Mebrouk J. Consequently, multiple studies have found that non-Saudi nurses experience difficulty in understanding, and in some cases respecting, the cultural and religious practices of patients [20, 38]. The increasing number of non-Saudi or expatriate nurses has created several challenges in the delivery of health care. Bethesda: National Cancer Institute, US Department of Health and Human Services, National Institutes of Health; 2007. Aljadhey H, Mahmoud MA, Hassali MA, Alrasheedy A, Alahmad A, Saleem F, Sheikh A, Murray M, Bates DW. Moreover, the findings of this review indicate a need to improve communication between patients and health-care providers in order to provide safety and high-quality practice in Saudi Arabia, which will contribute to higher quality of care and patient satisfaction. h�b```�d 9�A�����,�� 8��j�Nq���ͨ���EȑE�ѨP��p4w�^���0ˉ���}L�k�I�y����0m���\�� Article  Approximately 75% of patients reported being satisfied with the health care they have previously received; however, while these patients are generally satisfied with the technical competence of nurses [30, 37], approximately half of them are dissatisfied with the interpersonal therapeutic communication of most expatriate nurses. 2013;20(3):187–94. Fleischer S, Berg A, Zimmermann M, Wüste K, Behrens J. Nurse-patient interaction and communication: a systematic literature review. Subsequently, the identified key words and search items were modified and used to search across CINAHL, PUBMED and PsychINFO. The data extraction form was structured into sub-sections, which included description of study (author, year of publication and title of paper), methods (study design, methods, sampling and sample size) and findings. This can help to improve the communication between nurses and patients in the delivery of health care services. If we didn't, we would have no need to communicate: something like extrasensory perception would take its place. Four studies identified communication practices as a key theme. 0 Practically, this makes it difficult for the nurses to understand the communication dynamics of patients in the process of seeking health care. Inpatients satisfaction with nursing services at king khalid university hospital, Riyadh, Saudi Arabia. However, despite this development, two studies have suggested that these courses appear to have limited impact and lack the ability to meet the needs of such nurses [32, 40]. In addition, religious beliefs and practices such as fasting and praying are perceived as relevant factors in the recovery of patients [36, 40]; however, some non-Saudi nurses have demonstrated difficulty in understanding these religious-cultural practices that contribute significantly in the delivery of health care. Four studies highlighted that communication barriers caused by the differences in religious-cultural practices have implications for the safety of the patients [27, 31,32,33]. The communication barriers occurring at different levels of the health system are ascribed to several factors, again mostly linked the differences in language, culture and religion [17, 18, 20, 26, 29, 34]. These barriers occur at different levels, including nurses to patients as well as at the inter-professional level [21, 34]. Six studies have shown that there are numerous interpersonal therapeutic communication barriers existing between nurses and patients as well as family caregivers [17,18,19,20,21, 27]. In particular, the language difficulties limit nurses’ ability to effectively communicate with patients [17, 18, 20]. Although most current interpreters are competent in the English language, their skills are limited to the understanding of medical terms and jargon. The review findings suggest that there is a diversity in the language, religion and culture of nurses providing health-care services in Saudi Arabia. The search items that facilitated the search process were barrier* or facilitat* or limit* or challeng* or difficult* or obstacle* or problem or issue AND communicat* or language or cultur* AND nurs* AND Saudi* AND quality or satisf* or effectiv* or impact. I am interested in the chart. Privacy Patient education and counseling; 2018. Current nurse–patient communication practices do not meet the needs of Saudi patients due to cultural, religious and language differences between nurses and patients. Twenty papers were included in the review (Table 1). Keywords: Effective communication, effects, barriers, nursing, caring, patient-centered care, therapeutic communication, patient satisfaction 1. There are numerous barriers to effective communication including: 1. The sub-themes identified from the ‘current communication practices’ theme were language, religion and cultural diversity; communication practices; and communication barriers. In fact, a recent systematic review [13] suggested that such communication barriers are common to many countries and they adversely affect the overall quality of health services. Hum Res Manag. Ultimately, the building of trust between nurse and child and avoiding a negative hospital or healthcare experience is one of the main goals when nursing paediatric patients. (2014) stated that the religious-cultural norms and values of Saudi patients appear as entirely new to many non-Saudi nurses [34]. 2013;29(1):24–9. Further, 15 of the included studies targeted nurses’ perspectives of the communication and five focused on patients’ perspectives of communication. Three studies suggested that where nurses have religious-cultural practices that differ from those of their patients, safety can be impacted [27, 32]. By using this website, you agree to our In particular, there are differences in culture, religion and language among non-Saudi nurses and patients. The review findings suggest that the interpersonal therapeutic communication barriers occur among health care professionals as well as between nurses and patients. BMC Nursing Predominantly, this takes the form of gestures and signs, and sometimes therapeutic touch as well as smiling [29, 36]. PubMed  2014;22(4):326–32. The main barrier to effective communication was the nurse’s lack of knowledge and skills. It has been argued that the provision of interpreters in all hospitals in Saudi Arabia would be a good step towards improving communication [32]. They identified several communication practices currently employed by nurses in health facilities across Saudi Arabia that are perceived to be effective in interpersonal therapeutic communication [18, 19, 29, 36]. In addition, some patients may need more attention from nurses in the process of treatment. The quality of the included papers in this review were evaluated using the Mixed Methods Appraisal Tool (MMAT) [24]. h�bbd``b`N @��D���j �8�Z"�¹Q �4��o�301����������o� � Treiman K, McCormack L, Olmsted M, Roach N, Reeve BB, Martens CE, Moultrie RR, Sanoff H. Engaging patient advocates and other stakeholders to design measures of patient-centered communication in cancer care. For example, both translators and family members have been shown to deliver an incomplete or unclear rendering of the conversation to the patient, which could adversely influence health-care practice [32]. These differences create barriers to clear and effective communication and produce a negative impact on health outcomes for patients in Saudi Arabia. Springer Nature. The effect of nurse-patient language barrier on patients’ satisfaction. Int J Nurs Stud. This can be perceived as disrespect, which might contribute to reported levels of violence towards nurses. Int J Nurs Stud. This barrier, is perhaps the most difficult to overcome because it involves changing a mindset, and thus it typically doesn’t change until the person leaves. All of the included studies were checked on the basis of data relevance as well as methodological rigor. 1). This integrative review aims to identify and synthesize quantitative and qualitative evidence on the communication practices among nurses and patients in Saudi Arabia and their effect on patient satisfaction, quality of care and safety. endstream endobj 1307 0 obj <>/Metadata 102 0 R/Pages 1304 0 R/StructTreeRoot 161 0 R/Type/Catalog>> endobj 1308 0 obj <>/MediaBox[0 0 595.32 841.92]/Parent 1304 0 R/Resources<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 1309 0 obj <>stream Verbal and non-verbal communication start from birth and does not end until death These databases and the time limit were chosen to ensure a comprehensive search and a sufficient breadth and depth in the retrieved literature. The authors want to thank the University of Newcastle Australia. Kitchenham B: Procedures for performing systematic reviews. The quality of the papers was assessed using the Mixed Methods Appraisal Tool (MMAT). Int J Nurs Pract. The verbal interactions are usually limited and delivered through few Arabic/Islamic terms. With this focus, nurses can help ensure optimal communication and patient care. For instance, limited knowledge and understanding of the culture and language of a health system on the part of a patient has been shown to limit the communication process between patient and clinician [13,14,15,16]. Staffing Shortages. These communication barriers can affect health outcomes, quality of health care, patient safety and patient satisfaction. There has been growing interest in research on nurse–patient communication in Saudi Arabia, including quantitative and qualitative studies [17,18,19,20,21], but despite the growing evidence base no study has focused on the communication experiences of patients. This is attributed to the increasing number of non-Saudi expatriate nurses providing health care to patients. The review included studies that focused on nurse–patient communication issues, communication barriers, and cultural and language issues. For example, patients may find it difficult to adhere to the nurse’s instructions, resulting in a clear threat to patient safety [26, 31, 33]. Moreover, having effective communication skills is essential for health-care providers’ practice and their ability to understand the clinical symptoms and psychological and emotional needs of their patients. 28 6.2 How effective communication relates with patients and nurses. Some cultural or religious practices, such as gender segregation or females covering their hair or faces, do not appear to be rational to many nurses. These barriers can create obstacles in the communication process. Cowan DT, Norman I. Van Bommel M. Expatriate non-Muslim nurses’ experiences of working in a cardiac intensive care unit in Saudi Arabia; 2011. arise in the communication process. PubMed  Challenges to and the future of medication safety in Saudi Arabia: a qualitative study. (2014) have suggested that language barriers could account for an increase in medication errors [31]. These barriers are classified into the following types. Mukhlid Alshammari. If you are unhappy or have lost interest in your job, you are far less likely to communicate effectively – both on the giving and receiving ends. A two-stage search approach was utilized to facilitate the search process. Article  2016;14(6):599–611. Also being extremely nervous, … Citation: Jurns, C., (September 6, 2019) "Policy Advocacy Motivators and Barriers: Research Results and Applications" OJIN: The Online Journal of Issues in NursingVol. Schooling. Contemp Nurse. Similarly, the communication barriers occurring at inter-professional level affect health services planning [31]. An integrative review was chosen to merge diverse methods, and synthesize findings from both qualitative and quantitative studies [22]. The authors declare that they have no competing interests. In particular, there are differences in culture, religion and language among non-Saudi nurses and patients. It is natural for patients to feel apprehensive about their health and wellbeing, yet a survey in 2016 found that only 38% of adult inpatients who had worries or fears could ‘definitely’ find someone in hospital to talk to about them (Care Quality Commission, 2017). Suliman WA, Welmann E, Omer T, Thomas L. Applying Watson’s nursing theory to assess patient perceptions of being cared for in a multicultural environment. This is attributed to the increasing number of non-Saudi expatriate nurses providing health care to patients. A total of 150 records were reviewed from CINAHL, EMBASE, PubMed, Medline, PsychINFO and Google Scholar, of which 26 duplicates were deleted. J Nurs Res. Seven of the included papers explained that there are differences in language, religion and culture among nurses providing health services to patients in Saudi Arabia [17,18,19,20, 34, 38, 40] with the language, religion and culture of non-Saudi nurses differing from their Saudi patients. Anderson J, Perry J, Blue C, Browne A, Henderson A, Khan KB, Kirkham SR, Lynam J, Semeniuk P, Smye V. “Rewriting” cultural safety within the postcolonial and postnational feminist project: toward new epistemologies of healing. Mohamed AG. 2006;17(1):82–8. The review revealed two major themes: ‘current communication practices’ and ‘the effect of communication on patients’. Unlike the expatriate nurses, almost all patients in Saudi Arabia speak Arabic and share the same cultural values, norms and religion [40]. Khalaf, A et al. 1. 1306 0 obj <> endobj Overall, data was extracted from 20 full text articles and included in the final synthesis (Fig. Collegian. %%EOF multiple communication barriers exist in a nurse-client setting, the nurse must dedicate additional time and effort to communicate effectively in order to maximize client care (Coleman & Angosta, 2016; Hemsley, Balandin, & Worrall, 2012). JD and MG managed the second review of the data extraction. Pace R, Pluye P, Bartlett G, Macaulay AC, Salsberg J, Jagosh J, Seller R. Testing the reliability and efficiency of the pilot mixed methods appraisal tool (MMAT) for systematic mixed studies review. This tool has been validated and widely used to asses quality of papers with different methods [24]. Soc Sci Med. 2003;26(3):196–214. Consequently, to improve access to treatment for patients, it is important not only to understand the burden of their conditions but also to address the therapeutic communication issues with service providers, particularly nurses. Nurse–patient communication plays an important role in improving not only patient’s relationship with the nurse, but also the patient’s own perception of the treatment process and outcome. Nurses who are aware of the common barriers to effective communication will be able to anticipate and properly react to any roadblocks. Atallah MA, Hamdan-Mansour AM, Al-Sayed MM, Aboshaiqah AE. Article  In some instances, these non-verbal communication practices help patients understand the process of health-care delivery. This article highlights the importance of effective communication skills for nurses. PubMed  Patient-centered communication has been identified as an essential component in delivering quality health services [4]. Two reviewers independently managed the selection process. Keatinge D, Bellchambers H, Bujack E, Cholowski K, Conway J, Neal P. Communication: principal barrier to nurse–consumer partnerships. Barriers of communication . The study concludes that language, culture and religion differences exist between patients and nurses in Saudi Arabia, primarily due to the preponderance of expatriate nurses in working in the Saudi Arabian health-care system. Communication for nurses: talking with patients. Manage cookies/Do not sell my data we use in the preference centre. J Public Health. 2010;1(1):1–11. Shouting down a flight of stairs doesn’t exactly make for great correspondence. However, the use of a systematic approach [23] – including data searching, data extraction and collaboration with experts in the field – attempted to reduce the impact of the limitations. effective nursing communication skills are a critical element of patient care (Candlin & Candlin 2003). Correspondence to All of them have read and approved the final manuscript. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. Al-Doghaither AH. The tool was developed and structured according to the systematic review reporting guidelines [25]. volume 18, Article number: 61 (2019) The authors want also to thank Debbie Booth, University of Newcastle librarian for supporting the literature search. Epstein R, Street RL. A recent study suggested that words such as “Bismillah” or “Alhamdillah” – which translate as “in the name of Allah” and mean to start with the blessing of God – are mostly used prior, during and after medication processes, largely to make the patient feel more comfortable [18]. © 2020 BioMed Central Ltd unless otherwise stated. Alosaimi DN, Ahmad MM. This training is delivered as an in-service program with the primary aim of exposing nurses to religious-cultural practices in the delivery of health care in Saudi Arabia [40]. Five studies highlighted that patients exhibit different levels of perceived satisfaction from different aspects of health care in Saudi Arabia [26, 30, 35, 37, 39]. In the health-care setting, several theoretical and conceptual approaches have been employed to improve health outcomes, including patient-centered communication [2,3,4,5,6]. Nurse Perceived Barriers to Effective Nurse-Client Communication @inproceedings{Brandenburg2017NursePB, title={Nurse Perceived Barriers to Effective Nurse-Client Communication}, author={Sara J Brandenburg}, year={2017} } In particular, the challenges are ascribed to several factors, mostly linked to cultural, language and religion differences. The barriers to good communication skills are many and include time pressures (nurses are so busy ad may not be able to get time to sit and talk with patients); lack of privacy; skills mix on the wards can mean there is a shortage of qualified nurses who are available to talk to patients; lack of training; and different languages. J Health Policy Manag. Anoosheh M, Zarkhah S, Faghihzadeh S, Vaismoradi M. Nurse–patient communication barriers in Iranian nursing. Client outcomes Apker, J., Propp, K.M., Ford, W.S.Z., & Hofmeister, N. (2006). 3. Preferred Reporting Items for Systematic Review and Meta-analysis. Effective communication is of the utmost importance when delivering healthcare. Patient Educ Couns. To improve patient satisfaction towards the nursing care, researchers must identify factors influencing the effective implementation of therapeutic communication between nurses and patients (Devi and Victoria, 2013; Balandin, 2007). Intensive care unit nurses' perceptions of the obstacles to the end of life care in Saudi Arabia. �x"y^:t[l9b�V�2�Sq��ʄ�? J Nurses Prof Dev. Res Theory Nurs Pract. MA, JD and MG worked closely to draft the manuscript. ��l�~�.ꦽ:�:R1�i�Cn��l80��Xsz����:n�G��W���7�h�X. 2002;8(1):16–22. Effective communication practices both within and between clinical professions are essential to minimize risk in hospital settings and improve patient care, especially during the OOH period [3, 4]. Al-Mendalawi MD. Factors associated with medication administration errors and why nurses fail to report them. From this, 124 titles and abstracts were assessed against the inclusion criteria, with 79 excluded. United States: Jones & Bartlett Learning; 2009. Sheldon LK. However, there are several barriers to nurse–patient communication in Saudi Arabia. 2015;98(10):1274–9. High-quality patient-centered communication has been shown to help patients strengthen their relationship with nurses, handle their emotions, understand important information regarding their illness, deal with uncertainty, and participate more fully in decisions regarding their health [2, 4]. The limited knowledge about the language, religion and culture of non-Saudi nurses, together with the current communication practices described earlier, have significantly contributed to nurse–patient communication barriers in Saudi Arabia. Part of There should be a focus on research in extensive training programs for nurses. Almutairi AF, Gardner G, McCarthy A. Perceptions of clinical safety climate of the multicultural nursing workforce in Saudi Arabia: a cross-sectional survey. In particular, patients may require attention in therapeutic communication to make complex and significant medical decisions. J Fam Commun Med. Further, the study was limited to papers focusing on Saudi Arabian health care, and so cannot be generalized to other settings. Have you ever tried to talk with someone from a different level of the house? Google Scholar. Developing effective nurse leaders may be more important now than at any previous time in history as many nurses are nearing the age of retirement. 1. 2019;4(2):105–10. Google Scholar. This issue is not unique to Saudi Arabia, due to increasing levels of immigration into developed countries such as United States of America and Australia, there is increasing cultural and linguistic diversity between nurses and their patients [12, 14]. Peer-reviewed articles containing any of a series of specific key terms were identified from sources such as CINAHL, EMBASE, Medline, PubMed and PsychINFO. Perception of nursing care: views of Saudi Arabian female nurses. CAS  For example, a message that includes a lot of specialist jargon and abbreviations will not be understood by a receiver who is not familiar with the terminology used.Regional colloquialisms and expressions may be misinterpreted or even considered offensive. Communication Communication skills 2: overcoming barriers to effective communication Author Moi Ali is a communications consultant, and board member of the Scottish Ambulance Service and of the Professional Standards Authority for Health and Care, and former vice president of the Nursing and Midwifery Council. (2013), these strategies include the use of interpreters or family member to translate conversations [32]. The data extraction form was developed using relevant methodological standards and criteria. Adv Nurs Sci. The integrative review used Knafl and Whittemore’s methodology [23]. !1������i,>���X�*, This leadership review will examine barriers associated with nurses developing effective leadership skills, enacting their leadership roles, and moving into leadership positions. ... (2005). In other words, your heart isn’t in it. Bozionelos [42] qualitative study of 206 expatriate nurses in Saudi Arabia found that nurses are provided with limited face-to-face training due to an overall pressure on nursing services related to the nursing shortage in Saudi Arabia. Types of Barriers: We face many barriers while communicating. This process consists of several components, including sender, receiver, context, medium, message and feedback. Aljadhey, H et al. Nurs Sci Q. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated. This was attributed to the fact that most of these expatriate nurses have limited knowledge about the practices of their patients. MA conducted the data extraction. The intended messages are not sent to the receivers . 2002;9(3):51. Five studies suggested that a comprehensive understanding of the culture, religion and language of a geographical setting play significant role in improving the quality of care and safety of the population [27, 28, 31,32,33].
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