NURSING PRACTICE COMPLIANCE AND SERVICE DELIVERY CHALLENGES AMONG HOME CARE NURSES IN THE KINGDOM OF SAUDI ARABIA: TOWARD THE DEVELOPMENT OF A MULTICULTURAL HOME CARE NURSING PRACTICE PROGRAM

This study, conducted from May to July 2026, examined nursing practice compliance, service delivery challenges, and cultural competence among home care nurses in the Kingdom of Saudi Arabia and explored the mediating role of cultural competence in the relationship between service delivery challenges and nursing practice compliance. An explanatory sequential mixed-methods design was used. The quantitative phase involved 112 home care nurses who completed a validated questionnaire measuring nursing practice compliance, service delivery challenges, and cultural competence. Descriptive statistics, Mann–Whitney U, Kruskal–Wallis, Pearson product-moment correlation, and hierarchical regression mediation analysis were employed. The qualitative phase involved eight purposively selected nurses who provided written narratives describing their lived experiences. Quantitative findings showed very high nursing practice compliance (M = 4.29, SD = 1.13), high service delivery challenges (M = 3.94, SD = 0.87), and high cultural competence (M = 4.20, SD = 0.89). Service delivery challenges were significantly related to cultural competence (r = .766, p < .001) and cultural competence was significantly related to nursing practice compliance (r = .805, p < .001). In the mediation model, service delivery challenges significantly predicted compliance before cultural competence was introduced (β = .635, p < .001); after cultural competence was entered, its effect became nonsignificant (β = .045, p = .615), while cultural competence remained significant (β = .770, p < .001). Qualitative findings described strong professional commitment, environmental and communication challenges, cultural adaptation, adaptive strategies, and emotional resilience. The integrated findings provide a basis for a Multicultural Home Care Nursing Practice Program focused on sustaining compliance, strengthening cultural competence, improving communication, and supporting adaptive practice.