Research Critique on Impact of Nursing diversity

Is the research study relevant to the study of nursing?

This research proves to be relevant to the study and practice of nursing by addressing issues surrounding ethnic diversity, specifically in nursing homes. This study informs the reader that in order to meet the rising health demands caused by increased globalization and a rising geriatric population, the need for a multicultural healthcare workforce has and will continue to become an evident reality across many countries. This research article describes the benefits experienced in a geriatric care facility where diversity in the nursing staff was made a priority by managers. Such benefits included increased sense of belonging throughout employees as well as reduced amounts of reported racial discrimination. Results drawn from this study reach a consensus that “A multicultural workforce can contribute to increased access to higher-quality care services for the entire population” (Debesay et al., 2022). It is stated however, diversity in the nursing workforce must be acknowledged beyond mere representation; To ensure an effective organization, managers must develop an inclusive organizational culture, and they must be able to engage with and deescalate difficult topics and conflicts that may arise in a multicultural workforce. Examples in this study included racism/verbal abuse directed at RN’s as well as decreased language proficiency amongst staff which was difficult but necessary to discuss and collaborate on solutions for. These efforts create a safe, inclusive and productive working environment, and implementation of these values is relevant and should be duplicated throughout global nursing practice.

Is the method/design appropriate in terms of the research question/hypothesis?

This study is based on a hermeneutic-phenomenological approach with interest in understanding the subjective experiences of various healthcare staff, leaders, and Registered Nurses in a multicultural workforce in municipal and private nursing homes. A phenomenological method is the best fit for this interpretive study; In phenomenological studies, the main data source is in-depth interviews with individuals who have experienced the phenomenon of interest (Polit & Beck 2021). Through these conversations, the researcher's goal is to enter another’s world and to discover the understandings found there. This method allowed the collection of personal accounts from all aggregate populations involved, ensuring adequate representation. A semi-structured interview guide was used to explore the participants’ perspectives on and experiences of working at and/or managing an ethnically diverse organization, their perceived benefits and challenges of working in an ethnically diverse organization, ways in which they utilize such diversity, and the need for further support in this regard. Each interview lasted approximately 60 min. All interviews were audio recorded, transcribed verbatim and anonymized (Debesay et al., 2022).

What was the research question/hypothesis? Was it clearly stated?

The research question in this article was not clearly stated. The authors stated “We still know little about how diversity is perceived and experienced from the perspective of both ethnic minority and majority healthcare workers in the everyday organizational culture of nursing homes. Therefore, we have explored how a multicultural workplace is endured through the accounts of employees and leaders in nursing homes.” It was stated there is a need to observe and acknowledge how multicultural work communities in nursing homes function. Although a question was not formally stated, the reader was made clear that this research was aimed at understanding how organizations and the workforce relate to ethnic diversity and multiculturalism.

What is the theoretical context/conceptual frameworks? If your article does not have a theoretical framework what do you suggest?

This article does not have a set theoretical framework. However, the Human-Environment Interaction seems to be the best fit for this study. According to Moran and Brondízio (2015), the Human-Environment Interaction framework is concerned with the processual relationships between people and environment as grounded in social contexts. This conceptual framework postulates that people and their specific cultures have a relation with the environment. This type of work brings about new methods and theories to the challenges posed by societal concerns and connects theory and practice in ways that address problems that arise from human interactions with the environment. This is a perfect fit in this research where negative interactions may occur due to personal attitudes and perceptions, and collaboration is needed amongst the population without need for managerial interference . Finally, the Human-Environment Interaction framework is concerned with advancing understanding of the interdependence of social and environmental problems through a network of interdisciplinary collaboration built upon the complementarity with disciplinary knowledge (Moran & Brondízio 2015).

Describe the results of the study, are they believable ?

This research produced results that were believable. Firstly, an appropriate sample size of 16 people were used. Amongst this group , there were nine native born nurses and seven foreign born nurses. The ages of these participants ranged from 30-60 years old and all participants had career experience ranging from 2 - 30 years as a Registered Nurses. Out of 16 participants only 2 were male. This sample size contains a diverse group that is representative of the average global nursing workforce. Sixteen participants proved to be an adequate sample size; In using a larger number of participants, there is no way to ensure a timely return of responses. One such finding being healthcare workers from majority backgrounds, without prior experience of working in diverse settings, did not reflect much about diversity in their everyday work life as compared to workers from minority backgrounds. This is quite common practice for any previously unaffected group who is not used to experiencing discrimination. Secondly, it was noted that diversity was often discussed by Nurses in relation to celebrations such as United Nations Day or specific potluck style lunch days. This demonstrated how having marked days for common activities serves as a symbolic model for collective practices to unite employees and integrate them into a shared social and cultural sphere of meaning. According to Debesay et al. (2022) These purposeful practices reflect the efforts and concern of organizational culture which may help nursing home wards to establish shared values in a multicultural workforce. Results from this study show how organizations connect with and utilize people so that they can collectively shed light on assumptions and values of the organization with regard to diversity without the added feeling of performative or superficial actions.

Are the results significant? In what way- use examples?

The results of this study are undeniably significant and should be repeated on a grand scale across many nations who struggle to maintain basic human rights by discriminating against ones cultural or ethnic background. According to the research, several people felt that a multicultural ward “contributes to greater understanding across different cultural backgrounds”. For example, a Registered Nurses said she has worked for a long time in environments where the RN’s have different backgrounds and that this made her more aware of various issues in the intercultural relations in the units. Moving forward, some significant themes analyzed in this research included understanding diversity through shared norms and multicultural experience , as well as challenging traditional norms in a multicultural workforce. According to research done by Debesay et al. (2022) ,some staff pointed out that a few RN’s were not used to shaking hands or having close contact with their head nurses (p.8). Nurse managers and supervisors also stated some colleagues from minority backgrounds were reluctant to contact them in the department and often failed to express problems they faced or needs they had. These results are significant because there was a misperception among the participants that some RN’s with minority backgrounds exhibited what they perceived to be more respect for leaders - making them less inclined to seek out their charge nurses if needed. With open and non judgemental discussion, these misconceptions and reluctance were able to be clarified and improved upon, increasing delivery of effective and safe care. Moreover, our findings indicate that the presence of employees from diverse cultural backgrounds was perceived as a benefit when issues of staffing capacity in connection with holidays and weekends presented a common challenge. It was stated in this study that several minority workers were able to take up work shifts during the majority population’s holidays, creating a sense of partnership and collaboration amongst staff. This is the most believable aspect in my opinion, because companionship is felt when someone is able to fulfill a person's need , causing them to reciprocate the action for the other person whenever needed.

Are the results transferable? How?

No, the results of this qualitative study are not transferable. Regarding transferability, this study provides a wide range of participants’ perspectives as well as contextual information to enable thick description and meaningful interpretations.(Debesay et al., 2022) However, since only individual interviews were conducted , this may have limited understanding about their responses in a group setting. Focus group discussions on similar institutions in other parts of the country and internationally are therefore recommended. Although the inclusivity practices of this long term geriatric healthcare facility should be duplicated, this documented lived experience of the participants cannot be repeated or reused in another trial, but expansion is strongly urged to reduce the evident gaps in multicultural nursing equality.

How does this research apply to YOUR specific practice as a Registered Nurse?

Since I belong to a minority ethnic group, I feel as if I already view nursing through a different lens. This research emphasizes the need for increased recruitment of multicultural Registered Nurses based on global trends of increasing age and increasing numbers of minority populations. Although I live in one of the most diverse regions on Earth, I have definitely scanned the halls of Intensive Care Units and observed the faces of who obtains the managerial positions, and found myself wondering where the adequate racial representation was. This is not to say those who currently hold these titles are unworthy, but rather that these opportunities should be presented to everyone, including diverse populations so that all those involved can benefit from their contributions and insight. Some of the major benefits of diversity and inclusion in the workplace is a new flow of ideas and creativity. Institutions of care should harness this and observe how these employees will fill the needed gaps and cultivate a productive,non ignorant, and well rounded workplace. Moving forward, this research applies to me in the fact that working in a facility that prioritizes diversity -including gender,age, and religious- is a huge area of importance to me. It is stated in the research that “Healthcare workers must feel included in that the working environment is adapted to their need for increased competence and wellbeing.” (Debesay et al., 2022) (p.12) I will be an advocate for appropriate and adequate representation in the nursing field while making sure I am providing culturally competent care to the best of my ability to all my patients so that I can lead by example.

Implications for nursing practice, be specific, how would this study impact nursing practice (use specific examples from the article)?

This study impacts nursing practice by demonstrating the need for increased knowledge and awareness of how multicultural work communities in nursing homes function. Although the participants in our study rationalized such diverse encounters and showed understanding, such incidents can nevertheless take a turn and cause psychological and emotional impact. As stated by Debesay et al. (2022), “feeling isolated, or marginalized can also lead to withdrawal and disengagement from work and thereby impact the overall mission of the healthcare facility” (p. 11) . For example, in this study it was noted that minority staff found it challenging to talk about their experience of discriminatory encounters out of the concern that they will be perceived as those who pose the problem. Such incidents pose a challenge to both the internal and external health of the organization, causing a rift in the total wellbeing of the RN’s and patients. However, when negative incidents are left unaddressed, they are construed as “unproblematic and normal”. There is a need for formal processes to deal with incidents, which include,discussions with the affected employee and discussions with the team to share and learn from such experiences. While patient centered care must remain our top priority as Registered Nurses, we need to ensure we are also being protected and not pouring from an empty cup- inevitably leading to burnout. Finally, nursing managers must raise their awareness of leading multicultural units and know their employees’ situations and varied needs in working life. For example, they must prevent harassment in the ward by taking any instances of patients’ racism seriously, as it can have major consequences for the wellbeing of healthcare workers and their functioning in the workplace.

Implications for future research, be specific and use examples from the article.

Considering the data and trends surrounding the issue , there is a need for more Registered Nurses working in Nursing Homes. There is also zero room and tolerance for discrimination of any kind, especially racial discrimination, in this day and age. Persons with immigrant backgrounds will undoubtedly be a major asset in this regard. Therefore, it is important to ensure fair working conditions, respect , and competent and engaged management that understand the challenges and will support RN’s with minority backgrounds. In order to fully take advantage of the benefits of diversity, institutions of care should aim at promoting inclusion, which serves as a key to gaining the benefits of diversity.According to this research, inclusion involves “how well organizations and their members fully connect with, engage, and utilize people across all types of differences”(Debesay et al., 2022). Both the psychological wellbeing of RN’s and the enhanced delivery of care to our elderly patients highly depend on the commitment of management to increase ethnic inclusion of their staff.

1. Debesay, J., Arora, S., & Fougner, M. (2022). Organizational culture and ethnic diversity in nursing homes: A qualitative study of healthcare workers’ and ward nurses’ experiences. BMC Health Services Research, 22(1). https://doi.org/10.1186/s12913-022-08184-y