Culturally sensitive nursing--questions

  1. I am doing a research paper on Madeleine Leininger, the founder of transcultural nursing, so I've been reading a lot of articles on the subject. We've also spent some class time discussing the importance of being sensitive to a patient's cultural background. I'd like to know how this works in the real world:

    If you work in a facility that serves a certain ethnic group or perhaps variety of ethnic groups, how helpful is it to understand their cultures? How does knowing their culture affect your practice? Does it make a difference in your approach? Do you research them on your own or does your facility provide education? Do you have interpreters available? What do you do when you don't?

    Leininger and others stress the importance of knowing other cultures and accomodating them as much as possible--obviously, most people who go to the hospital are sick and vulnerable and need all the TLC they can get. But there are going to be times when an understanding of a patient's culture isn't possible and you do the best you can. Do these patients try to meet you partway?

    Thanks in advance.
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  2. 14 Comments

  3. by   sooty40
    I am sorry i can't help with this topic as i haven't really worked in a place where the majority of the patients had a different culture ( religion ?) to mine but there did seem to be problems with the food provided by the hospitwal for the ethnic minorities - even though the chefs were supposed to be of the same background
    Also the reaction to bereavment was often ( to me ) extreme but not surprising to nurses of the same ethniticity i don't mean that to sound unsympathetic but I always found it difficult to deal with
  4. by   OB/GYN NP
    Hi Dianacs! I have worked in a hospital where there was a large population of various cultural groups (Orientals, Hispanics, Germans). I think it is helpful to be familiar with cultural and behavioral differences. It helps you to better determine what's going on with the patient. For instance, Oriental women tend to be pretty stoic in labor, so you may not notice when they are in more pain, and they could be ready to deliver, and they are only wincing a little with contractions. In this instance, you know not to trust HER actions to let you know when it's time to check her cervix. OB is my area, so that's what I think of, to describe how it's helpful, but I'm sure the same thing applies to lots of areas in nursing. The better you understand the patient, the more "in-tune" you can be with their needs. I'm not saying necessarily that knowing who the founder of transcultural nursing is will help you in your care of patients, but if you're like many nurses, we remember what's imoportant to keep from what we learned in school, and conveniently forget the rest. Forget it AFTER the test, of course.
  5. by   OB/GYN NP
    I didn't answer your other questions, so I'll add one more thing. Your hospital should provide interpreters, but I found that it was easier if I knew a few key phrases and questions, like how to ask if the patient thinks her water broke, etc, and be able to ask myself, instead of having to call for an interpreter, who may take a while to get there. Where I worked, the hospital provided some educational training in conquering language barriers, but for the most part, the research was done on my own.
  6. by   dianacs
    Thanks for your responses. I should clarify that I was only asking these questions out of personal curiosity, not as part of my paper (That's a whole other ball of wax).
  7. by   bagladyrn
    Dianacs - I'd have to say that I feel it is essential to understand something of a persons cultural matrix to be able to give complete care. I've seen pts. very negatively affected by someone who did not understand their culture. One easy to understand example was a young woman I found in tears alone in her room one night who finally relayed that (due to a doctor's forceful "warning" about the effects of gestational diabetes) she now knew that she would die before leaving the hospital and was worrying who would raise her children. In this case, she came from a culture who believe that to say "this can happen to you" is to wish it on them. Luckily, I had a wonderful coworker of her culture who took this seriously enough to come in at night and address this with her.
    If I'm not familiar with someone's culture, I make a point to ask when doing admission info with an interpreter "Is there anything special you need to do or have while you are here?"
  8. by   MollyMo
    Originally posted by bagladyrn
    If I'm not familiar with someone's culture, I make a point to ask when doing admission info with an interpreter "Is there anything special you need to do or have while you are here?"

    For us, it's not making a point of asking. It's written in our admission database to ask if there are any cultural or spiritual preferences that would affect care. There is even a chart with a breakdown of the most seen cultures to our area: country of origin;native language;religious and/or spiritual beliefs;responses to pain;treatment modalities,etc. You need to know so you don't accidentally offend someone when you're trying to help them.
  9. by   Faby
    hi. I've little experience with such cultural differences, but on ocassions I 've been really surprised of some people's habits, that were too much different from the rest of my usual patients. I think that if i should've known about those different habits my care would've been better. In example ; I work at an ob gyn unit, as chief nurse, and recently a woman was admitted in labor accompained by her husband and first child. She told us that her first child was born at home, and both, the mother and newborn were cared only by her husband. Fon the second deliver they noticed that something wasn't gong well, so they came to the hospital. So they wanted their child be with them during delivery, and they also would practice some sort of ceremony. actually the husband didn't wanted the doctor to touch the new born or the mother, as he wanted to be present only just in case. There was a real problem with that. And just after the newborn was with the mothw they wanted to go away, and cetrtainly they did.
    Another case was in anothe unit, med-surg, were i used to work at. A man died and the family wanted the nurse to give him a bath and put him clothes on. I explained that it wasn't possible, as it was against the hospital policy, and that the had to work it over with the company taht was taking care of the funeral and so on. they got really mad because it was an ancient custome of some part of the world that I can't remember. I really think it would've been different if I had known.
  10. by   hoolahan
    Great topic. I worked in a facility that had a charity heart surgery program for children from all over the world.

    Yes it is essential to understand some of the cultural differences. People from Russia do not think smiling is appropriate when discussing the child's care. Smiling while talking about a serious issue means you're an idiot. (This from a Russian born nurse/interpreter.)

    We had one Polish mother who wanted her child bundled up, and she felt like we were not keeping him warm enough. She settled for moistening non-sterile 4x4's that we kept at the bedside, with warm water, and laying them on the child. She kept going to the sink to refresh them so they would stay warm. We compromised by setting up the radiant warmer over him.

    How do I address it? Well, I worked nights, so forget the interpreters or asking about them. I would demonstarte any procedures I was going to perform, and we all knew a few basic words in the most common languages, like Drink, pee, pain, cough, take a deep breath. I found that cocoa cola and mama are universal!

    Some of the parents would have an English/whatever language dictionary, they would look up words in their question and show it to me in the book. I would look up my answers and show it to them. We drew pictures. Honestly, it was never much of a problem. They did usually have a sponsor who housed them while here, and usually it was a person of their native origin, so they were usually very helpful.

    We have had men who wished to keep their turbans on during surgery, and this was accomodated with the OR hats, and sterile towels wrapped and taped around it.

    Once many years ago, we had some gypsies who tied a nadana around the side rail and told us they put a curse on it, so if anyone took it off, they would be cursed for life. Do you believe one nurse just had to do it? I wouldn't touch that thing, and frankly, those people scared the heck out of me!!!

    I think it is something that you think more about with maturity, meaning, as you gain confidence in your own nursing abilities, your comfort level increases in asking those textbook questions. Open-ended questions work the best, like tell me how you learned to speak Spanish? Where do they get their prescriptions filled? Are the instructions written in their native language, can they read English? Where do they find strength when things are not going well? What kind of foods do you like to eat?

    Lenninger wrote the Transcultural Nursing text didn't she? That is a good book, but if you can get your hands on Estes, there is a great chapter on culture and spirituality in there, as well as how to do a cultural assessment.
  11. by   cactus wren
    Living in the Southwest I have frequent patients who are members of various Native American tribes.Each tribe has it`s own distinct culture, and to be an effective nurse, you need to know the differences.......becayse what is acceptable to one is verbottom to another......Many of the elders won`t speak English until they decide to trust you.......then their English is just fine.
  12. by   bagladyrn
    I've found that too, cactus wren! Working with Navajo pts, I used an interpreter when an elder did not respond to English, but never assumed that they did not understand. I also found that the elders tend to have a very dry sense of humor - one elderly gentleman in PACU was lying quietly when the nurse came over to check for return of sensation after a spinal - when touched he let out a loud yell, then lay there chuckling as the nurse practically levitated backwards from the shock!
  13. by   Teshiee
    I would have to say it depends on the culture itself. I work in California so I can see where cultural diversity plays a major role in our practice. I remember reading a book on different cultures it was very informative and helpful. Sometimes when we give care we may be offending the patient and not realizing it. I know that the Muslim culture men are forbidden to enter the room and some do their prayer at the bedside. I for one who may disagree with some of the customs even down right feel they may hinder their care, however as a caregiver I must try to be flexible and understanding. My job is not to judge but give the best I can at that time. Personally just being courteous, and pleasant transpire all cultures would be appreciated.
  14. by   semstr
    Hi, there, yes Madeleine Leininger was the first nursing theorist, who put culture diversity and caring on paper and did a lot of fieldstudies.
    Nowadays, there are quite a few others, who have similar, but a bit more realistic theories about diversity in culture.
    being from Europe, automatically means, caring for people from all over the world and their differencies.
    For patients this means, beginning with admission, not only questions about religion and do you want a priest/ Mulah, when necessary, but also about diets (religion related or not) and culturel or religious habits to be considered.
    Of course we have interpreters here and a lot of staff from all over the world.
    Want to know more about Madeleine Leininger: www.tcns.org or try www.transculturalnursing.org

    have fun and take care, Renee
    Last edit by semstr on Oct 25, '02

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