[Narayan, (2010)]. The review also showed that patients from culture might feel disinclined to take opioid medications due to cultural ban. For instance, in a study conducted by Sandy Lowering (2006) in a multicultural clinical setting in a Saudi Arabia, including patients form Irish, African, Asian, Filipino and Tswana, it was found that the use of narcotics was unacceptable for African, Saudi Arabian and Tswana patients due to cultural taboo on the use of sedatives and addictive substances. [Sandy Lovering, (2006)]
In these cases it is incumbent upon the nurses to establish good rapport and help the patients shed the cultural patterns that are hindering effective pain management. By skillful explanations and effective culturally sensitive communication the nurse should explain that the traditional beliefs should be abandoned in cases where they tend to compromise care. This could only be achieved by establishing culturally competent communication with the patient and educating about the need for change. One of the very effective tools at the disposition of nurses is the LEARN model.
Cross Cultural Communication (LEARN and RESPECT Models)
LEARN stands for 'Listen, Explain, Acknowledge, Recommend, Negotiate', an educational model that strikes a balance between the patient's cultural values as well as the nurse's professional standards. [Narayan, (2010)]. This communication model advocates active listening and sympathizing with the patient's viewpoint of the problem as the first stage in establishing a rapport with him. Next, the nurse can voice her own perception of the problem. This is followed by acknowledging and discussing the similarities and differences in perceptions. The next stage is when the nurse can recommend a plan that takes into account both the patient's considerations as well as fitting in with the professional standards. If after all these methodical approach with the patient, there is no agreement as to the course of treatment, the nurse should negotiate to reach an amicable treatment action that satisfies both the patient's cultural as well as the medical needs. The RESPECT models stands for creating Rapport, showing Empathy, providing Support, creating partnership, offering explanations, exhibiting cultural competence and establishing Trust. [CIRRIE]
As a case in point is Mr. Nguyen, a 68-year-old Vietnam veteran who was admitted in the emergency department, complaining abdominal pain. (Test results had indicated stomach cancer) Information gathered from his daughter revealed that Mr. Nguyen was using herbal tea as the only remedy for the pain for several months. A Buddhist by religion, Mr. Nguyen was reluctant to use any opioids as he felt it culturally taboo and that it gave 'negative energy' and that he would normally practice breathing meditation for 'balancing energy' levels as method of controlling the pain. The nurse in this case, showed excellent culturally competent communication skills as she listened carefully to the patient's concerns by using a qualified medical interpreter. Being culturally sensitive, the nurse acknowledged that meditation is a proven way to release tension and aid healing and that he should continue to practice it to ease his pain. Also, in tune with the patient's beliefs the nurse also explained him that too much pain can destroy the "energy balance" of the body and how pain-relieving medication can help restore the "energy balance." To make it more agreeable the nurse also suggested that opioids are available in liquid form that could be mixed with his favorite herbal tea. She recommended that he take a few drops of the drugs if the pain became intense. Few days later the patient requested half dosage of pain medication to be mixed with his tea. So in this case, by using excellent communication skills infused with cultural understanding and sensitivity, the nurse was able to persuade a stoic patient from a different cultural background to change his hard stance and agree to a treatment plan for his pain. Culturally sensitive communication is a key component to successful negotiation with patients from diverse ethnic backgrounds. [Narayan, (2010)]
Improving Cultural communication (Nursing Perspectives)
One recent research by Wong et.al (2009) focused on nurses' response to transcultural exposure in their work. The subjects for this study were 111 registered nurses working in the Kaiser Permanente medical center at Santa Clara. The researchers gathered information using multiple-choice questionnaires about nurse experiences in dealing with patients from different cultures and how they manage it and their expectations. When asked the question as to "what they draw on" when dealing with patients from different cultures all the study participants reported their reliance on previous experience, education and training, friends etc. Also 71 (63% ) subjects expressed the usefulness of interpretation services. As many as 86 (76% ) nurses in the study reported that they needed more culture oriented education and continued training. [Wong et.al (2009) ] This study highlights the need for including culture specific education and training for nurses to better equip them for culturally competent care delivery.
As the population demographics change the need for culture sensitive care provision becomes more prominent. An aging population and an increasingly diverse population mix of America have placed new demands on the healthcare staff and in particular critical care nurses. Culture has a significant effect on how the patient perceives illness and how he communicates with the caregivers and hence it can affect quality of care received. Culturally sensitive communication is the key to effective interaction with patients from different cultures and subcultures and to develop appropriate interventions. It helps to establish rapport with the patients and to help the nurse better negotiate with them to shed their cultural inhibitions and values that are counter productive to the their health. There is an urgent need to address the cultural component of nursing at the academic level, as this would better prepare the graduating nursing force for delivering quality care across the entire spectrum of patient population. Quality interpreter services is also a key component of caring for patients from diverse backgrounds and it is the responsibility of the health institutions to provide these services. Culturally competent communication is an integral part of the nursing care provision in a transcultural medical setting.
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