Cultural Differences in Nursing, Research Paper Example

In adiverse society, intercultural communication skills are becoming increasingly important and these skills becoming especially important at the end of life, when existential questions are paramount, questions that can be heavily influenced by the patient’s culture (Ekblad, 2000, p. 623).  The American Psychological Association, when writing about the significance of good cross-cultural communications between patients, their families and the health care team, states baldly that “Lack of open and culturally sensitive discussion may mean that the patient’s choice for end of life care is ignored” (American Psychological Association, 2013, p. 1) and note that a person’s ethnicity can influence important aspects of end of life care, such as what life support measures to use and whether to die at home, in a hospice or in a hospital. (American Psychological Association, 2013, p. 1).

While it is important to remember that culture must be assessed in the context of the individual – he or she may or may not be strongly influenced by the ethnic group they belong to – at least a basic knowledge of the norms and mores of different ethnic groups is useful to the nurse to avoid misunderstanding or miscommunication and to be able to truly respect the wishes of the dying patient.  This paper seeks to examine aspects of two ethnic groups – African American and Filipino American – then compares with to the author’s own ethnic group, Caucasian American and ends with a meditation on a nurse’s perspective on working with these ethnic groups.

African American Culture

There are many things to keep in mind when caring for African American patients and their families that help make care easier on everyone.  First, it is important to keep in mind that it is a sign of respect to communicate with the oldest family member and to keep them “in the loop” and that displays of emotion from family and patients during the dying process should be expected; it is also important to remember that many will opt to take care of dying family members at home, but will want support such as cleaning and preparing the body after death. They may or may not agree to organ donations or autopsies (Mazannee, 2003, p. 53).

Other considerations include the fact that African Americans are much less likely than their white counterparts to write advance directives or agree to hospice care.  Part of this is lack of access to culturally appropriate information on these issues, lack of understanding of medical terms, and mistrust of the medical system. Because of the history of racial discrimination in this country, older African Americans especially may believe that if they agree to hospice care, they will not receive the treatment that they need (Marquand, 2014, p.1).  Many Africans Americans also believe that palliative care will translate into a “denial of care”; in generally, African Americans tend to want more aggressive end of life care than their white counterparts (American Psychological Association, 2013, p. 1).

Filipino American Culture

There are also considerations to keep in mind when dealing with Filipino Americans and parts of their culture that can affect care. Typically, it is most appropriate to communicate information with the head of the family and out of the patient’s presence and public displays of emotion are within the norm for this particular ethnic group. The majority of Filipinos are Catholic, so they may wish to have a priest in for the ritual called the sacrament of the sick and to pray or use the rosary by the patient.  After death, the patient’s family may opt to wash and prepare the body themselves but may not choose organ donation or autopsy out of respect for the dead (Mazannee, 2003, p. 52).

Mazannee goes on in her paper, however, to discuss a case that illustrates how difficult and complex transcultural care can be. In a nutshell, the case revolves around a 15-year-old boy named Michael whose parents and grandmother migrated from the Philippines years before, though he himself was born and raised in the United States. While his parents and grandmother were strongly Catholic, he himself had broken away from traditional religion and had not attended Mass in several years.  Michael had recently been diagnoses with Ewing’s sarcoma which had already metastasized to his pelvic region and had undergone surgery, chemo and radiation.  Michael had been admitted to the hospital with neutropenia and fever subsequent to chemo and further imaging tests revealed new lesions on his lungs and pelvis.

At this point, Michael requested that he himself be present at the same time as his parents when test results were given and though his parents were shocked, they agreed to his request; his grandmother, however, was very upset and did not think that Michael had the right to be at these meetings.  Michael then requested that only he and his parents be at these meetings and that he needed someone to “take care of” his grandmother because she prayed the rosary over him all the time and he found this upsetting.  Spiritual advisors met with the grandmother, who was afraid that her grandson would not go to Heaven unless he returned to a more orthodox faith.  There were several meetings, including meetings with Michael, and a compromise was reached, that the grandmother could pray the rosary in his presence if she didn’t “talk about religion all the time”; there was a reconciliation of sorts, and his parents and grandmother were in fact, with Michael as his condition worsened and were saying the rosary as he died (Mazannee, 2003, p. 52-3). Here, transcultural nursing care was complicated by generational concerns.

Caucasian American Culture

Ekbland’s study at the Swedish hospital concluded that “in order to better understand other cultures, it is important to raise awareness about the staff’s own culture and to be aware of culture, particularly in the context of the individual” (Ekbrand, 2000, p. 624).  In other words, understanding the norms and mores of your own culture and what possible cultural biases you could be bringing to nursing care is a very important first step in developing cultural sensitivity.

In the author’s own culture – Caucasian American – there are also nursing considerations to keep in mind.  Caucasian Americans are descended from settlers who came to the “New World” from countries all across Europe and although the United States is becoming increasingly diverse, they still constitute what could be termed the culturallydominant group in this country (Dyer, 2009, p. 422).  While this group is actually an amalgam of ethnic groups from across Europe, each having their own distinctions, in general Caucasian Americans are coming from a Judeo-Christian background with an emphasis on salvation in the afterlife and strong Protestant work ethic which emphasized individual freedom, worth, and upward social mobility, along with an strong emphasis on achievement and money-making (Hendrickson, 2010, p. 1).  Primary nursing considerations for this group include beginning the visit with a firm handshake and maintaining direct eye contact while talking to present confidence and openness; all healthcare communication should be direct and honest, including a critique of patient behavior and advice for changing that behavior.  Verbal and written communication are valued over nonverbal communication and where appropriate, patient education in other media such as video or the Internet are welcomed (Dyer, 2009, p. 426).

Specifically in regards to end of life care, it is important to remember that Caucasian Americans are much more likely to have made plans and written advance directives than are patients of color (Marquand, 2014, p. 2), which is in keeping with the illustrated ethnic preference of accepting death and planning for it (Dyer, 2009, p. 426).  Of the major ethnic groups, Caucasian Americans are also the least likely to desire or accept life support (Blackhall, 1999, p. 799). Also, studies have shown that religion may not play as great a role in end of life care for Caucasian Americans as it does for some other ethnic groups.  For example, a recent study was done to contrast the differences between Caucasian and African Americans patients. It showed that, though the majority of both groups considered themselves to be moderately or highly spiritual, Caucasians were less likely to make their spirituality a part of their coping technique for end of life issues, and less likely to want CPR, mechanical ventilation or hospitalization for near-death situations (True, 2005, p. 174).  This might be because, although most Caucasian Americans report a belief in God, traditional religion plays a smaller part in everyday life: only 36% report attending a religious institution more than once a month (Dyer, 2009, p. 427).

A Nursing Perspective on Transcultural Patient Care

It is apparent in our increasingly diverse society that nursing both now and in the future is going to require cultural competence, or a clinician’s knowledge of a variety of cultures and the ability to translate that knowledge into plans of care that are culturally appropriate and respect the patient’s preferences (Mazannee, 2003, p. 4).  One way to do this, no matter what your patient’s ethnicity, is to use a cultural assessment tool kit for families and patients to determine who strongly a patient and their family identifies with their ethnic group and how this identification can affect patient choice (Mazannee, 2003, p. 5).  In regards specifically to end of life issues, educating patients on end-of-life care and making sure that they have a good understanding of what this entails, as well as simplifying documents like advance directives is a good way to help foster communication and trust between patients, families and members of the healthcare team which can help overcome any potential barriers that can arise due to cultural differences (Marquand, 2014, p. 2). The establishment of a trusting relationship is certainly the cornerstone to a healthy and effective collaboration of patients, families and healthcare practitioners to bring about the best patient outcomes possible. Without trust, a good healthcare relationship simply is not possible, regardless of ethnic background.

Conclusion

Nursing is never just a simple matter of giving someone medications, changing a wound dressing or talking to someone about diet and nutrition.  Even within the same culture, communication can be difficult because of a whole slew of other considerations, such as class, education level or the patient’s expectations or previous experiences with health care providers. When you add the complexities of transcultural communication into the mix, then language and education barriers, religious differences, and values can make care very difficult indeed.  However, it is something that nurses in every branch of the profession are going to have to learn to deal with, whether they are in obstetrics, geriatrics or anything in between: we simply are a more globalizes, poly-ethnic, poly-linguistic country (and world) than we have ever been before and that is not likely to change in the foreseeable future.

References

American Psychology Association.  (2013). “Culturally Diverse Communications and End of Life Care”. American Psychology Association Website. Web. 6 June 2014

Blackhall, L. et. al. (1999).  “Ethnicity and Attitudes towards Life-Saving Technology”. Social Science Medicine. 48(12) 799-789

Dayer, M.  (2009). “Considerations for White (Non-Hispanic) Nursing”.  Transcultural Nursing. Jones and Bartlett Publishing Company: New York, NY. Print.

Ekbland, M. et. al.  (2000). “Cultural Challenges in End of Life Care: The Reflections from Focus Group Interactions with Hospice Staff in Sweden”. Journal of Advanced Nursing. 3(15) 623-630

Hendrix, L. “Health and health care fo American Indian and Alaska Native Elders”. Stanford University Website.  Web. 6 June 2014.

Marquand, B. (2014).  “Making Their Wishes Known”.  The Minority Nurse Magazine Online. Web. 6 June 2014.

Mazannee, P. (2003).  “Cultural Considerations for End of Life Care”. American Journal of Nursing.  103(3) 50-59

True, G. (2005). “Treatment of Preferences and Care Planning at End of Life: Ethnicity and Spiritual Coping in Cancer Patients”. Annals of Behavioral Medicine.  30(2) 174-179