Culture Competency of Nurses in Saudi Arabia

Saudi Arabia is a center of Islam culture, being the place of pilgrimage and sacred relics. This aspect influences its population diversity and it especially concerns the health care system. Saudi Arabia medical personnel experiences major challenges in the working process and communication not only with the patients but also among the working staff. The nurses come from different countries such as India, the Philippines and many others. Since the staff varies in age, gender, competence, and education, the issue of cultural competency is quite critical. The diverse workforce creates significant problems for the health care system of Saudi Arabia. That is why the nurses need an assistance program for the professional development in the area of cultural competence, which helps to develop awareness about Saudi culture and identity for the nurses. Thus, cultural diversity of the nurses in Saudi Arabia reduces the quality of nursing service in the hospitals due to such issues as religious incompetence, lack of cultural knowledge, and communication, making it crucial to take some steps to improve the situation.

Identification of the Problem

The problem in nursing of Saudi Arabia is aggravated by the expatriate nurses, who are not educated enough about the culture and traditions of the country. Despite a variety of programs and attempts to enhance the situation, the problem is still grave and the nurses’ cultural competence is low. The research shows that all the efforts are in vain because the process is quite challenging and complex (Inocian, 2015). The nurses have serious gaps in cultural knowledge, as well as poor attitudes and understanding in the field of culture of Saudi Arabia. In addition, they have significant problems with communication because of insufficient communication skills and language knowledge. There is no possibility of using the assistance of an interpreter. There is also a significant problem of prejudice and ethnocentrism because of weak policy support. It influences the behaviors and attitudes of the patients and their relations with the medical personnel. Aside from expatriated nurses, the citizens of India and the Philippines who work in Saudi Arabia may also be unaware of different cultural aspects. The statistics show that the citizens form these countries constitute 53% and 39% accordingly (Inocent, 2015). It is an important issue for the nurses, as from the perspective of nursing the culture is a wide range of components in the working process such as communication, customs, values, actions, beliefs, ethics, and racial issues, as well as social and religious aspects. The medicine is closely related with the sacred rituals and beliefs of people, which should be deeply respected, considered, and applied in the process of treatment. Cultural competency includes not only medical skills to help during the recovery of the patient but also some cognitive skills to keep the appropriate relations with the people. The statistics show that the majority of the nurses in Saudi Arabia are from Asia and South Asia. It is estimated that about 87% of them come from Asian regions, while only 12,5% are form Arab countries and Saudi Arabia (Al-Wahbi, Kernohan, & Curran, 2014). The majority have little experience in the hospital settings since, according to statistics, 81% of nurses have less than 3 years of nursing experience (Al-Wahbi et al., 2014). Moreover, 56% of the nurses do not have previous cultural education of the nursing care (Al-Wahbi et al., 2014). The needs of the patients in Saudi Arabia are quite diverse. Furthermore, the nurses should not only be appropriate health care providers for the Saudi patients but also be appropriate in communication with the coworkers. Incompetence in religious issues does the biggest harm for the Saudi Arabia population.

Religious Incompetence

Religion of the Saudi citizens demands the biggest consideration and respect from the nursing personnel. People stick to strict rules of fasting during the ninth month of the Islamic calendar, known as Ramadan. In respect for the Muslim population, the representatives of other religions are not allowed to eat and drink in public places. It also concerns a variety of possible issues related to drinking and eating, such as bottles of water in the corridors of the hospitals. The nurses should be aware of fasting. They may not eat or drink in the hospital, as any association with food means disrespect towards the traditions. That is why the nurses should get the necessary education about the essence and importance of fasting; they should read the Quran passages associated with Ramadan prescriptions. In addition, during this time, the Muslims are allowed to work 72 hours out of 88. That is why non-Muslim nurses should respect such aspects and cover the shifts of their coworkers. Disrespect towards both the coworkers and the patients in the aspect of cultural diversity also concerns other religions.

People cannot apply the practices of their national religions and traditions in Saudi Arabia. The problem is that the nurses of different religions do not take into consideration these rules, as they are prohibited to pray and read the sacred texts of other religions. The problem is that the other rituals and practices in Saudi Arabia are restricted. This code of religious respect and ethics should be widely taught to the nurses in the Kingdom. The women in the country must wear traditional female clothes abaya regardless of their own religious beliefs (Karout et al., 2013). Thus, the dress code, fasting, the working process, and a number of other religious issues should be educated and applied by the nurses in the health care system of Saudi Arabia. The workers should be professional nurses in terms of transcultural nursing.

Transcultural Nursing in Saudi Arabia

Transcultural nursing includes wide cultural knowledge concerning gender ethics, language, religion, and values. Despite ethnical diversity in the state, the nurses are poorly educated in this aspect. They are almost unaware about the main issues of one of the most closed countries in the world. They lack knowledge about such practices as breastfeeding, Ko’hl, the “evil eye”, taboos in medicine, and others (Luna, 1998). The in-service education for the non-Muslim nurses in the Muslim countries is insufficient, which breaks the rules of the Islamic people. The issue should be considered and addressed because the Kingdom always requires the recruitment of additional working power from other countries. The quality of cultural competence can be enhanced in this aspect of transcultural nursing. The majority of the nurses are recruited for the maternity assistance in Saudi Arabia. That is why they must be aware about parental care (Karout et al., 2013). It is not sufficient to have surface knowledge about just food, clothes, or praying, the nurse should be deeply taught about all religious practices, norms, prohibitions, traditions, beliefs, phrases, and even language expressions.

Language Issues

The language barriers are one of the most complicated reasons for misunderstandings and poor communication in the diverse nursing of Saudi Arabia. The nurses cannot communicate appropriately with the patients and with their coworkers form the Kingdom. It is reported that the healthcare employees lack communication, which limits the abilities of treatment process and increases gaps between the people. The healthcare needs of the patients are affected and often violated. Misunderstanding is quite common since it is estimated that 87% of communication during the process of nursing practice in the hospital happens in other languages (Al-Wahbi et al., 2014). Moreover, the language affects not only the ability to communicate but also the cultural aspect. The nurse may be able to communicate in Arabian but not be able to explain or understand something, as some words have cultural connotations and specific meanings or several definitions (Almutairi, 2015). It is not enough to learn the language, it is necessary to be aware about cultural issues and ethnic patterns in communication. The nurse should know what is not appropriate to say or what is necessary to say at a certain moment. The language problem is even more complicated because of the impossibility to use interpreting services. The hospitals of Saudi Arabia demand not only enhancing the cultural competence, but also the usage of interpreting services in the hospitals (Albougami, 2015). In such circumstances, effective communication can be achieved as it will reduce the errors in understanding and communication, diminish disparities, and make the healthcare system comfortable. It is reported that the Saudi patients are not satisfied with the service of the nurses and the manner in which the nurses communicate with them. After interviewing 300 patients it was found out that the majority of them was not satisfied and associated it with the lack of knowledge, cultural competence, and communication skills of the nurses (Albougami, 2015). Moreover, the patients were dissatisfied because of many errors. Insignificant and serious errors in the nursing prescriptions and conclusions, in the data, personal histories, and other issues are common for the country with a complicated language barrier in nursing. It is estimated that the rate of errors in the orders is 56 per 100 orders (Albougami, 2015). In general, the system of healthcare suffers and is violated because of the wide cultural and ethnical diversity in the Kingdom. Furthermore, the citizens and even the children become the victims of such circumstances. The situation demands significant changes and intervention.

Recommendations

It is highly recommended to start the process of training and education of the nursing personnel in the aspect of cultural competence. It can be helpful for the nurses in acquiring the necessary transcultural knowledge. Such professionals will be more sincere, tender, sensitive, attentive, respectful, and efficient. The competence enhancement system is not properly developed and widely applied in the country, which leaves the problem unsolved. The system should be applied as soon as possible in such a country as Saudi Arabia because the state experiences wide and massive immigration of the working force, especially in the area of medicine. Aside from immigration, the expatriate nurses also need training and cultural competence education. 67% of all the nurses in the state previously had a different linguistic background (Aboshaiqa, Tumala, Inocian, Almutairi, & Atallah, 2017). It is necessary not only for the respectful and professional care, but also for the enhancement of communication within the hospital and for safeguarding their emotional, physical, and spiritual state. The risk of misunderstanding is quite high as well as reaction of the public to the lack of awareness of the nurses and their disrespectful attitude towards national sacred issues. Moreover, the nurse can be under a threat of aggressive attitude of the patients observing cultural incompetence (Truong, Paradies, & Priest, 2014).

The enhancement can be applied not only for the students of the universities and colleges but there should also be some practical programs for the nurses in the hospitals. It can be in the form of courses and lections performed by professional linguists, psychologists, experts in religion, traditions, and sociology. It would also be necessary to include a short course of economy and governmental system as these aspects are closely related with cultural patterns. The program of the training and motivation should be developed with the consideration of the changes in attitudes and diminishing the stereotypes (Truong et al., 2014). The programs and courses should be aimed at several directions, including cultural competence theory, coordination of behavior, clinical decision-making training, and development of communication skills (Aboshaiqa et al., 2017). Nurses that immigrated to Saudi Arabia from different countries usually arrived with different prejudices and stigmatized attitudes about the Saudi people (Al-Wahbi et al., 2014). Though their health problems are the same as in any part of the world, the concepts and attitudes toward the disease are different. The stereotyping should be reduced during the process of education and training. Aside from these changes, the system of monitoring and data collections should be improved, in order to observe the changes in the service quality and the changes in attitudes of the patients toward the health care providers in Saudi Arabia. Cultural aspects in the healthcare system of Saudi Arabia are as necessary and critical as proficient and skilled medical assistance, since culture is the most important aspect of human life related to health and quality of life.

Thus, Saudi Arabia patients suffer from incompetent attitudes and care of the health care providers. The problem is related to recruiting of the nurse staff form different countries. The majority of the immigrants are from Asia. Many expatriated nurses also face some issues of cultural incompetence. The patients of the hospitals are unsatisfied by the service because of the communication limitations and problems with understanding. The nurses are aware of the main religious restrictions and norms of the country but they do not respect the sacred patterns of Saudi Arabian patients, being non-Muslim medical providers. The cultural incompetence is quite critical in the Kingdom because it influences the quality of medical assistance and the process of treatment and comfort of the patient. The nurses should not only respect the rules of the citizens but also stick to the same traditions. The problem has to be addressed as soon as possible, and it is necessary to initiate a program of training and education of the diverse personnel with cultural incompetence.

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