The easy access to and development of medical technology in South Korea have led to an increase in the movement of foreign patients, resulting in a growing influx of patients from various ethnic and cultural backgrounds [1, 2]. There has been a consistently increasing trend of foreign patients visiting South Korea since it was legally allowed to attract foreign patients in 2009; the number of accumulated patients surpassed two million in 2019, increasing from approximately 320,000 in 2017 to approximately 490,000 in 2019. Furthermore, there has been an ongoing recovery in this growth trend following the downturn during the COVID-19 pandemic [3]. Among the foreigners seeking medical services in South Korea, there has been growing interest in people from the Middle East, who belong to the so-called “halal market” [4].

Recently, Middle Eastern patients have demonstrated a growing preference for South Korea as an overseas treatment destination. This trend can be attributed to the local expansion of South Korean hospitals, excellent medical technology and services, and lower medical costs than those in Western countries [5]. The number of patients from the Middle East has significantly increased from 2,035 in 2009 to 30,869 in 2022, which is a 15-fold increase. Moreover, 13.9% of these Middle Eastern patients opt for inpatient treatment compared to the total foreign patient population [3]. The proportion of medical expenses covered by patients in the United Arab Emirates is progressively increasing, establishing them as significant targets for medical services. This suggests that nurses in Korea are increasingly likely to provide care for Middle Eastern patients. Thus, nurses must consider patients’ sociocultural context.

When encountering patients with different cultural characteristics of the Middle East, Korean nurses may face diverse challenges, compared with those caring for patients from Korea [6]. Cultural characteristics of Middle Eastern patients such as halal dietary practices, hijab culture, religious practices, and gender-based customs are unique characteristics Korean nurses have not experienced yet, and failure to recognize them in advance can lead to inconvenience or misunderstanding between patients and healthcare providers [7]. To respect their culture, foreign studies are trying to comprehensively identify various phenomena that may occur while providing medical services to Middle Eastern patients through qualitative research [8, 9, 10]. As a result of the study, even in the West, where cultural diversity is relatively high, it has been shown that they do not receive the person-centered treatment they deserve due to a lack of understanding of Islamic cultures [11]. Because the proportion of the population adhering to Islam in South Korea is only 0.4%, Koreans have not had much experience of getting to know more about Islamic cultures. Consequently, Korean nurses may experience greater challenges when caring for patients from Middle Eastern countries, primarily because of religious factors, compared with other foreign patients [6]. Nurses’ lack of preparedness to understand the needs of foreign patients can result in complaints regarding communication, culture, and education [12]. Nurses may also experience communication problems and situations in which they do not meet the expectations of foreign patients regarding medical services [6]. Communication problems can lead to misunderstandings about treatment procedures and complaints and affect patient satisfaction and quality of care [12]. In previous studies, it has been reported that not sufficiently understanding patients from different cultures affects the clinical competency of nurses, which can negatively affect patients’ health [13].

To mitigate patient dissatisfaction because of cultural differences, it is necessary to understand and consider possible variations in cultural sensitivity based on individuals’ cultural backgrounds and the healthcare system. Domestic nurses in South Korea which are mainly composed of single ethnic groups, often possess limited knowledge and skills in caring for foreign patients owing to the homogeneous nature of the country, which leads to elevated levels of anxiety among nurses [14]. Moreover, few nurses have completed a cultural competency curriculum [14, 15], and there is a lack of shared guidelines or regulations at the hospital level, resulting in confusion in nursing practices and a dearth of cultural nursing competency programs [16]. Moreover, it has been reported that nurses’ cultural competency curriculum, cultural competence, and intercultural communication related to foreign patients affect patients’ health problems such as nurses’ basic nursing skills, physical assessment skills, and education skills for patients [16]. However, existing studies in South Korea have primarily focused on medical tourism, English-speaking patients, and multicultural patients. There is a lack of research on patients from Middle Eastern countries [6, 17]. The experience of caring for patients in different cultures is not simply a phenomenon that can be measured and confirmed quantitatively [18]. The cultural and social contexts are complexly comprehensive, and the process of sufficiently understanding and considering the phenomenon through a phenomenological method is necessary. Through this, it is possible to understand what kind of process nurses who care for Middle Eastern patients experience while nursing them and based on this, what is needed to provide quality care.

Therefore, we comprehensively explored the experiences of nurses working in clinical settings in tertiary hospitals in Korea vis-à-vis providing quality care to Middle Eastern patients. This allowed us to gain insights into their efforts and overall performance. Overall, the present study provides fundamental insights that may contribute to improving the quality of nursing services provided to Middle Eastern patients in Korea.

We conducted a phenomenological study to comprehensively understand South Korean nurses’ experiences in caring for patients from the Middle East. The nursing experiences were divided into four categories and 11 subcategories.

In line with Category 1, nurses have come into contact with different cultures that are uncommon in South Korea. Patients’ cultural characteristics and beliefs are deeply embedded in the daily lives of Middle Eastern patients through practices such as eating halal food and daily prayer [6, 7]. Their commitment to these practices continues during hospitalization, which often affects the treatment process. Thus, a deeper understanding of these patients’ lives and cultures is essential for leading them to perform appropriate health promoting behavior and to provide quality care [6, 7]. Oakley et al. [18] studied the experience of non-Muslim nurses caring for Muslim patients providing end of life care, and nurses focused on clinical care and did not embrace cultural practices that were important to them, which has been shown to contribute to increased stress for both nurses and caregiver. Therefore, hospitals should provide nurses with transcultural education and support to provide quality care that considers cultural diversity in caring for these patients. In addition, nurses have reported difficulties in performing nursing, such as identifying skin redness, pressure sore classification, and antibiotic skin test results due to differences in physical characteristics. These difficulties negatively affect the patient’s health and hinder quality care [6]. Therefore, their physical assessment education should be provided, as well as education about their culture.

In the present study, nurses reported being concerned about verbal communication errors when caring for Middle Eastern patients, particularly at night, when interpreter services are limited. Communication-related problems have long been reported by nurses caring for foreign patients [17, 24, 25, 26]. Research findings are similar to those of a previous study [12] reporting that the demand for “interpretation services” is the highest for tasks that require the efficient provision of nursing services to foreign patients. Problems in communication can lead to misunderstandings about treatment procedures and complaints and can negatively affect their health [12]. Therefore, language can represent a barrier to providing them with appropriate nursing care, so hospitals that treat Middle Eastern patients need to have sufficient manpower for interpretation. Intervention studies are mainly conducted for patients with different languages in countries with many immigrants, and in the Netherlands, where a quarter of the population has a migration background, it contributed to health promotion through educational videos produced in their language while being culturally sensitive to Islam to prevent the impediment of medical information provision due to lack of communication [27]. If interpreters cannot reside in hospitals 24 hours a day, producing and using video education materials in their languages could also be a good way to improve the quality of care.

In line with Category 2, despite the frequent hospitalization of patients from other cultures, nurses sometimes experience disappointment because of the lack of interpreters and the absence of proper support systems for them and for nurses. These findings are similar to those of Min [28], which reported that nurses experience negative emotions such as burden, embarrassment, and confusion when nurses care for foreign patients without adequate support in an unprepared situation. Additionally, Jang & Lee [17] reported emotions such as “disappointment,” consistent with the present study. Additionally, the nurses expressed that they did not feel a sense of accomplishment owing to their increasing workload, lack of communication, and lack of understanding of other cultures. These emotions were particularly evident in participants who provided higher-intensity nursing services to culturally diverse patients in situations in which emotional exchanges were hindered by communication barrier. Similarly, Min [28] noted the issue of nurses’ reduced self-esteem because of limited nursing skills. Therefore, it is necessary to prevent negative emotions by applying interventions such as simulation programs to nurses to promote an understanding of Middle Eastern culture before caring for patients. In a study that applied simulation program of United Arab Emirates patient to nursing students, it has been demonstrated that students’ cultural competence and level of empathy for patients have been significantly improved and can raise awareness of cultural diversity and improve quality of care [29].

In Category 2, nurses coordinate schedules with doctors and other departments, pay attention to various areas, such as providing halal meals, and experience increased workload due to various additional tasks. Many studies have already reported that nursing foreign patients takes more time and requires more workload than nursing domestic patients [6]. Now, it is necessary to systematically improve this problem by conducting research that specifically calculates which nursing works are additionally implemented and how much more time is required [30]. Based on severity, there is a study that categorizes direct nursing care, indirect nursing care, and personal time to identify workload and appropriate ratio of nurse staffing [31]. Based on these studies, the nursing of foreign patients should also be systematically analyzed, and appropriate nursing staff arrangements should be supported.

In line with Category 3, domestic hospitals attracting foreign patients have implemented measures to ease the communication burden on nurses, including establishing international clinics and dedicated coordinators [32, 33]. Nurses actively promote communication and provide optimal care with the help of interpreters and nutrition teams. However, the availability of hospital support services and nurses’ satisfaction with them vary depending on their resource utilization ability. This finding is consistent with previous studies involving patients from other cultures. Park et al. [24] investigated the work experience of nurses caring for foreign patients and found that satisfaction levels varied depending on the nurses’ resource utilization ability. Additionally, a study by Kim [34] on employees working in customer contact departments found that job resource identity affects job burnout and customer-oriented behavior. Thus, nurses who consistently aim to secure resources and identify hidden support services are more likely to experience positive outcomes when caring for culturally diverse patients. Resource utilization ability depends on how effectively hospitals inform and educate nurses about the support system [24]. Therefore, hospitals must provide continuous information so that nurses can accurately grasp the support system and easily access it. Hospitals that lack appropriate support systems should consider sharing resources through interhospital systems or increasing support through continuous demand surveys.

In the present study, nurses made an effort to form trusting relationships with their patients and provide emotional support and physical resources. Specifically, they strived to respect cultural differences by not interfering with prayer times, preparing for visits in advance, and using Arabic greetings or other expressions to empathize with patients. Moreover, this study indicated that when nurses respect the patient’s culture and exhibit communication-related goodwill, a trusting bond is formed and patients feel grateful [12]. Therefore, it is essential to implement effective hospital-level measures to improve communication and encourage a culture of respect by developing in-house signs and brochures and improving interpretation services [35]. In Japan, a study was conducted for nursing students, including diversity standardized patient simulation, which care patients of different cultures and religions, in the curriculum [36]. As a result, even students who had never encountered Muslim patients expressed that they opened their eyes to how to communicate with patients from other cultures, and this education promoted culturally competent nurses and increased self-efficacy for performing intercultural nursing skills. Learning attitudes that respect other cultures and preparing to empathize will be important in providing quality care by establishing trust relationships with patients in hospitals later.

Finally, participants reported experiencing personal growth by caring for culturally diverse patients. The nurses expressed that they derived the most satisfaction from patients’ expressions of gratitude, which fostered a sense of homogeneity; nurses saw patients as human beings and acknowledged and understood their differences. The bond between nurses and patients significantly influences the nurses’ satisfaction and sense of achievement [37]. The positive effects of forming bonds with patients are not limited to the same culture. Nurses caring for foreign patients also experience satisfaction and pride in weathering challenges [24]. Nurses who gained a sense of accomplishment and satisfaction through this process confirmed that their cultural competency had improved and that they felt more confident in subsequently caring for culturally different patients.

Cultural competency refers to the ability to recognize the cultural background of others and provide nursing care suitable to their cultural context by accepting and respecting different cultures [38]. Nurses’ cultural competencies in caring for foreign patients eventually affect their clinical performance [39, 40]. However, education and institutional support to increase clinical nurses’ cultural competency are still lacking. Therefore, there is a need for educational and training programs that focus on improving nurses’ cultural knowledge and skills [41]. Specifically, the quality of nursing care for culturally diverse patients should be improved through specialized nursing education based on the patients’ cultural backgrounds. Additionally, the International Council of Nurses Code of Ethics for Nursing, revised in 2021, “Nurses and Global Health” encourages nurses to collaborate globally to develop and maintain global health and emphasizes the globalization of nurses [42]. As nursing has become increasingly globalized, education for nurses with cultural competencies is needed for patients from various cultural backgrounds. Therefore, it is necessary to encourage nurses to keep up with international trends through systematic support and professional education in hospitals.

This study has the following limitations. First, in this study, nurses from various hospitals participated, but there may be bias in selecting subjects by posting a recruitment announcement at one graduate school and recruiting subjects through snowball sampling. Second, data collection was conducted only in the form of 1:1 interview rather than using various data collection methods in consideration of the nature and characteristics of the phenomenon to be studied. However, it is meaningful in that study supports education and institutional improvement needs for improving cultural competence and skills by deeply analyze the experience of nurses analyze the experiences of nurses caring for Middle Eastern patients, that have been lacking in domestic research. Through the study, it was confirmed that caring and considering for Middle Eastern patients based on in-depth understanding of the culture and customs of Middle Eastern is to provide quality care for them. Through this quality care, patients engage in desirable health promotion behaviors, empathize with each other, and improve nurse’s competency. If cultural competence is not supported, it may negatively affect the health outcome and satisfaction of the patients, and it may also affect the clinical ability of nurses, making it impossible to provide quality care. Therefore, it is significant that it identified what is providing quality care based on cultural competence and how nurses overcame difficulties and provided quality care and that it suggested the direction of field and research in the future.

We explored the experiences of nurses caring for patients from the Middle East. The findings confirmed the experiences of nurses caring for Middle Eastern patients, the challenges they faced, the treatment journey with these patients, and nurses’ ability to become better nurses. Nursing experiences with patients from the Middle East pertained to both personal and systemic aspects, indicating a growing need for improvement.

To provide optimal nursing care to Middle Eastern patients, it is necessary to improve nurses’ cultural competence and understand their unique cultural characteristics. This involves establishing a hospital environment in which nurses can deliver high-quality care while utilizing their cultural capabilities. Furthermore, it is important to develop an education program centered on field nurses and students to address and minimize the cultural shock experienced by nurses while providing care to patients from foreign cultures. Such educational measures can aid in improving the overall cultural competence of nursing students and practicing nurses, thus leading to improved nursing care for culturally diverse patients.