Façading in transcultural caring relationships : healthcare staff and foreign-born parents in childhood cancer care

The overall aim of this thesis was to explore the caring situation of families with a foreign background within the context of pediatric oncology in Sweden. Pediatric cancer entails a long period of continuous and cumulative stress for the entire family. Furthermore, Sweden has become an increasingly multicultural society, resulting in a need for studies and training in transcultural care.

The present thesis is based on 4 exploratory studies; I to III are from the perspective of healthcare staff and study IV from the perspective of foreign-born parents. The studies were used to generate a grounded theory unifying them. Grounded theory (GT) methodology was chosen for this thesis as it aims to discover how participants resolve their main concern; explaining patterns of behaviour that are problematic and relevant. Studies I and II included 5 focus group interviews with healthcare staff and 5 individual interviews with registered nurses. In study III, individual interviews were conducted with 12 nurses from different areas of pediatric care. In study IV, 11 foreign-born parents were interviewed; 4 of them with an interpreter. Data were analyzed according to the constant comparative method of GT.

Study I presents obstacles to transcultural caring relationships, including linguistic, cultural and religious, social, and organizational obstacles. Bridging, presented in study II, is the way healthcare staff resolve this, using communicational, transcultural and organizational tools. In study III overwhelming emotional expressions were found to override nurses professional preparedness; they continuously resolve this by protecting professional composure, using various strategies. In study IV, foreign-born parents need to struggle on accounts for much of their behaviour, which includes ways of resourcing and protecting self-interest in health care. Façading is the latent pattern of behaviour used by healthcare staff and foreign-born parents to resolve the main concern of protecting self-interest and is central in transcultural caring relationships.

These studies provide insights into social interactions in transcultural childhood cancer care that could be used to explain, interpret and predict. Formal theories of core categories would be of value and presented strategies could be used in achieving a more congruent and equal childhood cancer care for families with a foreign background.

List of scientific papers

I. Pergert P, Ekblad S, Enskär K, Björk O (2007). Obstacles to transcultural caring relationships: experiences of health care staff in pediatric oncology. J Pediatr Oncol Nurs. 24(6): 314-28.
https://pubmed.ncbi.nlm.nih.gov/18003591

II. Pergert P, Ekblad S, Enskär K, Björk O (2008). Bridging obstacles to transcultural caring relationships--tools discovered through interviews with staff in pediatric oncology care. Eur J Oncol Nurs. 12(1): 35-43. Epub 2008 Jan 22
https://pubmed.ncbi.nlm.nih.gov/18218338

III. Pergert P, Ekblad S, Enskär K, Björk O (2008). Protecting professional composure in transcultural pediatric nursing. Qual Health Res. 18(5): 647-57. Epub 2008 Mar 12
https://pubmed.ncbi.nlm.nih.gov/18337617

IV. Pergert P, Ekblad, S, Björk O, Enskär K, Andrews T (2008). Struggling on: A grounded theory from interviews with foreign-born parents in childhood cancer care. [Submitted]