NR 394 Discussion Reflection on Cultural Awareness

Cultural awareness goes beyond just knowing the details of another individual’s culture, but acknowledging and appreciating it. A lot of times, we subconsciously apply our cultural background onto others actions. For example, in Chinese culture, constant eye contact can be construed as defiance or “attitude” whereas in Western culture, eye contact is a sign of respect and attentiveness. So when communicating with patients, providers and healthcare teams, it is imperative we are culturally aware to prevent offending one another, improving communication for optimal patient care delivery. An example of miscommunication that occurred as a result of cultural differences is when a coworker who was offended that a coworker was continuously barking orders at her rather than asking nicely. Because of this, when these two coworkers would work together, they would constantly have tension and argue. They were inefficient in their teamwork because they would refuse to help one another. Eventually management stepped in as mediator. The coworker who felt she was constantly barked at explained that she did not mean to offend the other coworker but she explained that in her native county, it is not the norm to say “please” to do their job because “please” implied begging. However, in the United States, the term “please” is used very freely just to be polite. This miscommunication could have been better alleviated had both partitions acknowledged the tension early on rather than let it go on for months. This simple cultural difference interfered with patient delivery for an unnecessarily extended amount of time.

Thank you for sharing. This happens all the time in a field of nursing that I am close too. I was not aware that the reason could possible be saying “please” is begging. I didn’t even think to ask because I thought it would be rube and I would be yelled at, but maybe this is just a huge misunderstanding. Thank you for opening up my eyes, I guess that is what this class is all about. I really just let it go because I figured that’s the way they are, but really talking to them and letting them know the combined census is not happy with hearing things like this. Thank you for the read!

It is imperative that we apply cultural awareness to communication in our current clinical practices. I understand that in the business of life and our workday it can be very easy to forget this skill, but we must do our best to uphold these standards. One way to do this is to simply ask questions. One of the ways that I accomplish this is actually through our admission process. Thankfully, we are required to ask every new patient if they have any religious or cultural practices that they would like known to staff so that we can ensure they are upheld. This simple question works wonders for many of our staff members. By simply asking the question, I believe that this can help us to avoid miscommunications that could possibly occur.

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Unfortunately, I was told by my coworker of a miscommunication that has often occurred. She is from Morocco and is of the Muslim faith. She told me that when she is out in public with her husband and they meet new people, men often attempt to shake her hand when introducing themselves. Within her cultural and religious background, this is unacceptable as women are not allowed to shake hands with men. Unfortunately, there have been times where she attempted to explain why she could not shake their hands, but the individual was offended and did not allow her to communicate her reasoning.

This instance is very difficult to prevent as in our American culture it is almost standard to shake someones hand or hug them when greeting. With this challenge, I believe one of the best prevention methods would simply be more self-education, humility, and again asking questions. There is so much that we can learn from one another. I believe by being open-minded we can indeed grow into excellent nurses with a strong sense of cultural tact and respect.

Cultural awareness is so important today, in the multiracial world we are living in today .From my stand point I think it is imperative, that nurses have cultural awareness classes, in order for us to manage our patients appropriately .communication is very important .It is very difficult when you are not understand. Interpreters should be at hand to assist in manage individuals of foreign . languages. culture is the foundation of most of our live .Indeed communication is fundamental in cultural awareness.

Miscommunication is something that happens a lot and for the most part, culture has something to do with it. I have a patient that only speaks Italian and that makes communicating with her difficult. Effective communication between patients and health care providers is a critical element to quality health care. Becoming aware of patients’ attitudes, beliefs, biases, and behaviors that may influence patient care can help clinicians improve access to and quality of care.

There is a large Hispanic population in my area, and I have many Hispanic patients. My husband is Hispanic, yet I was ignorant of the importance of interpreters in communication. I have always offered to have an interpreter present when needed to communicate with a patient, but I did not realize the significance of the age and gender of the interpreter (Chamberlain University, 2021). I have always been reluctant to use family members to translate, because they may translate information in a way that they feel may be better for the patient instead of translating the true meaning of the conversation.

I responded to a rapid response in the middle of the Covid pandemic. When I arrived, the patient was a Hispanic gentleman that did not speak English that was very short of breath. We have Spanish interpreters in the building, but it took several minutes to find one to interpret. In the meantime, I needed to assess the situation. The patient was unable to keep his mask on due to the severity of his shortness of breath and he was grabbing his chest. One of the few things I can ask in Spanish is “do you have chest pain?”. He responded that he did. When I went to listen to his lungs, I noticed the writing on his shirt said, “I survived Covid”. Needless to say, this got my attention. I pointed to his shirt and he shook his head yes. However, without an interpreter, I was unable to clarify when he had Covid. EMS was on their way by the time the interpreter arrived. I used the interpreter to find out when the patient’s symptoms started and when he had Covid, but I was getting inconsistent information. When EMS arrived one of the paramedics spoke Spanish and was able to get more accurate information from the patient. Ultimately, the patient’s symptoms started suddenly after coughing. He spent 12 weeks in the hospital with Covid and he was discharged just the week prior to this episode. Ultimately, the inability to communicate did not change how I treated him but being able to communicate early on during this encounter would have made things run more smoothly. Ultimately the information from my non-verbal communication with the patient provided more meaningful information than the verbal communication with the interpreter. This encounter demonstrated how non-verbal signals are an effective form of communication (MasterClass, 2020).

This particular episode did result in a process change. Now an interpreter is required to respond to all rapid responses in the building. If it is determined an interpreter is not needed, they are able to leave.

References

Chamberlain University. (2021). Healthcare interpreter and translator [Lesson]. Chamberlain College of Nursing. https://chamberlain.instructure.com/courses/77751/pages/week-2-lesson-communication?module_item_id=11070827

MasterClass. (2020, November 8). 8 Important types of nonverbal communication. https://www.masterclass.com/articles/important-types-of-nonverbal-communication#what-is-nonverbal-communicationLinks to an external site.

Although interpreters are a great resource for us as nurses, it still can be difficult to communicate with patients. We as nurses often feel helpless when we can’t understand our patients and are trying to help them. In the instance of a rapid response, it must have been incredibly stressful to try to help this patient while not being able to understand him. This was a great example of miscommunication as a result of diversity. I can only imagine how the patients must feel when they need help and are unable to communicate their needs. I always wish I had learned Spanish as it would be incredibly useful in our profession. Thankfully you were able to use non-verbal communication to understand this patient’s immediate needs and facilitate his next level of care. It’s great that your facility used this as a learning experience and implemented the use of interpreters during all rapid responses.

Cultural awareness is complex, however it is imperative in our nursing practices. Personally, in the Emergency Room I work in we have a MARTI or My Accessible Real-Time Trusted Interpreter, which utilizes a live translator on a screen. Although these modern technologies are extremely useful in communicating with patients, there are still many cultural barriers that may affect communication. Culture includes much more than just different languages, and it is important to consider all factors. A great tool for applying cultural awareness to our nursing practice is the Transcultural Nursing Assessment Guide for individuals and Families in our books. This assessment guide allows us to thoroughly communicate with patients in regard to their culture and learn to better care for them. Thorough communication with our patients is an essential part of their care and it is important that we discuss different aspects of their culture rather than making assumptions or having stereotypical ideas based on our past experiences with those cultures. Cultural awareness is a continuous learning process for all of us.

An example of miscommunication as a result of diversity was when I was working in a subacute rehab. I had a patient that only spoke Arabic, sometimes her family was available to translate. She often refused the translation phone we had there, though not always. Typically patients would stay there for 3 weeks, so it took us time to learn and understand her cultural beliefs and values and build a trusting relationship with her. I remember one instance where she got very upset. A male CNA had entered her room to assist her in getting up, changed and ready for physical therapy. He had believed she was being difficult and was refusing her physical therapy. After further communication, we learned that in her culture she cannot be alone in a room with a male who is not a part of her family. As you can imagine, for a male to come into her room and suggest helping her change must have made her extremely uncomfortable. We eventually made a note in her chart that she could only be cared for by female staff. Although this did not necessarily result in an adverse outcome, this miscommunication could have been prevented. By meeting with her family that spoke english at the beginning of her stay, we could have made a better effort at understanding her culture and expectations of us as her healthcare providers.

Cultural awareness is a very important in communicating with patients to meet their needs. Even basic needs and how they are met vary by culture. In my current role as a CM I need members and their families to trust and have faith in me. To do that I need to understand their culture and in some cases very specific needs such as prayer time and a complete bath before prayer time. This may seem simple but to a member who needs bathing assistance they will need someone more than two times a week.
I also enter their homes so knowing when I need to take my shoes off vs walking in the house with my shoes on. If I were to walk in with my shoes on they automatically will view me as disrespectful although on my end it was a lack of knowledge. I also feel knowing which dialect of language they speak is helpful. We see a large population of Turkish members and with the many dialects in the language a lot of times a Russian interpreter is best. In this culture you see a lot of multigenerational homes with the younger women caring for their elders. All children and even grandchildren living in the home assist with care as needed.

In my role as a CM at times medication reconciliation and education is difficult with members of different cultures but even more so when they are not English speaking. Most translators/interpreters are not clinical and have difficulty relaying the information. I recently encountered this with a deaf member. The interpreter was having difficulty signing medical terms and the medications to the member which frustrated the member. This made the member want to rush through through the process or not complete it at all. Sometimes in these cases you need to be patient and/or think outside the box. Fortunately this member was younger and tech savy so he was able to text his medication list on a secured line.

The hospital where I previously worked, we would communicate with deaf and hard of hearing patients with a video remote interpreting machine that was on wheels. It was helpful because it helped us communicate with the patients. It made it so much easier to discuss different medications and treatments with them. I worked on a Telemetry/Step Down Unit floor, so it was extremely beneficial. I can see how easily some one would get upset and not want to complete an assessment because of a communicating barrier. Good thing your member was young and tech savvy.

I am currently employed with a emergency crisis facility. We are the emergency room for mental health and drug / alcohol addiction. I have worked here for eleven years. There is a wide verity of clientele that comes through our doors. Each person having a different story, upbringing, education, money, etc. The staff that work with these clients also have a different background and often are not able to relate to clients. I am part of a restraint team. I review all restraints that occur and report them to the state. We obtain certain information in order to evaluate and decrease the number of restraints that we (as a company) have. When I started this (five years ago), I noticed that Black/African American females were to most to be restrained. The cases were all different. Some clients went to a higher level of care and others were discharged into the community. We see far more Caucasian people so why are we restraining so many black females? Upon further investigation, we found out that it was the staff, not the client. Staff were more intimidated by a black female yelling and cussing than a white man yelling and cussing. In most of these cases, the staff needed to understand that their bias are driving their decisions. The leadership decided that it was a time for change. We hired a professional and had all staff members (from President to Janitor) take ten weeks of cultural diversity classes directly related to black culture. After the staff completed these courses, the restraint of Black / African American women went down. It has also helped to create a committee that continues to look at how we can improve on cultural awareness.

NR 394 Discussion Reflection on Cultural Awareness