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Examine own biases before teaching other cultures
As the United States becomes more culturally diverse, encounters with patients from other cultures are increasing, and patient education managers are devoting more time to determine how to develop appropriate teaching protocols and services.
"If you don’t learn about the different cultures in your service areas, then you tend to provide services that are not appropriate for that patient group," says Barbara Jones Warren, PhD, RN, CNS, CS, assistant professor at The Ohio State University College of Nursing in Columbus. It’s similar to a pediatric nurse trying to provide care for a geriatric patient without any concept of the culture of aging, she says.
Staff teaching must be consistent with patients’ belief systems; otherwise, they may not be compliant. "Patients may not believe that what is being taught is relevant to their lives if it is not consistent with their belief system," explains Cora Munoz, PhD, RN, associate professor at Capital University, also in Columbus. For example, a dietitian giving instructions about diet restrictions must use culturally appropriate foods when teaching or the patient might not know what to eat.
In order to teach culturally diverse patients, staff must understand what culture is, says Jones Warren. She defines it as a set of values, beliefs, and norms in which people from some type of self- or societal-defined group follow. Age, class, gender, sexual orientation, race, ethnicity, and religion can define groups.
Before learning the nuances of the various cultures of the patient groups they might teach, health care providers need to understand their own cultural perspective and their view of people from other cultures. "Knowing your own cultural biases helps you understand that if you are dealing with someone from a culture that is different from yours you will have to adjust. You will have to be able to not only understand that culture, but you have to understand that your perspective is not the only one," says Jones Warren.
Once staff members understand the aspects of culture, they need to be educated on the cultural groups they teach. However, one training session is not enough, warns Jones Warren. Learning must be an ongoing process. People must take the information they have about a culture, practice using it in their teaching until they are comfortable and then get more information, she explains. (See how one health care institution begins the learning process with Culture Clue sheets, p. 58.)
Education about the various cultures you work with is very important, agrees Munoz. Staff should be encouraged to attend training sessions and workshops, and read articles and books. However, it’s also important to note that the information does not always apply to the individual patient because there are a lot of intergroup differences.
Do a cultural assessment
The best way to assess cultural background is by asking questions in a sensitive way, says Munoz. "Nurses teaching culturally diverse patients should make an extra effort to communicate their caring and respect for differences," she explains. A basic understanding of the culture will help a health care provider ask the right questions.
It’s important for the educator to allot enough time for the interview so that he or she can get to know the patient and his or her views by asking such questions as: "Are there special things you eat when not feeling well?" "If you rush through the process of assessing individuals, you will get the wrong information or interpret it wrong," says Jones Warren.
When designing educational interventions for patients from other cultures, health care professionals must first respect their patients’ cultural practice. If the practice might interfere with a positive outcome, the health care provider needs to negotiate with the patient until they find how the patient is willing to make a behavioral change, says Munoz.
For example, Laotian women are expected to rest after having a baby; and in their country, they often lay on a bed that has hot coals under it for heat. The practice is based on the Asian belief that heat is good for some ailments and cold is good for others.
However, in Western medicine, the hygiene of postpartum patients is an important part of discharge instructions, and they are encouraged to shower. This active intervention associated with water that can at times be cold is not always acceptable to women from Laos who embrace their traditions.
Therefore, if the patient refuses to take a shower, the nurse would need to find another way of ensuring that the patient would practice good hygiene. "The nurse might say, I understand that you are not allowed to take a shower, but can you do an external douche.’ And as a result of the negotiation, there is a new outcome," says Munoz.
To provide culturally sensitive care, health care providers must have cultural knowledge and cultural skills of the patients they treat. They also need interpreter and translation services with materials written in the appropriate languages. In this way, they will be able to tailor their teaching to the culturally diverse patient, says Munoz. (For information on addressing language barriers, see Patient Education Management, April 2001, p. 40.)
For more information about teaching culturally diverse patients, contact:
• Barbara Jones Warren, PhD, RN, CNS, CS, Assistant Professor, The Ohio State University College of Nursing, 1585 Neil Ave., Newton 341, Columbus, OH 43210-1289. Telephone: (614) 292-4847. E-mail: firstname.lastname@example.org.
• Cora Munoz, PhD, RN, Associate Professor, Capital University, 2199 E. Main St., Columbus, OH 43209. Telephone: (614) 236-6382. E-mail: cmunoz@capital. edu.