Jay Balante1
1Registered Nurse, University of Sydney
Abstract:
Background:
Delivering cancer and end-of-life care is inherently complex, particularly in multicultural contexts where nurses must reconcile personal beliefs, professional obligations, and the diverse cultural values of patients and families. Although culturally informed care is a foundation of quality palliative care, limited research examines nurses’ lived experiences navigating these tensions. As health systems become more culturally diverse, understanding these dynamics is critical to supporting workforce sustainability and culturally responsive care.
Aim:
To explore how nurses navigate the intersections of personal beliefs, cultural frameworks, and professional responsibilities in the provision of cancer and end-of-life care.
Methods:
A multi-phase, cross-country qualitative design was employed. Phase 1 involved semi-structured interviews with internationally educated nurses in Australia. Phase 2 drew on mini-ethnographic case studies combining field observations and interviews in two palliative care services: an inpatient unit in Sydney and a community-based hospice in Kuala Lumpur. Thematic analysis and cross-case synthesis were used to generate key insights.
Results:
Findings revealed that nurses draw on layered personal, cultural, and professional values to mediate complex care encounters. In Malaysia, nurses recalibrated their sense of agency within hierarchical systems and under-recognised palliative roles. In Australia, tensions emerged between personal values and institutional protocols. Across both contexts, nurses engaged in ongoing emotional and cognitive labour to reconcile personal meaning, patient needs, and systemic norms. These tensions often went unacknowledged but deeply shaped care delivery.
Conclusion:
This study highlights the adaptive and negotiated nature of nursing in multicultural palliative care. Rather than simply applying guidelines, nurses dynamically adapted care to patients’ cultural and emotional needs within layered health systems. These findings call for educational and policy frameworks that promote cultural humility, support nurses’ reflexive practice, and position them as key agents in delivering responsive, person-centred palliative care.