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The
landscape of healthcare is changing. The location
for service is changing from hospital-based to
alternative locations - home, rehabilitation center,
subacute care center, and urgent care center.
Clients cross international borders to receive
healthcare. The age of the client is changing
from younger clients to older clients. Healthcare
personnel are changing from a common ethnic origin
to a variety of ethnic origins. Clients come from
many different ethnic backgrounds. All of this
change creates the need for healthcare personnel
to be familiar with transcultural or intercultural
principles of care.
Transcultural nursing is a recognized
specialty in nursing. Transcultural nurses focus
on the similarities and differences among cultures
order to provide appropriate healthcare based
on the client's values, beliefs, and healthcare
practices (Leininger, 1994). In addition to the
client's cultural values, beliefs and healthcare
practices affecting the healthcare provided and
received, the healthcare provider's cultural values,
beliefs and healthcare practices also impact the
outcome of each care situation. Working together
to provide the most appropriate care is difficult
when cultural values are shared, it becomes much
more difficult when cultural values differ or
even clash.
Within a healthcare team, there
might be multiple cultural backgrounds. In 1976,
I shared a home with Vietnamese refugees. I could
understand their English so when the youngest
son became ill I became the translator (speaker
of "American English") between the "Indian
English" the physician used and the "Vietnamese
English" the patient and his family used.
Frustrating - Yes! Rewarding - Yes!
One cultural value that may differ
is the value of time. Healthcare providers are
habitual time conscious. When the client does
not sense the same urgency for appointments or
therapies, misunderstandings can occur. Adapting
schedules, rearranging appointments and being
sensitive to cultural variations to the meaning
in time will promote better understanding between
healthcare provide and client.
Another cultural pattern that
varies between ethnic or cultural groups is who
makes the decisions. Frequently, the healthcare
providers expect the parents to make healthcare
decisions for a child. In some cultures, it may
be a group decision or the decision may be made
by the 'elder' in the family. The insistence that
only the parents be informed of the condition
of the child can cause friction within the family.
Communication is critical to providing
culturally appropriate healthcare. Speaking the
same language does not guarantee comprehension
between healthcare providers and between healthcare
providers and the recipient of healthcare. English
varies from country to country. Spanish varies
between Spain and countries in Central and South
America. Speaking different languages creates
confusion and misunderstanding. A person that
speaks a second language well may not know healthcare
terminology in the second language. When I was
learning French in Albertville, France, I became
ill with severe headaches. After one particularly
trying time in a doctor's office, I vowed never
to speak French again! Illness decreases a client's
ability to communicate in a second language. Translators,
although necessary, may add another layer uncertainty
to the communication between healthcare providers
and care recipients. Both verbal and non-verbal
listening skills are necessary for today's professional.
Education in cultural sensitive
skills should be part of every health care program.
Higher education institutions offer cultural anthropology,
intercultural studies, foreign language, cross-cultural
ministries, or similar courses. An objective of
courses like these is to help a person gain an
understanding of similarities and differences
between groups of people. It would be impossible
to learn specific similarities and differences
for all groups of people. Instead, the goal would
be to become more cultural sensitive and gain
an ability to recognize potential culturally sensitive
situations. Some institutions are requiring students
to meet a minimum requirement for cultural competency.
Specific programs of study require courses in
cultural studies.
Nursing programs have added courses
such as Intercultural Nursing, Transcultural Nursing,
Cross-Cultural Nursing, and Cultural Diversity
in Health Care. The objectives for these courses
include demonstrating awareness of other cultures,
identifying personal cultural biases, and integrating
cultural care in professional practice settings.
These courses have a didactic (lecture) component
and some may have a practicum or clinical component.
Intercultural Nursing at Indiana
Wesleyan University has both components. The didactic
component (2 credits) is taken during a student's
junior year. Upon completion of the junior year,
the student arranges for a 42 practicum (1 credit)
experience with a professional nurse. Students
request a professional nurse they know to be their
preceptor for their Intercultural Nursing Practicum
or they request help in locating a preceptor.
Students have spent time at hospitals in Gabon,
Kenya, Russia, Zimbabwe and Haiti, as well as
in a Mexican clinic, a Cambodian health center,
Indian reservations in the United States, and
at local providers of care for Mexican migrants.
Students have chosen to go to Mary Breckinridge
Hospital in Kentucky, and Hooverwood Nursing Home
(Kosher Jewish) and Citizen's Health Corporation
both in Indiana. Students research cultural phenomena
for their chosen location in order to have a basic
knowledge of the culture upon arrival. The experience
is stretching and life changing. Students report
on their experiences during the next school year.
Cultural care and sensitivity
is required of healthcare professionals today.
Each professional will encounter cultural similarities
and differences in their clients and their co-workers.
An ability of manage quality care in the changing
landscape of healthcare today is a skill that
can be learned and must be practiced. The landscape
is changing but the need for culturally sensitive,
excellent care will never change.
Author
Barbara a.Ihrke
Division of Nursing Education
Indiana Wesleyan University
Leininger,
M. (1994). Transcultural
nursing education:
A worldwide imperative. Nursing and Healthcare
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