Facing diversity under institutional constraints: Challenging situations for community nurses when providing care to ethnic minority patients

摘要

Aims. To explore the challenges faced by community nurses when providinghome health care to ethnic minority patients.Background. Norway has a growing number of immigrants, including olderimmigrant patients. Community nurses who provide home care encounterconsiderable challenges when delivering services to an increasingly diverse patientpopulation.Design. A qualitative study based on a hermeneutics approach.Methods. A qualitative study was conducted involving 19 nurses in Norwegianhome health care districts, which had high proportions of minority patients. Datawere collected in 2008.Findings. We identified three critical aspects of the encounters betweencommunity nurses and minority patients. The first was intimate care. Nursesperceived the fear of mistakes and crossing boundaries related to the cultural andreligious practices of minority patients as particularly stressful. The second wasrehabilitation after stroke. The beliefs of nurses in the benefits of rapidrehabilitation conflicted with those of the minority patients and their relativeswho favoured extended rest during recovery. Third, the commitment ofcommunity nurses to transparency in the care of dying patients was testedseverely when they met relatives who believed in religious explanations for thedestinies of patients and who wanted to conceal the true diagnosis fromterminally ill patients.Conclusion. Community nurses encountered various challenges due to a lack ofexperience with highly diverse patient populations. This situation will continue tocreate difficulties for nurses and minority patients if management support andappropriate training measures are not provided.