title: Facing diversity under institutional constraints: challenging situations for community nurses when providing care to ethnic minority patients.
abstract: OBJECTIVE
  To explore the challenges faced by community nurses when providing home health care to ethnic minority patients.
  
  
  BACKGROUND
  Norway has a growing number of immigrants, including older immigrant patients. Community nurses who provide home care encounter considerable challenges when delivering services to an increasingly diverse patient population.
  
  
  METHODS
  A qualitative study based on a hermeneutics approach.
  
  
  METHODS
  A qualitative study was conducted involving 19 nurses in Norwegian home health care districts, which had high proportions of minority patients. Data were collected in 2008.
  
  
  RESULTS
  We identified three critical aspects of the encounters between community nurses and minority patients. The first was intimate care. Nurses perceived the fear of mistakes and crossing boundaries related to the cultural and religious practices of minority patients as particularly stressful. The second was rehabilitation after stroke. The beliefs of nurses in the benefits of rapid rehabilitation conflicted with those of the minority patients and their relatives who favoured extended rest during recovery. Third, the commitment of community nurses to transparency in the care of dying patients was tested severely when they met relatives who believed in religious explanations for the destinies of patients and who wanted to conceal the true diagnosis from terminally ill patients.
  
  
  CONCLUSIONS
  Community nurses encountered various challenges due to a lack of experience with highly diverse patient populations. This situation will continue to create difficulties for nurses and minority patients if management support and appropriate training measures are not provided.
authors.affiliation: Faculty of Health Sciences, Department of Nursing, Oslo and Akershus University College of Applied Sciences, Norway.
authors.forename: Jonas
authors.initials: J
authors.lastname: Debesay
authors.affiliation: Faculty of Social Sciences, Department of Social Work, Child Welfare and Social Policy, Oslo and Akershus University College of Applied Sciences, Norway.
authors.forename: Ivan
authors.initials: I
authors.lastname: Harsløf
authors.affiliation: European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, UK.
authors.forename: Bernd
authors.initials: B
authors.lastname: Rechel
authors.affiliation: Faculty of Social Sciences, Department of Social Anthropology, University of Oslo, Norway.
authors.forename: Halvard
authors.initials: H
authors.lastname: Vike
mesh_terms: D000223:Adaptation, Psychological; D003152:Community Health Nursing; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008913:Minority Groups; D009664:Norway; D009723:Nurse-Patient Relations
keywords: diversity; front-line worker; home care; institutional constraints; transcultural nursing