International Portuguese Nurse Leaders’ Insights for Multicultural Nursing
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sampling
2.2. Focus Group
2.3. Ethical Considerations
2.4. Data Analysis
3. Results
3.1. Assumptions (of Transcultural Nursing Leadership)
3.2. Capitalizing Nurses
3.3. Improving Culturally Congruent Care
3.4. Team Problems and Strategies
3.5. Improving Effective Communication between Nurses and with Patients
4. Discussion
5. Limitations
6. Implications
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Category | Subcategories | Quotes |
---|---|---|
Assumptions of transcultural nursing leadership | Adaptation | “It has to be a leadership that is able to adapt” (P1). “Transcultural leadership is the challenge and adaptation of different cultures caring for different cultures” (P2). |
Cultural knowledge and humility | “Leading a multicultural team requires a sensitivity and humility to understand the needs that people have, not only linked to culture, religion, but to habits, principles” (P3). “Recognizing the differences of each culture and realizing the importance of the culture of each nurse and each team member on a daily basis” (P1). | |
Deconstruction of differences | “We are all equal in the world and I think it is important for those who come from such different places to realize that although people are extraordinarily different, with extraordinarily different habits, I try to deconstruct, break down all this difference” (P4). | |
Impartiality | “A leadership that is transcultural has to avoid unconscious bias” (P1). “Here we cannot give an opportunity to have more overtimes otherwise we can be accused of discrimination and favoritism” (P2). | |
Orientation for goals | “Conducting them in a harmonious way to achieve the end, our goal, which is such outstanding care” (P5). | |
Standardizing nursing practice | “The standardization of a nursing procedure, despite being exactly the same all over the world, the way it is performed is different” (P4). “Those who do not have a specific pediatric cardiology ICU experience, we have created a program […] to try to compensate a little bit that difference” (P3). |
Category | Subcategories | Quotes |
---|---|---|
Capitalizing nurses | Professional satisfaction | “Give the priorities for holidays at the most important times, mainly from a religious point of view […] we quickly come to conclusion when we get close to these teams that what the staff values the most is the holidays and the schedules” (P3). “We can give a little bit here to those who want more money […] give an opportunity to have more overtimes” (P5). “To give our nurses the option of having a similar level of training, similar opportunities, it’s not just one nationality that stays as charge nurse” (P2). |
Integration | “An intervention that is important for us, for transcultural leaders, is to understand the expectations of our health professionals” (P2). “If the probation period is required to take longer, it will take longer” (P4). “Choosing someone of the same nationality also to help to integrate and help to overcome some problems in the beginning” (P5). “Whenever there are these kinds of farewell parties, it is a little bit a moment of sharing experiences and culture and I think that this has worked very well and people get to know, end up respecting each other a little more and are able to anticipate the others’ needs” (P3). | |
Appreciating and recognizing | “I go to all my team members and say thank you for your work today, thank you to work so hard, and that makes the difference, because they feel recognized and they feel valued” (P1). “[…] they wanted to stay in my hospital […] I empowered them and that’s what they knew they were going to develop, their skills that they wouldn’t get in other places” (P2). | |
Retention | “[…] they have a project in common with the unit, they will feel that they have a mission and I think they feel better and will not want to leave the unit so easily” (P3). “Maybe those charge nurses didn’t leave because they felt an affective bond” (P4). “Most foreign nurses love training, they want to do a master’s degree, they want to do everything they can (…) it’s career progression, which is sometimes complicated when you’re a foreign nurse here (…) being a leader open to all cultures. For me, these are the three pillars: education, compassion and progression.” (P1) |
Category | Subcategories | Quotes |
---|---|---|
Improving culturally congruent care | In-services about culture | “An education program in the unit that promotes multicultural nursing care, encourages for example, the article of the week related to culture X, Y or Z” (P1). |
Cultural sensitivity development | “Encourage staff to meet new cultures […] to widen the boundaries, to know other things, this will make it much easier for them to adapt to what is different” (P4). | |
Care planning and organization according to patient’s culture | “When I have teenagers, I have to have that notion, we cannot assign male nurses to care of girls [Muslim]” (P3). | |
Management of expectations | “… one of the important points in relation to quality is this scope of service has to be accessible to the patient, understood by the patient, it’s one of the things we do on admission, and so both parties know the expectations, what is expected from the nurse and what the patient can expect from the team itself” (P2). | |
Resources for religious and linguistic needs | “Adjust the unit or adjust the department, the hospital, to have places to exercise their worship” (P5). “Translators for patient, in case the patient doesn’t know how to speak our language” (P2). | |
Adaptation of auxiliary services | “Meal times during festive seasons or, for example, during Ramadan, have to be adjusted” (P2). | |
Family inclusion | “When we include the family in the care (…) it makes things much easier for us” (P1). |
Category | Subcategories | Quotes |
---|---|---|
Team problems and strategies | Discrimination | “Using one’s own language gives rise to this kind of discrimination, which ends up causing this kind of discrimination and even some kind of bullying between nationalities” (P3). |
Prejudice | “I have a nurse assistant who doesn’t get on with them [Nigerian nurses], and I’m trying to demonstrate that it’s a conditional bias, that she’s only doing that to them and not to the rest of the team” (P1). | |
Speech misunderstanding | “People also did not understand me the same way they understand me in Portugal (…) We all have the same culture and there are things that are obvious and are quickly understood. And when we get to a multicultural team, we also have that barrier” (P3). | |
Early identification | “The early identification of those situations, i.e., a good observation and identification skills. Awareness also, i.e., being alert for that kind of problems, anticipation” (P2). | |
Culture mediation programs | “There is an RCN program called Cultural Ambassador (…) when there are problems they will investigate, they will understand if there is a cultural reason for that problem to have existed. So, as leaders, encouraging these kinds of programs is essential, because it will help us to understand when there is a problem, how we can act” (P1). | |
Prohibition of the mother tongue | “These problems that arise between different cultures come mainly from the language and that’s why we don’t allow them to speak their own language” (P3). | |
Performance appraisal | “We do a performance appraisal every year and if there is this kind of behavior, it has to be talked about” (P1). | |
Mixed working teams | “(…) I am always very careful to make the teams to bring all the nationalities together so they work together, they have the same goal, they work together and I think that helps a lot” (P3). | |
Nurse manager communication skills | “I myself had to develop my communication skills to adapt to them” (P2). | |
Nurse manager as a role model | “You have to give the example and they will follow the leaders” (P2). |
Category | Subcategories | Quotes |
---|---|---|
Promoting effective communication between nurses and with patients | Being a model for communication | “We had, as nurse managers, to be an example, so between us, we always spoke in English” (P2). |
Negotiate the mother tongue utilization | “(…) among friends they can speak their language. In the clinic they don’t speak, they have to speak the official language, it’s English and it’s a language that everybody understands” (P3). | |
Assign a preceptor of a different nationality | “I try not to put a new staff to be integrated by a staff of the same nationality (…) because if they are with someone of the same nationality, they will end up speaking the same language and they will not get used to speak in English” (P3) | |
Support the learning of the local language | “Motivate to take that course [of Arabic language] and make it possible to go (…) language is a linguistic barrier, it’s very distressing and I think it’s important to be able to communicate correctly with the patient to have that delivery of outstanding care” (P3). |
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Teixeira, G.; Lucas, P.; Gaspar, F. International Portuguese Nurse Leaders’ Insights for Multicultural Nursing. Int. J. Environ. Res. Public Health 2022, 19, 12144. https://doi.org/10.3390/ijerph191912144
Teixeira G, Lucas P, Gaspar F. International Portuguese Nurse Leaders’ Insights for Multicultural Nursing. International Journal of Environmental Research and Public Health. 2022; 19(19):12144. https://doi.org/10.3390/ijerph191912144
Chicago/Turabian StyleTeixeira, Gisela, Pedro Lucas, and Filomena Gaspar. 2022. "International Portuguese Nurse Leaders’ Insights for Multicultural Nursing" International Journal of Environmental Research and Public Health 19, no. 19: 12144. https://doi.org/10.3390/ijerph191912144