Cultural Assessment and Teaching In Nursing Education

Nurses Educator 2

General Cultural Assessment and Teaching Interventions

Cultural Assessment and Teaching In Nursing Education

Cultural Perspectives of Health Problems and Interventions,Assessment from Person's Cultural Aspects,Cultural Specific Guidelines for Assessment,LEARN Model for Cross Cultural Assessment ,Use of Interpreters,Strategies When  Use Interpreter.

Cultural Perspectives of Health Problems and Interventions

    Given that culture affects the way someone perceives a health problem and understands its course and possible treatment options, it is essential to carry out a thorough assessment prior to establishing a plan of action for short and long term behavioral change. Different cultural backgrounds not only create different attitudes and reactions to illness but also can influence how people express themselves, both verbally and nonverbally, which may prove difficult to interpret (Campinha-Bacote, 2003; Hodges & Segal, 2012). 

    For example, asking a patient to explain what he or she believes to be the cause of a problem will help to reveal whether the patient thinks it is because of a spiritual intervention, a hex, an imbalance in nature, or some other culturally based belief . The nurse should accept the patient's explanation (most likely reflecting the beliefs of the support system as well) in a nonjudgmental manner.

    Culture also guides the way an ill person is defined and treated. For example, some cultures believe that once the symptoms disappear, illness is no longer present. This belief can be problematic for individuals with an acute illness, such as a streptococcal infection, when a 1- or 2-day course of antibiotic therapy relieves the soreness in the throat. This belief also can pose a problem for the individual with a chronic disease that often has periods of remission or exacerbation.

Assessment from Person's Cultural Aspects

    In addition, readiness to learn must be assessed from the perspective of a person's culture. Behavior change may be context specific for some patients and their family members, that is, they will adhere to a recommended medical regimen while in the hospital but then fail to follow through with the guidelines once they return home. Also, the nurse must not assume that the values adhered to by professionals are equally important or cherished by the patient and family. 

    Consideration, too, must be given to specific cultural influences that may hinder readiness to learn, such as perceptions of time, financial barriers, and environmental variables. Finally, the patient needs to believe that new behaviors are not only possible but also beneficial for behavioral change to be maintained over the long term (Kessels, 2003).

    Providing culture specific programs and teaching interventions for children and adults from minority groups is both a practical and ethical need in the US healthcare system. To adequately serve patients in a multi ethnic society, attention must be focused on identifying cross cultural barriers and delivering culturally effective health education. 

    Studies have clearly shown that health outcomes are improved when education is appropriately given in the context of the individual (Bailey et al., 2009; Hawthorne, Robles, Cannings John, & Edwards, 2008; Vidaeff, Kerrigan, & Monga, 2015 ). 

Cultural Specific Guidelines for Assessment 

    The following specific guidelines for assessment should be used regardless of the cultural orientation of the patient (Anderson, 1987; Uzundede, 2006):

1. Identify the patient's primary language. Assess his or her ability to understand, read, and speak the language of the nurse.

2. Observe the interactions between the patient and his or her family. Determine who makes the decisions, how decisions are made, who is the primary caregiver, which type of care is given, and which foods and other objects are important.

3. Listen to the patient. Find out what the person wants, how his or her wants are different from what the family wants, and how they differ from what you think is appropriate.

4. Consider the patient's communication abilities and patterns. Note, for example, manners of speaking (rate of speech, expressions used) and non-verbal cues that can enhance or hinder understanding. Also, be aware of your own nonverbal behaviors that may be acceptable or unacceptable to the patient and family. 

5. Explore customs or taboos. Observe behaviors and clarify beliefs and practices that may interfere with care or treatment.

6. Become oriented to the individual's and family's sense of time and time frames.

7. Determine which communication approaches are appropriate with respect to what is the most comfortable way to address the patient and family. Find the symbolic objects and activities that provide comfort and security.

8. Assess the patient's religious practices and determine how his or her religious beliefs influence perceptions of illness and treatment.

    These guidelines will assist in the exchange of information between the nurse and patient. The teacher/learner role is a mutual one in which the nurse is both teacher and learner and the patient is also both learner and teacher. The goal of negotiation is to arrive at ways of working together to solve a problem or to determine a course of action (Anderson, 1987, 1990). The nurse must recognize that each person is an individual and that differences exist within and between ethnic and racial groups.

LEARN Model for Cross Cultural Assessment 

    Another useful framework for patient teaching is the LEARN model that emphasizes ways to improve cross cultural communication between tween patients and healthcare providers. These guidelines are as follows (Berlin & Fowkes, 1983):

L-Listen with sympathy and understanding to the patient's perception of the problem

E-Explain your perceptions of the problem 

A-Acknowledge and discuss the differences and similarities 

R-Recommend approaches to treatment

N-Negotiate agreement

Use of Interpreters

    When the nurse does not speak the same language as the patient, it is necessary to secure the assistance of an interpreter. Interpreters may be family members or friends, other healthcare staff. or professional interpreters. For many reasons, the use of family or friends as interpreters is not as desirable as using professionally trained individuals for nurse-patient interactions.

    Research has shown that ad hoc interpreters (eg, family, friends, nonclinical hospital employees) are much more likely than professional interpreters to make a clinically significant error in interpretation (AHC Media, 2012; Flores, Abreu, Barone, Bachur, & Lin, 2012). Family members and friends may not be sufficiently fluent to assume the role of interpreter, or they may choose to omit portions of the content they believe to be unnecessary or unacceptable. 

    Finally, the presence of family members or friends may inhibit communication with the nurse and violate the patient's right to privacy and confidentiality (Hadziabdic & Hjelm, 2013: Juckett, 2014; Kaur, Oakley, & Venn, 2014; Schenker, Lo, Ettinger, & Fernandez, 2008).

    Ideally, professionally trained interpreters will be used for assessment, teaching, and other important interactions. Interpreters can convey messages verbatim, and they work under an established code of ethics and confidentiality. When determining whether a healthcare interpreter is required, the nurse should consider how critical and complex the teaching situation is, the degree to which the nurse can be understood by the patient and family members, the patient's preferences, and the availability of resources ( Schenker et al., 2008).

    If a bilingual person is not available to facilitate communication, telephone interpreting services, such as Certified Language International, provide professional interpreters in more than 200 languages on a 24-hours-a-day, 7-days-a-week basis. These services are certified by The Joint Commission and other accrediting bodies, are approved by the US Department of Health and Human Services, and are HIPAA (Health Insurance Portability and Accountability Act) compliant. 

    Also, iPhones and iPads now have translation software apps, known as Vocre and My Language Pro, that will instantly translate voice or text into many different languages to connect people in the world. Thus, language is not the major barrier that it once was in the practical setting (http://www; mt=8).

Strategies When  Use Interpreter

    If not using an interpreter, the nurse can implement the following strategies when teaching patients who are partially fluent in English (Juckett, 2014; Stanislav, 2006).

  • Speak slowly and distinctly and allow twice as much time for the teaching session.
  • Use simple sentences, relying on an active rather than a passive voice.
  • Avoid technical terms (eg, use heart rather than cardiac, or stomach rather than gastric).
  • Also avoid medical jargon (eg, use blood pressure rather than BP) and idioms (eg, it's just red tape you must go through or I heard it straight from the horse's mouth).
  • Organize instructional material in a logical order.
  • Do not assume that the patient understands what has been said. Ask patients to explain what they heard by using the teach-back approach or request a return demonstration.

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