Multicultural workplaces: Language not the only barrier to safety, health
Multicultural workplaces: Language not the only barrier to safety, health
Occ-health nurses called on to learn their communities
No matter how large or small it might be, today's workplace is far different than it was 40, 20, even 10 years ago, and that difference extends far beyond paperless records and robotic assembly lines.
American workplaces are now true reflections of the country's immigrant population, and no longer are citizenship and English fluency the prerequisites to working in the United States that they once were.
But as this diversity enriches our society and swells workforces, it also presents some unique health and safety questions for the occupational health nurse.
"The first thing I ask [when addressing a group of occupational health professionals] is how many of them speak another language, and it's surprising how many don't," says Linda K. Glazner, DrPH, RN, COHN-S, a consultant in Wisconsin. "Then I ask if there are other languages spoken in their plant, and if so, what are they? English is the [language] of the United States, but it would behoove us to appreciate and recognize other languages."
Posting safety rules in multiple languages is a start, as is establishing access to qualified interpreters. But languages are only part of the mix when your worksite is a blend of cultures and ethnicities.
Cultural definitions of health vary
In 1991, the American Nurses Association (ANA) issued a position paper setting out reasons why nurses should take diversity seriously, and in what contexts they should think about cultural differences and their effects on health.
Among the aspects of diversity that the ANA says nurses need to understand are:
- how cultural groups understand life processes;
- how cultural groups define health and illness;
- what cultural groups do to maintain wellness;
- what cultural groups believe to be the causes of illness;
- how healers cure and care for members of cultural groups; and
- how the cultural background of the nurse influences the way in which care is delivered.
"Culture is one of the organizing concepts upon which nursing is based and defined," the ANA stated in its position paper. (The paper, "Ethics and Human Rights Position Statements: Cultural Diversity in Nursing Practice," can be accessed at www.ana.org/readroom/position/ethics/etcldv.htm.)
Though language as a barrier to understanding safety and health information is one obvious challenge in a multicultural workplace, it is by no means the only one.
For example, members of one culture might define health and illness differently from members of another culture. The occupational health nurse might want to determine some basic definitions of health as they apply to his or her employee group:
- Is it being able to do what you want to do?
- Is it physical and psychological well being? Physical is defined as there are no abnormal functions of the body and all systems are without the abnormal functions that would cause a problem physically; psychological means that one's mind is capable of a clear and logical thinking process and association?
- Is it being able to perform normal activities, such as walking, without discomfort and at an optimum level?
- Is it something else?
Glazner says occupational health professionals "need to check our own pulse" and become aware of personal attitudes, beliefs, biases, and behaviors that may influence, consciously or unconsciously, both the care of patients and interactions with colleagues from other racial, ethnic, and cultural backgrounds.
"Every clinical encounter is cross-cultural," she comments. "Developing partnerships with our patients and maintaining 'cultural humility' can help us to learn and better understand the historical, familial, community, occupational, and environmental contexts in which our patients live."
One way for health care providers to "check their pulses" on diversity awareness is to take a cultural quiz created by the U.S. Department of Health and Human Services and Management Sciences for Health, a nonprofit scientific and educational collaborative that seeks answers to public health issues. The quiz (available at erc.msh.org/mainpage.cfm?file=3.0.htm&module=provider) provides multiple choices to a number of questions dealing with health care situations involving providers and patients of different cultures, with additional readings provided to assist in understanding right and wrong answers.
Cultural difference impact safety
In the work setting, culture can be a safety and health issue, Glazner points out. "The Midwest has a large [Chinese] Mung population," she explains. "Asians often are very polite, and won't say they don't understand something. They will nod their heads, and won't say they don't understand. And that's a safety issue."
She works with members of a Somali population, as well, and often encounters the Muslim belief that the body is a whole, and that simultaneous injuries or illnesses are related.
"So if you have a headache and you stubbed your toe at work, the headache might not be a work-related complaint but the toe injury is, and you have to help [the employee] differentiate between the two while respecting his or her beliefs," she explains. "That becomes a workers' comp problem."
Get to know your community
Glazner points out that many cities have several different ethnic population groups, and an occupational health nurse whose employees include members of those cultural groups should make an effort to become familiar with the cultures.
"In most places where there is a large population of people who don't speak English, there is a local association that offers resources that can help us as health care professionals," she points out. "And the easiest way to get to know another culture is to eat the food. It's hard not to gain a better understanding of people when you sit down and break bread with them."
Glazner relates that in an occupational health department where she worked in Los Angeles, six workers, including herself, did not celebrate Christmas. So the Jewish, Hindu, and Buddhist co-workers put together a rice potluck—rice being a common dietary denominator—and shared not only a meal, but insights into each others culture and history.
But Glazner and others experienced in multicultural workplaces caution against taking cookbook approaches to any sociocultural group, for risk of stereotyping and overgeneralizing about a people and their attitudes toward health and safety.
"Diversity is often greater within groups than between them," Glazner says. Health care needs to be evidence-based, flexible, authentic, and ethical, no matter who the patient population is, she adds.
Employers who are most successful at maintaining a productive, healthy, multicultural workforce are willing to be creative, flexible, and open-minded.
Rather than fighting the religious practices of a particular group that may differ from the majority, Glazner says managers should examine work practices to see if they can accommodate and compromise to satisfy everyone.
"During Ramadan, Muslims fast during the day, so some companies alter their work practices so the majority of those employees' work hours are at night, so they can work and eat at night rather than working during the day, when they have to go without eating," she points out.
Measures such as the one just described, or in dividing 30-minute breaks into multiple shorter breaks to accommodate ritual prayer during the workday "is not fighting the cultures, but accommodating the work culture and religious culture."
Use of English versus another language at work must be based on safety and not employee preference, she advises. In some hospitals, for example, employees who do not speak English as their first language are permitted to speak whatever language they want outside of patient care areas, but in areas of patient care, must speak English.
"You accommodate where you can, and if you can't you explain why and at least show that you recognize that this is something that is important," she says.
[For more information, contact:
Linda K. Glazner, DrPH, RN, COHN-S, CCM, CHES, FNP, FAAOHN, president, Linda K. Glazner & Associates, Wausau, WI. E-mail [email protected].
Management Sciences for Health, 784 Memorial Drive, Cambridge, MA 02139. Phone: (617) 250-9500. E-mail: [email protected].]
No matter how large or small it might be, today's workplace is far different than it was 40, 20, even 10 years ago, and that difference extends far beyond paperless records and robotic assembly lines.Subscribe Now for Access
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