Exploring cultural competence of nurses and associated barriers in Ethiopian tertiary hospitals: A qualitative study

BackgroundsCultural diversities in both patients and health professionals possess difficulties in cultural care. Such cultural diversities can lead to culturally inappropriate care and health disparities. Delivering culturally competent nursing care is a powerful tool to provide care equally for all patients and eliminate health disparities among culturally diverse people. The present study aimed to explore the cultural competence of nurses and associated barriers in Ethiopian tertiary hospitals.MethodsThe study was conducted on eight purposively selected key informants from March 1 to April 30, 2018. Data was collected using semi-structured questions through face to face in-depth interview. The collected data analyzed using thematic analysis and presented in the form of text and table.ResultsEight (n = 3 females and n = 5 males) participants were involved in the study. After extensive analysis, four themes emerged: cultural competence, linguistic competence, cultural competence education and training, and barriers to cultural competence. Another six subthemes of barriers encountered by participants identified and consisted of the language barrier, trained interpreter and translator limitation, lack of knowledge of the patient's culture, lack of multicultural nursing workforce, and shortage of nursing staff, cultural and linguistic stereotypes.ConclusionsNurses less focused on cultural aspects of patients, and they focused more on biological factors and patients' disease. Interestingly, they expressed respect for the cultural and religious practice of patients and showed an interest to learn about cultural care nursing. Cultural competence of participants was hindered by several barriers that need nurses to overcome it.     

The experiences of migrant health nurses employed in seasonal satellite nurse-managed centers: a qualitative study

This research study describes the unique experiences of nurses who are employed in migrant health seasonal satellite nurse-managed centers in the upper Midwest. Data were generated through semistructured interviews with 10 seasonal nurses. Phenomenology served as the research method. Four themes were identified including seeking seasonal employment, establishing migrant seasonal satellite nurse-managed centers, learning the culture of Hispanic migrant farmworkers, and referring Hispanic migrant farmworkers for medical care. During their seasonal employment, nurses learned to establish and operate satellite nurse-managed centers. Due to the migrant health nurses' daily contact with their clients, they were able to establish rapport that led to a trusting relationship. This enabled them to provide culturally sensitive and lifestyle appropriate care to the migrant farmworker population.     

Readmission is experienced as inevitable among older adults receiving homecare: A qualitative interview study

Background

Older adults receiving homecare have an increased risk of readmission. The transition from hospital to home can be experienced as unsafe, and older adults describe themselves as vulnerable during the post-discharge period. Thus, the objective was to explore the experiences of unplanned readmissions among older adults who receive homecare.

Methods

We conducted qualitative individual semi-structured interviews with older adults, 65 years or above, receiving homecare and being readmitted to an emergency department (ED) between August and October 2020. Data were analysed by systematic text condensation as described by Malterud.

Findings

We included 12 adults aged 67–95 years, seven were male, and eight lived alone. The analysis derived three themes: (1) Responsibility and security at home, (2) the role of family, friends and homecare and (3) the importance of trust. The older adults felt that the hospital strived for too-early discharge, as they still did not feel well. They worried about how to manage their daily life. Active involvement of their family increased their sense of security, but those living alone described feeling anxious being at home by themselves after discharge. Although older adults did not wish to go to the hospital, inadequate treatment at home and the feeling of responsibility for their illness made them feel insecure. They expressed that earlier negative experiences affected their trust in the system and their inclination to ask for help.

Conclusions

The older adults were discharged from the hospital despite feeling ill. They described inadequate competencies from healthcare professionals in the home as a contributing factor to their readmission. The readmission increased a sense of security. Support from the family in the process was essential and provided a sense of security, whereas older adults living alone experienced feelings of insecurity in the home environment.     

Palliative sedation and moral distress: A qualitative study of nurses

BackgroundClinical nursing practice may involve moral distress, which has been reported to occur frequently when nurses care for dying patients. Palliative sedation is a practice that is used to alleviate unbearable and refractory suffering in the last phase of life and has been linked to distress in nurses.AimThe aim of this study was to explore nurses' reports on the practice of palliative sedation focusing on their experiences with pressure, dilemmas and morally distressing situations.MethodsIn-depth interviews with 36 nurses working in hospital, nursing home or primary care.ResultsSeveral nurses described situations in which they felt that administration of palliative sedation was in the patient's best interest, but where they were constrained from taking action. Nurses also reported on situations where they experienced pressure to be actively involved in the provision of palliative sedation, while they felt this was not in the patient's best interest. The latter situation related to (1) starting palliative sedation when the nurse felt not all options to relieve suffering had been explored yet; (2) family requesting an increase of the sedation level where the nurse felt that this may involve unjustified hastening of death; (3) a decision by the physician to start palliative sedation where the patient had previously expressed an explicit wish for euthanasia.ConclusionsNurses experienced moral distress in situations where they were not able to act in what they believed is the patient's best interest. Situations involving moral distress require nurses to be well informed and able to adequately communicate with suffering patients, distressed family and physicians.     

Compliance in peritoneal dialysis: A qualitative study of renal nurses

End-stage renal failure is a life-threatening condition, often treated with home-based peritoneal dialysis (PD). PD is a demanding regimen, and the patients who practise it must make numerous lifestyle changes and learn complicated biomedical techniques. In our experience, the renal nurses who provide most PD education frequently express concerns that patient compliance with their teaching is poor. These concerns are mirrored in the renal literature. It has been argued that the perceived failure of health professionals to improve compliance rates with PD regimens is because 'compliance' itself has never been adequately conceptualized or defined; thus, it is difficult to operationalize and quantify. This paper examines how a group of Australian renal nurses construct patient compliance with PD therapy. These empirical data illuminate how PD compliance operates in one practice setting; how it is characterized by multiple and often competing energies; and how ultimately it might be pointless to try to tame 'compliance' through rigid definitions and measurement, or to rigidly enforce it in PD patients. The energies involved are too fractious and might be better spent, as many of the more experienced nurses in this study argue, in augmenting the energies that do work well together to improve patient outcomes.     

Facilitators and barriers for nurses in providing sexual education to myocardial-infarction patients: A qualitative systematic review

BackgroundMyocardial infarction (MI) greatly impacts an individual’s sexual health. It is reported that almost 40 to 80% population with MI are not able to resume their sexual routine after the illness due to organic or psychological sexual dysfunction. To reduce the prevalence of sexual dysfunction after MI, cardiac nurses are required to provide sexual counselling to their stable patients. However, this responsibility is seldom fulfilled by nurses due to several barriers. These barriers are not explicitly explored from the nurses’ perspective, which is necessary to understand in order to promote sexual counselling in cardiac health care settings.ObjectiveTo explore the facilitators and barriers of cardiac nurses in providing sexual education to post-MI patients.Design and methodA qualitative systematic review was undertaken by performing a systematic search from six databases along with search from reference lists of related studies.FindingsFour studies revealed 49 findings, which formed 10 categories and yielded four synthesised findings. These are: (1) Institutional Barriers such as lack of education, guidelines and material resources can prevent nurses from providing sexual education to MI patients; (2) Personal barriers such as uncertainty about the nurse’s role in sexual education, giving least priority to sexual counselling and lack of comfort with discussing sexuality can affect how nurses provide sexual education to MI patients; (3) Socio-cultural and religious barriers such as contradictory beliefs and gender differences can challenge nurses when providing sexual education to MI patients and (4) Nurses consider different strategies for addressing sexual education with MI patients, in individual or group settings.ConclusionTo promote sexual counselling, strategies are proposed by nurses, which can help in limiting barriers and facilitate in conducting counselling sessions. These strategies need to be validated from extensive research before implementing them into nursing practice.     

Hospital and homecare nurses' experiences of involvement of patients and families in transition between hospital and municipalities: A qualitative study

Background

Involving patients and families in nursing care is essential to improve patients' health outcomes. Furthermore, families play an essential role in supporting patients by helping nurses understand the patient's everyday life. However, families also need support. Involvement of patients and families is especially important when patients are transferred between hospital and home as transitions heighten the risk of compromising quality and safety in care. However, no consensus exists on how to involve them. Consequently, this may challenge a systematic approach toward patient and family involvement.

Aim

To describe hospital and homecare nurses' experiences with involving patients and their family members in nursing care in the transition between hospital and municipalities.

Method

Focus group interviews were conducted in the Gastro unit at a large university hospital in Denmark. Participants included 10 hospital nurses from three wards at the Gastro unit and six homecare nurses from one of three municipalities in the hospital catchment area (total n = 16). Data were analysed using qualitative content analysis. The study is reported according to the Consolidated Criteria for Reporting Qualitative Research.

Findings

Our analysis revealed one overall theme – “The complexity of involvement” – based on four categories: gap between healthcare sectors increases the need for patient and family involvement, lack of time is a barrier to patient and family involvement, involvement is more than information, and involvement as a balancing act.

Conclusion

The nurses experienced patients' and families' involvement as essential, but a discrepancy was found between nurses' intentions and their actions. Aspects related to a gap between healthcare sectors and various understandings of involvement challenged the systematic involvement of patients and families in the transition between healthcare sectors. However, the nurses were highly motivated to achieve a close cross-sectoral collaboration and to show commitment towards patients and families.     

New graduate nurses and dementia care in acute care: A qualitative study

With the increasing older adult population, new graduate nurses will be providing care for patients with dementia more frequently. The purpose of this qualitative study was to explore the experiences of new graduate nurses when providing care for patients with dementia in acute care environments. We conducted semi-structured interviews with eleven new graduate nurses in Ontario, Canada. Three themes emerged from the thematic analysis: (1) building of vision and values; (2) clashing of vision and values; and (3) making do with what you have. Barriers to providing dementia care in acute care were similar to barriers experienced by non- new graduate nurses reported in the literature, such as challenges with responsive behaviours, maintaining safety and providing psychosocial care. Facilitators identified were supportive colleagues and early exposure to dementia care.     

A pilot qualitative study relating to hardiness in ICU nurses: hardiness in ICU nurses.

Staff turnover in critical care units is a persistent problem. This very brief, pilot study examines the effects of hardiness and its impact on critical care nurses.     

Work-related trauma: the experiences of perioperative nurses

Traumatic experiences in the workplace are an integral part of the role of the perioperative nurse. The atypical nature and characteristics of these experiences is such that perioperative nurses may suddenly encounter reactions and feelings that are very different and more intense than anything they will have encountered previously. Furthermore, these events may increase the risk of them experiencing subsequent trauma stress reactions and place them at risk of profound distress and significantly impaired functioning. A survey of 233 nurses working in rural and metropolitan operating theatres assessed the range and types of traumatic work experiences. Results showed that exposure to traumatic events was reported by 161 (69%) of all respondents and a wide range of traumatic experiences were reported to have affected their well-being. The findings have implications for the formulation of trauma management strategies, both at individual and organisational levels and suggest new directions for education and research in promoting a recovery environment in which perioperative nurses can work.     

Healthy eating and physical activity among new graduate nurses: A qualitative study of barriers and enablers during their first year of clinical practice

BackgroundNew graduate nurses entering the workforce experience numerous barriers to maintaining a healthy lifestyle including shift work, the high cost of healthy foods at the workplace and high levels of exhaustion which reduce motivation to participate in regular physical activity. Research has documented unhealthy lifestyles among nurses across the profession. However, few studies focus on graduates' experiences during their transition into their careers.AimTo investigate the barriers and enablers to healthy eating and participation in physical activity for new graduate nurses during their first year of clinical practice, and to explore attitudes to participation in workplace health promotion programs.MethodsSemi-structured interviews informed by the socioecological model were conducted with 24 new graduate nurses and analysed using thematic analysis.FindingsFour key themes emerged as barriers to healthy eating and physical activity: time, shift work, work environment, and work culture. Participants indicated a high interest in workplace health promotion programs.DiscussionLimited time and shift work impact on the eating and physical activity behaviours of new graduate nurses which leads to unhealthy snacking to maintain energy, as does high levels of exhaustion, reduced motivation to eat healthy foods, and decreased participation in physical activity. The work culture and environment also influence eating behaviours. Inadequate breaks lead to consumption of foods that are quick to eat but often low in nutrients.ConclusionNew graduate nurses experience the same difficulties in maintaining healthy lifestyles as more experienced nurses. Understanding the barriers which influence their dietary and physical activity behaviours can help inform strategies to improve the health of nurses at a critical time when they enter the nursing workforce.