Migrant and ethnic minority nurses' experience of working in European health services: a qualitative study.

OBJECTIVE: To analyze the perception of culture and experience of working in European health services of a purposive sample of qualified migrant and ethnic minority nurses currently living in Belgium, Portugal, Spain and Turkey. METHOD: A qualitative phenomenological method was chosen. Individual interviews took place with 8 qualified migrant and ethnic minority nurses currently living in four European countries. Thematic analysis was conducted using Braun and Clark's stages after qualitative data had been verbatim transcribed, translated into English, and analyzed. RESULTS: Four themes and 4 subthemes emerged from thematic analysis of the transcripts. CONCLUSION: Migrant and ethnic minority nurses working in the European Union experience and witness discrimination and prejudice from patients and colleagues due to cultural differences. European health services should closely monitor and address discrimination and prejudice towards migrant and ethnic minority staff and patients, and take initiatives to reduce and, eventually, eradicate them.

Qualified Nurses' Perceptions of Cultural Competence and Experiences of Caring for Culturally Diverse Patients: A Qualitative Study in Four European Countries.

BACKGROUND: European nurses are expected to provide appropriate care for patients from diverse cultural backgrounds. However, there is limited knowledge and understanding of this process. The aim of this study was to analyse the perceptions of culture and experiences of caring for patients from diverse cultural backgrounds of a purposive sample of qualified nurses from four European countries, namely Belgium, Portugal, Spain and Turkey. METHODS: A qualitative phenomenological approach was selected in order to understand complex phenomena through the participants' lived experiences, meanings and perspectives. Individual interviews and focus groups took place with 28 staff nurses and 11 nurse managers from four European countries. The sociodemographic and cultural characteristics of the sample were described and analysed using descriptive statistics. Qualitative data were transcribed verbatim, translated into English and analysed following Braun and Clark's phases for thematic analysis. RESULTS: Five themes and twelve subthemes emerged from thematic analysis of the transcripts. The themes included: (1) relevance of culture for nursing; (2) culture in the healthcare service; (3) qualities of the healthcare professionals; (4) challenges to culturally competent care; (5) becoming a culturally competent nurse. CONCLUSIONS: There are challenges to the delivery of culturally congruent care, namely language and communication difficulties, prejudices and stereotyping in the health service, a tendency for ethnocentrism, a lack of education and training in cultural competence and a lack of support from the health service to facilitate new ways of acting.

Migrant and ethnic minority nurses' experience of working in European health services: a qualitative study / Experiência de enfermeiros migrantes e de minorias étnicas em trabalho em serviços de saúde europeus: estudo qualitativo / Experiencia de trabajo de enfermeras inmigrantes y de minorías étnicas en los servicios de salud europeos: un estudio cualitativo

ABSTRACT Objective: To analyze the perception of culture and experience of working in European health services of a purposive sample of qualified migrant and ethnic minority nurses currently living in Belgium, Portugal, Spain and Turkey. Method: A qualitative phenomenological method was chosen. Individual interviews took place with 8 qualified migrant and ethnic minority nurses currently living in four European countries. Thematic analysis was conducted using Braun and Clark's stages after qualitative data had been verbatim transcribed, translated into English, and analyzed Results: Four themes and 4 subthemes emerged from thematic analysis of the transcripts. Conclusion: Migrant and ethnic minority nurses working in the European Union experience and witness discrimination and prejudice from patients and colleagues due to cultural differences. European health services should closely monitor and address discrimination and prejudice towards migrant and ethnic minority staff and patients, and take initiatives to reduce and, eventually, eradicate them.

RESUMO Objetivo: Analisar a percepção da cultura e experiência de trabalho em serviços de saúde europeus de uma amostra intencional de enfermeiros qualificados migrantes e de minorias étnicas que moram atualmente na Bélgica, Portugal, Espanha e Turquia. Método: Optou-se pelo método fenomenológico qualitativo. Realizaram-se entrevistas individuais com 8 enfermeiros qualificados migrantes e de minorias étnicas que moram atualmente em quatro países europeus. A análise temática foi realizada por meio das etapas de Braun e Clark após os dados qualitativos terem sido transcritos na íntegra, traduzidos para o inglês e analisados. Resultados: Quatro temas e 4 subtemas emergiram da análise temática das transcrições. Conclusão: Enfermeiros migrantes e de minorias étnicas que trabalham na União Europeia vivenciam e testemunham discriminação e preconceito de pacientes e colegas devido a diferenças culturais. Os serviços de saúde europeus devem acompanhar de perto e combater a discriminação e o preconceito contra os trabalhadores e pacientes migrantes e de minorias étnicas, e tomar iniciativas para os reduzir e, em seguida, erradicá-los.

RESUMEN Objetivo: Analizar la percepción de la cultura y la experiencia de trabajar en los servicios de salud europeos de una muestra intencional de enfermeros calificados de minorías étnicas y migrantes que actualmente viven en Bélgica, Portugal, España y Turquía. Método: Se decidió utilizar un método cualitativo fenomenológico. Se realizaron entrevistas individuales con 8 enfermeros calificados inmigrantes y de minorías étnicas que actualmente viven en cuatro países europeos. El análisis temático se realizó utilizando las etapas de Braun y Clark después de que los datos cualitativos fueran transcritos palabra por palabra, traducidos al inglés y analizados. Resultados: Del análisis temático de las transcripciones surgieron 4 temas y 4 subtemas. Conclusión: Los enfermeros de minorías étnicas y migrantes que trabajan en la Unión Europea experimentan y son testigos de la discriminación y de los prejuicios de los pacientes y colegas sobre la base de la diferencia cultural. Los servicios de salud europeos deben monitorear de cerca y abordar la discriminación y los prejuicios hacia el personal y los pacientes de minorías étnicas y migrantes, y tomar iniciativas para reducirlos y, eventualmente, erradicarlos.

Nursing students' experience of learning cultural competence.

INTRODUCTION: European societies are rapidly becoming multicultural. Cultural diversity presents new challenges and opportunities to communities that receive immigrants and migrants, and highlights the need for culturally safe healthcare. Universities share a responsibility to build a fair and equitable society by integrating cultural content in the nursing curricula. This paper aims to analyze European student nurses´ experience of learning cultural competence and of working with patients from diverse cultural backgrounds. MATERIALS AND METHODS: A phenomenological approach was selected through a qualitative research method. 7 semi-structured focus groups with 5-7 students took place at the participants' respective universities in Spain, Belgium, Turkey and Portugal. RESULTS: 5 themes and 16 subthemes emerged from thematic analysis. Theme 1, concept of culture/cultural diversity, describes the participants' concept of culture; ethnocentricity emerged as a frequent element in the students' discourse. Theme 2, personal awareness, integrates the students' self-perception of cultural competence and their learning needs. Theme 3, impact of culture, delves on the participants' perceived impact of cultural on both nursing care and patient outcomes. Theme 4, learning cultural competence, integrates the participants' learning experiences as part of their nursing curricula, as part of other academic learning opportunities and as part of extra-academic activities. Theme 5, learning cultural competence during practice placements, addresses some important issues including witnessing unequal care, racism, prejudice and conflict, communication and language barriers, tools and resources and positive attitudes and behaviors witnesses or displayed during clinical practice. CONCLUSION: The participants' perceived level of cultural competence was variable. All the participants agreed that transcultural nursing content should be integrated in the nursing curricula, and suggested different strategies to improve their knowledge, skills and attitudes. It is important to listen to the students and take their opinion into account when designing cultural teaching and learning activities.

Perception and Experience of Transcultural Care of Stakeholders and Health Service Users with a Migrant Background: A Qualitative Study.

INTRODUCTION: While European health policies do frequently take into consideration the ideas and experiences of their users, the voices of minority and marginalized communities are not often heard. European healthcare services must address this issue as the number of healthcare users with an MM background increases. AIM: To explore the perspectives of key stakeholders and healthcare users with an MM background on transcultural care in four European countries. DESIGN: Qualitative phenomenological study. METHODS: Semi-structured, individual interviews were conducted with stakeholders and MM users. Interviews were translated and transcribed verbatim and were carried out from February to May 2021. Descriptive statistics was used to describe the characteristics of the sample; qualitative data were analyzed thematically following Braun and Clarke's phases, resulting in 6 themes and 18 subthemes. RESULTS: For stakeholders and MM users with long-established residence in their respective countries, cultural differences involve different family and community norms, religious beliefs, lifestyles, and habits. These components are perceived as in tension with healthcare norms and values, and they mediate in two key and related aspects of the relationship between MM users and healthcare providers: accessibility and communication. CONCLUSIONS: Communication and access to healthcare are key to MM health service users, and they are the most frequent sources of misunderstanding and conflict between them and healthcare professionals. IMPACT: It is important to extend the investigation of cultural issues in healthcare to stakeholders and MM users. There is no doubt that healthcare professionals should be trained in cultural competence; however, cultural competence training is not the only area for improvement. There should be a change in paradigm in healthcare services across Europe: from individual to organizational integration of culture and diversity.

Nursing Lecturers' Perception and Experience of Teaching Cultural Competence: A European Qualitative Study.

Cultural competence is an essential component in providing effective and culturally responsive healthcare services, reducing health inequalities, challenging racism in health care and improving patient safety, satisfaction and health outcomes. It is thus reasonable that undergraduate nursing students can develop cultural competency through education and training. The aim of this paper was to investigate nursing lecturers' perception and experience of teaching cultural competence in four undergraduate nursing programs. A phenomenological approach was selected to illicit nursing lecturers' perception of culture and experience of teaching cultural competence. Semi-structured personal interviews were held with a sample of 24 lecturers from four European universities. The anonymized transcripts were analyzed qualitatively following Braun and Clark's phases for thematic analysis. Six themes and fifteen subthemes emerged from thematic analysis of the transcripts. Cultural competence was not explicitly integrated in the nursing curricula. Instead, the lecturers used mainly examples and case studies to illustrate the theory. The integration of cultural content in the modules was unplanned and not based on a specific model. Nursing programs should be examined to establish how cultural content is integrated in the curricula; clear guidelines and standards for a systematic integration of cultural content in the nursing curriculum should be developed.

The Teaching and Learning Cultural Competence in a Multicultural Environment (CCMEn) Model.

BACKGROUND: Within the European higher education context, students and lecturers are encouraged to engage in teaching and learning activities abroad. This frequently involves using a second language and being exposed to students and lecturers from culturally different backgrounds. OBJECTIVE: To design a model for teaching and learning cultural competence in a multicultural environment (CCMEn). DESIGN: Theory development from empirical experience, research, and scholarly works. METHOD: This model was developed based on our experience of teaching and learning cultural competence in a multicultural environment in a nursing education context; it rests on three pillars, namely, Coyle's Content and Language Integrated Learning educational approach, the concept of social and emotional learning, as defined by the Collaborative for Academic, Social and Emotional Learning, and the existing literature surrounding teaching and learning cultural competence in higher education. RESULTS: The CCMEn model is intended to guide the process of teaching and learning cultural competence in a multicultural environment through the use of a second language and has been adapted from existing educational approaches and theory. CONCLUSION: Teaching and learning in multilingual and multicultural contexts in Europe is becoming more common. Students who learn alongside students and teachers from different cultural backgrounds need to be supported from an academic, linguistic and socioemotional perspective. We believe that the CCMEn model can serve as a guide to enhancing student learning in this context.

Student nurse perceptions of Gypsy Roma Travellers; A European qualitative study.

BACKGROUND: Gypsy Roma Travellers are Europe's largest ethnic minority group. Yet they remain one of the most stigmatised communities who have significant health inequalities. Whilst nurses have a role in promoting health access, there have been minimal studies exploring health care professionals' attitudes towards these communities and no studies exploring nursing students' perceptions. OBJECTIVES: To explore nursing students understanding, knowledge and perceptions of working with Gypsy Roma Travellers. PARTICIPANTS: 23 nursing students from across four European countries (UK, Spain, Belgium, Turkey) participated in the study. The students ages ranged between 19 and 32 year old, there was a mix of students between year one to year three of their programme and both male (n = 3) and female students (n = 19). METHODS: This qualitative research utilised focus groups and one to one interviews based at the four different universities, all following a pre-agreed interview schedule. Focus groups and interviews were conducted by the research team in the students' first language and later translated into English for analysis using thematic analysis. The COREQ criteria were used in the reporting of the study. RESULTS: Four themes were identified which included: Exposure to Gypsy Roma Traveller Communities, Perceptions of Gypsy Roma Traveller cultures, Unhealthy lifestyles and culture and Nursing Gypsy Roma Travellers. CONCLUSIONS: Although personal and professional contact with Gypsy Roma Travellers was limited, most of the students' perceptions of these communities were negative. Nurse educational programmes need to embed transformational learning opportunities enabling student nurses to critically reflect upon values and beliefs of Gypsy Roma Travellers developed both before and during their nursing preparatory programme if they are to work effectively in a respectful, culturally sensitive way. There is also generally, a lack of research focussing upon healthcare professionals' attitudes towards these communities that needs to be explored through further research.

The impact of nutrition literacy on the food habits among young adults in Turkey.

BACKGROUND/OBJECTIVES: Youth is the crucial stage between childhood and adulthood during which an individual acquires new behavior and practices including dietary habits, that may be influenced by his peers, social circle, nutrition knowledge level and other factors. The increase in awareness of young adults is of special importance from the perspective of health and prevention of obesity related chronic diseases. To measure the nutrition literacy level of university students using the Turkish version of Adolescent Nutrition Literacy Scale (ANLS). We evaluated their food habits using the Adolescent Food Habit Checklist (AFHC) tool and analysed it, if the eating habits were affected by nutrition literacy level. SUBJECTS/METHODS: A cross-sectional descriptive study was conducted on randomly selected 276 students studying in the Faculty of Health Sciences of Istanbul Aydin University, Turkey. Data was collected by means of ANLS and AFHC tools by face to face interview method. SPSS statistical sofware (IBM SPSS Statistics 19) was used to analyse the obtained data. RESULTS: Participants comprised of 47.1% males and 52.9% females with mean age of 20.0 ± 1.60 years. Mean body mass index (BMI) was determined as 22.4 ± 3.76 (23.6 ± 3.63 males 21.3 ± 3.57 females). Functional, interactive and critical nutritional literacy scores for male participants were 22.49 ± 5.71, 17.45 ± 4.84, and 28.28 ± 7.13 respectively (total 64.98 ± 10.15). For females the values were 24.66 ± 5.13, 20.17 ± 4.28, and 32.20 ± 5.65 (total 69.72 ± 8.59) respectively. For all the three sub-categories of nutrition literacy, the scores acquired by females were significantly higher than males (P < 0.001). In the AFHC tool, the mean score acquired by males were 9.26 ± 4.18 whereas for females it was 10.37 ± 3.40 significantly higher as compared to males (P = 0.007). CONCLUSIONS: The food habits of female participants were better than males; in accordance with their nutrition literacy status. It may be concluded that food habits are influenced by nutrition literacy and therefore stress much be given to increase the nutrition awareness among children youth as well as adults.