Effective Collaborative Working between Nurses in a Multicultural Setting in Saudi Arabia: Barriers and Solutions Rasha Abdulaziz Al Turki Submitted in Partial Fulfilment of the Requirements of The Degree of Doctor of Philosophy University of Salford, Manchester United Kingdom School of Health & Society May 2018 Contents Table of Contents List of Figures ...................................................................................................................................... iii List of Tables ........................................................................................................................................ iii List of Abbreviations ......................................................................................................................... iii List of Conference Presentations ................................................................................................... iv List of Conference/Symposium/Workshop Attendances ....................................................... v List of Conference Proceedings ....................................................................................................... v Glossary of Terms ................................................................................................................................. i Abstract ................................................................................................................................................... 3 Chapter One ........................................................................................................................................... 1 1.1 A Reflective Account of Learning through this Study ..................................................................1 1.2 Introduction ............................................................................................................................................3 1.3 Background ..............................................................................................................................................4 1.4 Problem Statement ............................................................................................................................. 15 1.5 Research Question and Aim and Objectives ............................................................................... 15 1.6 Research Rationale ............................................................................................................................. 16 1.7 Thesis Structure .................................................................................................................................. 16 1.8 Summary ................................................................................................................................................ 17 Chapter Two: Literature Review .................................................................................................. 19 2.1 Introduction ......................................................................................................................................... 19 2.2 Approach to Literature Review ...................................................................................................... 19 2.3 Findings from the Literature Review ............................................................................................ 37 2.4 Summary ................................................................................................................................................ 54 Chapter Three: Conceptual Framework .................................................................................... 56 3.1 Introduction ......................................................................................................................................... 56 3.2 Analysis of Potentially Relevant Theories and Models ........................................................... 62 3.3 Models of Transcultural Care (the 1950s) .................................................................................. 63 3.4 Ramsden’s Cultural Safety Model (1994) .................................................................................... 70 3.5 Trompenaars’ Model of National Culture Differences (1997)............................................... 71 3.6 Models of Cultural Competence ...................................................................................................... 72 3.7. Choice of Conceptual Framework ................................................................................................. 81 3.8 Summary ................................................................................................................................................ 83 Chapter Four: Methodology ........................................................................................................... 85 4.1 Introduction ......................................................................................................................................... 85 4.2 Philosophical Assumptions .............................................................................................................. 86 4.3 Ontological Assumptions .................................................................................................................. 87 4.4 Epistemological Assumptions ......................................................................................................... 88 4.5 Research Strategy ............................................................................................................................... 91 4.6 Justification ........................................................................................................................................... 96 4.7 Data Collection ..................................................................................................................................... 97 4.8 Sample ..................................................................................................................................................102 4.9 Credibility and Trustworthiness Issues in Qualitative Studies ..........................................105 4.10 Qualitative Data Analysis .............................................................................................................107 4.11 Summary ...........................................................................................................................................113 Chapter Five: Results ..................................................................................................................... 114 5.1 Introduction .......................................................................................................................................114 5.2 Demographic Data ............................................................................................................................114 5.3 Findings................................................................................................................................................116 5.4 Summary of the Findings ................................................................................................................190 5.5 Conclusion ...........................................................................................................................................191 Chapter Six: Discussion ................................................................................................................. 193 6.1 Introduction .......................................................................................................................................193 6.2 Discussion of Thematic Findings ..................................................................................................193 6.3 Benefits and Limitations of the Purnell Model as a Conceptual Framework ..................235 6.4 Conclusion ...........................................................................................................................................249 Chapter Seven: Conclusion ........................................................................................................... 252 7.1 Introduction .......................................................................................................................................252 7.2 Overview of the Study and Contributions to Knowledge ......................................................253 7.3 Study Strengths and Limitations ..................................................................................................254 7.4 Recommendations ............................................................................................................................255 7.5 Dissemination Plan ..........................................................................................................................261 References ......................................................................................................................................... 262 Appendices .................................................................................................................................................278 Appendix 1: Interview Guide ................................................................................................................278 Appendix 2: Participant Consent Form (Interview) ......................................................................282 Appendix 3: Letter of Ethical Approval