Parents’ experiences of nurses’ cultural competence in Swedish paediatric care

Due to global migration, Sweden, as is the case for many other countries in Europe, has become a multi-ethnic society. The multi-ethnic composition of the Swedish population has led to an increasing diversity of patients and health staff in health care. The increased diversity in Swedish healthcare creates challenges for the staff of ethnic Swedish as well as the staff of minority ethnic, in terms of working together and working with diverse patient groups. The challenges are mainly related to communication with people who share neither the same native language nor the same cultural values or health beliefs. In relation to healthcare, the need for culturally competent care to overcome these challenges is reported in almost all studies about the caring relationship in the multi-ethnic societies.

The overall aim of this thesis was to explore the experiences and expectations of culturally competent care and the cross-cultural care encounters among parents of hospitalized children in Swedish paediatric care. The thesis is based on two qualitative studies carried out from the perspective of parents of hospitalized children in Swedish paediatric care. Study I addresses ethnic Swedish parents experiences’ of minority ethnic nurses’ cultural competence and the care provided by them. Study II addresses the expectations and experiences of cross-cultural care encounters among minority ethnic parents in Swedish paediatric care. The sample in Study I consisted of 14 parents of ethnic Swedish background while the sample in Study II consisted of 12 parents of ethnic minority backgrounds whose children were being cared for at a children’s hospital in the Stockholm County Council. The data for both Study I and Study II were collected by semi-structured interviews and analysed using content analysis.

The nurses’ cultural competence was described by the ethnic Swedish parents and the minority ethnic parents in terms of the nurses’ ability to provide professional and sensitive care based on their professional knowledge and their respect for the human being. The parents’ experiences of the care relationship and the cross-cultural care encounters, as well as their expectations of the nurses’ cultural competence, were affected by various factors and were also described at different levels. The importance of the nurses’ professional approach, a well-functioning communication and the significance of organizations for the parents’ experience of cross-cultural care encounters were identified in both Study I and Study II. This thesis confirms some of the constructs in the cultural competence models, such as cultural sensitivity and cultural encounter. However similarities with the definition of patient-centeredness care, such as the importance of a personal care relationship and the importance to being treated and respected as a unique individual and not as a part of a culture group, have also been emphasized. Culturally competent care is about professional and sensitive care based on respect for the patient as a unique individual. The challenges involved in cross-cultural care encounters are mainly related to lack of familiarity with language, culture and diversity rather than to differences between cultures. It is important to overcome the challenges of language and communication obstacles in cross-cultural care encounters. The healthcare system has a significant role in facilitating the provision of culturally competent care.

List of scientific papers

I. Tavallali, AG., Kabir, ZN., & Jirwe, M. (2014). Ethnic Swedish Parents' experiences of minority ethnic nurses' cultural competence in Swedish pediatric care. Scandinavian Journal of Caring Sciences. 28 (2)-255-63.
https://doi.org/10.1111/scs.12051

II. Tavallali, AG., Jirwe, M., & Kabir ZN. Cross-cultural care encounters in paediatric care - minority ethnic parents’ experiences. [Submitted]