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Trans-cultural Health Care Provision: A Personal Reflection on a Patient I Have Cared for or a Health Care Incident
Description of the Event
As globalization continues to influence immigration, the entire society is increasingly becoming diversified in nature. More often than not, I tend to meet persons from different cultural backgrounds during my career. This particular event occurred on a Saturday morning and it involved a Filipino mother who was brought in at the facility while in labor. Since she had not been coming to this facility for her prenatal clinic, it became very difficult to trace her medical history. Nonetheless, the entire team in obstetrics was dedicated and since it seemed like a normal delivery, we did not expect any complications. However, as the lady was brought to the delivery table, I realized that she could not communicate in English fluently.
This became frustrating along the way because she could not clearly explain the stage of her labor in order to be assisted accordingly. Furthermore, the lady seemed shy and was hesitant about removing all her clothes. Since her labor was progressing, I in some instances became worked up and shouted at her. However, she remained adamant and was even reluctant to use the delivery table. This was further compounded by the fact that she could not communicate clearly.
Despite these shortcomings, we managed to convince the lady to comply and she delivered safely. Before she could leave the delivery table, there was a group of students form the university who wanted to examine her vagina. I approved for this and allowed them to carry on with the examination. I realized that after this, the lady was very bitter and did not want to speak to anybody. Another argument erupted when she was requested to take a bath immediately after delivery. She refused taking a bath and maintained that sponging would be fine for her. However, she was forced to take a bath as the hospital could not condone this.
Worse still, she insisted on leaving the hospital on the next day after delivery and did not approve of her being taken to a community unit for a few days. From a medical point of view, this was unacceptable as she had not fully recovered and her or the baby could develop complications. Efforts to educate her using pamphlets about the need to stay in hospital or community unit for some days proved futile. Irrespective of her protestations, she was not allowed to leave the hospital until the third day after delivery. All through the incident, the client kept asking for a Filipino midwife or nurse. At various times, he refused to talk and just stared at the nurses without following the instructions that were being given to her.
Reflection and Evaluation of the Experience
This experience was insightful but had far reaching implications on my quality of performance and work environment. From the outset, I felt that the client was simply being troublesome and uncooperative. This triggered feelings of frustration and undermined my ability to be flexible and accommodate the inherent cultural differences. Certainly, angry feelings compound an individuals ability to not only think straight but to also perform the given task in an effective manner. The work environment eventually grew tensed as the client became adamant and exhibited unfamiliar mannerisms. At some point, I was overwhelmed with feelings of frustration and found myself shouting at the lady to cooperate in order to make it through the delivery. I found it difficult to even cooperate with my fellow work mates in helping the client. Seemingly, they had also become frustrated and some of them were on the verge of giving up on the lady. At this point, I took the initiative of encouraging them to be accommodative in order to ensure that the lady benefits form the quality healthcare. Despite reassuring the teammates, I felt deep inside that there was dire need for the lady to cooperate with the medical staff in order to benefit more form the system.
As indicated earlier, globalization has culminated in the diversification of the work place in different ways. More than ever, ethical as well as cultural differences are becoming apparent during nursing practice. In order to enhance optimal performance, medical practitioners are expected to adjust their modes of strategic thinking and adapt accordingly to the dynamic cultural trends. This can only be attained if they are exposed to an environment that supports a diverse population. In this respect, the theory of transcultural care and university becomes of paramount importance as it equips the medical personnel with skills and knowledge that is required to deal with the emergent problems with ease. Essentially, the provisions of this model are responsive to the changing needs of the current society.
The nursing care theory is defined by a systematic evaluation of the changing patterns as well as cultural dimensions of a given society. In particular, it entails a review and consideration of the kinship, religious, economic, educational, political, legal, cultural values and the technological factors of a client. Further, it analyzes the impacts that the relationships between these factors can have on the behavior of the medical staff as well as the work environment on the whole. Also, it examines the inherent universalities and diversities that exist between and within different societal groups (Leininger, 1989). In the long run, it seeks to ensure that nursing behavior is informed by the implications of the preceding dynamics. This enhances cultural sensitivity and harmonic co existence as any inconsistencies that may arise during the interactions between patients and practitioners are eliminated upfront.
With reference to my experience with the Filipino client, it is certain that we shared different cultural values. Besides the communication problem, it is certain that she was uncomfortable with the standard procedures at the facility. The fact that she was a Muslim and was therefore reserved could have contributed to her discomfort. Her inability to communicate fluently in English was a clear indication that her education levels were also low. Undoubtedly, these had massive influences on her behavior and can be implicated for her deviance.
The inability to understand and appreciate the intrinsic cultural differences had negative impacts on the overall performance of the medical personnel. As clearly indicated, my behavior was not entirely informed by the apparent cultural diversity. Just as the client who insisted on being attended to by an individual of a her cultural orientation, I also wished that the client could be of a similar culture and conversant with the normal procedures at the facility. Despite eliminating possibilities of conflicts, this would have enhanced the quality of service delivery.
Basically, I failed to effectively exercise the basic principles of the intercultural nursing theory. My main weakness was the inability to understand and appreciate the influence of the cultural, educational, economic and religious factors to the behavior of the client. Notably, this triggered a negative attitude in the client who preferred by attended to by a midwife from her cultural orientation. Instead of realizing the negative effects that my cultural insensitivity was having on the entire process and taking necessary intervention measures, I got frustrated and tied to force the lady to adapt to the current system. In this regard, I failed to learn form the experience and instead became frustrated and presumed that the lady was unappreciative of the effort that were being made by the entire team to help her through the delivery. At this point, I did not also realize that the client was entitled to this service by the law. By assuming that the lady was conversant with the hospital procedures and her deviant behavior was uncalled for, I failed to empathize with her position. This led to tension that compromised the quality of the work environment.
Despite this, I was keen to encourage the fellow teammates to put in their best with respect to quality service. I did not let my experience influence their attitudes and behaviors in any way. I provided sufficient guidance on what needed to be done throughout the process. I believed that regardless of the cultural differences, the lady needed to have a normal delivery. I applied my knowledge and vast experience in the field in helping the lady to deliver normally. This is regardless of the communication hitches and lack of sufficient critical information about her medical history. After delivery, I ensured that she stayed in the hospital for a few days for her and the baby to be observed as expected. This was important in ensuring that irrespective of her background, she had access to quality healthcare. In this consideration, my persistence with respect to the client following standard procedures ensured that she was accorded quality medical attention. Nonetheless, this was at the expense of her cultural satisfaction.
Understanding the role of Transculturalism
Essentially, the development of the cultural theory of nursing care was informed by the realization that the nursing experiences and interactions were compounded by a host of cultural conflicts. It is for this reason that it seeks to bridge the current gaps by ensuring enhancing cultural maintenance, accommodation and restructuring (Kelleher & Hillier, 1996). The main aim for this was to ensure that clients are given culturally informed healthcare. Attainment of this desirable state of affairs is depended n various interactions that occur on an individual, family, group, community and health professional levels. In addition, cultural congruent care can only be delivered if the practitioners are well versed with the diverse cultural values, expressions and patterns. Arguably, lack of cultural competence can be used to explain why I behaved in the particular manner. Not only did I lack fundamental knowledge regarding the culture of the Filipino women, I also did not understand their cultural patterns and general ways of life. Notably, this undermined my ability to enforce ethics in my nursing practice however much I tried to.
In his research, Donnelly (2000) indicates that lack of cultural competence has far reaching implications on the quality as well as performance of the health care practitioners. To begin with, it makes the medical personnel to refrain from working with cultural groups or attending to the clients from different cultures. This is for fear of the inability to attend to the cultural needs of the patient that significantly contribute to feelings of satisfaction. In some cases, this is influenced by the misperceptions that the medical personnel have for the particular culture. Patients suffer detrimental effects as they are not given the required medical care. In addition, it leads to lack of commitment with respect to addressing the particular needs of the patient. In this regard, Andrews (1995) posits that the medical personnel might get frustrated along the way because of culture clash.
This was apparent in my experience as I witnessed the dedication of my staff decrease. Some of them were on the verge of giving up on the client. This was a clear indication of lack of commitment to their duties. Cultural incompetence also leads to the development of cultural misconceptions about a given population. In stead of basing their judgments of factual information and experience, medical personnel in this respect are often tempted to rely on hearsay in developing their perceptions towards cultural clients. Although this was not experienced at the scenario under review, it can be posited that if interventions measures are not undertaken in a timely manner, subsequent Filipino cases are likely to be informed by various misconceptions. In most cases, the conceptualizations of the medical staff are not based on facts and a clear understanding of all the cultural domains of a given multicultural client.
A lack of knowledge and clear understanding about the cultural needs of specific populations makes it difficult for the medical professionals to prepare accordingly for such patients. For instance, Andrews (1995) cites that they fail to equip themselves with facilities that are reflective of the cultural concerns of their clients. As a result, this leads to culturally inappropriate actions that undermine quality healthcare. Clients in such instances feel offended and frustrated by a lack of understanding of their cultural values by the medical professionals. They are seldom satisfied with the quality of service and would prefer alternative institutions in future. Put differently, Leininger (1989) indicates that this leads to cultural pain that is characterized by hurtful feelings. Both the clients and medical professionals are adversely affected.
Jeffreys and Zoucha (2001) ascertain that stereotyping is a common characteristic of medical environments that are culturally blind. This involves labeling patients based on previous misconceptions about different aspects of their way of life. It culminates in incidences of bias in which clients are accorded a different treatment that is consistent with their perceived group identification. Social research affirms that incidences of discrimination adversely affect the relationship between the medical professionals and the clients. On a secondary level, discrimination and prejudice impacts negatively on the relationships between the medical personnel, organizational relationship and interdisciplinary professional relationships. Ultimately, this culminates in work place multicultural conflicts that disrupt harmonic working environments.
In their research, Small, Rice, Yelland and Lumley (1999) indicate that poor communication is a factor that migrant mothers have grappled with since historical times. Migration detaches them from the family networks and exposes them to health services that they are unfamiliar with. Yet despite this, providing vital information during pregnancy remains imperatively important as it influences the choices that are made at different times and aids in preparing women to deal with uncertainty with ease. It can not be disputed that the satisfaction of expectant mothers largely depends on clear communication and assurance from their care givers.
The Filipino mother in my case demonstrated acute concerns regarding communication and the resultant sensitivity of the health care services that she was accorded. In this respect, language barrier made her to exhibit a high degree of isolation and was not self determined during delivery. At this point, it should be appreciated that self determination is an important aspect that is encouraged in midwifery. This further compounded the scenario as she experienced more difficulties than she expected. Furthermore, the lack of clear communication affected my perception towards the client as it changed to being negative. Although this was not exhibited externally, it is a factor that compromised my ability to give quality healthcare in this case.
Speros (2005) cites that communication barrier often makes immigrant women to feel unsafe in the hospital environment. The inability to have access to qualified interpreters and lack of family members around them who are instrumental in advocating and participating in decision making makes it difficult for the women or their families to feel secure. In future, it would be important to hire qualified and permanent interpreters at the facility. This would ensure that such emergencies are taken care of effectively. Cultural studies also show that Filipino women tend to be shameful and exhibit reluctance whenever they are examined by male doctors (Small et al, 1999).
In particular, they feel embarrassed when expressing their gynecological problems to male doctors. This can be used to explain why the woman was shy from the outset. The medical team attending to her comprised of various male nurses. Since the obstetrics unit did not have many female doctors, this situation could not have been addressed accordingly. This can be attributed to the fact that the facility has not been receiving a large number of Filipino mothers. Despite this, the concerns of the few have seldom been addressed as they often exhibit reluctance to present their concerns. In this regard, it would be imperative to advise the administration to staff more female doctors and nurses in the obstetrics unit.
In his review about the impacts of culture on the maternal health of the Filipino mothers, Small et al (1999) found out that the traditional customs of the Filipino required that women needed not to take a bathe immediately after delivery. This was to be undertaken at least ten days after safe delivery. In addition, women are not allowed to tae a bathe during their menstruation. Bathing at these specific times was believed to cause ill health and led to development of health complication such as rheumatism in future. Thus at such times, the respective women use sponging, steam bathes and herb poultices. This provides useful insights with regard to the experience that I had with the Filipino lady. Notably, her reluctance to take a bathe after delivery was rooted on this belief. In this respect, I would have exhibited a high degree of accommodation and allowed her to use steam bath or sponging instead. Personally, I considered this an unacceptable healthcare practice and forced the lady to take a bathe.
Another culture clash pertained to the food the Filipino mother was given after bath. Instead of taking more liquids to ease lactation, the client took very few and in some cases none. This action according to Andrews (1995) was informed by the cultural belief that lactating milk is not good for the baby. This is unlike the medical view point that recommends breast feeding for a significant six months after birth. In this respect, it would be important to carry out prenatal classes and provide vital information to the immigrant women. Regardless of the fact that medical practitioners refrain from proving a lot of information to the clients on the premise that it would scare them, it is important that certain factual information be passed on accordingly.
At this point, it can be acknowledged that inter cultural care has different dimensions that pertain to universality, culture, uniqueness and context. The care that each woman is accorded needs to be unique and customized to reflect their individual needs and concerns. Childbearing is a complex process that is also characterized by increased anxiety because of its sensitive nature. In other words, expectant women are often anxious as they do not know whether they would survive childbirth. This is further compounded by the various events that tae place form prenatal to post natal care. The health of their baby is also a common source of anxiety. It is therefore important to understand the influence of these background factors to the wellbeing of the woman in order to provide customized care. This eases anxiety and enhances confidence and satisfaction of the health care services that are rendered.
Equally important is the differences in cultural orientation or values of the women. In this respect, Kelleher and Hillier (1996) assert that while in some cases the religious values could be similar, in others these are different. Further, women require special attention with regards to several other cultural concerns such as prayer, diet, family interactions, steam bath and so on. It is noteworthy that these contribute significantly to the welfare of both the mother and the baby. Also worth appreciating is the recognition that there exist universal expectations from healthcare service providers. These entail listening, concern, kindness, respect, being present and understanding. The values are fundamental and need to be enforced across all ethnic groups.
Notably, caring is at the center stage of the intercultural theory. If the Filipino woman could have been accorded kindness, trust, love, respect and a listening attitude form the entire team, it is unlikely that she would have gone away feeling dissatisfied with the quality of health care services. Inter cultural care also needs to be independent of the context of the patient and the medical staff. Arguably, the busy and inflexible schedules that lay ahead made it difficult for me to spent sufficient time with the client and perhaps understand her concerns. In future, this also needs to be accorded utmost attention by the relevant stakeholders. Incentives need to be put in place in a bit to increase the number of professionals in the medical field.
Lessons learned
At this juncture, it is certain that the experience was a great awakening for me. It helped to acknowledge the importance of transcultural principles in health care. I was able to learn that cultural congruent care entails self reflection of one’s culture that boosts the identification and appreciation of the inherent strengths and weaknesses. Knowledge of this influences future decisions and emphasis is placed on furthering the strengths and limiting the weaknesses. In essence, it promotes self awareness and actualization that are fundamental for effective service delivery.
Most importantly, it enhances openness and honesty that strengthens the relationships between the clients and the healthcare professionals. Besides self evaluation, realistic self-appraisal is imperative in boosting my confidence when working with culturally diverse clients. This enhances transcultural self-efficacy especially during service delivery. As indicated earlier, this has enabled me to identify the gaps that exist and to precise strategies to bridge them. With this knowledge, I will pursue further education, review vital literature, participate in transcultural courses, initiate and maintain collaborations with professionals who have transcultural competence and establish viable networks in order to acquaint myself with the inherent cultural differences across the globe. This would enhance my cultural sensitivity and promote quality health care service delivery in future.
References
Andrews, M. (1995). Transcultural Nursing: Transforming the Curriculum. Journal of Transcultural Nursing, 6 (2), 4-9.
Donnelly, P. (2000). Ethics and Cross-Cultural Nursing. Journal of Transcultural Nursing, 11, 119-125.
Jeffreys, M. & Zoucha, R. (2001). The Invisible Culture of the Multiracial, Multiethnic Individual: A Transcultural Imperative. Journal of Cultural Diversity, 8, 7984.
Kelleher, D. & Hillier, S. (1996). Researching Cultural Differences in Health. London: Rutledge.
Leininger, M. (1989). Transcultural Nurse Specialists and Generalists: New Practitioners in Nursing. Journal of Transcultural Nursing, 1, 4-16.
Small, R., Rice, P., Yelland, J., & Lumley, J. (1999). Mothers in a New Country: The Role of Culture and Communication in Vietnamese, Turkish and Filipino Women’s Experiences in Giving Birth in Australia. Women Health, 28 (3), 77-101.
Speros, C. (2005). Health Literacy: Concept Analysis. Journal of Advanced Nursing, 50 (6), 633-40.