Overseas Qualified Nurses’ intercultural communication: An exploration of perspectives, experiences, and practices

Abstract

Overseas qualified nurses (OQNs) from non-English speaking backgrounds comprise a significant proportion of Australia's health workforce. While numerous studies have identified that OQNs encounter intercultural communication challenges and dissonance, there has been little exploration into nurse educator perspectives and few observational studies of OQNs’ intercultural communication with healthcare teams and patients. The aim of this research was to examine OQNs’ perspectives, experiences, and intercultural communication practices.

The overall study design was qualitative, using semi-structured interviews and participant observation with thematic and discourse analyses, respectively. The theoretical underpinnings and principles of this research are informed by frameworks of intercultural communication, Communities of Practice, and patient-centred communication. This research comprises three studies: an interview study with nurse educators; an interview study with OQNs; and an observational study with OQNs. The first study comprised interviews with 12 nurse educators of the pre-registration course, revealing the areas and causes of communication challenges encountered by OQNs, as well as engagement strategies to address these challenges. The second study involved interviews with 21 OQNs to explore their intercultural communication experiences. The OQNs’ transition process evoked uncertainty due to concerns about language and cultural and contextual issues, leaving OQNs feeling like uncertain novices, even for those working in Australia for several years. Findings of the two interview studies informed the design of the third study, which was observational and investigated inter-professional, intra-professional and nurse-patient communication. Participants were 13 OQNs who were shadowed for a 2.5 to 3 hr period during their clinical work at a public teaching hospital. Linguistic evidence of inter-professional and intra-professional communication from the observational study showed limited casual interactions, such as small talk between OQNs and other members of the team. This lack of informal interactions can contribute to a lack of team cohesion and negatively impact open team communication. Patient-centred communication was achieved to varying degrees. The findings provided evidence of positive rapport building strategies, including non-verbal communication that assisted and countered communication hindered by lack of fluency, vocabulary and accents. Brevity in information provision to a team member or missed opportunities in offering advice or reassurance to a patient or a family member are features that impeded desirable outcomes in team communication and patient-centred communication.

Collectively, this research makes an original contribution to existing knowledge by revealing patterns of OQNs’ intercultural communication through interactional evidence from the observational study with patients and the healthcare team. In addition, the combined reflections and evidence from educators, the OQNs, and the observed interactions add to existing literature in terms of the interplay of language features on comprehension and effective communication, and also contextualise this interplay in the conduct of clinical work. These findings provide evidence that could enable OQNs to gain insight into their practices, and the local team members to reflect on their role in effective team communication. Another application of this research is its potential contribution to inform the national accreditation body for nursing, curriculum developers, and employers of the significance of developing intercultural communication competence for OQNs and healthcare teams.