Overcoming cultural barriers for better care

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    borrowing approaches from anthropology, a small segment of nurses have sought to revise the way that medicine deals with patients. the approach, known as "culturally sensitive care," contends that a strictly western view is inadequate to address the needs of patients and their families in the modern world.

    ap/new york times, oct. 1, 2002
    by gina maranto
    http://www.nytimes.com/2002/10/01/he...cy/01nurs.html

    "i started doing drugs when i was 13," says suzanne ferraro, a middle-aged caseworker with a mane of curly hair.

    ms. ferraro sits in the cluttered space that serves as examining room and office for elaine kauschinger, the family nurse practitioner who runs the university of miami school of nursing's health center at the agape women's center.

    "suzie did every drug around," says ms. kauschinger, "and she knew everything about the streets. when we first met in 1998, neither one of us knew what the other one was talking about. we were from completely different cultures."

    as the two listened to each other over time, says ms. ferraro:
    "we taught each other. i learned about nursing, and she learned about real life on the street."

    ms. kauschinger laughs. "i would ask questions like: how do you shoot up heroin? what happens in a drug bust? how do you get drugs in jail?"

    through this interchange, ms. kauschinger says, she learned how better to deal with her substance-abuse patients at the residential agape women's center, a large majority placed there by the florida department of corrections. collaborating with ms. ferraro, she has done a pioneering study of why addicts who have aids fail to take their medications.

    ms. ferraro succeeded in breaking the drug habit and getting an associate's degree. now, she is studying for a bachelor's degree and serving as a case worker at the center.

    ms. kauschinger's approach to nursing represents a trend that has been gaining adherents since the 1960's. borrowing approaches from anthropology, a small but energetic segment of people in nursing have sought to revise the way that medicine deals with patients.

    often tending to people in communities that are isolated from access to medical care because of language and cultural barriers, these nurses emphasize the role that culture plays in shaping people's attitudes toward medicine and their compliance with medical instructions.

    the approach is known broadly as culturally sensitive care, and its basic contention is that a strictly western view is inadequate to the task of addressing the needs of patients and their families in the modern world.

    this, they say, is because patients carry with them deeply ingrained attitudes toward health and disease that derive from varied backgrounds. moreover, behaviors that appear inexplicable or inappropriate to western eyes may stem from beliefs that patients hold to be reasonable and well founded, even if they clash with standard practices.

    such ideas have influenced medical institutions and accrediting bodies. last year, the department of health and human services' office of minority health put forward standards for "culturally and linguistically appropriate services" to help health care organizations meet the needs of multiethnic patients. language difficulties, in particular, can lead to misunderstandings, misinformation and misdiagnoses that may inconvenience, embarrass or even endanger patients.

    recently, the joint commission on accreditation of healthcare organizations decided to re-examine the culturally appropriate care, intending to issue new guidelines.

    "for quite a while, medicine has recognized the diverse practices of immigrants," said dr. larry purnell of the department of nursing at the university of delaware.

    such practices may include using herbal or home remedies, consulting traditional healers or conceiving of illness in spiritual terms.

    but such thinking was relatively rare until the 1960's, dr. purnell said, when immigration to the united states again rose precipitously.

    it was then that dr. madeleine leininger, now an emeritus professor of nursing at wayne state university in detroit, began developing a theory that used techniques drawn from anthropology to investigate people's underlying beliefs and traditional healing arts.

    others followed her lead, and the field now has thousands of adherents, and multiple interrelated theoretical approaches that go by the names of transcultural, cross-cultural, multicultural or culturally competent nursing.

    in recent years, the field has expanded rapidly to consider the spectrum of religious, linguistic, ethnic, economic and gender differences that may affect health care. in the last two years, for example, the journal of transcultural nursing has published research on how to care for islamic and jewish patients; for haitian, eritrean, jordanian and cambodian immigrants; for h.i.v.-positive blacks; for korean-americans with mentally ill adult children; for puerto rican mothers who are breast-feeding their infants; for lesbians, residents of poor urban communities, hutterites and rural people of appalachia.

    an important goal is to improve public health by reaching groups that have been poorly served. "basically, from a community health point of view, if people are presented with ideas that are culturally relevant to them, they will take more responsibility for their own health," said dr. juliene lipson, a professor at the university of california at san francisco school of nursing.

    dr. lipson recounted the story of four women from the afghan health education project of the bay area who were able to teach afghan immigrants there how to do breast self-examinations.

    many afghan women are extremely modest, she said, so much so that they do not want to touch themselves. they would have been appalled if a doctor or nurse had privately shown them how to do the examination, or had shown them a film featuring a naked body.

    accordingly, dr. lipson's group, which included a woman from afghanistan who is also a physician, devised a session for teaching self-examination to the afghan immigrants, young and old, without nudity, using drawings and a model breast made of soft plastic.

    "they were excited," said dr. lipson, "and the older women asked for more classes on women's health." in follow-up calls some months later, the women reported that they were continuing to perform the examinations on their own.

    another central goal of culturally sensitive nursing is to engender respect for people's traditional approaches to medical care, partly to gain their confidence. dr. lydia desantis, who teaches at the university of miami school of nursing and has extensively studied haitian and cuban immigrant communities in south florida, said it was critical for nurses not to condemn cultural practices. if they do, she said, patients may stay away from clinics rather than seek treatment.

    dr. lauren clark of the nursing school at the university of colorado health sciences center, discussed work she had done with mexican-americans in san antonio. among preschoolers she studied there, one-third were already quite overweight. the mothers were feeding their children solids at a very young age and giving them sweet tea in their bottles — standard care in mexico.

    "their idea was that a healthy baby should be heavy so as not to appear malnourished," dr. clark said. "in effect, we had to negotiate between two sets of values. we had to convince them that they were not trading in their `mexicanness' by following pediatricians' guidelines" to help reduce the children's weight and the risk of diabetes.
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  4. 9 Comments so far...

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    I am a member of the transcultural nursing society and I get the journal 4 times a year. Excellent studies in there!! Very well researched and presented!
    www.tcn.org is the link.
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    Finally. If only this was part of the core curriculum in nursing school from day ONE.
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    it is here, since 1997
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    Could you do that link again, please? I seem to have gotten a wrong number....

    Also, I was always fascinated with other cultures and was taking a minor in anthropology before nursing school....so I've always been quite convinced that cultural awareness was relevant for nurses.
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    I'm doing my nursing theory paper on this theory.
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    The Transcultural Nursing Society

    The Journal of Transcultural Nursing (JTCN) is the official journal of the Transcultural Nursing Society. This peer-reviewed publication provides a forum for nurses, health care professionals and persons from other disciplines to discuss issues related to the advancement of knowledge in the area of culturally congruent health care delivery. JTCN provides the mechanism for a dialogue by encouraging contributions from international researchers, practitioners, and theoreticians about the relationship between culture and health care.

    The journal's mission is to promote dissemination of research findings concerning the relationship among culture, nursing and other disciplines, and the delivery of health care. Toward this end, the JTCN seeks to foster the exchange of opinions from multiple perspectives on cultural topics that affect nursing and health care research, education, and practice throughout the world.
    http://www.tcns.org/journal/
    Last edit by NRSKarenRN on Oct 9, '02
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    From TCN: Volume 13, Issue 4, October 2002

    Author:
    Madeleine Leininger, PhD, LHD, CTN, RN, FAAN, FRCNA

    Founder's Focus: Linguistic Cliches and Buzzwords in the Culture of Nursing pg 334

    Sounds like an interesting article. Think I need to visit college library soon.
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    Thanks for posting ... I'll definately check them out as I write this paper.
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    They are very helpful too, when you need something give them a call or write an e-mail.
    I so much wanted to go to Toronto, but helás, too expensive from here.

    PS: sorry for the worng link, Karen put in the right one. Thanks!
    Renee


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