Adapting to Cultural Diversity in Healthcare 1

Adapting to Cultural Diversity in Healthcare 1

Adapting to Cultural Diversity in Healthcare

Christopher C. Roth

Kent State College

Abstract

Nurses and healthcare members must learn and recognize different cultures and customs to adequately provide care. Some needs that must be considered are: Religious needs, cultural customs, boundaries in communication, and caring aspects of the sick and ill. There ismore than one way to care for a client, and nurses must be flexible to accept the challenge of caring for a patient that is from a different background.

America is known to be a melting pot of diverse cultures from around the world.When it comes to healthcare, nurses must be aware of the needs and customs of their clients. Religious beliefs are important to clients, and cultural boundaries must be considered and respected. Madeleine Leininger’s work on cultural based care is discussed and has made an impact on methods of treating clients and really caring for the sick and needy. It is also very important to inquire about complementary and alternative care that clients use, to get a better understanding of the health history and techniques patients use to heal or prevent injury.

Culturally Diverse Religious Needs.

When caring for culturally diverse patients, we must be sensitive to the spiritual needs of the individual. Health is defined by Merriam-WebsterOnline Dictionary as “the condition of being sound in body, mind, or spirit; especially: freedom from physical disease or pain” According to Verna Benner “Spiritual care can take many different forms; there is no one way that we touch another’s spirit. This process involves recognizing and honoring the religious beliefs and practices of those in our care”(preface vii). I believe that nurses must be aware of, and respect different religions because of the importance and strength that the patient draws from his or her religion. Let’s look at a few beliefs that nurses can be aware of, to adapt special needs into practice. In O’Briens spiritual care and religious traditions:

The keeping of a kosher dietary regimen, if not injurious to health, is very important to many Jewish patients coping with an illness experience (Fine, 1995), as is the keeping of Shabbat or Sabbath, which is observed from sunset on Friday evening to sunset on Saturday (2008, p.133).

Some practices by Muslims may need to be taken into special consideration. If a Muslim patient is in the hospital these practices include “ritual prayer, prayed five times each day (preceded by ritual washing) while facing Mecca (the East); honoring Ramadan, the month of fasting from sunup to sundown” (O’Brain, 2008, p. 135). Nurses should think of ways in which they can provide quiet time throughout the day. This can be difficult in the hospital with many different departments coming and going trying to get certain tests done. The nurse providing care for the patient can place a sign on the patients door requesting quiet time or a please do not disturb sign. Catholics may request a priest for the sacrament of the Anointing of the Sick. A nurse could help arrange this with the family or loved ones if the patient is in terminal health or asks for the service. When dealing with blood products and transfusions, there are some religions that will not participate. “Jehovah’s Witnesses have been the most vocal in opposing all blood transfusions, but have recently carved out exceptions for some blood-derivative products” (Carson & Koenig, 2008, p. 108). The main goal nurses can strive for, in my view, is to be educated and sensitive when dealing with spirituality issues.

Cultural Diversity in Health Care and Leininger’s Work.

One of the leaders in Cultural Diversity is Madeleine Leininger, PhD, LHD, DS, CTN, FAAN, FRCNA. Leininger developed many theories that are used to this day such as her Cultural Care theory. Madeleine developed what is known as the “Sunrise Model to Depict Dimensions of the Theory of Culture Care Diversity and Universality” (Leininger, 2001, p. 191) to help nurses “depict factors influencing care” (p. 190). This theory starts from the Culture Care Worldview, and finishes with Culturally congruent Care for Health, Well-being or Dying. Leininger relates religious, philosophical, technological, economic, educational, political, cultural, and social factors in the Sunrise Model. Some of Leiningers ideas on Cultural based care are:

1)Care is the essence of nursing and a distinct, dominant, central, and unifying focus. 2)Culturally based care (caring) is essential for well-being, health, growth, survival, and in facing handicaps or death. 3)Culturally based care is the most comprehensive, holistic, and particularistic means to know, explain, interpret, and predict beneficial congruent care practices.4) Culturally based caring is essential to curing and healing, as there can be no curing without caring, although caring can occur without curing, 5) Culture care concepts, meanings, expressions, patterns, processes, and structural forms vary transculturally, with diversities (differences) and some universalities (commonalties) (p.192).

Cultural boundaries in nursing are always going to be present and we must look at ways to cross the gap between cultures. A journal by Health and Wellness at Akron Summit County Public Library explains that “important information might be withheld or misinterpreted if a language barrier exists or a mutual understanding between the parties cannot be reached” (V20(1),p6). The meanings of a word or phrase in one culture may not transfer to the meaning of a word in another. “Provide all clients with limited English proficiency (LEP) access to bilingual staff or interpretation services. A language line can be accessed 24 hours a day, 7 days a week by dialing 1-800-528-5888” (Cherry & Jacob, 2011, p. 223 & 228). Also, things like eye contact and personal space vary from culture to culture. “Although some cultures , such as the Euro-American, value direct eye contact as a sign of attention, other cultures, such as African-American or American Indian, may view direct eye contact as rude behavior” (p. 223). Rachel Spector (2009)explains personal space at different levels in Cultural Diversity In Health and Illness. These levels are Intimate zone, Personal distance, Social distance, and Public distance in which “different ethnocultural groups have varying norms related to the use of space” (p. 26). “For instance, Asians frequently believe that touching strangers is inappropriate; therefore, they have a tendency to prefer more distance between themselves and others, particularly health professionals whom they have not previously known” (Cherry & Jacob, 2011, p. 223). Another cultural difference that is important to note is the view of time orientation.

Certain cultures in the United States and Canada tend to be future-oriented. People who are future-oriented are concerned with long-range goals and with care measures in the present to prevent the occurrence of illness in the future. They prefer to plan by making schedules, setting appointments, and organizing activities. Others are oriented more to the present than the future and may be late for appointments because they are less concerned about planning to be on time (Spector, 2009, p 26-27).

As a result, when medications have to be given within a certain time frame, it may be difficult for a patient to adhere to taking medications at specific time. One way to avoid this situation would be to instruct the client that they need to take their medication in the morning when they get up, or the evening or night. This will help the patients relax about strict practices that they may not be accustomed to.

Authority figures differ from one culture to another. This is important to understand because it may not be acceptable to ask for past medical history directly from the woman of the family. Questions regarding past medical history or signing consent forms may need to be directed to the husband or other authority figure in the family or social group “In many cultures, including Romany ‘Gypsy’, Asian, Middle Eastern, and Hispanic, males are traditionally the authority figures” (Galanti,G. A. 2008, p. 95).

Complementary/Alternative Therapies and Aspects of Care

Complementary nursing techniques are important to recognize in nursing because many patients use them. Some of these are passed down from generation to generation and others may simply be a cheaper alternative that the patient uses in conjunction with modern healthcare practices. “Therapies such as meditation, imagery, support groups, music therapy, humor, journaling, reminiscence, caring-based approaches, massage, touch, healing touch, active listening, and presence have been practiced by nurses throughout time” (Lindquist & Snyder, 2010, p. 8). Different cultures have different healing and alternative medicines and herbs. “In the context of North America, the land has been a source of healing. The first step for an Indian doctor was to learn to walk in balance with the Earth Mother” (Lindquist & Snyder, 2010, p. 16). Mexican Americans care includes, “When a family member became ill, household remedies consisted of medicinal plants, fright-illness rituals, massage, and sweat baths. If no relief resulted, the family and relatives joined for a curing ceremony of prayer, sacrificial offerings, ritual meals, and a pilgrimage to local shrines” (Lindquist & Snyder, 2010, p. 18). Another alternative therapy is healing touch.

The concept of energy systems as part of the human interactive environment and healing has been part of many cultures for centuries. Ancient East Indian traditions speak of a universal energy (prana) that flows and activates the life force (kundalini) (Hover0Kramer et al., 1996). In China, Japan, and Thailand, the basic life energy is called chi, qi, or ki (Lindquist & Snyder, 2010, p. 253).

I believe that the use of complementary therapies will continue to increase. “An exciting aspect of complementary therapy use is learning about healing practices that have been used for centuries in other cultures and the role these might have for a broader arena in health care” (2010, P. 454). Nurses should look at the whole person trying to understand their past history, environments, hazards to health, and must include the patients healing techniques he or she uses to fully understand the patient’s approach to healing. I believe that alternative therapy will become better intigrated into the future healthcare system because nurses and doctors cannot ignore the effects that alternative therapy has on individuals.

Well-rounded healthcare teams will meet the needs of diverse populations by including all aspects of culture and individualism. Time, personal space, consent, authority figures, and eye contact are only a few areas in which one culture may differ from another. It is important that nurses and other healthcare members continue to learn and grow from educational programs that include the teachings and beliefs of many groups around the world. Madeleine Leininger reminds us that “caring should be at the center of what we do as nurses and that cultural based care is the most comprehensive and holistic care nurses can provide” (Leininger, 2001, p. 192).

References

Carson, V.B., Koenig, H.G. Eds. (2008). Spiritual dimensions of nursing practice. (Rev. ed.). West Conshohocken: Templeton Foundation Press.

Cherry, B. Jacob, S. (2011). Contemporary Nursing: Issues, trends, and management. (5th ed.). St. Louis: Elsevier.

Galanti, G.-A. (2008). Caring for Patients from different cultures (4th ed.). Philadelphia:University of Pennsylvania Press.

Health. 2008. In Merriam-Webster Online Dictionary. Retrieved October 17, 2010, from

Health and Wellness Resource Center. (2010). Growth in cross-cultural competency improves patient care. Health Governance Report. 20(1),6(2).Retrieved October 8, 2010, Akron Summit county public Library.

Leininger, M. (2002). Culture Care Theory: A Major Contributionto Advance Transcultural NursingKnowledge and Practices. Journal of Transcultural Nursing, 13(3), 189-192. Retrieved from

Lindquist, R., Snyder, M. Eds. (2010). Complementary & alternative: Therapies in nursing. NewYork: Springer Publishing Company.

O’Brien, M. E. (2008). Spirituality in nursing: Standing on holy ground (3rd ed.). Sudbury, Massachusetts : Jones and Bartlett Publishers.

Spector, R.E. (2009). Culture diversity in health and illness (7th ed.). New Jersey: Prentice Hall.