Chinese Patients’ and Family Caregivers’ Perception of Care Quality, A Qualitative Study in Australian Hospitals


  • Ying Yu College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
  • Lily Xiao College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia
  • Di Chamberlain College of Nursing and Health Sciences, Flinders University, Bedford Park, South Australia, Australia



caregivers, culturally competent care, cultural diversity, minority groups, communication barriers, quality improvment


Cultural diversity in the Australian population is significant. It challenges health professionals in Australia's acute and critical care settings to provide culturally competent care for ethnic minority patients. Chinese Australians are the largest ethnic minority group in Australia. However, their experiences in acute hospital settings remain largely unknown. Studies on this patient group are much needed to address the research gap and add research evidence on transcultural nursing for the international community. The aim of this study was to explore Chinese patients’ and their family caregivers’ perceptions of care quality in Australian hospitals. A qualitative descriptive study design was used in this study. Adult Chinese patients born in mainland China and who had an acute and critical care admission were recruited from metropolitan hospitals in South Australia in 2019 using the snowball method. Semi-structured interviews were conducted in Mandarin. Data were transcribed verbatim in simplified Chinese for thematic analysis. Results were translated to English and checked by a bilingual team member. Ten participants participated in the study. Four main themes were identified from the data analysis: 1) the feeling of being disoriented in the ICU; 2) desire for comfort; 3) lack of engagement in treatment and care plans; and 4) lack of participation in quality improvement feedback to the care system. Chinese people have unique cultural beliefs, communication patterns, and health-seeking behaviors. To provide culturally competent care for acute and critically ill Chinese patients, health professionals are required to incorporate transcultural nursing theory, knowledge, skills, and attitudes into everyday practice.


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Australia Bureau of Statistics. "MEDIA RELEASE: ABS reveals insights into Australia’s Chinese population on Chinese New Year."!OpenDocument (accessed 15/2/2018, 2018).

Australia Bureau of Statistics. "Disability, Ageing and Carers, Australia: Summary of Findings." (accessed 17th May, 2021).

(2019). The state of patient safety and quality in Australian hospitals 2019. [Online] Available:

M. M. Leininger, "What is Transcultural Nursing and Culturally Competent Care?," J Transcult Nurs, vol. 10, no. 1, pp. 9-9, 1999, doi: 10.1177/104365969901000105.

M. M. Leininger, Transcultural nursing : concepts, theories, research and practice, 3rd ed. ed. New York: New York : McGraw-Hill, Medical Pub. Division, 2002.

L. D. Purnell and E. A. Fenkl, Textbook for transcultural health care : a population approach : cultural competence concepts in nursing care, Fifth edition. ed. Cham, Switzerland : Springer, 2021.

L. Purnell, "A Description of the Purnell Model for Cultural Competence," Journal of Transcultural Nursing, vol. 11, no. 1, pp. 40-46, 2000.

H.-M. Tsai, T.-L. Chu, and W.-P. Yu, "People of Chinese Heritage," in Textbook for Transcultural Health Care: A Population Approach: Cultural Competence Concepts in Nursing Care, L. D. Purnell and E. A. Fenkl Eds. Cham: Springer International Publishing, 2021, pp. 295-319.

Nursing and Midwifery Board of Australia. "Code of conduct for nurses." (accessed 28th Jan, 2021).

S. M. Shepherd, C. Willis-Esqueda, D. Newton, D. Sivasubramaniam, and Y. Paradies, "The challenge of cultural competence in the workplace: Perspectives of healthcare providers," BMC Health Serv Res, vol. 19, no. 1, pp. 135-135, 2019, doi: 10.1186/s12913-019-3959-7.

M. M. Andrews and J. S. Boyle, "Transcultural Concepts in Nursing Care," J Transcult Nurs, vol. 13, no. 3, pp. 178-180, 2002, doi: 10.1177/10459602013003002.

E. Curtis et al., "Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition," Int J Equity Health, vol. 18, no. 1, p. 174, Nov 14 2019, doi: 10.1186/s12939-019-1082-3.

(2006). Cultural CompetenCy in health: A guide for policy, partnerships and participation.

Y. Yu, L. Xiao, and D. J. Chamberlain, "Perceptions of care in patients from culturally and linguistically diverse background during acute and critical illness: A integrative literature review," Aust Crit Care, vol. 34, no. 5, pp. 486-495, Sep 2021, doi: 10.1016/j.aucc.2020.11.004.

J. Ben, D. Cormack, R. Harris, and Y. Paradies, "Racism and health service utilisation: A systematic review and meta-analysis," Plos One, vol. 12, no. 12, Dec 2017, Art no. e0189900, doi: 10.1371/journal.pone.0189900.

M. D. Silva, S. Tsai, R. M. Sobota, B. T. Abel, M. C. Reid, and R. D. Adelman, "Missed Opportunities When Communicating With Limited English-Proficient Patients During End-of-Life Conversations: Insights From Spanish-Speaking and Chinese-Speaking Medical Interpreters," J Pain Symptom Manage, Oct 25 2019, doi: 10.1016/j.jpainsymman.2019.10.019.

R. L. Van Keer, R. Deschepper, L. Huyghens, and J. Bilsen, "Mental well-being of patients from ethnic minority groups during critical care: a qualitative ethnographic study," Bmj Open, vol. 7, no. 9, Sep 2017, Art no. e014075, doi: 10.1136/bmjopen-2016-014075.

S. Høye, K. Kvigne, S. Åström, E. Severinsson, and I. Öster, "Encounters between multicultural family members and the nurses in the context of intensive care," Clin Nurs Stud, vol. 3, no. 1, pp. 89-99, 2015, doi:

R. B. Harris, Donna M. Cormack, and James Stanley, "Experience of racism and associations with unmet need and healthcare satisfaction: the 2011/12 adult New Zealand Health Survey," Australian and New Zealand Journal of Public Health, vol. 43, no. 1, 2019, doi: 10.1111/1753-6405.12835.

L. Doyle, C. McCabe, B. Keogh, A. Brady, and M. McCann, "An overview of the qualitative descriptive design within nursing research," Journal of research in nursing, vol. 25, no. 5, pp. 443-455, 2020, doi: 10.1177/1744987119880234.

L. S. Nowell, J. M. Norris, D. E. White, and N. J. Moules, "Thematic Analysis: Striving to Meet the Trustworthiness Criteria," International Journal of Qualitative Methods, vol. 16, no. 1, 2017, doi: 10.1177/1609406917733847.

J. Chen, J. Smith Helen, and X. Liu, "Language and rigour in qualitative research: Problems and principles in analyzing data collected in Mandarin," BMC Medical Research Methodology, vol. 8, no. 1, p. 44, 2008, doi: 10.1186/1471-2288-8-44.

Y. S. Lincoln and E. G. Guba, Naturalistic inquiry. Beverly Hills, Calif.: Beverly Hills, Calif. : Sage Publications, 1985.

P. Liamputtong, "Doing Research in a Cross-Cultural Context: Methodological and Ethical Challenges," in Doing cross-cultural research, ethical and methodological perspectives, P. Liamputtong Ed., (Social Indicators R esearch Series, no. 34): Springer, 2008, ch. 1, pp. 3-21.

J. Cunningham and L. D. Kim, "Post-operative delirium: a review of diagnosis and treatment strategies," Journal of Xiangya Medicine, vol. 3, pp. 8-8, 2018, doi: 10.21037/jxym.2018.01.03.

Z. E. Barter, G. T. Tucker, and K. Rowland-Yeo, "Differences in Cytochrome P450-Mediated Pharmacokinetics Between Chinese and Caucasian Populations Predicted by Mechanistic Physiologically Based Pharmacokinetic Modelling," Clin Pharmacokinet, vol. 52, no. 12, pp. 1085-1100, 2013, doi: 10.1007/s40262-013-0089-y.

K. Kim, J. A. Johnson, and H. Derendorf, "Differences in Drug Pharmacokinetics Between East Asians and Caucasians and the Role of Genetic Polymorphisms," J Clin Pharmacol, vol. 44, no. 10, pp. 1083-1105, 2004, doi: 10.1177/0091270004268128.

L. S. Karliner, E. A. Jacobs, A. H. Chen, and S. Mutha, "Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature," Health Serv Res, vol. 42, no. 2, pp. 727-54, Apr 2007, doi: 10.1111/j.1475-6773.2006.00629.x.

S. Muni, R. A. Engelberg, P. D. Treece, D. Dotolo, and J. R. Curtis, "The Influence of Race/Ethnicity and Socioeconomic Status on End-of-Life Care in the ICU," Chest, vol. 139, no. 5, pp. 1025-1033, 2011, doi: 10.1378/chest.10-3011.

R. Van Keer, R. Deschepper, L. Huyghens, and J. Bilsen, "Mental well-being of patients from ethnic minority groups during critical care: a qualitative ethnographic study," BMJ Open, vol. 7, no. 9, 2017.

S. Wooldridge and J. Branney, "Congruence between nurses’ and patients’ assessment of postoperative pain: a literature review," British Journal of Nursing, vol. 29, no. 4, pp. 212-220, 2020, doi:

S. Høye and E. Severinsson, "Intensive care nurses’ encounters with multicultural families in Norway: An exploratory study," Intensive Crit Care Nurs, vol. 24, pp. 338-348, 2008, doi: 10.1016/j.iccn.2008.03.007.

J. D. Thornton, K. Pham, R. A. Engelberg, J. C. Jackson, and J. R. Curtis, "Families with limited English proficiency receive less information and support in interpreted intensive care unit family conferences," Crit Care Med, vol. 37, no. 1, pp. 89-95, Jan 2009, doi: 10.1097/CCM.0b013e3181926430.

S. S. Au, A. Roze des Ordons, A. Soo, S. Guienguere, and H. T. Stelfox, "Family participation in intensive care unit rounds: Comparing family and provider perspectives," J Crit Care, vol. 38, pp. 132-136, Apr 2017, doi: 10.1016/j.jcrc.2016.10.020.

L. Lu, J. Liu, and Y. C. Yuan, "Health Information Seeking Behaviors and Source Preferences between Chinese and U.S. Populations," Journal of health communication, vol. 25, no. 6, pp. 490-500, 2020, doi: 10.1080/10810730.2020.1806414.

C. Doherty and C. Stravropoulou, "Patients's willing ness and ability to participate actively in the reduction of clinical errors: A systematic literature review," Social Science & Medicine, vol. 75, pp. 257-263, 2012, doi: 10.1016/j.socscimed.2012.02.056.

A. M. N. Renzaho and Nidhi Dhingra, "Assessing the impact of post migration lifestyle changes on migrant settlement trajectories," Western Sydney University, Sydney, 2016.




How to Cite

Y. Yu, L. Xiao, and D. Chamberlain, “Chinese Patients’ and Family Caregivers’ Perception of Care Quality, A Qualitative Study in Australian Hospitals ”, International Journal of Advanced Health Science and Technology, vol. 3, no. 2, pp. 118–126, Apr. 2023.



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