A qualitative study exploring nurses' experiences of supporting South Asian people with dementia and their family carers.

Catharine Jenkins, Atiya Kamal
Author Information
  1. Catharine Jenkins: Birmingham City University, Birmingham, UK. ORCID
  2. Atiya Kamal: Birmingham City University, Birmingham, UK. ORCID

Abstract

AIMS: To explore nurses' experiences of providing support to South Asian (SA) people with dementia and their family carers and to identify barriers and enablers of good transcultural care.
DESIGN: A qualitative, phenomenological design was used.
METHODS: Fifteen registered community and in-patient nurses were recruited via one NHS Mental Health Foundation Trust. Nurses were from diverse backgrounds (Black, Ghanaian, Irish, Mauritian and White), 13 females and 2 males, and had been qualified from between 2 and 49 years. One-to-one semi-structured interviews were conducted between July and October 2019.
RESULTS: A thematic analysis identified three themes. 'Communication challenges' highlighted the impact of language barriers and the consequences of misunderstandings due to a dissonance in cultural values between nurses and interpreters. 'The bi-directional impact of culture' identified the two-way dynamics of transcultural work, the process of countering mutual stigma, and revealed an original perspective on how 'cultural desire' grows through practice experiences rather than being a prior motivation for learning. 'Learning experiences' showed that most learning was informal, experiential and prolonged, with nurses feeling they had unmet learning needs.
CONCLUSION: Nurses have minimal training opportunities and are under-supported in their transcultural work, potentially perpetuating the disadvantages that SA people with dementia and their families face in relation to healthcare. Enhanced cultural understanding of self and others and application of specific communication strategies could support nurses, together with interpreters, to build rapport and effective working relationships with each other and service users.
IMPACT: Transcultural nursing is a key competency, but nurses experience difficulties with providing care which is recognized as effective by SA family carers. The development of more acceptable and effective services requires improved mutual cultural understanding between nurses, interpreters and families, underpinned by joint brief training interventions, leading to more effective professional communication, better care outcomes and improved satisfaction with services.

Keywords

References

Ali, P. A., & Johnson, S. (2017). Speaking my patient's language: Bilingual nurses' perspective about provision of language concordant care to patients with limited English proficiency. Journal of Advanced Nursing, 73(2), 421-432. https://doi.org/10.1111/jan.13143
Ali, P. A., & Watson, R. (2018). Language barriers and their impact on provision of care to patients with limited English proficiency: Nurses' perspectives. Journal of Clinical Nursing, 27, 5-6. https://doi.org/10.1111/jocn.14204
Alzheimer Europe. (2017). European Dementia Monitor 2017: comparing and benchmarking national dementia strategies and policies. http://alzheimer-europe.org/Publications/E-Shop/European-Dementia-Monitor-2017/European-Dementia-Monitor-2017
Alzheimer's Disease International. (2022). World Alzheimer Report 2022 Life after diagnosis: Navigating treatment, care and support. https://www.alzint.org/u/World-Alzheimer-Report-2022.pdf
Alzheimer's Society. (2022). Black, Asian and minority ethnic communities and dementia research. https://www.alzheimers.org.uk/for-researchers/black-asian-and-minority-ethnic-communities-and-dementia-research
Amiri, R., & Heydari, A. (2017). Nurses' experiences of caring for patients with different cultures in Mashhad, Iran. Iranian Journal of Nursing and Midwifery Research, 22(3), 232-236. https://doi.org/10.4103/1735-9066.208156
Baghirathan, S., Cheston, R., Hui, R., Chacon, A., Shears, P., & Currie, K. (2020). A grounded theory analysis of the experiences of carers for people living with dementia from three BAME communities: Balancing the need for support against fears of being diminished. Dementia, 19, 1672-1691. https://doi.org/10.1177/1471301218804714
Blakemore, A., Kenning, C., Mirza, N., Daker-White, G., Panagioti, M., & Waheed, W. (2018). Dementia in UK south Asians: A scoping review of the literature. BMJ Open, 8(4), e020290. https://doi.org/10.1136/bmjopen-2017-020290
Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa
Brijnath, B., Gilbert, A. S., Kent, M., Ellis, K., Browning, C., Goeman, D., Adams, J., & Antoniades, J. (2021). Beyond crisis: Enacted sense-making among ethnic minority carers of people with dementia in Australia. Dementia, 20(6), 1910-1924. https://doi.org/10.1177/1471301220975641
Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13, 181-184.
Clini, C., & Valančiūnas, D. (2021). Introduction-South Asian Diasporas and (imaginary) homelands: Why representations still matter. South Asian Diaspora, 13(1), 1-7. https://doi.org/10.1080/19438192.2020.1812180
Fadaeinia, M. M., Miri, S., Azizzadeh Forouzi, M., Roy, C., & Farokhzadian, J. (2022). Improving cultural competence and self-efficacy among postgraduate nursing students: Results of an online cultural care training program. Journal of Transcultural Nursing, 33, 642-651. https://doi.org/10.1177/10436596221101925
Gerchow, L., Burka, L. R., Miner, S., & Squires, A. (2021). Language barriers between nurses and patients: A scoping review. Patient Education and Counseling, 104(3), 534-553. https://doi.org/10.1016/j.pec.2020.09.017
Giebel, C. M., Worden, A., Challis, D., Jolley, D., Bhui, K. S., Lambat, A., Kampanellou, E., & Purandare, N. (2017). Age, memory loss and perceptions of dementia in South Asian ethnic minorities. Aging & Mental Health, 23(2), 173-182. https://doi.org/10.1080/13607863.2017.1408772
Giebel, C. M., Zubair, M., Jolley, D., Bhui, K. S., Purandare, N., Worden, A., & Challis, D. (2014). South Asian older adults with memory impairment: Improving assessment and access to dementia care. International Journal of Geriatric Psychiatry, 30(4), 345-356. https://doi.org/10.1002/gps.4242
Helman, C. G. (1995). Culture, health, and illness: An introduction for health professionals (3rd ed.). Butterworth-Heinemann.
Hofstede, G., Hofstede, G. J., & Minkov, M. (2017). Cultures and organizations: Software of the mind: Intercultural cooperation and its importance for survival. MTM.
Hovland, C. A., & Mallett, C. A. (2021). Family caregivers for older persons with dementia offer recommendations to current caregivers: A qualitative investigation. Journal of Research in Nursing, 26, 796-806. https://doi.org/10.1177/17449871211041682
Hsieh, E. (2010). Provider-interpreter collaboration in bilingual health care: Competitions of control over interpreter-mediated interactions. Patient Education and Counseling, 78(2), 154-159.
Husserl, E., Sheehan, T., & Palmer, R. E. (1997). Psychological and transcendental phenomenology and the confrontation with Heidegger (1927-1931). Kluwer Academic Publishers.
Ilgaz, A. (2022). Culturally competent nursing approach and health literacy in elderly care. Journal of Education and Research in Nursing, 18(1), 133-137. https://doi.org/10.5152/jern.2022.69782
Jenkins, C., Ginesi, L., & Keenan, B. (2016). Dementia care at a glance. John Wiley and Sons Ltd.
Kilian, S., Swartz, L., Hunt, X., Benjamin, E., & Chiliza, B. (2021). When roles within interpreter-mediated psychiatric consultations speak louder than words. Transcultural Psychiatry, 58(1), 27-37. https://doi.org/10.1177/1363461520933768
Leininger, M. (2002). Cultural care: A major contribution to advance transcultural nursing knowledge and practices. Journal of Transcultural Nursing, 13, 189-192. https://doi.org/10.1177/10459602013003005
Mak, J., Roberts, B., & Zimmerman, C. (2021). Coping with migration-related stressors: A systematic review of the literature. Journal of Immigrant and Minority Health., 23, 389-404. https://doi.org/10.1007/s10903-020-00996-6
Nielsen, T., Antelius, E., Spilker, R., Torkpoor, R., Toresson, H., Lindholm, C., & Plejert, C. (2015). Dementia care for people from ethnic minorities: A Nordic perspective. International Journal of Geriatric Psychiatry, 30(2), 217-218. https://doi.org/10.1002/gps.4206
Ogliari, G., Turner, Z., Khalique, J., Gordon, A. L., Gladman, J. R. F., & Chadborn, N. H. (2020). Ethnic disparity in access to the memory assessment service between South Asian and white British older adults in the United Kingdom: A cohort study. International Journal of Geriatric Psychiatry, 35(5), 507-515. https://doi.org/10.1002/gps.5263
Parveen, S., Peltier, C., & Oyebode, J. R. (2017). Perceptions of dementia and use of services in minority ethnic communities: A scoping exercise. Health & Social Care in the Community, 25(2), 734-742. https://doi.org/10.1111/hsc.12363
Patriksson, K., Nilsson, S., & Wigert, H. (2022). Being a gift-multilingual healthcare professionals in neonatal care. Journal of Neonatal Nursing, 28(1), 67-71. https://doi.org/10.1016/j.jnn.2021.04.002
Quinones, A. R., Kaye, J., Allore, H. G., Botoseneanu, A., & Thielke, S. M. (2020). An agenda for addressing multimorbidity and racial and ethnic disparities in Alzheimer's disease and related dementia. American Journal of Alzheimer's Disease & Other Dementias, 35, 1-7. https://doi.org/10.1177/1533317520960874
Rayment-Jones, H., Harris, J., Harden, A., Silverio, S. A., Turienzo, C. F., & Sandall, J. (2021). Project20: Interpreter services for pregnant women with social risk factors in England: What works, for whom, in what circumstances, and how? International Journal for Equity in Health, 20, 233. https://doi.org/10.1186/s12939-021-01570-8
Sharma, S. (2012). Immigrants in Britain: A study of the Indian diaspora. Diaspora Studies, 5(1), 14-43. https://doi.org/10.1163/09763457-00501002
Sidhu, M. S., Griffith, L., Jolly, K., Gill, P., Marshall, T., & Gale, N. K. (2016). Long-term conditions, self-management and systems of support: An exploration of health beliefs and practices within the Sikh community, Birmingham, UK. Ethnicity & Health, 21(5), 498-514. https://doi.org/10.1080/13557858.2015.1126560
van den Heuvel, E., Victor, C. R., & Clare, L. (2020). Improving the Experience of Dementia and Enhancing Active Life (IDEAL): Investigating the perspectives of people from ethnic minority communities. Alzheimer's Dement., 16, e037479.
Woods, B., Arosio, F., Diaz, A., Gove, D., Holmerová, I., Kinnaird, L., Mátlová, M., Okkonen, E., Possenti, M., Roberts, J., Salmi, A., Buuse, S., Werkman, W., & Georges, J. (2018). Timely diagnosis of dementia? Family carers' experiences in 5 European countries. International Journal of Geriatric Psychiatry, 34(1), 114-121. https://doi.org/10.1002/gps.4997
Zhang, C. X., Crawford, E., Marshall, J., Bernard, A., & Walker-Smith, K. (2021). Developing interprofessional collaboration between clinicians, interpreters, and translators in healthcare settings: Outcomes from face-to-face training. Journal of Interprofessional Care, 35(4), 521-531.

Grants

  1. /Birmingham City University

MeSH Term

Female
Humans
Male
Caregivers
Dementia
Nurse-Patient Relations
Nurses
Qualitative Research
South Asian People

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