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.

Thinking Critically About Rural Gender Relations: Toward a Rural Masculinity/Male Peer Support Model of Separation/Divorce Sexual Assault

After decades of neglect, a growing number of scholars have turned their attention to issues of crime and criminal justice in the rural context. Despite this improvement, rural crime research is underdeveloped theoretically, and is little informed by critical criminological perspectives. In this article, we introduce the broad tenets of a multi-level theory that links social and economic change to the reinforcement of rural patriarchy and male peer support, and in turn, how they are linked to separation/divorce sexual assault. We begin by addressing a series of misconceptions about what is rural, rural homogeneity and commonly held presumptions about the relationship of rurality, collective efficacy (and related concepts) and crime. We conclude by recommending more focused research, both qualitative and quantitative, to uncover specific link between the rural transformation and violence against women.

Dangerous Exits: The Abuse of Women in Rural America

Decade after decade, violence against women has gained more attention from scholars, policy makers, and the general public. Social scientists in particular have contributed significant empirical and theoretical understandings to this issue. Strikingly, scant attention has focused on the victimization of women who want to leave their hostile partners. This groundbreaking work challenges the perception that rural communities are safe havens from the brutality of urban living. Identifying hidden crimes of economic blackmail and psychological mistreatment, and the complex relationship between patriarchy and abuse, Walter S. DeKeseredy and Martin D. Schwartz propose concrete and effective solutions, giving voice to women who have often suffered in silence.

Policing the Rural Crisis

Based on empirical research in a number of rural communities in north-western NSW, this article explores the dynamics of rural crisis as it is manifested in and through popular attitudes and campaigns around law and order. There is no denying that crime rates in many rural communities are high, often very high by national standards, or that local crime disproportionately involves Indigenous offenders (and Indigenous victims). However, the views expressed in interviews with established White residents, in local media and in organised campaigns around law and order are suggestive of a much deeper sense of threat and crisis. This, it is argued, can be explained in relation not simply to crime rates but the way in which crime is experienced at the local level and the manner in which it is connected to other unwanted change that is seen to threaten the integrity of these communities. In order to understand these anxieties it is necessary to explore historical patterns of settlement, the economic structure and the culture of rural communities. Indigenous Australians have, at best, occupied an ambiguous and fragile position in relation to membership of these communities, a form of ‘passive’ belonging, ‘conditional’ on deference to dominant White norms governing civic and domestic life. Local Indigenous crime can be a source of deep anxiety not only because it causes harm to person and property but because it is interpreted by many Whites as a repudiation of the local social order, a signifier of larger threats to the community and on occasions as a harbinger of social breakdown. The article explores some of the key themes emerging from interview material that characterise this sense of crisis and relates them to the larger pattern of change affecting many communities: economic decline, changing government policies and priorities, the growing relative economic and political power of Indigenous people, debates about native title and so on.

Crime in Rural Australia

Contemporary rural crime is more varied and sophisticated than it once was. The new forms range from agricultural crimes, such as the theft of water designated for agricultural production, to environmental crimes such as the illegal dumping of waste. They take place side by side with “traditional” rural crimes such as cattle duffing while “urban” crimes such as drug and alcohol abuse and violent assaults are also prevalent, and on the rise. Crime in Rural Australia covers them all. It brings together leading academics who examine the major dimensions of crime and justice in rural and regional Australia including: •the extent of rural crime •farm crime •violence •juvenile crime •policing •Indigenous crime and justice •crime prevention •drugs •fear of crime, and •sentencing and punishment. It includes vignettes on rural policing and the stock squad from the perspectives of the NSW police. An ideal text for rural crime and criminology courses, Crime in Rural Australia will also be of interest to criminal justice practitioners, policy-makers, and criminology scholars. Three of the editors, Dr Elaine Barclay, Dr John Scott and Associate Professor Russell Hogg, are associated with the Centre for Rural Crime at the University of New England. Professor Joseph F. Donnermeyer is the International Research Co-ordinator for the Rural Crime Centre and is a leading US scholar on rural crime at Ohio State University.

Urban pre-service teachers’ conceptions of teaching in rural communities

Encouraging quality teaching staff to apply for and accept teaching placements in rural and remote locations is an ongoing concern internationally. The value of different support mechanisms provided for pre-service teachers attending a rural and remote practicum[1] are investigated through theories of place and the school-community nexus. Qualitative data regarding the experiences of the pre-service teachers were collected through interviews and case study notes. This project adds to our understanding of practicum in rural areas by employing a conceptual understanding of place to propose how the experiences of a four-week practicum may contribute to urban pre-service teachers’ conceptions of work and life in a rural community

Pathways for developing a 'smart' workforce : does the achievement of formal workplace qualifications encourage participation in higher education?

The purpose of this paper is to investigate a public workforce education initiative in the context of State and agency policies designed to enhance employee capabilities to adapt to a volatile and changing environment. In particular, we are concerned with public employees’ experience of a higher educational pathway that resulted in their obtaining a Diploma level qualification. In addition to understanding the employees’ experience of this pathway we were interested in whether the experience contributed to their openness to the prospect of university level education. We conducted telephone interviews with a sample of participants from the program. Employees reported very positive experience of the program; in particular employees reported enhanced efficacy beliefs, a strong sense of achievement, and a feeling of recognition. This experience is explained by four main factors; (1) a program design that was well aligned with the employees learning needs, (2) strong support by organisational staff who delivered and assessed participants on capability criteria, (3) strong management support for employees’ participation, (4) an academic ceremony that provided participants with public recognition of their achievement by valued others. Participants’ motivation to participate was primarily intrinsic rather than extrinsic. Participants in the study reported that their experience in this educational pathway gave them the confidence to consider the possibility of university level education. The paper also discusses the practitioner-academic collaboration that led to the development of this paper.