title: Sociocultural and linguistic boundaries influencing intercultural communication between nurses and Moroccan patients in southern Spain: a focused ethnography.
abstract: BACKGROUND
  During the last 25 years, cultural diversity has increased substantially with global migration. In more recent years this has become highly evident in the south of Spain with its steadily increasing Moroccan population. The accompanying differences in ethnocultural values and traditions between the host and newcomer populations may greatly impact healthcare interactions and thus also effective provision of care. This landscape provides for excellent exploration of intercultural communication in healthcare settings and elucidation of possible ways to overcome existing barriers to provision of culturally competent care by nurses. This study aimed to ascertain how nurses perceive their intercultural communication with Moroccan patients and what barriers are evident which may be preventing effective communication and care.
  
  
  METHODS
  A focused ethnography was conducted with semi-structured interviews of 32 nurses in three public hospitals in southern Spain. Interviews were audio-recorded and transcribed verbatim before undergoing translation and back-translation between Spanish and English. Data was managed, classified and ordered with the aid of AQUAD.6 (Günter L. Huber, Tübingen, Germany) qualitative data analysis software.
  
  
  RESULTS
  As an important dimension of cultural competence, findings from the interviews with nurses in this study were interpreted within the framework of intercultural communication. Various barriers, for which we have termed "boundaries", seem to exist preventing effective communication between nurses and their patients. The substantial language barrier seems to negatively affect communication. Relations between the nurses and their Moroccan patients are also marked by prejudices and social stereotypes which likely compromise the provision of culturally appropriate care.
  
  
  CONCLUSIONS
  The language barrier may compromise nursing care delivery and could be readily overcome by implementation of professional interpretation within the hospital settings. Moreover, it is essential that the nurses of southern Spain are educated in the provision of culturally appropriate and sensitive care.
authors.affiliation: Department of Humanities and Education Science, Universidad de Almeria, Ctra. Sacramento s/n, La Cañada de San Urbano, Building No. 2 (Building C), Office 0.222, 04120, Almería, Spain.
authors.forename: Fernando J
authors.initials: FJ
authors.lastname: Plaza Del Pino
authors.affiliation: Department of Humanities and Education Science, Universidad de Almeria, Ctra. Sacramento s/n, La Cañada de San Urbano, Building No. 2 (Building C), Office 0.222, 04120, Almería, Spain.
authors.forename: Encarnación
authors.initials: E
authors.lastname: Soriano
authors.affiliation: Faculty of Nursing, University of Alberta, 3rd Floor Edmonton Clinic Health Academy, 11405 87th Avenue, Edmonton T6G 1C9, Canada.
authors.forename: Gina Ma
authors.initials: GM
authors.lastname: Higginbottom
keywords: Cultural competency in nursing; Immigration in Spain; Intercultural communication; Moroccan immigrants