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In
Saudi Arabia nursing care is provided by both Saudi and foreign nurses.
Foreign nurses make up 66.4% of the total nursing workforce. As a result the
workforce is multicultural and more than 40 languages are spoken. This paper
identifies and addresses the cultural competence experience of registered
nurses in 5 hospitals in Jeddah city. It explores the relationship between
educational experience and the nurses’ experience and ability to deliver
culturally competent nursing care. This qualitative study used the Three
Dimensional Puzzle Model of culturally congruent care as a framework. An
interview guide with a piloted list of questions developed from the 4 theory
constructs described in the puzzle model was followed. Semi structured
interviews were used for qualitative data collection. Sixteen interviews were
carried out in 4 hospitals in the western region of Saudi Arabia. Five
different themes emerged: culture diversity, culture awareness and knowledge,
culture attitude and sensitivity, language facilitation and organizational
support. Results showed that there were gaps in cultural competency in the
multicultural nursing workforce in Saudi Arabia and that leaders in health
care should be aware of and address these issues. In conclusion this study makes
an important contribution to new knowledge in the field of cultural diversity
for both the patient and the nurse in Saudi Arabia.
Keywords: Cultural diversity, Cultural awareness, Culture
sensitivity, Culture competence, Multicultural health care organization,
Saudi Arabia.
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ملخص المشاركة:
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The
study intended to identify and address the current cultural competence level
of registered nurses at five different hospitals in Jeddah city Saudi Arabia.
The nurses in Saudi Arabia are culturally and educationally diverse with more
than 40 languages in common use Due to shortage in the national nursing
workforce, to varying degree. Cultural diversity exists in the Saudi health
care system as an attractive destination or steps point to global immigration
to the developed countries. Further complexities appear as approximate one
third of the total population (31%) is culturally diverse, as well. In
addition, the concept of culturally competent care is still new to both healthcare
organizations and educational institutions. It is essential to be valued or
embraced on the provider level and patient level, as well. Using Cross-
sectional design, which is incorporated quantitative data that included a survey.
The participants nurses selected for the survey by a cluster stratified
random sampling applied at each hospital. This included collecting
quantitative data using Cultural Competence Assessment (CCA) tool. The CCA
scale with (CAS and CCB) subscales developed from the three dimensional
puzzle model of culturally congruent care for culture competency four
constructs. A total of 427 nurses completed the questionnaires. Descriptive
and inferential statistics used to analyze survey data. The data revealed the
nurses levels of the cultural competence were 87 out of 125 (M=87.33;
SD=12.9). It was adequate and indicated moderate level of culture competency
of participants. The participant answers on the self-report question showed
moderately high level culture competence (M=4.08; SD=0.75). The participants
scores on the CAS subscale indicated moderate levels of perceived cultural
awareness and sensitivity (M=3.67; SD=0.39) which is a slight higher than CCB
subscale scores of culturally competent behaviours performance (M=3.36; SD=0.79).
No significant difference detected between the age groups or years of
experience of the nurses and the culture competence in this context the study
did reveal a statistically significant difference between educational level,
using other language, previous cultural competence, exposure to diverse
patients and religious groups. The participants were facing difficulties to
achieve cultural competence. Consequently they appeared to have difficulties
in the language, cultural Knowledge, culture Attitude, culture diversity and
organization Support. Importantly there was inadequate organization support
to manage with the multicultural staff in which participants struggled with
the language barriers, diverse’ colleagues and patients, inadequate cultural knowledge
and lack of cultural sensitivity. The CCA tool was a valid and reliable tool
for the current study. Within multicultural nursing context in Saudi Arabia,
there is difficulty to implement culture competency by health care providers
that was remarkably clear. Further it is a requirement for health care
leaders of having information on basic culture competence. The findings of
the study contribute significant new knowledge to the area of cultural diversity
for the patient and the nurse. It provides theoretical development to the
field of transcultural nursing specifically to culture competence. Despite
its limitations, this study of provider perspectives on cultural competence has
produced useful insights that can inform nursing practice, research, educational
programs, and quality care initiatives in the context of culture competence.
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ملخص المشاركة:
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Saudi Arabia is a developing country with
financial stability and as a result the country attracts a variety of
workforce groups from around the world with approximately one third of the
total population (31%) is culturally diverse (CDSI 2010). More than 40
languages are spoken in daily nursing routine care among its nursing
workforce (Crane 1994; Luna 1998). The Saudi Arabian health care system is
shaped by the cultural, social, religious and historical factors of Saudi
society (Gallagher and Searle 1985). Cultural differences and variations make
nurses passionate regarding interaction with various cultural and ethnic
groups. The diversity within the nursing workforce may also lead to tensions
between individualism and collectivism. As a result of cultural differences
between them, problems may arise (Weinnick and Krauss 2000; Dysart-Gale 2005)
with a potential conflict and misunderstanding between the care provider and
care recipient (Purnell 2000). However, there are benefits in a diverse
workforce, such as an increase in problem-solving ability, learning from
colleagues from other cultures, and learning from living in another culture
for various periods of time (McGee 1994; Howard 2006). The influence of
culture in health care professionals is obvious within clinical practice,
education, research, and administration (Andrews and Friesen 2011). Mebrouk
who conducted qualitative research among nurses in Saudi found the Islamic
values affected the Saudi nurses’ care and their perception of care (Mebrouk
2008). The aim for the study was to achieve an understanding of the cultural
competence of nurses in the kingdom of Saudi Arabia. Methodology “QUAN+qual” A
descriptive, cross sectional design, multi-method approach was used;
Quantitative was the primary method, using questionnaires supported by
qualitative interviews. Quantitative data was analysed using descriptive and
comparative statistics (IBM-SPSS). Qualitative data was also analysed
descriptively using content thematic analysis.
Results: A total of 427 nurses completed
the questionnaires; 16 of these were also interviewed using a semi-structured
interview. Analysis showed that the nurses scored a total of 87 (out of 125;
SD=13) on the CCA instrument indicating a moderate level of cultural
competency. The mean was 3.5 (SD=0.5) on a five-point Likert-type scale. The
mean self-reported competence was 4 (SD=0.75). The qualitative findings
indicated that the participants can achieve cultural competence through
language facilitation, cultural awareness, culture sensitivity, culture
diversity and organisational support. Conclusions: The qualitative study
partly illustrated the limitation of the model. Two new themes emerged that
were not in the previous model: language facilitation and organisational
support. This study has demonstrated significant outcomes and new knowledge
in the area of cultural competence and has provided knowledge at a baseline
level of cultural competence among the nurses in five different hospitals in
the western part of Saudi Arabia within the Jeddah region. This study also
makes a contribution to the theoretical development in the field of
transcultural nursing and more specifically to cultural competence, despite
some limitations; this study of provider perspectives has provided useful
data that can inform nursing practice, research, educational programs, and
quality care initiatives in the context of cultural competence.
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