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Core components in the care of immigrants with psychoses: A Delphi survey of patients, families, and health-care staff


  • Sally Hultsjö, RPN, BSc, MScN, PhD.

  • Carina Berterö, SRNT, MScN, PhD.

  • Hans Arvidsson, BPsych, PhD.

  • Katarina Hjelm, SRNT, MScN, PhD.

Sally Hultsjö, Department of Psychiatry, Hus D9, Ryhov County Hospital, Jönköping 551 85, Sweden. Email:


The aim of the present study was to identify core components in the care of immigrants with psychosis in Sweden. Experts (n = 43) from different perspectives (immigrants, families, and health-care staff) were assembled and used to score the importance of statements regarding components in the care for a person with psychosis in three questionnaire rounds. After each round, the opinions were consolidated and compared to identify whether consensus was reached. Consensus was reached about the importance of being treated on equal terms, regardless of country of birth. Staff interest and respect, shown in different ways of understanding, was valued. Consensus could not be reached on approximately half of the statements, of which four tended to be ranked towards unimportant. Those included that staff should have specific cultural knowledge or that the patient should be allowed to decide whether to be cared for by male or female staff. Nor was it regarded as important to identify a person's religious or ethnic background. The results illustrate the importance of fundamental psychiatric nursing, which should enable nurses to identify and meet the basic needs of all patients, regardless of country of origin. Areas for which consensus was not reached illustrate a future challenge for health-care staff to identify situations when cultural clashes could appear. Staff should have strategies to accomplish cultural negotiations to build an effective treatment alliance with the patient, as well as the family, to meet individual needs.