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The native language requirement of foreign nurses who work in elderly homes in Malta

Student Name: Jojo Thomas

ID number:

Unit code and title: Research in Nursing

Title of assignment: Research Proposal

Name of Unit Coordinator:

Due date: 28/03/2019

Word count: 2500

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The native language requirement of foreign nurses who work in elderly homes in Malta


The native language requirement of foreign nurses who work in the elderly homes in

Malta is a great concern of today, because of the Maltese language, the official language of

Malta, which is a mixture of Arabic, Italian, English, and French and it is one of the toughest

languages in the world. The new generation can speak English; however, many of the older

people cannot speak English, and they use the Maltese language to communicate. The newly

recruited foreign nurses will have difficulty in understanding this language because the

management will not provide any training for these staff members to learn this language. How

can native language proficiency of overseas nurses improve the quality of nursing care in elderly

homes in Malta? This would be the question getting investigated. Interpersonal relationship

between nurses and residents are affected mainly when there is a communication barrier. These

communication barriers will affect the client’s recovery or well-being (Sethi & Rani, 2017).

This study is important because the local language barrier of the foreign nurses may put the

residents at risk of reduced quality of care delivery (Sethi & Rani 2017). Many of the elderly

residents may not communicate in English and the use the local language to communicate with

their health care providers. Patients who have some communication problems are more likely to

be experienced with clinical or medical complications (Sethi & Rani 2017). So this problem is

significant and worthy to be explored.

This would be an interpretative qualitative study using purposive sampling, and the

analysis will be based on phenomenology. It will explain how the nurses and the residents

experienced the problems occurred due to the language barrier of the foreign nurses and what

was their response. The majority of the nurses and patients have reported that the language
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barrier is an obstruction of quality care delivery (Amoah, Anokye, Boakye, Acheampong, Budu-

Ainooson, Okyere, Afriyie, 2019). Depending on the nursing theories is one of the ways to

develop professional knowledge and communication skills. This would provide a rationale and

the systematic practice to nursing, which promote the moral and ethical framework to guide

nursing actions (da Silva, Costa, Silva, Oliveira, Almeida, &Fernandes, 2015). The nurse should

use the tools of communication that is listening, clarification, and acceptance (da Silva et al.,

2015). The native language skills are essential to utilize all the tools of communication

effectively, especially in elderly care.

Literature review

There are several studies that have been conducted to find out the communication barriers

between nurses and elderly residents. In a study conducted among the residents of the state of

Victoria in Australia determined that a large number of languages have been used by many

residents from a non-English speaking background with a large unmet language resources

need( Runci, Eppingstall, Ploeg, Graham, & Connor,2015). The nurse-patient communication is

marked as an inseparable part of every health care setting, and it determines the quality of care.

There are several barriers to effective communication such as a nurse or patient characteristics,

environmental factors or language. All the barriers should be eradicated to promote effective

communication (Amoah et al., 2019). According to the American nurses association, the nurse

has the role of patient advocacy. Therefore the nurse must preserve a professional nurse-patient

and therapeutic relationship with boundaries to their role. It makes important that the nurse

make techniques in clinical settings to interact with patients because it is an important part of

their work. Language can be acted as a barrier for any form of communication, and therapeutic

communication is not an exception (Amoah et al., 2019). Nursing staff members who do not
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speak the same language may experience difficulty in determining the basic care needs, and the

residents are at risk (Runci et al., 2015). The study which conducted in Victoria has several

factors as strength. It included a larger number of samples and aged care facilities. Short clear

and open questionnaires have used to collect data. This study had revealed the linguistic needs

of the elderly residents of these settings. This study proved that some of the residents do not

have access to the care staff who does not speak the patient’s own language (Runci et al., 2015).

Knowing the native language will improve the outcome of the nursing care, and it improves the

therapeutic communication and quality of the care at the same time. A foreign nurse who works

in an aged care facility may encounter problems when dealing with patients who do not speak or

understand English. The nurses have to make sure that all the patients are receiving the same

quality of care as the one who does not have a language barrier (Safouan, R. 2018). The foreign

nurse who starts working in elderly homes may seek help from their colleagues and sometimes

may use the professional interpreters to communicate with the elderly. Professional interpreters

may not be available all the time (Safouan, R. 2018). The proficiency in the native language will

help the nurse to identify the requirements of the patients and to maintain an effective

interpersonal relationship between the patient and nurse. The studies which have conducted on

the communication barriers can find the gaps in the practice and can improve quality care

delivery. The native language is important to create contact with the residents. Emotions are

affected and communicated through the language, as were memories in the elderly with dementia

(Söderman, Rosendahl, Söderman, & Rosendahl,2016). Less availability of the articles, which is

based on the native language requirement of foreign nurses is a weakness of these studies, which

may lead to inadequate evidence to prove and analyze the research question. Problems in

communication with colleagues and patients may create negative emotions and lack of
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confidence in overseas trained nurses. The qualified overseas nurses have reported the

embarrassment when they could not understand what the patient and family have told them

(Zanjani, Ziaian, & Ullrich, 2018).

Research design and methodology

This would be an interpretative qualitative study which will explore the importance of

native language requirements of foreign nurses who work in elderly homes in Malta. This

phenomenological study will be conducted to understand the participant’s experience, feelings,

about the research question. Data collection will be based on face to face interview, which can

be structured or semi-structured. These interviews will be conducted according to the time and

convenience of the participants in the elderly care settings.

The qualitative study in this research would be practical, and it may lead to credible

answers. This would be an interpretative qualitative study to explore lived experience of foreign

nurses and the residents regarding the requirement of the local language in nursing care delivery,

and this method helps to gather credible answers using one to one interviews. Qualitative

research methods are used to describe a process or experience, and the goal of the qualitative

research method is to make meaning of experience or phenomena by following the data (Cruz &

Tantia 2017). The overall purpose is to understand a situation or how something has experienced

in a meaning full way. In a qualitative study, it is more important who is the participant than

how many are the participants, and the result would be within the specific context of the subject

not in a generalized form like in quantitative research (Cruz & Tantia 2017). This research

would be about how native language proficiency ofoverseas nurses can improve the quality of

nursing care in elderly homes in Malta. The research is going to be conducted in one to one
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interview format, so this methodology would be suitable for this research to formulate a credible

answer for the research question.

Study population

This study would include 10 overseas nurses who work in elderly homes in Malta and 10

residents who do not speak or understand the English language. The native language speaking

nurses and the English speaking residents would be excluded from this research. Purposive

sampling will be used because of the specific knowledge of the samples regarding research

topics (Cruz & Tantia 2017). These nurses have worked in an elderly care setting with many

residents who do not know the English language and speak only Maltese language, and their

experience of that situation is the key factor to consider them as a sample. The residents who

experienced difficulty to communicate with their primary care provider because of the language

barrier, and it is the factor them to be elected as samples. These samples would be able to

communicate more in-depth details of the research issue. This sample would be selected using

purposive sampling to ensure that the gathered data is informative (Ingham-Broomfield, 2015).

An instrument to be used

One to one interview method will be used in this research, which allows the researcher to

collect data regarding the research question in-depth. Data collection in a qualitative study aims

to explore and describe the experiences. In-depth questions in an interview method may reveal a

deeper experience of a participant (Cruz, & Tantia, 2017). Each participant will be asked semi-

structured open-ended questions regarding the experience when they have come across the

incident of the language barrier, and how was their experience on different aspects of that

incident. Each interview will be recorded and transcribed. It would allow gaining detailed
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information about their personal feelings and opinions. There is more space for detailed

questions in this method and it is applicable for the illiterate residents too.

This study would be reliable because there would be a coherent rationale to conduct this

study. The difficulty faced by foreign nurses and the non-English speaking residents during care

delivery is very important because it can affect the quality of care and put the patient at risk. This

instrument is reliable as findings gathered by using the interview method will be a representation

of the studied population, and it can be reproduced at any time using the same methodological

structure (Patterson, & Dawson 2017). This method will be valid because the measurements are

sufficient, and it would be constant in the future, in any other studies, if the same population will

be selected. The samples would be studied in a reproducible way, using an appropriate interview

method (Patterson, & Dawson 2017).

Data collection

The data will be collected through the semi-structured interviews using open-ended

questions for both the targeted populations. This will include obtaining the consent of ethical

committee and from the participants before the data collection for the research,pre-planning of

questions to make sure the relevance of the questions is going to be asked. Next step would be

interviewing the nursing staffs and the residents at their convenient time. These interviews

would be recorded and transcribed and then it would be coded and sorted to interpret for the

result of the research. The coded data contain the main ideas presented in the data collected first.

Interpretation of data will be conducted by close and careful reading through the texts. This task

would be challenging because the philosophical principles of every individual may affect the

answers (Clark, & Vealé,2018). The data collection would be carried out within 4-5 weeks, and
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the expected study result would be the proof of requirement of native language skill for the

foreign nurses who work in elderly homes in Malta.

Data analysis

The first step of data analysis would be identifying and locating the raw data which is

collected from the research. The first step would be based on the interpretation of the text by an

analyst. The second step would be structuring the data detailing the link between data collected

and the research question (Ganapathy, 2016). Then the patterns in the data will be searched, and

this pattern would be characterised by similarity, difference, frequency, sequence,

correspondence, and causation. All gathered data will be coded with descriptive names, symbols,

or category names to collect the sense out of text data. Then systematically reduce the

complexity of the gathered data to get the explanations of the process or situation. A theme can

be obtained as the result of coding and comparison with literature would be done, and finally, the

validation would be done (Ganapathy, 2016).

Ethical Considerations

Ethics are the norms to conduct which distinguish between acceptable and unacceptable

behaviour (Clark, 2019). Permission from the ethics committee and informed consent from each

participant, in a written format, would be collected before research. The language of the consent

form would be clear and understandable. The steps which include in research would be clearly

explained by the researcher to the nurses and the residents who participate in the research, and

they will be informed that at any time they can withdraw their consent. The questions raised

from the participants would be answered in an understanding manner. The research standards
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would be followed by the researcher as it is outlined by the ethical guidelines. It would be

ensured that the identity of the participants will be anonymous. The privacy of the participants

would be protected by storing the collected data after coding and numbering instead of names

and positions. It would be ensured that all the participants are protected from significant harm or

unauthorized accessto their shared data (Ingham-Broomfield, 2015). Different types of

researches produce different ethical problems. Decisions about the ethical procedures would be

made by both the researcher and the institutional review board (Clark, 2019). Throughout the

research, the rights and welfare of the participants will be protected. The standards of protection

will include avoiding harm, collection of informed consent, and maintaining privacy and

confidentiality. The researcher would protect the participants from doing an effective and

meaningful study (Clark, 2019).


Every research has limitations. The main limitations of this proposal would be,

participants could have fear and the improper reveal of their experience, opinion etc. Lack of

prior research would be another limitation of this study because it would be a new research topic

about the requirement of this particular language and the supportive evidence from the literature

may be less available. Another limitation of this study can be a lack of time of the participants,

especially nurses, as they have a lot of work in a scheduled time. In this research, the sample

size would be a limitation because of their increased number so that the opinions of the samples

may not represent the opinion of the entire population. This study would be potentially

beneficial for the local community of residents who do not speak English because the

management can ensure the necessary steps to overcome the language barriers to secure the

safety and quality of care delivery and protection from the risk of language barriers. The
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community of foreign nurses also would benefit from this study because it indicates the necessity

of native language proficiency and its importance in nursing care delivery. The foreign nurses

can avoid embarrassment if they study the native language, and they get more acceptances

among those patients who do not speak English and their family. The foreign nurses who came

to work in the elderly homes in Malta will experience the language barrier issues when they deal

with the patients who speak only Maltese language. Being in a vulnerable state with the inability

to express themselves lead the patient to a daunting experience, hence talking to a patient in

native language makes them more receptive to what is being said ( Safouan,2018). This study

would be conducted to reveal the need for native language proficiency for overseas trained

nurses to work in an elderly home. This qualitative study would be conducted using one to one

interviews which are easy for the residents and the nurses to answer. Standard data analysis

method will be used to extract the result from the raw data. This study may equally benefit both

the study populations to avoid barriers to deliver or to receive quality care. This study would be

contributing to the knowledge of the importance of native language in the context of elderly care,

and it would help the professionals interact better with the elderly.
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