Transcultural Nursing in West Florida

Florida is one of the top employers for nurses nationwide. According to the U.S. Bureau of
Labor Statistics, Florida ranks #4 for highest employment of nurses by state. Florida is also one
of the most popular states for retirement, which contributes to the significant demand for nurses.

Although Florida nurses earn a moderate salary compared to other states, cost of living is among
the lowest in the U.S. Additionally, Florida is one of only seven states that don’t collect an
individual income tax, allowing nurses the chance to keep expenses low and save money.

Aside from the huge demand for nurses, many are drawn to Florida for the lifestyle. The state
boasts 5 of the top 15 beaches in America as reported by U.S. News. The weather is beautiful
year-round, amusement parks such as Disney World are in your backyard, and cruise ships
depart from all coastlines. The cities are rich with eclectic cultures, attracting tourists annually
from around the world, in addition to the abundant inhabitants who proudly represent their
Caribbean and Latin American roots in communities.

A Patients 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.
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.

DO’s for Nurses:

1. They share your experiences and observations where it’s helpful
2. They involve the spouse and/or families in the plan of care.
3. They share the truth without judgment.
4. They observe
5. They listen.
6. They Question Physician Orders If They Don’t Make Sense
7. Show self-confidence to the patient (even if you don’t feel it), but never fake knowledge you
don’t possess.
8. You are the patient’s advocate—in some settings, you may be the only one who’s there to
stand up for him/her. Never be afraid to speak up for his/her needs.
9. If you want respect from your colleagues, the best way to get it is to show up when you’re
scheduled to work, and do your share, plus a bit more.
10. Never consider yourself to be above doing the more menial tasks: answering call lights,
cleaning commodes, fetching water or changing beds or helping a patient to the bathroom. If
you’re sitting at the desk doing nothing in particular, and a patient needs help, it’s your job to
help.
11. Nursing is all about prioritizing. At any given time, you might have five or six tasks that need
doing. It’s up to you to decide which must be done first, and which can afford to wait a few
minutes.
12. Clean up after yourself.
• Don’t expect to be an expert during your first year on the job
• Never give a medication without understanding what it’s for, or why it was ordered.
• Establish a good relationship with your co-workers. Nursing often requires teamwork, and
teams work best when every member respects each other

DON’TS for nurses:

1. Do not pre-chart anything in the medical records.
2. Do not prearrange medications and take them out of the packaging if you are not going to
administer them right away.
3. Do not remove medications and carry them around with you.
4. Do not keep medications in your pocket if you find the patient is asleep or if they refuse to
take the medication. Always make sure you return it.
5. Do not sign that you witnessed a waste of narcotics if you actually did not do so.
6. Do not document anything that you did not do.
7. Do not forget to document the name of anyone else who provides care to a patient, such as
starting an IV, inserting a catheter or calling a physician.
8. Do not act outside the scope of your practice unless policies and procedures allows it.
9. Do not forget to renew your license. Practicing nursing without a license is a criminal event.
10. Don’t say “This won't hurt at all,” “We're just really busy,” “We can't find your chart,” ...
“I'm sure it's nothing serious,” “Oops,” “That’s not my patient.”
11. Nurses should never complain or gossip about another caregiver
12. Keep your personal and religious beliefs to yourself
13. Never act too busy to give a client attention and care
14. Don’t pretend to know everything.

Space and Distance

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.
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.

Eye Contact
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.
Time And Punctuality
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.
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.
Touch
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.
Communication
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.
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.

Recipe for success

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.

Overcoming barriers to communication

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.
 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?”
 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'slanguage. This shows that you're aware of
and respect his native language.
 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.

Source:

Emma Manlantao Arana

59 y/o
Retired Nurse at West Florida Hospital
Brunner & Suddarths textbook of Medical- Surgical Nursing, 10 Edition, S. Smeltzer & B. Bare,
Linnin colt Williams & Wilkins.