A case study examination of the influence of cultural diversity in the multicultural nursing workforce on the quality of care and patient safety in a Saudi Arabian hospital

The purpose of the study: The purpose of this study is to investigate the influence of cultural diversity, in a multicultural nursing workforce, on the quality and safety of patient care and the work environment at King Abdul-Aziz Medical City, Riyadh region. Study background: Due to global migration and workforce mobility, to varying degrees, cultural diversity exists in most health services around the world, particularly occurring where the health care workforce is multicultural or where the domestic population comprises minority groups from different cultures speaking different languages. Further complexities occur when countries have a multicultural workforce which is different from the population for whom they care, in addition to the workers being from culturally diverse countries and with different languages. In Saudi Arabia the health system is mainly staffed by expatriate nurses who comprise 67.7% of the total number of nurses. Study design: This research utilised a case study design which incorporated multiple methods including survey, qualitative interviews and document review. Methods: The participant nurses were selected for the survey via a population sampling strategy; 319 nurses returned their completed Safety Climate Survey questionnaires. Descriptive and inferential statistics (Kruskal–Wallis test) were used to analyse survey data. For the qualitative component of the study, a purposive sampling strategy was used; 24 nurses were interviewed using a semi-structured interview technique. The documentary review included KAMC-R policy documents that met the inclusion criteria using a predetermined data abstraction instrument. Content analysis was used to analyse the policy documents data. Results: The data revealed the nurses‘ perceptions of the clinical climate in this multicultural environment is that it was unsafe, with a mean score of 3.9 out of 5. No significant difference was detected between the age groups or years of experience of the nurses and the perception of safety climate in this context; the study did reveal a statistically significant difference between the cultural background categories and the perception of safety climate. The qualitative phase indicated that the nurses within this environment were struggling to achieve cultural competence; consequently, they were having difficulties in meeting the patients‘ cultural and spiritual needs as well as maintaining a high standard of care. The results also indicated that nurses were disempowered in this context. Importantly, there was inadequate support by the organisation to manage the cultural diversity issue and to protect patients from any associated risks, as demonstrated by the policy documents and supported by the nurses‘ experiences. The study also illustrated the limitations of the conceptual framework of cultural competence when tested in this multicultural workforce context. Therefore, this study generated amendments to the model that is suitable to be used in the context of a multicultural nursing workforce. Conclusion: The multicultural nature of this nursing work environment is inherently risky due to the conflicts that arise from the different cultural norms, beliefs, behaviours and languages. Further, there was uncertainty within the multicultural nursing workforce about the clinical and cultural safety of the patient care environment and about the cultural safety of the nursing workforce. The findings of the study contribute important new knowledge to the area of patient and nurse safety in a multicultural environment and contribute theoretical development to the field of cultural competence. Specifically, the findings will inform policy and practice related to patient care in the context of cultural diversity.

Towards a comprehensive and integrated knowledge-based urban development model : status quo and directions

Incorporating knowledge based urban development (KBUD) strategies in the urban planning and development process is a challenging and complex task due to the fragmented and incoherent nature of the existing KBUD models. This paper scrutinizes and compares these KBUD models with an aim of identifying key and common features that help in developing a new comprehensive and integrated KBUD model. The features and characteristics of the existing KBUD models are determined through a thorough literature review and the analysis reveals that while these models are invaluable and useful in some cases, lack of a comprehensive perspective and absence of full integration of all necessary development domains render them incomplete as a generic model. The proposed KBUD model considers all central elements of urban development and sets an effective platform for planners and developers to achieve more holistic development outcomes. The proposed model, when developed further, has a high potential to support researchers, practitioners and particularly city and state administrations that are aiming to a knowledge-based development.

Tampere region under the microscope : a critical analysis from the knowledge perspective

Purpose – In the context of global knowledge economy, knowledge-based urban development (KBUD) is seen as an effective development strategy for city-regions to survive, flourish and become highly competitive urban agglomerations – i.e., a knowledge city-region. This paper aims to evaluate the KBUD dynamics, capacity and potentials of a rapidly emerging knowledge city-region of Finland – Tampere region. Design/methodology/approach – The paper undertakes a review of the literature on regional development in the knowledge economy era. It adopts a qualitative analysis technique to scrutinize the dynamics, capacity and potentials of Tampere region. The semi-structured interview process starts with the pre-determined key actors of the city-region with an aim of determining the other key players. Next, with the participation of all key players to the interviews, the research reveals the principal issues, assets and mechanisms that relate to KBUD, and portrays the strengths, weaknesses, opportunities and threats of the city-region. A critical analysis of the findings along with the previous studies is undertaken to provide a clear picture of the dynamics, capacity and potentials of the emerging knowledge city-region. Originality/value – This paper reports the findings of a pioneering study focusing on the investigation of the KBUD dynamics, capacity and potentials of Tampere region. The paper critically evaluates the city-region from the knowledge perspective with the lens of KBUD, and the lessons learned and the methodological approach of the paper shed light to other city-regions seeking such development. Practical implications – The paper discusses the findings of a study from Tampere region that critically scrutinizes the KBUD experience of the city-region. The research provides an invaluable opportunity to inform the regional decision-, policy- and plan-making mechanisms by determining key issues, actors, assets, processes and potential development directions for the KBUD of Tampere region.

Comparing: knowledge-based urban development of Vancouver, Melbourne, Manchester and Boston

The research reported in this paper introduces a knowledge-based urban development assessment framework, which is constructed in order to evaluate and assist in the (re)formulation of local and regional policy frameworks and applications necessary in knowledge city transformations. The paper also reports the findings of an application of this framework in a comparative study of Boston, Vancouver, Melbourne and Manchester. The paper with its assessment framework: demonstrates an innovative way of examining the knowledge-based development capacity of cities by scrutinising their economic, socio-cultural, enviro-urban and institutional development mechanisms and capabilities; presents some of the generic indicators used to evaluate knowledge-based development performance of cities; reveals how a city can benchmark its development level against that of other cities, and; provides insights for achieving a more sustainable and knowledge-based development.