Discussion: Cultural Considerations in Nursing

Influence of Cultural Diversity on Health

Influence of Cultural Diversity on Health Program Transcript

[MUSIC PLAYING]

NARRATOR: This week, our experts discuss the influence of cultural diversity on health.

LOUISE FITZPATRICK: You have to understand the religion, the culture if you can, or at least be knowledgeable about it. One never knows what someone's health ideas are or where the ideas are coming from. In many cultures, I make a home visit to see a new baby, and find it's 95 degrees outside, but the baby is all bundled up as if it were the middle of winter. It isn't necessarily ignorance or the lack of knowledge that the family or the caretaker in the family has. A lot of it is very much related to culture, to what the grandmothers say, to what customs and traditions have grown up.

Here in the city of Baltimore, when I was student, a nursing student, and I was in the Eastern Health District. And almost every young pregnant woman was eating Argo starch. And they developed what they called pica, and a desire for Argo starch. And the result always was anemia, and of course it was not good for the nutrition of the baby either. But this was a tradition, and it was something that came from the south, but was a very, very common practice. So you know, you begin to wonder, why is this happening? But it has to do with tradition and what has been done in the family, and what has been done in that particular group of people in a population.

HUDA ABU-SAAD HUIJER: When I was in California, I was at UCSF for many, many years, and the nurses there were flabbergasted. They would come to me and say, can't you come and help us? Because we have a woman in labor with an Arab background, and she is screaming. I mean, that's a very, very good example of the difference in culture, really. The expectation, of course, of a woman in labor in the Arab world is exactly this. If she does not show verbally her pain, then she is not in labor. So basically, the way of expressing pain is to scream. And nurses had no idea that this is really an acceptable way of dealing with it in her own culture. And if she didn't do it, it means she is not going through the labor that she should be going through.

A woman from a Scandinavian country will be going through her pain silently. Really, they would not even open their mouth. A woman from the Middle East would be screaming. And so they learned how do deal with it. They would put them in different areas, far, so at least you can respect the culture.

LOUISE FITZPATRICK: It's also, who makes health care decisions in the family? We tend-- nurses go in, tend to speak to the mother about her child or about her own health, and need to recognize that within certain cultures, she may not be

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Influence of Cultural Diversity on Health

the decision maker, and that you would never suggest certain kinds of practices if the husband was not involved or the male partner was not involved in some way. And whether it's in this country or any other country.

I've worked among people in the Middle East, particularly in the Muslim population. And you have to know where the decision making power comes. What are the religious taboos? What are the customs? What is it that you need to be able to adapt to, not just expect the patient to be able to adapt to, so that you can find other ways to perhaps promote what health practices you're trying to encourage without in any way disturbing their belief system? And I think that comes with time, experience, and sensitivity, but you have to have the knowledge of the people that you're serving.

And that's one of the things that's fascinating about public health nursing, and is most fascinating about working with populations abroad in a global sense, because we celebrate difference. Yes, there are certain commonalities that are very important, but we celebrate the differences, and we're able to accept those differences and work with them, and let the patient kind of guide us through the process rather than always the reverse.

HUDA ABU-SAAD HUIJER: People in Lebanon are more family-oriented. So the family is involved with everything, the Decisions. Even my current research now is with palliative care and in particular, with cancer patients. We did the same study in Holland, and I think it was very clear that the patient is autonomous. I mean, they make the decisions. The patients make the decisions about different things related to their treatment, but also how to end their life.

Now Lebanon, the family is really sort of the focus of the treatment, the management, the follow-up of care, and the like. The patient is very well protected. This is a very different cultural orientation really towards illness and how one perceives illness, and copes with it.

Talking about the cancer patient, for instance, the first thing that we did in Holland, the patient is told about their condition. In Lebanon, the patient is not told, not directly, about their condition. So this is an area where the family-- the physician and the family have this sort of dialogue about, should the patient be informed? Are they able to cope with the diagnosis? And in many cases, the family is the one, at some point, that decides in order to protect the patient, the patient is not told about the diagnosis. So there is always this indirect way of trying to deal with health-related issues.

And in this particular case, actually a diagnosis such as cancer. And from a family perspective, of course, they want to protect the patient. However, the patient himself is telling us, I want to know, but I'm afraid if I tell my family, I will hurt them, and they will have the burden. So I mean, these issues, we never dealt with in Holland, because it was very straightforward. This I'm autonomous. I

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Influence of Cultural Diversity on Health

deal with it. If I'm told-- I should be told. I deal with it, and I direct my own life. In Lebanon, the whole family directs the patient's life.

And so that's a very different way of looking at things, and that's also, for the health professionals, a dilemma. Because a physician is also in a dilemma. When I talk to the physicians, how can you not tell the patient, even if the family refuses? But they say, culturally, we cannot do that. The acceptable way of doing it is to go through the family and see if the family would give us approval. So I mean, this is a dialogue that we always have now with the physicians, because they are already, between themselves also, trying to find ways to deal with this.

The nurses are in the same situation because they cannot really disclose this information directly to the patient. They are not allowed by law to disclose a diagnosis to the patient. I think the cultural issues that we address here are communication issues. Do we tell? Should we tell? Or do we keep it a secret in order to protect?

Now religion is another issue, of course, altogether. The country has 17 different sects. So basically, if there is a problem, the first thing that the people would do is turn to their religion, especially when it comes to end-of-life situations. And we have seen it in action, because every single religion has its own ways of dealing with the illness itself, but also issues related to end of life. And this is a fascinating area. So I mean, religion plays a major factor in the life of the Lebanese, and its impact on health care and the care of the sick.

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CAROL HOLTZ: Traditional medicine has a really different theoretical framework, particularly traditional Chinese medicine. It's based on the chi, which is very hard to define. The spirit of the wind that goes through a person. It relies on the hot and cold theory. Certain diseases are hot and certain diseases are cold. And in order to rectify them, you need the opposites. And they use a lot of traditional herbs. Herbs can be given orally, topically, rectally, put on the skin as a paste, intravenously, and so on. I was fascinated by the pharmacies in China.

Tai Chi exercise, for instance, that I saw in the morning in the parks, particularly among the older adults, I thought were fascinating. The moxibustion, which is use of-- it's really a transference of heat in certain locations. Of course, inserting of the needles in different locations. Insertion of needles does not really coincide with our neurological system, but they have different tracks in certain areas, or if needles are inserted are supposed to cure certain illnesses, depending on the location.

I came with a terrible case of poison ivy, and they inserted the needles, which they did show me that were sterile. And I was fascinated with the fact that I got immediate relief. I also was fascinated with the fact that many people are able to,

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instead of having anesthesia, can use insertion of needles in place of anesthesia for some types of surgeries. So I have a tremendous respect for traditional medicine. And it's been around for thousands of years, and there's a reason why.

We use traditional medicine. It's particularly among ethnic cultures in the United States. Native Americans, many Latinos use traditional medicine. Interestingly enough, the hot and cold theory is also used in other cultures. So I find it fascinating.

LESLIE MANCUSO: In Nigeria, in upper Nigeria, a very strict Muslim area, it's very important that the people listen to their imam. It's a very important religious spokesperson for them. I had the opportunity when I went to Nigeria last year to meet with the imam, to talk about maternal and child health, to talk about what we knew are areas that could be helped and could be improved in maternal and child health that we already knew about. We didn't need to do the research.

And this imam, speaking out and saying, I believe that my mothers and children in the community deserve to have access to health care, should be going to clinics, is really critical. And so that was a piece that we knew in order to work in that area, in order to be sensitive to their needs, we brought that into the program and into the country to make sure we worked with them side by side.

There's many other cultural beliefs that we must recognize. There's beliefs in Africa that if a woman's in pain in labor she must see two sunsets before she goes to a facility. Now we know what that means. Quite often, she will die before the second sunset. And so what we have to do is work with those beliefs, and then teach using and working with their professionals in their communities so that they learn why perhaps that is not a good time period, and why we may need to work with that time period and get a skilled provider in there during that time period. But there has to be that sensitivity and respect for those cultural beliefs as you do those changes.

Influence of Cultural Diversity on Health Additional Content Attribution

MUSIC: Creative Support Services Los Angeles, CA

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Influence of Cultural Diversity on Health

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