Multilevel Factors Influencing Nurse–Patient Communication in Linguistically Diverse Healthcare Settings: A Qualitative Descriptive Study in Saudi Arabia

Background: Effective nurse–patient communication is fundamental to quality care delivery, yet language barriers pose significant challenges in multicultural healthcare environments. In Saudi Arabia’s diverse healthcare landscape, nurses frequently encounter patients who do not speak Arabic, potentially compromising care quality and patient safety. Objective: To explore multilevel factors influencing communication between Saudi nurses and non-Arabic-speaking patients, using Bronfenbrenner’s ecological systems theory as a conceptual framework. Design: A qualitative descriptive study employing semi-structured interviews analyzed through reflexive thematic analysis. Setting: Four healthcare facilities (two governmental and two private hospitals) across Saudi Arabia. Participants: Eighteen Saudi registered nurses with experience caring for non-Arabic-speaking patients, recruited through purposive sampling. Methods: Semi-structured interviews (n = 18) were conducted in Arabic or English between November 2025 and February 2026. Data were analyzed using Braun and Clarke’s reflexive thematic analysis, organized within Bronfenbrenner’s ecological levels. Collaborative reflexive coding and member-checking with six participants supported analytical rigor. Results: Five main themes emerged: (1) Individual-level competencies and preparedness (microsystem), (2) Interpersonal dynamics and cultural sensitivity (microsystem), (3) Unit-level resources and organizational support (mesosystem), (4) Institutional policies and language services (exosystem), and (5) Healthcare system and societal influences (macrosystem). Participants identified language proficiency gaps, cultural misunderstandings, inadequate interpreter services, and systemic barriers as primary challenges affecting communication quality. Conclusions: Communication between Saudi nurses and non-Arabic-speaking patients is influenced by complex, interconnected factors across multiple ecological levels. Interventions should address individual competency development, organizational support systems, and policy-level changes to ensure equitable, safe, and effective communication for all patients.