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However, the breadth of the 40 studies included, which enabled interpretation beyond single studies as well as saturation, ensured that a more comprehensive consideration of the aim, including both preconditions and consequences, relationships between parts and opposites of caring, was possible. Meta-synthesis like this study can contribute to evidence-based care from a lifeworld perspective in midwifery care Berg et al.

Quantitative studies were excluded because the results are not comparable with qualitative results. The qualitative part, used in the studies that had both quantitative and qualitative findings, could possibly have been excluded because they had only a few open-ended questions superficially analysed. However, inclusion meant that they brought both width and saturation to the other studies. Both the authors of this article have international work experience in care, research, and education.

The first author has worked in Zambia, Lesotho, Nepal, and Vietnam during a year period. Both the authors have worked in other Nordic countries and also have international contacts. Both belong to the Swedish-speaking minority in Finland. This has sensitized the authors to cultural and language questions in nursing care.

This study includes studies about caring between several cultures done in several countries.

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Although the original raw data is not available, the studies are. Health care professionals need to learn more about specific cultures and phenomena, especially the ones that they encounter most often. Professional interpreters of the same sex need to be available and used without cost for the patient.

Without a common language or functioning communication, there can be no relationship between the patient and nurse, where caring can occur. Continuity of care also seems to be an advantage for women from other cultures because it helps in building trust. Professionals with knowledge of several languages and experience from working in other cultures need to be employed.

Female professionals are preferred in maternity care. The professionals need to ask the women about their culture and their needs and show that they care. They need to inform the women and let them choose. Professionals need to be aware of their own culture and other cultures, traditions must be respected and majority culture not forced upon patients. Not only does a lack of education lead to incompetence among health care professionals but also organizations and societies are sometimes racist or discriminating against women.

An effective system to combat discrimination, racism and stereotypes to avoid ill-being and negative outcomes of childbirth is often missing. Cultural competence might not be enough because there is a risk for categorization and stereotyping when differences are focused upon.


Intercultural Economic Analysis

Cultural safety, suffering because of differences and an appreciation of common humanity should also be considered cf. Baumann, Circumcised women do not get optimal care.

Apart from a lack of awareness and knowledge and legal issues about circumcision, some midwives and doctors have no practical skills how to manage delivery and do not know when, where and how to cut. Knowledge about diet and traditional beliefs like hot—cold theory is often missing. Many women, especially Asian and African, want more help after delivery with childcare, household tasks, and personal needs to be able to rest and recover. For some women it is a double burden to adapt to a new culture at the same time as to deliver a baby and adapt to motherhood.

Especially lonely women with traumatic backgrounds and an unsure legal status are vulnerable and at risk of depression and feelings of abandonment after delivery. These women who often miss their family and community support would need female supporters from the same cultures to help them during pregnancy, delivery, and the postpartum period. In addition, support groups after delivery are beneficial. Resources like interpreters, childcare, transport, diet, material in different languages and human resources are needed and enable intercultural caring. Some practices in maternity care are influenced by western culture, e.

All cultures do not have the same autonomy concept as western cultures. For women who have no support from a family and social network, the midwife might be the only person to confide in Berggren et al. If reciprocal caring is missing there is a risk for isolation and unnecessary suffering Finfgeld-Connett, Many studies about circumcised women, health, acculturation, postnatal depression, pain, and suffering were excluded from this study.

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These and other studies in midwifery about ethnic groups like Somalis, Vietnamese, African American, and Spanish Americans could be interpreted in new meta-syntheses in the future. This study raised new questions about acculturation, disempowerment, and suffering because of immigration or ethnic affiliation. This study has highlighted the importance of context and culture in supplement to the universal and the unique dimensions of caring.

It has also shown the inner core as well as the importance of outer factors for the experience of caring by mothers in maternity care. Power, racism, and legal status have especially strong influence on how caring is experienced and on the result of the nursing and health care. In the intercultural caring model the relationship between patient and nurse is seen as reciprocal and asymmetric.

Asymmetric means that the nurse had more responsibility, but it can as seen in this study also be misused as racism. Racism, discrimination, and intolerance often have support in organizations and political and legal structures of societies or outer factors.

This study has highlighted cultural and social aspects of caring, human being, health, and suffering, which are not previously emphasized in the caritative theory. The dimensions of the intercultural caring model ontological, phenomenological, and practical activities have also been reformulated in a new and expanded way universal, culture, context, and unique.

The authors have not received any funding or benefits from industry to conduct this study.

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National Center for Biotechnology Information , U. Published online Feb 8. Author information Article notes Copyright and License information Disclaimer. Correspondence: A. E-mail: if. Accepted Sep 3. This article has been cited by other articles in PMC. Abstract The aim of this study is to explore and describe a patient perspective in research on intercultural caring in maternity care.

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Keywords: Intercultural, caring, meta-ethnography, meta-synthesis, maternity care. Introduction The world is becoming more multicultural and the Nordic countries have more patients from different cultures. Aim The aim of this meta-ethnography was to explore and describe a patient perspective in research on intercultural caring in maternity care. Expressing the synthesis in written or other form. Literature search Published research has systematically been searched for from March until March , through homepages, databases, references, authors, and journals.

Table I Studies describing intercultural caring in maternity care included in meta-synthesis. American In-depth interviews Constant comparison analysis Reid and Taylor , Republic of Ireland 13 women Traveller Unstructured non-directive interviews Data-analysis was guided by an established framework Reitmanova and Gustafson , Canada Six women Five countries In-depth semi-structured interviews Two step process of content analysis Rice , Australia 27 women Hmong Individual in-depth interviews Thematic analysis, ethnographic Rice and Naksook , Australia 30 women Thai Interviews, participant observations Thematic analysis, ethnographic Rice, Naksook, and Watson , Australia 26 women Thai Interviews, participant observations Thematic analysis, ethnographic Sharts-Hopko , Japan 20 women American Interviews Comparative content analysis Small, Rice, Yelland, and Lumely , Australia 60 of women Vietnamese, Turkish, Filipino Interviews, schedule adapted from postal questionnaire.

Yelland et al. Open in a separate window. Inclusion and exclusion criteria Inclusion and exclusion criteria have been used. Analysing and synthesizing Each article was read several times in full and its substance was analysed and expressed in metaphors themes , which were written down with their description and examples. Ethics Although ethical issues have been considered in the included studies, ethics here is primarily concerned with choosing to synthesize an important field of study that has not previously received adequate attention.

Summary and context of included articles This meta-synthesis consists of 40 articles published between and Figure 1. Caring versus non-caring Although there are many descriptions of caring, there is also non-caring. Patients want respectful and not condemning care: I was lucky when I met a midwife in Sweden who knew about circumcised women. Language and communication problems versus information and choice In almost all the studies, language or communication problems are described.

Access to medical and technological care versus incompetence In many of the studies women are very thankful of the good care they have received. Here a Somali woman talks about Swedish midwives' incompetence to care for circumcised women: I and other women who have not been opened before delivery suffer most. Acculturation: preserving the original culture versus adapting to a new culture Patients and their families want to preserve some of their culture and adapt other parts to the majority culture.

Here a Filipino woman wanted to follow her tradition but the nurses want her to adapt: The thing is we have to follow their practices here. Professional caring relationship versus family and community involvement The relationship between the patient, in this case the women and their caregiver nurses, midwives, or doctors is prerequisite to caring. Caring is important for well-being and health versus conflicts cause interrupted care Caring is presented as preserving and promoting well-being and health.

Vulnerable women with painful memories versus racism Many of the women are described as vulnerable and lonely. The overarching metaphor Alice in Wonderland was interpreted as the overarching metaphor with three aspects, when the opposite metaphors based on the findings in the 40 studies were reread and synthesized into a new whole. Intercultural caring has different dimensions: uniqueness, context, culture, and universality Caring is described as unique to each woman, as person-centered or individual.

Intercultural caring has an inner core of caring and is affected by outer factors The universal part of intercultural caring is the inner core of caring.

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Discussion The findings in this meta-synthesis explore and describe a patient perspective on intercultural caring in maternity care in 40 qualitative articles. Implications for clinical care Health care professionals need to learn more about specific cultures and phenomena, especially the ones that they encounter most often.

Future studies Many studies about circumcised women, health, acculturation, postnatal depression, pain, and suffering were excluded from this study. Conflict of interest and funding The authors have not received any funding or benefits from industry to conduct this study. References Aagaard H. Mothers' experiences of having a preterm infant in the neonatal care unit: A meta-synthesis. Journal of Pediatric Nursing. Beyond cultural competence. Nursing practice with political refugees. Nursing Science Quarterly.