Understanding Culture and Transcultural Nursing Care - Cultural Diversity In Nursing Practice
An overview of Transcultural Nursing
Although it is a common knowledge and it is widely accepted that people differ in culture among various racial groups, yet this established fact is hardly ever considered when administering nursing care. That's where Transcultural Nursing Care comes in.
And due to the apparent relevance on the emerging challenge in the lack of attention to these cultural differences in health care practice which resulted in an inferior nursing care, more and more health care organizations including educational institutions and nursing associations are becoming more aware of the significance of culture to nursing practice, which led to the development of Transcultural Nursing Care.
Hence, it was then established that having cross-cultural nursing knowledge would enable the Nurse to interact effectively with the individual preferences of each culturally influenced health behaviours to prevent misunderstanding and to enable the nurse to provide suitable care in a culturally diverse health care setting.
Significance of cultural diversity in health care practice
Every patient’s attitude and behaviour towards their health and illness differ in many ways, but the most profound difference that must be religiously considered is the role of the underlying cultural factors affecting the patient’s outlook on their health condition.
Biological differences as a result of both hereditary and environmental factors which forms the genetic diversity among human beings is a contributing factor that varies greatly in determining why some individuals are more susceptible to certain diseases and why specific drugs have differing effects to certain individuals.
Awareness of the nurse on the prevalence and susceptibility of specific individuals to certain types of diseases, or the suitability of certain medication with a certain group of people enables the nurse to detect early signs and symptoms for effective intervention and immediate prevention.
Society and Culture
It should also be taken into serious consideration to recognize the fact that even though culture with its existing structure are subject to change brought about by the effect of social shifts as immigrants learn to adapt to their host culture, yet still, we cannot ignore or dismiss the possibility that culture change occurs in unpredictable stages, that people in a growing culturally diverse population strive to maintain their traditional cultural habits and beliefs even with the prevailing dominant values and traditions of the host society. Failure to recognize this logical truth is the very reason that substantiates for the failure of the health care system resulting in a substandard patient care.
Since there is a wide variation of culturally influenced health behaviours and beliefs as a result of culturally induced traditional interpretation of illness and disease and their causes, the need to develop a diverse nursing approach to consistently meet each distinct behaviour and belief is essentially important to serve as determinants from which a careful analysis and conclusion can be derive from, and to relate them to these individual preferences in order to render a careful nursing assessment and diagnosis, which when not appropriately recognized and not carefully applied to nursing practice may cause tension and confusion between the nurse and the patient, wherein the nurse would most likely rely only on pure assumptions and make inaccurate assessments which would result in the delivery of unsuitable nursing care.
Factors affecting health care intervention resulting from cultural diversity
In a culturally diverse health care setting in a multi-ethnic society, health care providers can only accomplish optimal patient care by developing a sense of deeper understanding, patience and tolerance on the variation of cultural beliefs and practices of culturally diverse individuals.
The exhibited effects on individuals influenced by their cultural values and beliefs are manifested in their behaviour ranging from the way they seek medical attention or by the way they view or respond to the care and treatment of the health care provider.
The following examples provides some insights about these culturally influenced behaviours:
Expression of pain
There are many forms of habits and behavior that the health care provider must learn to recognize in a multicultural health care setting. For instance, the most obvious response of most hospital patients is to immediately complain upon feeling any slightest discomfort wherein the most common reaction of the patient would be to seek immediate medical attention the very instant they feel even the smallest amount of pain, yet patients from Asian countries exhibit calm endurance of pain and may not ask for any medication at all.
The Chinese are particularly known to endure pain without medication. It is a part of their traditional discipline to hold back the pain and strongly believe that it is an act of courtesy on their part to refuse pain medication for the sake of the greater good of the majority who have greater need of the pain medication. In other words, it is traditionally impolite and shameful for a Chinese to be prioritized just to relieve his own discomfort while there are others who are suffering with much worst condition than him.
Similarly, it is also a common practice for most Asian women to refrain from showing their feelings of pain or discomfort during childbirth, because crying out in pain is an emotional outburst of complaint, hence it would be a disgrace not to gratify oneself to appreciate the suffering of childbirth as a wonderful experience of motherhood. By being aware of such traditional Asian customs and belief, the nurse must learn to be observant to check for any signs of restlessness in the patient in order to determine the need for treatment or medication even if the patient persistently refuses to submit to medical procedures by trying to conceal their pain or discomfort.
But while it is a customary habit for most Asian women to be tolerant to the pain and discomfort of childbirth, Middle Eastern and Hispanic women tend to express their childbirth experience (including any other feelings of pain) very loudly. But health care providers should be very careful not to always confine their thoughts to theoretical assumptions base on this cultural pattern by categorizing loud expression of pain as a normal condition based on the conception of the cultural traits inherent with this particular group of people. It would be wrong to ignore the Middle Eastern and Hispanic women’s loud screams by assuming this expression as their usual traditional response to pain without doing any further nursing assessment on the cause of the excruciating pain which could potentially be an indication that something is really very wrong.
Coin rubbing as self medication
Health care providers may also find that the Asian’s traditional practice of rubbing their body with a coin to be a very disturbing act of inflicting pain to the body. Coin rubbing is a traditional type of healing which is widely practiced by most Asians that often gives the impression of human torture.
The purpose of coin rubbing is an attempt to quickly stimulate the healing of illness but would result in the presence of red welts on the surface of the skin where the coin is rubbed. This practice is also often mistaken for child abuse when applied by the elders to a child.
The result of coin rubbing is also known to cause incorrect diagnosis due to the deceptive appearance of the noticeable red welts, which is often firstly identified and initially assumed as some form of distinguishable symptom despite its irrelevance to the real cause of illness. In this case.
If the health care provider is aware that the red welts were caused by the traditional healing practice of coin rubbing, then the health care provider will not be distracted away from the real cause of the illness, allowing them to explore other possibilities instead of the visible red welts by focusing on the other symptoms associated with the illness to determine a correct diagnosis and a suitable course of action.
Women and family honor
Another unique traditional practice and belief influenced by culture that must be expected and respected by the health care provider is the effect of a strictly practiced tradition owing to a firm conviction to the value of female purity as the foundation of family honor, like that of the restricted Middle Eastern culture that strictly prohibits male nurses to examine their women.
In this case, health care institutions should make appropriate arrangements to exclusively provide only female nurses and staff to attend exclusively to Middle Eastern women patients. The room of the Middle Eastern women patient should also be treated with utmost privacy that permission to enter the room should always be with the informed consent of the husband or with the eldest male of her immediate family.
Strict compliance to ask permission from the husband or the eldest male in the family should also be adhered to when performing other activity that requires the Middle Eastern women to undergo any medical procedures.
Another culturally influenced behaviour which can often be misunderstood by the nurse as a strange mannerism is the avoidance of eye contact by the Asian patients, a behaviour which is often regarded offensive and misinterpreted as a sign of rejection of trust, but when perceived correctly as a culturally influenced behaviour is in fact an act of acknowledging respect for the superiority of the nurse over the individual’s health and well-being.
Health care providers should also be aware that direct eye contact may be regarded as sexually provocative and should be avoided between men and women when tending to Middle Eastern patient or when conversing with their immediate family.
Useful Reading Resources
It should also be noted here that communication barrier is the most familiar obstacle that can be experienced by the health care provider in an actual face to face encounter with patients in a multicultural health care setting, as would a simple human interaction as a direct eye contact which can have implications to some cultural meanings.
Efficient nursing assessment and intervention is very dependent on effective communication, which requires a clear and unobstructed exchanging of thoughts, feelings and experiences between the patient and the health care provider or even among health care providers.When health care providers and patients do not speak a common dialect, the use of an interpreter is often the only alternative means to convey the right message.
Other aspects of culture affecting communication can also include issues such as in the Asian culture wherein there is great respect placed on the eldest male as the head and decision maker of the family, therefore all nursing intervention instructions from the health care provider to the Asian patient should be conveyed only through this eldest Asian male and not directly to the patient.
However, there are also some instances wherein cultural values can cause inconvenience in communication even when speaking the same language, that even having a translator who speaks the same dialect with the patient could also have communication problems due to the effect of cultural rules that must be strictly followed.
A typical example would be the Hispanic culture wherein extreme privacy in discussing the Hispanic woman’s private parts even with the male members from within her own family is strictly observed. In this case, it would be highly inappropriate for a male member of a Hispanic family to translate in their own dialect the details of a medical procedure to be performed on their women that would involve her private parts.
To avoid embarrassment, the male family member would resort to describing a general area of the body where the female part is located thus resulting in a vague explanation of the actual medical procedure that the patient will be subjected to. This could potentially result in a legal dispute between the patient and the health care provider as a result of the unexplained risk involved in the medical procedure without the informed consent of the patient. In such a case, it would be sensible to make use of same-sex language interpreter.
Knowing how to interact with culturally diverse individuals will help the health care provider to avoid misunderstanding with a multicultural patient population.
Effect of cultural diversity among health practitioners
In a multicultural health care setting, difference in cultural values and belief is also known to cause disagreement among health care workers. Known occurrences of such conflict and misunderstanding have transpired as a result of work related issues involving differences in opinions and practices among cultures.
The conflict often arises from a huge gap on the understanding of how a particular culture should appropriately behave or interact to the other culture, each imposing their own cultural value to the other. When such conflict resulting from cultural differences among the health care workers is not resolved, the health care system will suffer thus affecting the delivery of health care to the general patient population.
To eliminate all possibilities of cultural factions among cultures in the organization, it would be helpful for health care institutions to provide trainings and seminars to bridge the gap in order to cultivate understanding between cultural differences.
Developing awareness of cultural factors affecting working relationship will help promote understanding of the reasons behind the conflicting issues, which will re-establish compatibility between opinions and belief to put aside and settle the differences.
Another effective solution is to assign a counsellor to act as intermediary between co-workers to resolve opposing issues in order to bring a harmonious working relationship between co-workers within the organization.
By becoming accustomed to developing flexibility in familiarizing with diverse cultural beliefs and practices, the Nurse develops the ability to provide efficient culturally appropriate health care to various culturally influenced health behaviours and beliefs with their patients. Having the ability to effectively address and interact to these individual preferences stemming from cultural diversity eliminates the barriers to the delivery of an effective health care management.
Although it would be impossible to familiarize and remember every traits and habits about every culture, but the most important point is to possess the ability to have constant awareness of the people’s cultural values that must be religiously considered in the study and practice of professional Nursing.
A professional health care provider takes pride in fully dedicating themselves to the responsibility bestowed upon the profession which is devoted to providing reliable care for the well-being of the general patient population without discrimination of race, ethnicity or culture but with due regard to everyone’s value in life as human beings, just like you and me, and just like everybody else.
So what is Cultural Diversity once again? (You might persistently inquire while scratching your head)
Culture - that fundamental substance of learned behaviour common to a civilized society, or the way of life of a group of people in a society. The human traits and beliefs, customs and traditions that forms that primary aspect that distinguishes the distinct social characteristic of an individual which establishes their social identity in belonging to a social group or as a member of their civilized society.
This traditional knowledge and values were acquired from generations of ancestral beliefs as how the ancestors of a certain group of people viewed and responded to their environment and populated their territorial bounds with a civilized human society.
Every civilized human society has their own specific cultural attributes owing to their natural habitat and resources which greatly influences an individual’s attitudes, values, ideals and beliefs.
The significance of culture to an individual can be based on the way they relate themselves to the world around them through their values and beliefs, which is influenced by their long established customary habits and abilities to adapt to their environment to respond to their existence to sustain life in order to survive.
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