Developing cultural sensitivity among Malaysian registered nurses as self-initiated expatriates in Saudi hospitals

This conceptual study explores the prerequisite to develop cultural sensitivity among Malaysian female Registered Nurses (RN) residing in Saudi Arabia who aim to become knowledge workers in the healthcare sectors. Key questions examined are: How do female RN knowledge workers acculturate themselves in a new environment and acquire cultural sensitivity? What adjustment processes were involved? In this study, we introduce a conceptual framework to explain this adjustment process and develop propositions to explain how female RN as knowledge workers adjust to a new environment where there is a large cultural distance between their home culture (Malaysia) and the host culture (Saudi Arabia). Using cultural adjustment theory we propose three classes of antecedents: individual, contextual and organizational

Regional variations in inpatient decompensated cirrhosis mortality may be associated with access to specialist care: results from a multicentre retrospective study

Introduction Specialist centres have been developed to deliver high-quality Hepatology care. However, there is geographical inequity in accessing these centres in the United Kingdom (UK). We aimed to assess the impact of these centres on decompensated cirrhosis patient outcomes and understand which patients transfer to specialist centres. Methods A UK multicentred retrospective observational study was performed including emergency admissions for patients with decompensated cirrhosis in November 2019. Admissions were grouped by specialist/non-specialist centre designation, National Health Service region and whether a transfer to a more specialist centre occurred or not. Univariable and multivariable comparisons were made. Results 1224 admissions (1168 patients) from 104 acute hospitals were included in this analysis. Patients at specialist centres were more likely to be managed by a Consultant Gastroenterologist/Hepatologist on a Gastroenterology/Hepatology ward. Only 24 patients were transferred to a more specialist centre. These patients were more likely to be admitted for gastrointestinal bleeding and were not using alcohol. Specialist centres eliminated regional variations in mortality which were present at non-specialist centres. Low specialist Consultant staffing numbers impacted mortality at non-specialist centres (aOR 2.15 (95% CI 1.18 to 4.07)) but not at specialist centres. Hospitals within areas of high prevalence of deprivation were more likely to have lower specialist Consultant staffing numbers. Conclusions Specialist Hepatology centres improve patient care and standardise outcomes for patients with decompensated cirrhosis. There is a need to support service development and care delivery at non-specialist centres. Formal referral pathways are required to ensure all patients receive access to specialist interventions