucial role of social support for mental health and the use of psychosocial services. We therefore explored the role of social networks in the access to psychosocial care among elderly migrants in The Netherlands. Methods: A qualitative study was conducted using semi-structured group interviews and individual interviews. The eight group and eleven individual interviews (respectively n = 58 and n = 11) were conducted in The Netherlands with Turkish, Moroccan, Surinamese, and Dutch elderly. The data were analysed through coding and comparing fragments and recognizing patterns. Results: Support of the social network is important to navigate to psychosocial care and is most frequently provided by children. However, the social network of elderly migrants is generally not able to meet the needs of the elderly. This is mostly due to poor mental health literacy of the social network, taboo, and stigma around mental illness and the busy lives of the social network members. Conclusions: Strategies to address help-seeking barriers should consider mental health literacy in elderly migrants as well as their social networks, and counteract taboos and stigma of mental health problems.

Do attitudes and behavior of health care professionals exacerbate health care disparities among immigrant and ethnic minority groups? An integrative literature review

OBJECTIVES

Recent investigations of ethnicity related disparities in health care have focused on the contribution of providers' implicit biases. A significant effect on health care outcomes is suggested, but the results are mixed. The purpose of this integrative literature review is to provide an overview and synthesize the current empirical research on the potential influence of health care professionals' attitudes and behaviors towards ethnic minority patients on health care disparities.

DESIGN

Integrative literature review.

DATA SOURCES

Four internet-based literature indexes - MedLine, PsychInfo, Sociological Abstracts and Web of Science - were searched for articles published between 1982 and 2012 discussing health care professionals' attitudes or behaviors towards ethnic minority patients.

REVIEW METHODS

Thematic analysis was used to synthesize the relevant findings.

RESULTS

We found 47 studies from 12 countries. Six potential barriers to health care for ethnic minorities were identified that may be related to health care professionals' attitudes or behaviors: Biases, stereotypes and prejudices; Language and communication barriers; Cultural misunderstandings; Gate-keeping; Statistical discrimination; Specific challenges of delivering care to undocumented migrants.

CONCLUSIONS

Data on health care professionals' attitudes or behaviors are both limited and inconsistent. We thus provide reflections on methods, conceptualization, interpretation and the importance of the geographical or socio-political settings of potential studies. More empirical data is needed, especially on health care professionals' attitudes or behaviors towards (irregular) migrant patients.

Religion, assessment and the problem of 'normative uncertainty' for mental health student nurses: a critical incident-informed qualitative interview study

There is limited research around how mental health (MH) student nurses interpret and differentiate between people's religious and cultural beliefs and the existence of psychopathological symptomatology and experiences. Here we focus on one cultural issue that arose from research exploring how MH student nurses approach and interpret religion and culture in their practice - that is, the difficulties in determining the clinical significance of the religious beliefs and experiences expressed by the people they care for. While problems with establishing the cultural boundaries of normality in clinical assessments are an important area of debate in cultural psychiatry, it remains a peripheral issue in MH nurse education. An anthropologically informed qualitative research design underpinned 'critical incident' (CI)-focused ethnographic interviews with 36 second and third-year MH nursing field students and seven undergraduate MH branch lecturers. Follow up focus groups were also carried out. Interview transcripts were subject to thematic analysis. Four subthemes were identified under the broad theme of the clinical significance of religious-type expression and experience: (1) identifying the difference between delusions and religious belief; (2) identifying whether an experience was hallucination or religious experience; (3) the clinical implications of such challenges; and (4) applying religion-specific knowledge. There are clinical implications that may result from the difficulties with assessing the clinical significance of religious beliefs and experiences, identified in both our research and within international cultural psychiatry literature and research. Misinterpretation and therefore wrongly assessing someone's experience as pathological is a significant concern. It is suggested that CI analysis could be adapted to help nurses, nursing students and nurse educators recognize the religious dimensions of mental distress, particularly those that then potentially impact upon the accuracy and person centeredness of clinical assessment. Further research is proposed to investigate the clinical assessment and training needs of nurses in the area of religion and mental distress.

Barriers in access to home care services among ethnic minority and Dutch elderly--a qualitative study

BACKGROUND

Ethnic minority elderly have a high prevalence of functional limitations and chronic conditions compared to Dutch elderly. However, their use of home care services is low compared to Dutch elderly.

OBJECTIVES

Explore the barriers to access to home care services for Turkish, Moroccan Surinamese and ethnic Dutch elderly.

DESIGN

Qualitative semi-structured group interviews and individual interviews.

SETTING

The Netherlands.

PARTICIPANTS

Seven group interviews (n=50) followed by individual interviews (n=5) were conducted, in the preferred language of the participants.

METHODS

Results were ordered and reported according to a framework of access to health care services. This framework describes five dimensions of accessibility to generate access to health care services, from the perspective of the users: ability to perceive health needs, ability to seek health care, ability to reach, ability to pay and ability to engage.

RESULTS

This study shows that while barriers are common among all groups, several specific barriers in access to home care services exist for ethnic minority elderly. Language and communication barriers as well as limited networks and a preference for informal care seem to mutually enforce each other, resulting in many barriers during the navigation process to home care.

CONCLUSION

In order to provide equal access to home care for all who need it, the language and communication barriers should be tackled by home care services and home care nurses.

Black African migrants: the barriers with accessing and utilizing health promotion services in the UK

BACKGROUND

The inequalities for different ethnicities and social classes in accessing health services is well documented, but although a number of recent policy developments have aimed to tackle health inequalities, very little is known about the experiences of Black African migrant communities in accessing health promotion information and services. The aim of the study were to examine the experiences of Black African migrant families in accessing health promotion services.

METHODS

A convenience sample of 90 Black African migrants in the north of England participated in the study. Quantitative and qualitative data were collected utilizing a self-administered questionnaire in Arabic, English, French and Swahili. The findings were analysed using descriptive analysis and a variation of the constant comparative method. Themes and categories were identified across transcripts and appropriate quotations have been used to illustrate themes.

RESULTS

Major findings that emerged from the analysis showed that participants were concerned about their insufficient ability to communicate, which appeared to undermine their capacity to access health promotion services. Lack of literacy and proficiency in English was perceived as an underlying problem in seeking health promotion information and support.

CONCLUSIONS

The findings have a number of implications for health promotion practitioners; in particular, the need to work collaboratively with migrant groups in order to identify and develop appropriate cultural sensitive communication strategies. The study concludes by suggesting the need to explore further the communication needs of migrant families and the implications for the take-up of health promotion services.

A survey of issues of ethnicity and culture in nursing homes in an English region: nurse managers' perspectives

AIMS

This survey explored issues of ethnicity and culture in nursing homes in one English region.

BACKGROUND

The older black and minority ethnic population in the UK is increasing, and this is the first detailed study of numbers of black and minority ethnic residents in nursing homes and of managers' perceptions of their abilities to respond to residents' needs.

DESIGN

Mixed methods.

METHODS

Date were collected in 2008. A postal survey was sent to all nursing homes in the region. A sub-sample of managers participated in semi-structured telephone interviews.

RESULTS

A hundred and one homes responded to the survey, and 13 managers were interviewed. One-third of homes had black and minority ethnic residents, and 95% had staff from these groups. Managers' underlying philosophies of care were to treat each resident individually and not by category. It was felt that individualised care plans resulted in residents' needs being met appropriately. Culturally sensitive care delivery varied. Some homes had established systems that were responsive to residents' diversity, while others responded to the needs of black and minority ethnic residents on an 'as-required' basis. Managers' identified advantages in having staff from diverse backgrounds, although prejudice from residents towards staff emerged as a theme and managers' responses varied. Staff training in the provision of appropriate end-of-life care was identified as a need.

CONCLUSION

Black and minority ethnic residents form a small but growing minority of nursing home residents. Predicted increases in this resident group mean that managers must consider the delivery of culturally sensitive services. Future research is needed to explore the perspectives of black and minority ethnic residents.

RELEVANCE TO CLINICAL PRACTICE

Nursing homes in England are increasingly diverse communities, and staff training needs must be addressed to promote quality care for all residents.

Healthcare services for Japanese elderly long-staying in Thailand from the perspective of the patient and healthcare providers: a survey study

Long-stay refers to a long visit abroad by retired middle-aged and older people. This study describes the attitudes/opinions of elderly Japanese long-staying subjects and healthcare providers in Thailand. Two cross-sectional questionnaire surveys were conducted in Chiang Mai Province, Thailand. Questionnaires were sent to a sample recruited from a self-help group of Japanese elders in Thailand (n = 68) and to Thai healthcare providers (n = 101). About half of the Japanese subjects routinely used a Thai medical service, although only 15% had been admitted to the hospital. Half of the Japanese subjects thought the quality of Thai medical services was high. Many elderly Japanese subjects were unable to speak either English or Thai, leading to communication difficulties. About 80% of healthcare professionals found no difference between caring for elderly Japanese subjects and people from Thailand. Most healthcare providers agreed that Japanese language training should be available to medical staff as translators were not always available. Healthcare providers agreed with the Thai government policy promoting long-stays. The most recognized obstacle in caring for Japanese long-stay elderly was the language barrier. More research on Japanese elders staying abroad is needed to promote effective communication between Japanese elderly and other ethnic healthcare professionals.