Table 1.

Characteristics of the included studies

Author/year	Study design	Methodology	Participants	Settings	Quality of the paper	Key findings related to review
MD Al-Mendalawi [26]	Cross-sectional survey	Quantitative	116 patients	In-patient at tertiary referred hospital	Medium	Patients are satisfied with health services regardless of language barrier.
ZA Mani and MA Ibrahim [20]	Cross-sectional survey	Quantitative	77 nurses	ICU at tertiary referred hospital	High	There are communication difficulties between nurses and patients in end-of-life care.
A Shubayra [27]	Descriptive Semi-structured, face-to-face interviews	Qualitative	9 nurses	Peritoneal dialysis at tertiary referred hospital	High	Language barriers impeded effective nursing education to patients.
M Silbermann, RM Fink, S-J Min, MP Mancuso, J Brant, R Hajjar, N Al-Alfi, L Baider, I Turker and K ElShamy [21]	Descriptive survey	Quantitative	776 health-care providers	Oncology department at three tertiary referred hospitals	High	There are numerous communication difficulties in palliative care.
WA Suliman, E Welmann, T Omer and L Thomas [28]	Descriptive survey	Quantitative	393 patients	Three national guard health affairs facilities	High	There are communication barriers that influence nurse–patient relationships.
G Abudari, H Hazeim and G Ginete [29]	Phenomenological design	Qualitative	10 nurses	Oncology department at tertiary referred hospital	High	Non-Muslim nurses are facing several challenges in taking care of Muslim cancer patients.
AH Al-Doghaither [30]	Not reported	Quantitative	450 patients	In-patient at university hospital	High	Different levels of satisfaction are perceived by patients related to nurses competency level or interpersonal skills
H Aljadhey, MA Mahmoud, MA Hassali, A Alrasheedy, A Alahmad, F Saleem, A Sheikh, M Murray and DW Bates [31]	Exploratory design	Qualitative	65 health-care providers	Secondary level and Private hospital	Medium	Communication barriers threat patient safety (medication error).
AF Almutairi, G Gardner and A McCarthy [32]	Cross-sectional survey Case study design	Mixed method	319 nurses	In-patient at tertiary referred hospital	High	Nurses from different cultures have different perceptions about the safety environment.
BM Hammoudi, S Ismaile and O Abu Yahya [33]	Cross-sectional survey	Quantitative	367 nurses	In-patient at four tertiary referred hospitals	Medium	Nurses’ languages and cultural diversity influence medication administration as well as reporting errors.
A Khalaf, A Westergren, Ö Ekblom, HM Al-Hazzaa and V Berggren [34]	Explorative design	Qualitative	15 nurses	In-patient at secondary health level hospital	High	There are differences in language, religion and culture among nurses providing health services.
AG Mohamed [35]	Cross-sectional survey	Quantitative	343 nurses	Five hospitals at different health levels	Medium	According to nurses, patients can be dissatisfied due to many reasons including communication.
J Mebrouk [36]	Phenomenological design	Qualitative	5 nurses	In-patient at tertiary referred hospital	High	Saudi nurses have enough knowledge regarding language, religion and cultural whereas expatriate lack knowledge. Expatriate nurses usually use non-verbal communication.
H Alabdulaziz, C Moss and B Copnell [17]	Explanatory sequential design	Mixed methods	234 nurses	Paediatrics at secondary health level hospitals	High	There are differences in language, religion and culture among nurses and patients.
DN Alosaimi and MM Ahmad [18]	Descriptive Semi-structured interviews	Qualitative	20 nurses	In-patient at tertiary referred hospital	High	Limited verbal communication and limited knowledge of religion and culture exist among expatriate nurses.
MA Atallah, AM Hamdan-Mansour, MM Al-Sayed and AE Aboshaiqah [37]	Cross-sectional design	Quantitative	100 patients	In-patient at tertiary referred hospital	Medium	Different levels of patient satisfaction occur depending on either nurses’ competency or interpersonal skills.
E Sidumo, VJ Ehlers and S Hattingh [38]	Descriptive, exploratory study design	Quantitative	50 nurses	Obstetric unit at secondary level hospital	Medium	Limited knowledge about cultural and religious practices exists among expatriate nurses.
H Al Fozan [39]	Cross-sectional design	Quantitative	302 patients and family caregivers	In-patient of national guard health affairs facility	Medium	Patients are satisfied with Saudi nurses who have same language, culture and religion.
P Halligan [19]	Phenomenological design	Qualitative	6 nurses	ICU at tertiary referred hospital	Medium	Patients misinterpret some of the expatriate nurses’ non-verbal communication.
M Van Bommel [40]	Phenomenological descriptive	Qualitative	63 nurses	CCU at tertiary referred hospital	High	There are language, cultural and religious diversity among expatriate nurses and patients in ICU.