Cultural Awareness for Nurses Powerpoint

2. A PATIENT'S BEHAVIOR is influenced in part by
his cultural background. However, although
certain attributes and attitudes are associated
with particular cultural groups as described in
the following pages, not all people from the
same cultural background share the same
behaviors and views.
When caring for a patient from a culture
different from your own, you need to be aware
of and respect his cultural preferences and
beliefs; otherwise, he may consider you
insensitive and indifferent, possibly even
incompetent. But beware of assuming that all
members of any one culture act and behave in
the same way; in other words, don't stereotype
people.

3. The best way to avoid stereotyping is to
view each patient as an individual and to
find out his cultural preferences. Using a
culture assessment tool or questionnaire
can help you discover these and
document them for other members of the
health care team.
Keeping the caveat about stereotyping in
mind, let's take a look at how people from
various cultural groups tend to perceive
some common behaviors and key health
care issues.

4. People tend to regard the space immediately
around them as an extension of themselves. The
amount of space they prefer between
themselves and others to feel comfortable is a
culturally determined phenomenon.
Most people aren't conscious of their personal
space requirements—it's just a feeling about
what's comfortable for them—and you may be
unaware of what people from another culture
expect. For example, one patient may perceive
your sitting close to him as an expression of
warmth and caring; another may feel that you're
invading his personal space.

5. Research reveals that people from the United
States, Canada, and Great Britain require the
most personal space between themselves and
others. Those from Latin America, Japan, and the
Middle East need the least amount of space and
feel comfortable standing close to others. Keep
these general trends in mind if a patient tends to
position himself unusually close or far from you
and be sensitive to his preference when giving
nursing care.

6. Eye contact is also a culturally determined behavior.
Although most nurses are taught to maintain eye contact
when speaking with patients, people from some cultural
backgrounds may prefer you don't. In fact, your strong
gaze may be interpreted as a sign of disrespect among
Asian, American Indian, Indo-Chinese, Arab, and
Appalachian patients who feel that direct eye contact is
impolite or aggressive. These patients may avert their eyes
when talking with you and others they perceive as
authority figures.
An American Indian patient may stare at the floor during
conversations. That's a cultural behavior conveying
respect, and it shows that he's paying close attention to
you. Likewise, a Hispanic patient may maintain downcast
eyes in deference to someone's age, sex, social position,
economic status, or position of authority. Being aware that
whether a person makes eye contact may reflect his
cultural background can help you avoid misunderstandings
and make him feel more comfortable with you.

7. Attitudes about time vary widely among cultures and can
be a barrier to effective communication between nurses
and patients. Concepts of time and punctuality are
culturally determined, as is the concept of waiting.
In U.S. culture, we measure the passing and duration of
time using clocks and watches. For most health care
providers in our culture, time and promptness are
extremely important. For example, we expect patients to
arrive at an exact time for an appointment—despite the
fact that they may have to wait for health care providers
who are running late.
For patients from some other cultures, however, time is a
relative phenomenon, and they may pay little attention to
the exact hour or minute. Some Hispanic people, for
example, consider time in a wider frame of reference and
make the primary distinction between day and night but
not hours of the day. Time may also be marked according
to traditional times for meals, sleep, and other routine
activities or events.

8. In some cultures, the “present” is of the greatest
importance, and time is viewed in broad ranges rather
than in terms of a fixed hour. Being flexible in regard to
schedules is the best way to accommodate these
differences.
Value differences also may influence someone's sense of
time and priorities. For example, responding to a family
matter may be more important to a patient than meeting a
scheduled health care appointment. Allowing for these
different values is essential in maintaining effective
nurse/patient relationships. Scolding or acting annoyed
when a patient is late would undermine his confidence in
the health care system and might result in more missed
appointments or indifference to patient teaching.

9. The meaning people associate with touching is culturally
determined to a great degree. In Hispanic and Arab
cultures, male health care providers may be prohibited
from touching or examining certain parts of the female
body; similarly, females may be prohibited from caring for
males. Among many Asian Americans, touching a person's
head may be impolite because that's where they believe
the spirit resides. Before assessing an Asian American
patient's head or evaluating a head injury, you may need to
clearly explain what you're doing and why.
Always consider a patient's culturally defined sense of
modesty when giving nursing care. For example, some
Jewish and Islamic women believe that modesty requires
covering their head, arms, and legs with clothing. Respect
their tradition and help them remain covered while in your
care.

10. In some aspects of care, the perspectives of
health care providers, patients, and families may
be in conflict. One example is the issue of
informed consent and full disclosure. For
example, you may feel that each patient has the
right to full disclosure about his disease and
prognosis and advocate that he be informed. But
his family, coming from another culture may
believe they're responsible for protecting and
sparing him from knowledge about a serious
illness. Similarly, patients may not want to know
about their condition, expecting their relatives to
“take the burden” of that knowledge and related
decision making. If so, you need to respect their
beliefs; don't just decide that they're wrong and
inform the patient on your own.

11. You may face similar dilemmas when a patient
refuses pain medication or treatment because of
cultural or religious beliefs about pain or his
belief in divine intervention or faith healing. You
may not agree with his choice, but competent
adults have the legal right to refuse treatment,
regardless of the reason. Thinking about your
beliefs and recognizing your cultural bias and
world view will help you understand differences
and resolve cultural and ethical conflicts you may
face. But while caring for this patient, promote
open dialogue and work with him, his family, and
health care providers to reach a culturally
appropriate solution. For example, a patient who
refuses a routine blood transfusion might accept
an autologous one.

12. People from all cultures celebrate civil and
religious holidays. Get familiar with major
holidays for the cultural groups your facility
serves. You can find out more about various
celebrations from religious organizations,
hospital chaplains, and patients themselves.
Expect to schedule routine health appointments,
diagnostic tests, surgery, and other major
procedures to avoid such holidays. If their
holiday rituals aren't contradicted in the health
care setting, try to accommodate them.

13. The cultural meanings associated with food vary
widely. For example, sharing meals may be
associated with solidifying social or business ties,
celebrating life events, expressing appreciation,
recognizing accomplishment, expressing wealth
or social status, and validating social, cultural, or
religious ceremonial functions. Culture
determines which foods are served and when,
the number and frequency of meals, who eats
with whom, and who gets the choicest portions.
Culture also determines how foods are prepared
and served, how they're eaten (with chopsticks,
fingers, or forks), and where people shop for
their favorite food.

14. Religious practices may include fasting, abstaining from
selected foods at particular times, and avoiding certain
medications, such as pork-derived insulin. Practices may
also include the ritualistic use of food and beverages.
Many groups tend to feast, often with family and friends,
on selected holidays. For example, many Christians eat
large dinners on Christmas and Easter and traditionally
consume certain high-calorie, high-fat foods, such as
seasonal cookies, pastries, and candies. These culturally
based dietary practices are especially significant when
caring for patients with diabetes, hypertension,
gastrointestinal disorders, and other conditions in which
dietary modifications are important parts of the treatment
regimen.

15. Along with psychosocial adaptations, you also need to
consider culture's physiologic impact on how patients
respond to treatment, particularly medications. Data have
been collected for many years regarding different effects
some medications have on persons of diverse ethnic or
cultural origins. For example, because of genetic
predisposition, patients may metabolize drugs in different
ways or at different rates. For one patient, a “normal dose”
of a medication may trigger an adverse reaction; for
another, it might not work at all. (Think of how
antihypertensive drugs don't work as well for African
Americans as they do for white ones.) Culturally
competent medication administration requires you to
consider ethnicity and related factors—including values
and beliefs about herbal supplements, dietary intake, and
genetic factors that can affect how effective a treatment is
and how well patients adhere to the treatment plan.

16. Various cultural groups have wide-ranging beliefs about
man's relationship with the environment. A patient's
attitude toward his treatment and prognosis is influenced
by whether he generally believes that man has some
control over events or whether he's more fatalistic and
believes that chance and luck determine what will happen.
If your patient holds the former view, you're likely to see
good cooperation with health care regimens; he'll see the
benefit of developing behavior that could improve his
health. Some American Indians and Asian Americans are
likely to fall into this category.
In contrast, Hispanic and Appalachian patients tend to be
more fatalistic about nature, health, and death, feeling
that they can't control these things. Patients who believe
that they can't do much to improve their health through
their actions may need more teaching and reinforcement
about how diet and medications can affect their health.
Provide information in a nonjudgmental way and respect
their fatalistic beliefs.

17. Clearly, you can't take a “cookbook” approach to
caring for patients based on their cultural
heritage or background. Transcultural nursing
means being sensitive to cultural differences as
you focus on individual patients, their needs, and
their preferences. Show your patients your
respect for their culture by asking them about it,
their beliefs, and related health care practices.
They'll respond to your honesty and interest, and
most will be happy to tell you more about their
culture.

18. Establishing an environment where cultural differences are
respected begins with effective communication. This
occurs not just from speaking the same language, but also
through body language and other cues, such as voice,
tone, and loudness. The Joint Commission on Accreditation
of Healthcare Organizations (JCAHO) requires facilities to
have interpreters available, so your facility should make a
list available. But at times you'll be on your own,
interacting with patients and families who don't speak
English. To overcome the barriers you'll face, use these
tips.
* Greet the patient using his last name or his complete
name. Avoid being too casual or familiar. Point to yourself,
say your name, and smile.
* Proceed in an unhurried manner. Pay attention to any
effort the patient or his family makes to communicate.

19. * Speak in a low, moderate voice. Avoid talking loudly.
Remember, we all have a tendency to raise the volume and
pitch of our voice when a listener appears not to
understand. But he may think that you're angry and
shouting.
* Organize your thoughts. Repeat and summarize
frequently. Use audiovisual aids when feasible.
* Use short, simple sentences and speak in the active
voice.
* Use simple words, such as “pain” rather than
“discomfort.” Avoid medical jargon, idioms, and slang.
* Avoid using contractions, such as don't, can't, or won't.
* Use nouns instead of pronouns. For example, ask your
patient's parent, “Does Juan take this medicine?” rather
than “Does he take this medicine?”

20. * Pantomime words, using gestures such as pointing or
drinking from a cup, and perform simple actions while
verbalizing them.
* Give instructions in the proper sequence. For example,
rather than saying, “Before you take the medicine, get into
bed,” you should say, “Get into your bed, then take your
medicine.”
* Discuss one topic at a time and avoid giving too much
information in a single conversation. For example, instead
of asking, “Are you cold and in pain?” separate your
questions and gesture as you ask them: “Are you cold?”
“Are you in pain?”
* Validate whether the patient understands by having him
repeat instructions, demonstrate the procedure you've
taught him, or act out the meaning.
* Use any appropriate words you know in the person's
language. This shows that you're aware of and respect his
native language.

21. * See if you have another language in common.
For example, many Indo-Chinese people speak
French, and many Europeans know three or four
languages. Try Latin words or phrases, if you're
familiar with the language.
* Do what you can to pick up a language that
many patients in your area speak. Get phrase
books from a library or bookstore, make or buy
flash cards, or make a list for your bulletin board
of key phrases everyone on staff can use. Your
patients will appreciate your efforts, and you'll
be prepared to provide better care.

22. Stacy McDaniel, RN
smcdaniel@shchc.org
490 Sitman St.
Greensburg, LA 70441