Perioperative nurses’ experiences of communication in a multicultural operating theatre: A qualitative study
Introduction
Communication is pivotal to nursing (Brereton, 1995) and more so when working as part of a team (Leonard et al., 2004). When difficulties in communication arise in high pressure technical environments such as the perioperative setting, there is a potential for adverse outcomes for patients (Nagpal et al., 2012). Moreover, when staff in the operating theatre belong to multicultural backgrounds, each with their own unique style, background and training, it is likely that breakdowns may occur during communication.
Multiculturalism has become the norm in several developed countries (Australian Bureau of Statistics, 2011, Culley, 1996, Esses and Gardner, 1996, Reisch, 2008). Whether it is due to immigration or to colonisation, the clash of cultures can cause difficulties. Issues around race and ethnicity are multiplied in the presence of low socio-economic status. The experience of immigration can cause struggle, frustration and conflict for individuals and their families as they work to gain acceptance within their new culture. This is also true in the health sector both for patients as well as for health professionals employed in a foreign system (Magnusdottir, 2005, Papadopoulos, 2006). Although the health care system seems to accept multiculturalism in the workplace, practices continue to remain monocultural (Meleis, 1999). For instance, in their study, Omeri and Atkins (2002) highlight some of the problems faced by immigrant nurses in Australia which include, ‘professional negation’, ‘otherness’, and communication problems.
Few reports have explored the dynamics of communication in a multicultural operating theatre setting. Using a phenomenological approach, this paper describes the ‘lived experiences’ of perioperative nurses in a multicultural operating theatre of a metropolitan public hospital in Melbourne, Australia.
Section snippets
Background
A multi-cultural society is one which consists of people belonging to different cultures. Such a society can exist in three different ways. First, and the most commonly observed process is where individuals belonging to the minority culture adopt most of the cultural norms and behaviours of the dominant or host group (assimilation). Second, individuals from the minority and majority groups adopt some cultural norms of the other groups (cultural pluralism) and third, where there is little
Methods
The methodology for this study was inspired by the hermeneutic phenomenology of Martin Heidegger (Dowling, 2007). According to the Heideggerian school of thought, humans construct the world from their own experience and background and hence the term ‘lived experience’ is used rather than simply ‘experience’ (Racher and Robinson, 2002). This construct acknowledges that a person's understanding of reality is influenced not only by interpretations but also by historical information (Liamputtong
Results
Fourteen semi-structured interviews were conducted with nurses working in the pre-op, scrub-scout and recovery sections of the operating theatre (See Table 1). Participants identified difficulties in communication as the most significant issue in the multicultural operating theatre. The three themes that emerged from the lived experiences of the nurses were:
- 1.
Difficulties in communication affects patient care
- 2.
Difficulties in communication affects the working atmosphere.
- 3.
Social integration could
Discussion
The findings from this study suggest that a major factor that impedes the smooth running of the operating theatre relates to the difficulties in communication between individuals from different cultural and linguistic backgrounds. Eckermann and colleagues argue that human beings do not easily tolerate difference (Eckermann, 1988). They are suspicious of strangers and react to them on the basis of ethnocentrism and stereotypes. This phenomenon is referred to as culture clash. When cultures are
Conclusion and implications
Communication by itself can pose a challenge in the operating theatre setting, but when dovetailed with multiple cultures, the challenge can be all the more complex. Although catering to the needs of patients from multicultural backgrounds in the operating theatre continues to be problematic, developing a sense of camaraderie and fostering good relationships between staff in the operating theatre can improve communication and foster a better working atmosphere. This could in turn improve
Author contributions
JC conceived the study with contributions from AI and IE. JC undertook data collection. JC carried out data analysis with help from AI and IE and wrote the initial drafts. AI, JC and IE contributed to the final drafts. All authors read and approved the final manuscript.
Acknowledgements
The authors wish to thank Allison O’Dell for her help with arrangements for data collection.
Conflict of interest
The authors declare that they have no conflict of interests.
Funding
None declared.
Ethical approval
The study's ethical approval was given by Peninsula Health (Approval number HREC/10/PH/56 dated 15th March 2011).
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