Overseas nurses as cultural mediators: An exploration into the experiences of Indian nurses from Kerala on their journey towards achieving cultural competence and successful acculturation in Malta

  • Neville Schembri

Student thesis: Doctoral ThesisDoctor of Health (DHealth)


Background: The growth in migration trends amongst nurses has proliferated in recent years and the hiring of Foreign Educated Nurses (FENs) is identified in extant literature as a practical and realistic solution to tackle nursing shortage. Recruitment and retention of FENs in Malta has been a continuous problem throughout the years and albeit some measures have been put in place to address this problem, some of them still leave the country after a few years and find further opportunities in other European countries. This study proposed to explore the experiences of Indian (Malayalee) nurses in Malta as they seek to achieve cultural competence and become acculturated into Maltese society

Methodology: The methodology adopted for this qualitative study is guided by its research questions. The data was collected through online individual semi-structured interviews with 25 FENs in Malta selected on a set of predetermined criteria. Data analysis was carried based on Gioia Methodology; an inductive logic approach to interpretive grounded theory; by conducting an in-depth analysis of the interview transcripts aimed at developing a data structure providing a graphical representation of how the analysis progressed from raw data to emergent theoretical concepts.

Findings: From the stories of the participants, a six-dimensional model was developed capturing personal, social, and professional experiences through different phases of their journey in Malta. The model represents Settlement and Acculturation Challenges (Settlement Dysfunctions, Distorted Support Dynamics and Communication and Cultural Diversity); Work Related Experiences (Professional Sensemaking) and Reflections on the Future (Promoters of Settlement and Dispersion Dilemmas).

Conclusions: It was recognised that as FENs take up employment in Malta, they undergo a similar process of adaptation and acculturation. Their continual journey in search for personal and professional satisfaction is influenced by a number of inter-related factors which all contribute to the difficulties perceived by the participants. As time passes, they all have to take decisions whether to stay in Malta or embrace further opportunities for working as nurses in other European countries offering more attractive salaries and work conditions, but not necessarily providing the same quality of lifestyle. Although some of these factors have been already identified in extant literature on the phenomenon, it need to be emphasised that the issues raised by the participants in this study are mainly context dependent.
Date of Award24 May 2023
Original languageEnglish
Awarding Institution
  • University of Bath
SupervisorGina Wisker (Supervisor)

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