Methods: A focused ethnographic approach was adapted for this study to explore the experiences of nurses communicating with Chinese patients with dementia. Focused ethnography is an adaptation of the traditional ethnography to address a specific phenomenon experienced by a particular group (Knoblauch, 2005). The study used a non-continual, short-term field visits followed by in-depth interviews to understand the issues related to communicating with Chinese patients with dementia in a natural setting (Cruz & Higginbottom, 2013; Morse, 2007). The data was collected over a period of three months in 2016 where 19 nursing staff working in the dementia unit were interviewed using semi-structured interview. A non-participant observation was conducted without the knowledge of the staff working in the ward. This approach was approved by the University Institutional Review Board; as it enabled the researcher to observe nurses’ behaviours, communication patterns and interactions with patients in the most naturalistic environment. A non-participant observation checklist was used to guide data collection in a systematic approach. No personal identifiers of any nurse were recorded to maintain their privacy. The non-participant observation was conducted over a period of two weeks in September 2016 where the primary author observed and recorded the occurring communication processes in the dementia care unit. The cumulative time for the non-participant observation was 40 hours, and each observation lasted between 45 and 180 minutes during the morning and afternoon shift. Field notes including the descriptions of the context, unique events, typical routines, as well as the primary author’s reflections were recorded discretely during the observations. A semi-structured interview approach was also used to provide a framework to guide researchers (Holstein & Gubrium, 2011) during the interview. The interview questions followed an open-ended approach to explore the participants’ experiences when communicating with patients with dementia. Examples of interview questions asked were: “Can you share with me what you characteristics a nurse need to have when taking care of patients with dementia?”; “Can you share with me how your experience when communicating with patient with dementia.” Probing questions were also asked to clarify responses of the participants when needed. The one-on-one interviews (n = 19) were approximately 50 to 80 minutes in duration and all interviews were conducted in a private room by the researcher. All interviews were audio-taped with participants’ consent. Data from non-participant observations, interview transcripts and field notes were triangulated for thematic analysis using the six-step approach suggested by Braun and Clark.
Results: In this study, “Embracing diversity and accepting the difference” was found to be the central theme to describe the phenomenon as experienced by the nurses working with Chinese patients with dementia. This description highlighted that, although the nurses encountered barriers in communicating with patients with dementia, they acknowledged that they should be more understanding and accepting of the behaviours of their patients due to their illness, and that they have a role in ensuring that they can communicate more effectively with them. The three subthemes which supported the central exhaustive description: (i) acknowledging cultural differences, (ii) understanding the patients and (iii) overcoming communication challenges.
Conclusion: This study highlighted the need for nurses to understand Chinese cultural characteristics among patients with dementia especially to emotional expressions when not being understood by others, re-examine work demands, and the importance of ongoing education and support for the nurses working in a dementia care unit.