Cultural Approaches to Patient Teachings

Introduction
Every culture has its own unique set of values and ethics. For that reason, cultural approaches to teaching patients are important for the spread of health literacy, health promotion, self-care, and better preventative care (Jeffreys, 2015). Cultural competence is considered an essential part of nurse education, as it focuses on the need for nurses to possess culturally competent skills when dealing with diverse patients of different backgrounds. Having a cultural approach to patient teaching has been shown to be primarily beneficial because it allows the nurse to more effectively tend to the needs of the patient by way of an efficient and strategic integration of different aspects of the patient’s culture within the care process. Cultural competence is achieved when one engages in a constant process of learning about other cultures as well as one’s own: it is about becoming culturally aware and culturally wise—and through this development devising ways to interact with patients of different backgrounds so that they receive the best quality care they can possibly receive. This paper will present key information about the topic of cultural approaches to patient teaching, particularly on the Asians with cervical cancer population, and discuss how it relates to nursing health promotion via patient teaching.
Key Information
One definition of a cultural approach to teaching patients is that it “is oriented toward critical, reflective practice” and can help nurses to “develop knowledge about the role of nurses in reducing health inequalities and lead to a comprehensive ethical reflection about the social mandate of health care professionals” (Garneau & Pepin, 2015, p. 9). However, that is not the only way to define the cultural approach. Another is this: the key to understanding the cultural approach to teaching patients is to remember that culturally competent nurses do not impose their own personal cultural norms on the client but instead learn to adapt their knowledge, which can help the client make the right health decisions, in a way so that the knowledge is communicated in a manner consistent with the client’s own cultural understanding of health. Culturally competent nurses, in other words, must be aware of the fact that not every patient they treat is going to have the same background, beliefs or experiences that inform them in the decision making process.
This awareness of variances in cultures is the basis of the Transcultural model of nursing put forward by Maier-Lorentz and Leinenger (2008) in their seminal article on transcultural nursing. As Shen (2015) points out, the transcultural theory of nursing enables nurses to provide meaningful care within the context of the patient’s own cultural framework. This is important because it provides the patient with understanding that might otherwise be denied them as all patients perceive their choices through the lens of their own cultural experience. In other words, the parameters or meaning of quality care that may apply to one patient may not apply to another patient of a different culture, background or belief system. A nurse trained in transcultural nursing will have developed a sense of these differences and will be aware of indicators that can alert them to the right cultural approach to take. Or they can be mindful to ask questions that will prompt the appropriate responses in patients with respect to their particular cultural preferences and background.
The Hofstede model of cultural dimensions is another helpful resource when discussing the background and significance of cultural approaches to patient teachings. The Hofstede model has been applied in numerous disciplines: everything from business administration to tourism to nursing (Mazanec, Crotts, Gursov & Lu, 2015; Papadopoulos & Koulouglioti, 2018). It is important to consider the cultural dimensions in nursing for many reasons. One example of why knowing the cultural dimensions is important can be found in those situations in which robots may be used in medicine to treat a patient. Some patients of particular cultures may be less willing to work with robots in medicine than other cultures; thus, “with the increased use of humanoid robots in the healthcare system, it is imperative that nurses and other healthcare professionals explore and understand the different factors that can affect the use of robots with patients” (Papadopoulos & Koulouglioti, 2018, p. 653). However, there are many other reasons for why cultural approaches to teaching are important. Cultural competency is essential in today’s world. Dynamic changes in society in recent years due to immigration and globalization demand that attention be given to cultural competency. Awareness of how cultures interact and clash is necessary for advancing the field of nursing. Examining a specific target population can help to explain this in more detail.
Target Population
Asians with cervical cancer can serve as an appropriate example of a cultural approach to teaching patients can be accomplished. The Hofstede model of cultural dimensions can be useful in teaching the nurse, first and foremost, about how the Asian population is likely to view the decision making process when it comes to health. However, numerous researchers have shown that the Asian population itself consists of a variety of different subsets of populations, not all of whom will share the same cultural orientation. For example, Japanese Americans may differ from Chinese Americans in certain ways. Ho, Tran and Chesla (2015) show that it is not a simple procedure to assess what is culturally meaningful among Asian Americans, particularly among the Chinese American population, partly because of a “complex definition of culture that moves beyond just race, ethnicity and language and also focuses on geography, religion, spirituality, biological and sociological characteristics” (p. 39). This complexity extends beyond just Chinese Americans and includes all Asian Americans, as Islam et al. (2015) show in their study of Asian American disparities as compared to other racial and ethnic minority groups in New York City. These disparities make it difficult to determine the extent to which culturally relevant health education material can have an impact on treating the Asian American population (Jih et al., 2016).
As Jih et al. (2016) point out in their study of educational interventions among Chinese Americans, print materials were helpful in increasing health knowledge and getting the target population to achieve the desired health care goal. However, as Islam et al. (2015) showed in their study of diabetes management among Asian Americans, overall Asian Americans were more difficult to manage in terms of moving them to take ownership of their own care management. Islam et al. (2015) found in their sampling of ethnic minorities that among all the various ethnic groups, Asian Americans were the least likely to manage their own care effectively. The reason for disparities in the differences of course is that not all Asian populations share the same cultural dimensions. In short, it is important to develop a better method of understanding this diverse population, which has a great deal of different ethnicities within its subset—from Chinese to Japanese to Indian to Filipino Americans: all have their own unique characteristics.
For example, according to the Hofstede model of cultural dimensions, Japan is a hierarchical society—but not as much as other Asian societies are (and at root is the sense that all Japanese are equal and that one who works hard will be able to succeed and climb his way up the ladder of society). Likewise, Japan is not as collective in its thinking as other Asian nations: it acknowledges that group harmony is good but it also respects human individuality. Japan is also very competitive and thus is understood as a masculine culture. Japan has a high uncertainty avoidance rating, meaning that it avoids uncertainty and takes efforts to protect itself against unknowns. Japanese also take a long-term view of things and are not short-sighted in their thinking or actions in general. Japanese exercise restraint and do not seek to gratify every impulse or desire (Hofstede Insights, 2018). These are qualities and characteristics that a nurse should know when treating a Japanese person. It would also be helpful to understand that not all Asian cultures are the same. The Japanese culture resembles the Western culture in more ways than, for example, the Chinese culture does. Japan is a high context culture. Non-verbal expressions and implicit communications are part of the fabric of their way of life. This contrasts sharply with the low context American culture, wherein Americans are used to explicit, direct and sometimes blunt ways of speaking. The Japanese communicate subtly and a nurse should be aware of how these subtle mechanisms of expression are used to convey significant information.
When treating an Asian patient with cervical cancer, however, there are some Asian commonalities that nurses can keep in mind to tailor their teaching of the patient. For instance, words and gestures to avoid around Asian patients should be known by the nurse. Making eye contact is considered rude in most Asian cultures, so a nurse should not try to stare down an Asian patient. Asians also do not hug generally speaking. Hugs are Western customs, not Asian ones—so even if a nurse is familiar with an Asian patient, a hug would be viewed as awkward and inappropriate. It is also helpful to avoid shouting out the names of companies that Westerners associate with Asia, such as Honda or Toyota. No one likes to be stereotyped and Asian patients are no exception. Nurses should be culturally sensitive and not assume that just because a person is Asian that patient will have anything to do with the things that the nurse associates with that part of the world. Furthermore, what may seem charming to Westerners find charming, can be irritating to an Asian patient.
Teaching an Asian patient about cervical cancer requires skill, sensitivity and finesse, because people of the Asian population are going to have unique considerations, thoughts, feelings and expectations of care with regard to the issue of cervical cancer. Understanding what is taboo, what is problematic, what is likely to cause fear or worry, and what is likely to be acceptable are things a nurse should understand before proceeding with any teaching exercise. The cultural approach for this population would open up a window of understanding and allow the nurse to gain deep insights into the mind and perspective of the Asian patient so that the nurse could help the patient to make effective decisions about how to handle their care with regard to a cervical cancer screening or diagnosis.
As Bedi and Devins (2016) note, “cultural values shape a woman’s experience of disease and introduce novel stressors that influence psychosocial needs and adaptation” (p. 31). When a nurse is providing teaching to an Asian patient about cervical cancer, the cultural approach would inform the nurse to be mindful of the patient’s particular needs, such as “culturally linked themes that play significant roles in shaping the illness experience; e.g., stigma and breast cancer, low priority of women’s health, collective experience of disease, and religion and spirituality” (Bedi & Devins, 2016, p. 31). The purpose of adopting the cultural approach in teaching patients of this population is that “by understanding the core cultural values and integrating them into clinical practice, Western healthcare providers may improve the quality of care they deliver and help women to extract the maximum benefit” (Bedi & Devins, 2016, p. 31). This example shows that when it comes to teaching patients of a specific population, it is always best practice to consider that population’s culture.
Benefits
The benefits of applying the cultural approach to teaching patients and health promotion are that the nurse can develop:
· An ability to develop rapport with diverse individuals
· Higher degree of sensitivity for patient needs
· Awareness of cultural values that can be used to predict behavior
· An ability to build better relationships with diverse communities
· An ability to bridge differences
Each of these is important and helpful in promoting quality care and even in practicing preventive medicine. The more able a nurse is to break down cultural barriers and communicate the essential information to diverse patients so that they can make informed decisions about their health care, the more a nurse will be able to promote health among that population as well as among a variety of others.
Nurses who take the time to listen and get to know their patients will be in a much better position to provide those patients with the knowledge and information needed to help them make good health decisions. In order to provide culturally appropriate care, nurses need to know and understand the patient’s point of view—and that will differ from patient to patient in many cases, because every patient will be coming from a unique place. Culture is important as it plays a tremendous part in the way people view themselves and those around them. It plays a part in how they think about health and health care.
Nurses need to be more sensitive to the patients of different cultures. They need to learn to recognize and deal with the variety of special needs of patients of different cultures. The nurse or doctor can become a true client advocate in this manner and work to improve the quality of care that the industry provides its diverse clientele. When nurses stop to consider the patient’s perspective instead of simply bulldozing along without even bothering to check with the patient to see if the recommended care treatment is in alignment with the patient’s belief system or cultural expectations, they do their clients a great service—and the patient will always be appreciative of this consideration. To enhance patient care and to develop patient-centered care, transcultural nursing and cultural competency in nursing are highly recommended.
Nurses and doctors have to be flexible and respectful of the viewpoints of others. Being rigid in this industry will not only be a barrier to providing quality and culturally competent care to patients, it will also prevent the patient from feeling that he or she is really part of the care process. Care providers who do not consider the patient’s perspective essentially box up the patient and disallow the patient from taking ownership in his or her own care. This goes against the grain of what it means to be a nurse, and that is why the cultural approach to teaching patients is essential: it gives the nurse the ability to get over the cultural obstacles and walls that may otherwise seem insurmountable. Whenever nurses struggle to communicate with a patient it can be primarily because they do not understand the patient’s perspectives or needs. Oftentimes the patient does not know how to communicate these needs or their perspective because they take both for granted—it is part of their cultural experience. The nurse must be mindful of this fact rather than assume that a surface, generalized reading of the patient is sufficient.
Conclusion
The cultural approach to teaching patients is essential in the world of nursing today. Immigration all over the world and globalization have led to more and more diverse cultures so that nurses, no matter where they are, have to be cognizant of the obstacles that can occur when they are trying to teach a patient who is of a different culture. The transcultural model of nursing can be helpful in providing the nurse with guidance and support and so too can the Hofstede model of cultural dimensions. These two can facilitate the nurse’s approach to teaching a population like the Asian population with regard to an issue like cervical cancer, which can have its own sensitivity issues that should be understood by a nurse before going ahead with a teaching plan. The nurse who is culturally competent is better able to encounter, interact with, communicate with and support patients of all different backgrounds.
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