This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Pergert, P. Articles by Björk, O. Search for Related Content PubMed PubMed Citation Articles by Pergert, P. Articles by Björk, O. Pubmed/NCBI databases Medline Plus Health Information Cancer Social Bookmarking                         What's this?

Obstacles to Transcultural Caring Relationships: Experiences of Health Care Staff in Pediatric Oncology

Childhood Cancer Care Unit, Astrid Lindgren Children's Hospital, Karolinska University Hospital/Solna, Stockholm, Sweden. Stockholm, Sweden, pernilla.pergert{at}ki.se

Solvig Ekblad, PhD

Department of Clinical Neuroscience, Psychiatry/HS, Karolinska Institutet, Stockholm, Sweden

Karin Enskär, RN, PhD

Department of Nursing Science, School of Health Sciences, Jönköping University

Olle Björk, MD, PhD

Swedish Children's Cancer Foundation (Barncancerfonden)

This qualitative study explores the caring situation of families with an immigrant background within the context of pediatric oncology care from the perspective of health care staff. Five focus group interviews and 5 complementary individual interviews were conducted after purposive and theoretical sampling, respectively. Grounded theory methodology revealed that obstacles to transcultural caring relationships are a main concern of the health care staff. These obstacles are divided into 4 main categories: linguistic, cultural and religious, social, and organizational. When health care staff fail to recognize obstacles to transcultural caring relationships, the result is inequity in care of families with an immigrant background. Equity in care for all does not mean identical treatment but, rather, care adjusted to the needs of the individual family regardless of background.

Key Words: Key words: grounded theory • transcultural caring relationships • communication • pediatric oncology

References

• Albin, B., Hjelm, K., Ekberg, J., & Elmstahl, S. (2006). Higher mortality and different pattern of causes of death among foreign-born compared to native Swedes 1970-1999. Journal of Immigrant and Minority Health, 8, 101-113.
• Almond, P. (2002). An analysis of the concept of equity and its application to health visiting. Journal of Advanced Nursing, 37, 598-606.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Andrews, M.M. (2003). Culturally competent nursing care. In M. M. Andrews & J. S. Boyle (Eds.), Transcultural concepts in nursing care (pp. 15-35). Philadelphia: Lippincott Williams & Wilkins.
• Baarnhielm, S., & Ekblad, S. (2000). Turkish migrant women encountering health care in Stockholm: A qualitative study of somatization and illness meaning. Culture, Medicine and Psychiatry, 24, 431-452.[CrossRef]
• Baarnhielm, S., Ekblad, S., Ekberg, J., & Ginsburg, B.E. (2005). Historical reflections on mental health care in Sweden: The welfare state and cultural diversity. Transcultural Psychiatry, 42, 394-419.[Abstract]
• Bazeley, P., & Richards, L. (2000). The NVivo qualitative project book. Thousand Oaks, CA: Sage.
• Blackford, J., & Street, A. (2002). Cultural conflict: the impact of western feminism(s) on nurses caring for women of non-English-speaking background. Journal of Clinical Nursing, 11, 664-671.[CrossRef][Medline] [Order article via Infotrieve]
• Blackhall, L.J., Murphy, S.T., Frank, G., Michel, V., & Azen, S. (1995). Ethnicity and attitudes toward patient autonomy. Journal of the American Medical Association, 274, 820-825.[CrossRef]
• Blomgren, G., & Stockholm County Council. ( 2002). Värdegrund för hälso- och sjukvården i Stockholms läns landsting [Ethical values in Stockholm County Council's health services]. Stockholm: HSNstaben Stockholms läns landsting.
• Campinha-Bacote, J. (1994). Cultural competence in psychiatric mental health nursing: A conceptual model. Nursing Clinics of North America, 29, 1-8.
• 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.
• Carrese, J.A., & Rhodes, L.A. (1995). Western bioethics on the Navajo reservation: Benefit or harm? Journal of the American Medical Association, 274, 826-829.[CrossRef]
• Cooper-Patrick, L., Gallo, J.J., Gonzales, J.J., Vu, H.T., Powe, N.R., Nelson, C., et al. (1999). Race, gender, and partnership in the patient-physician relationship. Journal of the American Medical Association, 282, 583-589.[CrossRef]
• Cortis, J.D. (2003). Culture, values and racism: Application to nursing. International Nursing Review, 50, 55-64.[CrossRef][Medline] [Order article via Infotrieve]
• Cortis, J.D., & Kendrick, K. (2003). Nursing ethics, caring and culture. Nursing Ethics, 10, 77-88.[Medline] [Order article via Infotrieve]
• Covington, L.W. (2001). Cultural competence for critical care nursing practice. Critical Care Nursing Clinics of North America, 13, 521-530.[Medline] [Order article via Infotrieve]
• Dilorio, C., Hockenberry-Eaton, M., Maibach, E., & Rivero, T. (1994). Focus groups: An interview method for nursing research. Journal of Neuroscience Nursing, 26, 175-180.[Medline] [Order article via Infotrieve]
• Donnelly, P.L. (2000). Ethics and cross-cultural nursing. Journal of Transcultural Nursing, 11, 119-126.
• Ekblad, S., & Baarnhielm, S. (2002). Focus group interview research in transcultural psychiatry: Reflections on research experiences. Transcultural Psychiatry, 39, 484-500.[Abstract/Free Full Text]
• Ekblad, S., Svensson, P.-G., & Janson, S. (1996). Möten i vården: transkulturellt perspektiv på hälso- och sjukvården [Encounters in care: Transcultural perspectives on healthcare]. Stockholm: Liber utbildning.
• Eriksson, K. (1997). Vårdandets idé [The idea of caring]. Stockholm: Liber AB.
• Eriksson, K. (2000). Vårdprocessen [The process of caring] (4th ed.). Stockholm: Liber.
• Essen, B., Hanson, B.S., Ostergren, P.O., Lindquist, P.G., & Gudmundsson, S. (2000). Increased perinatal mortality among sub-Saharan immigrants in a city-population in Sweden. Acta Obstetricia et Gynecologica Scandinavica, 79, 737-743.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Fagerstrom, L., Eriksson, K., & Engberg, I.B. (1999). The patient's perceived caring needs: Measuring the unmeasurable. International Journal of Nursing Practice, 5, 199-208.[CrossRef][Medline] [Order article via Infotrieve]
• Fallowfield, L.J., Jenkins, V.A., & Beveridge, H.A. (2002). Truth may hurt but deceit hurts more: Communication in palliative care. Palliative Medicine, 16, 297-303.[Abstract/Free Full Text]
• Fredriksson, L. (1999). Modes of relating in a caring conversation: A research synthesis on presence, touch and listening. Journal of Advanced Nursing, 30, 1167-1176.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Fredriksson, L., & Eriksson, K. (2003). The ethics of the caring conversation. Nursing Ethics, 10, 138-148.
• Gadd, M., Johansson, S.E., Sundquist, J., & Wandell, P. (2003). Morbidity in cardiovascular diseases in immigrants in Sweden. Journal of Internal Medicine, 254, 236-243.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Gerrish, K., Chau, R., Sobowale, A., & Birks, E. (2004). Bridging the language barrier: The use of interpreters in primary care nursing. Health & Social Care in the Community, 12, 407-413.[CrossRef][Medline] [Order article via Infotrieve]
• Glaser, B.G. (1978). Theoretical sensitivity: Advances in the methodology of grounded theory. Mill Valley, CA: Sociology Press.
• Glaser, B.G. (1998). Doing grounded theory: Issues and discussions. Mill Valley, CA: Sociology Press.
• Glaser, B.G., & Strauss, A.L. (1967). Awareness of dying. New York: Aldine.
• Glaser, B.G., & Strauss, A.L. (1967). The discovery of grounded theory: Strategies for qualitative research. New York: Aldine.
• Hicks, M.D., & Lavender, R. (2001). Psychosocial practice trends in pediatric oncology. Journal of Pediatric Oncology Nursing, 18, 143-153.[CrossRef][Medline] [Order article via Infotrieve]
• Hupcey, J.E., Penrod, J., & Morse, J.M. (2000). Establishing and maintaining trust during acute care hospitalizations. Scholarly Inquiry for Nursing Practice, 14, 227-242.[Medline] [Order article via Infotrieve]
• Inglehart, R., & World Values Survey. (2000 ). The Inglehart Values Map. Retrieved July 10, 2006, from http://www.worldvaluessurvey.org/
• Jamieson, L., & Williams, L.M. (2003). Focus group methodology: Explanatory notes for the novice nurse researcher. Contemporary Nurse, 14, 271-280.[Medline] [Order article via Infotrieve]
• Kaufert, J.M., & Putsch, R.W. (1997). Communication through interpreters in healthcare: Ethical dilemmas arising from differences in class, culture, language, and power. Journal of Clinical Ethics, 8, 71-87.
• Kaufert, J.M., Putsch, R.W., & Lavallee, M. (1999). End-of-life decision making among Aboriginal Canadians: Interpretation, mediation, and discord in the communication of "bad news." Journal of Palliative Care, 15, 31-38.[Web of Science][Medline] [Order article via Infotrieve]
• Koenig, B.A., & Davies, E. (2003). Cultural dimensions of care at life's end for children and their families. In M. J. Field & R. E. Behrman (Eds.) & Institute of Medicine (U.S.) Committee on Palliative and End-of-Life Care for Children and Their Families, When children die: Improving palliative and end-of-life care for children and their families. Washington, DC: National Academy Press.
• Lavizzo-Mourey, R.J., & MacKenzie, E. (1995). Cultural competence—An essential hybrid for delivering high quality care in the 1990's and beyond. Transactions of the American Clinical and Climatological Association, 107, 226-235.
• Leininger, M.M. (2002a). Cultures and tribes of nursing, hospitals, and the medical culture. In M. M. Leininger & M. R. McFarland (Eds.), Transcultural nursing: Concepts, theories, research and practice (3rd ed., pp. 181-204). New York: McGraw-Hill, Medical Publishing Division.
• Leininger, M.M. (2002b). Transcultural nursing and globalization of health care: Importance, focus, and historical aspects. In M. M. Leininger & M. R. McFarland (Eds.), Transcultural nursing: Concepts, theories, research and practice (3rd ed., pp. 3-43). New York: McGraw-Hill, Medical Publishing Division.
• Lindencrona, F., Ekblad, S., Johansson Blight, K., & Swedish Migration Board. ( 2006). Integration och folkhälsa—en kunskapsöversikt [Integration and public health—a knowledge overview]. Norrköping: Integrationsverket.
• Masera, G., Spinetta, J.J., Jankovic, M., Ablin, A.R., Buchwall, I., Van Dongen-Melman, J., et al. (1998). Guidelines for a therapeutic alliance between families and staff: A report of the SIOP Working Committee on Psychosocial Issues in Pediatric Oncology. Medical and Pediatric Oncology, 30, 183-186.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• McKinley, D., & Blackford, J. (2001). Nurses' experiences of caring for culturally and linguistically diverse families when their child dies. International Journal of Nursing Practice, 7, 251-256.[CrossRef][Medline] [Order article via Infotrieve]
• McNamara, B., Martin, K., Waddell, C., & Yuen, K. (1997). Palliative care in a multicultural society: Perceptions of health care professionals. Palliative Medicine, 11, 359-367.[Abstract/Free Full Text]
• McPherson, J. (1999). The Steven Lawrence inquiry (Report No. cm 42/4262). London: HMSO.
• Ministry of Health and Social Affairs, Socialdepartementet. (2003). The Health and Medical Service Act (Hälso- och sjukvårdslagen) (1982:763). Retrieved March 13, 2007, from http://www.sweden.gov.se/sb/d/574/a/23125
• Munet-Vilaro, F. (2004). Delivery of culturally competent care to children with cancer and their families—the Latino experience. Journal of Pediatric Oncology Nursing, 21, 155-159.[Abstract/Free Full Text]
• National Public Health Commission (Nationella folkhälsokommittén). (2000). Hälsa på lika villkor: Nationella mål för folkhälsan: Slutbetänkande [Health on equal terms: Final proposal on national targets for public health]. Stockholm: Ministry of Health and Social Affairs.
• Pergert, P., Ekblad, S., Enskar, K., & Bjork, O. (in press). Bridging obstacles to transcultural caring relationships— Tools discovered through interviews with staff in pediatric oncology care. European Journal of Oncology Nursing.
• Pettersson, T., & Esmer, Y. (2005). Vilka är annorlunda? Om invandrares möte med svensk kultur [Who is different? About immigrants' encounter with Swedish culture]. Norrköping, Sweden: Integrationsverket (Swedish Migration Board).
• Pitner, R.O., & Sakamoto, I. (2005). The role of critical consciousness in multicultural practice: Examining how its strength becomes its limitation. American Journal of Orthopsychiatry, 75, 684-694.[CrossRef][Medline] [Order article via Infotrieve]
• Price, K.M., & Cortis, J.D. (2000). The way forward for transcultural nursing. Nurse Education Today, 20, 233-243.[CrossRef][Medline] [Order article via Infotrieve]
• Richardson, A., & Thomas, V.N. (2006). "Reduced to nods and smiles": Experiences of professionals caring for people with cancer from black and ethnic minority groups. European Journal of Oncology Nursing, 10, 93-101.[CrossRef][Medline] [Order article via Infotrieve]
• Richardson, L.D. (1999). Patients' rights and professional responsibilities: The moral case for cultural competence. The Mount Sinai Journal of Medicine, 66, 267-270.
• Robertson, E., Iglesias, E., Johansson, S.E., & Sundquist, J. (2003). Migration status and limiting long-standing illness: A longitudinal study of women of childbearing age in Sweden. European Journal of Public Health, 13, 99-104.[CrossRef]
• Robertson, E., Malmstrom, M., & Johansson, S.E. (2005). Do foreign-born women in Sweden have an increased risk of non-normal childbirth? Acta Obstetricia et Gynecologica Scandinavica, 84, 825-832.[CrossRef][Medline] [Order article via Infotrieve]
• Statistics Sweden. (2007). Befolkningsstatistik i sammandrag 1960-2006 [A summary of population statistics 1960-2006]. Retrieved March 31, 2007, from www.scb.se/BE0101
• Swedish Migration Board. (2005). Statistics on our activities. Retrieved August 13, 2005, from http://www.migrationsverket.se/
• Trill, M.D., & Holland, J. (1993). Cross-cultural differences in the care of patients with cancer. A review. General Hospital Psychiatry, 15, 21-30.[Medline] [Order article via Infotrieve]
• van Wieringen, J.C., Harmsen, J.A., & Bruijnzeels, M.A. (2002). Intercultural communication in general practice. European Journal of Public Health, 12, 63-68.[CrossRef]
• Vydelingum, V. (2006). Nurses' experiences of caring for South Asian minority ethnic patients in a general hospital in England. Nursing Inquiry, 13, 23-32.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]

Journal of Pediatric Oncology Nursing, Vol. 24, No. 6, 314-328 (2007)
DOI: 10.1177/1043454207308066


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				P. Pergert, S. Ekblad, K. Enskar, and O. Bjork Protecting Professional Composure in Transcultural Pediatric Nursing Qual Health Res, May 1, 2008; 18(5): 647 - 657. [Abstract] [PDF]

This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Pergert, P. Articles by Björk, O. Search for Related Content PubMed PubMed Citation Articles by Pergert, P. Articles by Björk, O. Pubmed/NCBI databases Medline Plus Health Information Cancer Social Bookmarking                         What's this?