When teaching, consider cultural influences
Negotiate when cultural beliefs create conflicts
When cross-cultural teaching encounters occur, health care providers, nurses, and other disciplines must be aware of barriers to education. While an interpreter can help get the message across, the fact that patients know and understand a regimen does not mean they will adhere to it.
Therefore, it is important to know something about a patient’s culture in advance. At Grant/ Riverside Hospitals in Columbus, OH, cultural handbooks are kept on each unit so staff can look up particular cultures as needed.
"This can help the staff understand aspects such as eye contact, touch, space, decision making, rituals, and health care beliefs," explains BJ Wingert, RN, BSN, MS, patient education specialist at the health care system. Having a general understanding of a culture can help staff ask questions or assess what the individual patient believes and practices, she says. "We need to ask questions so we tailor the teaching to the individual," says Wingert.
Questions might include what they do to heal themselves such as whether they use herbals or home remedies. Questions about the cause of their condition might be asked as well as who makes decisions and who helps with care in the family unit.
While it is important to understand a little bit about a patient’s culture, a personal assessment is a must, agrees Bria Chakofsky-Lewy, RN, supervisor of caseworker/cultural mediators and interpreters for Community House Calls Interpreter Services at Harborview Medical Center in Seattle.
She advises making copies of Culture and Nursing Care, A Pocket Guide by Julienne G. Lipson available on each unit. In addition, it is important to teach staff to negotiate with patients. If instructions conflict with what patients think will make them well, they will not follow them, she explains.
To help staff negotiate with patients, they are taught the "Learn Model" (Berlin EA, Fowkes WC; 1983):
• L: The first step in an encounter is to listen. "As long as you come to the encounter with respect for what your patient’s worldview reality is, what their goals are, and you listen, then you will be very successful," says Chakofsky-Lewy.
• E: The second step is to explain the information you have for the patient.
• A: Acknowledge the differences and similarities in the patient and provider’s beliefs. "Based upon having listened and acknowledged what the similarities and differences are, we can recommend a strategy and then negotiate," explains Chakofsky-Lewy.
• R: Recommend a plan.
• N: Negotiate an agreement. "We often think all we have to do is give the information. That is not the case. We have to find out what the circumstances are and how we can help adjust whatever it is we are teaching to those circumstances," explains Chakofsky-Lewy.
When cross-cultural teaching encounters occur, health care providers, nurses, and other disciplines must be aware of barriers to education. While an interpreter can help get the message across, the fact that patients know and understand a regimen does not mean they will adhere to it.
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