Nurses’ Multicultural Transactions With Critically Ill Patients’ Kins and Its’ Impact on Quality of Care: a Study at Kenyatta National Hospital Critical Care Unit

Abstract

Introduction: Patients from different cultural backgrounds are admitted in critical care unit (CCU). Nurses are faced with challenges in trying to incorporate the patient’s cultural needs in health care and at the same time render quality care. Most of the patients in CCU are unable to communicate effectively due to their level of consciousness, thus communication is between the nurse and the next of kin. Thus, multicultural transaction in such situations is very important as it enhances delivery of quality care. Study Objective: To explore the nurses’ multicultural transactions with critically ill patient’s kins and its’ impact on quality of care at KNH CCU. Methodology: A descriptive phenomenological study design was employed where nurses gave their own lived experiences in multicultural transactions with critically ill patients’ kins. Study population was critical care nurses who had worked in CCU based on the inclusion criteria. Purposive sampling method was used. Data was collected through in-depth interviews using an interview guide informed by study objectives. Audio recorded data was transcribed verbatim and entered into a computer through a word processing program and entered into QSR international NVivo 11 Software for analysis. Content analysis technique was used to help identify themes. Results: Five main themes emerged from the study which are; restrictive cultural beliefs, Nurse personal influence in care, Nurses response in care, limitation of care and enabling practice. In investigating the nurse culture integration in care, some nurses found it difficult to integrate the kins/patients’ culture into care but there were those who were able to integrate some of the culture into patients’ care. Nurse’s cultural competency was found to be low which limited their ability to handle each situation critically and improve patient outcomes. Nurse’s personal culture was not found to influence patient care but was mostly guided by the nurse code of ethics. Main challenges included difficulty in management of the cultural/spiritual needs of kins. Conclusion and Recommendations: From the study it was noted that critical care nurses lacked cultural competency in multicultural transaction. This explains the constant conflicts as observed in the analysis. Training on cultural competency is required to improve interaction with kins and patients in critical care unit. The critical care unit should incorporate a multidisciplinary team that will put into focus the different needs of kins as they seek to improve the quality of care in critical care unit.