Developing a Deeper Understanding
"It is important to be aware of your own values, beliefs, expectations and cultural practices, and consider how these impact the care you give to people from cultures different from your own" (Queensland Health Website).
Issues arising from differences in language and communication style is a daily concern of medical staff at St. Elizabeth Family Medicine Residency Program. Many St. Elizabeth's patients speak little or no English at all, and the availability of interpreters can be extremely limited. Oftentimes, even interpreters cannot serve as an effective medium of communicating between a nurse and a patient, because many words exist in English that do not exist in other languages, and vice-versa. Furthermore, in order for an interpreter to successfully convey a concern that a patient may have, that interpreter must 1)understand the culture as well as the language, and 2)must be a respected member of the ethnic community and trusted by the family. However, the staff have taken recent steps to increase the availability of trained medical interpreters, which should be much more accessible in the upcoming months.
Issues That May Arise:
(the following information is from Galanti, Geri-Ann, 1997 Caring for Patients from Different Cultures)
-unfair assumptions about patient levels of understanding: Body language such as nodding and other gestures frequently varies across cultural lines, and a nurse's assumption that a patient is nodding or saying "yes" does not necessarily mean that they understand. Dignity and self-esteem are particularly important for many Asians, and they may be hesitant to ask their nurses or doctors to repeat themselves. On the contrary, patients may often understand when the nurse assumes that they have failed to understand due to their silence or lack of English-speaking ability, and a nurse repeating an instruction numerous times may cause patients' to feel patronized (Galanti, p.20).
-use of first names: Many people from other cultures are not as comfortable referring to strangers and acquaintances by their first name as we are in America, so a nurse should always ask his/her patients which name they prefer to be called before directing questions or examining the patient (Galanti, p.19).
-eye contact and touching: Members of some cultures are very reserved and stoic, and rarely use direct eye contact and touching to emphasize points, especially towards a member of the opposite sex. Members of other cultures may be open, expressive, and affectionate, even towards mere acquaintances. Doctors and nurses should try to make themselves aware of some general cultural patterns of a patient's ethnic group before entering the room and examining the patient or directing questions at him or her. Among many Bosnian Muslims as well as some traditional Vietnamese, direct eye contact is frowned upon, especially when directed at a member of the opposite sex or towards an elderly individual (Galanti, p.26).
-respect beliefs and attitudes, and listen and observe: A healthcare provider can best serve the needs of a patient if he/she is willing to listen and learn about the patient's different perspectives and experiences, and remain sensitive to body language. However, "the same body language may express different messages in different cultures: maintaining eye contact may be a sign of respect, and smiling may be a sign of apprehension" (Queensland Health Website).
