Health Science Technology - Practicum CULTURAL DIVERSITY Health Science Technology - Practicum

TRANSCULTURAL NURSING BASIC CONCEPTS Main Goal: provide culturally specific care. Must be a basic knowledge of key terminology Culture Cultural values Culturally diverse nursing care Ethnocentrism Race Ethnography

CULTURE refers to norms and practices of a particular group that are learned and shared and guide thinking, decisions, and actions.

Cultural Values the individual's desirable or preferred way of acting or knowing something that is sustained over a period of time and which governs actions or decisions.

Ethnocentrism the perception that one's own way is best when viewing the world. Our perspective is the standard by which all other perspectives are measured and held to scrutiny.

Ethic and Race Ethnic relates to large groups of people classified according to common traits or customs . Race Though many definitions exist, there appears to be no established agreement on any scientific definition of race. What we do find though, is the general belief among the scientific community that race has no biological or natural basis.

Culture and Patient Care Culturally diverse nursing care an optimal mode of health care delivery refers to the variability of nursing approaches needed to provide culturally appropriate care that incorporates an individual’s: cultural values beliefs practices including sensitivity to the environment from which the individual comes and to which the individual may ultimately return

The Provider Culture Health care and patients often begin their relationship separated by a huge cultural gap. As providers of health care we are socialized into the culture of our profession.

This professional socialization teaches us a set of beliefs, practices, habits, likes, dislikes, norms and rituals, factors that comprise a given culture.

We even speak a different language (medical terminology) and our understanding and beliefs regarding health and illness differ greatly from the population at large.

Western Medicine Medical objects vs Ethical problems By its nature treats patients as medical objects, a biomechanical entity. Patients are detached from their own lives and life stories and physically taken from their home settings into the unfamiliar setting of a hospital, to be treated by different specialists.

But patients often resist this treatment in a number of ways and the resulting conflicts express themselves as "ethical problems."

Patient care: health and illness So how can we as providers of health care, meet the perceived needs of the patient as defined by the patient?

Care means that the patient should be treated as a human being, with a life beyond the hospital and a meaning beyond the medical world.

Cultural Competence   To be culturally competent the healthcare provider needs to understand his/her own world views and those of the patient, while avoiding stereotyping and misapplication of scientific knowledge.

Cultural competence is obtaining cultural information and then applying that knowledge. This cultural awareness allows you to see the entire picture and improves the quality of care and health outcomes.

Adapting to different cultural beliefs and practices requires flexibility and a respect for others view points. Cultural competence means to really listen to the patient, to find out and learn about the patient's beliefs of health and illness.

To provide culturally appropriate care we need to know and  to understand culturally influenced health behaviors.

Culture and Barriers The patient’s perception of illness and disease and their causes varies by culture which affects their approach to health care. 

Culture also influences how people seek health care and how they behave toward health care providers.

How we care for patients and how patients respond to this care is greatly influenced by culture. Health care providers must possess the ability and knowledge to communicate and  to understand health behaviors influenced by culture. Having this ability and knowledge can eliminate barriers to the delivery of  health care.

Understanding and Tolerance As individuals, nurses and health care providers, we need to learn to ask questions sensitively and  to show respect for different cultural beliefs.  Most importantly, we must listen to our patients carefully.

The main source of problems in caring for patients from diverse cultural backgrounds is the lack of understanding and tolerance. Very often, neither the nurse nor the patient understands the other's perspective.

Other Barriers: Cultural Factors Why should the Western health care system adapt to the needs of other cultural groups? Why don't immigrants learn to speak English?...

Most would say, Yes they should adapt to our culture and learn our language.  Unless cultural differences are taken into account we can not provide optimal health care for all patients. Misunderstandings can often lead to misdiagnoses.

Patient Care Goals As healthcare providers we need to develop a cultural insight and a deeper appreciation and respect for the rights of culturally diverse individuals. Culture, ethnicity and religion are strong determinants in an individual's interpretation or perception of health and illness and their response to treatment and healing. 

Stereotyping and Generalizations Do not assume that the criteria for a certain cultural group are true for every patient who belong to that racial, ethnic, or cultural group. A Stereotype is an ending point, no attempt is made to learn whether the individual in question fits the statement.  A Generalization is a beginning point, it indicates common trends, but further information is needed to ascertain whether the statement is appropriate to a particular individual.

Case Study 1 A Hispanic woman had to sign an informed consent form for a hysterectomy. The patient spoke no English and the hospital staff relied on her bilingual son to serve as the interpreter. When the son explained the procedure to the mother, he appeared to be translating accurately and indicating the proper body parts. His mother signed the consent form willingly. The next day, however, when she learned that her uterus had been removed and she could no longer bear children, she became very angry and threatened to sue the hospital. 

Case Discussion Because it is inappropriate for Hispanic male to discuss her private parts with his mother the embarrassed son had explained that a tumor would be removed from her abdomen and pointed to the general area. The woman became quite angry and upset because a Hispanic woman's status is derived in large part from the number of children she produces.  Even speaking the same language is not always sufficient. Cultural rules often dictate who can discuss what with whom. In general, it is best to use a same sex interpreter when translating matters of a sexual or private nature. 

Case Study 2 When the nurse entered the room of her Iranian patient, she found the patient huddled on the floor, mumbling. At first she thought the patient had fallen out of bed, but when she tried to help her up the patient became visibly upset. She spoke no English and the nurse had no idea what the problem was. The patient had been praying. 

Case Discussion She was practicing her religion in the traditional manner. Since she was scheduled for surgery the next day, she thought it was especially important to pray.  Devout Muslims believe they must pray to Mecca, the Holy Land, five times a day. Traditionally, they pray on a prayer rug placed on the floor. If the nursing staff had some understanding of Muslim customs, they could have arranged to provide the patient some privacy during certain times of the day so she could pray. 

Case Study 3 A middle-aged Chinese patient refused pain medication following cataract surgery. When asked, he replied his discomfort was bearable and he could survive without any medication. Later the nurse found him restless and uncomfortable. Again the nurse offered pain medication. Again he refused, explaining that her responsibilities at the hospital were far more important than his comfort and he did not want to impose. Only after she firmly insisted that the patients comfort was one of her most important responsibilities did the patient finally agree to take the medication. 

Case Discussion Chinese are taught self-restraint. The needs of the group are more important than those of the individual. Another factor that may be involved in Asian's refusal of pain medication is courtesy. They generally consider it impolite to accept something the first time it is offered.

Case Discussion The safest approach for the healthcare provider is to anticipate the needs of an Asian patient for pain medication without waiting for requests. Healthcare providers should be aware of Asian rules of etiquette when offering pain medication, food or other services. But if the patients continue to refuse medication, their wishes should be respected. 

Case Study 4 A Vietnamese woman was rushed to the hospital by her adult children. The emergency room personnel discovered dark red welts running up her arms, shoulders and chest, yet the only presenting complaint was dizziness. When questioned, her son explained that he had rubbed her body with a quarter.  A nurse becomes concerned when she finds an elderly Chinese patient rubbing him self with a quarter( she thought he was trying to hurt himself). When she took the coin away from the patient, he became very upset, grabbed it back from her and continued to rub his arms and legs, leaving dark red scratches. 

Case Study 4 cont. A Vietnamese girl in her first year at an American elementary school, was not feeling well one morning, so her mother rubbed the back of her neck with a coin. When the school staff discovered the welts on the girls neck, they immediately assumed they were seeing a case of child abuse and reported the family to the authorities. 

Case Discussion In each case the patient was practicing a traditional form of healing known as coin rubbing. There are several variations, including heating the coin, but they all involve vigorously rubbing the body with a coin. This produces red welts, which can distract medical staff from the real problem or be mistaken for child abuse.

It is important to recognize and become familiar with this practice, and not to be distracted from the real problem or mistakenly make accusations of child abuse.  Asians rubbing their children with coins is not any more abuse than Americans having thin pieces of metal wrapped around their children's teeth and tightened until their teeth move out of place. Braces are usually applied for merely aesthetic reasons. Coin rubbing, at least, is an attempt to heal. Apparently, it often works, only the failures show up in the medical system.