Nurses’ descriptions of the experience of caring for culturally diverse clients

Over the last few decades, Canada has become a culturally diverse society. It is now commonplace for nurses to care for clients from cultures different from their own. Caring for culturally diverse clients present unique challenges to nurses. These clients often do not speak English and come to the hospital setting with varying health beliefs and customs. Furthermore, the challenge of caring for culturally diverse clients may uncover feelings in nurses about various ethnic groups. While there is an encouraging trend to include cultural content in nursing curricula, the effectiveness of nursing programs in preparing nurses to care for culturally diverse clients is not known . Additionally, there is evidence to suggest that culturally diverse clients may receive a lower standard of nursing care that might be explained by factors such as the nurse's knowledge, previous contact with ethnic minorities, attitudes, education, support, and the hospital setting. Few studies about nurses' experiences of caring for culturally diverse clients have been found. The purpose of this study was to explore the descriptions of recently graduated nurses of their experiences of caring for culturally diverse clients and to thereby gain an understanding of both the nature of the experience and any factors influencing the experience. A descriptive-exploratory design in the qualitative (naturalistic) tradition was selected to address the Level 1 question. The design took some direction from the phenomenological objective about understanding lived experience, but broadened that perspective to focus upon the shared elements within the specific experience of caring for culturally diverse clients. Eight recently graduated nurses were each interviewed twice. Data analysis proceeded simultaneously with the interviews through a process of constant comparative analysis. The conceptual structure that emerged from the thematic analysis was validated with the participants during the second interviews. The findings of the study revealed the experience of caring for culturally diverse clients as one of considerable complexity and persistent challenge. On the basis of the participants' varied descriptions, the nurses were conceptualized on a continuum of commitment to cross-cultural nursing, ranging from being resistant to being competent to being impassioned. While the nurses demonstrated a propensity to practice from a particular position on the continuum, their level of commitment at any given point might be influenced by personal or contextual factors that moved them toward either end of the continuum. Notably, the impassioned nurses all described an experience of awakening to the complex imperative of cross-cultural nursing that came out of specific situations in which they were sensitized to the minority experience. In order to provide culturally sensitive care, the participants implemented creative and flexible efforts in connecting with the client, working with the family, accommodating for cultural practices, and balancing expectations. The nature of the experience for the nurse and the quality of care provided to culturally diverse clients was also influenced by certain contextual factors, or catalysts, beyond the control of the nurse. The catalysts identified were the setting of health care, the support of colleagues, the commitment of the institution, and the foundation of education. Most significantly, the study uncovered the presence of racism in health care settings. The most obvious examples of racism came in the descriptions by the participants of the resistant nurses who were not represented in the sample. Other examples included inequities at the institutional level. In light of these findings, implications for education, administration, practice, research, and public policy were identified.

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