Challenges and opportunities for the multicultural aged care workforce: A systematic review and meta-synthesis

The Experiences of People From Ethnic Minority Backgrounds Living in Care Homes-A Qualitative Systematic Review

The experiences of people from ethnic minority backgrounds living in care homes-A qualitative systematic review.

AIM

Despite the increasing need for older people from ethnic minority backgrounds to be able to access good quality, culturally competent care home provision, globally, there is an absence of literature exploring care home residents' perspectives. This study conducted a systematic review, identifying and synthesising qualitative evidence, which explored the experiences of residents', and their families, from ethnic minority backgrounds, who live in care home settings.

DESIGN

A qualitative systematic review. Nine electronic databases, MEDLINE, Nursing and Allied Health, CINAHL, ASSIA, AMED, Sociological Abstracts, PsycINFO, Web of Science, SCOPUS, were systematically searched for research published after 2005 until 2025.

REVIEW METHODS

This systematic review of qualitative studies was conducted in accordance with The PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Studies were appraised for quality based upon validated critical appraisal tools from the Joanna Briggs Institute. Qualitative data were extracted and synthesised using reflexive thematic analysis.

RESULTS

Sixteen studies were identified from the international literature that explored care home experiences from the resident's and families' perspectives. Three key themes were extrapolated: Patter, which includes how cross-cultural communication skills and language affect care experiences; Place, which includes the care home environment, the multi-ethnic environment, and quality of care; and Person, which encompasses the individual's culture, values, beliefs, food, and family.

CONCLUSION

There is limited literature from the UK and low-to-middle income countries exploring care home residents' perspectives on care provision. Key components of culturally competent care include culturally sensitive communication, adaptable environments that support residents' chosen lifestyles, and inclusive, family-centred approaches to living well.

IMPACT

For nurses within the adult social care sector, to recognise the need for further research, education, and policy initiatives aimed at enhancing the care home provision for people from ethnic minority groups.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

Social resilience within the carescapes of Asian female migrant aged care workers

Increasingly, Asian female migrants are playing a significant role in meeting Australia's aged care workforce demand. This article analyses the lived experiences of Asian female aged care workers using the carescape concept, and a theory of agency to understand aged care access and workforce availability. It aims to identify the wider institutional and social structures that influence their agency and contribute to their social resilience as a critical member of the aged care workforce. Qualitative data were used for analysis; specifically, semi-structured interviews which were conducted with 10 Asian female migrant workers from the aged care sector. Analysis reveals that social and institutional structures both challenge and facilitate agency, and thus access to the aged care industry. The findings provide a deeper understanding of agency and highlights the social structures which contribute to developing social support networks and social resilience. Workplace policies and practices which facilitate the agency, adaptation and transformation of this workforce are important to understanding access to the industry and the retention of Asian female migrant aged care workers.

First-Line Managers' Experiences of Leading a Multicultural Staff Group in Nursing Homes and the Implementation of Language Development Initiatives: A Qualitative Study

INTRODUCTION

Foreign-born care workers with limited native language proficiency have become a challenge for first-line managers (FLMs). The study explores FLMs' experiences of their role of leading a multicultural and multilingual staff group in nursing homes and implementing language development initiatives.

METHOD

This is an explorative descriptive study. Four focus-group discussions were held with 12 participants. Data analysis was performed in accordance with the method described for focus-group discussions.

RESULTS

Three categories with six subcategories were generated: Challenging to adapt leadership to multicultural environment; Challenging and stimulating to work with language development; and Challenging to bridge gaps when conditions change.

DISCUSSION

FLMs' role to implement different strategies and models to promote a favorable working environment, collegial relationships, and competence development is demanding. In conclusion, FLMs need sufficient time, resources, and support to develop competence in transcultural nursing leadership to deliver culturally congruent care and implement language development initiatives in multicultural teams.

Leadership in Culturally and Linguistically Diverse Healthcare Workplaces: A Scoping Review

AIM

To map the existing literature and research themes related to leadership in culturally and linguistically diverse healthcare workplaces and identify potential research gaps to guide future studies.

DESIGN

A scoping review.

METHODS

The review followed the Joanna Briggs Institute scoping review methodology. A total of 15,078 studies were imported into Covidence for screening. Results were analysed using inductive content analysis.

DATA SOURCES

Searches were conducted on CINAHL, Medline (Ovid), ProQuest, Scopus, and the Finnish Medic database. Unpublished studies and grey literature were searched using MedNar. The scoping review included published and unpublished original studies in English, Finnish, and Swedish with no time or geographical limits.

RESULTS

The review included 19 studies. This scoping review identified four main categories of leadership in culturally and linguistically diverse healthcare workplaces: promoting cultural adaptation, being a cultural mediator, ensuring competence development and continuous education, and developing culturally sensitive leadership.

CONCLUSIONS

Leaders should adopt a supportive and open leadership style to promote cultural adaptation in culturally and linguistically diverse workplaces. Leaders' cultural competence can be enhanced through continuous education and training. Leaders should provide competence development opportunities for all employees in culturally and linguistically diverse workplaces. The findings highlight the need for more research (e.g., educational intervention studies) to understand the challenges and opportunities of leading a diverse workforce in a healthcare setting.

IMPLICATIONS FOR HEALTHCARE MANAGEMENT

The findings highlight the importance of leadership in promoting cultural adaptation and inclusive environments in culturally and linguistically diverse workplaces. Leaders should continually develop their cultural competence to effectively lead culturally and linguistically diverse workplaces. Developing culturally sensitive leadership requires strong communication skills and cultural understanding to promote inclusion.

IMPACT

Our review's results underscore the need for healthcare organisations to embrace leadership practices that are inclusive and culturally competent in increasingly diverse workplaces. As the workforce becomes more diverse, it is important to understand how leadership characteristics influence culturally and linguistically diverse healthcare workplaces.

REPORTING METHOD

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews was used when reporting the results.

PATIENT OR PUBLIC CONTRIBUTION

There was no patient or public contribution.

TRIAL REGISTRATION

The protocol was registered in the Open Science Framework (10.17605/OSF.IO/2AK73).

'I tried to get into their shoes and their culture'. Care worker experiences in cultural end-of-life care: Interpretative phenomenological analysis

AIM

What are care workers' lived experiences caring for people of culturally and linguistically diverse backgrounds during end-of-life care?

DESIGN

Interpretative phenomenological analysis METHODS: The lived experiences of 11 care workers within the Australian Capital Territory and region who have cared for someone of a culturally and linguistically diverse background during end-of-life care were captured. Each care worker was interviewed individually and answered a series of semi-structured open-ended questions.

RESULTS

Using interpretative phenomenological analysis, three group experiential themes were derived: (i) navigating cultural shock and death, (ii) the hard work of communication and (iii) searching for deeper connections with client and self. Within these were key elements: Care workers worked hard to embrace cultural diversity, but struggled to meet cultural needs, particularly in relation to the unpredictable timeline of dying. Care workers relied on themselves and their improvisation, but experienced self-blame for inadequate care and unexpected challenges in communication. Blurred boundaries in relation to therapeutic relationships were apparent, and care workers felt alone with emotional burden, but also found belonging and joy in their work.

CONCLUSION

Care workers' experiences are vital to understanding the barriers and challenges in providing culturally appropriate end-of-life care. Care workers repeatedly experienced an emotional burden and vicarious trauma throughout their work in this field. Care workers were self-reliant in all aspects of care including communication and consistently desired education, training, resources and support. There remains inadequate research on care workers and their role within the Australian healthcare context.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Care workers need access to support and resources including professional translators to provide culturally appropriate end-of-life care. Workplaces and registered nurses should facilitate training and provide guidance to care workers. A person-centred approach is required during all client encounters while maintaining appropriate therapeutic relationships including therapeutic use of self and professional boundaries.

REPORTING METHOD

COREQ Checklist.

PATIENT OR PUBLIC CONTRIBUTION

During this study, care workers were interviewed on their experiences caring for people of culturally and linguistically diverse backgrounds during end-of-life care. Patients were not directly involved within this study, but their views may have been expressed through the care workers' experience.

Experiences of Communication and Working During the Covid-19 Pandemic Among Nursing Home Staff: A Qualitative Interview Study

AIM

To describe nursing home care staff's experiences of encounters and communication with colleagues, residents and residents' family members as well as their experiences during the Covid-19 pandemic while working in a multicultural environment.

DESIGN

A qualitative descriptive study.

METHODS

Interviews with 17 care staff from nursing homes in Sweden were analysed using qualitative content analysis.

RESULTS

Care staff reported different working experiences related to their possibility to prepare themselves, and some felt more supported than others by their managers. Feelings of pride were experienced when Covid-19 infections were prevented. Overall, they received information about Covid-19, but not initially. Acceptance of colleagues with limited Swedish language skills was reported, but frustration and impaired communication were common. Negative mental health effects from working with critically ill residents and taking care of the deceased were reported.

CONCLUSION

Employers did not provide care staff with sufficient information and support, and strategies are needed to maintain communication with and between care workers. Further support is needed to maintain care workers' mental health and well-being during critical working conditions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nursing home management needs to implement clear structured tools for communicating essential information. These tools should take language skills into consideration. During pandemics, care workers must receive the support they need to maintain their mental health and well-being.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Factors influencing multicultural acceptance of Korean nursing students

BACKGROUND

South Korea has already become a multicultural society due to immigration, marriage, and employment of foreigners, and the use of medical institutions by foreigners is increasing. In order to establish a therapeutic rapport relationship with foreigners, it is necessary to study multicultural acceptance. This study aimed to examine and identify the factors influencing the degree of multicultural acceptance of Korean nursing students.

METHODS

This study used a cross-sectional descriptive design. Study participants included 147 nursing students at University in Seoul or Gyeonggi-do, South Korea. Data included demographics, multicultural acceptance, cultural empathy, and multicultural attitude. Data were collected from March to June 2021. Data was analyzed using linear regression model in SPSS PC + version 23.0 statistical software program.

RESULTS

The adjusted R-squared representing the explanatory power of the model was 72.5%. The strongest predictor was cultural empathy (β = 0.55, P < 0.001), followed by multicultural attitude (β = 0.26, P = 0.001), residential area where they lived for the past 5 years (β = 0.19, P = 0.001), accessibility to multicultural internet and media (β = 0.17, P = 0.003), whether they have foreign friends (β = 0.16, P = 0.003), and multicultural education experience (β = 0.02, P = 0.002).

CONCLUSION

This study suggests that to improve the degree of multicultural acceptance of Korean nursing students, their cultural empathy and multicultural attitude should be strengthened. Nurses need to pay attention the influencing factors to improve the multicultural acceptance of Korean nursing students.

Job satisfaction and wellbeing among migrant care workers in nursing homes: An integrative review

AIM

To systematically analyse and synthesize studies investigating job satisfaction (including turnover and turnover intention) and wellbeing (physical, social and psychological including work stress, acculturation stress and sick leave) among migrant care workers in nursing homes.

DESIGN

An integrated review was conducted.

METHODS

Joanna Briggs Institute's manual guided the analysis of qualitative data (n = 31). Quantitative data (n = 17) were summarized and integrated with the qualitative findings.

RESULTS

Migrants described high job demands, limited control and social support, and stress possibly related to acculturation. Although, compared to natives (born in the country), inconsistent results were reported about wellbeing and job satisfaction, migrant care workers reported enjoying the relational aspects of work and feeling pride when providing care. A satisfying work environment for migrant care workers enables them enjoying working in elderly care with pride.

PUBLIC CONTRIBUTION

Help managers to promote an inclusive working life in line with the United Nations Sustainable Development Goal number 8.

International Portuguese Nurse Leaders' Insights for Multicultural Nursing

Cultural diversity among patients and healthcare workers in the Portuguese healthcare organizations will increasingly challenge nurse managers to develop favorable nursing work environments and to improve culturally congruent care.

AIM

This study aimed to identify nurse managers' interventions that improve favorable nursing work environments in multicultural nursing teams and culturally congruent care for patients, based on Portuguese nurse leaders' experience in international settings.

METHODS

A qualitative and exploratory study was conducted as the first stage of a sequential exploratory mixed study design. A convenience sample of Portuguese nurses with leadership experience of multicultural teams was recruited to participate in one focus group. Qualitative data were recorded and transcribed for content analysis. Text segments were organized into themes and categories with the support of the qualitative software IRaMuTeQ.

RESULTS

Nurse managers' interventions, such as adapting the leadership style, thanking nurses for their work, adjusting the unit to attend to patients' worship practices, and supporting foreign nurses in learning the local language, were categorized into three main themes and five categories-transcultural nursing leadership assumptions, capitalizing nurses, improving culturally congruent care, team problems and strategies, and improving effective communication.

CONCLUSIONS

These findings corroborate international studies, advocate for capable nurse managers to lead in a globalized world, and are suitable to develop a transcultural nursing leadership questionnaire.

Staff perceived challenges and facilitators in supporting resident self-determination in ethno-specific and mainstream nursing homes

AIMS AND OBJECTIVES

To explore and compare staff perceived challenges and facilitators in supporting resident self-determination in ethno-specific and mainstream nursing homes.

BACKGROUND

Staff and residents in ethno-specific and mainstream nursing homes in most developed countries have shown increased cultural and linguistic diversity. This socio-demographic change poses significant challenges for staff to support resident self-determination of their own care. In-depth understanding of those challenges in the two types of nursing homes is much needed to inform practice in nurse-led nursing home care settings.

METHOD

A qualitative description approach with thematic analysis was used in the study. Data were collected through five focus groups with 29 various direct care workers from two ethno-specific nursing homes and a mainstream nursing home in Australia between March-September 2020. The study report followed the COREQ checklist.

RESULTS

Four themes were identified from focus group data. First, participants perceived communication challenges in identifying residents' preferences, especially in ethno-specific nursing homes. Second, team efforts that included residents and their family members were highly valued as a way to meet residents' preferences. Third, participants described various levels of staff engagement in residents' care planning. In addition, staff in ethno-specific nursing homes possessed richer resources to maintain meaningful relationships for residents compared with their counterparts in the mainstream nursing home.

CONCLUSIONS

Staff in ethno-specific nursing homes experience more challenges in supporting resident self-determination but have richer resources to develop culturally safe and culturally competent care compared with their counterparts in the mainstream nursing home.

RELEVANCE TO CLINICAL PRACTICE

Findings provide new insights into challenges and practical solutions in supporting residents to self-determine their own care in cross-cultural aged care.

PATIENT OR PUBLIC CONTRIBUTION

This study was co-designed with three aged care organisations who funded the study. Staff employed by these organisations participated in the study.

Fostering an ethos of cultural humility development in nurturing inclusiveness and effective intercultural team working

AIM

To discuss the importance of fostering an ethos of cultural humility development in cultivating inclusiveness and effective intercultural team working.

BACKGROUND

Widening cultural and ethnic diversity of the health care workforce enriches the working environment and encourages a broader perspective on health care services and delivery. However, the intricacies of learning to work effectively within intercultural health care teams and adapting to new ways of working are often under estimated and thus overlooked.

EVALUATION

In adopting a framework for cultural humility development (Hughees et al., 2020, 10.1016/j.profnurs.2019.06.005), this paper proposes some practical suggestions for nurturing intrapersonal, interpersonal and system level cultural humility simultaneously.

KEY ISSUES

Fostering an ethos of cultural humility development within the workplace can support inclusiveness and better intercultural team working relationships. Nurses need support in developing awareness of their own cultural beliefs, whilst examining perceptions of cultural difference.

CONCLUSION

Examining cultural factors that influence intercultural working relationships will help in identifying structures, supports and approaches required for integration and inclusiveness.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurturing ways of supporting interpersonal, intrapersonal and systems levels cultural humility development inspires the self-awareness, openness and respect for cultural difference required. Developing culturally responsive leadership styles and prioritizing their own cultural humility development is critical.