Table 1.

List of included qualitative studies, their characteristics and contributions to the results

Author, year, country	Aim/objective	Methods and study setting	Data analysis	Results	Quality score
1. Almutairi et al. (2015) Saudi Arabia	To explore notions of cultural competence with non‐Saudi Arabian nurses working in a major hospital in Saudi Arabia	A single‐case study design in an 800‐bed teaching hospital. Face‐to‐face audio‐recorded, semi‐structured interviews with 24 non‐Saudi Arabian nurses from North America, Africa, Europe, Asia, Australia, New Zealand and the Middle East	Deductive analysis according to Campinha‐Bacote's framework for cultural competence (Campinha‐Bacote, 2002) and inductive analysis	Nurses within this culturally diverse environment struggled with the notion of cultural competence in terms of each other's cultural expectations and those of the dominant Saudi culture The findings emphasize how cultural skills within a multicultural context are also related to the nurse's ability to integrate and apply cultural knowledge that is not confined to interactions with patients; it is also dependent on skilful interactions with other healthcare professionals to ensure safe and effective care Organizational support might be implemented to help nurses overcome the dissonance and disempowerment they often encounter	High
2. Connor and Miller (2014) USA	To identify the perceived sources of work‐related and non‐work‐related stress and describe the factors that influence stress in Filipino immigrant nurses	A cross‐sectional qualitative design. 20 Filipino women working as registered nurses in the Chicago metropolitan area were interviewed	Auerbach and Silverstein's method (Auerbach & Silverstein, 2003)	The immigrant nurses’ stress was influenced by both the situational and cultural context, which contributed to the complexity and multidimensionality of their experience. Understanding the specific stressors faced by immigrant nurses will assist in developing/will facilitate the development of culturally appropriate interventions to mitigate the nurses’ stress and challenges	High
3. Estacio and Saidy‐Khan (2014) UK	To explore the experiences of racial microaggression among migrant nurses in The United Kingdom	Eleven migrant nurses in two hospitals in the Midlands of England, nine originally from the Philippines, one from Kenya, one from Zimbabwe and one from Zambia. The nurses kept a reflective diary for 6 weeks to record and reflect on their experiences of living and working in The United Kingdom. They were contacted by phone every 2 weeks. A World Café event was organized to bring all the participants together.	Transcripts of the diaries were thematically analysed (Braun & Clarke, 2006)	The participants’ diaries reflected incidences of racial microaggression. At the micro level, migrant nurses experienced racial microaggression through racial preferences and bullying. Institutional racism also hindered the nurses’ opportunities for further training and promotion. Organizational infrastructures need to be in place to encourage better multicultural interactions in the workplace	Moderate
4. Kishi et al. (2014) Australia	To investigate the experiences of Japanese nurses and their adaptation to their work environment in Australia	Individual semi‐structured interviews with 14 Japanese registered nurses working in Australian hospitals	Thematic analysis was used for identifying, analysing and reporting patterns (themes) within the data (Braun & Clarke, 2006)	There is a need to better support overseas qualified nurses (OQNs) as they progress to a stage of settling as registered nurses in a new country. Workplace mentorship programs tailored to the needs of OQNs and based on a greater understanding of those needs may ease their transition towards becoming more effective members of the healthcare team. Education of nursing colleagues about the personal experiences of OQNs may help to build more empathic relationships between locally qualified nurses and OQNs	High
5. Xiao et al. (2014) Australia	To examine relationships between social structures and nurses’ actions that either enabled or inhibited workforce integration in hospital settings	Focus groups and face‐to‐face in‐depth interviews with 24 immigrant nurses from China, Columbia, Malaysia, Singapore, South Korea and Zimbabwe with non‐English‐speaking backgrounds. Many had more than 10 years nursing experience in their home country	Structuration theory (Giddens, 1984) with double hermeneutic methodology was used to interpret the nurses’ perceptions of factors affecting workforce integration	A multicultural team places stress on both host nurses and immigrant nurses as they need to learn from each other and make allowances for team members. Organizational policies and procedures can also generate discrimination that impact on migrant nurses. A regular review of the organization's policies and procedures to reflect the ever‐changing workforce is imperative	High
6. Zhou (2014) Australia	To explore experiences of China educated nurses working in Australia	46 in‐depth interviews with 28 China‐educated nurses at two sites	Based on grounded theory using the constant comparison method (Charmaz, 2006)	Unrealistic expectations predisposed the nurses to many hardships, disappointments and frustrations. Providing access to adequate and realistic information that ensures a balanced view of immigration life would be beneficial. More dialogue and discussion are needed to promote mutual understanding and increase the efficacy of support services	High
7. Alexis (2013) UK	To gain an understanding of international educated nurses’ (IENs) experiences of working in the National Health Services in England	A hermeneutic phenomenology approach with two phases: Phase 1: 12 individual interviews with IENs in a District General Hospital in England. Phase 2: 4 focus group interviews. The informants originated from The Philippines, South Africa, The Caribbean and Sub‐Saharan Africa	The data were thematically analysed using a qualitative data analysis software package and guided by Van Manen's analytical framework (Manen, 1990)	IENs encountered a number of challenges to their work practices in an English hospital. There is a need for both IENs and home ‐grown nurses to adapt to each other's cultural differences. Support is necessary as it leads to job satisfaction with the ultimate effect of better patient care	High
8. Lin (2013) USA	How Filipina nurses transition into and adapt to nursing practice in the US Hospital system	In‐depth interviews with 31 Filipina nurses employed in a hospital setting in Texas	Grounded theory (Strauss & Corbin, 1998)	Nurses from other countries can encounter hardships associated with cultural dissimilarities, language barriers, diversity in nursing practice, differences in social norms and feelings of alienation	Moderate
9. Wheeler et al. (2013) USA.	To gain a deeper understanding about the experiences of internationally educated nurses (IENs) compared to US registered nurses (RNs) practicing in two urban hospitals in south eastern USA	A cross‐sectional, qualitative descriptive design. Two phases of semi‐structured interviews. The second phase comprised a more in‐depth interview with 9 US RNs and 11 IENs from Oceania, the Pacific, East Asia, Southwest Asia, Africa (Sub‐Sahara), the European Union and the Caribbean	The constant comparative method (Creswell, 2003)	IENs and newly licensed US RNs faced similar barriers when they began practicing in the USA, but IENs faced additional challenges of adjusting to the attitudes of US patients, the perceived lack of respect for nurses and delivering total patient care IENs would benefit from orientation regarding/in terms of the cultural differences in the USA. Healthcare facilities might consider extra orientation for IENs to help them understand their new environment and perform to the best of their abilities	Moderate
10. Alexis and Shillingford (2011) UK	To explore the perceptions and work experiences of internationally recruited neonatal nurses (IRNNs)	Husserl’s phenomenological approach underpinned the study. Semi‐structured face‐to‐face interviews with 13 nurses	Colaizzi's analytical framework was used to analyse the data (Colaizzi, 1978)	Given that IRNNs are part of the workforce, it is important to offer them support as this could enable them to provide high quality care Accepting, valuing and supporting IRNNs can create a much more satisfying workforce and ultimately improve the standard of care for patients. This study highlights the inconsistencies in the nature of support for IRNNs in that only some participants received support from colleagues as well from their managers, which enabled them to become far more confident in their work environment	High
11. Jose (2010) USA	To elicit and describe the lived experience of internationally educated nurses (IENs) who work in a multihospital medical centre in the urban USA	A phenomenology of practice design. Narratives from guided interviews with 20 new IENs from the Philippines, Nigeria and India were collected	Giorgi's principle of data analysis (Giorgi, 1985)	Inadequate orientation was a predominant concern voiced by the participants. Due to the paucity of research about US IENs, there is a possibility that the hospitals were unable to identify the learning outcomes and provide appropriate content suited to the needs of IENs. Building on the IENs’ solid education from their homelands and their individual strengths were emphasized	High
12. Liou and Cheng (2011) USA.	To explore and interpret the lived experience of a Taiwanese nurse working in a U.S. Hospital	A single‐case study. Four in‐depth telephone interviews were conducted	The interpretive process of the hermeneutic circle was used to avoid inappropriate interpretations and to produce rich descriptions and in‐depth interpretations (Cohen, Kahn & Steeves, 2000)	The nurse felt that due to the language barrier she was unable to provide the highest quality of nursing care of which she was capable in the United States. Support from people in her work environment was especially important for avoiding or repairing breakdowns in communication. Advantages of working in the U.S. nursing system include sick leave and a more humane patient–nurse ratio	High
13. Smith et al. (2011)	To explore how overseas qualified nurses (OQNs) experienced the practice of nursing in Australia	Individual interviews with 13 nurses from nine different countries; China, South Africa, Japan, Taiwan, Zimbabwe, Hong Kong, The Philippines, Sweden and Nepal	Moustakas’(1994) scientific approach to phenomenological analysis	A major issue was holistic patient care as the participants had not attended to basic nursing care in their previous practice. Lack of communication and problem‐solving skills, in addition to unfamiliarity with documentation and patient education made them feel disempowered	High
14. Allan (2010) UK	To examine the experiences of mentoring for overseas‐trained nurses in the UK	An ethnographic interpretative study using mixed methods. Results reported in this article are based on individual in‐depth interviews with 93 overseas‐trained nurses	Qualitative analysis	The main barrier to effective and non‐discriminatory mentoring was the lack of preparation within both the NHS and the care home sector about how cultural differences affect mentoring and learning for overseas‐trained nurses. They were concerned that their existing skills were not up to British standards. They experienced the need to nurse in the “British” way, in addition to/as well as bullying and discriminatory practices in the workplace	Moderate
15. Tregunno et al. (2009) Canada	To gain greater insight into the degree to which internationally educated nurses (IENs) are competent to practice safely upon registration	Semi‐structured interviews of 30 nurses from 20 countries. Half of the participants worked in long‐term care, two in community and the remainder in acute care settings. Years in Canada: 3 (on average)	Constant comparative methods (Strauss & Corbin, 1998)	The IENs reported that nurses in Canada were expected to be more assertive, to have more responsibility for patients, to be more involved in decision‐making and to have more egalitarian relationships with physicians than they were accustomed to. The results highlight areas of potential public risk. “The novice to expert model” is used to understand the need for additional intervention and successful workplace transition	Moderate
16. Yu, Gutierrez, & Kim, (2008) USA	To examine Chinese nurses’ lived experiences in the US healthcare environment	9 in‐depth interviews with Chinese nurses working in the US conducted in English	Colaizzi's analytical framework (1978) was used to analyse the data	The study revealed real and potential risks for patient safety and quality of care. However, these nurses managed to turn challenges into opportunities: High level of job satisfaction, desire for learning, execution of strategic plans and career enhancement through further education, proactive in terms of adapting to workplace demands	High
17. Magnusdottir (2005) Iceland	To generate an understanding of the lived experience of foreign nurses working at hospitals in Iceland	The Vancouver school of doing phenomenology. Dialogues with 11 registered nurses from seven countries (nationalities not specified because of ethical issues)	Thematic analysis	The voices of foreign nurses in international data banks are predominantly the voices of English‐speaking nurses from developing countries who migrate for financial reasons and work in English‐speaking industrialized countries. The foreign nurses had stressful experiences as “the other”. Co‐workers and supervision may be more important than personal support. The language barrier was central to the nurses’ experience

Auerbach, C.& Silverstein, L. B. (2003). Qualitative data: An introduction to coding and analysis: NYU press.

Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77‐101.

Campinha‐Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181‐184.

Charmaz, K. (2006). Constructing Grounded Theory: A Practical Guide through Qualitative Analysis (Introducing Qualitative Methods series).

Cohen, M., Kahn, D. & Steeves, R. (2000). Hermeneutic Phenomenological Research: A Practical Guide for Nurse Researchers: Sage publications.

Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In R. S. Valle & M. King (Eds.), Existential‐Phenomenological Alternatives for Psychology (pp. 6): Oxford University Press.

Creswell, J. W. (2003). Research design: Qualitative, quantitative, and mixed methods design. Sage, London.

Giddens, A. (1984). The constitution of society: Outline of the theory of structuration: Univ of California Press.

Giorgi, A. (1985). Sketch of a psychological phenomenological method. Phenomenology and Psychological Research. Duquesne University Press, Pittsburgh, 8‐22.

Manen, M. V. (1990). Researching lived experience. State University of New York Press, New York, NY.

Moustakas, C. (1994). Phenomenological Research Methods: Sage publications.

Strauss, A. & Corbin, J. (1998). Basics of qualitative research: Procedures and techniques for developing grounded theory: Thousand Oaks, CA: Sage.