Table 1.

Illustration of the theme development.

Quotes from interviews	Subthemes	Themes
“He and his social support were interested and concentrated during teaching, but understood afterwards that there was a lot of misunderstanding …”(P 1) “… not everyone is like an open book at the first visit because you have the language barrier …” (P 3)	Linguistically related challenges	To accept challenges
“It was very difficult to activate and convince her to get out of the bed to avoid pneumonia.” (P 8) “I do not want to talk to a nurse. I want to talk to a doctor.” (P 10) “They are so grateful for they do not want to be a burden by asking questions.” (P 5)	Culturally related challenges
“Traumatic war experiences make an invisible barrier… have stronger integrity, do not let people in so easily …” (P 2) “… so it ended up in that I made a picture of, good morning and good night on the box …”(P 5) “I try as much as possible to prepare the patient. You win in the end if you listen about their actual needs. If the patient does not understand, then you have to find new ways to make them understand by drawing or somehow …”(P 8)	To think outside the box	To use creative strategies
“Youcan’t be judgmental when the patient is telling their story about things other than their health; otherwise, the patient stops telling more.” (P 2) “It’s a gut feeling if you have worked for many years, you also see in the eyes and behaviors and understand what patient is talking about” (P 1)	To make use of proven experience
“Not everyone wants an interpreter… think they have not interpreted what they have said… or they might know each other …”(P 12) “It is difficult to move forward in a conversation when it involves three people’s views (interpreter, patient & nurse)” (P 13) “Especially for the first visit, I always hire a professional interpreter, even if e.g. there are children who accompany their parents, […] so you know that they understand the given medical information”(P 7)	Adequate use of interpreters
“They live with incredible stress… for example, one woman from Syria had so many other issues… I think sometimes do I know what she needs really… she lives in an incredible pressure all the time, so these with her blood pressure or heart worries, they come as a bit (…) secondary.”(P 12) “It was also about post-traumatic stress disorder after traumatic experiences from home country. This meant that patients could not focus on their own health or information.” (P 1) “It can be both stresses, financial worries…that overshadow the health which is for me the most important… I need to work with a psychologist or counselor first to strengthened the patient.” (P 4)	Teamwork
“Before I start talking, I always ask the patient what they have in their heart… Patient sit and think…it is important that the patient feels involved.” (P 6) “It’s about trying to find the person behind the patient …”(P 3)	Building a caring relationship
“Those who do not know the difference between the health center and the emergency room, where to go, what to do …” (P 5) “Need to help with documents from authorities.”(P 11) “… Those from overseas countries may have difficulties in understanding organs, how they work and body awareness. Their explanatory model for the symptoms is different.” (P 12) “I mean a patient has to live with heart failure all his life and needs to understand what symptoms he should be aware of and take appropriate actions.” (P 9)	Patients knowledge and responsibility	Problems related to health literacy
“Relatives gets the same education as the patient to be able to support…they should also be able to step in when needed.”(P 9) “Daughter conveys the message about medication change as the mother did not really have control over her medicines.” (P 7)	Relatives as an asset
“When giving advice, the nurse must make sure that the patient has understood the information. The goal is to get home and be able to manage the system (heart pump) by themselves. How much they can drink, but very difficult when theydon’t know how much is 1 L”(P 5) “Self-care must be adapted according to the patient’s level.” (P 13) “I think you should meet each patient as an individual to meet them for giving information.” (P 6)	To support the patient in the best way	To work according to nurse’s obligations